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

1068 Abstracts 60372-60376

12th World AIDS Conference

may be involved. Available treatments for aphtous ulcers in HIV-infected patients
including corticosteroids and thalidomide are unsatisfactory.
Design: Open trial
Methods: 5 patients with documented HIV-infection and symptomatic oral ulceration (n = 2), esophagus ulceration (n = 1), anal ulceration (n = 2) were treated.
All had enlarging necrotic lesions resistant to corticosteroids or thalidomide. No
infectious, neoplastic or specifics organisms were found on biopsy. Attacks had
persisted for 8 weeks to 4 months. Antiretroviral therapy including protease
inhibitor was maintened during the study.
Results: After 6 weeks with oral Pentoxifylline (800 mg/day), 4 patients (80%)
became asymptomatic and ulcers were resolving. This occurred in a mean of 4
weeks. There were no side effects. Mean CD4 count at the start was 108 ~ 48
and at the end 123 ~ 35, HIV RNA viral load decreased from 0.5 log10 to the
baseline at the end of the treatment.
Conclusions: Pentoxifylline is an effective treatment for chronic ulceration in
HIV patients. The efficacity could be mediated both by a down regulation of TNF-Oa
and a transient decrease of HIV RNA viral load.
60372 Pregnancy decision making in a well-motivated cohort of
HIV infected women
Anil Purohit12, Joan Duggan2, H. Walerius2, J. Chakraborty2, S. Khuder2,
M. Kosy2, A. Locher2. c/o Judy Sukeski, Dept. of Physiology & Molecular
Medicine, Medical College of Ohio, 3035 Arlington Avenue, Toledo, Ohio;
2BIDMC Harvard Medical School, Boston, MA, USA
Issues: Most HIV infected women have been counseled to avoid pregnancy
due to the risk of vertical transmission to the fetus. ACTG 076 documented a
significant risk reduction (67.5% relative risk reduction) in vertical transmission
among women taking AZT beginning in the second trimester of pregnancy. The
impact of this study on reproductive decisions among HIV infected women is
unknown.
Project: A well-motivated cohort of 69 women attending HIV related workshops
or Infectious Diseases clinics were surveyed about their pregnancy histories HIV
diagnosis and future pregnancy plans.
Results: 52% of the women surveyed were 26-35 years old; 43% were white;
45% were black; 75% earned - $20,000/year; 54% had post-high school education; 66% had HIV diagnosis <5 years ago; 92% had CD4 > 200. 29% of patients
surveyed had never conceived. 42% of patients have 1 or 2 children. 59% of
patients have not become pregnant since receiving a diagnosis of HIV. 38%
of patients surveyed had become pregnant after HIV infection was diagnosed.
42% of these pregnancies were unplanned and were primarily due to condom
failure. 14% of patients have had an abortion or miscarriage. 10% of patients had
planned pregnancy and/or succeeded in conceiving since receiving a diagnosis
of HIV. These patients were predominantly lower income, non-white patients with
education beyond the high school level. 6% of patients have HIV infected children.
71% of patients did not have any plans for pregnancy within the next two years.
39% of these patients indicated that vertical transmission risk reduction with AZT
would affect their future pregnancy plans. 20% of patients were unsure of their
future pregnancy plans and all of them indicated that vertical transmission risk
reduction with AZT would affect their future pregnancy plans.
Lessons Learned: Widespread dissemination of information on the reduction
of the risks of vertical transmission may be a significant factor in HIV infected
women's reproductive decisions. The majority of women do not currently plan for
future pregnancies once HIV is diagnosed.
60373 Factors associated with prevalent versus incident HIV
infection among sex workers in Cameroon
Sharon Weir1, R.E. Roddy2, L. Zekeng3, K.A. Ryan2, E. Wong2. 1PO. Box
13950, Research Triangle Park, NC 27709; 2Family Health International,
Durham, NC, USA, 3Ministry Of Public Health Yaounde, Cameron
Objective: To determine whether factors associated with prevalent HIV infection
in the screening phase of a randomized controlled trial (RCT) of nonoxynol-9 were
also associated with acquisition of HIV infection among the initially HIV-negative
sex workers who enrolled in the RCT.
Methods: At baseline, 2,260 female sex workers in Cameroon were interviewed about their sexual behavior and demographic characteristics and tested
for HIV. HIV-negative women who enrolled in the RCT were counseled to use
condoms and vaginal film (either N-9 or placebo). We randomly split the screened
population into 2 samples and identified in one sample risk factors for prevalent
infection (prevalence odds ratios [POR] >1.0). Then we assessed whether these
factors were associated in the other sample with incident infection during the RCT.
Results: Baseline prevalence of infection (18%) was associated with older
age (POR = 1.9), -4 children (POR = 2.2), recent arrival to the city (POR =
4.4), lower education (POR = 2.6), recent sex with a new client (POR = 1.7),
use of antibiotics (POR = 2.7), not using a condom with the last partner (POR =
1.7). 40 of the 585 HIV-negative women in the split sample who enrolled in the
RCT seroconverted (incidence rate = 6 per 100 p.y.) Of the baseline variables

associated with prevalent infection, only low education (incidence rate ratio = 2.7)
was associated with incident HIV.
Conclusion: Risk factors for prevalent infection may not identify characteristics
of those most likely to acquire new infection. This may be particularly true in the
context of an educational intervention that removes barriers to condom acceptability, accessibility and use. The effect of loss-to-followup on on assessment of
risk factors for incident infection cannot be fully evaluated.

60374 1Pharmacoeconomic analysis of four treatment options
for CMV retinitis in Swiss AIDS patients
Raffaele Malinverni1, Willy Oggier2, P.J.K. Steger3, S. Rusterholz1, H.J. Furrer1.
1AIDS Unit, Inselspital, Polkliniktrakt 2, Bern; 2Health Economist, St. Gallen;
3Pharmacia & Upjohn Lagerstr. 14, Dbbendorf, Switzerland
Background: Four different options are available for the treatment of CMV-retinitis
in Swiss AIDS patients. In order to have economic criteria for the selection of treatment, a pharmacoeconomic analysis was performed to evaluate the treatment
costs of the various regimens.
Methods: Four regimens were considered: 1. foscarnet (FOS) 90 mg/kg iv bid
(induction), 90 mg/kg iv qd (maintenance); 2. ganciclovir (GCV) 5 mg/kg iv bid
(ind), 5 mg/kg iv qd (maint); 3. GCV 5 mg/kg iv bid (ind), 1000 mg po tid (maint);
and 4. cidofovir (CID) 5 mg/kg iv qwk x2 (ind), 5 mg/kg iv/2 wk (maint). Treatment
costs were calculated for 120 days and they included labor costs, drugs, medical
devices, and laboratory examinations based upon the current practice at the
University Hospital of Berne. Effective cost data was provided by the Cantonal
Hospital of St. Gallen. Induction was 2 weeks for regimens 1, 2 and 4; and 3
weeks for regimen 3. Based on published data, reinductions for regimens 1 and
2 were considered after 60 and 90 days, and after 120 days for regimen 4.
Reinductions for regimen 3 were considered every 30 days.
Results:
1. Foscarnet 2. Ganciclovir 3. Ganciclovir 4. Cidofovir
iv iv iv/po iv
Treatment costs for 120 days [SFr.] 43770 38'390 34'430 18'240
Assuming the second reinduction with the regimens 1 and 2 occurring after
120 instead of 90 days, treatment costs [SFr.] with FOS iv (39'540) and GCV iv
(35'612) would be only slightly less. Conversely, assuming the second reinduction with CID after 90 instead of 120 days, treatment costs would be unchanged
(18'230).
Conclusions: Treatment costs for CMV-retinitis in Swiss AIDS patients are
substantially lower for cidofovir compared to foscavir iv, ganciclovir iv, or ganciclovir iv/po. Quality of life data were not included in this evaluation but they are
likely to favor cidofovir due to less frequent infusions and less time of hospitalisation. Clinical data with direct comparisons of treatment efficacy and toxicity are
needed before definitive conclusions about cost-effectiveness of these treatment
options can be drawn.
60375 Broad spectrum resistance to HIV-1 strains by antisense
sequences expressed in CD4+ cells
Norman Kelker1, D. Liu1, J. Richardson2, J. Laurence2, J. Ng1, B.E. Thalenfeld1,
D.L. Englehardt1. 1 ENZO Biochem, Inc., 60 Executive Blvd. Farmingdale, NY;
2 Cornell University Medical College, New York, NY, USA
Objectives: To assess the effectiveness of three antisense RNA sequences
to protect CD4+ cells from a broad spectrum of HIV-1 strains including clinical
isolates.
Design: In vitro challenge assays of antisense producing CD4+ cells with HIV-1
strains.
Methods: As a basis for the development of an antisense-based therapeutic
we have developed three antisense sequences directed against two functional
regions, TAR and tat/rev, of the HIV-1 genome (J. Virol. 1997 71:4079-4085).
Each sequence was embedded in the transcribed region of a U1 snRNA gene.
CD4+ cells (U937) were transfected with a DNA expression vector carrying the
three U1/antisense sequences. The transfected cells were then subjected to virus
challenges with a variety of HIV-1 strains that included patient isolates, syncytium
inducing strains and others. Assessment of cell protection was made by assays
for p24 production and cell viability.
Results: Transfected CD4+ cells expressing the three antisense sequences
were highly protected from HIV-1 challenge even at high multiplicities of infection.
Protection to challenge from clinical isolates varied between 92% and 99% as
compared to control cells.
Conclusion: Cells expressing these antisense sequences are protected from
destruction by a broad spectrum of HIV-1 strains. These sequences thus provide the basis for development of a broadly protective anti-HIV-1 gene therapy
protocol.
|60376 Who invited HIV/AIDS? 1st Nation's family-based support
model
Tammy Abram. 2164 Gottingen Street, PO. Box 47049, Halifax, Canada
Issues: The effects of HIV/AIDS in the First Nation Communities are amplified
by the physical, mental, emotional and spiritual impact on the individual, family
and community. Cultural Depression, the link or connection of the effects of
Cultural Depression and HIV/AIDS and the role of the Family in a 1ST nation
community.

Project: A working understanding of Cultural Depression and its effects on
the First Nation people was linked to the high rate of reported AIDS cases in
Canada. A working group consisting of representatives from various fields was
used to develop a whole response to HIV/AIDS and related issues. Traditional
and Conventional tools were combined to develop a Family-based Community
response to HIV/AIDS. Each 1st Nation community is unique and will need to
identify its own issues, needs and resources. The Atlantic First Nations AIDS