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

422 Abstracts 23400-23404

12th World AIDS Conference

Conclusions: Seminal HIV-1 viral load is strongly correlated with plasma viral
load.
23400 1 Determination of viral load in breakfast and plasma in HIV
infected mothers
Bruno You, N. Coulibaly, C. Montcho, P. Combe. Ditrame-CI Group; Labo
Cedres 01BP/839, Abidjan 01, Ivoiry-Coast
Introduction: In developing countries, transmission of HIV by breastmilk could
represent 30% of mother-child contamination. Determinants of this mode of transmission remain unclear. We describe here viral load in breastmilk, and plasma
among 42 mothers.
Method: 8 days after pregnancy, blood and breastmilk specimens were collected and viral load has been determined by the branched-DNA (b-DNA) method
(Quantiplex, Chiron Diagnostic), since we have assessed this quantitative method
for "in-breastmilk" viral load measurement.
Results: Viral load average were: 3,918 Eq/ml versus 28,196 Eq/ml in the
breastmilk and the plasma respectively. The mean ratio of matched viral loads
"in-breastmilk" versus plasma was of 1:17 (range: 50:1 to 1:180). No correlation
between "in-breastmilk" versus plasmatic viral loads was observed. Furthermore,
no significant difference was observed between "in-breastmilk " viral loads in
non-transmitter (NT) versus transmitter (T) mothers, even for 3 cases of late
"mother-child" transmission suspicion. In contrast, a significant difference was
observed at level of plasmatic viral loads (10,500 Eq/ml versus 85,000 Eq/ml)
between NT and T mothers.
Conclusion: These data indicating low viral load in breastmilk could suggest a
low rate of viral production by breastmilk cells. Quantification of intra-cellular viral
load in breast cells is yet in progress and should be presented.
123401 1 Gingival fluid (GF): Possible role in transmission of HIV-1
in advanced HIV disease and advanced periodontal
disease
Mojca Mati6id1, M. Poljak2, J. Tomai61, L. Vidmar1, B. Kramar3, U. SkaleriC1.
1Dpt. of Infectious Dis. Univ. Medic. Centre, Ljubljana; 2 nstitute of Microbiology,
Medical Faculty, Ljubljana; 3Dpt. of Oral Medicine, Medical Faculty, Ljubljana,
Slovenia
Objectives: To search for proviral HIV-1 DNA in GF of patients, previously determined as HIV-1 seropositive in various stages of HIV disease and to find some
relationship with their general and periodontal clinical, virologic and immunologic
status.
Design: Prospective, controlled study.
Methods: GF samples from 35 HIV-1 seropositive patients and 10 HIV-1
seronegative controls were evaluated for the presence of proviral HIV-1 DNA.
The clinical and immunologic classification of HIV infection, periodontal status,
oral lesions and gingival bleeding plasma HIV-1 RNA viral load and antiretroviral
drug use were documented in all HIV-1 seropositive patients. GF samples were
collected by paper points and analysed by polymerase chain reaction for the
presence of HIV-1 DNA using a slightly modified commercial diagnostic test.
Results: Out of 35 HIV-1 seropositive patients, expressing most various stages
of HIV disease, proviral HIV-1 DNA was detected in 17 who revealed significantly
higher plasma HIV-1 RNA viral load compared to the group of 18 HIV-1 positive
patients harbouring no HIV-1 DNA in GF samples (p = 0.03). In the group of 17
GF HIV-1 DNA positive patients a significant correlation between the periodontal
clinical attachment loss and plasma HIV-1 RNA viral load was noticed (p = 0.002).
HIV-1 DNA was found only in GF samples of patients with a peripheral blood
CD4+ cell count below 500 x 106/I. Out of 26 GF samples of HIV-1 seropositive
patients, containing blood, HIV-1 DNA was detected in 14. In three HIV-1 DNA
positive GF samples no blood was found. The antiretroviral therapy, local gingival
bleeding and oral lesions had no significant influence on detection of HIV-1 DNA
in GF samples.
Conclusion: Mononuclear cells present in GF harbouring HIV-1 DNA could
represent a potential epidemiologic source of HIV-1 infection (i.e. at dental procedures, vigorous kissing) in the presence or absence of local gingival bleeding
especially in persons with advanced HIV-1 infection and increased loss of periodontal clinical attachment.
1641 */23402 Treatments, intimacy and disclosure in the sexual
practice of HIV-infected adults in Australia
Michael Bartos, D. Ezzy, K. McDonald, D. O'Donnell, R. de Visser. National
Center for HIV Social Research, Latrobe University, Lckd Bag 12, VIC, Australia
Background: In 1997 HIV-infected adults were surveyed concerning health status, economic and social situation and sexual practice. Completed responses (n =
925) represent 8% of the population of HIV-infected persons in Australia as measured in national surveillance. An associated focussed interview study (n = 45)
on the impact of new treatments on familial, friendship and sexual relationships
was conducted in 1997/1998.

Results: Condom use in intercourse with regular partners depended on the
HIV-status of the partner. In the previous six months, 26% of respondents always
used condoms where the regular partner was also known to be HIV-infected
whereas 71% always used condoms with an HIV-negative or unknown-status
regular partner. In intercourse with casual partners 49% always used condoms.
Women and heterosexual men did not differ in their pattern of condom use from

gay and bisexual men. The belief that new combination anti-retroviral treatments
are effective had no impact on condom use with regular sero-discordant partners
but was significantly associated with more consistent condom use with casual
partners. Interview data showed the impact of new treatments on sexual practice
was indirect, resulting from a greater integration of living with HIV into other aspects of social life. In regular relationships where both partners are HIV-infected
condom use is increasing in the light of beliefs about viral load and drug resistance. Interview data also shows that condom use with regular partners depends
primarily on the known HIV status of the partner. In sero-discordant relationships
condoms may be seen as a symbolic barrier to intimacy. In intercourse with casual
partners, issues around disclosure of HIV status predominate. Disclosure and
condom use (if the partner is thought to be HIV-negative) are more likely where
there are greater social bonds.
Conclusion: Within regular partnerships condom use depends on partner HIVstatus while in sex with casual partners disclosure of HIV-status and the degree
of social obligation to the partner are more important in determining condom use.
New treatments are not having an effect on PLWHAs attitudes and beliefs about
condom use, but they are having an indirect effect in improving life prospects.
S23403 AIDS treatment advances and perceived need to maintain
safer sex practices among gay and bisexual men
Jeffrey Kelly, R. Hoffman, D.J. Rompa, M.L. Gray. Cair Med College, W1 1201, N
Prospect Ave., Milwaukee, WI 53202, USA
Objectives: To determine whether news about AIDS treatment advances has
influenced perceptions about the severity of AIDS and the need to maintain safer
sex practices in a large community sample of gay or bisexual men.
Design: Cross-sectional survey study.
Methods: 373 men recruited in community venues and reporting knowledge
of combination therapies completed questionnaires that inquired about their HIV
status and treatment history (if HIV+), and elicited information concerning their
perceptions of the seriousness of AIDS and any changes in their adherence to
safer sex guidelines since learning of AIDS treatment advances.
Results: The large majority of HIV- men felt that AIDS is still a very serious
threat and indicated that they adhere as much as ever to safer sex practices.
However, some HIV+ men - those on combination therapy regimens - showed
different patterns. 23% of these men felt that AIDS is nearly cured, 16% felt
that being HIV+ isn't a "big deal" now, and 18% agreed or strongly agreed that
they personally practice safer sex less often since new treatments came along.
11% of HIV+ men on combination therapy regimens, 5% of HIV+ men not on
the regimens, and 6% of HIV- men agreed with the statement that new medical
treatments for AIDS make safer sex less important than it once was. Although
the views are not widespread, a subset of gay men report behaving less safely
due to news of improved treatments.
Conclusions: Some persons may be construing treatment advances and feedback of their own improved health in ways that lessen their adherence to safer
sex. Continued safer sex counseling is needed in treatment and service programs
for HIV+ persons, especially given the possibility that drug resistant HIV could be
transmitted to others.
23404 1 Patterns of condom use reported by HIV infected and
at-risk women at three time periods
Jan Moore1, E. Schoenbaum2, D. Warren3, P. Schuman4, A. Rompalo5,
T. Fiore6, M. Kennedy3. 1CDC 1600 Clifton Road Mailstop, Atlanta; 2Montefiore
Medical Center, New York, NY; 3Centers For Disease Control, Atlanta; 4 Wayne
State University, Baltimore. MA; 5Brown University, Providence; 6Centers For
Disease Control, Atlanta, GA, USA
Objectives: 1) To describe patterns of male condom use reported by HIV infected
and uninfected at-risk women at tree time periods; 2) to compare characteristics
of women and partners reporting different condom use patterns.
Methods: 871 HIV+ and 439 women at risk for HIV were interviewed, given
physical exams and HIV counseling every 6 months, as part of an ongoing
prospective study of HIV infection in women conducted in 4 US cities (HER
Study). The current analyses presents longitudinal data collected at baseline, 6
month, and 12 month interviews.
Results: 59% of the sample was African American, 16% Hispanic, and 25%
white; 59% had a history of injecting drug use; and 72% had annual incomes
below $12,000. Women's reports of condom use by male partners were examined
for women who were sexually active at all three time points (N = 375 HIV+ and
201 HIV-). Of these women, 37% of HIV+ and 15% of HIV-women reported that
their partners always used condoms at all three time points. 20% HIV+ and 34%
of HIV-reported inconsistent condom use at early study visits but reported always
using condoms thereafter, suggesting behavior change following entry into the
study. 22% of HIV+ and 50% of HIV-reported inconsistent or no condom use at all
3 assessments. A pattern of consistent condom use at three assessments was
more common among HIV+ (37%) than HIV- women (15%; chi sq = 57.2, p <.05),
women without a history of drug injection (33%) versus those who had injected

(20%; chi sq = 14.0, p < 05), and women not using cocaine (35%) compared to
those who did (16%; chi sq = 30, p <.05). HIV+ women with uninfected partners
had the highest rates of consistent condom use at all three time points (44%),
followed by HIV- women with an infected partner (32%); HIV- women who had a
partner of unknown or negative serostatus reported the lowest rates (11%).
Conclusions: HIV infection of the self or partner is clearly associated with
consistent condom use for women with male partners. However, a large per