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

800 Abstracts 42137-42141

12th World AIDS Conference

antigen and levels of anti-p24 antibodies. FACScount (Becton Dickinson) and
commercial ELISA' s from Sanofi Diagnostics Pasteur were used.
Results: For all 21 patients tested mean CD4 T-cell count was 253 cells/mm3
(range 25-756). Count equal or lower than 200 was found in 12 (57%), from 200
to 400 cells/mm3 in 4 (19%) and higher than 400 in 5 (24%). Four from these with
CD4 T-cells < 200 were found positive for free p24 antigen and three of them
deceased within one year after being HIV diagnosed. Negative and low levels of
anti-p24 antibodies were found in 52% versus 48% with high levels.
Conclusions: The data directly show advanced stage of HIV infection in over
50% in newly established Bulgarian HIV seropositives and indicate that these
persons have been probably infected since more than 4-5 years. We propose
this complex of markers as routine for HIV diagnosis for better surveillance of HIV
and AIDS in Bulgaria.
42137 Increasing trends in the prevalence of HIV infection
among blood donors in West Bengal
Nemai Bhattacharya, D.K. Neogi, T. Chakra Borti, P. Banerjee. Dept. of Virology,
School of Tropical Medicine Chittaranja Avenue, Calcutta, India
Objective: To evaluate the increasing trends in the prevalence of HIV (1 and 2)
infections among blood donors in West Bengal.
Design: Controlled study.
Methods: A total number of 110,164 blood samples collected from persons with
different high-risk behaviour, were screened between July, 1987 and November,
1997. Among the different high-risk groups, 60,488 were blood-donors. The blood
samples were tested by different rapid and reader-based ELISA test kits and
repeatedly reactive sera were confirmed by WB using HIV BLOT 2.2 (Diagnostic
Biotechnology).
Results: 194 blood donors were found to be reactive against HIV out of 60,488
(0.32%) screened in this laboratory. 37,560 professional donors were screened
of which, 35 were shown to have antibodies against HIV (0.09%). In the voluntary
or, replacement blood donor group, it has been observed that HIV sero-positivity
rate was as high as 0.69% (N = 159).
Conclusion: Incidentally, it is worth-mentioning that HIV-2 reactivity was documented for the first time in West Bengal during 1994. Subsequently both HIV-1 &
HIV-2 started showing an increasing trend in different high risk groups including
blood donors, mostly voluntary. Rising trend in HIV in blood donors indicates
spillover in General population.
42138 Slow seroconversion of HIV in a severely ill patient
Chetan Oberai1, S.K. Hira2, H.M. Gharpure3, M.M. Kura4. 1257 Central Avenue
Road, Chembur. Mumbai 400071; 2Professor, University of Texas, ARCON.
Mumbai; 3lmmunologist -M. G. Medical College. Mumbai; 4Lecturer, Grant
Medical College Mumbai, India
Objective: To emphasise the role of specific tests such as PCR and RT-PCR, in
an ELISA negative but clinically suscpicious patient with high risk behaviour.
Design: Prospective case report.
Methods: A 25 year old debilitated cachexic male presented with reactivated
pulmonary tuberculosis (TB), oral candidiasis and severe form of Stevens Johnson
Syndrome. History revealed his high risk status ofmultiple heterosexual exposures
and alcoholism, removal of parietal tuberculoma of the brain and intermittent anti
TB and anti-epileptic treatment. However he has no history of sexual exposures
or blood transfusions for the past three years. Surprisingly ELISA and Western
Blot (WB) tests were negative. But DNA-PCR and RT-PCR were positive. Repeat
ELISA and WB done at monthly intervals over the next three months revealed
gradual seroconversion.
Results:

Abbott's 3rd gen. Plus EIA Assay kits, Germany., and/or Rapid Elavia Mixt kits
of Diagnostics Pasteur. * Confirmatory Western Blot assay (WB): The repeated
reaction (RR) ELISA Oscreened specimens were run by WB kits: HIV Blot 2.2
(HIV-1/HIV-2 Western Blot, Diagnostics Biotechnology, Singapore) kits, and/or
New -Lav-Blot, Sanofi Diagnostics Pasteur.
Results: Positive WB cases were put in a table-form:

Area
SEA
SA
Total

N +ve WB (%)
42 930 13(0.03)
61 062 356 (0.58)
103 992

95% Confidence Interval
0.0136-0.046
0.523-0.643
369 (0.35)

Conclusion: * The highest prevalence rate of HIV infection in South Asia has
been reflected in their poulations working in KSA. We recorded a prevalence rate
of 0.58% among them, comparing to 0.03% in SEAsian workers in Saudi Arabia.
* We recommend through HIV screening for South Asians before being recruited
to work abroad, allow only the HIV negative ones.
42140 The course of HIV RNA levels over 17 years of HIV
infection in a cohort of haemophilic men
Caroline Sabinl, H. Devereux2, A.N. Phillips2, A.M. Hill3, C.A. Lee4,
C. Loveday2. IDepartment of Primary Care and Population Sciences, Royal
Free Hospital School of Medicine, Rowland Hill Street, London NW3 2PF;
2Department of Retrovirology, Royal Free Hospital School of Medicine, London;
3Glaxo-Wellcome Research, Greenford; 4 Haemophilia Centre and Department
of Haematology, Royal Free Hospital and School of Medicine, London, England
Background: Whilst monitoring of HIV RNA levels is now recognised as an
essential part of patient management, very little is known about the natural history
of HIV RNA levels over the entire course of HIV infection. We describe the course
of HIV RNA levels over 17 years in a cohort of haemophilic men.
Methods: All haemophilic men at the Royal Free Hospital, London who seroconverted to HIV are reviewed every 3-6 months for clinical and laboratory review.
HIV RNA levels were retrospectively measured on stored serum samples each
year after seroconversion using the Roche Amplicor assay. Rates of increase of
viral loads were estimated using linear regression methods and were compared
between subgroups using the Wilcoxon test.
Results: A total of 894 HIV RNA measurements were available from 107 men
(median: 8 per patient, range: 1-16). Log RNA levels increased linearly over
time, with a median yearly rate of increase of 0.12 log (copies/ml) (range 1.14
to -0.49). Individuals who developed AIDS or who died experienced more rapid
yearly rates of RNA increase (0.15/year in those who developed AIDS, 0.19/year
in those who died) than individuals who remained AIDS-free (0.05/year) and those
who remained alive at the end of the study period (0.05/year, p = 0.0001 for both
comparisons). Older individuals experienced a more rapid rate of RNA increase
over the study period (0.16 versus 0.07 per year in those older and younger than
the median age of 22 years at seroconversion, p = 0.02). The risk of AIDS and
death increased as the viral load increased, with median RNA levels at the time of
AIDS and death of 5.2 and 5.4 log (copies/ml), respectively. However, there was
wide inter-individual variability in the RNA levels prior to death, with maximum
RNA levels prior to death ranging from 3 to 5.88 log (copies/ml).
Conclusions: This cohort provides one of the first chances to study the patterns of viral load change over the entire course of HIV infection in a group of
patients with known dates of seroconversion, the majority of whom were not
treated with highly active therapy. There is no evidence of a viral load set-point
in these individuals, with RNA levels increasing overtime, especially in those with
progressive disease and in older individuals. This may explain some of the effect
of age on the incubation period that has been documented in other studies.
1164*/42141 Plasma and genital tract viral load and STDs in
early HIV infection
Connie Celum1, K. Mayer2, S. Holte3, D. Dondero4, S.P. Buchibinder5,
J. Douglas6, H.W. Sheppard4. 1901 Boren Ave Suite 1300, Seattle, WA 98104;
2Memorial Hospital/NEBHS, Pawtucket RI; 3Fred Hutchinson Cancer Research
Center, Seattle, WA; 4 Viral & Rickettsial Disease Laboratory, Berkeley, CA;
5Department of Public Health-AIDS Office, San Francisco, CA; 6Denver
Department of Public Health, Denver CO, USA
Objective: To assess the relationship between plasma and genital tract viral load
(VL) and semen VL and STDs during early HIV infection.
Design: Paired plasma and semen or cervicovaginal lavage (CVL) samples
were obtained every 3 months from persons who enrolled in the HIVNET cohort
of newly infected participants. For men, urine and rectal samples, and for women,
cervical samples were obtained at enrollment for gonorrhea (GC) and chlamydia
(CT) ligase chain reaction; all participants were asked about interim STDs in
the prior 3 months at follow-up. Roche PCR was performed on plasma, semen
and CVL samples; NASBA, which includes a silica extraction for inhibitors, was
performed on a subset of semen samples. Limit of detection was <200 for Roche
PCR and <400 for NASBA with >200 mcl of sample (or <1000, with <200 mcl
of sample).
Results: 99 seroconverters (86 M, 13 F) were enrolled in the HIVNET early
infection study an average of 6 months after seroconversion, 58 of whom took
antiretroviral treatment during follow-up. 84%, 29% and 54% had detectable viral
load by plasma PCR, semen PCR, and semen NASBA, respectively. Median
viral load in plasma was 11,010 (range <200-608,549) compared to a median of

Test-ELISA:
WB:
DNA-PCR
RT-PCR

Day 1
-ve
-ve
ND
ND

Day 30
-ve
indeterminate
+ve
+ve

Day 60
+ve
ND
+ve
ND

Day 90.
+ve.
+ve.
+ve.
ND (ND = not done)

In high risk behaviour patients more specific tests such as DNA-PCR and
RT-PCR are suggested, to detect slow seroconverters.
42139 Seroepidemiological prevalence of HIV in Southeastern
Asian and South Asian recruiters to Saudi Arabia
Sami E. Fathalla1, I.H. AI-Sheikh2. Cons. Virologist, Dammam Regional Labs &
B. BK., PO. Box 4103, Dammam 31491; 2Assistant Professor, Haematologist,
Dammam, Saudi Arabia
Objective: Asian Overseas Contract Workers (OCWs) reach around 2 millions in
Kingdom of Saudi Arabia (KSA). Most of them have been recruited from Southeast
Asia (SEA): [The Philippines, Thailand, Indonesia, and Korea], and from South
Asia (SA): [India, Pakistan, Srilanka, Nebal and Bangladesh]. It is known that HIV
infection is in continuous escalation in these counteries. Hence, our object was
to record HIV prevalenc among these (OCWs).
Design: 103 992 blood serae were collected for a period of eight years
[1989-1997]
Methods: * Screening tests: We used one of these ELISA kits: (depending
on the then available kit): HIV-1/HIV-2 recombinant synthetic peptide antigen,