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

1148 Abstracts 60802-60806

12th World AIDS Conference

Conclusion: Strep pneumoniae and salmonellae are the classical community
acquired bacteremias in AIDS patients: The former in non-Ethiopian and the latter
in Ethiopian patients. All other bacteremias reflect the distribution of pathogens
causing nosocomial bacteremia in immunosupressed patients. These features
should determine empirical antibiotic therapy in AIDS patients.
60802 Multi-level community participation: Script development
and approval process for a teen-oriented radio soap
opera
Joan Clayton-Davis. Nashville PM/, 1219 9th Avenue North, Nashville,
Tennessee 37208, USA
Issue: Managing the inclusion of several levels of HIV prevention related community input and approval requires development of effective process systems.
Project: The Nashville Prevention Marketing Initiative (PMI) developed an
HIV prevention, teen-oriented radio soap opera targeting 12-15 year old African
American youth living in low income housing as part of a social marketing demonstration project sponsored by the Centers for Disease Control and Prevention
(CDC). Major tasks included development of key messages and a script for the
radio soap opera and gaining community approval prior to studio production of
cassettes or compact disk for use by radio stations. Final script approval included
seven level of approval obtained from the radio soap opera head writer, youth
advisory team, site-based staff, lead agency staff, steering committee, community
review panel from the state public health department, and the CDC. With input
from each group, a system was created to achieve final approval of 4-13 episodes
of the script within two weeks. The system included the use of overnight mail,
e-mail, facsimile transmission, teleconferencing, and written documents.
Results: The script approval process has been very successful with each
review group responding with comments and giving final approval of 4 to 13
episodes of the script within two weeks. The process has increase community
input and gives a broader base of community support to the program.
Lessons Learned: Community input and approval that involves the target
group and broader community requires a great deal of effort and planning in order
to gain community support for HIV prevention efforts that target younger teens.
60803 Sexually transmitted diseases in victims of rape the
experience at St. Gabriel's hospital in Malawi
Dickman Zimba1, C.Q. Nyirenda2, 0. Kaluwa3. 1Lilongwe Central Hospital PO
Box 149 Lilongwe; 2JSI-Stafh Project Lilongwe; 3AIDS Secretariat Lilongwe,
Malawi
Objective: To determine the risk of acquisition of sexually transmitted diseases
by victims of rape.
Method: The risk of acquiring a sexually transmitted disease as a result of rape
is not known, in part becuase it is difficult to ascertain whether infections were
present before the assault or were acquired during it. To investigate this question,
we examined female victims of rape within 72 hours of the assult and at least one
week after the assault.
Results: Of the thirty girls and women intially examined within 72 hours of
rape, 12/30 (40%) were found to have at least one sexually transmitted disease.
These diseases included infections caused by Niesseria gonorrhoeae (10% of
those tested), Trachomonas vaginalis (11%), Treponema pallidam (8%), herpes
simplex virus (2%) and HIV-1 (9%).
Among the 15 patients (60%) who returned for at least a follow-up visit (excluding those who were found infected at the first visit or who were treated
prophylactically), the incidence of new disease was as follows:
Gonorrhoeae (10%), Trichomoniasis (20%), Herpes simplex virus (5%). There
were no new infections with treponema pallidam or HIV-1 but follow-up serologic
testing was performed in only 30% of the patients.
On the basis of our assumptions that most veneral infections present within
72 hours of the rape were pre-existing and that new infections identified 1 to 20
weeks later were acquired during the assault, we conclude that the prevalence of
pre-existing sexually transmitted diseases is high in victims of rape and that they
have a lower but substantial additional risk of acquiring such diseases as a result
of the assult.
60804 1 Research on possible treatments of HIV-associated
cognitive impairment
Benedetto Vitiello. NIHM-Office on AIDS-5600 Fishers LN. Rockville MD 20857,
USA
Objectives: To present and discuss recent research on possible efficacy of
pharmacological agents in the treatment of HIV positive patients suffering from
cognitive impairment.
Design: Randomized, controlled clinical studies with adequate prospective
assessment of cognitive functions.
Methods: A review of recently (last 2 years) completed trials aimed at evaluat
ing the potential benefits of medication for patients with HIV-associated cognitive
impairment.
Results: A placebo-controlled study of two doses of nimodipine (90 mg/day and
300 mg/day p.o.) for 16 weeks in 49 patients with HIV-associated dementia has
been completed. Also because of the small sample size, no statistically significant
drug effect was detected. A larger trial has compared peptide T (6 mg/day intranasally) to placebo for 6 months in 214 non-depressed patients with evidence of

milder cognitive deficits on a comprehensive battery of neuro-psychological tests.
On the primary outcome measure, a global score of neurocognitive performance,
there was no statistically significant difference between the two treatment arms.
Subgroup analyses suggested a possible effect in patients with relatively spared
immunologic function. A phase III multi-site trial is currently in progress, comparing the NMDA-receptor blocker memantine (10-40 mg/day p.o.) to placebo for
16 weeks in a projected sample of 120 patients with HIV-associated dementia.
In addition, systematic assessments of the possible effects of new antiretroviral
therapies on cognitive impairment have started.
Conclusions: Besides the published existing data in support of the short-term
efficacy of zidovudine, there is still no specific treatment for patients with HIVassociated cognitive impairment. Ongoing research is testing specific hypotheses
and is likely to clarify the possible therapeutic value of certain neuroprotective
agents and antiretrovirals.
60805 Predictors of viral load response in triple therapy with
protease inhibitor (PI) in HIV infected patients
Jean L.V.C. Meynard1, L. Morand-Joubert, M. Guiguet2, A. Rachline1,
N. Boukli1, M.C. Meyohas1. 1 Hpital Saint-Antoine, Paris; INSERM U444, 75012
Paris, France
Objective: As many factors may be involved in therapeutic response to triple
therapy with PI, the aim of this study was to determine the influence of epidemiological factors (sex, risk factors), clinical status (previous number of AIDS defining
events), immunological status (baseline CD4 T cell count), virological factor
(baseline viral load), previous antiretroviral therapy and duration of AZT therapy
(> ou < 6 months), number of prescribed reverse transcriptase inhibitors (RTI),
therapeutic strategic (switch to different RTI or only addition of PI) and compliance,
on early virological response (M2) after initiation of triple therapy with PI.
Methods: These results concerned 167 patients treated with triple therapy
including PI. A viral load response was defined in three types: complete response
(undetectable: <500 copies/ml) for 100 patients; partial response (significant decrease: >0.5 log from baseline) for 30 patients and no response for 37 patients.
Results: Only two parameters were associated of good virological response:
no previous antiretroviral therapy (p < 0.001) and good compliance (p < 0.001).
No significant difference was observed between patients with no prior therapy and
pretreated patients, in terms of median baseline CD4 count and observance. The
baseline median viral load was higher in naive patients despite a better response.
In pretreated patients, the type of response appeared to be dependent on the
duration of AZT treatement (p = 0.06) and good compliance (p = 0.06). Among
the 100 patients with initial complete response, only 23/81 were still undetectable
after a median of 13 months of therapy.
Conclusion: No prior antiretroviral therapy and good compliance seems to be
major parameters for better efficacy of triple therapy with protease inhibitor.
S608061 Practical outcomes of hepatitis B and C virus (HBV, HCV)
during HIV infection
Michelle Bentata-Pessayre1, A. Mosnier1, P. Berlurean1, J.P. Pathe1, F. Le Gal2,
P. Soussan2. 1Sida Unit, Avicenne Hospital, 125 Rte. de Stalingrad, 93009
Bobigny Cedex; 2Laboratory of Virology, Avicenne Hospital, Bobigny 93009,
France
Objectives: To evaluate the incidence, complications, intricacies and feasibility
of specific therapy during HBV, HCV and HIV co-infection.
Methods: During the period 95-97, HBV and HCV serologies were screened
up in 381 HIV+ patients (p) in a monocentric cohort. HCV-RNA and HBV-DNA
were performed in positive p.44% of them were IDU, 19% heterosexuals, 14%
homosexuals, 19% Africans or Caribbeans and 1% contaminated by blood or
derived products. Med CD4 cell count was 169/pl (0-1180) and <200 in 216
(37%). Med plasmatic HIV-RNA was 32000 copies/ml (0-2106) before treatment
and became undetectable in 163 p/230 (71%) treated with protease inhibitors (PI)
(50%) or with only nucleoside analogues (NA) (50%). Mental disturbance was
present in 53% of all our p, alcoholism in 33% and active drug abuse in 25%.
Results: 43% of all the p were HCV+ (84% in IDU, 11% in heterosexuals, 5%
in homosexuals, 6% in Africans-Caribbeans) and 80% of them were HCV-RNA+.
70% of all the p were HBV+ (87% in IDU, 34% in heterosexuals, 69% in homosexuals and Africans-Caribbeans) but only 11% of them were Ag HBs+ and 4.5%
HBV-DNA+. 37% of all the p were HCV and HBV+ (77% of IDU and <5% in the
other groups) and 81% of them were HCV-RNA+ and only 3% HBV-DNA+. 22p
had cirrhosis due to alcohol (13), HBV (2), HCV (6). No difference in HCV-RNA
could be seen between untreated and treated patients, receiving NA or PI combination therapy, neither between HCV+ or HCV and HBV+ patients, nor in patients
with or without detectable HIV-RNA. Med ALAT were 50 U/I in HCV+, 35 in HBV+,
73 in HCV and HBV+, and 34 in HCV and HBV-. ALAT were significatively
higher in HCV+ p undergoing NA or PI combination therapy. During the follow-up,
49 p (13%) died, 36 (73%) of their HIV infection and 4 (8%) of posthepatitic
cirrhosis. 7p underwent IFN therapy but 4 stopped because of intolerance and/or
inefficacy. Right now, we have only 5p, without alcoholism, drug addiction or

mental disturbance, who are eligible for IFN therapy.
Conclusions: In HIV infection, HCV co-infection is prominent in IDU, most often associated with HBV, but only HCV is replicated. Under antiretroviral therapy,
with or without PI, the ALAT are higher and HCV replication is not modified. An
undetectable viral load doesn't influence the HCV replication. Finally, very few
patients are eligible for INF therapy, which might change the global outcome of
such patients.