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

1120 Abstracts 60652-60656

12th World AIDS Conference

in the culture supernatant fluid was measured by titration on HFF cells. HIV-1 p24
antigen was detected by enzyme linked immunosorbent assay (ELISA).
Results: The two TSCDs compounds, showed inhibitory effect on CMV antigens production, at non cytotoxic concentrations. The first derivative at 8 pg/ml
inhibited CMV antigens and infectious CMV synthesis in 93% and in 92% of
infected HFF cells respectively. In HOS-HXG cells, at 2 pLg/ml, it inhibited CMV
antigens and infectious CMV synthesis in 67% and in 80% of infected cells
respectively. The second derivative showed less efficient inhibitory effect on CMV
antigens production. The two compounds, at the same concentration which inhibited CMV replication, had no inhibitory effect on HIV-1 p24 antigen level in
HOS-HXG cells. This may suggest that the HIV-1 p24 gene, in HOS-HXG cells,
behaves like a cellular and not as viral gene. The parental drug M-IBT, which
inhibited pox viruses, had no effect on CMV replication and HIV-1 p24 synthesis.
Conclusions: These TSCDs inhibited CMV replication, at a concentration
range which had no effect on cell growth. Further studies are needed in order to
establish the TSCDs as anti-CMV drugs for treatment.
S60652 Genetic characterization of viral quasispecies in blood
and cervical secretions of HIV-1 and HIV-2 infected
women
Jean-Louis Sankale1, S. Mboup2, M.E. Essex1, P.J. Kanki1. 1Harvard AIDS
Institute Laboratories, 651 Huntington Ave., Boston, MA, USA; 2Universite
Cheikh Anta Diop, Dakar, Senegal
Objectives: To determine the viral shedding in genital secretions of HIV-2 and
HIV-1 infected individuals and characterize the viral quasispecies in the blood
and genital secretions for both viruses.
Methods: We evaluated 25 HIV-2 infected and 11 HIV-1 infected female sexworkers from Dakar, Senegal. We amplified and sequenced multiple clones of the
C2-V3-C3 region of the surface envelope glycoprotein from cervical secretions
and PBMC samples from three HIV-2 infected individuals, and the C2-V3 region
from four HIV-1 infected individuals.
Results: The prevalence of viral shedding in genital secretions was 16% and
36.4% for HIV-2 and HIV-1 infected women respectively. A phylogenetic analysis
showed that in most cases the viral sequences from blood and genital secretions
were intermingled and subclusters were not discerned according to sample site.
However, in one individual, a clearly distinct quasispecies was observed in the
two sites. The average nucleotide distance was similar in both genital secretions
and blood, as was the distance between sequences from the two sites. This
seems to indicate that virus present in cervical secretions was similar to viruses
in the blood in the C2-V3 region.
Conclusion: Viral genital shedding is more common in HIV-1 than in HIV-2
infected individuals which may explain the lower transmission rates of HIV-2. We
found inconsistent viral compartmentalization between blood and genital secretions suggesting that preferential transmission of HIV variants may be due to
multiple factors.
606531 Acting on clinical trials - The experience of AIDS
organizations
Janine Barbot. Cermes-182 BD de la Villette 75019 Paris, France
Objective: This work is part of wider research into ways of mobilising organizations with regard to the clinical research into, and the distribution of new
molecules. It has two bases: 1 - AIDS activists are presented within research and
marketing organisations, with, in particular, the creation of areas for discussion
with both the pharmaceutical industry and with public agencies. 2 - This mobilisation is part of a framework in which promotion through the media of questions
relating to biomedical research is particularly strong. Subjects that are therefore
often debated during meetings between specialists and associations, and in the
press too, are the ways in which clinical trials are organised, and the conditions
under which patients should have access to new molecules before they have
been registered. The objective here, is to analyse, from a sociological point of
view, the action of organizations fighting against AIDS, with regard to the running
of clinical trials.
Methodology and Main Results: It first refers to past work, and briefly describes how TRT5 was created (TRT5 is an french interassociative group which
defends the interests of persons suffering from HIV in clinical research). The
organisation of meetings, in 1993, between associative militants, methodologists
and clinicians to discuss trial protocols with the support of the Agence Nationale
de Recherche sur le Sida (ANRS) is an original experiment in France. Using
a series of ethnographic observations made between 1994 and 1997, the work
analyses the way in which, during these meetings, associations took position on
the methodology of controlled trials based on criteria of clinical effectiveness. It
makes a detailed analysis of the associative work done on this occasion on the
information and consent sheets aimed at patients.
This work assesses the effect on associative mobilisation of current evolution
with regard to carrying out trials: the use of viral load as predictive markers of
clinical effectiveness, and the wider access, outside trials, to molecules that are

both more numerous and more effective.

S60654 Bridging the gap between need and resources in rural
communities: A train the trainers program in Kentucky
Laura Kaplan. Katec 915 South Limestone Lexington Kentucky 40503-9824,
USA
Issue: Kentucky has the fourth fastest growing HIV infection rate in the US.
Characteristics of marginalized communities such as poverty, isolation, and inaccessible, limited health and social resources are shared by Kentucky and South
Africa's Northern Province. Until recent epidemiological reports, people believed
HIV was an urban problem. A shift in services to these marginalized areas must
now take place to prevent further crisis.
Project: Provides health caregivers in rural communities access to current
information, filling resource gaps The Kentucky AIDS Training and Education
Center's Train the Trainers program bridges the gap between rural need and rural
resources. Community health workers learn medical; psychosocial; prevention
methodology and rationale; legal and ethical issues; and presentation strategies.
Indigenous workers train providers and consumers in their communities, becoming catalysts for collaborative projects. This expertise is being transferred to rural
South Africa. Researchers bring skills from both nations so communities own
resources to meet their needs.
Results: More than 200 trained health care professionals are providing
HIV/AIDS information and education classes in Kentucky's 120 mostly rural
counties. Kentucky has legislative and licensing requirements for HIV/AIDS education for health care professionals and facilities. The team of researchers and
community health workers will adapt the materials to their community needs.
Lessons Learned: Educating health care providers in rural areas is cost effective. Bringing programs to communities is not working. Training people to build
their own programs does work. Myths are built on lack of information. Accurate
HIV information debunks these myths and strengthens communities efforts to
prevent infection and provide treatment.
60655 Mixed cryoglobulinemia in HIV-1 infected patients: A role
for HIV-1 in cryoglobulin formation
Theodore Kordossis1 2, Antonios N. Dimitrakopoulos2, A. Hatzakis3,
H.M. Moutsopoulos2. 175 Mikras Asias Street Athens 11527; 2Dept of
Pathophysiology, Medical School Athens; 3Dept. of Hygiene-Epidemiology
Medical School Athens, Greece
Objectives: To investigate the prevalence of mixed cryoglobulinemia (MC) in
HIV-1-infected patients and the possible pathogenetic role of HIV-1 in the formation of cryoglobulins (Cryo).
Methods: Eighty nine concecutive patients with HIV infection (74 males and
15 females, mean age 35.5 years) at various stages of disease were evaluated
for the presence of Cryo. The amount of Cryo was measured by ultaviolet absorption at 280 nm and 260 nm and the type of Cryo was identified by agarose
gel electrophoresis, combined with immunofixation. Sera from all patients were
evaluated for CD4 counts, HIV-1 RNA levels, Hepatitis C virus (HCV) antibodies,
and C3, C4. Cryoprecipitates were examined for antibodies to HIV-1 and HCV,
and for HIV-1 RNA and HCV RNA sequences by RT-PCR. Complete clinical data
for all patients was available.
Results: Cryo (type II an d ) was detected in 24 HIV-infected patients (27%).
Among the study population patients, HCV infection was identified in 11, and 6
of them were Cryo-positive (54%). Prevalence of Cryo was statistically significant
higher in HCV-positive HIV-infected patients than in HCV-negative patients (p =
0.02). Precence of Cryo was not statistically significant correlated to the stage of
HIV-illness, AIDS status, CD4 cell counts and introduction of antiretroviral treatment. HIV-1 RNA levels were significantly higher in the Cryo-positive patients
(mean ~ SD 57.7 x 103 ~ 63.8 x 103 copies/ml) than in Cryo-negative (mean ~
SD 33.3 x 103 64.7 x 103 copies/ml), (p = 0.001). Anti-HIV and HIV-1 RNA were
detected in all cryoprecipitates examined.
Conclusion: MC is frequently found in HIV-1 infection and it seems that HIV-1
per se plays an important role in the formation of cryoglobulins.
60656 | Care of drug users with HIV followed by GPs: Results of
the SPESUB cohort study of maintenance treatment with
high dosage buprenorphine
Anne Duburcq1, Y. Charpak1, P. Blin1, M.P. Martin2. 1Eval-75 Rue Du Faubourg
Saint Antoine 75011 Paris; 2Schering Plough Levallois Ferret, France
Background: In France, high dosage buprenorphine (Subutex'") was officially
available in February 1996 for the maintenance treatment of major opioid addiction. A prospective cohort was initiated in order to assess patient outcomes: rate
of retention in treatment, drug use, IV injection and social situation evolution.
Methods: 101 GPs (general practitioners), known to be involved in drug user
management, had to include the first 10 opioid drug addict patients with a prescription of high dosage buprenorphine. Patients were followed during one year.
This study was an opportunity to assess care of drug users living with HIV and to
compare outcomes of maintenance treatment on this specific population to other

patients.
Results: Between April and July 1996, 919 patients were included, of whom
112 (12.2%) are living with HIV and 166 (18.1%) declared as "unknown status".
Comparing to patients without HIV, patients with HIV are older drug users, living
more often alone and without stable housing. GPs more often advise them to
consult a specialist of infectious problems. But, although they have more psychiatric problems than other patients, they are less referred by GPs to a psychiatrist,