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

124 Abstracts 13192-13196

12th World AIDS Conference

13192 HIV and hepatitis B/C infection among injecting drug
users in Europe
Lucas Wiessing1, H. Houweling2, R. Hartnoll1, A.M. Downs1, J.C. Jager2. 1 Eur.
Monit. Ctr. Drugs & Drg. Addict. (EMCDDA) Rua Cruz De Santa Apolonia,
25-1-811, 3016, Lisboa, Portugal; 2Nat. Inst. Publ. Hlth. & Environm. (RIVM),
Bilthoven, France
Objectives: To describe historical and current spread of HIV and current spread
of hepatitis B/C viruses in injecting drug users (IDUs) in Europe. To describe harm
reduction measures in the European Union (EU).
Methods: Estimates of HIV prevalence and incidence from reported AIDS
cases and analyses by birth cohort were obtained by back-calculation within an EU
project (Concerted Action on Multinational AIDS Scenarios (BMH1-CT94-1723)).
Data were collected in EU member states on current levels of infection of HIV and
hepatitis B/C viruses and on harm reduction measures, through National Focal
Points within the Reitox network of the European Monitoring Centre for Drugs
and Drug Addiction (EMCDDA).
Results: Recent rises in HIV prevalence are reported from Portugal (IDUs
in drugs treatment) and Belgium (notifications). Back-calculations from reported
AIDS cases also suggest increasing HIV incidence in Portugal, but stable or
declining incidence in other countries. Birth-cohort analysis shows that new cohorts of young IDUs continue to become infected in Europe, although at lower
rates than in the initial phase of the epidemic. Eastern Europe shows extreme
rises in reported AIDS cases and HIV prevalence (screening). New combination
therapies lead to a sharp decline in reported AIDS cases in some countries.
Hepatitis B and C prevalences are extremely high in many countries, with an
estimated total of 500,000 HCV infections among IDUs in the EU. Most countries
in the EU have introduced harm reduction measures (information, clean needles
and syringes, condoms, counselling and testing), but often only since the 90ies
and not nation-wide. Levels of injecting among heroin users in treatment differ
much between countries, but have decreased in general.
Conclusion: HIV and hepatitis B/C viruses constitute a major health burden
for injecting drug users in Europe and are not under control. Harm reduction
has become an acceptable option in most countries, although coverage still
seems limited. Work is needed to identify factors that can lead to improved
effectiveness.
13193 1 HIV-1 clade distribution in southern France
Jacques Reynes1, M. Peeters2, M. Segondy3, E. Delaporte4. 1Hospital Gui de
Chauliac 34295 Montpellier Cedexs; 20rstom Laboratoire Retrovirus,
Montpellier; 3CHU Laboratoire Virologie, Montpellier; 40rstom Programme Sida,
Montpellier, France
Background: HIV-1 exhibits an extensive genetic diversity. The different subtypes
or clades have distinct geographic distributions. Clade B is involved in the HIV-1
epidemic diffusion throughout European countries.
Objective: To assess the spread of non-B HIV-1 clades in Languedoc, a
southern France area.
Methods: We studied the distribution of HIV-1 clades in 100 HIV-1 infected
adults who were consecutively examined by one physician (J.R.) between August
1995 and October 1996. All these patients resided in Languedoc. HIV-1 subtyping
was determinated by heteroduplex mobility assay (HMA). In some cases, HIV-1
clade determination was confirmed by DNA sequencing in the V3-V5 region of
the env gene.
Results: 20 patients were infected with non-B HIV-1 subtype strain (14 A, 2
C, 3 E, 1G). These patients were predominantly infected through heterosexual
contact (no history of parenteral drug use). Of the 17 patients who were infected
with a clade A, C or G strain, 4 were native of Africa, 7 had a partner from
sub-Saharian Africa and one received blood products in Africa.
Two patients infected by clade E strain had been infected in Thailand through
sexual contact. Seropositivity of 7 patients infected with non-B clade strains has
been established before 1990.
Conclusion: Non-B HIV-1 clades have been present in southern France (20%
of the population studied) for some time. Clade A is predominant; clades C, E
and G are also encountered. Most non-B HIV-1 clades were sexually transmitted
from a partner that had been infected in a country in which the non-B clades are
predominant.
13194 Genetic characterization of HIV-1 in Russia: Evidence of
increasing infection with subtype A, subtype B, and
novel A/B recombinant
Aleksei Bobkov1, E.V. Kazennova1, L.M. Selimova1, N.N. Ladnaya2,
V.V. Pokrovsky2, R. Cheingsong-Popov3, J.N. Weber3. 1The D.I. Ivanovsky
Institute of Virology 16 Gamaleya Street Moscow 123098; 2Federal AIDS
Centre, Russia; 3Imperial College School of Medicine, UK
Background: The Russian Federation experienced an explosive HIV-1 epidemic
mainly spreading among injecting drug users (IDUs). To study HIV-1 genetic

subtypes and to estimate genetic diversity in different risk groups, blood samples
were collected from 350 HIV-1 infected subjects from various parts of Russia.
Methods: Initially PBMC DNA and plasma RNA samples were amplified and
analysed using heteroduplex mobility assay. To further characterize the relationship between the HIV-1 variants circulating among different risk groups, the 1.2
kbp env gene fragments encoding a portion of gp120 as well as the 0.75 kbp gag
gene fragments were cloned and sequenced.

Results: Genetic analysis of the HIV-1 derived from IDUs showed that 63.6%
(56/88) of these viruses belonged to subtype A. However, B subtype viruses
(4/88, 4.5%) were also found. The sequence data showed a marked intra-subtype homogeneity (the average means of interpatient genetic distance were
1.07% and 1.70% in gag gene or 1.84% and 2.33% in env gene for subtype
A and subtype B, respectively). Moreover, 31.9% (28/88) of HIVs found among
IDUs were gagA/envB recombinants originated from those two strains. A wide of
genetic subtypes was found among heterosexuals (n = 72), including A (39.4%),
B (20.8%), C (19.4%), D (9.7%), G (5.5%), H (1.3%), as well as A/E (1.3%) and
D/G (2.6%). Intrasubtype genetic distance between the A-D subtype sequences
encompassing the C2-V3 encoding regions ranged from 1.4 to 15.8% suggesting
that these subtypes were to Russia by multiple sources. 99% of homosexual men
were infected with B subtype. The HIV-1 G subtype viruses were epidemiologically
linked with the nosocomial epidemic in South Russia.
Conclusion: Taken in the epidemiological data revealed that more than 90%
of HIV-1 cases reported in the Russian Federation in 1997 have been identified among IDUs, rapid spread of the subtype A and B viruses as well as MB
recombinant may be suggested.
S13195 HIV-1 subtypes and viruses specific for Dutch drug users
in heterosexually infected individuals in The Netherlands
Eline L.M. Op de Coul1, R.A. Coutinho2, J. Goudsmit3, W. Lukashov3. 1Nieuwe
Achtergracht 100 1018WT Amsterdam; 2Municipal Health Service, Amsterdam;
3Academic Medical Center, Amsterdam, The Netherlands
Objective: To study the molecular epidemiology of HIV-1 infection among asymptomatic heterosexuals, the possible spread of non-B viruses and the origin of
HIV-1 subtype B strains.
Methods: Sequences of the gp120 V3 region were obtained between
1988-1996 from 90 subjects in Amsterdam and analyzed by using signature
pattern analysis and phylogenetic methods.
Results: The HIV-1 viruses of 52 women and 38 men belonged to subtype B
(n = 54), A (n = 20), C (n = 6), E (n = 1), F (n = 4) and G (n = 3). Two viruses were
unclassified. Among 50 individuals originating from HIV endemic areas 30 (60%)
had a non-B infection. Among individuals of European origin who reported one or
more sexual partners from an HIV endemic area this proportion was 56%. Among
individuals of European origin with no known sexual partners from HIV-endemic
areas (n = 26) only subtype B viruses were identified. Among 54 subtype B viruses,
22 (41 %) had the synonymous nucleotide substitution in the second glycine codon
at the tip of the V3 loop (the GGC pattern), identified previously as specific for the
Dutch drug users. The other previously described IDU sequence patterns were
significantly more often observed among GGC, than among non-GGC containing
sequences. In addition, we identified another amino acid change specific for the
GGC sequences. In the phylogenetic analysis, the GGC sequences from heterosexually infected individuals clustered separately from the non-GGC sequences
and together with the Dutch IDU consensus sequence. Both the nonsynonymous and, especially, synonymous distances among the GGC sequences were
significantly lower than among the non-GGC sequences.
Conclusion: Multiple genetic HIV-1 subtypes are present among heterosexuals in Amsterdam, but there is no evidence for spread of non-B infections among
individuals of European origin with no known sexual partner(s) from HIV-endemic
areas. Our data provide evidence for a common origin of the viruses in Dutch
IDUs and the GGC viruses in heterosexuals. We suggest that a considerable
proportion of the viruses in heterosexually infected individuals in The Netherlands
may have originated from Dutch IDUs.
13196 1 Increase in deaths due to causes unrelated to HIV
infection: A proportional mortality analysis
Nicola Low1, R. Weber2, M. Egger3, M. Battegay4. 1Dept of GU Medicine, Kings
College School of Medicine, 15-22 Caldecot Road, London; 3 University of Bristol,
Bristol, United Kingdom; 2University of Zurich, Zurich; 2Basle, Switzerland
Background: Death rates from HIV infection are falling, due to improved treatment. This study examines trends in and risk factors for death from causes
unrelated to HIV.
Design: Proportional mortality analysis within a national prospective cohort
study.
Methods: Deaths of participants in the Swiss HIV Cohort Study were examined according to cause and year of death. Proportional mortality rates (95%
confidence intervals) were calculated. Risk factors for death from non-HIV related
causes were investigated in logistic regression models.
Results: 3,336 deaths were registered from 1988 through September 1997.
688 deaths were due to causes other than HIV infection: suicide, 95 (14%);
intravenous drug overdose, 55 (8%); gastrointestinal, 51 (7%/); cardiovascular,
35 (5%); accident/murder, 23 (3%); other/unclear, 429 (62%). The proportional
mortality rate for definite HIV related death fell from 85% in 1988/89 to 72%
in 1996/97, p < 0.001 for trend (figure). The odds of non-HIV related/unclear
deaths increased by 11% (95% Cl 3-20%) for each successive two year pe
riod after controlling for transmission group, age and CD4 count at registration.
Compared with gay men, injecting drug users were 2.04 (95% CI 1.64-2.55)
times more likely to die from non-HIV or unclear causes after controlling for
confounding.
Conclusion: As death rates from HIV infection have fallen, the proportion of
people dying from unrelated or unclear causes has increased. The risk is greatest
for those infected through injecting drug use. This increase in deaths due to