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

1132 Abstracts 60712-60716

12th World AIDS Conference

figure out their similarities and defferences in terms of family matters, sex and sexual practices and other important issues concerning one or both partners. This
project includes health counsellors and a medically qualified OB-Gynecologist
who provide the help and services among PLWHIV/PWAs.
Results: This project has been able to help couples living with HIV/AIDS in
making firm and better decisions whether to raise a family or not and the possible
consequences of such decisions. Six (6) couples had adapted family planning
methods and seven (7) singles have been oriented in terms of reproductive health.
Lesson Learned: Reproductive Health is a very important issue in empowering
PLWHIV PWAs in making decision on their own where options are in hand and
given in terms of choices to be made by people living with HIV/AIDS.
60712 1 Professional men's attitude and risk perception of HIV in
Ghana
Anthony M. Sallar12, J. Azoh3. ic/o Snaps Preparatory Schools Box 1951 Accra,
Ghana; 2 University of British Columbia Vancouver BC; 3 University of Montreal,
Montreal PQ, Canada
Objective: To examine the attitude and reaction of the professional male urban
dweller toward the HIV epidemic and sexual risk (unprotected sexual intercourse
with multiple partners whose HIV status is not known).
Design: Unstructured, one-on-one in-depth interviews.
Methods: Professional men (N = 15) aged 34-41 were interviewed. The highest number of AIDS cases in Ghana is found in men within this age group.
These professionals all have a minimum of Bachelor's degree and are in private
businesses, accounting, law, engineering and in the civil service. They were
interviewed on AIDS knowledge and transmission, and what specific steps they
have taken to reduce their chances of infection.
Results: Findings suggest that even though AIDS knowledge and transmission
routes were very high, very few study participants took concrete steps to minimize
their risk. Participants believe their risk of contracting HIV remains very low as
long as they do not take new sexual partners and trusting that their current multiple partners remain faithful partners; or where there is a new sexual encounter
they use condom until they feel comfortable with the new partner. None of the
study participants had physically seen someone with full blown AIDS except a
television footage of someone with AIDS. They believe that experience might
drive the reality home to them. Most admitted the lack of condom use as a
preventive measure because condoms inhibit sexual pleasure.
Elsewhere in the African continent, being an urban dweller and a professional
was a risk factor for HIV infection. The same may apply to Ghana since HIV has
begun to diffuse into the population from the risk groups when the epidemic first
begun. There is an urgent need for AIDS education workshops in the workplace
with videos, and PWAs sharing with others how HIV has impacted on their lives
and that of others.
60713 Responsiveness and interpretation of patient reported
vision measures in cytomegalovirus retinitis and AIDS
Albert Wu3, B. Martin1, A. Gilpin1, D. Jabs2. 1Dept. of Epidemiology, 2Dept. of
Opthamology 3School of Hygiene, Room 633 - Johns Hopkins University, 624 N
Broadway, Baltimore, MD, USA
Objective: To validate and explain the meaning of vision-related-quality of life
(QOL vision) scales using results of vision testing in patients with CMV retinitis.
Design: Cross-sectional and longitudinal analyses of data from a randomized
clinical trial comparing intravenous foscarnet, ganciclovir, and combination treatment for relapsed CMV retinitis. Patients (N = 279) were recruited at 12 SOCA
sites.
Methods: QOL vision scales assessed visual symptoms, visual function, and
impact of treatment administration. Clinical measures included visual acuity, visual
field, and extent of retinal involvement. Responsiveness of QOL vision scales
to longitudinal changes in clinical measures were assessed by linear regression
using Generalized Estimating Equations.
Results: QOL vision scores decreased with greater abnormalities on ophthalmologic exam. Changes in visual function and visual symptoms were moderately
correlated (p < 0.01) with changes in clinical measures (visual acuity, visual field,
and extent of retinal involvement). Clinicians and patients may understand QOL
vision scores better if they are equated to vision testing results. For example,
an 11 point decrease on the visual function scale corresponded to the difference
between 20/20 vision and the point at which patients cannot drive legally without
eyeglasses.
Conclusions: Patient-reported measures of vision-related quality of life were
responsive to changes in vision in patients with AIDS-related CMV retinitis.
S60714 Saquinavir (SQV) in combination with ritonavir (RTV) and
d4T in patients with advanced HIV disease
Manuel Battegay1, E. Bernasconi2, M. Flepp3, P. Vernazza4, R. Malinverni5,
C. Jaccard6, S. Morgenthaler7, P. Erb1, B. Hirschel8. 1 University Hospital of

Basel, Petersgraben 4, 4031 Basel; 2Cantonal Hospital Lugano, 6900 Lugano;
3University Hospital of Zurich, 8091 Zurich; 4Cantonal Hospital of St Gallen, St
Gallen; 5University Hospital of Berne, 3010 Berne; 6University Hospital of
Lausanne, 1011 Lausanne; 7Roche Pharma Schweiz AG, 4153 Reinach;
8University Hospital of Geneva, 1211 Geneva, Switzerland
Objectives: The combination of SQV and RTV is almost universally effective

in patients (pts) with moderate or little immunosuppression (Cameron), but has
failed in heavily pretreated, immunosuppressed pts (Lorenzi et al. AIDS 1997).
The aim of this open label study was to evaluate the combination of SQV + RTV
+ d4T in pts with immunosuppression (CD4 count below 250 cells/t/l and a HIV-1
RNA level >10,000 copies/ml). Patients were not previously treated with d4T or
any protease inhibitor.
Methods: Treatment was initiated with SQV 600 mg bid in combination with RTV
400-600 mg bid (in a dose escalating manner) and d4T 30-40 mg bid. Changes
in CD4 cell count and plasma HIV-1 RNA load (Roche Amplicor HIV monitor kit;
limit of detection 200-400 copies/ml and ultrasensitive assay) was measured,
as well as signs of clinical and laboratory toxicity. In addition, pharmacokinetic
analyses of SQV and RTV were performed.
Results: A total of 64 patients received the study medication. At baseline,
these patients had a median CD4 cell count of 80 cells//tl (range 0-231) and
a median HIV-1 RNA load of more than 100,000 copies/ml. On an intention to
treat analyses 79% of patients had either a more than 100 fold decrease of viral
load and/or were below detection limit (62%). CD4 cell counts had also increased
by over 100 cells//pl after 9 weeks. SQV concentrations were highly elevated
(range 10-100 x) in pts in whom RTV was measurable. Adverse events were
experienced in less than 20% of pts (fatigue, nausea). Favorable responses were
seen in patients who reached six months so far.
Conclusion: These data indicate that this regimen achieves a highly potent
viral load response in a high percentage of patients with advanced HIV disease.
Follow-up data of all patients enrolled (at months 6 and 9) will be presented.
|60715 Biomolecular and phylogenetic characterization of
Ugandan HIV-1 variants for development of VLP-based
anti-HIV-1 vaccine
Luigi Buonaguro, F. Russo1, M.L. Tornesello1, E. Beth-Giraldo1,
F.M. Buonaguro1, G. Giraldo1. Viral Oncology - ' stituto Nazionale Tumori "Fond.
Pascale", Cappellacangiani, Naples, Italy
Objectives: The main goals of this study are: 1) to monitor the distribution of
HIV-1 clades and characterize the genetic variability of immunological relevant
proteins of HIV-1 isolates from African regions with high incidence of infection,
in particular Uganda; and 2) to develop a Virus Like Particles (VLPs)-based
anti-HIV-1 vaccine, specific for the African A and D clades.
Methods and Results: The prevalence of A and D HIV-1 clades has been
shown by us in a Northern region of Uganda (Gulu) (Buonaguro, L. et al., J. Virol.
69:7971-7981, 1995). The gp120 coding sequence, from one of the A-clade
isolates, has been subcloned and fully sequenced in order to characterize the
nucleotide divergence versus previously identified HIV-1 isolates. The V3 region
of this isolate shows a 90% homology with isolates of A-clade identified in the
1988-1994 period, whereas, the V4 region is characterized by a triplication of
a 45-nt long stretch which has not been reported before. Direct DNA sequence,
performed on selected regions of PCR uncloned products, has confirmed the
representativity of the cloned fragment (Buonaguro, L. et al., submitted). The high
sequence homology of the V3 region has suggested the use of this gpl20 ORF for
the development of a specific A-clade VLP, in a baculovirus system, currently in
progress in our Laboratory. Furthermore, the V3-V5 region of the HIV-1 env gene
has been analyzed, by HMA and sequencing analysis, in seropositive partners of
5 discordant couples, enrolled in a surveillance program carried out at the Ugandan Virus Research Institute (UVRI) in Entebbe (Southern Uganda). The results
indicate the concomitant distribution of the A and D clade in the HIV-1 epidemic
of this Country, even though the degree of genetic divergence is progressively
increasing in relation to the epidemic span itself.
Conclusions: The data reported by us, and confirmed by others, suggest that
the A and D clades are persistently predominant in the Ugandan as well as in the
African HIV-1 epidemic. However, the significant intercontinental migrations are
determining a progressive increase of non-B clades throughout the world, strongly
suggesting the need of anti-HIV-1 vaccines based on a cocktail of different clades.
In this respect, the VLP-based approach appears to be promising for the reported
safety and the efficient induction of both humoral and cellular immunity.
VLP Vaccine collaborative groups: M. Monaco, D. Mantas (INT, Napoli, Italy);
R. Wagner, H. Wolf (Univ. of Regensburg, Germany); B. Biryahwaho, R. Downing,
SDK Sempala (UVRI, Entebbe, Uganda). Supported by Ministero Italiano della
Sanitb (Ric. Corrente 1998), X Progetto AIDS-ISS (1998), and the ICSC-World
Lab, Lausanne (Project MCD-2/7).
S60716 MAC prophylaxis with clarithromycin 500 mg daily
Paola Greiger-Zanlungo1 2, Z. Carrey2, G. Blick3, U. Gnudi4, U. Hopkins2,
V. Ranga2, M. Sharfuddin2. 11333 Somerset Road, Teaneck, NJ 07666; 2Mt.
Vernon Hospital, Mt. Vernon, NY; 3Blick Medical Associates, Stamford, CT, USA;
40spedale S Orsala, Bologna, Italy
Background: Mycobacterium avium complex (MAC) still continues to be one of
the most common opportunistic infection in HIV-infected patients. The best treatment strategy of MAC is one of prophylaxis. Pierce, et al (NEJM 1996) compared

prophylactic administration of clarithromycin 500 mg twice daily with placebo in
patients with AIDS. MAC infection develop in 6% of clarithromycin and 16% of
placebo-treated patients, respectively.
Objective: To compare the effects of clarithromycin 500 mg once daily to that of
500 mg twice daily for MAC prophylaxis in patients with CD4 cell counts <150/uL
Methods: Adult patients with confirmed HIV infection and CD4 cell counts
<150/uL were eligible for study participation. All patients received MAC pro