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

1072 Abstracts 60392-60396

12th World AIDS Conference

in weight and quality of life appeared to occur independently of protease inhibitor
use (chi-squared analysis). No potentially-related adverse effects were noted.
Conclusion: Pancrelipase therapy appears to be safe and to potentially have
beneficial effects on stool consistency, weight maintenance or gain, and quality of life issues in HIV+ patients with chronic diarrhea. Further study into the
mechanisms, appropriate patient profile, and value of pancrelipase therapy is
warranted.
60392 Cultural competence as capacity: Assessing HIV
prevention training and technical assistance in minority
communities
Karla Scott1, D. Gentry1, C. Gaebler1, S. Myhre2, C. Lopez3, E. Gantz-McKay3,
C. Pasqua2. 1Saint Louis Univ. Sch. of Public Health, St. Louis, MO; 2Stanford
Univ. School of Medicine, Palo Alto, CA; 3Mosaica, Washington, DC, USA
Background: With statistics indicating that a disproportionate number of people
with HIV are members of minority communities, the use of culturally appropriate
prevention strategies must be incorporated into organizational capacity building
efforts. The objective of this study is to identify and assess culturally competent training and technical assistance in prevention programs for intravenous
drug users; gay, lesbian, transgendered populations; African American, Latino/a,
Native American and Asian/Pacific Islander communities.
Design:Exploratory, triangulation
Methods: Key staff of 21 organizations responded to both qualitative and quantitative questions regarding cultural competence in their HIV prevention training
and technical assistance for minority communities. During audio taped structured
interviews, participants defined cultural competence and the operationalization
of concepts in T/TA. Comparative analysis of participant responses identified
themes. Responses to survey questions on cultural competence were analyzed
using SPSS and triangulated with interview data.
Results: Analysis indicated organizations define cultural competence as movement from awareness of cultural issues to responsiveness to specific cultural
needs in all aspects of organizational behavior: staff composition and training,
culturally appropriate language and in the development of culturally specific
training manuals and materials.
Conclusion: Training and technical assistance models which respond appropriately to cultural needs are considered strategic in prevention programs.
Incorporating cultural competence in HIV prevention training and technical assistance appears to increase organizational capacity to reach target populations.
603931 Disease progression markers in HIV infection:
a comparison of assays related to programmed cell death
and accepted markers of disease progression
Karl-Herrmann Klein1, Jan-Christian Wasmuth2, J. Rockstroh2, F. Hackbarth2,
M. Addo2, K. Schliefer2, U. Spengler2. 1Annabergerstrasse 501, Bonn; 2Dept. of
Internal Medicine, University of Bonn, Bonn, Germany
Objective: We compared three different lymphocyte-assays related to programmed cell death (Fas-expression, annexin-V-binding and "Apoptest") with
accepted markers of HIV-progression (CD4-count, HIV-RNA) to find a predictive
marker of immediate disease-free survival and CD4+ T cell-depletion.
Desgin/Method: Peripheral blood lymphocytes (PBL) obtained from 40 HIVinfected individuals and 10 non-infected controls were examined. A three-colour
flowcytometry was used to measure the expression of Fas-antigen (Immunotech)
and the exposure of phosphatidylserin on the external cell-surface with annexinV-binding (R&D Systems) and changes in plasma integrity with the "Apoptest"
(Ylem) in combination with the surface-markers CD4, CD8, CD19 and CD16 & 56.
CD4-counts and quantitative HIV-RNA (NASBA") were measured concomitantly.
The results of these assays were compared to CD4+ T cell-depletion <50/jil
and HIV-related complications (opportunistic infections or tumors) over the next
6 months.
Results: None of the markers could predict depletion of CD4+ T cells over the
next 6 months. In contrast disease-free survival could be predicted by Fas-expression <88% of PBL (Odds ratio 11.3; p < 0.001) and Annexin-V-binding below 51%
(Odds ratio 33.6; p < 0.001). The other surrogate markers of HIV-progression
(CD4-count, HIV-RNA) as well as the "Apoptest" could not predict disease-free
survival.
Conclusion: Our data suggest that analysis of apoptosis in PBL by Annexin-V-binding and Fas-expression but not conventional surrogate markers of
HIV-progression can be used as predictive markers for immediate disease-free
survival.
60394 Disease stage distribution among HIV-infected adults in
care with indications for antiretroviral (ARV) therapy:
Results from a representative US sample
Allen L. Gifford12, S.A. Bozzette1, B.J. Turner2, C.M. Winslow1, C. Nelson3,
M. Shapiro4, J.A. McCutchan1. ' SDVAMC and Univ of California, 3350 La Jolla

Village Drive MC 11 1N- 1, San Diego, CA; 2 Thomas Jefferson University,
Philadelphia, PA; 3HCSUS Community Advisory Board, Washington, DC; 4 Univ
of California, Los Angeles, LA, CA, USA
Objective: US guidelines recommend ARV drugs for all immune-impaired or
symptomatic HIV+ patients (Panel on Clinical Practices, DHHS), but non-AIDS
patients may lack health insurance due to low income and restrictive federal

Medicaid eligibility rules. We therefore estimated the proportion of patients with
AIDS among all HIV+ adults in clinical care in the US with ARV indications.
Methods: A nationally representative probability sample of all HIV+ adults
in care had detailed structured interviews asking lab values, HIV/AIDS diagnoses, and sociodemographic variables. We used preliminary weights to adjust
for sampling, multiplicity, and nonresponse, and linearization methods to correct for weights and multistage sample design. From the final sample of 2865
respondents, we report on 2825 subjects with ARV indications (AIDS, and/or
immune-impaired [CD4 200-499], and/or symptoms [thrush, fevers]). Subjects
were classified by Centers for Disease Control criteria [MMWR 1992; 41 (RR-17)].
Results: Among all US patients in care with ARV indications, 59% have AIDS
(>1 opportunistic complication and/or CD4 < 200). The proportion with AIDS
differs substantially between patient sub-groups (table).
ARVs indicated (N = 2825) AIDS No AIDS P
White 61% 39%.05
Non-White 56% 44%
Male 62% 38%.0001
Female 47% 53%
MSM 60% 40%.001
IVDU 64% 36%
Heterosexual 47% 53%
Health Insured 62% 38%.0001
Uninsured 45% 55%
MSM = men who have sex with men; IVDU = intravenous drug use; x2 test
Conclusions: Nearly half of patients in care with indications for ARV therapy do
not have AIDS, and these patients are far less likely to have any health insurance
to pay for needed ARV drugs. Vulnerable groups are particularly affected: heterosexually-infected women are much less likely and minority patients are somewhat
less likely to have AIDS, and thus they face restrictive federal Medicaid rules and
must seek local state or other special programs (ADAP) to access ARV drugs
recommended under federally-sponsored guidelines.
60395 Comparison of treatment for the HIV patient with double
therapy vs. triple therapy
Martinez Marisol1, Antonio Marques2, Jennifer Valdes2, Jorge Santana2. Ave
Fernandez Juncos Stop 19 #1306, Santure, Puerto Rico; 2San Juan AIDS
Program, Santure, PR, USA
Objectives: To compare the cost-effectiveness and duration of double antiretroviral therapy with nucleoside analogs vs triple antiretroviral therapy with Proteaseinhibitors in a hispanic community.
Design: Prospective, controlled study.
Methods: Adults hispanic patients from the San Juan AIDS program with confirmed HIV were evaluated viral load, CD4; prior to starting then on double therapy
(naive patients). Patients were started on double therapy at viral loads levels (q
PCR-RNA) and separated in three groups viral load >35,000 copies, viral load of
10,000 to 34,999 copies and viral load of <10,000 copies to determine duration
of of response, tolerance, morbidity, cost and effectiveness of therapy. A second
group was selected to be started on triple therapy (one protease inhibitor) and
were separated in the three groups based on viral load as stated before and
evaluated for the same parameters.
Results: Preliminary results showed that of 80 cases evaluated 46% were on
double therapy for an average period of 10 months and 54% were on triple therapy
for an average period of therapy of 10 months. Both groups were comparable in
terms of duration of effect reduction in percentage of viral load;a significant difference was observed in terms of cost as expected, adverse effects and adherence
to therapy.
Conclusions: Double therapy appears to be an effective, alternative and more
cost-effectiveness even with viral loads 35,000 copies in a naive patient. Protease
inhibitors should be used stepwise in patients with failure to double therapy, and
good adherence. In areas where accesibility to PI is limited these issues should
be considered and extensively evaluated.
| 60396 Premalignant cervical lesions (PCL) in HIV+ women in a
colposcopy clinic in Guadalajara, Mexico
Mario Guerrero1, Angel Suarez2, J.C. Sanchez2, I.L. Arevalo2, H.F. Montoya2,
E.V. Vasquez2, M.R. Ramirez2. tHarbor-UCLA Medical Center, 1124 W Carson
St., N-24, Torrance, CA, USA; 2 Instituto Mexicano Del Seguro Social,
Guadalajara, JA, Mexico
Background: Cervical-uterine Cancer (CU Ca) is a leading cause of death in
women in Mexico. More than 90% of the cases have been related to human
papilloma virus (HPV) infection, presumably sexually transmitted. Among newly
diagnosed women in Mexico, 64% have contracted HIV sexually.
Objectives: To assess PCL and HPV in biopsies taken in HIV+ women at the
Centro Medico Nacional de Occidente colposcopy clinic.

Methods: A prospective study of sequentially encountered HIV+ women with
no known cervical disease. A detailed history including risk factors was followed
by colposcopy, cervical cytology and biopsy. DNA was extracted from fresh tissue,
and amplified by PCR with primers for HPV 16 and 18.
Results: Of 14 patients studied thus far, 7/14 (50%), had cervical cytology
performed in the previous year. Only 8 of the 14 had risk factors associated with
CU Ca (multiple partners, early onset of sexual activity). In 7, cervical intraepithe