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

12th World AIDS Conference

Abstracts 32436-32440 609

Results:

Prevalence surveys
Total patients
Predominant risk behavior
Previous marker disease
Actual marker disease
AIDS patients
Patients with antiretroviral therapy

1/92
31
IDU' 81%
TB" 77%
TB 63%
84%
23%

3/94
32
IDU 97%
TB 70%
TB 56%
91%
66%

1/97
22
IDU 82%
TB 64%
TB 40%
86%
45%

1/98
22
IDU 91%
TB 39%
TB 44%
82%
59%

Injection drug user, ' Tuberculosis.
Conclusion: 1) The predominant risk behavior was IDU. 2) The most frequent
previous and actual marker disease was TB. 3) Most of the patients had AIDS. 4)
To the inmates considered "hard to treat patients" you have to give them a very
good information so as to obtain an adequate adherence.
32436 Other drug abuses by young Camerounians living with
HIV/AIDS
Jean Roger Kuate, Julbert Tonye, Grace Boume Charre, Joseph Penda Melone,
Emmanuel Mbog. BP 4675 Yaounde, Cameroun
Introduction: Drug addiction in Cameroon implies the consumption of indian
hemp, solvents, barbiturates and oral tranquilizers, alcohol and tobacco. The use
of injectable drugs is rare in this country.
Objective: to assess the importance of drug abuses by youths who know they
are infected with HIV/AIDS and to whom the danger of drug abuse has been
explained.
Methodology: 2 groups of 15 persons who are less than 40 years were observed and interviewed. During these personal interviews aiming at supporting
them psychologically as far as their drug addicted behaviour is concerned, it was
noticed that youths of group A were consuming at least one drug before knowing
that they were not consuming any drugs. This study was carried out between
November 1995 and November 1997 in Yaounde and Douala.
Results: Ever since they know that they are infected, their behaviour towards
drug has changed.
In group A: 85% of the youths doubled their tobacco consumption 54% in
addiction to tobacco drink alcohol to excess.
Alcohol consumption here is systematic though episodic at times. It happens
during depression and anguish crises. Barbiturates and tranquillizers are more
and more consumed by those who were already used to indian hemp (26%).
Multiple drug addiction is constant in this group. Only two persons (women)
succeded in giving up completely the use of drug.
In group B: 45% became drug addicts of which 22% are really dependent 20%
chosed to resort to a drug during "sadness crises".
35% kept in mind health hazards related to drug consumption and have stayed
away from it.
Conclusion: In Cameroon, taking care psycho - socially of youths living with
HIV/AIDS must take into account the risk of resorting to drug addiction as an outlet. Fighting against anguish and depression can be an efficient weapon against
drug addiction whose effect is to depress the human body weakened by HIV.
32437 Unaddressed needs of haemophiliacs with HIV in an area
with low infection rate in IDUs and sex-workers
Samiran Panda1, A. Chatterjee', A. Duttagupta2, P. Shrivastava2, U. Roy2,
D. Mahalanabis1. RIICE (Society for Applied Studies), 108 Manicktala, Main
Road Flat 3/21, Cal 54; 2Haemophilia Society-Calcutta Chapter, Calcutta, WB,
India
Issue: Care and counselling services should gain adequate weightage from the
start of HIV epidemic even if the infection rate is low in people with high risk
behaviour.
Project: Low prevalence of HIV among IDUs and effective targeted intervention
among sex workers in Calcutta has not allowed development of sufficient support
service for HIV care and counselling. Haemophilia Society of Calcutta has found
several members infected with HIV, from an infected batch of factors that was
distributed throughout the country a few years ago. These infected haemophiliacs
find it difficult to find support in a society not yet ready for it. An NGO dedicated
to operational research in health, generated a collaborative effort in this regard.
Results: Concerns of the parents of haemophiliacs have been addressed.
Haemophilia in itself is a burden to them; not only financially but also socially as
society holds an attitude of isolation to their children. Parents feel that with growing
age their children become more sensitive and aware about the helplessness of
their parents and tend to hide the bleeding episodes. HIV positive haemophiliacs
want to form their own group and need help. However, events of social isolation
published in media prevent them from coming out in public. Laboratories in the
city do not want to handle HIV positive blood for CD4/CD8 count, no facilities exist
locally for viral load estimation; antiretroviral therapy remains a feasibility beyond
reach. Haemophilia being a sex chromosome linked disorder has appeared in
several brothers of the same family and HIV has also affected several members
of the same families including spouses of haemophiliacs.
Lessons learned: Prevention effort should go along with effort for building care
and counselling services for the HIV infected. This would eventually strengthen
prevention activities as people with HIV work as valuable prevention soldiers.

32438 Monitoring treatment adherence in pediatric HIV:
Identifying the issues from providers and families
Elaine Gross1, C.K. Burr', D. Storm2, L. Czarniecki2, D. D'Orlando2. National
Ped. & Family HIV Resource Center, 732 Springfield Ave Summit N.J. 07901
Newark; 2FXB Center UMDNJ, Newark, USA
Issues:ln the US, HIV infection in children is a chronic illness. Long-term adherence to antiretroviral treatment is difficult. Combination antiretroviral therapy with
protease inhibitors raises new concerns about non-compliance for providers, children, and families. How families are managing medications needs to be assessed
in a systematic way. A first step in this evaluation should look at how parents are
taught about medications, and what support is necessary to avoid or overcome
problems.
Project: Nurses (n-60) at US Pediatric HIV programs were surveyed in the
spring of 1997 to identify how clinical sites were teaching about medications and
monitoring treatment adherence. Nurses were asked how treatment adherence
problems were identified and what difficulties with medications, families were
reporting.
Results: With a 42% response rate (n-25) the survey identified few sites (6/25)
with structured systems to teach and assess how families were managing medication. Few sites (4/25) used a medication teaching form. At 6 research sites,
pharmacists teach and monitor medications; at these and other sites, nurses teach
about medications. Adherence problems were identified by report from families
(n-23) or children (n-12), team members (n-11), pill counts/bottle checks (n-15),
drug diaries (n-5). Families reported difficulties with medications because of taste
(n-14), scheduling (n-10), problems around meals (n-7), too many medications
(n-7), fear of disclosure to schools (n-6), and difficulty swallowing pills (n-5).
Responders shared medication teaching tools and strategies, such as calendars
and schedules.
Lessons Learned: Identifying the complex issues around treatment adherence is important for children, families and providers. Results of this survey led
to development of a medication assessment tool being piloted at one site. This
tool will serve as quality assurance, to identify common problems, to learn from
families what works, and to identify interventions to support treatment adherence.
32439 1Antiretroviral therapy and medical management
guidelines (ATMMGs) of pediatric HIV infection
Gwendolyn Scott1, J. Oleske2, S. Grubman3, L.M. Mofenson4, C. Burr5, R. Van
Dyke6, B. Dashefsky5. tUniversity of Miami, PO Box 016960 04-4, Miami Fl;
2UMD-New Jersey Medical School, Newark, NJ; 3St. Vincent Hospital & Medical
Center, New York, NY; 4National Institute Child Health, Rockville, MD;
5FXB-Center for Children, Newark, NJ; 6Tulane University New Orleans, LA.
USA
Issue: To update the 1993 pediatric ATMMGs.
Project: In June 1996, a panel of experts in pediatric HIV/AIDS, family members of HIV infected children and government agency representatives met to
begin updating the 1993 pediatric ATMMGs. They reviewed published literature,
results of adult and pediatric clinical trials, and the consensus of expert opinion.
The ATMMGs addressed: initial antiretroviral therapy, choice of agents, consideration for changing antiretroviral therapy, problems in adherence to antiretroviral
therapy, treatment of opportunistic infections, standards for neurological and nutritional assessments, palliative care issues, and adverse reactions to the multiple
medications used in the treatment of HIV/AIDS.
Results: The panel recommended infants and children be initially treated with
combination drug therapy which include two nucleoside analogues and a protease inhibitor, and adolescents should be treated according to adult guidelines.
Rationale and choices for changes in antiretroviral drugs depended on changes
in viral load, immunological deterioration, and clinical disease progression. The
choice of new antiretrovirals included all 11 FDA-approved drugs, despite the fact
that only seven have pediatric approval. Specific drug therapy, including dosage
recommendations, were presented for the most common opportunistic diseases
seen in infants, children and adolescents. Difficulty in adherence to multiple drug
regimens in treatment of HIV/AIDS was addressed as well as management of
adverse drug interactions. Management of neurological complications, nutritional
deficiencies, and palliative care were also discussed.
Lessons Learned: Infants, children and adolescents should be started and
maintained on aggressive combination antiretroviral therapy. Adherence to therapy, management of adverse drug interactions, neurological, nutritional and
palliative care are all critical elements in the management of pediatric HIV/AIDS.
S32440 Protease inhibitor therapy in HIV-infected children
pretreated with multiple antiviral drugs
Guido Castelli-Gattinarat, P.O. Orlandi2, C. Cancrini1, M.L. Romiti2,
S. Livadiotti1, S. BernardiO, P. Rossi1. tOspedale Pediatrico Bambino Gesu Div.
Immunoinfettivologia Pzza S Onofrio, 4; 2Universita tor Vergata Roma, Italy
Aim: To investigate the clinical, immunological and virological response to com
bination therapy with protease in HIV-1 vertically infected symptomatic and
pretreated children.
Materials and Methods: 13 HIV-infected children (mean age 10 years) received triple combination therapies containing a protease inhibitor (9 indinavir, 2
saqunavir, 2 saquinavir) for a period of one year (mean 48 weeks). All patients
were also treated with 3TC, added as a new drug, and with ZDV in 10 or with DDI
in three, which was the previous treatment for a long periode. All of them were