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

102 Abstracts 12444-12447

12th World AIDS Conference

PI. Patient-reported reasons for D/C of the initial PI included: nausea/vomiting
(47%), diarrhea (41%), abdominal pain (37%), weakness/fatigue (34%), muscle
pain (23%), weight loss (23%), treatment failure (19%) rash (19%), altered taste
(18%), skipping too many doses (18%), too many pills (11%), and kidney stones
(8%). There was no difference in patients who D/Ced PI treatment compared with
those who did not by gender, race, HIV risk, education, housing status, active
substance abuse, number of comorbidities, hepatitis, missing appointments, PI
beliefs (prolonging life, curing HIV, improving CD4 or viral load) or PI-related
education received. Pts who D/C PIs were older than those who did not (40.1 vs
37.2 years, p = 0.04), had HIV longer (6.0 vs 7.1 years, p = 0.1) and more likely
to use alternative therapies for side effects (43.5% vs 28%, p = 0.05).
Conclusions: Discontinuation of protease inhibitors is common in clinical practice, with pt-reported reasons most commonly gastrointestinal and systemic side
effects, and treatment failure. Older patients are more likely to D/C protease
inhibitors; otherwise those who discontinue PIs are demographically similar to
those who continue. Interventions to improve durability of PI treatment should
include side effect management. Analysis of HIV viral load, CD4 count and other
laboratory data is planned.
12444 1Quality of life before and during combination
antiretroviral treatment in antiretroviral-naive patients
with very advanced disease
Marco Floridia, Raffaella Bucciardini, C. Tomino, V. Fragola, D. Ricciarulli,
S. Vella, G. Gianini, C.M. Galluzzo. Instituto Speriore Di Sanita'- Lab. Virology,
Viale Regina Elena, 299 - Rome, Italy
Objective: To evaluate quality of life in previously untreated patients with AIDS or
CD4+ < 200/mm3 before starting and after 24 weeks of combination antiretroviral
treatment.
Design: Data from a phase II, double blind, randomized multicenter trial comparing AZT + ddl + nevirapine (NVP) with AZT + ddl + placebo were used. A
modified MOS-HIV 30 questionnaire was used, analyzing results at 0 and 24
weeks.
Results: 9 health scales were calculated: 1) Physical functioning (6 items); 2)
Bodily pain (2 items); 3) Vitality (4 items); 4) Physical role limitations (2 items); 5)
General health perception (5 items); 6) Cognitive functioning (4 items); 7) Health
distress (4 items); 8) Mental health (5 items); 9) Social functioning (1 item). The
numbers of patients with evaluable questionnaires at weeks 0 and 24 were 65
(AZT + ddl + NVP: 30, AZT + ddl: 35) and 42 (AZT + ddl + NVP: 21, AZT + ddl: 21),
respectively. The item validity in terms of internal consistency (item-intrascale)
and of discriminant validity (item-extrascale) was confirmed by appropriate values,
both at baseline and at 24 weeks, for the calculated item-internal consistency
and item-discriminant validity correlation coefficients. The intercorrelations among
scales was also checked. The quality of life values in all scales were identical at
baseline between the two treatments, increasing at 24 weeks in both groups, with
no differences between treatments at this point (Figures).

with HIV infection or AIDS evaluate the quality of the primary care they receive in
outpatient settings.
Methods: Audio taped focus groups and cognitive interviews were conducted
with 31 HIV-infected patients of a NYC multi-specialty outpatient practice. Focus
group recruitment was stratified to include patients with varying demographic and
economic backgrounds, disease stages, and length of time since HIV diagnosis.
Participants gave written informed consent and received a small honorarium for
participating in interviews.
Results: Focus group participants identified factors that determined their satisfaction with their primary care providers, told how satisfaction with care affected
their adherence to treatment regimens, and gave feedback on a brief, self-administered survey to assess satisfaction with their health care. Dissatisfaction was
linked to risk of developing viral resistance when patients missed doses of their
anti-retroviral medications due to miscommunication or missed appointments.
The following factors determined satisfaction with outpatient care (in order of importance to participants): (1) perceived provider competence, (2) communication
quality and clarity, (3) perceived compassion of clinician and staff, (4) willingness
of providers to involve patients in treatment decision-making, (5) adequacy of the
provider's referrals and, (6) how convenient the practice setting and procedures
were. The HTSS was revised based on focus group feedback and pilot tested in all
HIV-infected patients seen in the multi-specialty private outpatient practice during
the month of March, 1998 (approximately 400 HIV-infected outpatients seen per
month). Data from the pilot test will be presented to document its reliability and
validity of the HTSS.
Conclusions: Qualitative research found patient-provider relationships are
second only to perceived clinician competence in determining satisfaction with
care. Adherence to outpatient HIV treatments and their outcomes may be improved if providers understand and monitor quality of care by asking patients to
report their satisfaction with the care they receive. The HTSS promises to offer a
useful tool for routinely assessing satisfaction with outpatient HIV care.
12446 Changes in attitude regarding antiretroviral (AR) therapy
among HIV-infected persons in Harlem
Sharon Manheimer, V. Kuteyi, C. Minnifield, W. EI-Sadr, J. Hunt. Harlem
Hospital/Columbia University, 506 Lennox Ave. Room 3101 A New York, NY USA
Objectives: To compare the extent of antiretroviral (AR) use among HIV-infected
outpatients in Harlem in 1997 ('97) and 1995 ('95), and to evaluate for changes
in attitude regarding ARs.
Design: Patient surveys
Methods: Surveys were conducted by a nonphysician in '97 and '95 among
adult HIV-infected outpatients (pts) in Harlem. Follow-up survey was modified to
include questions regarding protease inhibitor (PI) therapy.
Results: Demographics were similar in '95 & '97 except that more pts in '97
reported heterosexual risk for HIV infection [P < 0.005, OR = 3.15 (1.45-6.88)]
and less reported injection drug use (IDU) as their HIV risk [P < 0.001, OR = 0.19
(0.08-0.45)]. Differences in AR use and attitudes are summarized below:

100
60
40
20 --
PF BP VT RP GH RE IIDMII SF
SBaseline:NVP+ddl+AZT Bosline:AZT+ddI
100 -40.................
4 0....................../.....................
2 0..............................................................
0
PF BP VT RP GH RE HDMH SF
- BHaellne:AZT-+ddl * Week 24AZLI +ddl

100
8 0................ r..,
---.,,,,-,. / --..../,0 -.........:.............
40 \
20 -0 -PF BP VT RP OH RE HDMH SF
SBaellne:NVP+ddI+AZT Week 24:NVP+ddl+AZT
100
80 -. '- / "
60 -40
20
0
PF BP VT RP GH RE HDMH SF
Week24AZT+ddl Week24:NVP+ddl+AZ

Variable
AR use
"I don't need any AR medications"
"AZT can kill you"
"I don't trust doctors"
"I am interested in holistic" treatments

1995, % 1997, %
40 83
52 16
51 31
36 8
68 48

1995 v. 1997, P
S0.001
<0.001
<0.05
<0.001
<0.05

OR (95%CI)
0.14 (0.06-0.34)
5.63 (2.29-14.13)
2.28 (1.04-5.05)
6.47 (2.11-21.19)
2.36 (1.08-5.15)

Conclusions: The observed increase in quality of life values for all the scales
considered may reflect a positive effect of treatment. This result, however, needs
to be carefully analyzed, examining drop-out patients (to exclude the possibility
of a selection bias) and single items possibly responsible for changes in the scale
values. The similar changes observed for the two treatments do not suggest that a
more powerful and potentially more toxic regimen with three drugs has a negative
impact in terms of quality of life compared to a two-drug regimen. Complete data
will be presented.
12445 Development of the HIV treatment satisfaction survey
(HTSS) to improve adherence and quality of outpatient
care
Jane Scott-Lennox1, J.F. Braun2, J.E. Morrow, K. Lawson2, R. Tirelli2,
D. Dietrich2, P. Hergenroeder2, S. Kreiswirth2, A. McMeeking2, M. Mullen2,
K. Weiz2. 12404 Western Park Lane Hillborough, NC; Outcomes Research
Associates, Inc. Hillsbotough, NC; 2Liberty Medical, LLP of New York City NY,
USA
Objectives: To develop and test a brief, self-report survey to monitor how people

In '95, gay men [p < 0.05, OR = 9.05 (0.91-218.9)] and pts with CD4 < 500
[p < 0.05, OR = 8.39 (0.96-189.91)] were more likely to use ARs, while African
Americans [p < 0.05, OR = 0.22 (0.05-.93)] were less likely. These factors were
not significant in '97. The mean number of ARs was 1.3 (range, 1-3) in '95 &
2.6 (1-4) in '97. PI use was 71% in '97 & more likely in men [p < 0.05, OR =
3.54 (1.07-12.07)] & pts with CD4 < 500 [p < 0.05, OR = 4.0 (1.00-16.67)]. In
'97, 67% of pts agreed that new developments in HIV therapies made them more
eager to try ARs.
Conclusions: There were significant changes in AR use and patient attitude
toward HIV treatments and providers from 1995 to 1997. This may be related to
recent advances in antiretroviral therapies. Though diminished in 1997, there is
still a significant bias against AZT (zidovudine) in the Harlem community.
S12447 | Results of a clinical outreach to HIV infected individuals
living in SRO hotels
Karyn London1, Debbie Indyk1, J. Clark2, S. Stancliff3, A. Lee1, S. Nardi. 1Mount
Sinai Medical Center, Box 1045, 19 E 98 st., New York, NY 10029; 2Cornell
Medical School, New York, NY; 3AIDS Institute, New York, NY, USA
Objective: To assess the unmet needs of a population of actively drug using
persons living in congregate settings for homeless persons with AIDS who are
served there by a needle exchange program (NEP).
Design: A convenient sample.
Methods: In November 1996, in conjunction with offering influenza vaccinations
on-site to residents of three upper Manhattan SRO hotels serviced by CitiWide
NEP, a needs assessment survey was conducted to determine the history of
medical care utilization in the prior three months, and knowledge and acceptance of HIV-related prevention and treatment medications, by actively drug using
PWHIV/AIDS residents.
Results: Of 100 respondents who self-identified HIV positive, the overwhelming majority of whom have been given a prior AIDS diagnosis, 41% reported