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

12th World AIDS Conference

Abstracts 60580-60584 1107

more stress and, thus, more neuropsychological problems than HIV+ men or
non-infected controls.
Methods: All Subjects were compared on a brief neuropsychological battery,
Symptom Impact Profile (SIP), mood, economic status, and psychosocial support.
Exclusionary criteria were: younger than 19; history of head injury; current illicit
drug use (with exception of alcohol and marijuana); history of seizure disorder; or
previous psychiatric hospitalization (with exception of reactionary depression to
HIV diagnosis). Small sample sizes precluded multivariate analyses. Mann-Whitney U analyses and Yates Chi Square analysis corrected for small sample sizes
was used when indicated. A neuropsychological profile score of <ISD below
mean was defined as abnormal.
Results: 52 HIV+ (35 men; 17 women) and 22 HIV (10 men; 11 women)
subjects were assessed. 25% of HIV+ subjects and only 5% of HIV controls
demonstrated abnormal profiles in the predicted areas. Stress (SIP) was related
to neuropsychological performance only for the HIV+ subjects with abnormal
profiles. HIV+ women did not demonstrate higher stress levels. Mood, age, education, medication, illicit drug use, and English as a second language did not
account for the findings. However, HIV+ subjects with abnormal profiles had lower
IQ's. Nonetheless, simply having a lower IQ and HIV did not automatically result
in an abnormal profile.
Conclusions: A large proportion (25%) of HIV+ subjects in the study demonstrated mild neuropsychological deficits compared to HIV controls. We did not
find any significant difference between HIV+ men and women. Lower IQ (lower
cognitive reserve) and stress measures were related to neuropsychological findings in the HIV+ subjects with abnormal profiles. A better understanding of
the factors leading to mild neuropsychological deficits should offer for improved
support to prevent/diminish their impact on the lives of those living with HIV
infection.605801

AIDS mortality in adult patients in the last 3 years:
Decreasing trend from 1995 to 1997 in the Institute of
Infectious Diseases "Emilio Ribas" (IIER), Sao Paulo, SP,
Brazil

Jorge Casseb, G.L. Silva, K. Sakita, L. Medeiros. Institute of Infectious Disease,
Av: Arnaldo 455, 20 Floor, Room 2345, Sao Paulo, Brazil
Objectives: Institute of Infectious Disease "Emilio Ribas" is the most important
hospital for AIDS care in Sao Paulo City, with 180 beds reserved to adult patients
with AIDS. We have analysed trend of AIDS mortality and time of internation in the
ward, critical care center, and emergency room. The number of beds for the AIDS
patients did not change over time, as well as the number of health profissionals
during this time.
Design: Retropective data obtained from the Statistical Section of the IIER
Methods: Mortality rate was calcuted by dividing the total of in-patients to
number of deaths caused by AIDS in adults ( -15 years-old). Statistical analysis
was done by Chi Square with Yates correction.
Results:
Table 1. AIDS mortality in adult patients in the last 3 years in IIER

S60582 Directly observed therapy (DOT) of highly active
antiretroviral therapy (HAART) in patients with HIV and
tuberculosis (TB)
Brenda Jones, M. Otaya, E. Rayos, P. Velasco, C. Silva. University of Southern
California (USC), 1200 N State St Room 6442 LAC + USC Med, Los Angeles,
CA 90033, USA
Issues: Adherence to treatment is especially important in the administration
of antiretroviral regimens containing protease inhibitors. Administration of protease inhibitors to patients with TB is problematic due to drug interactions with
rifampin.
Project: Six patients co-infected with HIV and TB were treated. HAART was
initiated after 2 months of TB medications. A standard regimen of TB medications
was given for the first 2 months (isoniazid 300 mg, rifampin 600 mg, ethambutol
1200 mg, pyrazinamide 1500 mg QD). Thereafter, a modified regimen (isoniazid
300 mg and rifabutin 150 mg QD x 7 months) was administered by DOT on 5 days
and self administered on 2 days. Antiviral therapy consisted of nelfinavir 1000
mg TID, lamivudine 150 mg BID, plus stavudine 40 mg BID. One dose of HAART
was observed on each of the 5 days when TB medications were administered. A
community worker organized HIV medications and encouraged adherence with
self administered doses.
Results: HIV+ TB patients benefitted from the supervision of HAART by a
community worker knowledgeable about HIV and TB medications. Patients were
adherent with self administered doses of HAART and more aware of potential
adverse reactions.
Lessons Learned: DOT has been enormously successful in the treatment
of tuberculosis. Supervision of HAART by community workers may benefit HIV
infected patients on complex drug regimens.
60583 Predictors of mental distress and poor physical health
among homeless women
Adeline Nyamathi. 9 Ranchero Road Bell Canyon California 91307, USA
Objectives: To assess the predictors of risky sexual and drug use behaviors and
health outcomes among a sample of 871 homeless and drug-addicted women.
Design: Survey with structured instruments.
Methods: Subjects were recruited through directors of 19 homeless shelters.
After informed consent was obtained, baseline data were collected with a 45-60
minute questionnaire which was administered face to face by ethnically matched
African-American, Latina and White nurses and outreach workers well trained in
research methods. Participants were paid $5 for their time. Utilizing the Comprehensive Health Seeking and Coping Paradigm (Nyamathi, 1989) as the theoretical
framework, relationships among situational, personal, and social resources, cognitive appraisal, health seeking and coping response and health outcome were
assessed using structural equation models (SEM) with latent variables. Culturally
appropriate and psychometrically sound instruments were administered.
Results: Risky sexual behavior was predicted by parental drug abuse history,
less drug self-efficacy, and more dysfunctional social support. Current drug use
was predicted by a parental drug abuse history, less drug self-efficacy, high
perceived rewards for drug use, and high perceived costs for drug use. Mental
distress was predicted by risky sexual behavior, less social support, current drug
use, avoidant coping, less self-esteem, an abuse history, and dysfunctional social
support. Poor physical health was predicted by an abuse history, less drug efficacy, fewer perceived rewards for drug use, more costs for drug use, and health
protective behavior.
Conclusion: SEM is useful in predicting poor health outcomes including drug
use and sexual activity. Variables predictive of poor health outcomes included
psychological and social variables. Implications of results for intervention and
theory building are discussed.
60584 HIV infection through blood transfusion administrated in
Japan
Mitsuhiro Kamakura, S. Yamazaki2. 1 Dept. of Prevention Med. and Public
Health, Sch. of Med., Keio Univ., 35 Shinanomachi Shinshinju - Ward, Tokyo;
2National Institute of Insfectious Disease, Tokyo, Japan
Background: In 1997, two confirmed HIV infected persons who were infected
through blood transfusion with considerable certainty, were first reported since
the beginning of HIV-antibody screening of donated blood in 1986. They were
Japanese and the transfusion was administrated in Japan.
Methods: A retrospective survey was conducted.
Results: In February 1997, a donated blood sample was detected HIV positive
and excluded from the supply. And a retroactive survey revealed that the same
donor gave blood to the blood center 82 days before. The blood was HIV-antibody
negative at that time, but the stored sample was found to be HIV positive by PCR.
The donation was whole blood collection and was transfused to just one patient.
The blood center contacted the doctor of the recipient, and asked the checking
of HIV infection and related medical cares. The result of blood test after 99 days

of transfusion proved HIV positive. The second case confirmed HIV infection
through the transfusion of donated blood products, was reported 30 September,
1997. The patient was given blood products of 38 donors in 1993. Twenty-six out
of 38 donors were proved not to be in their "Window Period", because they were
identified HIV negative by the record of donation ever afterwards. Other 3 cases
took the HIV-antibody test and were negative. And the rest 9 cases were now
investigated retroactively.

Year N. Discard
1995 1471
1996 1307
1997 1113

N. death
603
651
371

death N. total
29 2074
33 1958
25 1484

Time in IIER/day
38
33
20

Year
95 vs 96
95 vs 97
96 vs 97

P Value
0.004
0.007
0.0001

Conclusions: Death rate in adults with AIDS has been decreasing significantly
from 29% in 1995 to 25% in 1997 in our institution. Also, we noticed that the
hospitalization time has decreased in 18 days at the same-time. Some factors,
such as physicians' awareness for HIV/AIDS diagnosis, early treatament for the
public health practicaters, and also improvement administration in the hospital
setting, might influence our observations. One possible explanation might be that
the Brazilian Government has provided access to the high active anti-HIV therapy
since november 1996.
60581 Prevalence study of HIV antibodies in patients with
non-Hodgkin's lymphoma (NHL) in Lagos, Nigeria
Ibironke Akinsete1, Alani S. Akanmu2, H.I. Analo2, O.S. Njoku3, C.C. Okany2.
I Dept. of Haemotology and Bid. Transf Luth PMB 12003, Lagos; 2Dept. of
Haemotology, Luth, Lagos; 3Army Base Hospital, Yaba, Lagos, Nigeria
Background: The incidence of NHL has been noted to be increasing by 2-3%
per year in the last two decades. This has been aetiologically attributed to
immunosuppression associated with HIV infection. We tested this association
by comparing the seroprevalence of HIV antibodies in Patients with lymphoid
malignancies (CLL and NAL) and healthy bolld donors.
Method: Routine blood donors were recruited over a period of 3 months and patients with lymphoid malignancies were recruited over a period of 15 months. They
were screened for HIV antibodies using an E1A technique. Positive specimens
were confirmed by Western blot.
Result: A total of 406 donors were screened. 20 (4.9%) were positive for HIV-1.
A total of 30 patients (20 with NHL and 10 with CLL) were screened.5 (25%) of
NHL patients were positive for HIV-1, None of CLL patient was positive. HIV-1 is
prevelent in NHL patients than in normal donor population in Lagos. (P less than
0.05. P = 0.0047)
Conclusion: HIV induced immunosuppression may be the predominant aetiological factor responsible for the increaning incidence of NHL worldwide.