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

116 Abstracts 13154-13158

12th World AIDS Conference

Although most of this use is not directly related to HIV transmission (non-injectable
drugs), they facilitate unsafe sexual practice.
Methods: A self-reported questionnaire was completed by a total of 759 university students (391 male and 368 female), aged 18-30 years old, covering
social-demographic aspects, sexual practices, use of illicit drugs; knowledge of
HIV and STDs and its prevention. Participation in the study was voluntary.
Results: 567 students (74.7%) lived most of their lives in big metropolitan
areas, with their parents (568, 74.8%), and are single (705, 92.8%). With respect
to drug use, alcohol use was reported by 84%, marijuana by 32% (35% males
x 28% females, p = 0.06), inhalants by 13%, cocaine by 9.5% (12% males x
5% females, p = 0.0007), but only 0.5% reported injecting drugs. There was
no relation between drug use and size of the city they lived most of their lives,
nor with living alone as compared to living with their parents. However, there
was a tendency of using more drugs among those who are married (p = 0.08).
Knowledge about HIV transmission did not influenced drug use. However, those
with a self perception of being at risk use more drug than those who believe that
are not at risk (p = 0.00003)
Conclusion: In spite of the awareness about AIDS and its prevention, it
appears that their behavior is still risky. Therefore, the implementation of psychoeducational programs that would promote behavioral change in relation to HIV
transmission is indicated. Grant FAPESP 93/3525-1
S13154 Epidemiology of HIV and AIDS in Bahrain
Mohammed Khalil Al Hadadd1, B.Z.H. Baig2, R.A. Ebrahim3. 1Psychiatric
Hospital-Ministry of Health, Manama; 2Ph.D., Manama; 3M.R.C.P, Manama,
Bahrain
Between 1986 and 1996, 378 HIV cases were identified in Bahrain, of whom 51%
were foreign nationals. Intravenous drug abuse was a major risk factor (38.8%)
among Bahraini nationals while transmission through sexual contact was more
common (45.7%) among foreigners. Other well known risk factors were also
represented in the two communities. The male to female ratio for the two communities were very different with 10:1 for nationals compared to 1:1.4 for foreigners.
Among the AIDS defining manifestations, Pneumocystis carinii pneumonia was
the commonest (50%), followed by tuberculosis (21%), oro-esophageal candidiasis, crytosporidiosis and toxoplasmosis.
Transmission through sex and maternal-fetus could emerge as significant
contributors in the spread of AIDS in Bahrain unless appropriate steps are taken.
S1315513 Genetic diversity of HIV-1 subtype E from recent
seroconverters in Thailand
Kwanjai Viputtigul1, A. Roungpong1, L.E. Markowitz2, M. de Souza3,
J. Gaywee4, F.E. McCutchan5, A.E. Brown2, S. Nittayaphan4. 1AFRIMS 315/6
Rajvithi Rd. Bangkok 10401; 2USAMC-AFRIMS Bangkok;
3HMJF/USAMC-AFRIMS Bangkok; 4 RTAMC-AFRIMS Bangkok, Thailand;
5 HMJF/Rockville Maryland, USA
Background: The human immunodeficiency virus type 1 (HIV-1) genome is characterized by a high degree of variation. A previous study showed that sequential
high antibody titer to the V3 loop is associated with the variability. This suggests
a role for the immune response in the evolution of viral variants during the course
of disease.
Objective: To study the genetic diversity of the envelope region among subtype
E viruses in Thailand.
Methods: Blood was obtained from 11 patients who seroconverted to HIV-1
subtype E between 1995-1996. We examined the variation in nucleotide sequences in the envelope region (V3) by direct sequencing of PCR amplified
PBMC DNA.
Results: The V3 nucleotide sequence differed by 6-12%. The variability of the
35 amino acid V3 loop was 3-17%. The predominant pattern of the tetrapeptide
sequence at the tip of the V3 loop was the GPGQ motif, as previously described
in Northern Thailand variants.
Conclusion: Recent seroconverters to HIV subtype E in Thailand demonstrate relatively limited genetic variability in the V3 region compared to other HIV
subtypes.
13156 HIV-1 dual infections and recombinants are an integral
part of the HIV epidemic in Brazil
Danuta Pieniazek1, A. Ramos1, A. Tanuri2, D. Hu1, J. Baggs1, M. Rayfield1.
1Centers for Disease Control, 1600 Clifton Road, Atlanta, GA, USA; 2UFRJ, Rio
De Janeiro, RJ, Brazil
Background: Although dual infections and recombinants involving sequences of
different HIV-1 subtypes have been previously reported, their prevalence has not
been evaluated.
Objective: To estimate the proportion of dual infections and recombinants
among HIV-1 infected persons living in Rio de Janeiro, an area where HIV-1

subtypes B and F are common.
Methods: Peripheral blood mononuclear cells collected in 1993-1994 from 107
HIV-1-infected persons were used for nested-PCR amplification of viral gag (p24
region), pol (protease), and env (C2-V3 domain). Potential dual infections and
recombinants were selected for further sequence analysis by using a combination
of restriction fragment length polymorphism and heteroduplex mobility screening
assays.

Results: Of the 107 specimens tested, 87 were infected with HIV-1 subtype B,
5 were infected with subtype F, 15 were potential dual infections caused by two
distinct viral strains, and 5 were recombinants of various subtypes. Phylogenetic
analysis of sequence data revealed that 7 dual infections were heterogeneous
and comprised subtypes B and F (1), F and D (2), B and D (1), and B and C (3
cases of familial clustering). The remaining 8 specimens from this group represented false dual infections due to hypermutated sequences (3) or point mutation
in the restriction site (5). In contrast to the heterogenous nature of heterotypic
dual infections, all 5 recombinants included HIV-1 genomes of subtypes B and
F only. The recombinant patterns based on gag, pol, and env included BFF (1),
BFB (1), B/Fgag/FF (2), and B/Fgag FB (1). Taken together, these data suggest
that while dual infections with multiple subtypes are common in Rio de Janeiro,
recombinant viruses comprise sequences of subtypes B and F only.
Conclusion: Our data indicate that dual infections (6.5%) and recombinants
(4.7%) are an integral part of the HIV-1 epidemic in Brazil. This knowledge is
vital to our understanding of the relevance of dual infections as a prerequisite for
recombination, and is immediately applicable for current vaccine research.
S13157 HIV-1 subtypes B and F circulating in children from Sao
Paulo, Brazil
Adele Caterino-De-Araujo1, E. Santos-Fortuna1, M.A.A. Rossini1,
I.M. Ramos-Dos-Santos1, J. Casseb2, M.R. Hendry3. 1lnstituto Adolfo Lutz - Av.
Dr. Arnaldo - 355 11 Andar - 01246-902 Sao Paulo SP; 2Faculdade De
Medicina, Univ. Sao Paulo, Sao Paulo, Brasil; 3Dept. Health Services, Berkeley,
CA., US
Background: In order to determine the HIV-1 subtypes present in children born to
HIV-1 infected mothers, we previously search for the presence of specific gp120
V3-loop antibodies in plasma samples obtained from a Vertical Transmission
Study Group from Sao Paulo, Brazil. Now, using molecular approaches we tried
to confirm the preliminary results using heteroduplex motility assay (HMA).
Methods: A total of 97 plasma specimens were analysed using an in house
peptide-EIA that employed a set of seven synthetic peptides representative of the
predominant HIV-1 subtypes detected in Brazil. Peripheral blood mononuclear
cells from 20 children were used in PCR analyses to search for an amplified
product of 1,2 Kb that include the V1-V5 region of the env gene, and a fragment
of 700-bp (V3-V5 region) which was subjected to heteroduplex motility assay
(HMA).
Results: The results obtained permitted serotype 64 out of 97 samples, disclosing subtype B in all cases, except one, which could be considered to be of
subtype F. Using HMA we were capable of subtyping 13 out of 20 specimens:
subtype B was detected in 11 samples along with subtype F in two samples.
Two others specimens remained indefined, and the last 5 samples could not be
amplified. In the majority of cases it was observed concordant results on peptide-EIA and HMA tests: 9 isolates were classified as subtype B using both tests.
Considering HMA a standard method, two cases of subtype F were erroneously
typed as subtype B when peptide-EIA was employed. On the other hand, two
samples that gave HMA indeterminate results, each one could be subtyped as
B and F when peptide-EIA was used. Although HMA and peptide-EIA analyses
of HIV-1 children specimens grouped them into subgroups B and F, to solve the
question of which of the tests correctly classifies the Brazilian isolates, it would
be necessary to extend the data, searching for DNA sequences.
Conclusions: The results obtained emphasize that peptide-EIA and HMA are
complementary tests. The observations despite being made on the basis of a
limited sample size, stress the presence of both, subtype B and F, circulating
among children that acquired HIV-1 infection by vertical transmission route in Sao
Paulo, Brazil.
13158 Clinical epidemiologic and serologic aspects of HIV
positive population of women
Elina Teicher, S. Lupo, R. Bortolozzi, P. Lavarello, C. Suarez, J. Palazzi,
R. Kneitschel. Caici, Rodriguez 1215, 2000 Rosario, Argentina
Introduction: As a result of the increasing heterosexual transmision of the HIV
the number of HIV positive women has increased progressively in our population
almost getting a relation of 1/1 men-woman.
Objective: To describe the epidemiological, clinical and serological aspects of
an HIV positive population of women in our clinic.
Methods: We reviewed all the medical records of the 208 HIV positive women
that came to our clinic between 1988 and 1997. We reviewed the serology for the
most frequent co-infections and the inmunological variables. The clinical staging
was done according to the WHO Staging System.
Results: The median age was 26 ys (15-45); 70% of the women acquired
the infection through heterosexual contact, 16% through iv drug use, 9% were
heterosexual/IVDU and 1% through a transfusion. 49% of the women were single,
28% married, 9% widowed and 6% divorced. 14% had universitary studies, 44%
had finished the high school and 32% had finished the elementary school. 26%
of the women were employees, 4% were professionals, 1% were students, 6%

were independent workers, 39% stayed at home with the housechores and 19%
were unemployed. 62% of the women had children from whom 7% were HIV
positive. According to the WHO staging at the beginning: 59% were stage 1.2%
stage 2.9% stage 3.6% stage 4; at the end of the study: 37% were stage 1.3%
stage 2.9% stage 3 and 19% stage 4.7% of the women were HVB positive,
41% HCV positive; 53% of the women had IgG anti-toxoplasmosis and 44%
IgG anti-CMV, 5% had positive Chagas serology and 5% a positive VDRL. The