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

1114 Abstracts 60618-60622

12th World AIDS Conference

Institute of Statistics and Geography, the it was applied the patients with AIDS
admitted in 8 services of TDA implanted in 1995 and distributed in 4 states of
Brazil.
Results: 118 patients were monitored of March to July of 1997. We observed
that 15% of the patients received less than 01 minimum wage a month, 42% from
1 to 3, 18% from 3 to 5, 4% of 5 at 10 and 13% more than 10 minimum wages.
(Observation: minimum wage = 112US $).
Conclusion: In Brazil, the access to the quality care is limited to a reduced
portion of the society. However, a factor that considered of great relevance is the
quality attendance, rendered by multidisciplinary teams, benefits mainly citizens
of low income and that the economic parameters (<1 and >10 minimum wages)
they are equally beneficiaries of these government projects.
60618 An analysis of accident of health care workers during
years 1994/1997
Mario Falciano1, S.A. Salotti2, M.A. Macedonio2, C.S. Coletta2, R.L. Rubino2,
B.N. Bergami2, T.G. Turbessi2. 1Viale Reginna Elena 330, Roma 00161; 2Dept.
of Infectious and Tropical Disease, Univ. La Sapienza, Rome I, Italy
We examined the data of professional accidents of 1070 health care workers at
hospital "Umberto I" of University "La Sapienza" of Rome from 1994 to 1997.
Results: 1070 health care workers (HCW) were divided into: 380 medical
Sdoctors, 535 nurses, 81 auxilary, 29 technicians, 15 other The wards where accidents occurred are: general medicine 377, surgery 590, hematology 20, dentistry
15, infectious diseases 43, laboratory 13, other 12. The number of accidents
subdivided by years: 1994 (281), 1995 (285), 1996 (260), 1997 (243). The means
of exposures: 742 needle pricke, 118 cut, 210 contamination
Needle pricke Cut Contamination
Medical Doctors 257 34 89
Nurses 392 53 90
In 69 cases the patients was HIV+, in 75 HBV+ and in 195 HCV+. Before
the accident, 759 HCW (70.9%) were already vaccinated for hepatitis B, while
278 (26.1%) requested the vaccination after the accident. Only half of the HCW
completed follow up until 6 months; among the 75 HCW with exposure to HIV+
patients follow up was completed by 58 (77.3%) while only 47.9% (477/995) HCW
exposed to patients with HIV test negative or unknown completed the follow up.
Conclusion: Despite the wide diffusion of information on occupational risk,
professional accidents are still very frequent, especially among nurses and in
surgery wards. The most frequent mean of exposure is needle prick. Data on
HBV vaccination show the low sensibilization of HCW to hepatitis B prevention. Adherence to post-exposure follow up was higher in HCW whose accident
occurred with a HIV+ patient.
60619 Ritonavir + saquinavir + 2 NRTIs as first line HAART
therapy: 21 patients from Cook County Hospital, Chicago
Renslow Sherer, J. Jasek, M. Maclean. HIV Center, Div. of I.D., Cook County
Hosp., Rush 1900, West Polk St., Chicago, IL 60612, USA
Objective: To evaluate Ritonavir (RIT) + Saquinavir (SQV) + 2 NRTIs as first line
HAART therapy in adults with HIV infection.
Design: Retrospective chart review of convenience cohort.
Methods: 21 PI-naive patients were begun on RIT 400 mg BID with dose
escalation & SQV 400 mg BID & 2 new NRTIs from 8/96 to 12/97. Chart review
was performed for death, clinical outcomes, viral load (VL), and CD4 counts,
which were obtained at </= 3 mo intervals.
Results: 21 patients received therapy for a median 5 mos (range 3-16). The
median CD4 count at start of treatment was 160 (3-462), and the median VL was
108,726 (2,839-0.8 mil). 11 (52%) of patients had CD4 < 200 at the start of Rx.
All were naive to PI Rx; 3 (14%) of patients were new to care and naive to all
therapy. The mean F/U in care for the other 86% was 60 mos (range 12-180),
and the mean duration of past nucleoside therapy was 62 mos. 18 (80%) received
D4T + 3TC. 53% (11/21) had VL < 500 by bDNA for >6 mos, and 15/21 (71%)
had VL < 500 at this analysis. The mean CD4 rise was 66 cells/mi. There were
no AIDS defining Ols; one patient died of a narcotic overdose. In 3 pts who failed
to reach undetectable VL, VL reductions averaged 1.4 logs; all were <10,000
copies at 3 mos. 3 (14%) patients discontinued the regimen due to adverse drug
effects, mainly GI. Self-reported adherence to the regimen was excellent.
Conclusion: +SQV as first-line PIs + 2 NRTIs was well-tolerated, associated
with good adherence by pt. self-report, & achieved excellent clinical & surrogate
marker outcomes in an inner-city cohort of NRTI experienced & naive pts with
advanced and earlier disease. 53% had VL below detection for >/= 6 mos, and
71% had VL below detection at the time of the analysis. 14% d/c Rx for AERs.
Twice daily dosing and infrequent side effects were key factors. Further controlled
and prolonged study is needed.

F60620 Universidaids Project: Partnership of universities with
the Brazilian AIDS program
Luiza De Paiva Silva, J.F. Assoni, C.A. Castelo-Branco, G.A. Silva. Brazilian
AIDS Program MOH, Brasilia, DF; SOS 304 BI. A Apt. Brasilia DF, 70337010,
Brazil
Issue: Universities develop training programs for health professionals, students

or community people concerning assistance, prevention and surveillance of
STD/HIV/AIDS in Brasil.
Project: Given the advance of the STD/AIDS epidemics in a large country as
Brasil, the Brasil AIDS Program, since 1996, has been developing a descentralized policy of training envolving Universities. They are invited to develop training
projects directed to assistance, prevention and surveillance of STD/AIDS, taking
into account the epidemiological situation of each region. One premise to participate in the Universidaids Project is the interaction with the local health services
that participate defining priorities in the training needs and also evaluating the
training process, through a interinstitutional comission. Projects envolve usually,
public health and internal medicine departments, as well as nursing, nutrition,
psicology, laboratory and social sciences departments. Nursing projects have a
special strategy using a specific modular material and problem based methodology. An assessment training group of educational and health professionals was
made up to allow the evaluation of the technical training issues in each institution.
Results: In 1997 were made 64 contracts with health training instituitions, covering 90% of Brasilian States, while in 1996 there were only 20 agreements. The
number of trained professionals was 33 in 1992, 1607 in 1995 and in 1997, with
the UNIVERSIDAIDS PROJECT, grew to more than 3500 persons (not included
many other training activities realized out of universities), in 122 training courses.
Among them 370 were nurses trained until now in the specific nurse training. The
assessment training group visited and evaluated 50 contracted health training
institutions. Descentralization permited the supplying of local training needs. It
has begun, also, discussions for formal curriculum changes including more AIDS
topics in some third grade teaching institutions.
Lessons Learned: Universities, previously absent and distant in the AIDS prevention or assistencial issues in Brasil, can be involved since there is a defined
and directed training policy, integrating universities and health services.
S60621 1 Maximising the benefits of HAART in the real world:
The role of a pharmacist-led antiretroviral clinic
Heathera Leake12, M. Fisher3, S.A. Eipe4, E.J. O'Moore3. ' Elton John Centre,
Brighton General Hospital, 2Dept. of Pharmacy, Brighton Healthcare NHS Trust,
3Dept. of HIV & Genitourinary Medicine, Brighton Healthcare, Brighton, UK
Background: The efficacy and cost-effectiveness of highly active antiretroviral
therapy (HAART) has been clearly demonstrated in large-scale clinical trials.
However, the results have been less impressive in the clinical setting. Many
reasons have been identified, including poor adherence, which may be best
addressed by a multidisciplinary approach.
Methods: Retrospective analysis of a dedicated pharmacist-led antiretroviral
(ARV) clinic (established 9/96) was performed. Prior ARV exposure, number of
concomitant medications, subsequent tolerability/toxicity, virologic response and
amendments to treatment were recorded.
Results: Data were available for 79 patients attending the service between
1/9/96 and 1/10/97 (33 ARV naive, 46 ARV experienced). Following consultation,
72 started or switched and 6 deferred ARVs. At 30/1/98, of those who started or
switched ARVs, 39 (54%) remain on the same regimen, 12 (17%) changed due
to intolerance/toxicity, 13 (18%) switched because of virologic failure and 5 (6%)
stopped therapy. Data to 5/98 will be presented, including a control group who
started/switched ARVs during the same period.
Conclusions: Individualisation of therapy (including consideration of lifestyle
and actual or potential tolerability and toxicity issues) may be crucial in maximising
the long-term benefit of HAART. This may be best achieved by adopting a fully
integrated multidisciplinary team approach which utilises the skills of a specialist
HIV pharmacist.
S60622 Cytomegalovirus (CMV) DNA detection using Amplicor
CMV test in a cohort of HIV-positive patients
John Paul, D. McElborough, R. Hargreaves, E.J. O'Moore, M Fisher. 'Brighton
PHL Royal Sussex County Hospital Brighton BN2 5BE Brighton, UK
Objectives: To determine rate of plasma CMV-DNA positivity in a cohort undergoing HIV viral load monitoring; to relate CMV status to HIV viral load, CD4+
count and clinical records of CMV disease.
Design: Retrospective study.
Methods: Amplicor CMV test, a qualitative CMV-DNA test kit, was applied to
355 plasma samples from 251 adult HIV-seropositive patients (16 female, 235
male). Stored surplus aliquots of specimens submitted for HIV viral load monitoring were randomly selected. Results were compared with HIV viral load, CD4+
count (197 samples) and clinical records.
Results: CMV-DNA was detected in 13/355 (4%) samples from 11/251 (4%)
patients. Compared with CMV-negative samples, CMV-positivity was associated
with lower mean CD4+ count (284 vs. 53/jtL: p = 0.001), higher mean HIV viral
load (4.5 vs. 5.1 log copies/mL: p = 0.037) and recorded diagnosis of CMV
disease: 4/11 (36%) (2 visceral, 1 retinal, 1 encephalitis) vs. 4/240 (2%) (retinitis,
2-21 months before sample date) patients.
Three patients (1 without CMV diagnosis; 2 given gancyclovir; all receiving an
tiretrovirals) became CMV-negative with associated drop in HIV viral load (mean:
2.03 log copies/mL) and rise in CD4+ count (mean: 97/p L). Four patients became
CMV-positive (1 fatal encephalitis, 3 without CMV diagnosis), without significant
changes in viral load (all > 4 log copies/mL) or CD4+ count (all <50 /IL).
Conclusion: Amplicor CMV test can be used to confirm clinical suspicion
of HIV-related active CMV disease. In this cohort, both anti-CMV therapy and
anti-HIV therapy appear related to reduction in CMV-positivity.