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

12th World AIDS Conference

Abstracts 22192-22196 301

22192 Impact of HAART on clinical evolution of genital warts in
HIV positive patients
Orlando Giovanna, Rosamarina Signori, M.M. Fasolo, M. Schiavini, A. Casella,
A. Gargnel. 2 Dept. of Infect. Diseases, Sacco Hospital, via G.B. Grassi, Milan,
Italy
Background: HPV infections in HIV+ patients are both very common and present
higher relapses rate than immune competent individuals. No drugs are actually
available for the etiologic treatment of such infections which tend to spread rapidly
and recur very frequently after surgical removal in relation to the degree of immunological impairment. Here we present an observational study on the impact
of antiretroviral therapies on clinical evolution of genital warts in HIV+ patients.
Methods: Diagnosis of genital warts was made on clinical basis in outpatients
attending SDTs from 1st January 1996 to 31st December 1997 and surgical treatment was instituted. Patients were divided in 3 groups according to antiretroviral
treatment. Each patient was assigned to 1 or more groups according to the
treatment modification in the course of HIV disease and followed up at 1, 3, 6, 9,
12 months interval.
Results: Among the 40 patients evaluable included in the study 13 were
treated with a combination of 3 highly active antiretroviral drugs (3D), 21 had only
2 transcriptase inhibitors (2D) and 6 had no treatment according to antiretroviral
guidelines (NT). Relapse rate after complete surgical treatment of warts obtained
in 24 pts was observed in 11.1%, 14.2% and 50% in 3D, 2D and NT respectively
at 1 month (p = ns), 22.2%, 7.1% and 50% at 3 months (p = ns) and 0%, 10% and
75% at 6 month interval (p < 0.01). Analysis of mean HIV RNA copies/ml showed
significant differences between patients with or without relapses (t < 0.01) while
no relation was observed with CD4+ cell counts.
Conclusions: relapses rate of genital warts in HIV positive patients are lower
in successfully treated with HAART or in 2D treated than in NT patients. This
effect seem related to the level of viral load which tend to increase over time in
NT patients and to decrease in 2D or in 3D ones. Immune recovery induced by
these combination regiments could explain the better clinical outcome observed.
81*/22193 Women personal collection of specimens as an
alternate strategy in fighting STD without speculum
Juan Carlos Flichman1, K. Amodio Siemaszko2, AG. Di Noto2, JM. Mendez
Ribas2. 1Marcelo T De Alvear 2345 1122, Buenos Aires; 2Hospital de Clinicas
Buenos Aires, Argentina
Objetives: To compare in Sexually Transmitted Diseases (STD) the results of
the Vaginal Cervical Swabs (VCS), gold standard of collection, with the first void
urine and Vaginal Tampons (VT), that most women perform routinelly each month,
can be done at any time and can be transported in phosphate sterile buffer for
processing many kilometres away.
Study Design: 50 (fifty) women answered to a survey prepared to such aim,
considering that the study was orientated to adolescents recently sexually actives.
Methods: Cultures for Lactobacillus sp (L), Gardnerella vaginalis (Gv), Aerobics and Anaerobics (AA), Ureaplasma urealyticum (Uu), Mycoplasma hominis
(Mh), Candida albicans (Ca) and Trichomonas vaginalis (Tv). For Chlamydia
trachomatis (Cht) and Neisseria gonorrhoeae (Ng), Ligase Chain Reaction (LCR)
was used. In the future we will extend the tampons specimens for HIV, HPV, HSV
1 and 2, primers for chancroid could be included in areas where the disease is
prevalent.

of the homosexual men with gonorrhea report having recently given or received
oral sex, while only 24% with chlamydia do. 81% of men with gonorrhea had urethral discharge; 55% of men with chlamydia had discharge. The mean duration of
symptoms before presentation varied from 3.25 days for men with both gonorrhea
and chlamydia, 3.92 days for gonorrhea alone, and 7.0 days for chlamydia alone.
Homosexual men presented earlier (4.3 days) than heterosexual men (5.9 days.
p < 0.04), regardless of etiology.
Conclusions: Homosexual men are more likely (RR 2.75) to have gonorrhea
than heterosexual men; heterosexual men are more likely (RR 3.05) to have
chlamydia. Concurrent gonorrhea and chlamydia is 2.18 times more likely in
heterosexual men, findings which may affect treatment decisions. Recent oral
sex, the presence of discharge, and shorter symptom duration were all more
suggestive of gonorrhea than chlamydia.
S22195 Prevalence of coinfection by HIV-1 and others
sexual/parenteral transmissible pathogens in Brazil
Ricardo A. Carmo1 2, A. Carmo2, C.A. Andrade2, A.A. Lima2, J.G.F. Oliveira2,
H.N.C. Bicalho2, M.S. Oliveira2, L.Q. Santi2. IRVA Horta Barbosa, 1037 Belo
Horizonte; 2Hospital Eduardo De Meneses F Hemominas, Belo Horizonte, Brazil
Objective: To study the prevalence of coinfection by hepatitis B virus (HBV),
hepatitis C virus (HCV), Treponema pallidum, Trypanossoma cruzi and human T
cell linphotropic virus types 1/11 (HTLV-I/II) in Brazilian patients infected by HIV-1.
Methods: A serological screening was applied to every patients tested for
anti-HIV in the Hospital Eduardo de Menezes, in Belo Horizonte, Brazil, between
the period of December 1995 and December 1997. The serological tests utilized initially were the anti-HIV1/2 (ELISA 3.0), anti-HBc-total (ELISA), HBsAg
(ELISA), anti-HCV (ELISA 3.0), anti-Treponema pallidum (ELISA or FTA-Abs),
anti- Trypanossoma cruzi (ELISA and Indirect Immunofluorescence and Indirect
Hemagglutination), and anti-HTLV-1/ll (ELISA). Patients with positive reaction to
the anti-HIV-1/2-ELISA and/or to the anti-HTLV-1/ll-ELISA were submitted to confirmatory tests with anti-HIV-1/2-Western-Blot and/or anti-HTLV-1/ll-Western-Blot
(WB), respectively. Only the patients with positive anti-HCV-ELISA in the first year
of the study were submitted to a confirmatory anti-HCV RIBA-2.0.
Results: This study analysed 1.284 patients submitted to the serological
screening. It was found a total of 650 (50.62%) patients infected by HIV-1 confirmed by both reactive HIV1/2 ELISA and WB tests. The prevalence of the others
markers in these HIV patients were: anti-HBc (total) = 276/650(.42.46%); HBsAg
= 30/650 (4.62%); anti-HCV (ELISA) = 96/650 (14.77%); anti-HCV (RIBA) positive = 8/49, indeterminate = 33/49, and negative = 8/49; anti-T.pallidum (ELISA
or FTA-Abs) = 242/650 (37.23%); anti-Tcruzi (at least two positive reactions
between ELISA, IIF and IHA) = 02/650 (0.31%); anti-HTLV-l/ll (ELISA) = 36/650
(5.54%), with positive anti-HTLV- 1/11 (WB) = 14/36 (38.88%), indeterminate =
11/36 (30.56%) and negative = 11/36 (30.56%).
Conclusion: The high prevalence of serological markers of infection by others pathogens like HBV, HCV, Treponema pallidum, Trypanossoma cruzi and
HTLV-I/II in HIV-1 patients teach us to be aware of the possibility of these coinfections, many of them with atypical manifestations and evolution modified by the
immunossupression caused by the HIV-1.
[22196 Drug use and STD prevalence/incidence among women
with HIV infection
Tracey E. Wilson1, L. Novotna2, H. Minkoff3, L. McNutt2, D. Dejarlais4,
J. Dehovitz5. 1450 Clarkson Avenue, Brooklyn, New York; 2SUNY School of
Public Health, Albany, NY; 3Maimonedes Medical Center, Brooklyn, NY; 4Beth
Israel Medical Center, New York, NY; 5SUNY Health Science Center At
Brooklyn, Brooklyn, USA
Background: To determine consequences of drug use among a cohort of women
infected with HIV, and to examine the association between drug use, sexually transmitted disease (STD) and a series of demographic, socioeconomic,
behavioral and clinical factors.
Methods: 155 women with confirmed HIV-positive serostatus were examined
at baseline and a one-year follow-up. Data collection included an interview on
demographic, socioeconomic and behavioral characteristics, testing of vaginal
cultures for T vaginalis, C trachomatis, N gonorrhoeae, serologic tests for syphilis,
and urinalysis for the presence of metabolites of cocaine and opiates. Incident
STDs were defined as (1) a negative test at baseline, but positive at follow-up, or
(2) a positive test at baseline, treatment and test of cure, and a positive test at
follow-up.
Results: Confirmed drug use prevalence was 36.5% and was associated with
greater number of sexual partners and lower age at first intercourse. STDs were
present at baseline in 46.0% of drug users and 25.2% of non-drug users (p =
0.001). Drug use was also associated with increased STD incidence, 23% versus
9.9%, p =.045. No significant difference was found in the distribution of CD4
counts in cocaine/heroin users versus non-users at baseline. However, another
indicator of clinical health status, the Karnofsky score, was 80 or below significantly more often in cocaine and heroine users than non-users (27.8% versus
10.9%, p = 0.003).

Conclusions: Drug use was common in this HIV-infected cohort, despite these
women being in care. Although these women had lower overall physical functioning, they were more likely to engage in risk behaviors that placed them at risk
for STD. HIV-infected women have not been successfully reached with regard to
efforts at implementing safer sexual and drug use behaviors.

Results L
VCS 17
VT 21
(Coincidence) % 100
Urine not done (nd)

Gv
5
5
100
nd

AA
4
4
100
nd

UU
7
5
71.4
nd

Mh
4
4
100
nd

Ca
5
5
100
nd

Tv
4
4
100
nd

Cht
4
2
50
4 (100%)

Ng
0
0
100
0(100%)

Conclusion: Tampons self obtained specimens evaluated were sensitive in
detection of Candida, Mycoplasmas, Trichomonas, normal and abnormal vaginal
flora. For Chlamydia trachomatis infection we recommended LCR in tampon and
first void urine. This kind of collection is important for screening, diagnosis and
epidemiological control of syndromic treatments.
22194 Gonorrhea and Chlamydia: Lack of co-infection in
homosexual men
Scott McCallister, Joseph W. Henry. Howard Brown Health Center, 938 W.
Nelson Ave., Chicago, Illinois 60657, US
Objective: Gonorrhea and chlamydia are frequent causes of venereal disease
in both heterosexual and homosexual men, occurring concurrently in 15-25%;
men diagnosed with one are generally treated for both. We sought to identify
the co-infection rate and some useful diagnostic markers at a primarily gay STD
clinic.
Design: Retrospective review of medical records at an outpatient STD clinic.
Methods: We reviewed the records of 83 consecutive male clients with either
gonorrhea (n = 57), chlamydia (22), or both (4). All patients were tested for gonorrhea by culture (61+), and for chlamydia by either DNA probe (1+), cell culture
(2+) or PCR (23+). Patients self-identified as homosexual (72) or heterosexual
(11). Demographics, symptoms, sexual histories, and lab data were noted.
Results: 54 homosexual men were + for gonorrhea (54/72, 75%), 15+ chlamydia (21%), and 3+ for both gonorrhea and chlamydia (4%). 3 heterosexual men
were + for gonorrhea (3/11, 27%), 7+ chlamydia (64%), and 1+ for both (9%). 72%