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

1090 Abstracts 60487-60491

12th World AIDS Conference

tion Health framework for community -based initiatives. Issues of power, control,
determinants of health, population -wide versus population -specific initiatives,
policy and evidence-based evaluation are being addressed. This initiative includes community workshops and consensus building among government and
non-government players.
Results: A smooth transition to incorporate Population Health concepts and
strategies in community- based programming into the existing Health Promotion
practices will require education strategies for the community and skills building in
areas of broadening programming to capture populations outside of HIV/AIDS, but
who are affected by similar determinants of health, evaluation and multi-sectoral
partnership development.
Lessons learned: Population Health concepts and strategies do not always
positively amend themselves to HIV/AIDS programming. However, focusing on
moving outside of the traditional health domain to address and influence determinants of health and risk behaviour and credible evaluative work are positive steps
towards maximizing resource utilization in the face of cost containment and finite
community - based funding.

S60487

Effect on virological and immunological parameters of
concomitant antiretroviral therapy and antineoplastic
chemotherapy (CT) in AIDS-related non-Hodgkin's
lymphoma patients (AIDS-NHL pts)

Marina Giuliano', Roberta Gastaldi2, G. Giannini1, I. Cordone2, G. Gentile2,
P. Del Bianco2, M.F. Pirillo', S. Vellas. 'l stituto Superiore Di Sanita'-Lab.
Virology Viale Regina Elena, 299-00161 Rome; 2Department of Cellular
Biotechnology and Hematology Rome, Italy
Objective: To evaluate the virological and immunological effects of the administration of antiretroviral therapy during antineoplastic chemotherapy in AIDS-NHL
pts.
Methods: Out of 6 consecutive AIDS-NHL Pts, 5 diffuse large cell B phenotype and 1 anaplastic CD30+/CD20+ lymphomas, 3 patients received CIOD
(Cyclophosphamide, Idarubicin, Vincristine, Desametasone) regime with G-CSF
(Group A) and the other 3 received the same regimen associated with combination antiretroviral therapy with stavudine (d4T) and didanosine (ddl) (Group B).
Plasma viral load and immunological parameters were evaluated at these time
points: before the start of therapy, after the third cycle and one month after the
end of CT.
Results: At NHL diagnosis, the two groups of patients (A vs B) were similar
for age, sex, NHL stage, immunological parameters and viral load (5.5 ~ 0.45 vs
4.1 ~ 0.8 logs: p = 0.09). At NHL diagnosis, two Pts in group A were CDC stage
B3 and one was in stage B2 while in group B one was CDC stage B3 and two
were stage C3. A significant difference between the two groups of patients (A vs
B) was found after the third cycle of CT of the following parameters: viral load
(5..9 + 0.3 vs 3.3 ~ 0.78 logs, p = 0.005) and mean absolute cell counts/mm3
of lymphocytes (166 ~ 57 vs 1000 ~ 100, p = 0.001), of CD3+ (116 ~ 72 vs
712 ~ 119, p = 0.005), of CD3+/CD4+ (27 ~ 32 vs 133 ~ 41, p = 0.02) and of
CD3+/CD8+ (70 ~ 41 vs 412 - 124, p = 0.04). Out of these parameters, only
viral load remained significantly different one month after the end of CT (5.6 ~
0.6 vs 3.1 ~ 0.9 logs, p = 0.032). Opportunistic infections occurred in two patients
in group A and in one patient in group B.
Conclusions: This study showed that the use of combined d4T and ddl therapy
during CT is well tolerated, improves immunological parameters and determines a
decrease of viral load in AIDS- NHL Pts. However, a larger number of AIDS-NHL
pts are needed to evaluate the impact of this combined treatment on the frequence
of opportunistic infections during CT.
60488 Plasma levels of proinflammatory cytokines after
pneumococcal immunization in HIV-1 infected patients
Hernan Valdez1, B.E. Sha2, A.L. Landay2, I. Valerio3, S.J. Purvis3, R. Asaad3,
M.M. Lederman3. 12061 Cornell Rd, Room 301 B, Cleveland, Ohio 44106;
2Rush-Presbyterian-St. Lukes Medical Ctr, Chicago IL; 3Case Western Reserve
University, Cleveland OH, USA
Pneumococcal immunization can cause rises in plasma HIV-1 RNA levels.
Proinflammatory cytokines can activate HIV-1 expression.
Objective: to ascertain if pneumococcal immunization is associated with rises
in plasma levels of proinflammatory cytokines in HIV-1 infected patients.
Design: plasma levels of tumor necrosis factor a (TNF-a) and interleukin-6
(IL-6) were measured serially in 6 HIV-1 infected patients after receiving pneumococcal vaccine and in 5 unimmunized controls.
Results: patients and controls were clinically stable, had a mean CD4 cell
count of 345, and 9/11 were receiving combination antiretroviral therapy. Plasma
IL-6 levels rose between 2 and 6 hours in immunized patients, but not in controls
(Table). TNF-a levels remained stable in both groups.
Mean serial plasma IL-6 levels in immunized and control patients (pg/mL)

60489 Increases in body cell mass of patients with HIV
associated wasting after treatment with recombinant
human growth hormone
Karlheinz Schmitt-Rau', Jaeger Hans2, L. Weitner3, H. Knechten4, A. Moll5.
'Serono Pharma GMBH, Gutenbergstrasse 5 85716 Unterschleissheim,
Munich; 2KIS Curatorium for ImmunoDeficiency, 80336 Munich; 3 Praxis Dr.
Weitner/Dr. Adam, 20999 Hamburgh; 4PZB, 52062 Aachen; 5Praxis am
Kaiserdamm, 14057 Berlin, Germany
Background: Even with highly active antiretroviral combination therapies
(HAART) a considerable number of patients with HIV-disease still loses weight
and/or body cell mass (BCM) to result in HIV associated wasting. The prevalence
of this condition, which constitutes a negative prognostic factor for survival, is still
estimated at 15-25%. Recently it could be demonstrated that by administering
recombinant human growth hormone [(rhGH(m)], Serostim'" in patients with HIV
associated wasting losses of lean body mass (LBM) and body cell mass (BCM)
could be reversed, resulting in a significant increase of physical function and
improvement of quality of life.
Objective of our study was to investigate the effect of [rhGH(m)] on BCM in
patients with HIV associated wasting despite HAART.
Methods: 30 HIV-infected patients were enrolled to receive s.c. 6 mg daily mammalian cell derived recombinant human growth hormone [rhGH(m)], Serostim',
ARES Serono, for 12 weeks. Patients had to show weight loss of a minimum of
5% in one year or weight less than 90% of the lower limit of ideal body weight.
Primary objective was the change relative to baseline in BCM determined by Bio
Impedance Analysis (BIA) during treatment and 2 months after end of treatment.
Results: 15 patients have completed the study up to now. There were no drop
outs so far. BCM as measured by BIA was significantly increased in these patients
(2.0 ~ 3.0) compared to baseline.
Increases in BCM could be sustained in most patients after discontinuation of
Serostim'" administration, showing that chronic treatment might not be necessary
in many cases.
Moreover, Serostim" was well tolerated during the 12 weeks treatment course.
Conclusions: Our results show that [rhGH(m)] (Serostim'") is an efficient treatment of AIDS Wasting Syndrome due to its ability to increase body cell mass,
which constitutes the metabolically active compartment of the human body.
Our preliminary results suggest, that patients are able to maintain their gains in
BCM beyond 12 weeks treatment. If confirmed, this would support earlier findings,
that Serostim'" is an acute intervention rather than a chronic therapy.
604901 Medication adherence issues in patients requiring
inpatient HIV care
Jack W. Ross1, S. Buckley2, J.A. Rancourt1. 'Hartford Hospital, 80 Seymour
Street, Hartford CT 06102-5037; 2Fairfield University, Fairfield CT USA
Objectives: To assess medication adherence in HIV positive patients admitted
to the inpatient HIV unit of a large urban hospital, to identify factors associated
with nonadherence, and to quantify costs and pill burden in this cohort.
Design: Prospective inpatient interview and retrospective outpatient chart review
Methods: All admissions to the inpatient HIV unit of a 800 bed urban hospital
over a 33 day period in 1996 were evaluated for medication adherence. Patient interviews were conducted and a compliance score assigned. Visiting nurse
reports, outpatient progress notes, and scheduling logs were reviewed. Costs
and pill burden per week were determined. Residential setting, HIV risk factors,
primary language, interpreter use, sex, age, ethic origin, reimbursement source,
and immunologic status were recorded.
Results: Twenty-three patients were enrolled with the following characteristics:
12 male, 11 females; mean age 42 years; mean CD4 62 cells; 12 with Spanish
primary language; 20 public assistance; and 13 intravenous drug use (IDU), 10
sexual acquisition. Adherence was poor in 14/23, fair in 4/23 and good in 5/23.
Medication costs were $169/week, and pill burden 50 pills/week (range 7-108
pills per week).
Conclusions: The majority of patients requiring inpatient care reported poor
medication adherence. Potential contributors included use of interpreters, homelessness, solitary lifestyle, and active IDU. Tools to foster adherence in these
populations need to be developed.
604~91 Gay Men's Task Force: A peer-led, community-level
intervention in Glasgow, Scotland
Paul Flowers, G.J. Hart, J. Frankis. MRC Medical Sociology Unit, University of
Glasgow, 6 Lilybank Gardens, G 128RZ, Glasgow, Scotland
Issue: Gay men in Scotland continue to report HIV risk-related behaviour. We
report on an evidence based, culturally appropriate project attempting to increase
the sexual health of gay men.

Immunized 0
Yes
No
p value = 0.02 by
Conclusion:
of IL-6. This rise
pneumococcal i

Project: A novel multi-agency intervention incorporating peer education, a free
hours 2 hours 4 hours 6 hours 8 hours 24 hours sexual health telephone line, and a genito-urinary medicine (GUM) project (based
2.9 2.9 4.5 6.3* 6.9 1.9 within a Gay and Lesbian community centre) has been established in Glasgow
5.6 5.3 5.1 5.9 6.4 5.9 city centre. Researchers have worked in close partnership with community organpaired t-test on hour 6 vs. hour 0. isations incorporating a variety of research methods to help design, monitor and
evaluate the initiative (i.e. large scale surveys, in-depth interviews, focus groups,
Pneumococcal immunization induces increases in plasma levels diaries, participant observation)
Smay contribute to the rises in plasma HIV-RNA levels seen after Results: In the first three months of the intervention, a total of 277 men have
mmunization. been contacted by peer educators within the gay bars of Glasgow. 104 men