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

12th World AIDS Conference

Abstracts 60569-60574 1105

prognosis of individuals to the information obtained by RNA level and CD4+ T-cell
count.
S60569 Patterns of therapeutic marijuana use in two
community-based cannabis buyers' cooperatives
Carroll Child1, T.F. Mitchell2, D.I. Abrams2. 1UCSF, 310 18th Street, Suite 201
San Francisco, California; 2University of California, San Francisco, San
Francisco CA, USA
Purpose: To describe patterns of therapeutic marijuana (MJ) use among HIV
sero-positive (+) compared to HIV sero-negative (-) individuals obtaining marijuana through local cannabis buyers' clubs in the San Francisco Bay Area.
Methods: Between 3'97 and 12'97, all adult clients of the San Francisco
Cannabis Cultivator's Club and the Oakland Cannabis Buyers' Cooperative were
invited, by existing site personnel, to voluntarily complete a one-page (13-question), anonymous self-report questionnaire (SRQ). Each respondent was asked
to complete the SRQ only once. Response choices on SRQ were not mutually
exclusive.
Results: A total of 206 SRQ forms were completed. Demographics of the
HIV+ and HIV respondents were similar for the number of forms returned (102
vs. 104) and mean age at time of SRQ completion (40 vs. 43). Study respondents were mostly male (78%), with a smaller percent of females respondents
in the seropositive group (3%) compared to the sero-negative group (36%). The
most frequent reason cited for MJ use among HIV+ was to "improve appetite improvement/weight gain" (71%); for sero-negatives, "feeling better mentally/reduce
stress" (65%) was most often noted. The second most frequent reason for MJ
use among the sero-positive group was "feeling better mentally/reduce stress"
(58%) and to "decrease physical pain/discomfort" (56%) among sero-negative
respondents. The most common method of MJ ingestion in both groups was
smoking (85% and 86%), with the most common MJ use frequency among
sero-positives being 3x/day (26%) and -5x/day (30%) in the non-HIV infected
group.
Conclusions: Distinct differences in therapeutic MJ use patterns, with respect
to frequency of use and reasons for use, were noted between HIV positive and
HIV negative buyer's club respondents. Little difference was observed between
the two study groups with respect to primary method of MJ ingestion.
S60570 1New injectors in the HIV epidemic among injecting drug
users in Bangkok, Thailand
Don C. Des Jarlais12, Suwanee Raktham3, S. Vanichseni3, P. Friedmann2,
K. Choopanya3, W. Subachaturas3. 1First Av & 16th Street New York NY 10003
Beth Israel Medical Center; 2Beth Israel Medical Center New York NY USA;
3Bangkok Metropolitan Administration Bangkok, Thailand
Objective: To examine the role of new injectors in the continuing high seroprevalence HIV epidemic among injecting drug users in Bangkok, Thailand.
Methods: A cross-sectional surveys of 300 injecting drug users (IDUs) entering drug treatment clinics in Bangkok was conducted in the fall of 1997. A
questionnaire covering demographics, drug use history and HIV risk behavior
was administered by a trained interviewer. Serum was collected and tested for
anti-HIV. New drug injectors were defined as persons who had begun injecting
5 years or less at the time of data collection, persons injecting 6+ years were
defined as long-term injectors. All of new injectors would have begun injecting
after knowledge about AIDS was widespread among IDUs in Bangkok.
Results: A very substantial - 41% - proportion of sample had begun injecting
within the previous 5 years. Rates of HIV risk behaviors were slightly but not
significantly higher among new injectors compared to long-term injectors: 44%
of new injectors reported injecting with equipment used by others vs. 34% of
long-term injectors (p =.11); 45% of new injectors reported unprotected sex vs.
39% of long-term injectors (p =.28). The new injectors reported a mean of only
3.14 years of drug injection, and 26% of them were HIV+ at the time of data
collection (44% of long-term injectors were HIV+).
Conclusions: The proportion of the sample who were new injectors, and the
high HIV infection rate among the new injectors indicate that initiation of new
persons into drug injection is a major contributing factor to the continuing HIV
epidemic among IDUs in Bangkok. Widespread knowledge about AIDS does not
appear to have a major deterrent effect to prevent initiation into drug injection.
New interventions to reduce initiation into drug injection are needed.
60571 Interaction between ritonavir and levothyroxine
Alice Tseng, D. Fletcher. University of Toronto, The Toronto Hospital, CW-315,
200 Elizabeth St. Toronto, ON M5G2C4, Canada
Background: Numerous interactions may occur with ritonavir due to its profound
effect on CYP450 enzymes and glucuronosyl transferase. We report a probable
interaction between ritonavir and levothyroxine in an HIV patient.
Case Report: The patient was a 29 year old male, with Kaposi's sarcoma and

Castleman's disease. In 11/95 his thyroid was mildly enlarged and thyroid indices
of: TSH 6.68 mU/L (normal 0.35-5.5), normal free T3 and T4, negative for thyroid
auto-antibodies. His CD4 was 318 and viral RNA 8,000-10,000 copies/mL (Roche
assay). In 01/96, his TSH was 9.25, and levothyroxine 0.125mg daily was started.
Three months later, a repeat TSH was normal at 2.31. In 01/97, ritonavir 600 mg
BID was initiated. In 02/97, his TSH had increased to 18.47, and his levothyroxine
dose was increased to 0.2mg daily. Three months later, his TSH was still elevated

at 9.88, and his levothyroxine dose was increased to 0.25 mg daily. In 08/97, his
TSH was 7.35. In 11/97, his antiretrovirals were temporarily discontinued due to
elevated LFTs, and the levothyroxine was reduced to 0.125 mg. His ritonavir was
replaced by indinavir; a month later, his TSH was 5.87.
Discussion: Since thyroxine undergoes conjugation with glucuronic acid, thyroxine concentrations may have been reduced secondary to induction of glucuronosyl transferases by ritonavir. This patient had been taking levothyroxine
for over a year, with stable thyroid indices. One month after ritonavir was added,
his thyroid indices increased dramatically, necessitating a doubling of his maintenance dose of levothyroxine. After ritonavir was discontinued, the patient was
able to return to his original dose of levothyroxine.
Conclusions: We describe a probable interaction between ritonavir and
levothyroxine. Clinicians should be aware of this potential interaction and adjust doses of levothyroxine as necessary when initiating or discontinuing ritonavir.
S60572 HIV related risk factors and HIV testing levels among
adolescents with drug abuse
David Pugatch, M. Ramratnam, A. Feller, D. Price, M. Thomas, B. Dickinson,
J.D. Rich. Brown University School of Medicine, Dept Pediatrics Rhode Island
Hospital 593 Eddy Street, Providence, RI 02903, USA
Background: Adolescents with recent substance abuse are at risk for HIV infection due to high-risk sexual and drug-injection behaviors. This study examines
HIV-related risk factors and HIV testing levels among adolescent and young
adults at an inpatient drug detoxification center.
Methods: A voluntary and confidential survey detailing HIV related risk factors
and HIV testing levels was administered to all patients at an inpatient drug detoxification center in Massachusetts. Charts of all patients who entered the center
between April 1st 1997 and December 31st 1997 were reviewed.
Results: 275 clients, ages 16 to 25 (mean 22), entered the center during the
study period. This population was: 61% male, 92% white, 5% black and 3% hispanic. Two hundred (73%) completed a survey on HIV testing and risk behaviors.
172 (86%) reported having sex while using drugs, 122 (61%) reported injection
drug use, 48 (24%) reported having sex with an injection drug user, 33 (17%)
reported sex in exchange for drugs or money, 17 (9%) reported a prior STD, and
4 (2%) reported having sex with an HIV infected individual. 64% of injection drug
users reported sharing needles. 23% of the respondents reported always using
condoms for vaginal sex while 17% always used condoms for anal sex. 98/200
(49%) of subjects reported ever having an HIV test. 26% of subjects requested an
HIV test during inpatient admission. Women were more likely than men to report
needle sharing (p = 0.04) and more likely to report a history of HIV testing (p <
0.01).
Conclusion: HIV risk behaviors are common among adolescents and young
adults in this drug detoxification center. The majority of this population injected
drugs and reported co-occurrence of drug use with sex. HIV testing is low in this
high risk population. Inpatient detoxification centers should be considered settings
for targeted HIV risk reduction and HIV testing among young drug abusers.
60573 Community level-pre and post-HIV-test counselling
multisector strategy for implementation
Giovanni Melendez. Apdo. Postal. 1289 Guatemala, 01001, Guatemala
Issue: Inadequate counseling system in pre and post HIV testing services.
Problems providing community level HIV testing.
Project: Implement HIV diagnosis at community level for the National Health
Network, utilizing rapid, third generation ELISA tests. Testing is available free
of charge at community health centers to interested persons. Training of nursing, laboratory and social work personnel in appropriate counselling skills was
mandatory prior to authorization for testing. This training is carried out jointly by
the National STD/HIV/AIDS Prevention and Control Program, under the Ministry
of Public Health Social and Social Services, and two national NGOs, all with vast
experience in STD/HIV/AIDS counselling. It is expected that training will provide
basic tools in the task of community-level counselling, as well as assess needs
for training among health care workers.
Results: Phase I, successful training of 56 workers from 53 community health
centers. Phase II, delivery of HIV testing services in each community health
center as well as pre and post test counselling for interested persons. Phase III,
in light of results obtained in Phase II, counselling training will be initiated in the
remaining health centers at the national level.
Lessons Learned: The intersectorial intervention has been more crredibility
and succesful at the personnel capacitated. The responsibility of the diagnostic
apropiated and recomended is shared by the government and the comunal health
services.
60574 A protease inhibitor support group helps patients
increase knowledge and meet health related goals
Bisher Akil1, Amy Bush2, E. Holloway1, K. Schneider3, P. Weismuller3,

C.L. Pearce3. IBuilding 50 1725 17th Street, Santa Ana, CA 92706; 2AIDS
Service Foundation, Irvine, CA; 30range County Health Care Agency, Santa
Ana, CA, USA
Issue: Compliance with HIV drug regimens, specifically protease inhibitors, is
essential in ensuring positive patient health outcomes and drug effectiveness in
the future.