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

1176 Abstracts 60962-60967

12th World AIDS Conference

26 and 30. More than a half (53.81%) feel discriminated and isolated in society
and may (62.83%) feel that they are treated oppressively.
The survey indicates that society characterizes a lack of acceptance, tolerance
and support for those who are infected. Psychological support is considered of
prime importance by 81.4% of surveyed woman and 77.8% of surveyed men.
There exists an enormous need to help those infected with HIV/AIDS who are
deprived of a family and accommodation. There is a great need to raise society's
awareness on the issues of HIV/AIDS through the education.
60962 1 What strategies for the HIV testing in a context of
resources scarcity? A Central-African country
experience, Democratic Republic of Congo (DRC)
Mabasi Mayala1, N. Nzila1, A. Disasil, B. Malele2. 1Project SIDA Kinshasa B.P
8502 KIN 1; 2Clinique MST Matonge, Kinshasa, Democratic Republic of Congo
Background: In context of resource-poor countries, HIV tests are never available
but often expensive. Specific strategies should be defined. This study aims to:
1. Determine utility of HIV testing in different areas of the fight against AIDS
(diagnosis, management of patients living with AIDS, blood transfusion, sentinel
surveillance). 2. Define orientations for an efficient use of HIV tests.
Method: Overview of available data of National AIDS Control Program on
different interventions mentioned above in 1996 (e.g. percentage of clinical AIDS
confirmed by laboratory, percentage of voluntary HIV test...)
Results: Utility of interventions based of HIV test in DRC, 1996.
Clinical AIDS according to HIV test result (*)( ) (73/90) 81%
Management case according to HIV test result (*) (32/90) 36%
Blood transfusion: HIV tess supplied/requirements (4,477/407,200) 1.1%
Voluntary HIV tests in STD clinic (3,141/7,168) 44%
HIV/AIDS notified cases/projected number (38,426/167,069) 23%
( ) Results of 90 practionners interview's in the bigs hospitals (6) of Kinshasa; (*) Usually,
Health workers ask HIV test to confirm presumed clinical AIDS in 80% of cases, often in advanced stage; patient information takes a little place in their preoccupations (5%).
Conclusions: 1. HIV test diagnosis neither contribute to reduce HIV infection
incidence nor improve the management of patients living with AIDS. 2. In priority,
some sectors such blood transfusion centers, reference center for AIDS and STD,
structures for voluntary testing, sentinel surveillance sites must be supplied in
HIV tests and organized.
S60963 Alpha-interferon (IFN) therapy combined with HAART for
progressive multifocal leucoencephalopathy (PML) in
patients with AIDS
Stephane Chadapaud', Isabelle Ravauxl, H. Tissot-Dupont', A. Donnet2,
A.N. Quinson', H. Gallais'. 'Infectious Diseases Unit, Conception
Hospital-Narseille; 2Neurology Dept-Tinono Hospital, Narseille, France
Introduction: At present, there's no documented efficious therapy for PML in
AIDS. Spontaneous remission, anecdotal reports or apparent cure with different
drugs have been described.
Objective: To describe the clinical and radiological impact of alpha-IFN and
HAART in four patients with AIDS-associated PML.
Design: Observational study.
Methods: Inclusion criteria were: focal neurological deficits with either characteristic radiological white matter lesions confirmed with Magnetic Resonance
Imaging (MRI). Patients with PML were assigned to receive alpha-IFN 4.5 MUI
subcutaneous per day for two months and then 4.5 MUI three times per week.
Results: Four HIV-infected patients were included in this study. All but one
were HVC seropositive with PCR HVC positive. IFN therapy was well tolerated;
nor general, nor toxic side-effects were observed. After one month of treatment,
patients clinically improved and felt subjectively better. Clinical improvements and
radiologic data will be presented.

Methods: Adult patients with suggested HIV infection were included. Blood
serum specimens were processed by "dry drop" method. ELISA was performed
in all samples with a help of 3 different kits. IB was performed after received
positive results in 2 or 3 kits. Positive results of IB was defined as a standard for
HIV identification. Investigation was repeated 6 months later in the case of the
negative result of IB, in the case of the doubtful result - 3 months later.
Results: A total of 369 ELISA positive cases were analyzed by IB in 1997,
45.8% (169/369) were diagnosed as positive, 117% (43/369) - as doubtful, 42.5%
(157/369) - as negative. The repeated investigations in the cases of the 1 negative result and 1 doubtful result have showed the same ELISA results and positive
IB ones.
Conclusion: Expert diagnostics may be improved by the usage of 3 ELISA kits
instead of one.
160965 The challenges of promoting condom use
Vastha Kibirige, E. Madraa. STD AIDS Control Programme, PO Box 8, Entebbe,
Uganda
Issue: To prevent STD/HIV transmission, an efficient system for Condom Promotion and distribution is very important.
Project: The Sexually Transmitted Infections Project (STIP) is supporting two
Social Marketing Organisations and distributes free unbranded condoms. A Condom Coordination Unit has been set up and Condom Focal persons identified for
each district to improve promotion & distribution to the people in both urban and
rural areas. While social marketers have been supported to promote their products openly through private radio stations, promotion of government unbranded
condoms has remained "quiet". Yet messages against condom use have reached
the public openly through both print & electronic media.
Results: Free unbranded condoms have been labelled poor quality while the
Socially marketed condoms indicate quality for rural populations. Knowledge may
be a barrier to condom use rather than price. Messages through public media
have the ability to enhance or destroy our condom promotion efforts.
The strengthening of social marketing efforts increases condom use. Condom
distribution to rural areas must be accompanied by carefully designed educational
messages backed by a clear and 'open' promotion strategy.
60966 Quadritherapy including RTV/SQV following tritherapy
including IDV failure: Results on RNA viral load and CD4
T cells count
Thierry Prazuck', D. Zucman2, C. Semaille', E. Cheuojon3, G. Cessot4,
L. Geffray5, G. Raguin1. 'Maladies Infetieuses-Centre Hosptitalier 94195
Villaneuve St. Georges, Cedex; 2Hopital Foch Suresnes; 3Hopital, Corbeil;
4lnstitut Alfred Fournier Paris; 5Hopital De La Croix, St. Simon, Paris, France
Objective: To evaluate the course of RNA viral load and CD4 T cells in HIV infected patients treated with antiretroviral (AR) quadritherapy including RTV/SQV
after withdrawal AR tritherapy including IDV due to lack of efficacy of the treatment
regimen (i.e. re-increase of sustained elevated level of RNA viral load)
Study Design: All patients from five parisian hospitals fitting inclusion criteria
were included in the follow-up study. RNA Viral load was considered undetectable
when lower than 200 copies/ml. Statistical analysis consisted in regression analysis of biological data.
Results: Thirty patients were included in the study with a follow-up to 40 weeks
after quadritherapy introduction. At baseline, mean CD4 T cells count was 107 (3
= 97, range: 0-270), mean RNA viral load was 4.62 log copies/ml (3 = 1.3, range
4.1-5.7). Mean duration of previous antiretroviral therapy was 8 months. None of
the patients were naive before receiving the AR tritherapy regimen. CD4 T cells,
RNA viral load variation and percentage of patients with undetectable RNA viral
load are shown in the table at 8, 16 and 20 weeks follow-up. 60% and 75% of
patients did not exhibit any significant RNA viral load variation at week 16 and
week 20, respectively.
Follow up (weeks)

Before IFN
CD4 (/mm3) ARN HIV

During IFN (3 months)
PCR VHC CD4 ARN HIV PCR VHC

Patient 1
Patient 2
Patient 3
Patient 4

74
217
89
15

1733
341 100
570,000
210,000

-10,000 157
-10,000 348
34
-10,000 39

<200 <10,000
<200 -10,000
5070
2700 >-10,000

W8 ACD4 T cells
ARNA viral load
% with undetectable RNA viral load
W16 ACD4 T cells
ARNA viral load
% with undetectable RNA viral load
W20 ACD4 T cells
ARNA viral load
% with undetectable RNA viral load

0
0.81 log (range: +0.2; --2.9)
15%
+13
0.78 log (range: +0.2; 2.9)
15%
+ 20
0.74 log (range: t0.5; 2.9)
12.5%

Conclusion: This observational study, suggests that the use of alpha-IFN
combined with HAART therapy involved beneficial clinical effect and stabilization
or regression of the radiological findings. A randomized comparative trial is now
warranted.
S60964 HIV infection expert diagnostics problems in the Russian
military forces
Pyotr Nacharov, E.I. Zmushko, A.N. Kuzmitch, J.V. Lobzin, V.A. Mitin,
N.V. Belgesov. Lebedeva Str 6 Saint-Petersburg 194044 AIDS Department,
Military Medical Academ, Russia
Objectives: To compare results of different ELISA kits and immunoblotting (IB)
in patients with HIV infection.)
Design: Prospective, controlled study.

Conclusion: AR quadritherapy including RTV/SQV in non naive patients after
AR tritherapy failure including IDV does not seem to be effective to control HIV
replication.
60967 Nelfinavir-induced urticaria and successful
desensitization
Pascal Demoly', D. Messaad', Dohin2, P. Godard1, J. Bousquet',
A. Trylesinsky2. 'Maladies Respitatoires-Hopital A. De Villeneuve 34295
Montpellier Cedex 5; 2ROCME Nevilly/Seine, France
Background: Allergic reactions to drugs occur more frequently in patients
with AIDS than in the general population. HIV-specific protease inhibitors have