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

12th World AIDS Conference

Abstracts 60717-60721 1133

phylaxis with clarithromycin 500 mg once daily. Blood cultures for MAC were
performed at two to four month intervals, Viral Loads every three months and Cd4
counts every four months.
Results: A total of 20 patients (16 males, 4 females) were followed for a mean
of 11 months (range 8 to 14 months). Mean baseline CD4 cell counts 74/uL
(range 10 to 142/uL). During the observation period all patients were maintained
on dual reverse transcriptase inhibitor therapy with one or two protease inhibitors.
As indicated by negative blood culture, no patient developed a MAC infection. No
patient died during the observation period. This group of patients were compared
to another group of 39 patients treated with clarithromi-cin 500 mg twice daily for
36 months, during this period no patients developed MAC infection.
Conclusion: Results from this preliminary analysis suggest that clarithromycin
500 mg once daily was as effective as 500 mg twice daily for MAC prophylaxis
for those patients receiving therapies containing protease inhibitiors. Protease
inhibitors do increase blood levels of clarithromycin, allowing a lower dosage
for MAC prophylaxis and improving the patients' compliance. No patient in their
groups developed MAC.
60717 Autopsy findings in long-term survivors with perinatal
HIV
Virginia Anderson. SUNY Health Science Ctr. at Brooklyn, 450 Clarkson Avenue,
Box #25 Brooklyn, NY 11203, USA
Issue: In utero HIV infection destroys the immune system before it can develop
and death in infants is frequent. Exposure to HIV during parturition stimulates
a lymphoproliferation in the bronchial and GI mucosa. These children have a
lower viral load, are relatively asymptomatic, attend school and do not develop
encephalopathy or opportunistic infection. Subclinical cases may be identified in
late childhood or early adolescence. A late onset means a slow progression with
a better prognosis for both morbidity and mortality.
Results: Autopsies performed on eight cases in the pre-protease era show enlarged lymph nodes and spleen depleted of follicles and T or B cells. The atrophic
thymus has Hassall bodies with a hyalinized microenvironment. Sparse visceral
lymphoid aggregates are variably present in the lung, gut, salivary glands, liver,
kidney, etc. This burnt out lymphoproliferative syndrome promotes overwhelming
infection. Pseudomonas sepsis, MAI, CMV, PML, chronic varicella (LPS), cryptococcoses has occurred in youth with perinatal HIV disease. HIV cardiomyopathy,
nephropathy and vasculopathy increase with age.
Lessons Learned: The unique natural history of late onset perinatal HIV disease likely results from intrapartum HIV exposure provides limited protection from
opportunistic infection during a phase of B cell lymphoproliferation. Exhaustion of
the immune response eventually results in infection or lymphoma. Traces of LPS
can be seen at autopsy.
S60718 1 EUROVIHTA - Development of a new concept for
secondary and tertiary prevention and creation of a
network of therapists in Europe
Luis Carlos Escobar Pinzon, J. Bock, D. Riener, M. Hautzinger.
Johannes-Gutenberg UniversitPt, Psychologisches Institut, Abteilung Klinische
Psychologie Staudinger Weg 9 D-55099 Mainz; 2AIDS-Hilfe Frankfurt a.M.e.V.
Frankfurt a.M.; 3Eberhard Karls Universit#t TObingen, Germany
Issue: A new concept for group programs for people with HIV/AIDS is developed,
evaluated and disseminated in most affected regions in D, E, F, I & P. Through
a network of European therapists the cooperation between non-governmental
organisations (NGO's) and Universities in the European countries is enhanced.
Project: The multicentric, European Research Project EUROVIHTA is carried
out by the Universitat TObingen and the Universitat Mainz. The cooperation partners are: AIDS-Hilfe Frankfurt a.M. e.V.; AIDS-Hilfe Stuttgart e.V.; Comite Ciutada
de Lluita contra la SIDA, Barcelona; COGAM, Madrid; Hospital Clinic i Provincial,
Barcelona; Liga Portugesa de Luta Contra a Sida, Lissboa; PARSEC, Roma;
and Universite R. Descartes, Paris V. The organisations meet and communicate
regularly to ensure the exchange of expertise. EUROVIHTA is cofinanced by
the European Commission, Section Public Health DG V/F/2. This is the largest
European controlled therapy study for psychological group programs.
The sample contains about 200 persons with HIV/AIDS from different subgroups, e.g homo- and heterosexual persons, ex/drug users. Physical symptoms,
psychological variables, medical therapy, surrogate markers and viral load are
controled to evalute the effect of the program. Indications for the subgroups, for
the different European regions as regards cultural differences, and for patients
undergoing anti-retroviral therapy are developed on the basis of new experience
gathered by the therapists. Evaluated therapy manuals in all languages are
published.
Results: Scientific findings concerning psychotherapy groups for people with
HIV/AIDS, in combination with the experience of therapists in most affected cities
and countries in the E.U, help create a widely applicable concept for therapy
groups. The networking of European organisations and the training of therapists helps to multiplicate the findings. Basing on this a cooporative project with

developing countries will be carried out.
Lessons learned: The cooperation helps to professionalise the NOG's, especially through the sharing of scientific results and practical experiences. The
economic and efficient concept for secondary and tertiary prevention contains
important findings for the work with various subgroups. The new concept helps
to enhance the quality of life for people with HIV/AIDS.

60719 Evaluation of HIV/AIDS prevention program among the
students, youth and adolescents at Makerere University
in Uganda
Suleiman Kasirye, S.S. Sentumbwe, N.D.R. Nakkazi. Center for Peace
Research, PO. Box 12785, Kampala, Uganda
Objective: To evaluate the on going HIV/AIDS prevention program udertaken by
Makerere university AIDS Control Association.
Methods: A total of n = 243 respondents M = 71.6% F = 28.4% were enrolled
in a cross sectional non descriptive study using a multistage random sampling
technique. Data collection was done using self administered questionnaire quantitatively and qualitatively by carrying out a series of focus group discussions.
Results: Generally almost all students had good knowledge about HIV/AIDS,
say causes, signs and symptoms. 61%reported to be sexually active with an
average of 2-4 sex partners with the the last one year, of these 91% reported to
have started sex between 13-24 years of age. STD prevalance was reported ly
high and the percieved risk factors included financial constraints Alcohol abuse
peer group influences redundancy and social c cultural beliefs.
Despite HIV/AIDS awareness there still existed risky behavior practice among
the University community that permitted con continued Disease transmission and
condom use was reportedly very low.
S60720 Setting up a geographic information systems (GIS) for
"FOSI", AIDS forum of NGOs in Democratic Republic of
Congo
Louis Ilunga Kalubi1, Konde M. Kader1, Henri Mukumbi2, Eric Mukaku3,
Zola Ngindu4, Arsene Binanga5, Saidi Misangu6. 'Projet PNUD/OMS-SIDA c/o
OMS RDC B.P. 1899 Kinshasa I A48, chaussee de Kimwenza Q. Kauka
Kinshasa/Kalamu; 2Forum Sida "FOSI" Kinshasa; 3Amo-Congo, Kinshasa;
4BDOM, Kinshasa; 53 C Sante, Kinshasa; 6SWAA-Congo, Kinshasa, Dem. Rep.
of Congo
Objectives: Puts in room one tools of management, of follow-up and of assessment for all NGOs of the platform AIDS, "FOSI" of the Democratic Republic of
Congo (DRC), to coordinate activities of struggle against the AIDS in the different
domains, in a first time takes in charge and the sensitization.
Design: From a data base and a mapping software, combined the information
pertaining to the activities of struggle against the AIDS with other informations
such areas action of NGOs to creat a comprehensive representation of the AIDS
situation of a community, health district or nation.
Methods:The use of GIS in health care and disease control is rapidly expanding. It offers a visual means to inter-relate situation analysis and programme
intervention monitoring across sectors. It also help different NGOs of "FOSI" to
spatially relate the multiple efforts of various collaborating agencies to one another
and to specific problems, actions and outcomes such as taken in charge and
sensibilization. To constitute a data base of "FOSI", to constitute elements put up
to date by results of activities on lands of the NGOs of the platform, particularly
in the hold in charge and the sensitization. In a first phase, the setting up of
the data basis will begin with some NGOs s: AMO-CONGO, SWAA-CONGO,
FOUNDATION WOMAN MORE, BDOM, 3 C Health and ALPI+
Results: To Give back the more efficient platform while concentrating efforts
of the different NGOs and in adapting strategies of struggle against the AIDS
according to elements provide by this tool.
Conclusion: To have a comprehensive view can be invaluable as it clearly and
easily articulates the parameters of health issues informing policy-makers of the
level of infrastructure available to combat AIDS problems;
S60721 Comparison of number of CD4+ cells to number of viral
RNA copies in sera of anergic patients with HIV disease
Arthur Gottlieb1, C.H. Kern III', H. Park1, M.S. Gottlieb2. 1Dept. of Microbiology
& Immunology-Tulane 1430 Tulane AVE SL38, Tulane University School of
Medicine, New Orleans, LA; 2IMREG Inc, New Orleans, LA, USA
Objective: Since the delayed-type hypersensitivity skin test response, a functional measure of cellular immunity, is an independent predictor of progression to
AIDS (Blatt, et al. Annals of Int. Med. 49:177 (1993)), we sought to compare two
other predictors of disease progression, the number of CD4+ cells to the number
of copies of HIV RNA in sera of allergic patients with HIV Disease.
Methods: Frozen sera which had been collected from a series (n = 14) of HIV
positive, allergic, and symptomatic patients (CD4+ cell number 223-383/mm3)
all of whom represented that they had not received specific treatment for HIV and
who had not reached the stage of frank AIDS, were used to determine the number
of copies of viral RNA present using the Amplicor test (Roche). Measurements
of both CD4+ cell number and the number of viral RNA copies were performed
by independent laboratories. The correlation between the results of the Amplicor
assay on plasma and sera has been found to be high.
Results: In this group of anergic patients, the number of copies of viral RNA
per ml ranged from less than 400 (the sensitivity of the assay) to 254,735 per ml.

Only a weak correlation between the number of CD4+ cells and the number of
copies of viral RNA was noted: r = 0.44, p.- 0.05. Among the seven patients not
known to have received treatment for HIV during the six month period following
determination of these parameters, one patient (CD4+ cell count 247/mm3 and
viral load of 9848 copies/ml) progressed to AIDS (lymphoma) while the patient
with the highest viral load (254,735 copies/ml and CD4+ count of 242/mm3) did
not progress.