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

1130 Abstracts 60701-60705

12th World AIDS Conference

Conclusion: An international collaboration increases the possibilities of achieving the best results in the shortest period of time. As a volontary organisation,
based on the work of fulltime students, we face may difficulties. However, what
we do have is an enormous motivation to work hard for our goals and to reach
them - together we can help!
60701 Combination therapy with nevirapine in treatment naive
and experienced patients
Celia Skinner, M. Murphy, M. Latzke, A. Chowdhucy, C. Aitken, J. Norman,
A. Pinching. Ambrose King centre Royal London Hospital London El IBB, St.
Bartholomew's Hospital London, UK
Aims: To assess the efficacy, safety and durability of response to nevirapine in
treatment naive and experienced patients.
Design: retrospective case-note review
Methods: Data was collected from on all patients receiving nevirapine as part
of the European named-patient programme in two inner London hospitals.
Results: 91 patients have received nevirapine, 37 (41%) were treatment naive.
Baseline characteristics include mean age 36 years (range 24-63), male 79
(87%), homosexual 72 (79%) and 54 (59%) of patients were CDC stages A or B.
76 (73%) patients continue treatment and have received therapy for a mean of 15
weeks. 15 (17%) patients have discontinued nevirapine and 12 of these patients
withdrew because of treatment limiting toxicity: rash (4), hepatitis (2) and nausea
(3) and other (3).

Median CD4 cells/mm3
(range)
Median HIV RNA (log10)
(range)
% undetectable (. 400 Roche Amplicor PCR)

Pre-treatment Week 12-16 Week 16-24
n = 91 n = 34 n = 26
240 322 355
2-810 (33-870) (30-750)
4.8 2.8 2.6
(2.1-6.3) (2.1-5.9) (1.9-5.5)
52% 58%

Conclusions: These preliminary results show that within a clinical setting nevirapine in combination with a variety of antiretroviral agents is well tolerated and
produces sustained and significant reductions in viral load in both treatment naive
and treatment experienced patients. Further data will be presented.
60702 Virological and immunological characterization of
HIV-infected non-progressors with high virus load
Josef Schneider, M. Bauer, M. Plass, R. Weis, S. Weiner, J.A. Rump,
A. Meyerhans. Hermann-Herder-STR. 11 D-79104 Freiburg Germany1 Dept.
Virology University Freiburg Freiburg Germany2 Dept Clin. Immunology Univers.
Freiburg Freiburg, Germany
Objectives: To understand the virological and immunological mechanisms underlying an exceptional slow progression of the disease in two patients with a
continuously high HIV-1 load.
Design: Longitudinal and cross-sectional comparison of virological and immunological parameters of the index patients with other infected persons and
uninfected individuals.
Methods: Virus core-antigen p24, CD4 cell counts, and lymphocyte CD markers were measured by established methods. Virus load was determined with the
bDNA assay (Chiron diagnostics) and virus was isolated by co-cultivation with
heterologous donor lymphocytes.
Results: Our patients were characterized by high antigenemia (400-800 /pg
p24/ml) lasting for more than 7 years and the lack of AIDS-defining symptoms.
The CD4 cell counts were in the range of 400-600//p blood with a decline of less
than 20 per year. A 100-1000-fold excess of soluble HIV antigen over HI-virus
RNA was found in the blood. Virus isolates were of the monocytotropic NSI-type
with a normal ratio of virus antigen to RNA. However, we observed a lower expression of the complement protection factors CD55 and CD59 and an excess of
perforin in CD4-positive T-cells as compared to uninfected individuals or patients
with a regular course of disease.
Conclusion: The present data suggest, that the CD4 T-cell pool can be stabile
in the presence of high virus turnover. The low expression of complement protection factors and the population of perforin expressing CD4 cells may contribute to
the rapid destruction of virus and/or virus-producing cells.
60703 Predictors of long-term virological and immunological
response to protease inhibitor therapy in HIV-infected
patients
Jose L. Casado, M.J. Perez-Elias, A. Antella, F. Dronda, P. Marti-Belda,
B. Frutos, C. Quereda. E. Infecciosas, Hospital Ramon Y Cajal, Cra. Colmenar
KM 91, 28034 Madrid, Spain
Background: To determine the long-term effectiveness and factors associated
to response after 1 year of protease inhibitor therapy in an unselected cohort of
HIV patients.
Methods: We prospectively studied 400 patients who started on saquinavir
(28%), ritonavir (26%), or indinavir therapy (46%) from March '96 to March '97.
Virological and immunological response were defined as HIV RNA level below
detectable limits (-200 copies/ml), and CD4 count increase greater than 100
cells/p L, respectively, after 1 year on therapy.

Results: Mean age was 36 years, and 69% were male. Most of the patients
were intravenous drug users (64%) as risk practice for HIV infection, and had
a prior AIDS-defining illness (54%). Ninety-five percent had received nucleoside
analogs previously. At entry, median CD4+ count was 84/tL and HIV RNA level
was 4.43 loglo copies/ml. In a logistic regression analysis, high HIV load at
baseline (RH, 1.65; p < 0.01), lower HIV RNA level decrease at the 3rd month
(RH, 0.47; p < 0.01), and use of saquinavir (RH, 1.19; p = 0.06) were associated
with lack of maximum response at 1 year. However, immunological response as
previously defined was strongly associated to lower CD4+ cell count at baseline,
and did not with HIV load. There was no strict correlation between maximum
virological response and immunologic benefit (r = 0.19, Spearman's test).
Conclusions: These data support the need for the most potent antiretroviral
therapy in patients with high initial HIV viral load, and underlines the importance
of early response in predicting outcome. Also, important immunological benefit
can be obtained from protease inhibitor therapy independently of HIV load.
|60704 Elderly HIV-infected patients in the era of protease
inhibitor therapy
Begoha Frutos, M.J. Perez-Elias, J.L. Casado, A. Antela, F. Dronda, J. Oliva,
R. Sabido. Department of Internal Medicine, Hospital Ramon Y Cajal, Madrid,
Spain
Background: Older HIV patients develop AIDS more rapidly and die more quickly
than younger persons, probably due to the inability of older persons to replace
functional T cells that are being destroyed.
Methods: We studied the virological, immunological, and clinical outcome of
27 HIV-infected patients aged 50 or greater who started on protease inhibitor
therapy from March '96 to March '97, in comparison to 373 young HIV adults
starting PI therapy at the same period.
Results: These 27 patients represented 5% of our cohort. There was a predominance of male (96%), and sexual contact as risk factor for HIV infection (78%).
At entry on saquinavir (26%), ritonavir (33%), or indinavir (41%) therapy, median
CD4+ cell count was 108/pL, and HIV RNA level was 4.39 logio copies/ml. A
previous AIDS-defining illness had been diagnosed in 52%, from a median time of
9 months, and they were heavily pretreated (96%). Compliance was considered
adequate in 82% of patients. On follow-up, CD4+ count increase and HIV load
decrease was similar to that found in younger patients, and no a higher incidence
of change of therapy due to intolerance or toxicity was found. Also, a low incidence
of opportunistic infections was found (7%). However, a trend to higher rate of
mortality was observed in this group of patients (7% vs 3%; p: 0.14).
Conclusions: In the era of protease inhibitor therapy, elderly patients are not
at highest risk of progression of the disease, and a marked immunological and
virological benefit is the rule. Therefore, age should not be considered as a
predictor of worse evolution and therapy must be warranted in these patients.
S60705| Innovative formative research using the WHO narrative
research method: The experience of the PSI/Romania
social marketing program
Dominique Meekers. 1120 19th Street, N. W Suite 600 Washington, DC 20036,
USA
Issue: To design effective AIDS prevention programs for adolescents, high quality
formative research is needed. Innovative formative research methods are needed
to obtained more detailed information about the social context that may affect
decision-making about sexual behavior and reproductive health.
Project: To learn about the social context in which youths form relationships
and make reproductive health decisions, a WHO narrative research workshop
was conducted with a group of Romanian youths. Through group discussions
youths identified a sequence of key events that commonly occur when youths
develop a sexual relationship; role plays were used to illustrate these events, and
to examine factors that may affect reproductive health decisions at various stages
in the relationship.
Results: The workshop indicates that peer influences are very important for
adolescents who are not yet sexually experienced, because couples often meet
through a go-between. Many parents have conservative atttitudes, try to control their children's sexual behavior, and have limited information about modern
contraceptives, which diminish parents-child interaction. Youths appear reluctant
to contact health professionals, and often make reproductive health decisions
without seeking advice from others. Hence, peer education and mass media
programs may have most potential for improving adolescent reproductive health.
Lessons Learned: The WHO Narrative Research Method is promising because it illustrates the contexts in which relationships develop and influences
on decision-making. Drawbacks are that implementation and analyses are difficult and relatively expensive. A supplementary narrative sample survey can
provide information about the prevalence and timing of various factors affection
reproductive health decisions.

60706 Genotypic characterization of HIV-1 isolated from AIDS
patients after prolonged therapy with Preveon " (adefovir
dipivoxil) added to existing regimens
Julie Cherrington, A.S. Mulato, P.D. Lamy, N.S. Margot. Gilead Sciences, 333
Lakeside Drive Foster City California 94404, USA
Background: Preveon'" (adefovir dipivoxil; bis-POM PMEA) is currently in clinical