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

12th World AIDS Conference

Abstracts 60676-60680 1125

needed to analyze a) the natural history of CAH and cirrhosis b) the incidence
of HCC c) the effects of INF therapy in long-term-survivos of HIV infection with
various degrees of immune deterioration.
60676An alternative model for support groups for health care
workers (HCW) involved in HIV infection
Dominique Meunier', Patrick Stoessel1, L. Ridel2, L. Tellier1. 1 c/o Association
Didier Seux 6, Rue De LAbbe-Gregoire 75006 Paris; 2Laboratoire De
Psychologie Clinique, Universite Paris 7, France
Issue: The purpose was to facilitate the access of HCW to opportunities for
reflection and clinical exchanges about their professional practice in a neutral and
appropriate setting. In the field of AIDS, many HCW have personal motivations
which go beyond the limits of their vocation as caregivers. Because of the identifications and projections with young patients, emotional involvment may become
overwhelming and thereby affect the quality of the caring relationship with a risk
of repercussions for the patients.
Project: The specificity of 'Association DIDIER SEUX Sante Mentale et Sida
(Mental Health and AIDS)', which was created in 1987, is to give space to HCW for
reflection on clinical, psychological, social and ethical aspects of HIV infection. It
is open to any professionals who, directly or not, deal whith HIV infection, weather
the practice has clinical implications or not, and to volunteers in associations for
patients. Since the beginning of HIV infection, the prevention of burn out among
HCW has been taken into account by the creation of support groups. But these
groups are not accessible to all categories of HCW and ignore difficulties linked
to the dynamics of the institution itself. In response, a specific process was set
up that included: a preliminary personal interview with a psychologist aimed at
defining the need, ten yearly group sessions run by a psychoanalyst and an
evaluation interview. It was complemented by a research and evaluation team
working from an analysis of the material of the sessions.
Results: We compared the results of one group of professional HCW with
one of volunteers. Despite differences in expressing personal, professional and
institutional issues, both groups emphazised institutional issues as the primary
source of distress. It is only when these issues have been dealt with that questions
concerning emotional implications within the caring relationship can emerge.
Lessons Learned: Because the groups occurred in an external and neutral
setting offered by our association, the initial expression of institutionally-based
distress was made possible, thus facilitating the further emergence of emotional
and narcissistic issues and their analysis.
The new antiretroviral therapies brought up new issues such as the role of
'medical' versus 'relational' aspects of care, dealing with chronic disability or the
patients' perception of temporality.
60677 Study of the deaf population using the testing site for HIV
from October 1996 to December 1997, Hospital La
Salpetriere, Paris
Jean Dagron1, B.L. Boussard2, B.C. Bruneau1, G.F. Galiffet2, B.J. Blanchard2,
G.C. Gargoier2, M.B. Moncelle3. 1 Hpital La Salpetriere Service Pr. Herson
67Bd de I'H6pital 75013, Paris; 2Sources Paris; 3FNSF Paris, France
This study is based on a questionnaire given to every deaf person using the
testing site. 126 deaf person responded. This study cannot be considered as
a representative sample, but still shows some specific aspects concerning the
deaf population. It represents approx. 2% of the deaf population living around
Paris (5-7000). Sexual orientation: 38 homosexuals or bisexuals of 126 = 33%
Compared to 6095 tests in the general population during 9 month in 1996, 447
homosexuals and 342 bisexuals = 13%.
Differences in the use of health care services: For a large majority of heterosexuals it was their first test. All homosexual men had already had at least one test
during the previous 6 months, 30 of the 126 persons (23%) had seen a medical
doctor, among them only one heterosexual man out of 34.
Differences in the choice of partners among deaf: 47 persons (37%) declare
having a regular partner.
Heterosexual men have deaf partners (regular or occasional) on the contrary
homosexuals have mostly hearing partners. 75% heterosexual women live with
deaf partners, but 50% have occasional sexual contact with hearing persons.
The reality of high-risk situations for HIV transmission among the deaf (1) a
multipartnership (31% of the sample) without automatic condom usage (50%of
multipartners and 16% of all); (2) HIV infected partners were mentioned for 6
homosexual or bisexual men on 34 (5%); (3) 8% declared being exposed directly
or indirectly to injecting drug users (IDUs). 4 men and 1 woman mentioned being
IDUs, 6 heterosexual women mentioned sexual practices with IDU's partners.
The creation of a medical service in sign language in January 1995 showed
that: The difficult access to health care for the heterosexual population where
the epidemic might start and develop on a specific profile in regards of sexual
practice mainly inside the community.
The need of specific support for homosexual men living with HIV infected

partners.
This study can help deaf associations to adapt prevention programs to the
specific risk situations for HIV transmission among the deaf.

60678 | Short-term efficacy and safety of ddl and 3TC both once
daily plus indinavir bid
Juan Gonzalez-Lakoz1, V. Soriano2, R. Rodriguez-Rosado2. 1Service Infectious
Diseases, ISC-III Calle/Sinesio Delgado 10; 2/nstituto Salud Carlos III, Madrid.
Spain
Background: expectations after introduction of new antiretroviral agents, mainly
triple drug combinations including protease inhibitors have turned hope to both
HIV+ patients and their clinicians. However, toxicity and compliance of regimens
including many pills, and with different schedules, have emerged as the most
issues limiting the expected benefits of anti-HIV therapy in the real life. In this
regard, choosing the less toxic and the best well tolerated drug combination has
became crucial, and is the only way to assure maintenance of viral suppression.
Patients and Methods: we analyze the immunologic and virologic outcome at
6 weeks of 32 individuals who began a triple combination of drugs with doses
optimized for assuring good compliance. Considering the prolonged intracellular
half-life of active metabolites of ddl and 3TC, these drugs were administered once
daily, and indinavir was administered twice daily. Patients choose schedules at
their convenience, avoiding mixing indinavir and ddl together.
Results: 26 (81%) were naive. Mean age was 35.5 years-old. 24 (75%) were
male. Risk group: 14 (44%) were IDUs, 12 (37%) were homosexuals, and 6
(19%) had acquired HIV through heterosexual contact. Mean plasma viral load
at baseline was 70,080 cop/ml, although 3 of them had undetectable levels of
viremia. After one month of therapy, only 3 patients remained with HIV-RNA
copies above the limit of detection of the assay. On average, CD4 counts raised
more than twice. Two patients developed toxicity (jaundice, and abdominal pain),
but only one required to withdrawn therapy.
Conclusion: The combination of ddl and 3TC both once daily plus indinavir
bid is well tolerated and seems to favor a good level of adherence. In respect
to efficacy, 29/32 (91%) of patients achieved undetectable levels of viremia after
one month of began therapy.
S60679 Usefulness of the new NASBA ultrasensitive assay
(Nuclisens) for quantifying HIV-1 plasma viral load
Carmen de Mendoza1, M. Gomez-Cano2, V. Soriano2, J. Gonzalez-Lahoz2.
1Service Infectious Diseases, ISC-III, Calle Sinesio Delgado 10, 28029 Nadrid,
2lnstituto Salud Carlos III, Madrid, Spain
Background: to analyze the performance of Nuclisens (Organon), an ultrasensitive method for the quantitation of HIV viral load, based on the NASBA technology.
The detection limit of this new assay is 20-25 cop/ml.
Patients and Methods: viral load was quantified by Nuclisens in plasma
collected from 142 patients who had undetectable values of viremia using the
2nd generation bDNA assay (limit of detection: 500 cop/ml). Patients could be
classified in a group without drug therapy (long-term nonprogressors, LTNP; and
naive recent seroconvertors), and pre-treated individuals (with mono- or bitherapy
with nucleoside analogues; and HAART, with triple or quadruple combinations
including protease inhibitors).
Results: Overall, 96 (67.6%) patients had positive results by Nuclisens despite
yielding undetectable levels of viremia by the bDNA. Unexpectedly, 51 (53.1%)
of positive samples by Nuclisens had values above 3-fold ( 1,500 cop/ml) using
the bDNA detection limit.

Total LTNP Naive ZDV- Nucleoside Triple
mono combo combo
No. of subjects 142 8 14 15 13 83
Nuclisens+ 96 6 14 9 9 54
Range 38- 150- 36- 240- 35 -8,000 58,000 6,600 11,000 75,000
Nuclisens -3-fold bNNA 51 3 9 3 5 29

Quadruple
combo
9
4
180 -6,400
2

Conclusions: 2/3 of patients with undetectable viremia by bDNA have detectable HIV-RNA using Nuclisens. Patients without therapy (either LTNP or
naive) tend to be Nuclisens positive more frequently (20/22) than those under
treatment (76/120) (p = 0.01). Unexpected high values of viremia reported by
Nuclisens could be attributed to the presence of non-B HIV-1 subtypes in 8 cases,
or hypothetically to a lower expression of pol versus gag sequences (which are
target for bDNA and NASBA probes, respectively) in the remaining subjects.
60680 1 Compartmentalization of HIV in patients having
sustained response to ZDV monotherapy
Maria Gomez-Cano, Maxte Perez-Oldeda, Vicente Soriano,
Juan Gonzalez-Lahoz. Service Infectious Diseases, ISC-III, Calle Sinesio
Delgado 10, 28029 Madrid, Spain
Background: Some individuals seem to persistently benefit from ongoing ZDV
monotherapy, without immunological deterioration or clinical progression for long
periods of time. Despite monotherapy no longer being recommended, these subjects are worthy of interest because they might yield important information on the
factors associated with nonprogression during antiviral treatment.
Patients: In a previous report (AIDS 1996; 10:1741) we described a group of 44
patients from an initial group of 280 who had CD4 counts above baseline values,
after being treated with ZDV for -2 years. At present, a total of 15 subjects
(5.4%) of the original population still remain on ZDV monotherapy, and show
undetectable levels of viremia using the 2nd generation bDNA assay (detection
limit, 500 cop/ml).