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

12th World AIDS Conference

Abstracts 60397-60401 1073

lial lesions were confirmed by microscopic cytology, 4 were high grade. HPV 18
DNA was found in only one biopsy in a subject without cytologic lesions, HPV 16
was not found. Only 2 patients had CD4 counts < 200/mm3 and neither of these
subjects had cytologic lesions.
Conclusions: Among HIV+ Mexican women the presence of risk factors for
CU CA was high (57%) as was the presence of cervical intraepithelial lesions
(50%). These lesions occurred in subjects with CD4 cell counts -200 and in the
absence of HPV 16 and 18.
60397 A randomized study of nucleoside regimens in
antiretroviral (ARV)-naive patients with CD4 counts of
20-300/mm3
Gildon Beall, M. Torno, P. Miller, S. Kruger. Harbor-UCLA Medical Center, Box
449 1000, W Carson St., Torrance, CA, USA
Objectives: To compare HIV RNA and CD4 responses and toxicity profiles in
three treatment arms in a 24 week open-label randomized study.
Methods: Of 29 patients enrolled, 9 were randomized to AZT/3TC, 10 to
D4T/3TC and 10 to DDI/3TC/D4T. HIV RNA was assayed by PCR with a lower
limit of detectability of 100 copies/ml. The three groups were comparable in terms
of CD4 (means 171, 108 & 152), HIV RNA (loglo means 4.7, 5.2 & 4.8), age (44,
38 & 36), and race. Two were female and 10% were intravenous drug users.
Results: After 12 weeks, the one-way analysis of variance of the computed
area under the curve (AUC) of change in HIV RNA and CD4 number and percent
failed to discern significant differences among the three treatments although in
17, HIV RNA fell more than 1.0 loglo in the first 4 weeks. HIV RNA was undetectable during 10 of 37 treatment-months (TM) of D4T/DDI/3TC (3 of 9 subjects);
compared to 0 undetectable out of 37 TM of D4T/3TC and 2 of 30 TM of AZT/3TC
(1 of 6 subjects). Clinician judgement required modification of ARV therapy before
week 12 in 40% of the patients on D4T/3TC but none of the subjects in the other
arms. Parameters of toxicity did not differ among the three arms.
Conclusions: Although there were no statistically significant differences between DDI/3TC/D4T, D4T/3TC and AZT/3TC in terms of AUC of viral load
decrease and CD4 count increase at 12 weeks, more subjects in the triple
nucleoside arm had undetectable HIV RNA (- 100 copies/ml).
S60398 Nutritional assessment of an HIV infected child in the
United States
Pamela Rothpletz-Puglia2, J. Oleske2, M. Boland', J. Banyai', D. D'Orlando1,
A. Dieudonne2. 1FXB, Center for Children, UMDNJ, 2UMD, New Jersey Medical
School, 185 South Orange Avenue, Newark, NJ, USA
Issues: To determine whether a well-nourished, relatively healthy (CDC classification: B1), HIV infected child would benefit from preventive nutritional education.
Project: To evaluate a HIV infected child's diet by accompanying the caretaker
to the grocery market to observe her food shopping patterns for a month, and to
evaluate the child's diet at the beginning and the end of the month.
Results: This caretaker, a blind and elderly woman, spent 65% of her monthly
income on food to feed a family of 3. Sixty percent of the monthly food budget
was spent on red meat, and the remainder was spent on foods such as cornmeal,
flour, milk, rice, cereal, peanut butter, grape juice, and white bread. No fruits and
vegetables were purchased aside from a 25 lb. bag of potatoes and 4 cans of
string beans. Closer scrutiny of the HIV infected child's diet just after the monthly
food supply was purchased and at the end of the month revealed the following:
The first 24 hr. recall was adequate in calories, protein, and met 100% of the US
Recommended Daily Allowance (RDA) for vitamins and minerals. However, the
second 24 hr. recall at the end if the month when less food was in the home, was
sufficient in calories and protein, but deficient in Vitamin A, Thiamin, Riboflavin,
Pyridoxine, Vitamin D, Vitamin K, Iron, phosphorous, Calcium, and Zinc. Therefore, an HIV infected child who appears well nourished may be consuming a diet
deficient in vitamins and minerals
Lessons Learned: 1) nutrient deficiencies may be prevalent even in an industrialized country such as the US, 2) families with a largely meat-based diet
may save money and increase the nutrient density of their diet by consuming a
more plant-based diet, 3) fortified cereal at the beginning of the month clearly
benefitted this child's nutrient intake, 4) HIV infected children may benefit from a
routine complete multi-vitamin with mineral supplementation.
| 60399 | Nutricional status in hospitalized patients with HIV
infection
Jesus Santos1, R. Palacios2, C. Romero2, R. Soriano2, A. Esteve2, A. Rivero2,
M. Marquez2. c/Anea; 22 Puerto de la Torre Malaga 29190; 2Hospital
Universitario De Malaga, Malaga, Spain
Objective: To describe nutricional status and to determine the correlation between
nutricional parameters and CD4 cells.
Methods: We prospectvely performed a cross-sectional study of consecutive

hospitalized patients in the Unit of Infectious Diseasesof our hospital from 05/96 to
09/96, accomplished through the epidemiological data withdrawal, analytical, clinical and anthropometric measurements: weight, height, triceps skinfold, midarm
circumference, midarm muscle circunference (MAMC), midarm muscle aerea
(MAMA), fat aereas (MAFA) and body mass index (BMI) being compared with the
reference standards (Med Clin 1988;91:223-236). For the statistic calculation the
RSIGMA" program for PC was used.

Results: We studied 100 patients, 79 were male and 21 female, mean age
33.2 + 8.2 years (21-63) and 82 had been diagnosed of AIDS previously. Risk
practices for HIV: 74 drug addicts (DA), 14 homosexuality (HMX), and 12 heterosexual. Customary use of heroin in 38 patients. The median of CD4 cells was 55
x 106/1 (mean 127.5; 1-830). The most frequent motives of hospitalization were
the opportunistic infections (49%). Nutricional status: 6% normal, 65% caloric
malnutrition (moderate-severe 81%), 23% mixed (moderate-severe 69%) and 6%
protein malnutrition. The CD4 were lower in the patients with protein or mixed
malnutrition than in the other (x 149.1 vs 74.5; p - 0.05). BMI waslower than 20
in half of the patients (x 19.8 + 2.8). BMI was inferior in the DA than in HMX
patients (x 21.3 vs 19.3; ANOVA p - 0.05), in customary users of heroin (x 20.5
vs 18.5; p - 0.001), in the patients with advenced HIV disease (CD4 < 50, x
20.4 vs 18.3; p - 0.05), and with lower levels of hemoglobin (. 10.5 g/l; x 20.2
vs. 19.1; p - 0.05). MAMC was the anthropometric parameter that greater linear
correlation presented with the CD4 cells.
Conclusions: 1.- The majority of the hospitalized patients with HIV infection
had already been diagnosed of AIDS case, they suffered from very advanced
disease and malnutrition was customary. Emphasize that almost a third of the
patients presented some degree of protein malnutrition. 2.-Protein and mixed
malnutrition werewell related to a smaller number of CD4 cells. 3.- The malnutrition, valued with the BMI, was greater in patients that acquired the infection by
DA, in customary users of heroin, in patients with advenced HIV disease and in
patients with anemia.
60400 Temporal trends in diagnoses of homosexually-acquired
HIV infection: Aquitaine (France), 1985-1997
Catherine Marimoutou', E. Bouzigon', P. Morlat2, P. Mercie2, D. Malvy2,
F. Dabis', I. Gecsa'. CISIH-INSERM U. 330, 146 rue Leo Saignat 33076
Bordeaux; 2Bordeaux University Hospital, Bordeaux, France
Objective: To describe temporal evolution of new diagnoses of HIV infection
in male homosexuals reported in a hospital-based information system on HIV
infection (GECSA).
Methods: Since 1987, the GECSA surveillance system includes all HIV-1 infected adult in-patients or out-patients of the Bordeaux University Hospital and
four other public hospitals of Aquitaine (Southwestern France). It account for 85%
of HIV positive patients diagnosed in Aquitaine. Temporal trends were studied on
annual diagnoses, observed and estimated after back calculation.
Results: As of June 30th, 1997, 4971 cases had been reported: 1792 of the
3724 males were homosexuals. Among men, the part of homosexuals in annual
diagnoses increased between 1985 (37%) and 1989 (52%), was stable until 1994
and increased again since 1995 (60%). The absolute number of new diagnoses
observed in homosexual males decreased however from 175 in 1987 to 88 in
1996. During the same period, there was a sharp decrease of new cases among
intravenous drug users (190 to 18 per year) and an increase in heterosexual
cases. Median delay between serodiagnosis and hospital first contact was 122
days (interquartile range: 13-1060) in homosexuals, 163 days for the others.
When correcting for reporting delay, there was no decrease in the absolute number of diagnoses in homosexuals (around 150 to 170 per year). In recent years
(1995-1997), a preceeding seronegative test before HIV diagnosis was reported
by 43% of homosexual males compared to 23% in the others.
Conclusion: We do not expect any decrease neither in the absolute number
nor in the proportion of annual diagnoses in homosexuals. This suggests a weakness in prevention practices in this population even if a subgroup self-perceives
at risk and repeats HIV tests over time.
S60401 A tiered coordination mechanism for STI control and
prevention
Jaak Labeeuw', R.O. Muga2, R. Poulussen', M. Kahindo2. 1Belgian
Development Corporation, Afya House, STD Extension, Cathedral Rd., Po Box
20781, Nairobi; 2Ministry of Health-Kenya, Kisumo, Kenya
Issue: An appropriate tiered coordination and supervision structure is required
for the integration of STI control and prevention interventions within the national
primary health care services.
Project: During the first years of the AIDS epidemic in Kenya, interventions
were limited in scope and coverage. These interventions were often planned
and implemented vertically and from the central level as districts lacked capacity. The health sector reforms address these issues through decentralization to
districts with support from the province. A demonstration project to offer supportive services to the districts through capacity building at provincial level was
therefore formulated using a participatory approach. In the project area, several
districts have the same ethnographic and cultural patterns making the province
the obvious choice for planning and implementation of information, education and
communication (IEC) strategies.
Results: A focal point has been added to the provincial health management
team (PHMT) and the PHMT members have been trained to facilitate interventions. Supervision and coordination has to a large extent been relegated to

the province. A comprehensive multi-media provincial IEC campaign has been
launched.
Lessons Learned: A tiered structure for the training, coordination and supervision of STI control and care is necessary and possible to ensure nationwide
coverage. A joint planning with involvement of the relevant stakeholders, appropriate financial and human resource allocation at the different levels, and a careful
delineation of tasks, responsibilities and authority is necessary to this effect.