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

12th World AIDS Conference

Abstracts 60408-60412 1075

60408 Race, HIV symptoms, recovery from drug abuse, and
appointment adherence are associated with quality of life
(QOL) among HIV infected women
Dennis Israelski1, R. Eversley2, S. Janjua1, S. Smith3. 1San Mateo County AIDS
Project/Stanford University 3700 Edison Street, San Mateo California, 94403;
2University of California - San Francisco CA; 3AIDS Community Research
Consortium Redwood City CA, USA
Background: Women with HIV may have demographic and psychosocial factors
which impact their QOL. We examined this relationship in a study that examined
barriers to medical care.
Methods: Demographic, psychosocial factors, and QOL data were obtained
from 41 participants enrolled in a prospective cohort study examining barriers to
care for HIV-infected women. QOL was assessed by the AIDS Short Form of
the Medical Outcomes Study. Significance was determined through ANOUA and
regression tests.
Results: Mean age was 39.6 years (26-65). 28 (68%) were African-American,
11 (27%) were Caucasian, 2 (6%) were other ethnicities. Mean monthly income
was $749 ($299-2000). 34 (84%) had history of chemical dependency; 22 (54%)
reported abstinence from illicit drugs (3-96 months). Among QOL subscales, age
was associated with decreased QOL in Pain (p - 0.01), Cognitive Function (p
0.01), and Health Distress (p < 0.01). Total number of HIV symptoms was
associated with decreased QOL in Role Function (p - 0.01), Health Distress (p =
0.05), Health Transition (p = 0.01) and Mental Health (p = 0.02). Active drug abuse
(compared to recovery from illicit drugs) was associated with decreased QOL in
Physical Function (p = 0.02). Decreased appointment attendance was associated
with decreased scores in Cognitive Function (p - 0.01). African-Americans had
lower scores in the Quality of Life subscale (p - 0.001).
Conclusions: These data suggest that recovery from chemical dependency
is positively correlated with QOL. Appointment adherence and race are also
important characteristics associated with overall morbidity in low income women
with HIV infection.
60409 Health issues and care needs of HIV infected persons in
France: Results of a 1996 survey
Jean-Marc Nadal, F. Bourdillon, B. Haury, S. Courtial-Destembert, G. Antoine.
Ministere De La Sante, 8 Av De Segur, Paris, France
Objectives: Within the framework of health resource planning with regard to
HIV infection, the French Ministry of Health has been making use of a planning
method targeted on the problems and needs of infected persons. Its initial step
consisted of a nationwide survey aimed at assessing qualitatively and quantitatively health problems within the population concerned and determining health
care, psychological and social needs linked to these problems.
Methods: A transversal, multicentric survey of hospital inpatients on a specific
day in September 1996. Medical and psycho-social data were collected for each
patient. On the basis of the probability of any patient being present on the day of
the survey, an extrapolation was done of the number of patients using hospital
care on a national basis.
Results: The survey was carried out in 90 French departments which make
up 95.3% of HIV linked hospital activity in France. The number of patients was
estimated as 73,400 persons with a sex ratio of 2.4. 33% were homosexual, 26%
were intravenous drug-users and 33% were heterosexual. According to the main
CDC-defined stages, the population studied was divided into stage A 45%, stage
B 31%, stage C 23%. Among AIDS cases, homosexual contamination accounted
for 35% of patients, while among symptom-free patients 40% of cases involved
heterosexual contacts. For 27,600 (37.6%) patients, the medical follow up was
provided jointly by hospitals and community-based GPs. The study shows that
there are still needs in the fields of psychological support (7,730 patients) and
social follow-up (2,900 patients).
Conclusion: The characteristics of the patients were in accordance with results
obtained from other national information sources (AIDS reports and patients receiving antiretroviral therapy). Continued nationwide programming should make
it possible to respond to patients requirements as yet unsatisfied.
|60410 An analysis the MOPH operational plan for prevention
and alleviation of HIV/AIDS 1998-2001
Bussaba Tantisak, W. Phoolcharoen. AIDS Division Dept. of CDC Ministry of
Public Health Tivanont Nonthaburi 11000, Thailand
Background: In an effort to improve activities aimed of the prevention and alleviation of HIV/AIDS and related social impact and in support of PWA, it is considered
that the managerial process and mechanism are the key factors for success in
operational plan.
Project: This operational plan include projects and activities in 7 dept. of
MOPH, Thailand. To contributed by MOPH AIDS Committee chaired by the director of CDC dept., secretariat by the director of AIDS division and the members
by coordinators of 7 dept. MOPH.

Results: This operation plan 1998-2001 has developed an 5 programs and 3
projects under a 2 minor plans. 1. Prevention and control HIV/AIDS plan cover
on health promotion in mother and child, social service network, CCC network,
clinical trail network, safety blood supply, counseling network, development of
laboratory, monitoring and evaluation of prevention and alleviation of HIV/AIDS
plan and HIV/AIDS epidemic. This plan be responded by 7 dept. and have
4,618.40 million bath. 2. Prevention and alleviation HIV/AIDS plan cover on social

marketing network, supply condom 100%, strengthen the public health care in
communities, revising and strengthening managerial processes and mechanisms
for dealing with HIV/AIDS and enhancing international co-operation of HIV/AIDS.
This plan is responded by 2 dept. and has 1,061.56 million bath.
Conclusion: This operational plan analysis based on SWOT analysis.
Strengthen: To emphasis is place upon the 5 strategies of National AIDS plan
1997-2001 and include the area, function and participation in each activities.
Weakness: To emphasis is place upon the quantity and unit of target groups but
it is not emphasis the characteristic of target groups. Opportunities: To emphasis
is place upon this plan is the framework of the request budget plan and make
the action plan in each year. Threats: To set up the activities of this plan that is
appropriate to the situation for solve the problems in this present.
60411 Combination of two nucleoside analogues as initial
antiretroviral therapy: A cohort study of 626 patients
(Bordeaux, France, 1992-1997)
Philippe Morlat1, L. Dequae-Merchadou2, F. Dabis2, I. Pellegrin3, D. Neau3,
P. Mercie4, I. Gecsa2. 1Hopital Saint-Andre 1 Rue Jean Burguet 33076
Bordeaux; 2lnserm Unite 330, Bordeaux; 3Hopital Pellegrin, Bordeaux; 4Hopital
Haut-Leveque, Pessac, France
Objectives: To examine trends in clinical and biological HIV disease progression among patients enrolled in the Aquitaine Cohort and who started between
1992 and June 30th 1997 a combination of two nucleoside analogues as initial
antiretroviral regimen.
Design: Prospective cohort study enrolled in the Bordeaux University Hospital
and 3 general hospitals in South-Western France. Information recorded up to
November 1st 1997 were used for analysis.
Results: 626 patients (pts) were included. The two main drug-combinations
used were AZT + DDI (44%) and AZT + DDC (41%). The CDC clinical stages at
entry were A (63%), B (23%) and C (14%). 66% of pts had a CD4' cell count
(CD4+) below 350//1L [group 1 (G1); median CD4~ = 220/1 L] and 33% had CD4+
equal or above 350/, L [group 2 (G2): median CD4+ = 456// L]. Median duration of
follow-up was 14 months in G1 and 9 months in G2. Viral load (VL) was measured
(bDNA) since 1996: initial VL was detectable (>500 copies/mL) in 95% of pts in
both groups (n = 282).
At 1 year, occurrence of a first AIDS event was 3.9% [Gi] and 1.3% [G2],
median CD4+ increase was 107 [G1] and 121//pL [G2]. Median drop of VL after 2
months of treatment was 1.6 loglo copies/mL in both groups. At 6 and 12 months
of follow-up, the probabilities of reducing VL below 500 copies/mL, at least once,
were 53 and 66% [Gi] and 58 and 74% [G2]; they reached 68 and 85% among
G2 pts with initial VL below 30 000 copies/mL. At last follow-up, 28% [ G,] and 7%
[G2] of pts had switched from dual to triple regimen including a protease inhibitor.
Conclusions: In our observational study, double nucleoside analogues regimen showed a patent beneficial impact in HIV infected pts with baseline CD4+
- 350/mL and especially VL < 30 000 copies/mL. This experience leads us to
consider dual therapy as a potent initial treatment in a population with moderately
advanced HIV disease.
S60412 Preliminary molecular evidence for a novel
Mycobacterium causing disseminated infections in Brazil
Beatrice Ninet1, P.G. Bauer2, C.A. Basilio2, C. Metral', B. Hirschel1. 'Hopital
Cantonal Geneve, Rue Micheli du Crest, Geneva, Switzerland; 2Gaffree e Guinle
Hospital Uni-Rio, Rio de Janeiro, RJ, Brazil
Background: M. avium, M. genavense, and M. xenopi together cause -98%
of disseminated infections with mycobacteria other than TB (MOTT), in Western
Europe and North America. Little is known about disseminated MOTT infections
in other parts of the world.
Methods: Paraffin-embedded, formalized autopsy samples of spleen and liver
from a 26 years old white woman with AIDS and presumed TB from Brazil
contained 4+ acid-fast bacteria by microscopic examination. Nucleic acids were
extracted and part of the 16S ribosomal DNA was amplified by PCR and sequenced.
Results: The sequence obtained (position 9 to 200 in E. colil alignment)
spanned the first variable region and was identical in the two samples. It clearly
differed from M. avium (4 nucleotides), M. tuberculosis complex (10 nucleotides),
M. genavense (9 nucleotides) and M. xenopi (15 nucleotides). Comparison with all
published 16S rDNA mycobacterial sequences revealed it to be unique, although
related to M. intracellulare (3 differences).
Conclusion: Sequencing of the 16S rDNA gene is a sensitive and specific
method for determining mycobacterial species in paraffin embedded formalized
autopsy tissues. We obtained a unique, previously unknown sequence from liver
and spleen of a random patient from Brazil. This suggest that species causing
MOTT infection in Brazil could differ from those in the North America and Western
Europe.