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

12th World AIDS Conference

Abstracts 13343-13347 155

Philippines, Dominican Republic, Vietnam, Japan, Canada, Laos, Mexico, United
States, and Thailand) the host organization (TeenAIDS-PeerCorps) found it could
maintain regular contact in a highly effective and inexpensive way. Because the
internet is interactive, peer educators are able to share their experiences while
learning from teens in foreign localities. Even for those few countries presently
without access, the interim use of email is available to governments, educators
and NGOs to pass on the information. Soon internet services will be widely
available in many locales worldwide.
Results: Following the initial training of peer teachers in their home areas, the
coordination of their local programs and on-going training has been successfully
maintained and enlarged through access to a centralized internet site in Boston,
USA. The result is that a small organization has been able to assist a wide circle
of individuals and communities at little expense or overhead. Information and
training materials are disseminated globally and freely downloaded for immediate
use. Additionally, the internet site was designed to allow diverse communities to
share their own experiences and solutions with others as an adjunct of the main
site. Peer educators report that they enjoy using the new technology to spread the
HIV/AIDS prevention message and in turn, receive valuable information. Because
the site is listed on "search engines" of the www, young people in communities
which have not been visited are able to access the site and benefit from the
information - expanding prevention efforts to new people.
Lessons Learned: As HIV/AIDS spreads into the teen population, educational
efforts using the new interactive technology of the internet are proving to be an
effective way for small organizations and developing nations to organize, maintain
and share information among diverse communities. Importantly, in an era of highly
competitive and diminishing funding, the benefits of the internet are cost-effective
- ensuring that prevention efforts can be more easily coordinated and replicated.
13343 Economic resources, survival and progression of the HIV
infection
Giuseppe Liotta1, M.C. Marazzi2, S. Mancinelli1, L. Palonbil, P. Narciso3,
A.M. Doro Altan1. 1 Via Tor Vergata 135-Chair of Hygiene 00173-Rome; 2Lumsa
University, Rome; 31RCCS L. Spallanzani, Rome, Italy
Objectives: to study relations between survival, progression of the infection and
socio-economic conditions in a sample of HIV positive people AIDS free.
Population and Methods: the study enrolled 330 HIV positive people at the
day hospital, II Div. Inf. Dis. L. Spallanzani - Rome, from 1.3.1994 to 31.3.1996.
The Functional Multidimensional Evaluation questionnaire for people with HIV
infection was administered to every person at the enrollment; the following interviews were held every six months. It was used to measure self-sufficiency in
performing ADLs, economic and social resources and physical and mental health.
More than half of subjects were or had been intravenous drug user, while 24%
of the sample considered to have been infected through etherosexual sexual
contacts.
Results: every subjects was followed for 2 years on average (range: 0.16-2.9
years). As of 31 december 1996, 89 persons (27%) were diagnosed as AIDS
patients, and 59 (17.9%) were dead. The incidence of AIDS cases was 14.9/100
person/year while the incidence of death was 8.75/100 person/year. The impact
of economic factors on progression of the infection and survival was heavier
on subjects with a CD4 count lower than 200//l. The Cox proportional hazard
regression pointed out a significative relation between shorter survival and CD4
count at the enrollment (RR = 5.8; CL: 2.8-11.8), CD4 decline (RR = 2.0; CL:
1.3-3.2) and self-assessment of economic situation (RR = 2.2; CL:1.3-3.7). As
far as it concerns the disease progression, a relation with CD4 count (RR =
5.6; CL:3.1-10.1), their decline during the time (RR = 2.3; CL:1.6-3.4), the age
of patients (RR = 1.5; CL: 1.1-2.0), the clinical stage of infection (RR = 1.4;
CL:1.02-1.8) and the lower income at the enrollment (RR = 1.40; CL:1.07-1.8)
was observed.
Conclusion: the relation between economic situation and survival has been
previously highlighted by other authors and seems to be confirmed by the present
study. In addition the progression of infection seems to be influenced by income.
The differences in survival and progression of HIV infection seem to be wider in
the sub-sample with less than 200 CD4//I, when the patients face the greatest
need of help.
13344 The health seeking behaviors of selected populations in
Metropolitan Manila
Janneke Roos1, Eliseo L. Prisno III1, L. Hernadez2. 1AIDS Unit Department of
Health Manila; 2University of the Philippines Manila, Philippines
Objective: To obtain baseline data on perception, accessibility and utilization of
STD services in selected sites in Metropolitan Manila so as to improve the quality
of STD services and develop a health promotion strategy.
Methods: Survey questionnares, interviews and focused group discussions
were used to collect data among vulnerable groups such as sex workers, MSMs,
youth and students, displaced persons, transport workers, seafarers and dockhandlers.

Results: STD remains a stigmatized disease as a result of which they resort to
self-medication. They have high awareness of STD based on symptoms. Advise
is usually sought from peers and pharmacists. Quality of STD care is insufficient
among the local health centers. Television, the local health center and radio
remain to be the sources of information of STD. There is high awareness of community health programs but less people participate. Community resources are
inadequate thus community health clinics should be strengthened. A good referral

system is perceived to be a need and should be implemented. Respondents feel
for need for health services, preventive measures and more IEC.
Conclusion: Intervention should focus on health promotion. Care should be
improved through training of health personnel and pharmacists. STD should be
integrated into other reproductive health services.
595*/13345 Psychological and neuropsychological predictors
of mortality and disease progression in HIV-1
infection
Jose Catalan.2, A.J. Champion1, T. Baldeweg1, Gazzard2. Imperial College,
2Chelsea & Westminster Hospital, 369 Fulham Rd, London SW10 9NH, UK
Background: Investigations into the contribution of psychological morbidity to
mortality and disease progression in HIV-1 infection have produced inconsistent
findings. This study aims to address the value of mood variables and neuropsychological (NP) measures for predicting mortality and disease progression.
Methods: Patients were prospectively assessed using anxiety/depression
scales, NP assessments and self-report information. Univariate and multivariate Cox Regressions, with baseline CD4 count as covariate. were used in the
analyses. 122 patients were followed-up for a mean of 3 years 4 months (maximum 9 years) in the mortality analysis; 116 patients were followed-up for a mean
of 2 years 4 months (maximum 8 years 8 months) in the disease progression
analysis.
Results: No mood variables were significantly associated with survival or disease progression. Low CD4 count was the most significant predictor of increased
risk of mortality and disease progression. Poor performance on several NP tests
was associated with increased risk of either mortality or disease progression;
poor scores on tests representing the 'complex attention' functional NP domain
(ie Trailmaking B and age-scaled Digit Symbol) were associated with increased
risk of both events.
Conclusions: The degree of immune dysfunction and neuropsychological impairment are more important in predicting disease progression and mortality than
mood variables.
12*/13346 Host's genetic background of HIV-1 infected
long-term non-progressors in France
Magdalena Magierowskal, D. Costagliola2, F. Sanson1, P. Debre1,
I. Theodorou'. French Alt and Immunoco French Multicenter Study Group, 'Lab.
d'lmmunologie Cellulaire et Tissulaire URA CNRS 625 CH Pitie-Salpetriere 83,
bid de I'Hopital 75013 Paris; 2B3E Inserm SC4 Faculte de Medecine Saint
Antoine Paris, France
Objective: To study the contribution of CCR2-641, CCR5-D32, SDF1-3'A and
HLA genotypes in HIV-1 infected long-term nonprogressors (thereafter referred
as ALT).
Design: The ALTs (n = 68, all of Caucasian origin) are subjects who experienced HIV-1 infection for at least eight years, with a stable CD4+ cell count >600
cells/mm3 and no antiretroviral therapy. The controls (n = 83) were subjects enrolled in the IMMUNOCO cohort with the same ethnic origins and not fulfilling the
ALT criteria. They are thought to represent a sample of rapid/normal progressors
of the French HIV-1 infected population
Methods: The genotypes of chemokine or chemokine receptor genes were
determined using PCR or PCR-RFLP assays. HLA-A and HLA-B typing was performed with standard serological methods and HLA-DRB1 with generic molecular
typing.
Results: The statistical analysis performed for each marker separately revealed that the frequency of the CCR5-D32 allele was significantly elevated in
ALTs compared to the control group. On the contrary, the frequencies of two other
mutated alleles: CCR2-641 and SDF1-3'A were not significantly different between
these two groups. The predominant HLA alleles in ALTs were A3, B14, B17, B27,
DR6 and DR7. A combination of these markers tested using a multivariate logistic
regression model showed the following results. If a subject is heterozygous for
CCR5-D32 and homozygous for SDF1 wild-type his chances of being ALT are
increased by 15-fold; 36-fold, when a B27 allele is present while the DR6 is
absent and 49-fold, if at least three out of the following HLA alleles A3, B14, B17,
DR7, are present.
Conclusions: The chemokine receptor and chemokine genes along with the
HLA genotype can serve as predictors of HIV-1 outcome for classification of
HIV-1 infected subjects as long-term nonprogressors or rapid/normal progressors. When all analyzed genetic markers are integrated in a multivariate analysis,
65% of long-term nonprogressors subjects and 82% of rapid/normal progressors
subjects were classified correctly, suggesting that the host's genetic background
plays an extremely important role in the evolution of HIV-disease.
190*/ 13347 1 Long-term non-progressors (LTNP): Prevalence
and predictors through 18 years of follow-up
Eric Vittinghoff1, M.I. Feinberg3, T. Elbeik2, S. Staprans2, M. Carrington4,

G. Colfax', S. Buchbinder1. 'Department of Public Health, Suite 500, 25 Van
Ness Avenue, San Francisco; 2University of California, San Francisco, CA;
3Emory University, Atlanta, GA; 4National Cancer Institute, Rockville, MD, USA
Background: To describe HIV disease progression, nonprogression, and predictors of loss of LTNP status among men who have sex with men (MSM) in the San
Francisco City Clinic Cohort.