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

584 Abstracts 32317-32320

12th World AIDS Conference

1996 (saquinavir 6/96, ritonavir 7/96, and indinavir 12/96). In order to assess
how gender, race and risk group influence knowledge regarding PIs at CCH we
conducted a patient survey shortly after the drugs became available.
Methods: The survey was piloted in 2/97 and administered from 3/97-6/97.
Patients were randomly selected from the clinic waiting room, verbally consented
and surveyed by experienced personnel. Latino patients were surveyed by a
bilingual interviewer.
Results: One hundred and fifteen people were surveyed of whom 56% were
female, 78% were African American (AA), 11% Latino, and 11% Caucasian. Risk
groups for HIV were: male-male sex (MSM) 23 (20%), injection drug users (IDU)
36 (31%), heterosexual partner (HS) 42 (37%), other 14 (12%). 70 (61%) of those
interviewed had heard of protease inhibitors or were aware of a "new potent HIV
therapy". Women were as likely to have heard of PIs than men (50% vs. 50%).
IDU and HS were less likely to have heard of PIs than MSM (61%vs. 55% vs.
74%, p =.316). AA (58%) were less likely to have heard of PIs than whites (83%)
or Latinos (75%) (p =.155). 25 (22%) of patients were on PIs. Women were
less likely to be taking PIs than men surveyed (33% vs. 12%, p =.011); this
was not influenced by risk group. CCH patients expressed some ambivalence
towards PIs; 68% believed the drugs were still experimental, but an equal majority
believed they were beneficial (64%) and stated willingness to tolerate side effects
to take the medication (61%). Over 70% of those interviewed, listed confidence
in their provider as the most important reason to take a PI.
Conclusion: Nine months after the first PI became available, 50% of HIV
infected patients at CCH had heard of these medications and only 22% were
taking a PI. Although women were as likely as men to have heard of Pis, they
were significantly less likely to be taking one. MSM were more likely to have heard
of PIs than HS or IDU. In this population, awareness of new HIV therapy appears
to have occurred slowly. As new HIV therapies become available, educational
efforts targeted at AA and IDU are especially needed.
S32317 1 Highly active antiretroviral therapy (HAART) leads to
significant but delayed increase of cd45ra+ t-helper cells
Olaf Degen1, H.J. Stellbrink2, J. Van Lunzen2. 1Universit t Hamburg, UKE
Medizinishe Universitat- und Poliklinik Pav. 33, Infe; 2Univ. Hospital Eppendorf
Med. Dept, Hamburg, Germany
Background: Previous reports suggested, that antiretroviral therapy fails to induce the expansion of naive T-helper cells (CD45+RA+) after short duration of
treatment (3 mths.).
Objective: To investigate the expansion of naive-type T-helper cells (CD45RA+)
and other T-cell subsets like CD3+, CD4+, HLA-DR+ in correlation with plasma
viremia during HAART.
Design/Methods: 22 pts. with reduction of plasma viremia > 2 log10, CD4
increase > 50% baseline after 3 montha of HAART were followed for a mean
of 8.1 months. Plasma viremia and T-cell subsets including CD3+, CD4+, CD8+,
CD45RA, HLA-DR were measured at 2, 4, and 8 months. The correlation between
changes in T-cell subsets and baseline parameters was assessed (initial viral
load and subsequent virological response to therapy; baseline T-cell subsets).
Results: 17 pts. received 2 NA+SQV, 4 pts. 2 NA+CRX, and 1 pt. 2
NA+RIT+SQV. Mean absolute CD4+ numbers increased from 230/ttl to 350/41 to
maximum levels at mth.4. Mean plasma viremia decreased from a mean of 5.2
log10 copies/ml at baseline to a mean of 0.8 loglo at 2 mths. 0.5 log10 at 4 mths.,
and 1.5 log10 at 8 mths. No significant changes in the percentage of CD45RA+
T-helper cells were observed after 2 and 4 mths. A highly significant increase,
however, was detected after 8 mths. of therapy (mean 6% at baseline to 37% at
mth. 8).
Baseline percentage of naive type CD4+ T-cells did not predict subsequent
response (r2 = 0.16, p = 0.48) There was no correlation between baseline plasma
viremia and subsequent increase of CD 45RA+ T-cells.
Conclusions Despite earlier reports, reconstitution of naive type T-helper cells
is achieved by HAART, but recovery needs months of effective antiviral therapy. Baseline naive-type T-helper cell percentage fails to predict subsequent
response. Moreover, no correlation was found between initiale plasma viremia
and subsequent increase of CD45RA+ cells.
32318 Antiretroviral uptake in Australia: The effects of gender,
medical advice and beliefs about efficacy and toxicity
Doug Ezzy, Gary W. Dowsett, M. Bartos, R. de Visser, D. Rosenthal,
D. O'Donnell. Centre for the Study of STDs, Latrobe University, Locked Bag 12,
Carlton, South Australia
Objective: To describe the medical, attitudinal and cultural correlates of differences in antiretroviral uptake between men and women with HIV infection in
Australia.
Design: Stratified purposive sample of people living with HIV/AIDS (PLWHA)
in Australia.
Methods: Participants were a national sample (N = 925) of PLWHA in Australia,
who completed a self-administered mail-back questionnaire between July 1997

and September 1997. The sample represents 8.3% of the current population
of PLWHA in Australia. A scale of confidence in antiretrovirals was developed
using factor analysis (range 1 (low confidence) to 5 (high confidence), mean 3.6,
median 3.7, alpha =.80).
Results: Seventy-eight percent of respondents were using antiretroviral drugs
for HIV/AIDS. PLWHA were more likely to be using antiretrovirals if they reported
ever having a CD4 count below 400 (86% vs 44%; c2(1) = 133.05, p <.01), and

indicated a doctor was a significant information source (81% vs 41%; c2 (1) =
47.59, p <.01). Men were more likely to take up antiretroviral treatments than
women (79% vs 58%, c2(1) = 13.78, p <.01). People who had not taken up
antiretroviral treatments were more concerned about the efficacy and toxicity of
antiretrovirals (mean scores of 3.8 for those treating and 2.6 for thse not treating
(t(891) = 26.12, p < 01). Logistic regression revealed that women's low confidence
in antiretrovirals was the main reason for their lower uptake of antiretrovirals.
Conclusions: PLWHA in Australia are well informed about antiretroviral treatments and concerns about the efficacy and toxicity remain an influential on treatments uptake along with medical advice in response to physiological changes
and sociocultural factors such as gender.
32319 1 HAART is not hard enough - Virological failure after 12
months of treatment in ART-naive HIV+ patients
Hans Jaeger1, E. Wolf', G. Hammel2, T. Zwingers2, J. Graafmans1,
A. Goetzenich3, H. Knechten4. KIS - Curatorium for Immunodeficiency, Munich;
2estimate GmbH, Augsburg; 3DAGNAE, Aachen; 4PZB for the ART 96
Evaluation Group, Aachen, Germany
Rationale: In the "post-Vancouver" era guidelines for the treatment of HIV infection had been changed towards more aggressive therapy. Recommendations
for ART-naive pts were to start with either a combination of at least two reverse
transcriptase inhibitors (RTIs) or a triple combination containing protease inhibitor
(PI).
Objective: To evaluate the efficacy and durability of viral load (VL) suppression
of different combination strategies in a German cohort of ART-naive pts having
started (HA) ART (HA = highly active) in summer 1996.
Methods: In a multicentre (80), non-randomized, observational study on ART
in formerly treatment naive pts, 828 pts are being monitored 3-monthly for VL,
CD4 cells, AIDS events and ART changes over an 18 month (m) period. In an
intent-to-treat analysis at m. 12 double and triple combinations as well as the most
frequent regimens were compared to each other for virological and immunological
efficacy with respect to therapy adherence.
Results: 63% of 828 pts started on double, 33% on triple therapy. Most frequent regimens were ZDV/3TC (39.5%), ZDV/3TC/IDV (11.5%), ZDV/ddC (9.2%),
d4T/3TC (8.9%) and ZDV/3TC/SQV (8.9%).
Initial ART Basel. CD4 VL M. 12 delta CD4 VL-%
(mean) (median) (mean) < 500 cop./ml
Double therapy 275/1l (n = 515) 56 kEq/ml +115/tl* (n = 347) 43.1
Triple therapy 211/pl (n = 278) 100 kEq/ml +176/1t (n = 177) 62.6
p < 0.005, p = 0.001.
Between the triple regimens there are significant differences; 30.2% of the pts
in the SQV (hard gel capsules) group never reached undetectable VL levels vs
10.3% on ART containing IDV. 51.7% of the pts with at least one follow-up through
month 12 switched from initial double, 39.8% from triple combination.
Conclusion: Although the probability of success (undetectable VL) with a
PI-containing triple regimen is higher as compared to initial double therapy in
ART-naive pts, after one year in more than half of the patients under initial triple
combination VL suppression is incomplete. Further studies will show whether an
early intensification of the initial regimen aiming at a VL below 50 copies/ml possibly followed by a reduced maintenance regimen can replace current strategies,
will be accepted and tolerated by the pts and will lead to a more durable VL
suppression.
32320 Early initiation of antiretroviral therapy normalizes
CD4/CD8 ratio in HIV infected patients
Stefan Markus Weiner1, S. Usadel1, M. Schlesier1, J. Schneider2, H.H. Peter1,
J.A. Rump1. 1 Med. Univ. Clinic, Dept. Rheumatology, Hugstetter Str. 55,
D-79106 Freiburg; 2Univ. Clinic, Dept. Virology, Freiburg, Germany
Background: Clinical or immunological benefit of early treatment of the HIVinfection has not been clearly documented so far.
Methods: Four patients received antiretroviral combination therapy within 3-6
months after primary HIV infection and were followed up for 12-36 months. One
untreated patient within the first 24 months after HIV infection, as well as five
patients with late initiation of antiretroviral therapy served as historical controls.
Immunological and virological parameters as p24 antigen, viral load (bDNA,
Chiron diagnostics), and T-cell markers were closely monitored.
Results: When starting the antiretroviral therapy the average CD4 cell count
was 637 ~ 183/1l and rose to 821 ~ 194/l1, and CD8 cells dropped from 1281
~ 613/pl before therapy to 553 ~ 68/pl in the early treated patient group. At
baseline mean CD4/CD8 ratio was 0.60 (range 0.3-1.1). CD4/CD8 ratio was
normalized after 4 (2 patients), 27 and 34 months respectively. In the control
group of late treated patients (more than 5 years after HIV infection) as well as in
one patient without therapy during the first 24 months of HIV infection CD4/CD8
ratio remained below the normal range.

Conclusions: We present encouraging results arguing for an early antiretroviral therapy of HIV-infected patients. In this small cohort early suppression of virus
replication leads to a prolonged immunologic stability and normalization of the
CD4/CD8 ratio.