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

12th World AIDS Conference

Abstracts 42468-43104 867

42468 Hospital/day: An alternative for assistance of HIV reactive
patients
Raul L. Bortollozzi, D. Dahi, M. Giraudo, J. Alvarez, C. Sartori, N. Barral,
J. Masdracchia. Alberdi Hospital, Rosario; 585 San Juan St. 2000 Rosario,
Argentina
This assistencial modality born in our Hospital in response to the demand increase,
even so the change of the kind patologies attendance. This change obligate us to
develop a quicker and more effective system of assistance, to take advantage at
maximun the Hospital activities avoiding innecesary hospitalizacions, diagnostic
delay and postpone the especific therapeutic, producing reduction of morbility.
The aims proposed include the improvement of the atention quality, to facilitate the
resolution of patient problems, avoiding long home and job abscence thereby is a
complement of the traditional asistance. The Service is the character polivalent,
giving to those patient who needs a frecuent clinics controls, and complements
with laboratory exams, common diagnostic exploration and parenteral therapeutic
in one or two applications per day. The Hospital/Day is the best system for the
assistance to the HIV reactive patients. At 15th months working this way and with
1242 consults, in which 388 were HIV reactive patients and from these 388, 294
were medical controls, and 241 need laboratory exams and 58 need X-Ray and
other diagnostics probe in 33 cases. Procedures therapeutics were done in 66
times, in 57 cases asking the high complexity exams or interconsult with other
especialist phisicians.
The "J. B. Alberdi" Hospital, is a medium complexity Hospital with a interdisciplinary team obtains great result in almost all the situations with the support of
high complexity centers
43101 Serum RANTES as an early prognostic marker of HIV-1
disease progression
Paolo Lusso', Simona Polo2, C. Gobbi2, F. Veglia2, M.S. Malnati2, P. Farci3,
A. Sinicco4. 1 P2/P3 Laboratories-Dibit-San Raffaele-via Olgettina, 58-20132,
Milano; 2San Raffaele Scientific Institute, Milano; 3Univ. of Cagliari-lnternal
Med., Cagliari; 4Univ. of Torino-lnf. Dis., Torino; Italy
Objectives: To investigate the correlation between the serum levels of the HIVsuppressive C-C chemokines, RANTES, MIP-1 a and MIP-1 /, and the risk of
HIV disease progression.
Design and Methods: We retrospectively selected 21 patients from an incident cohort followed-up longitudinally between 1985 and 1996 at the University
of Torino. The selection criteria included the availability of adequate numbers of
properly stored, sequential serum samples and a stringent follow-up documenting all the stages of HIV infection. Nine were rapid progressors (RP; patients
who developed AIDS within 60 months of antibody seroconversion), 7 slow progressors, (SP; patients who developed AIDS after 60 months), and 5 long-term
asymptomatic (LTA; patients with circulating CD4' cells higher than 400/mm3,
no signs of HIV disease, no antiretroviral therapy for more than 96 months).
Serum chemokine levels were measured by ELISA and correlated with various
immunological and clinical parameters.
Results: The geometric mean of serum RANTES over the entire follow-up was
significantly higher in RP (68.6 ng/ml; 95% CI 56.9-82.7) than in SP (23.7; 95%
Cl 20.0-28.2) (p - 0.001) or LTA (19.5; 95% CI 15.5-24.5) (p < 0.001). This
difference was already significant during the early clinical stages, when patients
had peripheral blood CD4+ cell counts greater than 400/mm3 (RANTES: 60.9
ng/ml in RP, versus 16.7 in SP [p < 0.001] and 20.0 in LTA [p < 0.001]). By
contrast, MIP-1 /( and MIP-1 /1 were not significantly different among the three
study groups. Multivariate analysis demonstrated that the mean RANTES during
the period between seroconversion and AIDS was independently associated with
the time to AIDS (RR 4.5, 95% Cl 1.1-18.2; p = 0.035), as was the rate of decline
of CD4+ cells (RR 1.6, 95% Cl 1.2-2.3; p = 0.003).
Conclusions: A high level of serum RANTES is an early independent predictor
of rapid HIV disease progression. The use of this novel prognostic marker can
help optimize the therapeutic management of individual patients since the initial
stages of HIV infection.
43102 Poverty and the role of men and women in the spread of
HIV and AIDS in the African sub-continent-situation
analysis
Marcus Schivte. PO. Box 1332 Windhoek, Namibia
Introduction: Poverty influences in a negative manner life expectancy at birth
in developing countries around the world but more so in Africa, especially in
Sub-Saharan Africa where the situation of HIV and AIDS has become very
critical.
Situation Analysis: Morbidity and mortality among young age groups, and
also among the children under the age of 5, are significantly increased in poverty
stricken circumstances.
It is a worrying aspect that in African countries, the poor is getting poorer, while

the few rich are getting richer. The risk to HIV and AIDS for the poor is increased
greatly.
HIV/AIDS impact on poor communities is much more serious than in affluent
conditions. The poor with AIDS dies much earlier, because nutrition and general
health condition are already bad. They are unable to afford modern preventive
devices, antiretroviral drugs and opportunistic infection therapy. It is true in this
regard that: Poverty + AIDS =

Men in developing countries and indeed in Sub-Saharan Africa seem to have
acquired more education than women, and are therefore a bit more well off
than their female counterparts. HIV and AIDS seem to move from older men to
younger women in developing African countries, confirming the "Sugar Daddy"
phenomenon. Rape, forced sex, polygamy are some of the ways in which the
infection is also spread.
Women on the other hand are often innocent victims, though sexual workers
(mainly women) would contest against the innocence in this respect. In developing situations female condoms are unavailable and where they are, it becomes
impossible, economically or culturally to acquire this enpowerment. Children born
with HIV are on the increase as young mothers are infected.
3. Conclusion: Clearly, observations in poor communities show that poverty,
status of men and women in society, play a determinant and major role in the
spread of HIV/AIDS.
4. Recommendations: Alleviation of poverty is not only the way towards sustainable development, but can have significantly positive impact on the spread
of HIV/AIDS. Change of attitudes, improvement in socio-economic and legal
situation of women and population in general, has a positive impact on HIV/AIDS.
136*/43103 HIV testing behavior among at-risk populations:
Why do persons seek, defer, or avoid getting
tested in the United States?
J. Stan Lehman', F.M. Hecht2, P.L. Fleming', S. Coleman2, M. Chesney2,
A. Bindman2, D. Osmond2. Centers for Disease Control, 1600 Clifton Road,
Atlanta, GA; 2University of California, San Franciso, CA, USA
Background: Targeted education and counseling programs promote risk recognition and HIV testing for persons in high risk groups. However, many persons delay
HIV testing or avoid it altogether. The HIV Testing Survey assessed HIV testing
behavior in recognized risk groups, including reasons for delaying or avoiding
HIV testing.
Methods: Anonymous interviews were conducted in 9 states, among 2369 HIV
negative or untested persons at-risk for HIV: 748 Men who had Sex with Men
(MSM) recruited at gay bars; 770 street-recruited injection drug users (IDU); and
851 heterosexuals (HET) recruited at sexually transmitted disease clinics. In a
structured interview, participants were asked to indicate whether or not any of
17 factors were reasons why they had delayed or had not been HIV tested, and
among these factors, the main reason.
Results: Of 2369 persons interviewed, 1808 (76%) persons had been tested
for HIV, and 561 (24%) had not been tested. Overall, 1968 (83%) cited at least
one reason for delaying (D) or not (N) HIV testing. The main reasons were: Afraid
to find out- (D-29%, N-28%); thought HIV negative- (D-13%, N-15%); didn't think
at-risk-(D-11%, N-20%); and didn't want to think about being HIV positive-(D-10%,
N-9%). Less frequently cited reasons included: Felt there was little that could be
done about being HIV positive- (D-5%, N-6%); didn't have time- (D-6%, N-5%);
and worry about having test results reported to the government (D-3%, N-2%).
HET clients had less frequently been tested (68%) compared to MSM (80%) and
IDU (82%). However, the main reasons for avoiding HIV testing were generally
similar across these groups.
Conclusion: Among persons in high risk groups, the most common reasons
for delaying or not HIV testing are related to fear of being HIV positive and lack
of recognition of their own risk for HIV. Although HIV prevention programs have
routinely addressed these issues in the US, they continue to be significant barriers
to successful national HIV prevention programs. These data should assist in the
formation of revised strategies to promote risk recognition, knowledge of HIV
antibody status, and sustained behavioral risk reduction.
43104 Early HIV detection: Successes and failures
Frank Sorvillo1, Peter Kerndt2, G. Bunch2, S.L. Odem2. '600 S Commonwealth,
Los Angeles CA 90005; 2HIV Epidemiology program, Los Angeles CA, USA
Objective: To determine the frequency and factors associated with early detection
of HIV infection.
Methods: A population-based sample of adult persons with AIDS is routinely
interviewed in Los Angeles County and includes a 30% random sample of men
who have sex with men (MSM) and all other persons reported with AIDS. The
time between patient-reported first positive HIV test and AIDS diagnosis was
calculated. Early detection was defined as recognition of seropositivity more than
5 years before a diagnosis of AIDS. The association between early HIV detection
and sociodemographic and behavioral factors was assessed for the period May,
1991 through December, 1997. Logistic regression was employed for multivariate
analysis.
Results: Over the study period 22% (474/2144) of persons interviewed met
the criterion for early detection. In bivariate analysis early detection was more
common in males (23.7%) than females (13.1%), among whites (32.6%) than
blacks (17.0%), US-born Latinos (19.5%) and foreign-born Latinos (12.5%), in
adolescents and young adults (4.4%) than older age groups (22.7%), and among
MSM (24.2%), injecting drug users (IDU, 18.9%) and MSM/IDU (33.7%) than

persons with a heterosexual risk (8.6%) or no identifiable risk (9.8%). Trends of
increasing early detection with higher education level and income were observed.
In multivariate analysis, early HIV detection was less likely for women (adjusted
OR [AOR] = 0.6, 95% CI 0.4, 0.9), blacks (AOR = 0.5, 95% CI 0.4, 0.7), US-born
Latinos (AOR = 0.6, 95% CI 0.4, 0.8), foreign-born Latinos (AOR = 0.4, 95% CI
0.3, 0.6), adolescents and young adults (AOR = 0.1, 95% CI 0.01, 0.67) and