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

1066 Abstracts 60361-60365

12th World AIDS Conference

60361 Ritonavir promotes increased growth in HIV-infected
children
David Nadal1, F. Steiner2. Pediatric AIDS Group of Switzerland; 1Steinwiesstr.
75, 8032 Zurich; 2University Children Hospital, Zurich, Switzerland
Objectives: To assess the impact of ritonavir on growth in HIV-infected children.
Design: Prospective, open label, multicenter study.
Methods: Children receiving 2 reverse transcriptase inhibitors were offered
additional ritonavir (2 x 350 mg/m2/day). MV load, CD4+ cells, and body height
or length were monitored. The latter were Z-scored to allow age-independent
comparison of growth by calculating A Z-scores before and while on treatment.
Results: Since July 1996 a total of 36 patients were prescribed 38 courses
of ritonavir. 2 children discontinued ritonavir due to side effects, 2 due to lack of
adherence, and 1 patient died. Body length data at weeks -24, 0, and +24 were
available for 27 (82%) of the 33 children on ritonavir for at least 24 weeks. At
initiation of ritonavir, the median age of the 27 children was 7 years (0.4-16.3), the
mean CD4+ cell count 215/p1L (1-888), and the mean plasma HIV load 256'527
copies/mL (6,718-1,734,613). The mean AZ-score weeks -24 to 0 was -0.5
(-3.01 to 0.74) and the mean A Z-score weeks 0 to +24 was 0.34 (-1.63 to
2.58) (paired t test, p = 0.019). Segregation of patients into responders (>2 loglo
reduction of HIV load at week +24 compared with week 0; n = 16) with a mean
HIV load of 317 RNA copies/mL (<100-2271) and a mean CD4+ cells 699//tL
(164-1520) and non-responders (<2 loglo HIV reduction; n = 11) with a mean
HIV load of 376'902 RNA copies/mL (429-3,700,328) and a mean CD4+ cell
count of 250//iL (0-939) revealed that the increased growth was dependent on
viral load reduction.
Conclusions: Supplementation of ritonavir to antiretroviral treatment with 2 reverse transcriptase inhibitors resulted in significant promotion of growth in those
children showing decrease of HIV load >2 logio.
60362 The challenge of adherence: An educational model for
non-medical HIV service providers
Pablo Colon, C. Arboleda, S. Johnson, W. Rogerson, P. Warren. GMHC 119
West 24th Street 7th Fir. New York, NY, USA
Issues: Adherence to drug treatments and to medical care is difficult for most
HIV+ people. Education for service providers about adherence to HIV medications
and medical care is necessary so that they can provide adherence information
and support to their clients.
Project: The Treatment Education and Advocacy Department at Gay Men's
Health Crisis, NYC designed and conducted a conference on adherence to antiretroviral therapy entitled "A working conference to discuss the new challenges:
Adherence and Compliance". This conference was tailored to the educational
needs of non-medical AIDS/HIV service providers (casemanagers, health educators, peer educators, and treatment advocates). The goal was to educate service
providers about the complexity of adherence and to share ways to help clients
adhere to therapy. The format of the working conference consisted of: 1) Lectures
on: The experience of a community doctor in helping patients adhere to treatment
and issues surrounding adherence to medications 2) Presentations by a panel
composed of: An HIV+ woman on antiretroviral therapy, a health educator in the
prison setting, and an HIV+ ex-drug user involved in harm reduction advocacy.
3) Participants were divided into four work groups and shared barriers to adherence and strategies to help their clients adhere to treatment. 4) The information
obtained from the four work groups was presented and discussed. 5) Written
materials were provided.
Results: 40 HIV service providers participated in the conference. 23 evaluations were collected. The conference structure and curriculum were well received
by the participants. Conference participants identified barriers to adherence and
shared strategies to help clients adhere to medications. A summary of the barriers
to adherence and of the strategies to help clients adhere to medications identified
by service providers will be presented.
Lessons learned: Educational initiatives around adherence to antiretroviral
are needed and requested by service providers. The interactive "working" educational model seems to suit the "hands on" approach of the targeted audience.
Non-medical service HIV providers can identify barriers to adherence and can
provide clients with strategies that promote adherence.
60363 Protease inhibitor adherence and HIV-1 RNA response
Jane Woodward1, P.S. Wareham2, L. Grohskopf3, D. Madigan4, T.M. Hooton3.
14334 35th Ave W Seattle, WA; 2University of Washington, Department of
Pharmacy, Seattle, WA; 3University of Washington, Department of Infectious
Disease, Seattle; 4University of Washington, Division of Statistics, Seattle, WA,
USA
Background: Poor adherence with protease inhibitor (PI) therapy engenders viral
resistance and failure of therapy, but it is not clear what degree of poor adherence
leads to suboptimal HIV-1 RNA response.
Methods: PI prescription refill and HIV-1 viral load (VL) data were reviewed

for all pts. first starting PIs at a primary care HIV clinic from May 1997-October
1997. 90% of patients filled their prescriptions at an on-site pharmacy. Refill dates
were used to calculate an Adherence Level (AL) for each pt., (defined as total
number of days PIs were dispensed divided by total number of days between
first fill and last fill). Baseline VL was defined as the last VL within 3 months prior
to starting PI therapy. Final VL was defined as the latest VL obtained before or
within 1 month of the last refill date. Pts. obtaining PIs from outside pharmacies,

who had <2 months of PI therapy, who had undetectable baseline VL, and who
had no baseline or final VL measure were excluded.
Results: for the 73 pts. (median baseline VL = 14.100 copies/mL) are summarized at right. Worsening adherence is significantly associated with decline in
viral load response (p < 0.001). Baseline VL was not predictive of final VL.
Percent of pts. with final HIV-1 RNA undetectable

100% 90-99% 75-89% <75%
n=26 n=20 n=11 n=16
PI adherence level
Percent of pts. wtih final HIV-1 RNA undetectable.
Conclusions: This study shows that there is a significant association between
PI adherence level and HIV-1 RNA response, and confirms that prescription refill
data can be meaningful in predicting HIV-1 RNA response in patients seen in a
primary care HIV clinic.
60364 Expecting the unexpected: Identifying and reducing
perceived occupational hazards in HIV partner
notification
Maribel Valle1, J.A. Levy2. 1UIC-SPH 2121 W Taylor, Chicago, IL 60612; 2Univ.
of Illinois at Chicago, Chicago, IL, USA
Objective: This paper examines perceptions of risk and the strategies used by
notification staff to reduce their likelihood of work related harm.
Design: Qualitative ethnographic interviews and observations.
Methods: Data were drawn through participant observation and in-depth interviews with 10 contact tracers about their experiences conducting HIV partner
notification in poor urban areas with high violent crime-rates, drug-use and gang
activity. Using Atlas-Ti for data management and coding, the analysis focuses
on the notifiers' perceived threats to their personal safety when notifying named
partners and the strategies used to reduce these risks.
Results: Not knowing the "hot spots", street-norms, and geographic lay-out
of a neighborhood was found to pose considerable threat to personal safety.
Being perceived as or in collusion with police or immigration authorities was
deemed highly dangerous. Strategies to avoid personal harm included adopting
an "insiders" dress and demeanor, establishing credibility and legitimacy on the
streets, finding sponsorship, offering a social "hook" and creating social and/or
spatial safety zones.
Conclusion: The findings have implications for developing safety guidelines
and training programs for protecting public health and other HIV partner notification personnel.
60365 Nelfinavir-nevirapine rescue therapy for patients failing
protease inhibitor based therapy
Janet G. Gilmour, D.B. Gregson, B.L. Done. St. Joseph Health Centre, 448
Oxford Street, East London, Ontario, Canada
Little information is available to guide the treatment of patients with advanced HIV
disease who have received extensive prior therapy. Approximately 50% of patients
who have received prior therapy with nucleoside analogues will fail initial protease
inhibitor (PI) therapy. Some of these patients may exhibit an initial response to
PI therapy, but subsequently demonstrate virological, clinical or immunological
failure.
Treatment of patients failing PI based therapy poses a significant challenge to
the clinician. We report on a group of eleven such patients. All have received
extensive prior therapy, including at least one PI based regimen. All had evidence
of virologic failure (no change in viral load from baseline or an increase to greater
than 'baseline' viral load) Many also had evidence of immunologic and/or clinical
failure. Patients were treated with a regimen containing nelfinavir and nevirapine
(DMP 266 in one case) plus one or two nucleoside reverse transcriptase inhibitors,
where this was possible, at their treating physicians discretion.
Results: At this time, eight patients have been followed beyond twelve weeks
(Range 12-24 weeks). The regimen appears to be well tolerated and generally
well liked by patients. Our initial response rate is 50%. Fifty percent of patients
have achieved a viral load decrease of 1.0 log or greater, with the majority of these
becoming undetectable (<500 copies/ml, Chiron bDNA). Longer term follow up
data (viral load, CD4, clincical) will be presented on this small cohort.
Conclusion: In our small sample, the combination of nelfinavir and nevirapine
proved a well tolerated regimen with an initial response rate of 50% in a group of
patients resistant to therapy. This combination should be considered for rescue
therapy in patients failing other PI based regimens.