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

12th World AIDS Conference

Abstracts 60944-60948 1173

and extramarital relations; single women and occasional relationships; female
partners in serodifferent couples, infected through the marital relationship; men
with homosexual practices; and regular or occasional drug users.
Conclusion: socio-economic conditions and neocultural representations are
indissociable from the immigrant's condition and also concern second-generation
immigrants. Prevention policy should not only be based on proximity, but also be
designed according to these different logics of infection, which are particular to
the groups identified by the survey.
S60944 Seroprevalence of HIV infection among pregnant women
from a low HIV incidence area of Spain
Raul Ortiz De Lejarazn, J.M. Eiros, P. Martinez, A. Pascual, M. DeFrutos,
A. Rodriguez Torres. Serv. Microbiologia, Hosp. Universitario, c/Ramon y Cajal
n03, 47011 Valladolid, Spain
Background: ACTG 076 proved the benefits of AZT therapy on reductions of
vertical HIV infection. However there is not general agreement concerning the
HIV diagnosis to be included among routine obstetric analytical tests.
Methods: From July 1995 to December 1997 we carry out a prospective
unlinked anonymous screening of HIV antibodies in 4,476 sera submited to our
laboratory for TORCH and rubella antibodies. Every week we made pools of ten
sera each one. They were tested for HIV antibodies (VIDAS HIV 1+2, bioMerieux,
France), sera from reactive pools were individually tested and those reactives
confirmed by Western blot (Bioblot HIV-1 plus, Genelabs Diagnostic, USA) using
WHO criteria.
Results:

Year
1995
1996
1997
Total

Sera tested
1,136
1,762
1,578
4.476

HIV infected
5
2
1
8

% CI

0.44
0.11
0.06
0.17

(0.41-0.47)
(0.10-0.11)
(0.09-0.02)
(0.19-0.16)

Conclusions: These results justify mandatory offer of HIV diagnosis in all
pregnant woman together with other obstetric tests even in low HIV incidence
areas from countries with high rates of AIDS.
60945 Evaluation of a new automated screening test for the
simultaneous detection of antibodies HIV 1/2 and p24
antigen
Prudencio Martinez, R. Ortiz De Lejarazu, V.F. Padron, J.M. Eiros, A. Rodriguez
Torres. Serv. Microbiologia, Hosp. Universitario, c/Ramon y Cajal n~3, 47011
Valladolid, Spain
Objectives: To evaluate a new automated screening test for the simultaneous
detection of anti-HIV1 and anti-HIV2 as well as p24 antigen.
Design: Transversal study.
Methods: A total of 383 serum samples were obtained, 218 negative serum
samples (16 laboral accident, 50 pregnant women, 100 blood donors, 40 multiple
transfusion recipients, 12 weak reactivities by ELFA or Western blot) and 165 HIV
serum samples (158 positive serum and 7 BBI panel).
Serum samples were tested using the VIDAS HIV DUO test (bioMerieux,
France). This technique associates a final fluorescence reading (ELFA), which is
automated in the VIDAS system. The disposable single-use cone serves both as
a solid support (the lower section is coated with synthetic peptides representating
the immunodominant region of GP41 for HIV1 and GP36 for HIV2, and the upper
section is coated with anti-p24 monoclonal antibodies) and as a pipette system. The other reagents are arranged in ready-to-use cartridges having various
recessed cups where the different reaction phases occur. The sample volume
required is 200 /1I; the test time is 90 minutes. This test provides concentration
values directly related to the fluorescence (Relative Fluorescent Value) detected
in the reading.
The gold standar for antibodies and p24 antigen were the Western blot (Bioblot
HIV-1 plus, Genelabs Diagnostic, Switzerland) and ELAVIA Ag I (Sanofi Diagnostic Pasteur, France) respectively.
Results: The sensitivity and specificity were 100% and 96.8%. In the cases
of recent infection, p24 antigen was detected at the same time by the test and
the gold standard. The p24 antigen sensitivity was established at approximately
13 pgr/ml when tested with antigen standar (HIV-1 Antigen, Sanofi Diagnostics
Pasteur, France).
Conclusions: This test has proven with sufficient reliability (Sen: 100% and
Spec: 96.8%) that it can be applied in the safety screening required for biological
samples, and that it also allows the diagnosis of persons infected with HIV to be
shortened in cases of acute infection, thanks to its ability to detect p24 antigen.
60946 Seropositives and unprotected sex - What are the
consequences?
Adjobi Edmond Djomian, G.S. Gbeli Siko, K.F. Kadjo Filix. '06 BP 1021 Cidexl
Abidjan 06 Cote D'lvoire; 2Club Des Amis; 3Caritas Bonou, Cote D'lvoire
Objective: Research into the reasons why seropositive people do not use condoms,
Methods: The information was collected from group discussion with seropositive people. This observation was made because it was noted that seropositive

people had contracted sexually transmitted diseases and then become pregnant;
or ahd children. The group discussions per allowed us to understand the ditterent
reasons why people did not use condoms.
Results: For women, socio-cultural and economic factors were identified; 35%
of them did not communicate their positive serological status to their partner. 70%
had fear of resection by their family. 80% were ashamed of being seropositive.
45% had no financial resources. 10% wanted to have children.
For the men; 90% even though they were awave of their positive serological
status, continued to pratice unprotected sex. 55% had difficulties in declaning
their serological status to their partners.
55% had fear of being seen as having infected their partner.
Conclusion: The continuance of unprotected sex by seropositive people is
very worrying. They expose themselves to reinfection, and put their health at risk.
It is necessary to convince seroposiitive people to practice safe sex.
Education in local dialect, as well as in french, is needed.
60947 Opportunistic infections in AIDS patients during
antiretroviral therapy: 12 months follow up
Paola Corsi, M. Zazzi, G. Buffini, A. Farese, S. Vigano, L. Ambu, S. Bartolozzi.
U.O. Malattie infective-Careggi, Firenze, I, Italy
Objectives: The decline in the number of cases of AIDS in 1996 reported by
the Italian National AIDS Register led to formulate specific hypothesis on new
antiretroviral drugs efficacy and on extensive use of preventive treatment for
opportunistic infections (01) in AIDS patients.
Patients and Methods: A total of 59 patients, selected among all 1996 prevalent cases and notified cases by our Division to Register until 31.1.97, without
previous antiretroviral treatment, was followed for a period of 12 months after
the first AIDS defining illness. Patients were divided into 4 groups according to
antiretroviral therapy subsequently received; no therapy (8 patients), one drug
regimen (20), two drugs (17), three drugs (included a protease inhibitor, 14).
Results: The most frequent AIDS defining events, without relevant differences
among 4 groups, were: Pneumocystis carinii pneumonia (27 cases), Kaposi's
sarcoma (7), Candida esophagitis (4), extrapulmonary cryptococcosis (2), Cytomegalovirus systemic disease and retinitis (2).
Opportunistic infections into 4 groups were respectively 4 (50%), 9 (45%), 4
(23.5%), and 1 (7.1%). The average time of onset was respectively 4.7, 5.1, 8
and 10 months. The most frequent infections were AIDS dementia complex (5
cases, 74 in the first group), Mycobacterium avium-complex infections (2) and
cerebral lymphoma (2).
Notheworthy the absence of pneumocystosis and only one case of cerebral
toxoplasmosis in a patient with suppressive therapy with pentamidine.
Conclusions: Our data shows a progressive decline of incidence of 01 in
AIDS patients correlated with the activity of antiretroviral therapy they received
and a significant efficacy of triple therapy with protease inhibitor to reduce the
frequency (p < 0.0001) and to increase the latency of 01. Moreover the decline
of AIDS dementia complex and the absence of Pneumocystis carinii pneumonia
may be correlated to combination antiretroviral therapy potency and to extensive
programmes of suppressive therapy against 01.
S60948 Changes in the profile of HIV infected patients five years
apart
Javier Marco, R. Barba, D. Joya, B. Garcia-Meabe, S. Cabrera, S. Plaza,
J. Gomez-Rodrigo. Hospital Severo Ochoa, Madrid, Spain
Aims and Methods: Retrospective analysis of demographic, sociocultural, clinical and therapeutic characteristics of two groups of HIV infected patients. Inclusion
criteria: patients reaching for the first time a level of 300 CD4 or less either in
1992 or in 1997.
Results: 55 patients with a mean age of 33.2 years (68% male, 32% female).
Concerning toxic habits, 75% were heavy smokers, 32% alcohol abusers and
20% ex-drinkers; 20% were still parenteral drug abusers while 36% had quit
the. Attempts at drug quitting in 1992 were made individually (60%) or through
institutional programs (15%) whilst this pattern was significantly different in 1997
(p < 0.02; 28% and 52% respectively). No differences were found in sexual behaviour (36% married or stable partner; 61% single, divorced or multiple partners)
or in HIV status of sexual partner (17% positive, 48% negative, 34% unknown).
Cultural level has not changed (38% below primary studies) neither has the
risk practice (74% parenteral drug users, 14% heterosexual, 2% homosexual,
9% unknown). No differences were found in VHB and VHC seroprevalence or
sexually transmitted disease prevalence. There was a significant difference in the
number of months from the moment of HIV seropositivity (24.5 and 66.9 months
in 1992 and 1997; p < 0.0001). Also, the number of CD4 counts performed prior
to our cutting point was significantly different (2.2 and 7.3 for 1992 and 1997
respectively; p < 0.0001). Significant differences were also found in the number
of visits to the outpatient clinic the previous 36 months (6.2 and 13.6 in 1992 and
1997 respectively; p < 0.0001) Concerning treatment, our patients were taking a
mean o 1.5 drugs in 1992 and 3.5 in 1997 (p. 0.01) with a number of pills per

week of 17.8 and 53.5 respectively (p. 0.0001). Antiretroviral drugs were in use
in 62% of our 1992 patients and in 86% of the 1997 group (p - 0.02).
Conclusions: 1) The sociocultural and demographic profile of HIV infected
patients has not changed in our environment in the last five years. 2) Institutional
methadone programs are the method of choice in our current patients for stopping
illicit drug use 3) Patients were identified later and followed less regularly at our
clinic five years ago. 4) Therapeutic complexity has dramatically increased.