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

1134 Abstracts 60722-60726

12th World AIDS Conference

Conclusion: In contrast to surrogate parameters, anergy is a direct and fundamental indicator of failure of the immune system. Contrary to prior reports of
a strong correlation of viral load to CD4+ cell number as prognostic indicators of
disease progression, there was only a weak correlation of these parameters in
this group of anergic patients.
=60722 Molecular epidemiology of HIV-1 in Maputo, Mozambique
Susan Engelbrecht1, I. Koulinska2, T. Smith3, J. Barreto2, E.J. Van Rensburg4.
Department Medical Virology, PO Box 19063 Tygerberg; 3Tygerberg Hospital,
Cape Town; 4 University of Stellenbosch, Cape Town, South Africa; 2 National
Institute of Health, Maputo, Mozambique
Background: More than 20.8 million people are living with HIV/AIDS in Sub-Saharan Africa, with Southern Africa the worst affected area on the African
continent. The envelope glycoprotein of HIV-1 is the most variable region of the
virus with the V3 loop, the third variable region, a major target of vaccine research.
No information on HIV-1 subtypes and V3 region sequences are available for
Mozambique.
Methods: Seven heterosexual patients from Maputo were tested for HIV using
both an enzyme immuno assay (EIA) and a V3 peptide EIA. DNA was isolated
from peripheral blood mononuclear cells (PBMCs) and the V3 region amplified
by polymerase chain reaction (PCR) to obtain a 300-bp product. PCR products
were directly sequenced. Nucleotide sequences were aligned by the CLUSTAL
V software program, together with reference sequences from the Los Alamos
HIV sequence database. Distance calculation, tree construction methods and
bootstrap analysis were done with the TREECON software package.
Results: A deletion and amino acid substitution in the sequence from a patient whose serum was non-reactive with the V3 peptide EIA was observed. The
tetrapeptide crown of the V3 loop was GPGQ for all sequences from Mozambique.
In the tree constructed using the neighbor joining method all the sequences from
Mozambique clustered with the C subtypes. According to this data, subtype C-like
V3 loop sequences predominate in Maputo.
Conclusions: Although subtype C sequences were detected in Maputo, it may
not reflect the HIV-1 genetic diversity in other provinces of the country. Large
epidemiological studies based on methods like V3 peptide serology and DNA
sequencing will facilitate subtyping of HIV in the other provinces of Mozambique.
F60723 Seroepidemiologic analysis regarding KSHV/HHV8
infection in populations from Uganda and Tunisia - High
and low risk African regions for HIV infection
Gaetano Giraldo1, E. Beth-Giraldo1, M.D.R. Ghrabi2, S.D.K. Sempala3,
B. Biryahwaho3, F.M. Buonaguro1, M. Monaco'. 'Instituto Nazionale Tumori
Fond. Pascale, Capella dei Cangiani Naples 1-80131, Italy; 2Centre IBN ZOHR,
Tunis, Tunisia; 3Uganda Virus Research Institute, Entebbe, Uganda
Objective: To establish antibody prevalences to HHV8 in a) patients wfth Kaposi's sarcoma, b) hospital populations and c) healthy populations with and
without known risk behaviour for HIV infection.
Methods: About 3100 serum samples from adult and juvenile populations
(bled 1985-87 and 1992-94) were analysed for HIV infection (ELISA, IIF and WB
confirmed). More than 2400 of them were tested for HHV8 antibody prevalence
by IIF with confirmation by immunoblot analysis using the TPA-stimulated BCBL-1
cell line, chronically infected by HHV8 (lytic antigen).
Results: Antibody prevalence to HHV8 in KS from Tunisian and Ugandan
patients revealed 92% seropositivity. While in Tunisia, the HHV8 seroprevalence
in 1090 sera tested was 4.7-19.9% (healthy adults without known risk behaviour
for HIV infection as compared to sex workers), the HIV-1 positivity was 0.3-0.9%,
respectively. In Uganda, a) urban hospital populations'sera were 17% positive to
HHV8 and 46% positive to HIV-1; coinfection of HHV8 and HIV-1 was observed
only in 8% of the patients. b) Rural healthy populations' HHV8 and HIV-1 seroprevalence was similar, ranging from 4-12% in juveniles and adults, respectively.
Double infection in juveniles was not observed while it occurred in 2% of the
adults tested.
Conclusion: The data a) confirm the specific serologic association of HHV8
with KS and b) demonstrate low HHV-8 antibody prevalences in Tunisian and
Ugandan populations, which identifies that HHV-8 is not an ubiquitous virus.
Supported by Ministero Italiano della Sanita (Ric. Corrente 1998); ICSC-World
Lab, Lausanne (MCD-2/7).
60724 | Experience in the restorative care of patients with
HIV/AIDS on a rehabilitation in-patient service
Herbert L. Thornhill, M. Rivera-lturbe, M.C. Labbe. 506 Lenox Ave, Harlem Lem
Hospital Center Dept. of Rehab. Med., Columbia University/Harlem Hospital,
New York, N.Y. 10037, USA
Issue: People living with HIV/AIDS who develop disabling physical impairments,
related or unrelated to HIV, may require comprehensive, interdisciplinary restora
tive care on a rehabilitation in-patient unit.
Project: We describe our experience in the restorative care of persons with disabling physical impairments and HIV/AIDS, on an urban accredited Rehabilitation
In-Patient Unit. The period extends from July 1985 through December 1997, covering most of the HIV-epidemic years. Admission criteria were the same as those
for other rehabilitation patients. Referrals came largely from the acute services of
this facility which serves a federally designated, health professional shortage and

medically underserved area, 67.5% African American and 23% Latino. Patients
received comprehensive restorative care from an interdisciplinary rehabilitation
team. We collected information on diagnostic categories according to impairment,
cause and relation to HIV infection. Additionally, we include HIV risk behavior,
alcohol and other drug use, functional change and survival.
Results: The population included thirty four (34) persons: twenty five (25)
males and nine (9) females. The overall mean age was 43 years: females, thirty
eight (38) and males, forty six (46). Sixteen (16): 10 males and 6 females had
AIDS, overall mean age 46. The most common impairments were non-traumatic
brain dysfunction and peripheral nerve disorders. Approximately one third of
the impairments were related to HIV disease. The most common risk behavior
was needle drug use (19 patients). Thirty (30) gave a history of drug use: 22
polydrug and 8 single drug. The Functional Independence Measure (FIM) was
used to measure overall functional change. The average change of plus 21 was
comparable to our non-HIV patients. Among the 18 who have died, average
time survived from discharge until death was 15 months for the AIDS patients
and 37 months for HIV patients without AIDS. Among those alive December
97, the AIDS patients had survived 12 months and those without AIDS, 42
months.
Lessons learned: An increasing number of such persons have been admitted
to this unit since July 1985. These persons with severely disabling impairments
showed measurable functional benefit from a patient-centered comprehensive
interdisciplinary rehabilitation program despite, in some cases, relatively short life
expectancies. More admissions can be expected with the decrease in the HIV
mortality rate and expected increase in chronicity. This experience suggests a
growing opportunity for providers to enable PLWA and disabilities to expand their
scope of independent living.
[60725 Life experience: "Thanks to God Joly Ngoya is still alive"
Ngoya Mpiana1, Kisi2, Binanga3. 1AMO-Congo 1290 AV Kasa-Vubu C/Bandal
BP 67 Kinshasa I Rep. Dem.; 2BDOM Kinshasa; 3 3" Csante Kinshasa, Congo
Objective: to show haw pratying and a psychological support can help people
living HIV to improve their life conditions.
History: JOLY NGOYA was maried in 1992 when she was 23 years old,in 1993
her husband died et left JOLY with a baby 1 year. Aged in 1994, abandonned
by her and his parents, NGOYA was adopted by a christian familly which tried
to initiate ngoya in praying and asking for help to god in 1997 when she was 28
years olds, NGOYA was engegd in AMO-Congo, a national NGO dealing with HIV
orphans, where she is in charge of making yourg people sensitive to AIDS and
HIV problem. Six months after she has been engaged, her baby died of AIDS.
Method: praying and believing deeply to GOD as the only solution to my HIV
problem.
Results: thanks to the prayer I have been able to:
- avoid suicide
- overcome the fear of being infected by HIV and to show to people my
seropositivity
- imply myself in AIDS control activities
- share my experience with other people living with HIV.
- Keep myself in a good health
Conclusion: praying has had a significacant impact on my life conditions.
60726 HIV risk characteristics for clients at a HIV counselling
and testing (CT) centre in Uganda
Mary Grace Alwano Edyegu1, J. Kalule1, R. Mukasa1, C. Campbell2,
J.H. Namwebya1, F. Baryaramal, E. Marum3. 1AIDS Information Centre PO Box
10446, Kampala; 3CDC/USAID Kampala, Uganda; 2Centers for Disease Control
& Prevention Atlanta GA, USA
Background: The AIDS Information Centre has provided HIV counselling and
testing (CT) in Uganda since 1990 and over 350,000 clients have been served.
Data are collected routinely regarding demographics, sexual behavior and reasons for requesting for CT. The data collection tool was revised in May 1997.
Methods: Data on 11,188 clients who said they had never taken an HIV test
before, between July to Dec 1997 were analysed for seropositivity by various
characteristics, and four high risk factors identified.
Results: Of the 11,188 clients analysed, the clients at higher risk for HIV infection were: male >30 yrs or female age >25 yrs; no or primary education only;
coming alone for testing even when one has a sexual partner; and the following
reasons for requesting CT: client or client's partner feeling ill, having HIV or STD
symptoms, and risky behavior by client or client's partner (including having other
sexual partners and non-condom use). P-values for these characteristics were
each highly significant for both sexes. The seropositivity rates by number of risk
factors are below:

Numbers of Risk Factors

Overall

0 1

3 4

Male HIV+
Female HIV+

4.9% 6.9% 19.8% 39.5% 58.9% 18.9%
8.4% 10.6% 35.6% 52.8% 61.7% 30.0%

Conclusions: Older age, lower education level, testing individually when one
has a sex partner, and reporting high risk reasons when requesting an HIV test
were good predictors for seropositivity; six in ten clients with all the four risk
factors were HIV positive. Such methods to identify clients at high risk of being
infected could help target these individuals for counselling and testing services.