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

154 Abstracts 13338-13342

12th World AIDS Conference

exposure group, year of seroconversion during 1984-94, or calendar year at risk
during follow-up period 1985-96 contributed at most a small additional effect on
survival or progression to AIDS.
192*/13338 Geographic variation in disease progression in 664
HIV-1 seroconverted injecting drug users in
Europe?
Maria Prins. For the European Seroconverter Study among injecting drug users;
Munipal Health Service Nieuwe Achtergracht 100 1018 WT Amsterdam, The
Netherlands
Background: HIV disease progression might vary by geographic area due to
differences in the spectrum of AIDS-defining illnesses and (assess to) clinical
care. Therefore, we evaluated the effect of geographic area and other potential
cofactors on disease progression in 664 injecting drug users (IDU) with known
intervals of HIV seroconversion from 8 cohorts in Europe.
Methods: We studied the effect of geographic area, other sociodemographics,
drug use and repeated HIV exposure on progression from HIV seroconversion to
the first CD4 count <200 cells//il, AIDS and death from AIDS using Kaplan-Meier
methods and Cox proportional hazards analysis. We considered the confounding effect of study-design related factors (e.g. setting of follow-up, inclusion of
retrospectively identified seroconverters). In addition, we accounted for pre-AIDS
death from natural causes by estimating when each endpoint would have occurred
if death could be eliminated (based on the CD4 decline prior to each endpoint).
Results: Accounting for pre-AIDS mortality, the median incubation time from
seroconversion to the first CD4 count <200 cells/Ill was 7.7 yrs (95% confidence
interval (CI) 7.1-8.3) and to AIDS 10.4 yrs (CI 9.8-o0). The 10-year survival
was 70.3% (Cl 62.8-76.6). AIDS-defining conditions did not differ significantly by
geographic area. The age-adjusted relative hazard (ARH) of AIDS for IDU from
central and southern Europe compared with IDU from northern Europe was 2.0
(CI 1.3-3.3) and 1.2 (CI 0.6-2.4) before, and 1.5 (CI 0.7-3.4) and 1.2 (CI 0.6-2.5)
after taking variation by study-design related factors into account. Accounting for
study-design related factors, the ARH of death from AIDS was 0.9 (Cl 0.3-2.5) for
central and 1.2 (CI 0.4-3.5) for southern Europe compared with northern Europe.
For the first CD4 count <200 cells/ttl these figures were 1.0 (CI 0.6-1.6) and
0.8 (Cl 0.5-1.4). Age at seroconversion was the strongest predictor of AIDS and
death from AIDS. No statistically significant differences in disease progression
were found by gender, foreign nationality, continued HIV exposure and drug use.
Conclusions: We found no evidence for variability in HIV disease progression among regions in Europe. Future studies evaluating geographic differences
should consider the confounding effect of study-design related factors and differential non-AIDS mortality. As age is an important determinant of disease
progression, it should be considered in recommending treatment.
13339 Ethnic origin and provision of health care for HIV patients
in Europe - Results from the EuroSIDA study group
Anders Blaxhult1, A. Mocroft2, R. Zwi Bentwich3, B. Colebunders4,
T.L. Benfield5, F. Mulcany6. 1Dep of Infectious Diseases Karolinska Institute
Danderyo Hospital, Danderyo; Karolinska Institute Danderyo Hospital,
Danderyo, Sweden; 2Royal Free Hospital School of Medicine, London, UK; 3Ben
Ari Instituteof Clinical Immunol, Rehovot, Israel; 4 Institute of Tropical Medicine,
Antwerpen, Belgium; 5Hvidovre Hospital, Copenhagen, Denmark; 6 James
Hospital, Dublin, Ireland
Objectives: To determine if differences in ethnic origin influence access to
health-care and survival among HIV patients in Europe.
Design: A European prospective, observational multicentre study.
Methods: A number of HIV clinics in 17 European countries are following
4498 patients with HIV in the EuroSIDA study. Patients were enrolled following a
routine clinic visit. Data on demographics, treatment and laboratory results were
collected at time of recruitment and thereafter every 6 months.
Results: There were no differences in any aspects of health care or survival between 4062 native European patients (EU), and 287 patients who were
migrants from Asia and Africa (AA). Patients presented at similar levels of immunodeficiency (median CD4 counts at recruitment is 171 x 106/L for EU and
200 x 106/L for AA, p = 0.012, wilcoxon test), had equal access to antiretrovirals
and trial medications (median CD4 counts at initiation of first antiretroviral drug,
zidovudine, is 200 x 106/L for both EU and AA, p = 0.35, wilcoxon test), and had
similar survival following an AIDS defining illness (mortality at 12 months 40.1%
for EU and 44.9% for AA (p = 0.29).
Conclusions: No differences related to ethnic origin were found in disease
stage at presentation, treatment regimens or survival among patients seen at various HIV centres in Europe. Community based studies are needed to determine
if there are populations who do not reach the treatment facilities.
S13340 Psychosocial factors affecting the progression of the
HIV-disease in homosexual men

Joram Ronel'2, U. Mitzdorf2, E. Wolf3, E. Jaegel-Guedes3, H. Jaeger3.
Institute fur Medizinische Psychologie, Goethestr. 31 D-80336 Munchen;
2Institute of Medical Psychology, University of Munich, Munich; 3KIS, Curatorium
for Immunedeficiency, Germany
Objectives: This study attempted to identify psychological and sociological factors which may influence the progression of the HIV-disease in homosexual men

by taking their specific psycho-cultural situation into consideration. Participants
from two different states of HIV-progression, Long-Term-Non-Progressors (LTNP)
and Short-Term-Progressors (STP) were compared.
Design: Explorative, controlled study.
Method: 13 LTNP (more than 8 years since HIV-infection, asymptomatic, no
medication, CD4 > 500/ml and viral load <10,000/ml) and 9 STP (2 to 4 years
of HIV-infection, CD4 <400/ml and viral load >100,000/ml before therapy-onset,
no CDC-C). A self-administered, 415-item-/questionnaire was applied, covering 6
dimensions: Socio-demographic background, psychosocial aspects of sexuality
and HIV-infection, health- and disease-behavior, patient-physician-relationship,
and socio-cultural influences. In addition, 8 standardized instruments were used,
measuring personality, social support, psychopathology, mood states, health locus
of control, coping, quality of life, and social desirability.
Results: Statistically relevant differences were revealed for the following topics:
STP suffer from more psychopathological symptoms and feel subjectively less
well than LTNP. STP appear to be less controlled than LTNP, e.g. in the way
they inform their environment about their HIV-infection and their homosexuality.
STP show more internal homophobia, LTNP more self-accepting attitudes. STP's
ideals in life and those concerning sexuality lean more towards subcultural values, while LTNP orientate themselves rather towards heterosexual standards. For
STP the HIV-infection plays a more significant role in everydaylife than for LTNP.
STP develop more feelings of guilt and moral burden for having been carelessly
infected with HIV than LTNP.
Conclusions: It could be demonstrated that two distinct progression groups
differed significantly in several psychosocial aspects. As some of these aspects
might be influenced by the clinical state and as the number of cases in this study
was small, the results should only carefully be generalized. Nevertheless the
outcome adds to the psychoneuroimmunologic understanding of the HIV-disease
and may contribute to improve treatment and prevention concepts.
S13341 Psychoactive substance use among people living with
HIV/AIDS: Current practice and future action
Gundo Weiler1, A. Ball1, M. Donoghoe1, S. Rana1, T. Rhodes2, M. Singh3
1 WHO, Geneva, Switzerland; 2The Centre for Research on Drugs, London, UK;
3Life Giving and Life Saving Society, Kath Mandu, Nepal
Issue: WHO and UNAIDS have a joint initiative to develop and disseminate
standards for good practice in counselling, treatment and care for people living
with HIV/AIDS.
Project: It is assumed that a significant proportion of the estimated 30 million
people living with HIV/AIDS use psychoactive substances (including alcohol). Yet,
the health impact of such substance use has not been determined and adequately
addressed. The initiative involves a review on current knowledge and practice by
researchers and service providers to inform the development of more effective
services and other responses.
Results: Injecting drug users (IDUs) have been identified as one group not
having adequate access to counselling and health services, and when HIV positive, accessibility to support interventions may even decrease. Poor quality of
treatment and care services for HIV positive IDUs is of major concern, especially
in developing countries. However, there are examples illustrating that integration
of injecting drug use issues and HIV/AIDS treatment is feasible and effective.
The review of current knowledge and practice reveals gaps in knowledge and
practice in other areas besides treatment and care, especially in regard to medical
and psycho-social mange of HIV, risk behaviours, human rights, ethical issues,
legislation, and occupational health. Examples show that these gaps do not only
appear in the context of IDU but also in relation to other psychoactive substance
use, including licit ones.
Lessons Learned: The review of current knowledge and practice reveals
a complex association between the use of psychoactive substances and HIV
serostatus. This association should be reflected when designing support interventions and planning during health policy. WHO and UNAIDS endeavour to
support this process through elaborating guidelines for good practice.
| 13342 | Using the Internet: Cost-effective way to expand AIDS
prevention efforts for youth
John Chittick. 43 Charles Street, Boston, MA 02114, USA
Issue: A major problem exists for AIDS organizations attempting to encourage
and organize localized efforts on a regional or global basis. The logistics of
coordinating programs in far-flung areas can be an expensive and difficult undertaking. Yet it is commonly accepted that universal prevention efforts benefit from
shared knowledge. This experience is especially true for vulnerable teenagers
who despite cultural and linguistic differences share the basic bond of adolescence - making peer education efforts of uniform interest to teens around the
world. Consequently, if crucial information is not readily disseminated to those
youth most at risk, HIV spreads at a more rapid rate. With the advent of the
internet, even small and poorly-funded entities can provide effective prevention
education and coordinate programs from a centralized location without the added

expense of sending outside consultants and trainers to diverse locales on a
regular basis.
Project: Based on a continuing Harvard University research project that initiates
teen peer education efforts globally, it was hypothesized that the worldwide web
could be a cost effective and virtually instantaneous medium to coordinate on-site
trainings through the use of off-site internet communication. Following training
sessions with youth and government agencies working to prevent teenAIDS (in the