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

1108 Abstracts 60585-60589

12th World AIDS Conference

Conclusion: The validity of screening test expected to shorten the "Window
Period", should be assessed in developed countries. The Ministry of Health and
Welfare begins to examine the validity of PCR for the screening of donated blood
in Japan.
60585 Medical doctors attitudes towards selected ethical
aspects of HIV and AIDS
Elzbieta Ciaston-Przeclawska, D.K.B. Daniluk-Kula. 52-54 Dereniowa Str.,
02-776 Warsaw Poland, National Office for AIDS Prevention, Warsaw, Poland
Objectives: -to determine the consistency level and scale of internalisation of the
basic ethical norms and principles of conduct in relation to persons living with HIV
and patients with AIDS, -evaluation how much doctors attitudes are determined
by legal habits and established formal norms, and how much they are modified
by generalised set of professional norms.
Design: survey on name-address sample of doctors, on the area of 21
provinces.
Methods: the research was performed on November 1997. In the sample there
were doctors from 21 selected provinces chosen on the basis of data concerning
absolute case of HIV infection in the years 1985 - 1996.
Results: doctors are subject to similar conditions as the rest of society. They
share fear attitudes usually connected with inconsistency in their knowledge
of issues connected with infections, In inconsistency of attitudes towards HIV
infections is mainly caused by loosening, of the system of ethical norms.
Conclusion: as it may be concluded that every newappearing danger (for civilisation) will cause similar problems in patient - doctor relation, it seems that along
specyfic programs there should also be unified, general programs of trainings in
ethics, relation to sick persons, mutual doctor - patient relationship.
S60586 Isolation and analysis of viral properties and nucleotide
sequence of HIV from patients with HIV infection in
Hiroshima area, Japan
Shunji Matuda1, M. Noda2, A. Toyota2, T. Yamane1, T. Takata1, S. Tokumoto2,
M. Miyata1. 1 Kure National Hospital, Kure Hiroshima, Japan; 2Perpectural Inst.
for Public Health, Hiroshima, Japan
Objectives: HIV-infection is spreading in Asia. In this study, we tried to isolate
HIV and to analyze virological properties and gene variability of the HIV obtained
from infected-individuals in Hiroshima area, Japan.
Methods: HIV was isolated by coculture of patient's PBMC and plasma with
normal PHA-Blast and the replication was determined by RT activity, CPE and
immuno-staining. The V3 region of HIV-provirus in PBMC from HIV-infected
individuals was amplyfied by PCR and nucleotide sequence was determined
automated sequence analyzer (Pharmacia). The nef region of provisus was also
analyzed by the same methods.
Results: Most of the isolates from patients in latent phase, CDCII, showed the
property of slow/low type HIV and the provisuses from patients in late stages,
CDCIV, showed the property of rapid/high type HIV. The sequences of V3 region
of provirus from most PBMC were coincided with the consensus sequence of subtype B with few exceptions which were coincided with the sequence of subtype E.
Among sutype B sequences, the number of amino acid substitution was increased
in provirus from the patients in the late stage. The most frequent substitution of
nucleotide was A to G. The substitution of nef resion was also analysed. Provirus
in PBMC and viral RNA in plasma from the patients with combination therapy was
hardly detected by usual methods.
Conclusion: Different subtypes of HIV are spreading in Hiroshima area. The
nucreotide substitution was increased in provirus from patients in late stage and A
to G substitution was predominant. The HIV-isolation by coculture and detection of
provirus by PCR became difficult in blood samples from patients with combination
therapy.
60587 Characteristics of IgA anti-HIV antibodies in plasma and
saliva from patients with HIV infection
Shunji Matsuda, M. Noda. Kure National Hospital, Hiroshima, Japan
Objectives: The role of IgA antibodies on HIV -infection has not been clarified.
To prevent the HIV -infection through mucosal sites and to understand the mechanisms of mucosal lymphoid organs in HIV-infection, the characteristics of IgA
anti-HIV antibodies must be clarified. In this study, we analyzed the biochemical
properties and binding sites on viral proteins of IgA anti-HIV antibodies.
Methods: The concentration of immunoglobulins was determined by nephelometry. Viral components which bind IgG and IgA antibodies were detected by
western blotting using commercial kit. Molecular size of IgA anti-HIV antibodies
was determined by gel filtration using Sephacryl S-300. The binding sites of
IgG and IgA anti-HIV antibodies on gp160 were determined using overlapping
synthetic peptides covering whole gp160.
Results: The concentration of total IgA was not changed even in the late stage,

while those of IgG and IgM were lowered in the late stage of the disease. IgA
anti-HIV antibodies bound mainly to Env proteins and occasionally to Gag and
RT proteins, whereas IgG antibodies were produced against most of the viral
components. In some plasma, IgA antibodies against Env were decreased. IgA
anti-HIV antibodies in plasma were suggested to contain the polymeric form IgA
by gel filtration. Most of the IgA binding sites on gp160 were the same as those
for IgG antibodies. However some binding sites were different between IgG and

IgA, suggesting that IgA anti-gp160 may play a different role in HIV-infection from
IgG anti-gpl60 antibodies.
Conclusion: IgA anti-HIV antibodies have different properties from IgG anti-HIV
antibodies and were suggeted to play a unique role in HIV-infection.
Acknowledgment: We appreciate Prof. B. Wahlen, L. Levi (Karolinska Inst.)
for allowing the use of their overlapping synthetic peptides and Dr. Y. Yokota, Y.
Yasuda (NIH, Japan) and E. Lucht (Huddinge Hosp.) for providing the patients'
samples.
160588 1Impact of interventions on adherence rates
Cassy Workman, Rachel Musson. Fitzroy Street Centre, 75 Fitzroy Street, Surry
Hills, Sydney, NSW, Australia
Background: Previous studies reported patients adhere to treatments 60-80%
of the time. Poor adherence with anti-HIV medications leads to viral resistance
and consequently adherence is now considered one of the major problems in HIV
clinical management. In a high caseload HIV practice several interventions had
been previously implemented attempting to improve adherence. These included;
extended consultation time to explain and reinforce instructions, tailoring the
choice of drug regimen to patient lifestyle, frequent follow-up when initialising
or changing treatment regimes, rapid viral load feed back, reminder calls and
alarms.
Method: Adherence data was collected using an anonymous questionnaire
which was completed in the absence of the doctor. Results from 77 consecutive
patients, over a two week period, were analysed.
Results: 73% of patients recorded their adherence with antiretrovirals as being
100%, 26% of patients reported an adherence rate of 80-100% and 1% reported
60-80%. Rates of adherence did not seem to be related to the dosing regime eg,
55% of patients on BID dosing reported 100% adherence and 46% of patients on
TID dosing reported 100% adherence. Adherence rate was not effected by the
number of drugs in the treatment regimen. In patients reporting 100% adherence
27% were on triple therapy, 30% on quadruple therapy, and 17% on either 5 or 6
drug combinations. Depression was not found to be related to the number of drugs
in the regimen. When patients don't take medications specifically as directed, the
majority (48%), are taking medications at different times than instructed. Only
18% of patients are taking their medications wrongly with respect to food. 28% of
patients, used reminders, the most popular being partners and friends.
Conclusions: Self reported ratings in this study were found to be considerably
higher than previously documented. Possible reasons for over reporting of adherence were reviewed. In this practice currently 90% of patients, stable on therapy
for 12 weeks or more, have viral loads below the limits of detection. This suggests that these results are a fair representation of these patients' behaviour and
that the interventions implemented have significantly improved patient adherence
rates compared to those previously reported.
60589 Support house: A matter of human rights and redeeming
the citizenship of people with AIDS
Olga N. Rios, M.F.C. Gomes. Associagao Irmdos da Solidariedade, Rua Santo
Antonio 44, 28081-520, Campos, RJ, Brazil
Problem: Due to migration of poor populations looking for an opportunity in the
petro-chemical plant in Campos and the low quality in the public health system in
Northern State of Rio de Janeiro, particularly concerning AIDS, the large population of this part of the country was extremely vulnerable to the HIV infection and
people with AIDS did not count with any possible care or assistance.
Project: In 1989, the Support House Association Brothers of Solidarity was
founded, to assist, shelter, and defend the interests of people with HIV and AIDS.
Initially, despite the prejudice of the local community, the head of the organization
leaded a media strategy to raise consciousness about the epidemic, and slowly
captivating the attention and support from the local people. Several activities
were organized and assistance to people with HIV and AIDS provided, such as
lodging, free distribution of medication, distribution of supplies of nourishment for
poor families affected, social and psychological care and public interventions on
prevention, as well as campaigns to raise funds and support, besides the free
distribution of condoms. The Legal Department was founded in 1994 to provide
legal support and counselling to PLWHA.
Results: The organization raised many donations in the local community. Over
390 people are assisted in diverse activities in the Support House and thirty
people with AIDS are living there permanently receiving health care, plus three
seropositive children who live with their mothers. Several people with AIDS who
did not even have an identity card could be registered and become a legal citizen
and recovered their self esteem and in many cases could reintegrate in the
society.
Lessons Learned: Despite discrimination and prejudice experimented not only
by people with AIDS but also by those who helped them, the resistance could
be beaten and nowadays the local community supports the entity in several
ways. AIDS in the community was understood as a natural result of the epidemic
in the country and a problem of everyone. The good results of the Campos'

Support House are consequence of conscientious public interventions towards a
conservative society.