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

1092 Abstracts 60498-60502

12th World AIDS Conference

Objective: To study the epidemiology of HIV infection in Asians resident in the
UK
Design: Retrospective case notes review
Methods: HIV positive Asians attending an East London HIV Unit from
1990-1997 were analysed.
Results: 14 men and 2 women of Asian odgin were seen comprising of 2%
of the HIV population. 10 were from the Indian subcontinent (Pakistan-4, India-4,
Bangladesh-I, Sri Lanka-I), 1 from Thailand, 1 from Indonesia, 3 Chinese from
Hong Kong, Taiwan and Malaysia respectively and 1 Indian from Uganda. The
Sd Lankan acquired the infection initially in Zambia. Of the 14 men, 7 were homosexuals and 2 were haemophiliacs. The 2 women acquired the infection from
blood transfusions in Pakistan and Indonesia. There were no injecting drug users.
At presentation, 6 patients had Category A infection, 6 Category B and 4 had
Category C (3 P. carinii pneumonia, 1 toxoplasmosis). 2 patients from Category B
and I from category A subsequently developed AIDS (1PCP, 1 Kaposi's sarcoma,
1 tuberculosis). The mean CD4 cell count was 240 cells/c.mm (range 20-840),
8 had a count of <200 cells/cmm. 11 patients had combination antiretmvirals. 2
patients died, 1 from hepatocellular carcinoma and 1 from late disease.
Conclusion: The Asians in the UK represent a heterogeneous group reflecting
the global epidemic. Whichever route of initial acquisition, widespread travel and
immigration will continue to lead to an increasing number of imported cases.
60498 Parenteral nutrition in AIDS
Sandra Treviho', G. Luna2, L. Nieto2, M. Santoscoy2. 'SUR 99-A #727 Colonia
Sector Popular, ZC:09060 Mexico City; 2Hospital General Gabriel Mancera,
Mexico City, Mexico
Objective: To evaluate the usefulness of total parenteral nutrition (TPN) in patients with AIDS, in terms of mortality and survival compared with a group of
patients without AIDS.
Design: Retroprospective, longitudinal, observational and comparative study.
Methods: We recorded the data of all adult AIDS patients that received TPN
from september '92 to september '97. Demographic data, duration of the TPN and
inhospital mortality were recorded. These data were compared with those from a
group of free-AIDS patients that received TPN simultaneously at our institution.
Survival was evaluated prospectively only for the group of patients with AIDS.
Chi square test was used to compare differences between groups and student's
t test for continuos variables.
Results: Fifty-five patients with AIDS and sixty-eight control patients were
included in the study. The most frequent indication for TPN was chronic diarrhea
in the group of AIDS whereas in the control group pancreatitis was the main
indication. Median age in the AIDS group was 34.2 years (range:27-41) and 61.4
years (range:35-78) in the control group. Eighteen deaths were reported in each
group (AIDS group:30.9% and control group: 26.4%, p > 0.6). Median survival
after hospital discharge was 7.5 months (range: 1-40).
Conclusions: TPN is a useful therapeutic tool in order to increase the survival
of patients with AIDS. Despite of the differences of clinical features between the
study and control groups, there was not statistical differences in mortality.
60499 Patients with cutaneous Kaposi's sarcoma (KS) have
higher viral loads than patients with visceral KS
Leopoldo Nieto1, G. Luna2, S. Treviho2, M. Santoscoy2. 'Campos Eliseos,
#414-A Int 1001 Colonia Lomas De Chapultepec, Mexico City; 2Hospital General
Gabriel Mancera, Mexico City, Mexico
Objective: To compare the viral load between patients with AIDS related-KS,
visceral of cutaneous.
Design: Prospective, observational and comparative study
Methods: Adult patients with AIDS-related KS in whom a viral load test was
performed before starting chemotherapy. Viral load was always performed using
the RT-RNA PCR test. Patients with changes in antiretroviral therapy 4 weeks
prior to the viral load were excluded. Patients were classified into two groups
according to the stage of the tumor: Group A:Visceral involvement, GroupB:
Restricted to skin. We also compared TCD4 cell count. A student's T test was
used to compare differences among groups.
Results: Seventeen patientss were included in the study. All were males with
an median age of 35.2 years (range: 28-42). Eigth patients were in group A and
9 in group B. Group A encompasses six patients (four gastric and two pulmonary
KS). One patient in each group had HAART, the rest had a combination of two
NRTI. Mean viral load for group A was 10,018 copies/ml (SD 10422) and 168,018
(SD196,908) for group B. We found no statistical differences between groups in
relation toTCD4 cell count (Mean:94 for group A and 86 for group B), age or
evolution time of HIV infection. Interestingly, 2 patients with visceral lymphoma
with the same clinical characteristics of group A patients, had also significant
lower viral load values when compared to group B patients.
Conclusion: We have not an explanation for this apparent paradoxical event.
However, we think that an increase in inflamatory mediators may be associated
with KS progression, thus allowing a decrease in viral load. Sequential studies to

determine the viral load patterns before and after KS diagnosis are warranted

60500 HIV screening practices towards pregnant women in the
Paris area, France
Elisabeth Couturier, C. Six, A.C. De benoist, J.B. Brunet. European Centre on
AIDS, 14 Rue val D'osne 94415 St. Maurice Cedex, France
Objectives: To assess HIV screening practices towards pregnant women, by
pregnancy outcome (delivery/voluntary abortion), among physicians of public and
private medical centres of the Paris area.
Methods: In all public centres, the medical chiefs were interviewed. In private
centres, a systematic random sampling of physicians was done. They answered
1 or 2 telephone questionnaire(s) concerning practices towards women who
deliver (Qd) and/or women undergoing voluntary abortion (Qa). Information collected were on screening practices of the physician and/or of the medical centre,
information and counselling given to women.
Results: From April to June 1997, 52 public and 149 private physicians (response rate: 100% and 87%) were interviewed. Overall, 307 questionnaires were
collected (165 Qd, 142 Qa). Among public physicians comparing the context
of delivery to abortion, 3% had never had an HIV(+) woman vs 2%. Screening
practices were respectively, routine screening with systematic informed consent
in 89% vs 49%, without consent in 11% vs 14%, targeted at women at risk
in 0% vs 32% and on woman request in 0% vs 5%. HIV information booklets
were available in 19% of maternities vs 49% of abortion units. Among private
physicians comparing the context of delivery to abortion, 44% had never had an
HIV(+) woman vs 62%. Screening practices were respectively, routine screening
with systematic informed consent in 68% vs 29%, without consent in 29% vs 11%,
targeted at women at risk in 2% vs 29% and on woman request/no screening in <
1% vs 31%. Among them, 12% had booklets available in the context of delivery vs
16% in abortion. Among private physicians having a routine practice, 17% used
the test as an opportunity to systematically inform on HIV infection women who
delivered vs 43% for women undergoing abortion; similar results were observed
among public physicians (22% vs 48%).
Conclusion: Our data suggest that in the context of delivery, routine HIV
screening has became the rule in public as in private centres. The highest proportion of private physicians prescribing an HIV test without consent shows that
the application of the 1993 law requiring to offer an HIV test at prenatal visit is
different in the 2 sectors. In the context of abortion where no regulation exists, HIV
prevalence is higher in the public sector than in the private one and physicians
have an HIV screening practice linked to their medical experience.
60501 The influence of group therapy on mortality in women
who lived with HIV
Jacquelyn Summers', L. Capps2, R. Robinson3, S. Zisook4, J.H. Atkinson3,
S.J. Browns, I. Grant3. 164 Tamlpais Rd. Berkeley California; 2UC Berkeley
Department of Psycholog, San Diego, CA 3UCSD HIV Neurobehavioral
Research Center, San Diego, CA; 4UCSD Department of Psychiatry, San Diego,
CA; 5AIDS Research Alliance, West Hollywood, CA, USA
Objective: To determine the effect of group therapy on survival in seropositive
women.
Design and Setting: Case control study of deceased women from a university
based HIV research center. Subjects: All 21 HIV-seropositive women who died
during the course of participation in a longitudinal cohort study of HIV between
Aug. 1991-May 1996. Main Outcome Measure: Duration of survival from time
of HIV diagnosis to date of death as influenced by age, ethnicity, education,
marital status, family size, disease staging, and participation in HIV-related group
therapy.
Results: Using Kaplan-Meier product limit survival estimates (p <.05, likelihood ratio), participation in group therapy was found to affect duration of survival
from date of known seropositivity to date of death (p <.01). Proportional hazards
regression demonstrated that HIV-related group therapy (p <.02) and family size
(p <.03) significantly influenced survival time (p =.002).
Conclusions: These analyses suggest that participation in group therapy is
associated with increased longevity in women diagnosed with HIV. It is important
to consider the salutary effects of social ties on survival for women living with HIV.
Based upon these findings, a randomized clinical trial of group therapy in women
living with HIV is warranted.
60502 Study of lymphocyte subsets in recurrent aphthous
ulcers in HIV-1+ and HIV-1 - patients
Zulema Casariego', T. Herrero2, T. Pombo3, P. Cahn4. 'B. Mitre 1371-4aM-103
Buenos Aires, Professor Doctor Dent. Buenos Aires 1036; 2Dr. Med.
Immunologist Buenos Aires, 1425; 3Dr. Med. Anatomo-pathology Buenos, 1642;
4Hospital Fernandez, Buenos Aires, Argentina
Recurrent aphthous ulcers (RAU) is a morbid oral lesion of unknown etiology.
Objectives: 1-to analize CD4 cell counts in peripheral blood. 2-to investigate
local immune reaction in HIV+ RAU+ and HIV+ RAU-patients (ptes.)
Desing: preliminary study

Methods: Group A:10 ptes.RAU+, group B:6 ptes RAU-.lt was investigated
by flow-citometry, peripheral blood: CD4/cells Mediam.D.St.+Man-Whitney test
(p = 2 tails).18 biopsies were taken (in lpte. = 3times.) Speciment controls:Hematoxylin-Eosin staining by ELIT VECTASTAIN SYSTEM DAB. Immunohistochemicalstain for: S-100, CD57, L-26, CD68, UCHL-1 (CD45RO-LT). Staining
intensity: N ( ), I (+/-), PF (focal +), P (+), VP (++). Test Fisher and Montecarlo
Simulation Interval Confidence (IC) 99%. t = 24 months.