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

1110 Abstracts 60596-60600

12th World AIDS Conference

S60596 Screening for HIV in pregnancy: Improvement in rates of
testing in an area of low prevalence
Simon Dobson12, David Burdge2, D. Money2, D. Patrick2. 1'British Columbia's
Children's and Women's Hospital, 4500 Oak Street, Vancouver, British Columbia
V6H 3N1, 20ak Tree Clinic and the University of British of Columbia, Vancouver
BC, Canada
Background: With the success of AZT in reducing the vertical transmission of
HIV from mother to infant, in June 1994 BC Centre for Disease Control recommended that all pregnant women be offered HIV testing during antenatal care.
Pre and post test counselling was strongly encouraged. Questions were added
to the Province's antenatal form. The HIV result is not documented on the form
for reasons of confidentiality.
Methods and Results: At BC Women's Hospital, antenatal forms were reviewed for one week's admissions. Medical Staff were encouraged to improve the
rate of at least offering HIV testing. One year later one week's admissions were
reviewed.

Results: The analysis of variance with repeated measures show a significant
drop in HIV viral load over the study period but no change in HCV viral load
whatever the PI used:
n =43 Baseline Month +3 Month +6 Month +9 p
HCV RNA MEq/mL 33.1 + 5.8 37.6 + 5.8 31.7 + 5.5 33.5 L 8.5 0.14
HIV RNA 104 copies/mL 18.8 + 5.2 3.3 + 1.4 3.05 4 1.05 5.6: 1.8.0.01
Further statistical analysis showed no correlation between HIV-RNA with HCV
viremia.
Conclusions: HIV-protease inhibitors have no activity against HCV replication
even with long treatment in coinfected patients. Specific inhibitors of the HCV
NS3-protease will be further required.
S60599 Satisfaction of HIV/AIDS patients receiving care at
Bamrasnaradura Hospital, Thailand

Review Admissions - Week 1-7 November
Has HIV testing been discussed? YES
NO
Not documented
Has HIV testing been done? YES
NO
Not documented

1995 n = 145 1996 n = 121 Chi2 P Yaowarat Inthongl 1, Daundaun Tanomchitt22. 1126 MO 04 Bamrasn Aradura
62 (43%) 81 (67%) --.0005 Hospital Tiwanon RD Nont Haburi 11000; 2Professional Nurse Monthaburi,
7 (5%) 4 (3%) Thailand

76 (52%)
79 (55%)
12 (8%)
54 (37%)

36 (30%)
92 (76%)
10 (8%)
19 (16%).0005.0005
-.0005

Conclusions: Rates of HIV testing of pregnant women in an area of low
disease prevalence (4/10,000) have increased substantially over a short period
of time. Testing is as likely done for primips and multips. No differences by ethnicity were noted. Obstetricians have overtaken their family practice colleagues
in offering testing. However, in one third of women discussion of testing is still
not documented even if testing is subsequently done. Once discussed, testing
was rarely refused by women. A voluntary approach to HIV testing is likely to be
successful in pregnancy.
60597 Delayed detection of maternal transmission of HIV-1 to
preterm twins by respiratory syncytial virus infection
(RSV): A case report
Isabelle Mendel1, V. Brossard2, T. Blanc3, B. Clavier4, I. Gueit5,
C. Buffet-Janvressel. I Virologie Centre Hospitalier Universitaire CH. Nicole
76031 Rouen Cedex; 2Neonatologie CHU CH Nicole, Rouen; 3Reanimation
Pediatrique CHU CH Nicole, Rouen; 4Gynecologie Obstetrique CHU CH Nicole,
Rouen; 5Maladies Infectieuses CHU CH Nicole, Rouen, France
Perinatal HIV-transmission causes a broad spectrum of clinical diseases and
clinical courses. We report herein a case of preterm twins with delayed detection
of HIV infection of one of the twins.
Mother: 28 years-old, AZT 2 x 250 mg/d from 8 to 25 weeks' gestation;
normal follow-up twin pregnancy; HIV viral load undetectable; CD4 from 344 to
500/mm3; prematurate rupture of membranes at 25 weeks' gestation and delivery
at 26 weeks.
Twin A (First Born): breech delivery, birthweight 710g, normal neurological examination, hyaline membranes disease requiring artificial ventilation and specific
treatment.
Twin B (Second Born): cephalic delivery 5 min after ruptures of the membranes, birthweight 820 g. The recommended zidovudine treatment was given to
both neonates and was stopped after 50 days because HIV-PCR, p24 antigen
and viral culture tests were consistently negative.
At 4 months of age, twin A was admitted to hospital ith severe bronchiolitis
due to RSV that resulted to death, despite intensive care. The baby was found to
be HIV-infected with positive HIV-RNA (4 log), culture and antigen tests. Twin B
remained HIV negative.
Conclusion: - Mother to child HIV transmission can be detected after a long
period of negative PCR results especially in preterm infants (lower sensitivity) -Prematurate rupture of membranes is a major risk factor for perinatal HIV
transmission -Prophylaxis for RSV infection should be targeted to preterm infants
60598 1 Lack of activity of the protease inhibitors on the HCV
replication in HIV-coinfected patients
Isabelle Mendel1, L. Froment2, C.I.S.I.H. Haute-Normandiet, Buffet Janvresse1.
1 Virologie Centre Hospitalier Universitaire CH. Nicole 76031 Rouen Cedex;
2DESP CHU CH Nicole, Rouen, France
Background: Coinfection of patients with HIV and hepatitis C virus (HCV) is
common. The HCV therapy with interferon gives a poor efficiency in those
patients but the HIV protease inhibitors (PI) are known to reduce significantly the
HIV viral load.
Objective: To evaluate the influence of the PI on the HCV replication during a
9-months period.
Methods: HCV-RNA levels (bDNA 2.0, Chiron) as well as HIV RNA copies (PCR
Monitor Roche or bDNA 2.0 Chiron) were determined in 43 HIV/HCV-coinfected
patients. The RNA quantification was measured before and every three months
after the addition of one PI either saquinavir (22 patients), or indinavir (15 patients) or ritonavir (6 patients) to an antiretroviral therapy consisting of nucleoside
analogues.

Objective: 1. To evaluate patient satisfaction within the HIV/AIDS outpatient
services of Bamrasnaradura Hospital, the major public infectious disease hospital
in Thailand.
2. To study the relationship between social and demographic factors (age, sex,
education level, occupation and place of residence) and patient satisfaction in
relation to the 5 activities of each of 5 service units within the HIV/AIDS outpatients
department (OPD) namely, Registration, Triage Nurse Unit, Physical Exam. Unit,
Pharmacy, and Medical Fee Requisitional Unit.
Method: Incidental sampling was utilised to select a sample of 527 patients
who completed a questionnaire in the OPD of the hospital between 3-9 July
1996.
Results: The sampled HIV/AIDS patients expressed a general high level of
satisfaction to all 5 activities of the 5 service units. Team activities of facilitating
and co-ordinating care, friendship, and quality of care rated at the moderate-high
satisfaction level. Place of residence correlated to satisfaction level in 4out o f 5
units. Occupation and education level significantly correlated (p-value -- 0.05) to
satisfaction within the Nurse Triage and Medical Fee Requisional Units. Within the
Registration Unit facilitation, coordination and quality of care correlated to age,
sex, marital status and occupation. Place of residence was significantly related
(p-value < 0.05) to facilitating care, friendship and quality of care.
Conclusion: This study will assist the hospital in improving service efficiency
and the quality of care delivered at Bamrasnaradura Hospital. As a result, patients
and their families will receive optimal care and support when attending a major
HIV/AIDS hospital service in Bangkok. This will also have a positive impact on
the economic and social circumstances of these patients and families affected by
HIV/AIDS.
| 60600 Financial support on AIDS activity for NGOs in Thailand
in 1995
Sunsanee Smitakestrin. AIDS Division Dept. CDC Ministry of Public Health
Tivanont Nonthaburi 11000, Thailand
Issue: Allocation budgets on AIDS activity for NGOs in Thailand and present the
result of evaluation of NGOs activity on 1995.
Project: In 1995 CDC Department of MOPH was allocated the budget amount
75 million Bhts. to 153 projects from 95 NGOs for AIDS activity. Most activity was
IEC (52.3%), medical Service includes care, shelter service & Hospice Service
(17.6%) self helf group support and human right Campaign (14.4%) Counselling
(13.1%) Strengtening NGOs (2.6%). Most area of activity was BKK (34.6%).
And most NGO work on many targets. The methods of evaluation was indepth
interview and review literature and NGOs' reports and random sample from 92
projects 47 NGOs, the result was NGOs varried on the difference of size, administrative structure and potentiality of organization. Some NGOs were legal
(47.4%), most NGOs located in the BKK (46.3%). About IEC, most NGOs tended
to work with general targets. Training the volunteers were the strategy to develop
potentiality and encourage community to solve the problems in the future. About
medical services, care activity and self help groups could evaluate clearly than
other activities and successful. About counselling, most Ngos brought the counselling process integrated in the other activity. And about the strengthening NGOs
activity, they had training and shared their experiences, tecniques and involve the
collaborated process of NGOs network.
Lesson Learned: The procedure of prevention and control of AIDS in Thailand
which is the collaboration of GO-NGOs & private sectors should cover the activity,
area & risk targets, outreach targets and should have continuous collaborated
system and good reationship. MOPH should emphasize GO-NGOs sharing mechanism and decentralize the submission project, make decision projects, allocation
budget and evaluation projects to CDC regions.