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

12th World AIDS Conference

Abstracts 60323-60328 1059

60323 | Hepatitis B flare after highly active antiretroviral
treatment (HAART)
Vicenzo Vullo, C.M. Mastroianni, V. Trinchieri, M. Lichtner, P. Santopadre,
B. Vecchi, A. Corpolongo. Dept. of Infect Trop Diseases, La Sapienza University,
Piliclinico Umberto I 00161 Rome, Italy
Background: Recent studies have reported the occurrence of some opportunistic
infections, such as mycobacterial or cytomegalovirus diseases, shortly after the
initiation of highly active antiretroviral treatment (HAART). It has been suggested
a local reactivation of these diseases depending on enhanced immunity in areas
of latent infection.
Methods: We described an HIV-infected patient who developed a reactivation
of hepatitis B infection within 12 weeks after HAART was started.
Results: A 62-year-old homosexual man with advanced HIV infection (CD4+
and CD8+ T-cell count = 93/mmc and 812/mmc, respectively; plasma HIV RNA
= 5.7 log) was treated with HAART, including stavudine, didanosine and ritonavir.
The patient was receiving liposomial amphotericin B 3 mg/kg every two weeks as
maintainance treatment for a visceral leishmaniosis. He had also a chronic HBV
infection with positivity of serum HBsAg, anti-HBc IgG and anti-HBs, but normal
ALT. After two months of HAART, the HIV RNA was undetectable and CD4+ and
CD8+ T-cell count rose to 187/mmc and 1351/mmc, respectively. A month later,
the patient developed symptoms of acute hepatitis (painful tender hepatomegaly,
weight loss). There was elevation of serum ALT (1340 IU) and concurrent presence of serum HBeAg and anti-HBc IgM. Serology for HAV, HCV, and HDV was
negative, and ultrasonography showed no liver or biliary abnormality. The patient
recovered after temporarily stopping the antiretroviral treatment.
Conclusion: HIV-seropositive HBV carriers may develop a marked clinical
hepatitis flare shortly after starting HAART. It is likely that the disease reactivation
may be induced by the immunological reaction after the restoration of CD4+ and
CD8+ T-cell responses to HBV.
60324 Regression of AIDS-related Kaposi's sarcoma lesions
following treatment with cidofovir
Claudio M. Mastroianni, P. Santopadre, G. Forcina, C. D'Agostino, B. Vecchi,
V. Trinchieri, V. Vullo. Dept Infect Trop Dis, La Sapienza Univ, Policlinico
Umberto I, 00161 Rome, Italy
Background: Recent studies have indicated that Kaposi's sarcoma-associated
herpesvirus (KSHV) replication is sensitive in vitro to antiviral drugs.
Methods: We described an AIDS patient with Kaposi's sarcoma (KS) who
showed a regression of KS skin lesions following treatment with cidofovir.
Results: A 44-year-old heterosexual female with advanced HIV infection (CD4+
T-cell count = 19/mmc and plasma HIV RNA = -5.7 log) presented with a
4-months history of cutaneous KS. After 3 months of protease inhibitor therapy
with saquinavir, she developed a cytomegalovirus (CMV) retinitis but KS lesions
remained unchanged. She initially received ganciclovir which was switched to
cidofovir (5 mg/kg every two weeks) because of severe hematological side effects.
After a month of treatment with cidofovir, the patient's KS lesions progressively
decreased in sizes and numbers, and no new lesions have been observed. No
concurrent treatments for KS were done during cidofovir therapy. Two months
later, cidofovir treatment was stopped because of the occurrence of uveitis, and
recurrence of KS lesions was observed.
Conclusion: Treatment with cidofovir has potential benefit in the course of
AIDS-associated KS independently of protease inhibitor therapy. It is likely that
the regression of KS lesions is attributable to the ability of cidofovir to block the
HHV-8 replication.
60325 Interleukin (IL-2 deficiency aggravates the defect of
natural killer cell activity in AIDS patients
Bouchra Zerhouni, K. Sanhadji, M. Ottmann, L. Kehrli, J.-L. Touraine.
Laboratoire des Deficits Immunitaires Faculte Rth Laennec, Rue Guillaume
Paradin 69008 Lyon, France
Objective: To study the activities of natural killer (NK) and lymphokine activated
killer (LAK) cells as well as the T helper (Th) responses in HIV-infected patients.
Methods: NK, LAK and Th activities were analysed from peripheral blood
mononuclear cells (PBMC) of 12 symptomatic AIDS patients with CD4 lymphocyte count below 200//tl, 12 asymptomatic patients with a CD4 lymphocyte count
between 450 and 600//Il and 12 HIV-seronegative individuals.
Tumor target cells were used in order to detect NK and LAK activities and the
Thl and Th2 functions were evaluated by IL-2 and IL-10 production respectively.
Results: The decrease in NK cell activity in AIDS patients was correlated with
the deficiency of IL-2 production and the elevation of IL-10 release. Exogenous
addition of IL-2 restored partially the deficit, but the LAK activity remained lower
in AIDS patients than in asymptomatic and control subjects.
Conclusion: Our data suggest that the lack of IL-2 production and the increase
of IL-10 levels aggravate the lytic defect. Correction of the IL-2 deficiency, and
possibly the excess of IL-10, may result in partial improvement in immunodefi
ciency..60326 Carrying citizenship in the pocket
Suzana H.S.S.S. Lopes, C. Ruthes, M.R. Benedetti, P.C. Bahia, C.B. Quadro,
A.I.F. Martinez. GAPA, General Salustiano, Porto Alegre, RS, Brazil
Problem: Inexistence of printed material (guides) dealing with health, STD/AIDS
prevention and citizenship that could also work as a "document" of identification
linking the target population (sex workers) to the NGO. The material will be of
frequent use, like an appointment book with addresses of the most looked after
public services.
Project: The team of volunteers at NAESP (Group of Action and Studies about
Prostitution) from GAPA/RS (Support Group for the Prevention of AIDS) has
created, along with systematic meeting groups of sex workers, a printed material
(the "Health and Citizenship Guide") composed of three topics - health, citizenship
and HIV/AIDS - in an A&Q format. This material was inspired by the model of the
employment book, which was a recurrent wish from the groups. The volunteers
also created a "Guide of Useful Adresses" comprehending services related to
health, citizenship an social assistance in the shape of a credit card which works
as a complement for the "Health and Citizenship Guide".
Results: (1) The collective discussion for the creation of the materials gave
origin to a series of reflexions in the systematic meeting groups concerning the
themes approached.
(2) The "Health and Citizenship Guide" and the "Guide of Useful Adresses" are
tools present at work for the consultation and identification (among the professionals of a given area and other social actors) which are shown proudly by their
owners.
(3) Many of the sex workers want to join the activities of NAESP in order to get
these guides.
(4) Other activities of STD/AIDS prevention with this or orther audiences asked
permission to use the guides created as source for the creation of similar material
for their own projects.
Our conclusion is that it is greatly advantageous to make printed material designed to accomplish one especific and permanent goal in the cultural universe of
the target population. The success will be proportional to the active participation
of the target population in the creation of such material.
[ 60327 Comprehensive care of HIV+ women at primary care
services, a study and proposal in Buenos Aires,
Argentina
Mabel Bianco', L. Pagani2, M.I. Re2. Feim, Parana 135 Piso 3ro. 13, 1017
Buenos Aires, Argentina
Issue: In Argentina the care of HIV persons is delivered in complex hospitals.
Primary Health Care Services are not prepared for HIV Care. The increasing
incidence of HIV, specially in poor urban areas at Greater Buenos Aires oblige
many HIV+ people to attend big hospitals to satisfy their health care needs. They
spent more time and money. At hospitals the fragmentation of services affects
the accessibility and also limits the care in family planning and gynaecological
services.
Project: To promote Primary Health Care for HIV+ women in Greater Buenos
Aires, we made a situational analysis in a community Health Center. We studied
the incidence of HIV/AIDS, the availability of services, the needs perceived by
HIV+ women compared to non infected women and the attitudes and capability of
the health personnel, the community and the women to satisfy their health needs
in the Health Center. We interviewed health professionals and a sample of HIV+
women and non infected women.
Results: Positive and non positive women share the same basic need and
prefer the Health Center Care because it is geographically and culturally closer
to them. The basic health needs are: family planning services, STDs and gynaecology and obstetric care. HIV+ women express the fear to lose the free drug
provision and the confidentiality of their HIV status if they attend the Health Center.
Non + women do not express fear nor discriminatory attitudes to share services
with + women. The personnel of the Health Center require training on technical
and behavioral aspects, to avoid discriminatory attitudes. A proposal of training
and reorganization of Primary Health Care to Women was elaborated including
family planning services, STDs, Gynaecological cancer and other services.
Lessons Learned: Through the interviews we learnt that + and non + women
have the similar health needs. Non + women have no problems to share services
with HIV+ women. Health professionals and personnel reject and discriminate
those + women withdrawing them from the Health Care Center.
60328 | Counselling/creating awareness about HIV/AIDS amongst
males who have sex with males
Arif Jafar1. 'Project Admn. Bharosa Project 21/6/5 Peerpur House 8 Tilak Marg
Lucknow, India
Issue: As the dreaded AIDS started spreading its fangs in India, the necessity of
creating awareness amongst various social groups was strongly felt. The group
decided to target Male Who Have Sex With Males

Project: The group since its inception has one of its major aims to create
awareness and provide counselling about HIV/AIDS to males who have sex with
other men. For the purpose earlier the group had been publishing a regular
bimonthly magazine. A number of seminars, workshops and discussions have
been conducted. A drop-in-centre has been established.
Results: The response has been very encouraging and enthusiastic. The level
of ignorance has been found to be very high because of prevalent social taboos