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

866 Abstracts 42462-42467

12th World AIDS Conference

42462 Ten years in HIV medical attention: Are the patients the
same?
Maria Rosa Galvan12, J. Galindez2, P. Ramos2, H. Hoet2, A. Greca3,
C Battagliotti3. 1Bv. Oroio 91, Rosario Pcia., Santa Fe; 2Retrovirus Unit;
3lnternal Medicine, Hospital Escuela Eva Peron, Gro. Baigorria; SF, Argentina
Objectives: We have been working on AIDS since 1987. Epidemiology clinical
status, treatments differences and similitudes between our first 50 patients and
our last fifty, are analyzed.
Methods: Retrospective study of 100 School Hospital Eva Peron and from our
Private office, Clinical Histories
Results: Our first patient was attended in june 1987 and our last, ten years
later, in December 1997. In our first group (FG) 90% were males and in our last
group (LG) only 56.5%. Mean age was 32 in FG and 28 in LG. From FG, 38
(76%) asked for psychological attention. In LG only 10 (20%) did.
From patients in FG 8 died; 10 are still asynthomatics, 12 advanced to AIDS
and are receiving antiretroviral therapy. We lost control over the rest (20) 40%.
26.9% in FG were ADVP and 41% in LG. HTS, 2.1% (FG) and 24% (LG). HMS
69% (FG) and 23% (LG). Vertical transmission 0% (FG) and 9% (LG). Others 2%
(LG) and 3% (LG). We did not have 1897' Group 1 patients in the FG. In our LG,
5% are acute infections. Group two 80% (FG) and 52% (FG); group three, 8%
(FG) and 12% (LG). 2% (FG) and 31% (LG). were group four. We diagnosed 3
opportunistic infections - 2 PNC and 1 CMV Retinitis (FG), and 24 (TBC, 8 - 3
were ganglionar-; PNC, 3; Toxoplasmosis, 3; Criptococcosis, 4; Histoplasmosis,
2; SK, CMV and Cryptossporidium, 1; in the (LG). CD4+ rate was 465 cel/mm3
with an average between 110 y 1042 in the FG. Now the rate is 242 with average
4 to 768 CD4+. Virus Load was not available in the 80'. We had the chance to
study 32 on our LG. The average rate of the first study was 43256 copies/mm3.
Only two patients from the first group received medical treatment (AZT
monotherapy). Now 35% are with combinated therapy. 25 receives primary
profylaxis and 7 secondary profylaxis.
Conclusions: There are a lot of differences between our first and last patients.
Epidemiology, clinical stage and medical attention had changed. Also patients
hope is different, many of them returned, after years without coming to control.
S42463 Nosocomial infections (NI) in HIV infected patients in an
Brazilian hospital
Maria Clara Padoveze, Plinio Trabasso, M.C. Padoveze, R.M. Figueiredo. AV.
Theodureto De Camargo, 488, AP220, 13075-630, Hospital Das
Clinicas-Unicamp, Campinas, SP, Brazil
Objectives: To compare the incidence of NI in HIV infected patients and non HIV
infected patients cared in an infectious disease ward.
Methods: The occurence of NI according to the C.D.C. criteria was evaluated
among 429 HIV infected and 467 non HIV infected patients admitted to the
Infectious Disease Division of a general Hospital, in Campinas, Sao Paulo State,
Brazil.
Results: 65 episodes of NI were diagnosed in both groups. When considering
the number of infections in each patient, the HIV infected group had significantly
higher rates (p < 0.001) of NI (40 infections episodes/30 patients) compared to
the non HIV infected group (25 infections episodes/20 patients). The HIV infected
group had 17 blood stream infections (BSI), 12 urinary tract infections (UTI) and
6 pneumonias (PNEU). Among the non HIV infected group, 8 had BSI, 8 had UTI
and 6 had PNEU. BSI had significantly higher rates in the HIV positive patients.
Acinetobacter baumanii and methicillin-resistant Staphylococcus aureus were the
most common etiologies in both groups. The HIV positive patients were more
likely to have A. baumanii NI than the non HIV infected.
This study identified the NI in HIV patients comparing to HIV group cared in
the same ward and suggested that the HIV patients were more likely to have NI
episodes and BSI than the other studied group. In HIV infected group, the NI by
A. baumanii were more frequently than the non HIV group.
i 42464 Incidence of post-transfusion HIV (PT-HIV) in patients
receiving autologous and allogenic transfusions
Debasish Gupta, A. Chandra, D. Dilip, B. Bobji. S.V. Institute of Medical
Sciences Tirupati 517507, A.R, India
Objectives: To evaluate the incidence of PT-HIV in surgical patients who receive
either allogenic or autologous transfusions.
Design: One year prospective study on planned surgical patients requiring
transfusions.
Methods: Patients undergoing planned surgery during the year 1996 were
included in this study and were divided into 2 groups depending on their transfusion protocols: Group A comprised of 1220 patients who received allogenic
blood transfusion, while Group B had 152 patients who were transfused with
autologous blood only. Patients who were transfused with both autologous and
allogenic blood were excluded from this study. All the patients were found to
be seronegative for HIV preoperatively. All blood units were screened for HIV

by standard ELISA technique (ORTHO Diagnostics Inc.) and only seronegative
blood units were transfused. All the patients were routinely screened for HIV at 6
months follow-up post-operatively.
Results: Out of 1220 patients in Group A, 1 (0.08%) developed PT-HIV, while
none of the 152 patients in Group B had PT-HIV. 3 units of allogenic blood
was transfused to this I patient who developed PT-HIV. All the 3 donors were

called upon and I of them demonstrated HIV seropositive by the same screening
procedure.
Conclusion: Autologous transfusion has a clear advantage over allogenic
transfusion regarding the incidence of PT-HIV. Though screened allogenic blood
is considered to be safe enough, but it cannot entirely eliminate the window phase
of infection which can lead to PT-HIV.
42465 1Selective process for a nursing group in the day-bed
AIDS/HIV unit - Clinical Hospital, Unicamp
Helena Christina Cruzeiro Sampaio, M.R.C. Colombrini, M.C. Paiva, I. Barcella.
'State University of Campinas Unicamp, Rua Doutor Quirino 959 apto. 11
Centro Campinas SP CEP 13015 -081; 2Unicamp, Campinas, Brasil
Issue: Number of nurses in the day bed AIDS Unit - Clinical Hospital - Unicamp
Project: The authors describe a method, applied for the selection of nurses
(Internal Recruitment and candidate selection), who fit the required profile and
position. The right choice of candidate involves a profound work between a Human Resources analist (a psychologist) and the candidate, each one with its own
attribuitions and responsabilities. This method is composed of three parts and
refers to: 1.the analisation of descriptions and specifications of the required profile for this position. 2. the recruitment of candidates and the selection of, testing
knowledge and profile according to the position. There will be psychological tests,
group dinamics, interviews and the elaboration of evaluation texts. 3. the choice
and training of the candidate.
Conclusion: With the introduction of the Selective Process we were able to obtain: highly qualified professionals, allowing us to improve the assistence offered
to HIV/AIDS infected patients, and the day bed Unit administrative structure.
S42466 Follow-up in a AIDS clinic at the periphery of Sao Paulo
Robinson Camargol, S. Andre', R. Seccol, A. Rocha', R. Kafka2, L. Brigido2.
1CR. AIDS Sapopemba, Municipality of Sao Paulo, Alameda Irae 385 Casa 8,
2lInstitute Adolfo Lutz, Sao Paulo, SP Brazil
To describe the characteristics of the AIDS clinic at Sapopemba (AIDS reference
center), serving 730.000 in the lowest economical stratum of the city of Sao Paulo.
Design: Retrospective, uncontrolled study
Methods: 1234 patients (447 women, 787 men, mean age 32) have been
seen at the CR since opening in September 1991 through December 97. Among
patients that disclosed their risk/vulnerability (r/v) factor, the major risk in the male
population is IDU (33%), followed by 27% heterosexual and 14% men sex men.
Women refer mostly (317, 71%) heterosexual contacts as the only vulnerability,
with 160 of then with IDU partners. Fifty five women (12%) referred IDU. Most
of the IDU in both gender have stopped injecting, but many switched to inhaled
crack. 415 (34%) died and 211 (17%) patients have abandoned the follow up. 552
(45%) presented at the clinic with AIDS. Tuberculosis is the major disease in the
clinic, (226 patients with pulmonary TB and 37 with other forms of TB) followed
by 224 with pneumonia suggestive of PCP. 496 are today on follow up, with 150
using antiretrovirais. Most are still using AZT + DDI. 66 on triple regimen including
protease inhibitor protease inhibitor (ritonavir 33, indinavir 23, saquinavir 10).
Conclusions: The use of intravenous drugs have diminished dramatically in
the area, and was substituted by the use of crack but it was in the last year.
The small number of adolescents in this population suggest the need of outreach
programs for this segment of the population.
42467 | The effects of HIV/AIDS testing and counselling on
patients and clients in a Nairobi hospital
Janet Kazibwe', E.W. Gatua2. 1 The Nairobi Hospital, PO Box 30026, Nairobi;
2Kenya AIDS NGOs Consortium Nairobi, Kenya
Issues: HIV/AIDS testing and counselling have become integrated in the Hospital
Management of AIDS patients in Kenya. The role of the Nurse and Doctor in counselling is central and should be well organised for the benefit of patients/clients.
Project: The sample population was randomly and purposely selected. A total
of 169 subjects participated in the study. A quasi experimental study was used.
Data from Doctors and Nurses was collected by questionnaires; patients/clients'
data was collected by questionnaires and interviews. The data was analysed
using descriptive statistics and presented in script form; Graphs, Tables and
Pie charts were used. The Nurses responses represented 76.3%, while Doctors
responses represented 16.56% and patients/clients responses were 7.1% of the
total response. Conclusions were drawn from the data findings.
Results: The hypothesis was strongly supported by 82.1% doctors who observed positive effects and benefits of pre-test counselling, 45% of Nurses affirmed
that patients who received pre-test and post test counselling, coped better with
effect of AIDS/HIV.
Lessons Learned: Patients who receive pre and post test counselling are
better prepared to inform a relative/spouse of sero-positive status, settle into the
community easily, overcome denial and depression faster and are committed to

behaviour change.