Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

1050 Abstracts 60278-60282

12th World AIDS Conference

purchase NS in 19 of the 28 pharmacies in Anchorage; each of these sold at least
1 NS to an IDU. The majority (82%) of attempts were made at four pharmacies.
Only 2% of IDUs use pharmacies within the census tract of their residence; an
additional 12% use a pharmacy in the adjacent census tract. The modal reason
(41%) given for not attempting to purchase NS at a pharmacy was that NS were
obtained from friends. Sixteen percent indicated they were either afraid to ask for
NS at a pharmacy, or lacked the information required to do so.
Conclusions: The overwhelming majority of attempts to purchase NS at a
pharmacy in Anchorage are successful. Many pharmacies are used successfully,
but a small number are used for the majority of NS sales. There was no evidence
of a chain-wide store policy regarding the sale of NS to IDUs. Proximity does
not affect NS purchasing behavior. IDUs who lack skills or information requisite
to using pharmacies for NS purchase may benefit significantly from a pharmacy
sales intervention.
S60278 Antisocial personality disorder and HIV behavior risk in
drug users
Shelley Theno, A.M. Fenaughty1, D.G. Fisher1, S. Turner1. IVDU Project,
1 University of Alaska, 3211 Providence Drive, Anchorage, AK, USA
Background: Studies that examine behavioral risk factors for HIV often do not
take into account personality characteristics associated with risk-taking. One common diagnosis made among drug users (DUs) is Antisocial Personality (ASP)
disorder. We examined the relationship between ASP and behavioral risk factors
for HIV among drug users.
Methods: Participants were 388 DUs not currently in substance abuse treatment who completed the National Institute on Drug Abuse Risk Behavior Assessment (RBA), and items specific to ASP diagnosis. RBA assesses drug use
history, needle-sharing practices, and sexual behavior within the last 30 days. The
ASP comprises two subscales, childhood conduct disorder and adult antisocial
behavior; diagnoses on both scales is required to form a diagnostic assessment
of ASP.
Results: Prevalence of diagnoses was childhood conduct disorder (41.8%)
and adult antisocial behavior (62.6%); 31.7% of our sample was classified as
both, indicating ASP diagnosis. We found ASP injection drug users (IDUs) used
higher numbers of used needles, F(1.71) = 5.76, p =.01, and ASP women used
needles without first cleaning them more often than did ASP men or non-ASP
IDUs, F(1.30) = 18.43, p =.0002. ASP DUs had a higher number of sex partners,
F(1,279) = 3.22, p =.07, and more drug injecting sex partners, F(1,269) = 4.76,
p=.03.
Conclusions: Antisocial personality disorder is significantly associated with
both drug and sexual high-risk behavior. ASP women are particularly vulnerable
for HIV infection. Assessment of ASP in drug users may result in increased
treatment success and therefore decreased risk for HIV infection.
S60279 ACTG 853: Effects of treatment for MAC infection on
cytokine expression in HIV-infected persons
Rodger D. MacArthur1, M. Lederman2, C.A. Benson3, M.C. Chernoff4,
L.F. Mahon5, B. Yen-Lieberman6, S. Purvis7. 14201 St Antoine UHC-7D, Detroit
Michigan 48201; 2Case Western Reserve University Cleveland OH; 3University
of Colorado HSC Denver CO; 4 Harvard School of Public Health Boston MA;
5Actg Operations Center Rockville MD; 6Cleveland Clinic Foundation Cleveland
OH; 7Case Western Reserve University Cleveland OH, USA
Objectives: To determine if treatment of MAC infection in HIV-infected persons
on stable antiretroviral therapy is associated with decreases in plasma levels of
TNF-a, IL-1, IL-6 and HIV RNA.
Design: Eight week prospective laboratory study.
Methods: HIV-infected persons newly diagnosed with proven or presumptive
MAC infection who were to receive at least a 2-drug clarithromycin-containing
regimen were enrolled within 3 days of initiation of therapy for MAC. Specimens
were obtained at baseline, week 4 and week 8 for plasma TNF-ct, IL-1 1, IL-6, HIV
RNA, serum neopterin, and inducible TNF-u, IL-I/, and IL-6. Specimens were
processed, frozen and stored for batch analysis at a later date.
Results: 21 persons were enrolled. Nine individuals with documented positive
baseline blood cultures for MAC who remained on stable antiretroviral therapy
had specimens obtained at both baseline and week 4. Eight individuals had
specimens obtained at baseline and week 8. Data are reported for log (base
10) values for each parameter. Plasma TNF-a levels decreased from baseline
to week 4 (p < 0.09) and decreased further at week 8 (p < 0.04). Decreases
were seen in plasma IL-6 levels at week 8 (p < 0.06) and plasma HIV RNA at
week 4 (p < 0.09). Decreases in plasma TNF-ca levels were correlated at week
4 with decreases in plasma IL-6 levels (p < 0.02) and at week 8 with decreases
in plasma HIV RNA (p < 0.04) and decreases in plasma IL-6 levels (p < 0.09).
No significant changes over 8 weeks were seen in levels of plasma IL-1/-, serum
neopterin or inducible IL-1/, IL-6, or TNF-a. Changes in serum neopterin levels
were inversely correlated with changes in plasma TNF-a levels at week 4 (p <
0.01) and at week 8 (p < 0.02) and with plasma IL-6 levels at week 4 (p < 0.06).

Conclusions: Treatment of MAC infection in HIV-infected persons on stable
antiretroviral therapy results in significant decreases in plasma levels of TNF-cu
and IL-6, which are correlated with decreases in plasma HIV RNA. These findings
suggest a role for TNF-a and IL-6 in the immunopathogenesis of MAC infection
and associated ongoing HIV replication.

60280 HIV prevention/strategies among the Latino population in
the southwestern United States of America
Charlene Doria-Ortiz. 6905 Alamo Downs Pkwy San Antonio, Texas 78238, USA
Issue: The population is at risk for HIV infection due to lack of appropriate
prevention and awareness strategies targeting this population.
Project: Given the disproportionate rate of HIV among the Hispanic population
in the USA, community-based bilingual/bicultural strategies of prevention and
awareness must be addressed and implemented. The model implemented by
CHPD incorporates a training and technical assistance (T/TA) system which has
the capacity to provide culturally and linguistically appropriate service for people
of Hispanic descent. The process of capacity building and empowerment through
T/TA is a one of helping community groups articulate its perception of an issue,
define a goal and develop a systems approach to achieving the goal that is
defined.
Results: The outcomes of the community-based bilingual/bicultural training
and technical assistance system is in the process of how providers and systems
learn to develop mechanisms and to explore alternative methods and designs
to enable a community to be proactive rather than reactive. It is a process of
capitalizing on differences, one which recognizes that concepts regarding health,
healing, wellness and health promotion/disease prevention can have roots in a
variety of cultural milieus.
Lessons Learned: By understanding these differences and integrating them,
unique and creative approaches can be developed that more effectively match
the health consumer's needs of often non-mainstream Latino populations in the
Southwestern USA.
S60281 Cytological profile in bronchoalveolar lavage (BAL) fluid
of HIV positive patients with pulmonary infections
Ning Wang12, M. Tamm2, P. Dalquen3, M. Soler2, C.T. Bolliger2,
A.P. Perruchoud2. 1Monash University Medical School, Department of Medicine,
Alfred Hospital, VIC3 181, Australia; 2Department of Respiratory Medicine,
3Department of Pathology - Basel Univ. Hospital, Basel, Switzerland
Objectives: The purpose of this study was to analyse the cytological profile in
BAL fluid from HIV-positive patients to determine if cell differentiation is helpful
for diagnosis of pulmonary infection (P.I.) in HIV-positive patients.
Design: Retrospective study.
Methods: BAL were performed in 217 HIV-positive patients (147 males, age 42
i 10 yr.; 70 females, age 35 ~ 7 yr.). BAL total cells count (Total C.C., x 103/mL)
and differential counts were evaluated. All BAL samples were cultured for bacteria (Bac), mycobacteria (Tbc) and fungus (Fung) growth, and Grocott staining
was used for detecting pneumocystis carinii (PCP), Cytomegalovirus (CMV) was
cultured from BAL fluid using immunofluorescence. BAL samples which showed
multiple pathogens were excluded from this analysis.
Results: Are shown in the table (median and range).

Diagnosis
Without P.I.
Bac.
PCP
Fung.
Tbc.
CMV

N
43
94
36
16
10
18

Total C.C. (x103/ml)
371 (43-3326)
362 (8-3624)
115 (0.2-2369)
385 (43-5535)
259(1-1595)
228 (65-5504)

Mac. %
83 (11-98)
76 (1-98)
60 (8-98)
65 (10-97)
77 (3-95)
88 (5-95)

Lym. %
8 (0-53)
8 (1-86)
14(1-85)
4 (1-35)
17(3-41)
7(1-44)

Neu. %
4 (0-86)
7 (0-98)
5.5 (0-74)
10(0-85)
2 (0-63)
2 (0-94)

Eos.
0 (0-5)
0(0-13)
0(0-13)
0 (0-67)
0 (0-1)
0 (0-3)

P < 0.05 vs without P.I. (HIV-positive without pulmonary infection).
Conclusions: 1. Bacterial infection was associated with a significantly increased neutrophil percentage. 2. The lymphocyte percentage was markedly
increased in PCP infection and tuberculosis.
|60282 | Prevalence of of HIV positive patients with cryptococcal
infections at Mpilo Central Hospital, Bulawayo, Zimbabwe
David Ndlovu. Bulawayo Group Laboratory, Bulawayo, Zimbabwe
Objectives: To study the prevalence and deaths of HIV positive patients with
Cryptococcal infections at Mpilo Central Hospital in Zimbabwe as from January
1997 to June 1997.
Methods: Data was compiled from reported cases including admissions, in patients and referred cases from other peripheral hospitals.The samples collected
from the patients included blood for HIV Antibody testing, Cerebral Spinal Fluid
for Chemistry analysis and Bacteriological culturing.
Results:

Jan
Feb
Mar
Apr
May
Jun
Total

Indeterm Negative Positive Total
1 - 2 3
- 1 3 4

4
8
7
2
26

5
9
8
3
32

Deaths
2
3
4
8
7
2
26

The total number of hospital deaths from January to June was 450. Therefore
the total number number of deaths that were caused by cryptococcal infection
constituted 6.4%