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

12th World AIDS Conference

Abstracts 60877-60881 1161

Conclusion: We found no evidence to suggest that the increase in the TB
incidence among younger Danes has been due to the HIV epidemic or to transmission from immigrants. TB among HIV-positive Danes is most often due to
recent infection and the patients are often IVDUs. We found no evidence of
nosocomial transmission of TB among co-infected patients. New measures for
TB control seams necessary.
S60877 | Knowledge, attitudes and beliefs about HIV infection and
AIDS among female sex workers in six Brazilian informal
sector mine areas
Aicinda Godoi. Quadra 4 BI C casa 50 Cruzeiro Velho, Brasilia Distrito Federal;
Clodoaldo de Godoy Garcia, Brazilia, DF, Brazil
Objectives: This study searchs for detailed information about attitudes and knowledge about HIV infection and AIDS among women that live in informal-sector
mine and work as prostitutes. Also identify their social representation, sexual
practices, preventive practices related to DST/AIDS, intravenous drug use and
self-perception of risk.
Design: qualitative study - focus group.
Methods: It was adopted a qualitative method of investigation. Six focus
groups were formed with female sex workers living in six mining areas of razil.
The mean size group was about eight women. The discussions were conducted
by trainned moderators following a previously elaborated script. The discussions
were recorded and later transcripted.
Results: The focus groups showed the following most relevant results:
- In general, female sex workers have good knowledge about HIV transmission and prevention methods, but there's some false conceptions of the ways of
transmission.
- Almost all women don't use condom in their sexual relations, despite of the fact
that they want and know it's importance. On the other hand, they don't consider
that it's necessary to use condoms when the isn't a client.
- Participants deny intravenous drug use
Conclusions: The study showed that good knowledge isn't enough to promote
changes in attitudes and to adopt safer sexual practices. Female sex workers
perceive themselves as in high risk for HIV infection, but don't use condoms
regularly, because of the clients refusal and the poor conditions of negotiation
caused by the social and economic difficults of their lives.
60878 Towards an integral policy for therapy support
Paul Hupkens. le Helmersstraat 17 1054 CX Amsterdam, Holland
Issues: The treatment of people with HIV/AIDS has seen rapid developments the
past two years.
These developments, however, have confronted both people with HIV and
those who offer them care with new problems, as the results of clinical reality are
not on a par with those of experimental trials.
One of the main causes is the incapacity of people with HIV/AIDS to keep up
the complex regime of taking their anti-retroviral medication. If the anti-retroviral
drugs are not used in the prescribed way, the virus will start replicating again. As
a result, chances are that resistant variants of the virus will be produced which
undermine treatment.
All of this demands the support of people with HIV when they are in the process
of deciding whether to start treatment, and when they are actually starting or
continuing it. It is important to realize that this is not a matter that only concerns
the patient and his/her care giver, but also pharmaceutical companies, health
care workers, partners, employers, and the government. All the measures that
are taken, and all the support that is being organized, are aimed at promoting
loyalty to the regime of therapy.
Project: In the Netherlands, various care givers/organizations have taken independent initiatives to help people to keep up their treatment. However, adjusting
to and co-operating with the target group and other disciplines has not been
deemed important enough. Consequently, the HIV Association and the AIDS
Fonds Foundation decided it was time to come to a co-ordinated policy for the
various complications that come with keeping up treatment. In January, an expert
meeting was organized, and attended by doctors, health care workers, people with
HIV, researchers and representatives of pharmaceutical companies, all of them
working together to realize a co-ordinated, long-term plan. All the aforementioned
parties are to assume a certain responsibility in executing this plan.
Results: Based on the results of the expert meeting, a program on therapy
support for the upcoming years is currently being formulated. This plan is concerned with describing actions, responsibilities, and timing. A presentation of the
progress that is being made with the plan is to take place during the convention.
60879 Low frequency of HIV-1 subtype C syncytium inducing
(SI) phenotype among Ethiopian AIDS patients
Almaz Abebe1, D. Demissie2, J. Goudsmit4, M. Brouwer5, G. Pollakis4,
A. Fontanet3, T.F. Rinke De Wit3. Ethiopian Health and Nutrition Research

Institute, 1242 Addis Ababa; 2Addis Ababa University, Addis Ababa; 3ENARP
Addis Ababa, Ethiopia; 4AMC University of Amsterdam, Amsterdam; 5CLB
University of Amterdam, The Netherlands
Objectives: To determine HIV-1 subtype C biological syncytium inducing (SI)
non-syncytium inducing (NSI) phenotypes at AIDS diagnosis of Ethiopians and to
assess possible genotypic mutations in the gp120 V3 loop, determining SI/NSI.

Design: Cross sectional study on hospitalized AIDS patients from Ethiopia.
Methods: Peripheral blood mononuclear cells of 63 Ethiopian AIDS patients
(CD4 < 200/ul) were cocultivated in the MT-2 assay for SI/NSI phenotype. RTPCR aided gp120 V3 sequencing was performed on plasma of 41 patients and on
17 biological clones generated from SI-PBMC of 3 AIDS patients. Phylogenetic
analyses were performed using MEGA software.
Results: The MT-2 cocultivation assay resulted in 60/63 (95%) NSI and only
3/63 (5%) SI phenotypes. Phylogenetic analyses of DNA sequences from 41
plasma samples (including 38 NSI and all 3 SI) identified all isolates as being
HIV-1 subtype C. Sequencing on 10 SI clonal isolates revealed that, in contrast
to the previously documented amino acid positions 11 and 25 for other subtypes,
two novel positively charged amino acids (positions 8 and/or 27) are associated
with SI phenotype in the Ethiopian HIV-1 C-subtype strains. The following features
were found to be in agreement with other HIV-1 subtypes: an increase of mean
net charge of the V3 loop in SI (6+) versus NSI (3+) sequences, a loss or shift
of the N-linked glycosylation site at V3 in SI and more amino acid heterogeneity
of SI V3 regions versus NSI. No correlations were found between specific amino
acid substitutions and CD4 counts of viral load.
Conclusions: A surprisingly low frequency of SI phenotypes were detected
in Ethiopian C-subtype AIDS patients. Heterogeneity, high net positive charge
amino acid substitutions, lost or shifted N-linked glycosylation sites and most
importantly, two novel amino acid positions were found to be related to the SI
phenotypes.
| 60880 Immunological markers with prognostic value for HIV
progression in Ethiopians
Tsehaynesh Messele1, N. Abdulkadir2, M. Brouwer3, A. Fontanet2, M. Roos3,
F. Miedema3, T.F. Rinke De Wit2. Ethio Netherlands AIDS Research Project At
Ehnri PO Box 1242, Addis Ababa, Ethiopia; 2ENARRP Addis Ababa; 3CLB,
Amsterdam, The Netherlands
Objectives: To determine the immune status of HIV-1 infected and non-infected
Ethiopians and to identify immunological markers associated with HIV disease
progression in Ethiopians.
Design: Cross sectional study.
Methods: Whole blood and plasma samples collected from 52 HIV-individuals, 32 HIV+ with CD4 count >200/ul and no AIDS defining conditions and 39
HIV+ with CD4 count <200/ul and/or exhibiting AIDS defining conditions were
analyzed by 3 color FACScan analysis and ELISA. Percentages and absolute
counts of naive memory- and activated cells were determined within the CD4
and CD8 T-cell subsets. Soluble IgE, IgA, IgG, CD27, TNFr-II and b2M were
measured in plasma. For HIV-Ethiopians all above markers were compared to
Dutch HIV-controls.
Results: When comparing T-cell subsets of HIV+ versus HIV-Ethiopians, all
significant changes (p < 0.05) were seen in the CD8 T-cells: progressive increase
of activated CD8 cells, decrease of resting CD8 cells, increase of memory CD8
cells, decrease of naive CD8 cells, decrease of effector CD8 cells, decrease of
expression of CD28 costimulatory molecule on CD8 cells. CD8 cells associated
to non- progression were significantly reduced in AIDS patients. The proportions
of naive T-cells (both CD4 and CD8) were significantly reduced in HIV-Ethiopians
versus HIV- Europeans. Plasma levels of b2M, sCD27, sTNFrlI, IgA, IgG were
elevated in HIV infected-versus non infected individuals.
Conclusion: In a cross-sectional study several CD8 T-cell subsets and soluble
immune markers were defined, which could serve as prognostic markers for
HIV disease progression in Ethiopians. The reduced proportion of naive T-cells
in HIV-Ethiopians, in comparison with HIV-Europeans, could be due to higher
exposure to environmental pathogens.
60881 Training package for case management of sexually
transmitted diseases
Ramesh Prasad Aacharya, Adhikari Ramesh Kant, Sharma Vijay Kumar,
Joy Pollock. Nepal Medical Association PO Box 189 Kathmandu, Nepal
Issue: Physician training on early detection and appropriate management of
STD cases is an important component of a comprehensive STD prevention
program.
Program: Training is based on a curriculum and materials that were developed
by Nepal Medical Association and Family Health International's AIDS Control and
Prevention Project. The course was piloted in a five-day master trainer's workshop followed by two-day STD Case Management Workshops for Physicians
held in 3 different areas of the country. The training manual is designed in a
comprehensive manner incorporating the syndromic approach recommended by
the World Health Organisation. This is useful for the physicians working in rural
areas where laboratory facilities do not exist and in communities where it is often
not culturally acceptable for a male doctor to examine the genitalia of female
patient. Also the training may be useful for the skill development of other care
providers like nurses and paramedics. The comprehensive approach of training
acknowledges the importance of provider attitudes, communication skills, patient

education and condom promotion, which are usually overlooked in conventional
medical training.
Results: An appropriate training package was prepared which can be utilised
by professional health care organisations or institutions conducting STD Training
programs for general practioners.
Lessons Learned: Similar appropriate manuals should be prepared for continuing Medical Education of the health care providers. As an implementing partner