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

1078 Abstracts 60425-60429

12th World AIDS Conference

the social security benefits related to the concept social psycho-medico support
(SPMS). We have a project of training a medical staff and paramedical staff for
clinic follow up and other sub-branches in other prefectures. To create an APMS
team and to train the staff and the leader of activities of the NGO's in IEC. To train
managers of NGO's. To train the persons intrested in the psycho-social follow up.
To provide them with an SOS service. To promote generating income associations
for AIDS-positive individuals.
Results: A SPMS core and a polyvalent center were created. Three (3) subbranches of SPMS in other prefectures were created. Ten (10) services put at the
disposal of the public and AIDS-positive individuals in the center (training, documentation, accompaniment, coffee-shop, cumpter literacy, games, film projection,
etc...).
Lessons Learned: The creation of Al -NADJMA center is a successful strategy.
In fact, a great number of young people were sensibilized and trained through the
center. Moreover the whole medical staff and other interessed individual received
appropriate training. AIDS positive individuals without possibility of stigmatization
and reject got social security benefits they needed.
60425 Identification of human immunodeficiency virus type 1
env subtypes B and A in French West Indies
Marlene Ouka1, E. Menu2, F. Barin3, O. Bera1, G. Sobesky4, F. Barre-Sinoussi2,
R. Cesaire1. 1ETS Hopital Pirre Zobda-Quitman BP 632, Fort de France Cedex,
Martinique; 2lnstitut Pasteur, Paris; 3CNRS EP Tours; 4CISIH-CHU, Fort de
France, France
Objectives: The caribbean basin is severely affected by the HIV pandemic, and
in Martinique, a French West Indies Island, AIDS is a growing public health
problem. It was very important to know what HIV-1 subtypes circulated.
Methods: Adult subjects positive for HIV-1 antibodies with available routes
of infection, tested at the Blood Center of Fort de France, were studied. The
serotype was investigated by a subtype-specific EIA (HIV-1 SSEIA), detecting
antibodies to V3 for subtypes A to E in positive sera. Nested-PCR was performed
in DNA extracted directly from patient PBMC, using oligonucleotides based HIV-1
env fragments (V3-V5, 0.7 Kb) and the genotype has been determined by the
HMA, two standards reference plasmids containing the env region of each HIV-1
subtypes A to E have been used (Transgene, Strasbourg, France). The sequence
will be realised to confirm the subtypes.
Results: 26 positive subjects (19 men and 7 women) were analysed. 23 individuals were infected by sexual intercourse (10 heterosexual, 8 homosexual,
5 bisexual), 2 by intravenous drug use, and 1 by transfusion before 1985. 24
reacted with V3 subtype-peptide B and 2 with subtype-peptide C. 9 genotypes
were realised by HMA. The 2 samples who have serotype C have formed heteroduplexes with the subtype A references indicating that they belong to subtype
A, the others were subtypes B. The HIV-1 subtype A infections have been found
in 2 men diagnosed in Martinique (one in 1991, contained through heterosexual
contact, the other, homosexual, in 1990).
Conclusion: This work shows the high predominance of HIV-1 subtype B in
Martinique, and reveals the minor presence of HIV-1 subtype A for 1990.
604261 Media and communication - Specific populations
Christopher Mumba. Communications Network on AIDS, Law and Ethics
(CONAIDS), PO. Box 30125, Lusaka, Zambia
Issues: Professionals living infected with HIV/AIDS in developing countries ultimately need legal protection to make their serostatus known to the public.
Project: A thoroughly researched survey in volving confidential personal interviews with a dozen of specialised personnel who are HIV-positive in Zambia
revealed fear, suicidal, anger, desperation, an xiety, and neglect as well as
carelessness among professionals serving in areas such as Journalism, Law,
Secretarial and Teaching who have only been open to their Counsellors but some
have hidden their seropositivity condition to their spouses and sexual partners.
Among the people interviewed were three Zambian Journalists who were sent
back from Canada in September 1997 after they tested HIV positive upon arrival,
Counselling and peer education against professionals who are HIV positive by
counsellors and educators who are also living infected wi th the virus provides
opportunity for the former to be open about their serostatus and live positively
with HIV infection.
60427 Antiviral benefits of compassionate release nelfinavir
Mark Nelson, A. Shave, C. Richardson, L. Catterall, B.G. Gazzard. Chelsea and
Westminster Hospital 369 Fulham Road London, UK
Aim: To describe the antiviral benefits of nelfinavir (N), when used in a compassionate release programme.
Methods: Retrospective case notes/computer record review.
Results: During the study period, 114 individuals were prescribed N, 2 were
voyagers, two never started the drug and 5 were given N to replace other an
tivirals, whilst viral load (VL) was undetectable. Of the others - 11 were antiviral
naive (AVN), 21 protease naive (PN), 37 had only received saquinavir (S) and 36
other proteases (ritonavir or indinavir (R/l)).
Results at 3 months are presented in the table. Patients responding to nelfinavir
in the S subset, were more likely to have received S for < 1 year and have a
VL < 10,000 than those who failed to respond. Those patients responding to
N with VL < 200 post R/I stopped R/I due to intolerance (5) rather than viro
CD4
VL/log
200
< 1000
Diarrhoea

AVN
+115
+5
-2.94
62.5%
62.5%
55%

PN S RI

+85
+5
2.04
37.5%
81%
33%

+36
NIL
-1.13
39%
46%
30%

+3
NIL
-0.83
26%
30%
36%

logical failure, or added multiple drugs, to which they were naive, to their new
regime.
Conclusion: 1. Antiviral benefit of N is best seen in protease naive patients.
2. Antiviral benefit may be possible post-S failure especially in individuals who
switch early. 3. Antiviral benefit unlikely in patients post R/l, unless patients stop
because of intolerance. 4. Diarrhoea is a common side effect - but is easily
controlled with very few patients stopping because of this side-effect. 5. Nelfinavir
is an effective protease as 1st choice with other data suggesting one may be able
to sequence from. Use of nelfinavir, post-failure of other proteases is relatively
ineffective.
604281 Attempt at maximally suppressive anti-HIV therapy
Jan M. Prins1, S. Jurriaans2, M.T.L. Roos3, H. Schuitemaker3, D.M. Burger4,
F. De Wolf2, J.M.A. Lange5. 1Academic Medical Center F4-221, Meibergdreef 9
1105AZ Amsterdam; 2Dpt Human Retrovirology, Amsterdam; 3Central
Laboratory Neth Red Cross Blood, Amsterdam; 4Dpt. Clinical Pharmacy
University Hospital, Nymegen; 5Dpt. Internal Medicine Ac Medical Center,
Netherlands
Background: Differential cellular phosphorylation of nucleoside analogues and
suboptimal tissue penetration of a triple antiretroviral combination may result
in incomplete drug pressure at the level of every infected cell. We are studying a five-drug-regimen with favourable phosphorylation and tissue penetration
characteristics.
Study Design: Patients who have not been previously treated with any of the
study drugs are eligible. Treatment consists of AZT 2 x 300 mg, 3TC 2 x 150 mg,
abacavir 2 x 300 mg, indinavir 3 x 1000 mg, and nevirapine 1 x 400 mg. Patients
are followed at regular intervals with extensive blood and tissue sampling.
Results: At the 1st February 1998, 13 patients have been enrolled, with a median follow-up of 31 (range 3-45) weeks. 11 patients had chronic HIV infection,
two had acute HIV infection. 3 patients developed hypersensitivity for abacavir.
In two of them hydroxyurea was substituted for abacavir, the other patient left
the study. Nausea necessitated the replacement of AZT by d4T in 3 patients.
As reported, viral load decline was significantly more rapid as compared to triple
therapy. In patients with acute HIV infection, the viral load decline appeared to
be slower. Suboptimal drug compliance due to side effects resulted in temporary
detection of HIV-RNA in 3 patients. A maximally 2.0 loglo decrease in HIV-RNA
was found in lymph nodes after 8 weeks of therapy. In one patient no virus could
be cultured from PBMCs at week 34 (clonal isolation under limiting dilution).
In three patients, positive cultures were obtained after 24 weeks. CD4+ counts
increased from a median value of 0.40 (range 0.03-0.68) < x 109/1 at study entry
to 0.58 (range 0.22-0.78) x 109/1 at week 24. After 8 weeks of therapy indinavir
trough levels dropped to <0.10 mg/I in 7 out of 10 patients. Adding ritonavir 2
x 100 mg resulted in a substantial increase in indinavir trough levels (mean 2.3
mg/I).
Conclusions: Using five-drug combination therapy the initial viral decline was
significantly more rapid, but side effects were more pronounced as compared to
triple therapy. HIV-RNA in lymph nodes dropped maximally 2.0 loglo in 8 weeks.
Suboptimal compliance due to side effects resulted in temporary detection of
HIV-RNA in some patients. Indinavir trough levels often dropped to suboptimal
levels during therapy, possibly due to enhanced clearance caused by nevirapine.
Adding low-dose ritonavir improved the indinavir trough levels.
60429 Micronutrient profiles and HIV
Marie-Christine Rousseau, C.M. Molines, O.S. Ould Metidji, J.M. Moreau. 50 BD
Sicard, 13008 Marseille, France
Objectives: To assess micronutrient variations in HIV/AIDS patients.
Methods: We studied 5 of the principal micronutrients (selenium (se), zinc (zn),
copper, iron and prealbumin) in 44 HIV-1 seropositive men and women. Patients
were divided in two groups: patients with a CD4 count <250/mm3 and patients
with a CD4 count >250/mm3. The mean differences between groups were assessed by analysis of variance and differences in the frequency of micronutrient
deficiency were determined by chi-square analysis.
Results: Ages ranged from 24 to 75 years old with a mean of 34 years, 34
(77%) of the patients were intraveinous drug users, 35 (80%) were receiving antiretroviral therapy, none had protease inhibitor. 34 (77%) patients had low plasma
se values, 11 (25%) had low plasma zn values, 7 (19%) had an iron deficiency and
17 (38%) had low prealbumin values whereas copper was elevated in 11 (25%)
of the patients. A comparaison of the patients in the group with advanced disease
(CD4 count <250/mm3) with the other group revealed significantly lower levels of
plasma se concentrations (p < 0.05), whereas no significant difference was noted
for zn, copper, iron or prealbumin between the 2 groups. In women advanced
disease group (CD4 < 250/mm3), zn was significantly lower than in men (P <
0.05). On the contrary se plasma concentrations were significantly lower in men
with CD4 count <250/mm3 than in women with CD4 count <250/mm3 (P < 0.05).