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

1162 Abstracts 60882-60886

12th World AIDS Conference

of AIDS Control and Prevention project, Nepal Medical Association and other
professional associations should prepare similar HIV/AIDS training packages.
S60882 Acute pelvic inflammatory disease associated with
genital mycoplasma and streptococci species is more
common in HIV-infected women
Kathleen Irwin1, A. Moorman1, M.J. O'Sullivan2, R. Sperling3, M. Brodman3,
M. Koester2, I. Soto3, J. Stewart1. HIV-PID Multi Center Study Grp; 1CDC
MSE-44 1600 Clifton Road, Atlanta, 30333 Georgia; 2University of Miami, Miami,
FL; 3Mt. Sinai Medical Center, New York, NY, USA
Background: In theory, symptomatic pelvic inflammatory disease (PID) in HIVinfected women may be caused by organisms thought to be nonpathogenic in
immunocompetent women.
Methods: We analyzed recovery of bacteria from endocervical swabs and endometrial biopsies collected from HIV-infected and uninfected women diagnosed
with PID using standard clinical criteria and HIV-infected women with cervical
dysplasia who did not meet criteria for PID. Specimens were tested for N. gonorrhoeae (NG) and facultative bacteria by culture and for C. trachomatis (CT),
mycoplasmas, and ureaplasmas by culture and PCR.
Results: HIV-infected women with PID were more likely than uninfected women
to have recovery of endometrial genital mycoplasmas (i.e., M. hominis. or M. genitalium, or M. fermentans: 14/28 [50.0%) vs. 24/108 [22.2%], p <.05) and
streptococci species (13/38 [34.2%] vs. 23/138 [16.7%], p <.05), despite somewhat greater use of broad-spectrum antibiotics shortly before enrollment by
HIV-infected women (40.9% vs. 27.2%, p =.08). Among the HIV-infected and
uninfected women in whom endocervical or endometrial NG or CT were not
recovered, endometrial mycoplasma (50% vs. 14%, p <.05) and streptococci
(38% vs. 18%, p <.05) species were more commonly recovered in HIV-infected
women. No endometrial streptococci (0/14) or genital mycoplasma species (0/7)
were recovered from HIV-infected women without PID. Recovery of other bacteria
did not differ significantly by HIV serostatus.
Conclusion: Past studies indicate that genital mycoplasmas and streptococci
may be ubiquitous in sexually active, immunocompetent women, but nevertheless
may cause PID. In our study, genital mycoplasmas and streptococci recovery was
more common in HIV-infected women with PID than uninfected women (especially
among women lacking NG and CT), and genital mycoplasmas and streptococci
were not found in HIV-infected women without PID. This suggests that these organisms play a more important role in PID pathogenesis in HIV-infected women.
However, CDC-recommended antibiotics for PID provide adequate mycoplasma
and streptococci coverage and should be generally effective in HIV-infected
women.
60883 Porphyria cutanea tarda: A controversial association with
HIV infection
Diego M. Caiafa1, Gabriela B.G. Bugarin2, Patricia T.P. Trinidad2, Edgardo
S.E. Sturba2, Isabel C.I. Cassetti2. 1 Peru 1515; 2Helios Salud, Buenos Aires,
Argentina
In the last years, several reports have been published about porphyria cutanea
tarda in HIV patients. It has been suggested that there is a causative relation
between both diseases.
A 33-year-old male, HIV seropositive, who has been intravenous drug user,
presented with skin lesions on the back of his fingers and hands: blisters, crusts,
hyper- and hypopigmentation and edema, exacerbated with minor traumatisms.
Also, he showed hyperpigmentation in forehead, ears and oral mucosa, and
brown spots on palms. Other findings included a moderately enlarged homogeneous liver, mild increased transaminases, and positive hepatitis C antibodies.
Liver biopsy showed chronic hepatitis with moderate inflammatory activity and
mild fibrosis. Porphyria cutanea tarda (PCT) was diagnosed based on the very
increased levels of porphyrins in blood and urine. Lesions markedly improved
with local measures.
PCT is a disorder of porphyrins metabolism due to a diminished activity of the
enzyme uroporphyrinogen decarboxylase. The disease needs extrinsic factors in
order to be clinically expressed, i.e. alcohol abuse, iron overload or exposition to
some drugs or toxins. Clinical manifestations include several kinds of skin lesions,
particularly vesicles, blisters, depigmentation, hyperpigmentation and hirsutism in
sunlight exposed areas. Almost all cases have hepatic dysfunction of unknown
cause: chronic hepatitis, cirrhosis, steatosis. A strong association of PCT with
hepatitis C virus infection has been shown, based on the higher prevalence of
HCV antibodies in PCT patients as compared with the general population, as
well as the finding of HCV-RNA in blood, liver and peripheric blood mononuclear
cells of PCT patients. A causative relation between PCT and HIV infection has
been suggested, due to the higher frequency of the former in HIV patients.
Nevertheless, almost all reported cases have some other porphyrinogenic factor,
particularly HCV infection.
PCT is the most common form of porphyria. Its causative relation with HCV
has been shown, as in the case of our patient. Testing every PCT patient for HCV

is recommended. The role of HIV in the pathogenesis of PCT must be further
evaluated.

S60884 Characteristics of HIV positive drug addicts in FR
Yugoslavia
Sanja Matovic-Miljanovic, Dragoljub Djokic. Institute of Public Health of Serbia,
Olge Alkalaj 6/32, 11000 Beograd, Belgrade, FR Yugoslavia
Objectives: To establish particular characteristics of drug addict HIV infected population, both in potential causes (sociodemographic and addiction characteristics)
and results and medical treatment of this group
Design: Retrospective study.
Method: The research has been taken through 1987. to 1995. on 1605 drug
addicts which has been tested on HIV during first month of their treatment in Institute on Addictions. Data were collected from their medical documentation. Trained
medical staff did the medical documentation evaluation and data entry. Sociodemographic characteristics were investigated (gender, residence, employment...),
phenomenon characteristics (age of first drug contact, duration of drug use, most
often used drug...), treatment characteristics (types of treatment, methadone
maintenance...). HIV positivity had a dependent mean status.
HIV infections is proved within 13.7% (220) of tested drug addicts. Education
has a positive influence (25.4% with primary school only, to 3.9% with high degree). Divorced and widowed drug addicts are more HIV positive (21.0%) than
married (14.7%). Existing of crime history is more often within HIV positive (67.6%
to 56.6%). Tested drug addicts in most cases are dependent on heroin (91.9% of
HIV positive to 87.3% of HIV negative), while 96.8% of HIV positive addicts are
of intravenous type.
Conclusion: Subculture characteristics of drug addicts population with beginning and spreading of HIV infection plays a great role in HIV/AIDS epidemic
prevention. Therefore, preventive programs should be based on comprehended
characteristics and needs of addicts population and subgroups within (woman
addicts, addicts in prison, married addicts).
60885 Peer group advocacy and the "dependency culture"
Bernard Forbes, J.V. Hows. UK Coalition of People Living With HIV, 250
Kennington Lane, London SE11 5RD, UK
Issues: UK models of treatment and social care have led to some people's
over-dependence on others and an inability to act, deal with or face up to the
disparate issues whilst living with the virus.
Project: The Advocacy Project began in 1985 aiming to (i) resolve difficulties
or problems faced by people living with HIV, (ii) allow commissioners of services
access to users' experience, and (iii) establish a model of advocacy that would
influence the planning and commissioning of services.
Many service providers adopted a predominantly "pity" model of care for clients.
By focusing more on the overwhelming fatality of diagnosis, than living full and
fruitful lives, service providers engendered a culture of dependence which is no
longer valid (if it ever was).
A major objective of our client intervention is to move people out of being
passive recipients of services, back into taking control over what happens to them
and how services are delivered. Whilst some never move out of dependence,
most have skills, even if initially they lack the confidence to tackle issues alone.
By giving them support and access to facilities (like a word processor or phone)
people can achieve results.
Results: As well as maintaining a heavy caseload, twenty clients were trained
and developed into volunteer advocates. Three have moved back into employment using their experience with us and many are still actively involved in peer
advocacy. A small number gave up due to illness.
Lessons Learned: That "victims" can deal with a range of incredibly complicated issues, develop themselves in the process, and free up time for "professionals" allowing them to improve the services they need to provide.
60886 Ultra-sensitive HIV-1 Monitor" Including ubiquitous
primers to quantify HIV-1-RNA in clinical plasma samples
Paul Deny1 2, Sid Takarly2, F. Le Gal2, V. Jeantils3, M. Bentata2, B. Jarrousse2,
P. Soussan2. 1Bacteriology-Virology Univ. Paris-Nord Hopital Avicenne Bobigny
93009; 2Hopital Avicenne Univ. Paris-Nord CISIH 93; 3 Hopital Jean Verdier
Unitv. Paris-Nord CISH 91, France
Background-Objectives: To approach undetectable viral load (VL) in plasma
samples from various geographical origins, we adapted new ubiquitous primer
from Roche diagnostic ("add-in " primers) in a standard 20 copies HIV RNA
detection after a high speed centrifugation step (24000 g).
Methods: 10 controls of known subtypes and 45 frozen plasma from 41 patients
were collected. Patients were followed using Quantiplex" HIV RNA 2.0 (b-DNA)
(69%) or Amplicor HIV-1 Monitorm' (200 copies/mL (c/mL) (31%). Twenty-two
samples (48%) were under the sensitivity level of the tests (respectively 500 and
200 c/mL). Among patients from various origins (Caribbean, Europa, North and
Sub-Saharian Africa), 13 samples corresponded to patients being always under
the detectable level of Quantiplex" HIV RNA 2.0.
Results: were compared to initial HIV RNA quantification. A concordance (Alog

<0.5) was observed among 30/45 plasma (66%). For 13 out of 15 discordant
results, mean viral level increased of 0.8 log. By contrast, the last 2 samples
showed a lower copy number (reduced 3.3 to 4 fold) as compared to the initial
value. Those two samples had the highest VL value (>4.3 105 c/mL) using
Amplicor HIV-1 Monitor" (200 c/mL) either with or without ubiquitous primers.
Among 13 patients with a VL always <500 c/mL using Quantiplex"' HIV RNA 2.0,