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

1124 Abstracts 60672-60675

12th World AIDS Conference

lymphocytes CD4 count >200/mm3 and Group B (GB) with lymphocytes CD4 <
200/mm3. Sex, age and risk factors for HIV infection were registred. Complete
blood count, CD4/CD8 cells count, alanin transpherases ciphers were processed
at baseline, first month and every two months. Viral load (NASBA) was processed
at baseline and sixth month. Efficacy was determinated by non developed of
clinical episodes indicatives of AIDS and increase in CD4 cells count >10%, and
decline in viral load <50%. The safety was determined by the presence or not of
gastrointestinal alterations.
Results: 80 patients were included: GA 43 (39 male, 4 female), GB 37 (33
male, 4 female). Age average: GA 37.9 ~ 7 years (25-60), GB 39.7 ~ 10 (25-66)
(NS). With AIDS diagnosis previous: GA 5 and GB 15 cases (p > 0.05). Time
therapy nucleoside previous: GA 44.5 ~ 25 mo (6-84); GB 37.9 ~ 23 mo (4-90).
One patient of GB developed lymphoma non-Hodgkin and died. GA any patient
developed AIDS or died (NS). Changes in CD4 cells count and viral load were
not significatives at sixth month in both groups: GA 327.5 ~ 72/mm3 (202-494)
to 345.2 ~ 116/mm3 (169-599); GB 112.3 ~ 57/mm3 (2-197) to 185.5 ~ 78/mm3
(18-310). GA 58.2 ~ 81 copies (1-360) to 44.7 ~ 76 copies (0-250) and GB 174
~ 212 copies (6-830) to 41 ~ 61 copies (2-260).
Conclusion: with the results, we consider that at sixth month of treatment with
Saquinavir, there are no significative difference between both groups, whenever
it is neccesary to continuer follow tip by to have better conclusion
S60672 Prevention among male prostitution in Paris
Ramzy Jaffan1, Erwin Abbeloos2. 1247 Rue de Belleville, 75019 Paris;
2Aides-lle-De-France, Paris, France
Issues: The current paper presents major vulnerability factors encountered in
a four year HIV prevention outreach project with male sex workers selling sex
to other men in inner Paris and evaluates current enpowerment strategies. Major new issues in HIV vulnerability reduction concern taking into account new
intra-european migration trends and the need to coordinate action against ineffective, repressive or discriminitory legislation.
Project: AIDES lie de France, a NGO, has been doing HIV outreach prevention
work since 1993 with male sex workers selling sex to other men. Intervention
objectives includes STD and HIV prevention and accessing health care, accomodation and social rights.
Results: 10 volunteers and a salaried prevention facilitor do twice a week
street interventions on foot or with a camping car and also propose individual
off the street follow up work, mainly for accessing health care and social rights.
Each friday evening, we reach about 50 up to 150 boys, and about 10 to 30 each
wednesday, at the Gare du Nord. Through the years, prostitution has changed
a lot: more occasionnal sex workers and less professionnal ones. Fortunatly
that we don't have only HIV workers we look after. The message we tried and
still try to communicate to the sex workers concerning HIV is well received,
even though there is always things to transmit more and more. Recent major
changes in intra-European migration patterns have brought large numbers of
economically disadvantaged Eastern Europeans, mainly Poles and Romanians,
onto the Parisian male sex market, upsetting traditional local market boundaries
between French nationals and North African or South American legal and illegal
immigrants. Although accessing these new populations can be problematic, the
gap between knowledge about HIV transmission and prevention remains a major
challenge. Client and sex worker ambiguity about <<real>> sexual orientation
makes outreach prevention work particularly delicate. Low self esteem, social
stigmatisation and repressive police action are major vulnerability factors with
regard to HIV in this population.
Vulnerability reduction strategies include respectively individual and group support and discussion and negotiation with local authorities, public and private
enterprises and police. Active political campaigning to modify discriminatory
health access legislation for illegal immigrants and to change French anti-brothel
laws whose only result has been to throw male sex workers back onto the streets,
railways stations and public parks has become the principal issue in local HIV
vulnerability reduction strategy.
60673 Talking about the body: Small-group interventions and
women's barrier methods for reducing risk of STD/HIV in
women in southern France
Erica Gollubt12, M. Savouillan3, G. Coruble4. 114 Rue Dieude; 3Movement
Fracais Pour Planing Familiale; 4Drass-Bouches Du Rhone, Marseille, France;
2Columbia University, School Public Health, New York, NY USA
Issues: Teaching women how to use female barrier methods of protection, such
as the female condom, has demonstrated that increasing comfort and familiarity
with the body leads to a greater sense of self-esteem, a greater ability to negotiate
with a partner, and greater frequency of protected sex. The evidence suggests
that women of varied backgrounds can benefit from this kind of intervention.
Project: Up to 10 community groups, including Northern and Western African
immigrants, as well as European-born women, of various ages, are currently
being enrolled in a pilot program mounted by the AIDS division of the regional

health department in Marseille, France (DDASS, Bouches du Rhone). The program consists of five, 2-hour sessions of training and discussion on issues related
to the risks of HIV/STD infection for women, use of female barrier methods (such
as the female condom and vaginal spermicides, the diaphragm and cervical cap),
sexuality, negotiation of safer sex, contraception, abortion, menopause, cervical
and breast cancer screening, being HIV+, and speaking with daughters and sons
about sex, pleasure, risks. Each session is guided by a trained counselor, and

discussion is encouraged. Women are provided with free female barrier methods
as well as male condoms, and referred for other services.
Results: 17 of the first 18 women enrolled returned for at least a second
session. All these felt the sessions to be either too short or the right length, and
15 wanted the program to continue beyond the 5 sessions. Reactions to women's
methods of HIV/STD protection are very positive, with most women taking home
samples to try. Also evident from the discussions among the women is the disturbingly frequent experience of violence, forced sex, and lack of pleasure during
sex.
Lessons Learned: A notable lack of information exists among women regarding their risks of infection through sex. Women from varied backgrounds
show great enthusiasm for learning about and trying female barrier methods, in
the context of risk-reduction counseling, and for discussing a variety of intimate
issues in small groups. These groups appear to act as support groups, especially
regarding protection, and also to encourage openness and lack of shame when
speaking of the body.
S60674 Desensitisation vs. rechallenge in HIV patients with
hypersensitivity to trimethoprim-sulfamethoxazole
(TMP-SMX): Result of the CISAI study
Tiziana Quirino', P. Bonfantil, E. Di Cintio2, L. Pusterla3, A. Cagni4,
M. Libanore5, L. Zampini6, M. Franzetti7, G. Ghiselli8. 11st Dept. of Infect. Dis. L.
Sacco Hospital via GB Grassi 74-20157 Milan; 2Mario Negri Institute, Milan;
3Infect. Dis. Dept. S. Anna Hospital, Como; 4Infect. Dis. Dept. S. Gerardo
Hospital, Monza; 5Dept. Infect. Dis. Arcispedale S. Anna, Ferrara; 62nd Dept.
Infect. Dis. Sacco Hospital, Milan; 7Dept. Infect. Dis. S. Bortolo Hospital,
Vicenza; 8Dept. Infect. Diseases, Ciggiono, Italy
Objectives: to evaluate if desensitisation approach is more effective than rechallenge in HIV infected patients with hypersensitivity to TMP-SMX; to estimate the
incidence of reactions to TMP alone.
Design: Multicentre, open, randomized study
Methods: Patients with previous documented hypersensitivity to TMP-SMX
who required primary or secondary PCP prophylaxis; patients who had previously
had serious adverse reactions to TMP-SMX were excluded. All patients eligible
for the study assumed 200 mg. TMP for 14 days and in case of no reactions were
randomized for desensitisation or rechallenge with TMP-SMX. The patients were
then followed up by periodical visits for six months.
Results: A cohort of 68 patients were studied: 14 were identified with TMP
hypersensitivity (20.5%) and 54 were randomized. Thirty-one of the 54 patientis
were attributed desensitization (group A) and 23 rechallenge (group B). The two
groups were comparable for sex, age, CD4+ cell count and stage of the disease.
Hypersensitivity reactions have been observed in 6 patients (19.3%) from group
A and 13 (24%) from group B. The difference between the two groups, performed
by chi square test, is not significant.
Conclusions: The desensitization approach has not shown better efficacy as
compared to rechallenge. The frequency of reactions to trimethoprim alone is
20.5%. Among the 68 patients tested, 41 (60%) tolerated TMP-SMX at reintroduction. These data are important in that they show that it is advisable, in
patients who have presented mild to moderate hypersensitivity reactions, to readministrate the drug before considering alternative prophylactic regimens, without
desensitization.
60675 1 Chronic active hepatitis and liver cirrhosis are crucial
complication in long-term survivors of HIV infection
Francesca Moretti, Roberto Novati, G. Morsica, G. Poll, A. Lazzarin. Milan,
IRRCS S. Raffaele Infectious Diseases, Stamira D'Ancona 20, Italy
Background: 1- In Italy, more than 60% of patients acquire HIV by drug addiction and are coinfected with HBV/HCV. 2- In such patients liver cirrhosis and
hepato cellular carcinoma are usually precedent by AIDS and death. 3- In recent
years howerer, HIV infected patients with a very slow or absent immunological deterioration over more than 10 years have been decsribed and termed as
long-term-non-progressors (LTNP).
Aim of the Study: to analyze the prevalence of infection with HBV and HCV
and related diseases in a large cohort of LTNP.
Patients and Methods: 46 out of 1800 patients (2.6%) were classified as
LTNP; the mean period since first diagnosis of HIV infection was of 11.7 years.
They all had CD4 T cells >500/l, at eenrollment and were naives to antiretroviral
drugs: 79% of them were drugs addicts or previous d.a. Clinical and immunological follow-up was set every 3 months. HBV and HCV serology and viral load were
measured with commercial kits.
Results: numbers refer to percentage of positive patients:

HCV Ab
85.4

HCVRNA HBsAg/Ab HCVAb+ HbsAg+ HCVAb+ HbsAb+
74.2 15.4/48.7 14.3 34.3

Persistent ALT elevation was obseved in 64.4% of patients; to date, 12 of
them underwent the liver biopsy: a normal liver resulted in 2 pts, Chronic active
hepatitis (CAH) in 7 and cirrhosis in 3. Finally, mean HCV viremia was of 5.07 x
105 copies/mL.
Conclusions: 1. CAH and cirrhosis are the most relevant complications related
to long-term survivorship to HIV infection in patients coinfected with HBV/HCV. 2.
Data on LTNP likely predicts the scenario that is being observed, as antiretroviral
therapies will significantly prolog survival in high rates of HIV + pts. 3. Studies are