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

12th World AIDS Conference

Abstracts 60293-60298 1053

I60293] Symposia on HIV series in the 21st century
Dennis L. Stover1, A.N. All Naqvi. 'Michigan AIDS Fund, 678 Front ST. N.W
Suite 159, Grand Rapids, Michigan; 2 Wayne State University AIDS Research,
Detroit MI, USA
A major philanthropic collaboration (W.K. Kellogg & C.S. Mott Foundations) sponsored four symposia to achieve consensus recommendations of great value to
private and public funders, program planners and public health officials. A monograph, published and disseminated after completion of the symposia, detailed
critical issues facing funders and service providers as the AIDS epidemic changes.
A futuristic view of needs for AIDS services and how to access and deliver these,
will offer critically-important dissemination of studies from North to South.
(1) New strategies for prevention are needed built on psychosocial issues of
empowerment and self-esteem (Stages of Trans-Theoretical Change Model); (2)
A new model of case management must be developed; (3) Adherence to combination therapies is the single most critical factor in their success, and, (4) Private
philanthropy can be a productive partner in AIDS services.
60294 Limited treatment options for antiretroviral treatment in
HIV-1 infected children: Analysis of a drug-experienced
cohort after multiple monotherapy regimens
Andrea De Maria, F. Fioredda, S. Boni, E. Donelli, C. Cirillo, S. Ratto, D. Bassetti.
Largo R. Benzi 10, 1-16134 Genova, Dept. of Infectious Diseases, Italy
Background: Currently limited availability of pediatric formulations of nucleoside
and non-nucleoside reverse transcriptase inhibitors and of protease inhibitors and
the absence of consensus guidelines for antiretroviral treatment of HIV-1 infected
children considerably frustrate clinical strategies. Additional uncertainty is generated in children who could clinically and virologically benefit from a a new suppressive combination regimen but have a history of multiple monotherapies with
different antiretrovirals. Based on HIV-1 dynamics, prolonged exposure to single
drugs in vivo in these children could predict failure of a combination regimen which
would include one or more of the drugs previously administered in monotherapy.
Objectives:.) to determine the size of this group of children among those
followed up in a prospective epidemiological and clinical cohort,.) to verify the
potentially available treatment options for those patients and.) to evaluate the
usefulness of RT genotyping by a commercial line probe assay (LIPA).
Patients and Methods: Retrospective analysis on clinical records of all HIV-1
infected children prospectively followed up at our centre or referred from other
hospitals. Age, mode of transmission, CD4 counts, plasma viral load, type and
duration of antiretroviral treatment, LIPA on stored plasma were analyzed.
Results: Of the 58 HIV-1 infected children ever followed up at our centre, 28
were actively followed up on Dec 1997, and 23 (mean age 7yr., range 3-11 yr.)
were currently treated with antiretrovirals. Monotherapy with at least one drug
had been previously administered to 18/23, including ZDV in 18 (100%) for a
mean of 1029 d. (22-2065 d.), ddl in 6 pts. (33%) for a mean of 244 d. (41-940
d.), d4T in 5 pts. (28%) for a mean of 205 d. (180-240 days), ddC in 1 patient
for 90 days. Without prior genotype or phenotype testing of the plasma HIV-1
quasispecies, no alternate 2-drug regimen with new NRTIs were available in
8 (34%) patients. Plasma samples of the 23 children are being analyzed for
drug-resistance by LIPA. Preliminary analysis in 4 chidren showed the presence
of mutated drug-resistant HIV-1 strains in 1 child whose plasma viral load was
only temporarily reduced by -1 log after the start of a new 2-drug regimen.
Conclusions: a considerable proportion (34%) of drug-experienced HIV-1 infected children may have no option for a potentially suppressive 2- or 3-drug
anti retroviral regimen. The limited availability of pediatric formulations of some
NRTIs, NNRTIs and PI, the possibility of vertical transmission of drug-resistant
maternal strains and the present lack of guidelines, advise for a more widespread
use of in vitro drug-resistance determination to assist clinical determination of
antiretroviral strategies in HIV-infected children.
60295 Testing urine for HIV-1 in five different populations at risk
in the Czech and Slovak Republics
Katherine A. Kacena1, K. Dohnal2, V. Benesova2, C.A. Gaydos1, T.C. Quinn1.
1720 Rutland Ave. Ross BLDG 1156, Johns Hopkins Univ., Baltimore, MD, USA;
2Charles Univ., Prague, Czech Republic
Objectives: Although high risk behaviors such as prostitution, injecting drug use,
and unsafe sex practices are widespread in the Czech Republic, the nationally
reported cumulative cases of HIV-1 are still under 500. In low prevalence populations, screening programs are affected by false positive results due to the test's
low positive predictive value. The HIV-1 Urine Enzyme Immunoassay (EIA) and
HIV-1 urine confirmatory Western Blot (WB) testing algorithm (Calypte Biotech,
Berkeley, CA) is a sensitive and specific method for detecting HIV-1 infection.
Ease of collection, storage, safety, and the ability to test for genital chlamydia
(CT) and gonorrhea (GC) favor urine collection over testing blood. We determined
the acceptability of anonymous HIV urine screening and performed the HIV test
algorithm in five Czech and Slovak at risk groups.

Methods: Females from five groups were studied; students ages 14-18 years
(n = 269), Slovakian Gypsies (n = 128), dermato-venerealogy (DV) patients (n
= 138), prenatal clinic patients (n = 134), and street sex workers (SW) (n = 23).
Participants, aware that no results would be made available to them, submitted
an anonymous urine specimen and completed a short risk behavior questionnaire
(except Gypsy and SW groups). Specimens were tested for genital CT and GC
by ligase chain reaction (Abbott) in the Gypsy, DV, and SW groups.

Results: Overall 96.3% (667/692) of study participants submitted urine and
99.6% (503/505) a questionnaire. Twenty-two of the 667 specimens (3.3%) were
initially HIV urine EIA reactive. When retested in duplicate, 13 specimens (1.9%)
were repeatedly reactive and subsequently tested by HIV urine WB for confirmation. All 13 specimens were negative by WB. Injecting drug use was self-reported
by 10.1% (10/99) of DV patients and 47.8% (32/67) of sexually active students
reported condom use. The estimated prevalence of CT and GC in Gypsies was
3.3% and 0%, in the DV clinic 6% and 2.3%, and in the SW 33.1% and 5.4%,
respectively.
Conclusions: This study supports the low nationally reported data on HIV-1
prevalence. Use of the HIV-1 urine testing algorithm avoided false-positive results. The collection of urine specimens allows for the simultaneous screening of
prevalent chlamydia and gonorrhea infections. Screening for HIV, chlamydia, and
gonorrhea will detect the appearance of HIV in these populations, as well as treat
sexually transmitted diseases that facilitate HIV transmission.
60296 Urine-based screening for gonorrhea and Chlamydia in
an MV primary care population
Emily Erbelding, D. Stanton, T.C. Quinn, A.M. Rompalo. Ross 1159 720 Rutland
Ave, John Hopkins University, Baltimore MD, USA
Background: Treatable sexually transmitted diseases (STDs) serve as cofactors
for the sexual transmission of HIV. Enhanced screening efforts among those
presenting for HIV primary care may be a successful prevention strategy. We
determined the prevalence of Neisseria gonorrheae (NG) and Chlamydia trachomatis (CT) infections and the prevalence of high-risk sexual behavior in an
HIV primary care population.
Methods: Patients presenting for a scheduled medical visit in an HIV primary
care clinic were asked to participate in an interview about recent sexual behavior
and to provide a urine sample. Urine samples were assayed for NG and CT
infection by the ligase chain-reaction based assay.
Results: 321 HIV-infected men and 216 HIV-infected women participated in
the interview on sexual behavior; of these, 497 were able to give urine samples
for analysis. The mean age of participating men was 40.3 years old; the mean
age of women was 36.8. 314 patients reported sexual contact in the prior 90
days; of these, only 35.9% reported condom use at last sexual contact. 45 of 537
(8.4%) reported more than 1 sex partner in the past month, and 61 of 537 (11.4%)
reported a new sex partner within the past 3 months. The prevalence of NG was
1.0% in both men and women. The prevalence of CT was 2.3% in men and 2.6%
in women.
Conclusions: High-risk sexual behavior and treatable STDs are not uncommon in HIV-infected patients enrolled in regular medical care. Case-finding and
early treatment of STDs in patients engaged in HIV primary care, as well as efforts
to modify high risk sexual behavior, may be successful HIV prevention strategies.
60297 International accessibility to HIV/AIDS information via
electronic mail
Corey Mackison1, A.M. Browett1, C.G. Cadden', D. Katz2. 1HIV/AIDS Treatment
Informatin Service, Rockville, MD; 2Nat'l Inst. of Allergy & Infectioous Disease,
Bethesda, MD, USA
Issue: Global interest in the range of options for the care of people with HIV/AIDS
has resulted in increased electronic mail and international requests for information.
Project: The AIDS Clinical Trials Information Service (ACTIS) and HIV/AIDS
Treatment Information Service (ATIS), providers of federally (US) approved clinical trials and treatment information, established sites on the World Wide Web
in 1996, and began receiving electronic mail requests for information. It quickly
became apparent that a much broader audience could access the services electronically than through the international telephone number. ACTIS and ATIS have
tracked these requests to follow trends in the types of inquiries, location of the
requester, and type of requester.
Results: Analysis of quarterly reports over the past two years reveled an
increase in the volume of electronic mail requests from foreign countries. Requesters from other countries are often health care providers, researchers, or
patients, who request information about the standards of care in the US, uses
and availability of approved and investigational medications, and study results.
Lessons Learned: Electronic media, and particularly electronic mail, increase
the avenues by which treatment and research information can be shared with an
international audience.
60298 1 Flexible parametric regression for retrospective studies
of HIV transmission in monogamous partnerships
Stephen Shiboski1, N. Padian1, A. Duerr2. 1500 Parnassus, MU420W University
of California San Francisco, CA; 2Centers for Disease Control and Prevent.
Atlanta, GA, USA
Objectives: Develop analysis methods for data from studies of sexual trans
mission which allow key parameters to be estimated without making restrictive
assumptions about exposure information.
Methods: Analysis methods are based on proportional hazards models for
doubly censored and truncated infection outcomes which arise in transmission
studies where infection times and exposure intervals are incompletely observed.
In addition to allowing risk factors to be investigated, flexible parametric estimates
of the per-contact infectivity are also possible. Diagnostic procedures are pro