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

1052 Abstracts 60288-60292

12th World AIDS Conference

I60288 Research on HIV/AIDS in Brazil, 1983-1997:
A comprehensive review
Francisco Inacio Bastos1, K. Coutinho2, J. Galvao3, R.G. Parker4. 1AV Brasil
4365 Biblioteca de Manguinhos Salva 209; 20swaldo Cruz Foundation, Rio de
Janeiro; 3ABIA, Rio Janeiro, Brazil; 4Columbia University, New York, USA
Objectives: As part of an ongoing project coordinated by ABIA, supported by the
Ford Foundation, aiming to review 15 years of public policies in Brazil respecting
HIV/AIDS, we carried out a thorough review of published research on HIV/AIDS
in the four main areas: basic science, clinical research, epidemiology, behavioral
& social sciences.
Methodology: Papers published in journals were retrieved through the consultation of main databases, e.g. Medline, LILACS. Books and book chapters were
searched for by cross-searching in major libraries. The worksheet created was
indexed for authorship; nature of the publication; year of publication; keywords;
major areas and subareas of knowledge & funding sources.
Results: Main positive findings (PF) and limitations (L) are described as follows: PF - a relatively large output vis-a-vis national scientific standards (over 400
publications in the period); sound cooperative work with international researchers;
interaction between international challenges and local concerns (e.g. social inequality, tropical diseases etc.); L - concentration of scientific activity in "islands
of excellence", basically located in the industrialized southeast; lack of diffusion
of the (many) papers published in Portuguese; difficulties to overcome barriers
to publish findings formerly presented as oral communications/posters in indexed
English-written journals. Some areas have "emerged" in the last years of the
period under analysis and seem to be promising: viral load evaluation techniques,
study of HIV/HTLV co-infection; incorporation of Brazilian research centers in multicenter clinical trials; use of modeling techniques and spatial analysis in forecast;
systematic evaluation of preventive programs.
Conclusions: Despite the significant increase of scientific output over the period studied, problems common to scientific investigation in developing countries
still limit the scope and diffusion of Brazilian science and its role in the fight against
the HIV/AIDS pandemic.
60289 The effect of highly active antiretroviral therapy (HAART)
on cervical dysplasia and HPV infection among
HIV-infected women
Ann Duerr1, K. Shah2, P. Schuman3, R.S. Klein4, S. Cu-uvin5. 1Centers for
Disease Control MSK34 4770 Buford HWY, Atlanta GA 30341; 2Johns Hopkins
University, Baltimore MD; 3 Wayne State University, Detroit MI; 4 Montefiore
Medical Center, Bronx NY; 4Brown University, Providence RI, USA
Objective: To investigate whether cervical dysplasia, and HPV persistence or
acquisition are reduced among women after initiation of HAART.
Methods: Among HIV-infected women in the HER Study, 48 women who had
initiated HAART were compared to 48 women with similar baseline CD4 count and
HPV infection status who did not initiate HAART. Changes in Pap smear results
and HPV status among women after 6 to 12 months of HAART were compared to
changes among the comparison group of women taking no antiretroviral drugs.
Presence of HPV was assessed by PCR using type-specific probes.
Results: Baseline CD4 counts for the HAART group (mean 210, range 0-681)
were similar to those of the comparison group who were taking no antiretroviral
drugs (mean 239, range 16-651). After 6 to 12 months, the HAART group showed
increased CD4 count (mean CD4 change = 65 cell increase); the comparison
group did not (mean CD4 change = 14 cell decrease) (p =.003). There was no
difference between the two groups with respect to changes in pap smear results
(p =.49), acquisition of HPV or persistence of HPV present at baseline (p =.64),
changes in the number of HPV types present (p =.71), or changes in the amount
of HPV present as measured by the strength of the HPV PCR signal (p =.88).
Conclusion: Improved immune status due to HAART, specifically increased
CD4 count, appeared not to alter the course of HPV-related cervical disease
in this small group of women followed for 6 to 12 months. Although significant
differences may be seen with longer follow-up, these preliminary results suggest
that HIV-infected women should continued to be followed closely for cervical
cytologic abnormalities despite HAART-associated increase in CD4 count.
| 60290 Implementing programs to reduce HIV among youth in
high risk situations
Diane Allensworth1, M.E. Vernon2, J. Martindale2. 13053 Pointe Court, Lithonia,
Georgia 30058; 2Atlanta, GA, USA
Issue: Providing effective programming to youth in high risk situations is critical
to reducing the HIV epidemic.
Project: To address the demographics of the HIV epidemic among adolescents,
the CDC's Division of Adolescent and School Health has organized several programmatic initiatives to reduce HIV among youth in high risk situations (YHRS): 1)
funding HIV prevention within a coordinated school health program in all state education agencies (SEAs) and 18 local education agencies where the epidemic is

severe, 2) funding national organizations with state/local constituents that provide
programming to large numbers of YHRS, 3) linking state health and education
agencies with non-governmental agencies serving YHRS, and 4) developing a
nationwide monitoring system that tracks priority health behaviors of YHRS. State
educational agencies have been funded to reduce HIV and other STDs among
youth using the school as a site. Data from a 1995 survey revealed that 70% of
all states and 83% of all school districts require HIV prevention education to all

students. CDC/DASH furthers asks SEAs to initiate supplemental programming
for YHRS. One example of programming linked representatives from the SEA and
the state health agency with organizations serving YHRS to develop an action
plan for YHRS both in and out of school. To complement the activity of SEAs,
CDC/DASH funds eight national non-governmental organizations to assist national, state, and local efforts to prevent HIV infection among large populations of
YHRS. Collaborating with affiliates, these national organizations provide effective
targeted intervention for various categories of YHRS.
Lessons Learned: (1) YHRS are difficult to reach because they often are
disenfranchised from traditional education and health systems. (2) Use of local
planning groups can facilitate coordination of interventions to YHRS if there is
broad representation of all constituencies, including youth. (3) Prevention efforts
need to be integrated into existing services being provided to YHRS.
|60291 Anticytomegaloviral activity and toxicity studies of
(-)-2-(S)-dihydroxyphosphinoyl-5-(guanin-9'-yl)methyltetrahydrofuran, a novel guanine phosphonate analogue
Jean Bedard, R.F. Rando, T.L. Bowlin, J. Clement, M. Lis, N. Chan, N. Turcotte.
Biochem Therapeutic Inc., 275 Armand Frappier, Laval, QC, Canada
Objective: To compare the efficacy and toxicological properties of a novel guanine
phosphonate analogue with HPMPC.
Results: In the present study, our efforts centered on characterizing
a novel phosphonate nucleoside analogue ((-)-2-(S)-dihydroxyphosphinoyl5-(guanin-9'-yl) methyl-tetrahydrofuran, compound 1). This compound was tested
in comparison with HPMPC for efficacy and toxicity in vitro and in vivo. Inhibitory
effect obtained for both compounds on HCMV propagation in vitro was similar with
IC50s ranging from 0.02 to 0.2 ug/ml for HPMPC and 0.08 to 0.09 ug/ml for compound 1. HCMV clinical isolates resistant to ganciclovir through mutations within
the UL54 DNA polymerase gene and a HPMPC resistant laboratory strain derived
from AD169 remained sensitive to compound 1 whereas their susceptibilities to
HPMPC was reduced. Both also exhibited equal potencies in the experimentally
induced murine cytomegalovirus infection in mice with a prevention or prolongation of mean day to death at dosages of 1.0, 3.2, and 10.0 mg/kg/day. In terms
of drug-induced cytotoxicity, both compounds were found to be nephrotoxic in rat
and guinea pig animal species in a five-day repeated dose study, the epithelium
lining the proximal convoluted tubules in the renal cortex being the primary target
site. The incidence and the severity of the lesions were found to be dose dependent. The lesions observed were characterized by cytoplasm degeneration and
nuclear changes such as karyomegaly and apoptosis. In the guinea pig model, a
greater incidence and severity of lesions was observed (P < 0.001) for HPMPC
when compared to compound 1 at a drug regimen of 10 mg/kg/day.
Conclusion: The results demonstrate an equal or slightly superior efficacy profile for compound 1 and most importantly a decreased nephrotoxicity compared
to HPMPC, suggesting that less toxic derivatives of phosphonate nucleoside
analogues are achievable.
|60292 Adapting treatment education trainings for three
populations of people with HIV/AIDS
Julie Davids1, J.M. Jeff Maskovsky2, A.H. Harley1, J.S. Shull'. Philadelphia
Fight 1233 Locust Street Philadelphia, PA 19107, USA
Issue: People living with HIV/AIDS need secondary prevention and treatment
education in order to learn how to stay healthy and prevent viral transmission to
others. This education must be tailored to meet the specific needs of different
populations of people with HIV.
Project: Project TEACH stands for Treatment Education Activists Combatting
HIV. We are a program located in Philadelphia that trains primarily low-income
people of color living with HIV/AIDS on secondary prevention, good medical
care for HIV/AIDS, peer education and communication skills, and AIDS activism.
Since 1996, we have held 7 training classes and trained 140 people living with
HIV/AIDS. The trainings include 48 hours of instruction, homework, field trips,
and a graduation ceremony. Most of the participants in the program have been
low-income, unemployed or marginally employed, African American people in
recovery from drug use who utilize 12-step programs and philosophies. In 1997,
we adapted the program to reach three HIV positive sub-populations: women,
the working poor, and injection drug users. We made a number of programmatic
shifts to accommodate these populations: 1) In the Fall of 1997, we conducted our
first satellite project at the drop-in center of the city's syringe exchange program.
Participants were HIV+ drug users with little social support who were not "out"
about their HIV status. 2) We also offered the standard training in evening hours.
This group was more likely to be employed, and had higher attendance rates. 3)
We began a monthly "women's seminar" to accommodate the information needs
of HIV+ women with family responsibilities
Results: The programmatic shifts we made were successful in reaching the
three sub populations. The retention rate for the night class was 100%. Additionally, consumer satisfaction questionnaires indicate a high level of satisfaction with
all three programs, and pre- and post- test results indicate significant increases

in knowledge about HIV and its treatment among those who completed the two
trainings. A leadership group emerged from the women's seminar, and began
coordinating trainings.
Lessons Learned: Treatment education programs are successful in reaching
HIV positive low income people with HIV, including women, the working poor, and
injection drug users, if they are tailored to meet the specific needs of the target
population.