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

846 Abstracts 42254-42363

12th World AIDS Conference

disenfranchised populations and to increase generalizability of research findings
by increasing representativeness of study populations.
42359 Increased cobalamin levels are associated with better
cognitive function in HIV-1 disease
Gail Shor-Posner, A. Campa, F. Wilkie, H. Lai, L. Shenghan, J. Quesada,
R. Gutierrez. University of Miami, Room 1008, 1400 NW 10th Ave, Miami, FL,
USA
Objective: Cobalamin (vitamin B12) deficiency is associated with a wide range
of neurological, psychiatric and cognitive alterations. The aim of this study was
to evaluate the relationship between plasma cobalamin levels, mental status and
cognitive performance in HIV-1 infected cohorts over time.
Design: A longitudinal study was conducted in 108 HIV-1 seropositive homosexual men and 30 HIV-1 infected male and female chronic drug users (CDUs)
with negative urine toxicology.
Methods: Plasma vitamin B12 levels and mental status were evaluated at 6
month intervals over 2.5-3.5 years using the generalized estimating equation
approach. Mental status was assessed using the Folstein Mini-Mental Status
Examination in both cohorts; cognitive performance was examined in the homosexual men over 1-2.5 years.
Results: A dose-dependent relationship between plasma vitamin B12 level
(range 33-1000 pg/ml) and mini-mental score was observed, with higher plasma
cobalamin levels significantly associated with better test scores in the homosexual
men (/ = 0.418, p = 0.009) and CDUs (f( = 1.64, p = 0.03). Cognitive performance
was significantly affected by cobalamin status in that lower plasma vitamin B12
levels were associated with more errors in verbal fluency (p = 0.001), visual
memory delayed recall (p = 0.009), and short-term memory scanning (p = 0.004).
Conclusions: The significant association between better cognitive function
and higher cobalamin levels strengthens the proposal that inadequate cobalamin
status contributes to cognitive impairment in HIV-1-infected men and women.
42360 Weight loss >10% and body mass index as predictors of
survival after AIDS diagnosis in the Aquitaine cohort,
France, 1985-1997
Rodolphe Thiebaut1, D. MaIvy2, F. Thiessard2, J.L. Pellegrin3, C. Cazorla3,
J.Y. Lacut3, I. Gecsa1. 1 Cisih-lnserm U. 330, Bordeaux; 2lnserm U. 330,
Bordeaux; 3Bordeaux University Hospital, Bordeaux, France
Objective: To study the predictive value on survival of body mass index value
at the time of first AIDS diagnosis and a weight loss >10% during subsequent
follow up.
Patients: Cohort participants aged over 18 and diagnosed prospectively with
AIDS before June 30th, 1997.
Method: Univariate and multivariate survival analysis (Cox model) was conducted using the two variables of interest and the following adjustment variables:
age, gender, initial AIDS classifying event in three categories of increasing severity, CD4 cell count and date of AIDS diagnosis, HIV transmission group, history
of antiretroviral treatment and use of primary prophylaxis. Weight loss >10% was
used as a time dependant variable and BMI as a fixed continuous quantitative
variable.
Results: 518/1126 (46%) patients who had weight loss information and 246/503
(49%) patients who had BMI information died after AIDS diagnosis. In univariate
analysis, subjects with a history of weight loss >10% had poorer survival (relative
hazard [RH] = 2.89, Confidence Interval [CI]: 2.51-3.33). BMI was a protective
factor (RH = 0.90 for one point increase; CI: 0.86-0.94). After adjusting for potential confounding factors, weight loss was the first pejorative factor associated with
death (RH = 2.50; CI: 2.09-2.99). The most protective factors were antiretroviral
treatment (RH = 0.30; CI: 0.24-0.38) and primary prophylaxis (RH = 0.60; CI:
0.48-0.74). Increase of the CD4 cell count by 50 reduced the risk of death by 16%
(RH = 0.84; CI: 0.80-0.89). The addition of BMI in the multivariate model did not
improve prediction. In the same model without weight loss, BMI was protective
(RH = 0.95 for one point increase; CI: 0.91-.99).
Weight loss >10% from usual weight value, an item of the AIDS classification,
appeared as a strong predictor of death after AIDS diagnosis. Furthermore, our
results indicate that the cross-sectional measure of BMI is a strong independent
prognostic factor of survival when follow up data on weight loss are not available.
42361 Nutritional supplementation and educational outreach for
lower income people with HIV/AIDS utilizing community
based and AIDS service organisations
Michael Onstott. 14230 McLane Ave. (P.O. Box 2187) Guernevil, LE, CA 95446,
USA
Issues Studies have shown that the majority of people with HIV/AIDS are
deficient in at least one or more micronutrients. Some deficiencies (ie. Glutathione, selenium, L-carnitine, vitamin E, etc.) are associated with increased

progression to AIDS, greater incidence of opportunistic infections and decreased
survival. Many HIV-positive individuals who might benefit from nutrient replacement/supplementation programs cannot afford such regimens and still others lack
the knowledge to adhere to them.
Project: Given the need for comprehensive nutrient supplementation programs
that include educational outreach in the form of literature, counseling and seminars, a volunteer-based project was developed to serve the HIV/AIDS community

- especially lower income individuals - initially among a rural-suburban population. The National AIDS Nutrient Bank (NANB) receives in-kind donations of
nutritional products from several corporate providers and distributes these free
to more than 100 low-income clients utilizing existing service organisations and
other groups (food banks, churches, etc.) as dispensary sites. NANB also offers
free nutritional counseling and seminars to the entire AIDS community (regardless
of income) through a collaborative effort with community and medical groups.
Results: Nutrient Bank clients are generally pleased with the program and
adherence rates are high. The majority report improved well-being and a lowered incidence of infections. At least six clients using L-glutamine supplements
have significantly ameliorated or eliminated intractable diarrhea and/or wasting
associated with the use of protease inhibitors and other prescription drugs. By
collaborating with other AIDS organisations, NANB has helped to raise awareness
of the importance of nutritional issues for people with HIV/AIDS. The regional
AIDS food bank, responding to the NANB program and its recommendations,
has upgraded the quality of nutritional products and information it provides to
hundreds of clients.
Lessons Learned and Recommendations: Collaborative efforts among community based groups, government funded AIDS organisations and corporate
sponsors can be successful in developing programs that educate people with
HIV/AIDS about nutritional issues and assist lower income individuals in accessing beneficial nutritional supplements. Corporate sponsorship from major
manufacturers of nutrients (Roche, Bristol Myers-Squibb, etc.) should be solicited
on a global basis to help local organisations develop projects that address some
of the nutritional needs of various regional populations.
S42362 Soya bean milk - An effective body building alternative
for people living with HIV/AIDS in resource-poor
countries
Daniel Uduak. Nigeria Youth AIDS Programme, SLT Block University of Calabar,
CRS, Nigeria
Issue: Provision of information, education and counseling as well as promoting
the use of soya bean milk to people with HIV/AIDs.
Project: The program started with liaising with the infectious Diseases Hospital
for referrals. Relatives of HIV-infected people that had successfully undergone
TB treatment and lacked appetite for solid food were given soya bean milk preparation booklets and advised to introduce patients to the beverage. Beverage was
taken as frequently as possible. Home care providers took body weights every
month end for eight months.
Results: During the process, 11 patients increased in weight considerably.
Five patients had fluctuating body weights. People with HIV gained weight faster
than those with AIDs-related complexes or full blown AIDs. There was a marked
decrease in incidence of opportunistic infections. Referrals increased and more
booklets were distributed.
Lessons Learned: Soya bean milk is preferred to other body-building sources
because it is cheap. Increase in referrals indicated that hospital staff and families
were satisfied with results achieved by consuming soya bean milk.
42363 1 Survival and infections in AIDS patients: Analysis
according to initial serum vitamin A levels
Jose Fernando De Castro Figueiredo1, M.J. Lorenzato2, S.A. Silveira2,
A.D.C. Passos2, M.L.V. Rodrigues2, L.C. Galvao2, H. Vannucchi2. 1Guaranta
76, 14040-190 Ribeirao Preto; 2Faculty of Medicine-USP, Brasil
Objectives: To investigate the survival and the type and topography of infectious
complications in patients with AIDS according to serum vitamin A levels at the
beginning of clinical follow-up.
Design: A prospective, observational, uncontrolled study.
Methods: The study was conducted on adult patients with AIDS and CD4
lymphocyte counts <200/mm3. Pregnant women and patients taking vitamin
supplementation were excluded. At the beginning of follow-up a blood sample
was obtained for measurement of plasma retinol by HPLC and the following
parameters were evaluated: date of admission to the study, type and topography
of infectious complications and date of eventual death. Hypovitaminosis A was
defined when initial plasma retinol was <1.6 limol/L. Survival was analysed by
the Wilcoxon rank-sum test and by the Kaplan-Meier survival curve. The types
and topographies of infectious complications were analysed by the exact Fisher
test.
Results: Thirty-nine patients were followed up (21 with hypovitaminosis A at the
beginning of the study). There was no difference in sex distribution, time of AIDS
diagnosis, CD4/mm3 or number of infectious episodes between patients with or
without hypovitaminosis A. Low levels of serum retinol were not correlated with
oral moniliasis (p = 0.742), bacterial pneumonia (p = 0.748), P carinii pneumonia
(p = 0.497), sinusitis (p = 0.752), oesophageal moniliasis (p = 0.609) or with
infections of the digestive (p = 0.751), respiratory (p = 141), and nervous systems
(p = 0.113) or involvement of the mucosae (p = 0.667). However, hypovitaminosis
A was correlated with lower survival during the first 2 years of follow-up (p =

0.0003).
Conclusions: Low plasma retinol levels at the beginning of follow-up were not
associated with the type or topography of infectious processes in patients with
AIDS. However, the patients showed a lower probability of survival during the first
two years of follow-up.