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

12th World AIDS Conference

Abstracts 60283-60287 1051

Conclusion: The above results indicate or show that cryptococcosis is a fatal
disease the number of HIV positive cases actually show an increase from January
to May and this might also indicate that this disease is quite common or is on
the increase in Bulawayo. The results show indicate that this disease is fatal
because out of a total of 32 samples tested for HIV antibody 26 of them died.The
prevalence indicates that this is due to HIV and not pigeon droppings.
60283 Medical students as HIV/AIDS educators
Anil Purohit 13, Mellary Chrisstie2, J. Duggan2, J. Chakraborty2. c/o Judy
Suleski, Dept. of Physiology & Molecular Medicine, 2Medical College of Ohio,
3035 Arlington Avenue, Toledo, OH; 3BIDMC Harvard Medical School, Boston,
MA, USA
Issues:The healthcare professionals must be knowledgeable about HIV/AIDS,
so that they can serve as healers as well as educators in their communities.
Project: During this project an interdisciplinary course was developed on
HIV/AIDS for the medical students at the Medical College of Ohio (MCO) for
skill-building of medical students as health care educators. This HIV/AIDS course
has been given for the last five years. The course is offered on three Saturdays,
eight hours per day with a total of 24 hours. The course starts with a pre-test.
A post-test is given at the end of the course. Over the years, students wanted
to have more science, medical issues and treatment of HIV-infected people. A
dramatic increase in knowledge was evident from the pre- and post-test. In 1997,
during pre-test, the lowest score was 33%, which increased to 60% during the
post-test, after the completion of the course The highest score during pre-test
was 73%, which dramatically increased to 100% during the post-test, although
only one student received this score. Evaluation of the course by the students
is consistently highly positive. Students taking this course are required to teach
groups of high school students regarding HIV/AIDS for one hour. The high school
teachers evaluate the performance of the medical students as HIV/AIDS educators. The feed back from the teachers is very good. They feel that this is a
very good program, which is beneficial to their students. They think that medical
students can be excellent peer educators.
Conclusion: We feel that HIV/AIDS topics can be used effectively for multidisciplinary teaching technique. Faculty members from different basic science
and clinical departments can participate in this course. Students' involvement in
interactive sessions with patients, basic and clinical science faculty members are
very effective. The feedback from high school teachers indicates that the medical
students can be effective HIV/AIDS educators.
60284 AIDS epidemics among adolescents in Rio de Janeiro
State, Brazil
Regina M.C. Guedes1, A.H. Matida2, K.R.B. Sanches2. 'Rua Mexico, Centro Rio
De Janeiro; 2Health Department Rio De Janeiro State, Rio De Janeiro, RJ, Brazil
Objectives: 1- To analyze trends on the profile of the AIDS epidemics among
adolescents in Rio de Janeiro State. 2- To provide information for future prevention
programs.
Methods: We selected all AIDS cases aged between 14 and 25 reported to the
AIDS Department of Rio de Janeiro State from 1982 to 1997. The group selected
included 25 y.o and younger considering that HIV infection had occurred during
their adolescence. Cases were distributed by age, place of residence and year of
diagnosis.
Results: The cumulative number of AIDS cases by December, 1997 was
17,523 (150.0/100,000 inhabitants). From this total, 1,468 (8.3%) were between
14-25 y.o. The ratio Male/Female was 3: 1. According to residence, 905 (61.6%)
were from the capital city and 563 (38.4%) were from inner cities in the State. In
the last period, particularly in inner cities, the proportion of cases, had increased
dramatically, showing that the period of diagnosis in the study group was highly
associated with place of residence.

weeks (range 1-37), 86% of the follow up period. Three children had to suspend
temporary the treatment for Haem. Anaemia (1 case), Pancreatitis (1 case) and
Nephrolitiasis (1 case). The first of these children switched to Ritonavir, which
has been taken regularly. One child suspended IND permanently, after 1 week,
due to recurrent vomiting. Three children developed new AIDS events (2 MAI, 1
cerebral lymphoma) and 1 died. The number of hospitalisations during the study
period had been compared for each child with the correspondent period of the
previous year (1996). Although the total number of days spent in hospital was less
in children receiving triple therapy (164 vs 144), the difference was not significant.
Within 8 weeks of treatment there was a reduction of HIV-1 RNA in 11 (78%)
patients (median 1.3 log). In 4 (28%) patients the viral load remained permanently
below 500 copies/ml but in only two case consistently at undetectable level. CD4
cell count increased gradually during the study period to a median of 185 cells at
6 mo.
Conclusions: Triple combination therapy seems to be well tolerated in children
with AIDS. Preliminary data on its efficacy show that only a small percentage of
children had viral load at undetectable levels, although most of the children are
improved clinically and immunologically.
S60286 The limits of an STD/AIDS prevention work with sex
workers in Brazil
Marcos Renato Benedetti1, S.S.S. Lopes2, M.C. Pegoratio2, F.D. Malaguez2,
K. Santos2, A.E.S. Rech2. Felipe Camarao 343/21 Porto Alegre RS; 2GAPA
Porto Alegre RS, Brasil
Problem: The communitary work of STD/AIDS prevention with sex workers,
developed by the NAESP (Group of Action and Studies about Prostitution) from
GAPA/RS (Support Group for the Prevention of AIDS), by means of visits to the
areas of prostitutions and groups for sistematic discussion tends to determine
an increase in the search for treatment of STD/AIDS. Such services ought to be
provided by the public health system. The sex workers, in spite of being aware
about their occupational risks, well advised and willing to manage their own
health and improve their quality of life, have little access to public health services,
because of its scarce and inefficient offer in Brazil.
Project: To develop and stimulate effective intervention in the quest for better
quality of life and the construction of citizenship for men, women and transvestites
who prostitute themselves, by means of policial action in the arenas where decisions are taken, concerning Public Health Policies, Social Assistence and Human
Rights.
Results: Effective participation at decision taking arenas to guarantee the
inclusion, in public policies for health, social assistence an human rigths, of the
needs diagnosed at communitary work.
Despite the effort made at local and state level decision taking arenas by
GAPA/RS volunteers, there is a systematic reduction of health services offered
as compared to the demand. This fact can ilustrate the negligence of public
policies in Brazil as a barrier to STD/AIDS prevention work with sex workers.
NGO volunteers and governmental policy makers should work more closely.
60287 1The "do not resuscitate" status of hospitalized
African-American adult patients with HIV disease
Willie Catherine Roberts1, B. Afessa2. 1 University Medical Center, Inc.,
Jacksonville, FL; 2University of Florida, FL, USA
Objective: To describe rate of Do Not Resuscitate (DNR) status of African
American (A/A) patients hospitalized with HIV disease and determine the factors
associated with the DNR status.
Design: Retrospective analysis of prospectively collected data
Methods: A cohort of 945 A/A adult patients with confirmed HIV disease were
identified during hospital admission from 4/95 to 12/97. We obtained the age, sex,
risk factor for HIV, DNR status and outcome of each patient. Factors associated
with DNR status and outcome were determined using student's T and chi square
analysis. P values less than 0.05 were considered significant.
Results: Patient mean age was 38.5 years; 59% were males. The risk factors
for HIV were homosexuality (84), drug injection (270) blood transfusion (12),
heterosexual contact (152), Sex Worker (28), needle stick (1), Sex worker + drug
injection (32), and homosexuality + drug injection (21). No risk factor was identified in 345. One hundred and twenty (13%) patients wanted no heroic measures
if they develop cardiopulmonary arrest (DNR group). Fifty five (6%) patient died,
15% of the males belonged to the DNR group compared to 10% females (P =
0.0145). The patients with DNR status were older than those without DNR (means
40.4-vs-38.2, P = 0.0118). There was no significant difference in risk factors for
HIV between patients who were in the DNR group and most who were not (P =
0.3179). Forty three (36%) patients with DNR status died compared to 10% of
most who didn't have DNR status (P. 0.0001).
Conclusion: Among hospitalized patients with HIV infection, those who consented for DNR status are more likely to be male and older. Patients with DNR
status have higher in-hospital mortality.

Period of diagnosis
1982-1987
1988-1992
1993-1997

Capital City Inner cities \2 (p value)
81 (8.9%) 20 (3.5%) 13.36 (p -.0002)
375 (41.4%) 119(21.1%) 27.16 (p -. 0001)
449 (49.6%) 424 (75.3%) 32.12 (p -.0001)

Conclusion: There has been a sharp increase in AIDS cases on the adolescents from inner cities areas compared to the Capital City. This points out to a
higher vulnerability of that group to HIV infection. These results can be used as
a strong rationale for determining priorities on behavior changes programs.
60285 Triple combination therapy in children with AIDS
Carlo Giaquinto', E.M. Rugal, V. Giacomet", F. Eseme", 0. Rampon1, A. De
Rossi2, R. D'Elia1. 'Dipartimento Di Pediatria Viagiustiniani 3 35128 Padova;
21stituto Di Pediatria, Italy
Objectives: To evaluate the safety, tolerability, and efficacy of a triple combination
therapy, including a protease inhibitor (indinavir, IND), in children with AIDS.
Methods: Fourteen children (mean age 9.7 yrs, range 4-14 yrs) with AIDS
(CDC class.) have been enrolled in the study. Children have been studied clinically,
immunologically and virologically (plasma HIV-RNA) monthly.
Results: All children were treated with IND plus two Nucleoside Analogues (8
AZT + 3TC, 4 3TC + DDI, 2 D4T + 3TC). The mean follow up period was 29
weeks (range 17-37). Children received triple therapy for a mean period of 25