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

1158 Abstracts 60860-60865

12th World AIDS Conference

least once in the year. Case definition for new TB and DMAC was always based
on culture isolation. Protease inhibitors (PI) were introduced in clinical standard
care at the Institute in January 1997.
Results: the yearly incidence of TB and DMAC over the observation period is
shown in the table

N subjects
TB n
TB rate %
DMAC n
DMAC rate %

1988
405
1
0.2
3
0.7

1989
464
10
2.2
4
0.9

1990
524
10
1.9
4
0.8

1991
566
6
1.1
10
1.8.

1992
622
8
1.3
6
1.0

1993
581
3
0.5
20
3.4

1994
637
4
0.6
20
3.1

1995
730
10
1.4
30
4.1

1996
812
6
0.7
29
3.6

1997
874
7
0.8
11
1.3

9/11 DMAC cases observed in 1997 occurred in the first semester. At the end of
1997 the proportion of subjects receiving no HIV therapy, bitherapy, and therapy
with 3 or more antiretroviral drugs including at least one PI was 26%, 25%, and
49%.
Comments: The incidence of DMAC presented a steadly increasing trend till
1996, and a sharp decline in 1997. The incidence of TB was stable throughout
the observation period. This uncontrolled study cannot demonstrate causal associations, however, the introduction of PI in clinical practice seems to determine a
dramatic decline in the incidence of DMAC.
608601 Prevalence of sexually transmitted infections including
HIV among sex workers in Kwazulu Natal midlands,
South Africa
Gita Ramjee1, S.S. Abdool Karim1, W. Sturm2. 1Medical Research Council, PO.
Box 17120, Congella, Durban 4000; 2Dept. Medical Microbiology, University of
Natal, Durban, South Africa
Objectives: The purpose of this study was to investigate the prevalence of sexually transmitted infections, including HIV among female sex workers operating at
truck stops in the KwaZulu-Natal Midlands of South Africa.
Methods: 145 sex workers were recruited from August 1996 to March 1997. A
gynaecological examination, including a speculum examination was performed.
Investigations were performed to identify N. gonorrhoeae, Syphilis, chlamydial
(infection), candidiasis, trichomoniasis, bacterial vaginosis and HIV infection.
Results: 50.3% of the sex workers were HIV positive. Infection with T vaginalis
was present in 41.3% of the women, C. albicans in 40.6%, N. gonorrhoeae in
14.3% and C. trachomatis in 16.4%. Bacterial vaginosis was present in 71% and
active syphilis in 42.1% of the women. Anal sex was associated with a higher risk
(odd ratio = 23; CI:1.1;4.7) of HIV infection.
Conclusion: The high prevalence of sexually transmitted infections, including
HIV clearly highlights the urgent need for interventions. In addition to empowering
women with methods they can use and control to reduce their risk of infection,
an effective approach to control of sexually transmitted infections also needs to
recognize the role of the clients, such as truck drivers, so that they also are
targeted for interventions.
60861 Risk denial among incarcerated women at high risk for
HIV
Brian Dickinsonl2, Patricia Affleck2, J.D. Rich2, M.M. Flynn2, H. Loewenthal2,
K. Flanigan2, K. Vigilante2. The Miriam Hospital, 164 Summit Ave. Providence,
RI; 2Brown University Providence, RI, USA
Objective: To describe discrepancies in HIV risk behavior and self-perceived HIV
risk of women enrolled in the Discharge Planning Program (DPP) at the Rhode
Island Adult Correctional Institution (ACI).
Methods: In 1992 the DPP was implemented at the ACI to help high risk
HIV negative women lower their risk of infection. We reviewed the discharge
planning questionnaires of sequentially incarcerated women in the DPP between
September 1993 and August 1995 to assess demographics and HIV risk behavior.
Results: 78 women were enrolled in the DPP during the study period. The
women were 47% white, 28% black, 18% Hispanic, and 6% Other. The mean
age was 31 (range 18-45). 29/78 (37%) women believed they were at risk for
HIV infection and 40/78 (51%) did not believe they were at risk. 43% of women
who identified themselves to be at risk for HIV traded sex for drugs and (17%)
traded sex for money (17%). 12/40 (30%) of these women were injection drug
users (IDUs) in the year prior to incarceration. 6/12 (50%) of these IDUs who did
not perceive themselves to be at risk for HIV infection reported needle sharing.
Further, 25/40 (63%) of the women who did not perceive themselves to be at risk
for HIV attended a class on HIV/AIDS.
Conclusion: Incarcerated HIV negative women with histories of drug or high
risk sexual behavior at the ACI are at high risk for HIV infection. Many women
are aware that their behavior is high risk; nevertheless, a substantial percentage
of high risk women do not perceive themselves to be at risk despite HIV/AIDS
education.

60863 First Cuban record of mucormycosis in a HIV infected
child
Ida Gonzalez1, M. Diaz Jidy2, A. Torres Gomez De Cadiz3, G. Martinez
Machin3, L.J. Perez Avila4. Autopista Novia Del Mediodia KM, 61/2 Lisa
mariano 13 Ciudad De La Habana; 2 nstituto Pedro Kouri, Ciudad Habana;
3Hospital Pediatrico Juan M. Marrves, Ciudad Habana; 4 Instituto Pedro Kouri,
Ciudad Habana, Cuba
Issue: Even through pulmonary mcormycosis is not commonly found in Cuba, it
is worth considering its incidence and test the patients for this disease.
Project: Given the increase of mycosis in immonodepreseed patients, the
mucormycosis among HIV/AIDS must be regarded as a possibility even through
it is not present regularly in some areas. However, this way be due to misleads
in diagnosis of die disease. The case presented is the first reported in Cuba in a
HIV/AIDS patient, that cured with Amphotericine B.
Results: The finding of cenocitic hyphas, the pathogenic agent of the disease,
characterises by 5-50 p, wide ramified to 90 and positive to silver-metenamine
coloration and Schiff in sputum and samples obtained from bronchial aspiration
confirmed the presumptive infection of mucormycosis.
Lesson learned: In a broncho-pulmonary disease of immunodepreseseed
patients, attention must be paid to the possibility of mycological infections.
60864 T cell HLA-DR surface expression as a surrogate marker
for HIV disease
Marcelo G. Marchetti 2, D. Bustos2, W.H. Belloso2, R. Quiros2, P. Saporiti2,
Y. Rivadulla2, A. Ascione2. 1Nueva York 3382, 1419 Buenos Aires; 2Hospital
Italiano De Buenos Aires, Argentina
In the search for new surrogate markers, T cell surface activation indicators such
as HLA-DR had been shown to increase throughout the course of HIV infection,
although its correlation with other markers is less established.
Objective: Evaluate the correlation of the expression of HLA-DR in T cells with
the absolute CD4+ count, CD4+ percentage in a group of HIV positive patients in
different stages of infection.
Method: Paired CD4+/HLA-DR evaluations were performed in HIV positive
patients in different stages of infection. CD4+ absolute count and CD4+ % were
either obtained with an Ortho Cytoron Absolute Flow Cytometer. T cell (CD3+)
count was obtained with FITC conjugate and HLA-DR was obtained with Phycoerythrin conjugate by two color immunofluorecence. Statistical analysis were
done with linear regression.
Results: 17 patients that had at least three paired CD4+/HLA-DR measurements were evaluated. Mean and median CD4+ counts were 181 and 150
cells/mm3 (r 29-426) for the first evaluation; 209 and 210 cells/mm3 for the
second (r 36-407); and 291 and 295 cell/mm3 for the third evaluation.
The correlation coefficient for the HLA-DR and the CD4+ absolute count was r
= 0.17 (p = NS). The correlation coefficient for HLA-DR and the CD4+% was r =
0.24 (p = NS).
conclusions: T cell surface activation by HLA -DR expression is elevated in
patients with HIV infection and preliminary evaluations suggested good correlation with CD4+ T cell count, but long term analysis demonstrated poor correlation
between HLA-DR and either CD4+ count and percentage. 2) Other factors beyond
CD4+ count might be influencing HLA-DR expression. 3) Long term analysis of
potential immunological prognostic markers seems warranted.
60865 LUCES: An empowerment model for Latinos in Maryland,
USA
Sonia E. Moral, D.A. L6pez2, A. Mendez3. IMontgomery Co. Department of
Health & Human Svcs. 8630 Fenton St. 10th Floor Silver Spring, MD 20910;
2Health Consultants International Laurel MD; 3Prince George's County Health
Dpartment Cheverly MD, USA
Issues: Latinos in suburban Maryland (USA) are disproportionately affected by
the HIV epidemic, and require a linguistically and culturally competent network of
services.
Project: LUCES (Spanish abbreviation for Latinos Unidos Contra el SIDA) is
the official Latino Committee of the Suburban Maryland HIV/AIDS Alliance - a
network of more than 18 private and public entities working together to improve
the availability, organization, and quality of health education and services for
individuals living with HIV disease. Since 1995, this standing committee has
provided expert information essential to planning sound health promotion programs, disease prevention strategies, and direct intervention services, as well as
to formulating public health polices that address the HIV-related needs of Latinos. LUCES strives to influence the development of a linguistically and culturally
competent network of services for a healthy Latino community.
Results: LUCES has brought together community members, leaders, health
educators and other professionals who have diverse backgrounds, values, priorities, and concerns around a common goal: a linguistically and culturally competent
network of HIV-related services. LUCES' members have gained knowledge and

developed skills to establish relationships, build trust, work with formal and informal leaders, form partnerships with private and public entities, and create
new solutions to challenges. LUCES has also provided leadership and guidance
in the following areas: personal and professional development of its members;
development and implementation of community assessments; data collection,
analysis, and reporting; formulation of public policies; advocacy; and planning,
implementation, and evaluation of programs and services.