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

12th World AIDS Conference

Abstracts 60623-60629 1115

S60623_ Pharmacokinetic (PK) interaction between nevirapine
(NVP) and rifampin (RMP)
Patrick Robinson, M. Lamson, M. Gigliotti, M. Myers. Boehringer Inge/heim
Pharmaceuticals, 900 Ridgebury Rd, Ridgefield, CT 06877, USA
NVP and RMP are metabolized by the hepatic p450 isozyme system. RMP is an
inducer of CYP3A4 and NVP induces CYP2B6 - CYP3A4. Thus, both have the
potential for important interactions with each other. We performed an open-label,
single arm trial of rifampin alone and with nevirapine to examine NVP and RMP's
PK effects on each other.
Methods: 22 patients (CD4 - 100 cells/mm3) were begun on RMP 600 mg q.d.
for 14 days; NVP was added (200 mg/d x 14 days, then 200 mg bid x 14 days).
Plasma samples were obtained on day 14 for RMP concentrations and on day 42
for NVP and RMP concentrations. The effect of nevirapine coadministration on the
steady-state pharmacokinetics of RMP was evaluated by comparing (Wilcoxon
Signed Rank test) the mean difference in steady-state RMP AUC and Cmaxss
determined before and after addition of NVP. NVP pharmacokinetic parameters
were compared to historical controls.
Results: NVP coadministration resulted in no significant change in rifampin
AUC compared to baseline values (35.86 ~ 19.47 ig-hr/mL versus 30.9 ~ 9.5
pg.hr/mL) and no significant change in rifampin Cmax (9.9 -- 2.7 /g/mL versus
9.7 ý 3.2 /g/mL). NVP clearance was significantly increased by RMP as evidenced by an approximately 58% reduction in NVP average concentration (1.9
L 0.6 /ig/mL) and 68% reduction in NVP Cminss (1.4 ~ 0.6 pg/mL) compared to
historical controls.
Conclusion: Consideration should be given to increasing the NVP dose by
50% (300 mg bid), if it is given concomitantly with RMP. However, there are no
safety data available for the combination of RMP/NVP at this NVP dose.
60624 Effect of antiretroviral treatment in Irish patients
Colette Barry', J. Kelleher2, H. Thaker2, M. Codd2, G.J. Sheenan12. 1St. John's
Ward Beaumont Hospital Dublin 9; 2Mater Hospital Dublin 7; 3Mater/Beaumont
Hospitals Dublin, Ireland
Background: The protease inhibitors (sequinavir, ritonavir & indinavir) and the
RT inhibitors (zidovudine, didanosine, zalcitabine, lamivudine & stavudine) were
all available to Irish patients by mid-1996. All anti-viral medications are provided
free of charge under the control of an I. D. specialist and without clinical restriction.
From July 1996 triple therapy became our standard approach. Routine HIV viral
load measurements became available from August 1996. This is the first report
of the results of triple/guadruple therapy in Irish patients from 2 centres in Dublin.
Methods: A retrospective chart review of patients who commenced triple or
guadruple therapy between July 1996 and June 1997. The information gathered
included demographics, CD4 counts, viral loads, previous antiretroviral therapies
and risk factors. The patients were seen at one to two monthly intervals and had
sequential measurements of CD4 and viral loads. Viral load was measured using
the Amplicor Roche method. Viral loads of -400 particles/ml were considered
undetectable. Response to treatment was defined as an undetectable viral load
achieved on at least one occasion.
Results: 53 patients met study criteria. These included 43 males and 10 females. Thirty gaymen, 12 heterosexuals, 10 IVDUs and 1 undefined. All patients
were taking 2 nucleoside reverse transcriptase inhibitors. The third agent was
a protease inhibitor or a non-nucleoside RTI. 41 (77%) patients had previously
been exposed to anti-viral therapy. 33 (62%) patients had CD4 counts -200. Undetectable viral load was achieved in 38 patients. Thus 72% achieved total viral
suppression. 26 (63%) of the patients who were exposed to therapy previously,
and all 12 naive patients achieved undetectable viral loads. 15 patients failed to
achieve viral suppression.
Conclusions: Over two-thirds of this patient population responded to therapy
achieving undetectable viral loads. The patients who failed to respond to therapy
had prior exposure to multiple antiretroviral drugs and were commenced on triple
or quadruple combinations in a sequential manner. The patients who failed to
achieve viral suppression were also found to be more immunocompromised.
60625 AIDS education program for illegal Burmese migrant
workers in Bangkok and surrounding areas
Komkai Hamamool. 111/9 Pan Road Bangkok 10500, Thailand
Illegal migrant workers from Burma are used extensively in Thailand, especially in
factories and as construction laborers. Our program seeks out these groups, who
are determined to be at increase risk due to frequenting sex workers or living in
restricted dormitories. They have little access to health care and are not targetted
by other AIDS education programs. They have a high rate of HIV incidence.
Our program trains AIDS educators, Thai and Burmese, to provide-quality
AIDS education to this hard-to-reach target group. Tailored programs are offered
to groups ranging in size from 30-300.
We have developed educational materials appropriate to the target group.
Audience participation is utilized in straightforward presentations related to trans
mission and prevention of HIV/AIDS. We also focus on changing attitudes towards
people with HIV/AIDS, and whn necessary provide advocacy for them to better
access health care.
The program is continually under development, and new target groups are
being sought.

Illegal populations are difficult to target. As illegals they are afraid to gather
in groups. Innovative techniques are necessary due to langauge and cultural
differences, and reticence to discuss sexuality.
60627 Egyptian university students: 2A population at risk for
HIV?
Joan MacNeil', F. El Zanaty2. 'Family Health International, 2101 Wilson Blvd,
Suite 700, Arlington, VA 22201, USA, 2Cairo University, Cairo, Egpyt
Objective: To determine risk for HIV/AIDS among Egyptian university students.
Method: A stratified proportional survey assessing HIV/AIDS knowledge, sexual risk behavior and risk perception was conducted among 1,250 university
students, ages 18-24, selected from 4 major Cairo universities.
Results: All 768 males and 526 females in the sample had heard of HIV/AIDS
but misconceptions were common (e.g. 39% thought HIV was spread by
mosquitoes). Only 32% of the sample reported access to information on AIDS in
the last month. Two hundred males (26%) and 16 (3%) females reported sexual
activity, with mean age at first intercourse 17 for men and 20 for women. Fifteen
of these 216 students were married. Of the 120 students reporting intercourse in
the 3 months preceding the study, 45 reported having more than one partner and
34 reported believing their partner had other sexual partners. Condom use at last
sexual intercourse was reported by half of these 120 students. Overall, gender
and religious affiliation accounted for major differences in beliefs, attitudes and
behavior. Older male students from secular universites were the most likely to
engage in risky behavior.
Conclusion: Despite cultural values which discourage sex outside of marriage
in Egypt, students are engaging in behaviors which place them at risk for HIV
and other STDs. The many misconceptions regarding transmission point to an
urgent need for culturally acceptable prevention interventions for all students, and
in particular for those whose religious beliefs and/or gender limits their present
access to services and information.
60628 Islamic response to HIV/AIDS impact in Indonesia
Runizar Roesin. JL. Percetakan Negara No. 29, Jakarta 10560, Indonesia
Islam is the religion of the majority of Indonesians, therefore Islamic response
to HIV/AIDS impact is very important in the country, Since the first AIDS case
in Indonesia was reported from Bali in 1987, Islamic response to HIV/AIDS in
Indonesia has developed positively from very inappropriate at the very beginning
due to inappropriate perception on the impact of HIV/AIDS to currently proactive response. The proactive response is based on their better knowledge and
perception on HIV/AIDS.
Islam leaders in Indonesia already held two national workshops on HIV/AIDS.
The first one was held in Bandung in 1996 and the second one was held in
Jakarta in 1997. Among the most important results of the workshops were Islamic
guidelines on HIV/AIDS and PLWHA.
The guidelines do not only emphasize on anti: discrimination, stigmatization
and isolation of PLWHA strongly but also on the prime importance of the role
of religious leaders in making National AIDS Programme a successful one. This
year the first workshop of Islam leaders in ASEAN region on HIV/AIDS will be
held in June 98.
S60629 Counselling on STD, HIV and AIDS: A challenge for
health workers
Sandra Lucia Filgueiras', S.F.D. Deslandes2, R.C.B. Brant1, M.C.P. Pimenta'.
'Brazilian AIDS and STD Program MOH; Brasilia DF: SQN 407 Bloco L. AP 207
70855-120 Brasilia, DF; 2FundaCao Oswaldo Cruz-MOH, Rio De Janeiro, RJ.
Brazil
Issue: In Brazil, the conception of counselling work on STD, HIV and AIDS in
public health services is often underestimated. In order to promote an effective
impact of this work it is necessary to evaluate the quality of the service offered to
the population.
Project: An evaluation of counselling activities developed by Centers for anonymous HIV/AIDS testing and treatment services was conducted by the National
AIDS Program in 1997. It focused on the health professionals and clients perceptions, of the quality of the service provided aiming at the necessary adjustment in
order to promote improvement in the quality of the service offered. The methodology used was a qualitative evaluation.51 interviews were performed with 25
clients and 26 health professionals; 10 focus groups with health staff and field
work; observation of 12 group counselling sessions, and, 43 individual counselling
sessions at 10 health services in 4 different regions of Brazil.
Results: (i) Organization of the counselling on STD and HIV/AIDS process
in the Public Health services routine. (ii) Development of continuing education
project in counselling for health professionals. (iii) Promotion of new evaluative
researches about counselling experiences.
Lessons Learned: Effective listening and communication skills are necessary

in order to stimulate clients' free expression of feelings, thoughts, and needs
related to health issues. This is necessary in order to reach a trustful client-professional relationship and important for the client to internalize information and
adopt safer sexual behavior.