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

1146 Abstracts 60790-60795

12th World AIDS Conference

60790 Changes in CD8 lymphocyte subset counts at different
ages among HIV-1 perinatally and postnatally infected
Kenyan children
Joanne Embree1, J.J. Bwayo2, S. Njenga2, N.J.D. Nagelkerke1,
J.O. Ndinya-Achola2, F.A. Plummer'. 1 Dept. of Medical Microbiology, University
of Manitoba, 730 William Ave., Winnipeg, MB, Canada; 2University of Nairobi,
Nairobi, Kenya
Background and Objective: To describe the changes in CD8 subset counts over
time in relation to the timing of HIV-1 transmission in African children not receiving
antiretroviral therapy.
Methods: CD8 subsets were measured and compared in HIV-1 perinatally,
postnatally and uninfected cohorts of children enrolled to HIV-1 seropositive
mothers and infants of seronegative mothers followed in The Nairobi Mother to
Child HIV-1 Transmission/Pediatric AIDS Study.
Results: CD8 subsets were determined on >1 occasion for 77 perinatally,
38 postnatally, 398 uninfected and 366 control children and the mean values
are presented in the graph. Mean CD8 counts were significantly (p <.0001)
higher among perinatally infected children compared with controls and uninfected
children at all ages and higher than postnatally infected children until 4 years of
age. Postnatally infected children had higher counts compared with controls after
2 years of age (p <.01).
Conclusion: Perinatally infected children respond immediately to HIV-1 infection with a sustained CD8 response. In contrast, the response of postnatally
infected.,children is both less immediate and less dramatic, likely reflecting differences in immune system maturity at the time of initial HIV-1 infection.
60791 Preliminary data of a pilot study comparing two protease
inhibitor (PI) regimens (d4T + 3TC + IDV vs. d4T + RTV +
SQV) in pre-treated patients
Miguel Santin, E. Consiglio, D. Podzamczer, F. Gudiol. Infectious Diseases
Service, C.U.S. de Bellvitge, Barcelona, Spain
Objective: To compare the efficacy and safety of two HAART regimens, one of
them containing a combination of Ritonavir (RTV)+ Saquinavir (SQV), in PI-naive
patients.
Design: Open-label prospective and comparative pilot study.
Methods: Patients with at least 3-month prior experience with nucleoside analogues (NA) other than d4T and 3TC, naive for PIs, and HIV-RNA (VL) >1000
copies/mL were randomized to receive d4T + 3TC + indinavir (IDV) (IDV group)
or d4T + ritonavir (RTV) + saquinavir (SQV) (RTV/SQV group). Usual doses of
NA and IDV, and RTV 400 mg b.i.d. - SQV 400 mg b.i.d. were used.
Results: Twenty-five patients, 12 in IDV group and 13 in RTV/SQV group were
enrolled. Mean age was 36 years and 19 were male. HIV risk factors were drug
abuse in 15, heterosexual contact in 6, and homosexual practice in 4 patients.
Mean plasma VL and CD4+ at baseline were 3.89 + 0.57 and 340 ~ 161
cells/mm3, respectively. There were no differences between both groups in terms
of demographic, clinical, immunological status and VL. We present follow-up
analysis data of 21 patients. Mean change of VL at 4 weeks was -1.0 log in the
IDV group and -0.93 log in the RTV/SQV group, and at 12 weeks, -0.81 log
and -1.07 log, respectively. After a mean follow-up of 89 days, 8/10 in the IDV
and 8/8 in the RTV/SQV groups achieved VL < 500 copies/mL (bDNA, level of
detection). Five out of 11 patients and 3 out of 10 discontinued the assigned initial
treatment in IDV and RTV/SQV regimens, respectively.
Conclusions: Our data suggest that both PI regimens are similar in efficacy
and safety. Follow-up will be actualized at the time of presentation.
S60792 Traditional media and HIV/AIDS prevention
George Kampango. Media and AIDS Society in Malawi (MASO), Private Bag
136 Lilongwe, Lilongwe, Malawi
The impact of the media in Malawi has been limited in the rural areas where
the majority of the people are not accessible to major media channels. Even
where the radio and newspapers are available, Malawi is beset by a very low
rate of literacy* which makes it difficult for people to read the newspapers and
understand radio information sufficiently.
The Media and AIDS Society in Malawi (MASO), therefore, used the people's
own traditional dances by organising Village Cultural Festivals which for time
immemorial Malawians have used to convey various kinds of messages.
Traditional media is rick, dynamic and more effective in HIV/AIDS message
dissemination. While it is expeditious, it is a sustainable strategy with a wider
scope of attraction and entertainment, essential in reaching out to all sectors of
the community and advocate for behavioral change.
S60793 Psychiatric and psychological consultations for
HIV-infected patients: Who, how, why?

Pierre Polomeni', A. Tellier2, Rey Camet2. 'Centre Hospitalier E. Roux 95600
Eubonne; Chiem 2Eaubonne, France
Background: Many studies have underlined the necessity to integrate the psychical aspects in the following of HIV-infected patients. They have shown positive
effects of psychological approachs, evaluated on several criteria (compliance,
reduction of depressive symptoms and anxiety, coping, social insertion, etc). In
France, a national study shows that HIV infected people have often an inadequate

response to their psychological and psychiatrist needs (Charmasson, 1995). We
examine the integration of a psychologist and a psychiatrist within a hospital care
team specialised on HIV infection and the effects of this model of organisation on
the patients' treatment.
Methods: We've analysed data concerning 141 patients (Jan/96 to Jan/98) in
order to establish: the frequence of the psychological and psychiatric consultations, determinant factors leading to these consultations, psychiatric diagnosis
and socio-cultural characteristics of these patients. We've tried to determine
correlations between these criteria, psychological support and the adherence to
medical treatment.
Results: We've noted that 34% of patients consult a psychologist or a psychiatrist (n = 48) as a result of a member of specialised care team's advices
(physician, nurse or social worker). The reasons of these advices are: difficulties to come to medical consultations, to take medical treatment, to carry out
professionnal activities, sleep or nutritional troubles, etc. In most of the cases,
these problems are linked to depressive states. 22% of the patients consultating
the psychologist have also seen the psychiatrist. The follow-up of drug users is
made in collaboration with a specialised center to facilitate the prescription of
buprenorphine. We note that psychological support leads to a better compliance.
Conclusion: Our experience allows to assert the interest of psychological and
psychiatrist consultations in order to improve medical compliance and quality
of life of HIV patients. We observe that the presence of a psychologist and a
psychiatrist within the medical team facilitates the accomplishment of medical
advices leading patients to apply for psychological support. Further studies can
decline this organisation's model of psychological and psychiatric intervention to
other pathologies.
60794 Modulation of human blood-brain barrier endothelial cell
receptors by HIV
Ronald Unger', Jens Oltrogge', H. von Briesen', S. Deckert', N. Bratzke2
SGeorg-Speyer-Haus Paul-Ehrlich-Str. 42-44, 60596 Frankfurt; 2University
Medical Center, Frankfurt, Germany
Background: HIV can be found in the central nervous system. The role that
human brain capillary endothelial cells (HBCEC) play in the process of HIV
passage through the blood-brain barrier (BBB) is unknown. One hypothesis is
that HIV is carried into the CNS by infected monocytes that migrate from the
blood into the brain. Migration of monocytes from the blood into the surrounding
tissue is a multi-step process in which interactions of adhesion molecules on
endothelial cells and their ligands on monocytes are crucial. Another hypothesis
is that HBCEC are target cells in vivo that can be infected directly by HIV resulting
in the release of infectious particles into the brain parenchyma or disruption of
the BBB. In order to elucidate how HIV gains entrance to the brain, we have
examined the effects of infection by HIV and interaction with HIV-infected cells on
the expression of various HBCEC adhesion molecules.
Methods: Freshly isolated HBCEC in early passage (2-5) were subjected to
various stimuli and assayed for infection by HIV and the expression of adhesion
molecule- and chemokine-receptors. Infection by HIV and changes in the expression of these receptors was analyzed by semi-quantitative reverse transcriptase
PCR.
Results: HBCEC are not easily infected by HIV; little or no replication of HIV
took place, although a low level of infection could be demonstrated in some cases.
In the presence of LPS, cell-free HIV or cell-associated HIV-infected cells, the
gene expression of adhesion molecules E-Selectin and VCAM-1 was upregulated
on HBCEC. Detection of or changes in HIV-1 co-receptor expression (chemokine
receptors, CCR3, CCR5, CXCR4) was not observed.
Conclusions: HIV alone or HIV-infected cells can strongly influence the expression of adhesion molecule expression on cultured human brain endothelial cells.
The absence of infection of HBCEC by HIV, the lack expression of chemokinereceptors known to serve as coreceptors for HIV-infection of blood cells and
the induction of adhesion molecule expression on HBCEC strongly supports the
"Trojan horse" theory of HIV entrance to the brain via HIV-infected monocytes.
S60795 Replication potential of HIV-1 in human
monocytes/macrophages depending on maturation
conditions
Reinhardt Andreesen1, Hagen Von Briesen2, V. Eisert2, M. Kreutz3,
H. Rubsamen-Waigmann4. 1 University Of Regensburg, Dep. Hematology
D-93042 Regensburg; 2Georg-Speyer-Haus, Frankfurtimain; 3 University of
Regensburg, Regensburg; 4BayerAG, Wuppertal, Germany
Objectives: Human monocytes/macrophages (MO/MAC) were cultivated under
various maturation conditions. The susceptibility of these MO/MAC derived from
different donors was analyzed for HIV-1 infection as well as the capacity for virus
replication in vitro.
Methods: MO/MAC from healthy donors separated by adherence were cultivated either with 4% human AB serum (SER-MAC) or serumfree with 100 ng/ml
M-CSF (M-MAC) and infected with monocytotropic strain HIV-1D117111. Virus pro
duction was determined by p24 release or RT activity in the 24-hour supernatant
or by p24 immunostaining. Cells were characterized by FACS-analysis using mAb
against CD14, CD16, CD4a, HLA-DR, CPM/MAX.1, CKR3, CKR5, CXCR4. The
supernatants were monitored for the secretion of IL-6, TNFoo, RANTES, MIP-lou.
Results: Levels of CD4a, CD16, CKR5 and HLA-DR expression as well the cytokine production were not significantly different between SER-MAC and M-MAC.
M-MAC were less susceptible to HIV-1 infection with only 8 + 4% of all cells