Program Supplement [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

commitments were secured. New measurements were
developed to foster interconnections between actors and a
system-wide focus on results. Rapid test kits were selected
over laboratory testing and new supervisory roles and
relationships with community-care networks were designed.
Lessons Learned: Systems thinking can be a very useful tool
for avoiding fragmented implementation. Used properly, it can
promote innovation and creativity. It also can promote the
maximum use of indigenous tacit knowledge, vital to address
cultural factors that increase vulnerability. It requires trust,
respect and transparent partnerships. Recommendation:
Systems thinking is compatible with how communities think
about issues. Given the needs for innovation and resource
mobilization, its wider use for experimentation is strongly
encouraged.
Corresponding author: Orobaton, Nosa, John Snow, Inc., 44
Farnsworth Street, Boston 02210, MA, United States,
Tel: [phone], Fax: [phone],
Email: [email protected]
[ LBOR08 I
Post-conflict HIV prevention response: lessons from East Timor
Thomas, Joe (East Timor)
This paper summarises the lessons learned from a 12 month
HIV/AIDS Prevention activitiy carried out in the newly
independent country, East Timor. Indonesia annexed this
territory in 1975 after Portuguese colonial rule collapsed.
About 200oo,ooo East Timorese were killed or died from disease
and famine during a 24-year fight for freedom. In a UN
monitored referendum on 30th August, 1999 the Timorese
voted against the Indonesian occupation. As a retaliation, the
military and the pro-Indonesian militia unleashed violence.
Massive population displacement resulted. The UN inherited a
violence-ravaged country with no trained health care providers,
or infrastructure. The UNTAET is consisted of approximately io,
ooo personnel of a multi national peace keeping force and civil
administrators. Timor is one of the poorest countriy with 41
percent of its people living below the poverty line. The 'AIDS
capacity building program' is an assistance package provided
to the UNTAET by AusAID. The objective is to support the MoH
in addressing most urgent HIV/AIDS prevention needs, and to
develop a strategic response to HIV/AIDS. The key outputs
are: ATimorese Working Group on STI/HIV/AIDS established,
urgent capacity building activities were identified, short term
prevention needs were addressed. Intersectoral collaboration
strengthened, and a strategic plan has been developed. The
key aspects of post conflict capacity development is:
establishment of new organizations and their management and
developing social capital. Effective approaches for capacity
development are in -service training, education, the
development of institutions, training of resource persons and
targeted technical assistance. The key to the post-conflict
sustainability are; enhanced knowledge, skills, experience and
level of involvement. Key 'social capital' needes in post conflict
situation are rapid efforts to develop skills in managerial and
technical staff, skills in mediating of contextual environment
Corresponding author: Thomas, Joe, Advisor/HIV/AIDS,
Ministry of Health, Telecom Building, Dili, East Timor,
Tel: [phone], Fax: [phone],
Email: [email protected]

LBOR09
Earlier initiation of HAART better preserves functional
immune competence even in persons who achieve "normal"
CD4+ T-cell counts
Lange, Christoph, Valdez, Hernan, Medvik, Kathy, Asaad,
Robert, Wild, Mary, Kalayjian, Robert, Lederman, Michael
(United States)
Background: To ascertain whether delaying antiretroviral therapy
will compromise functional immunologic recovery in HIV-1
infection we studied patients who normalized circulating CD4+ Tcell counts after HAART using responses to immunization as a
measure of functional immunologic competence.
Methods: Twenty-nine HIV-1 infected persons with CD4+ T-cell
counts >450 cells/pL and HIV-RNA 1 year after ART and 9 HIV(-)
controls were immunized at study entry and 4 weeks later with
tetanus-toxoid, diphtheria-toxoid, and keyhole limpet
hemocyanin. An immune-response-score (IRS) was calculated
using post-immunization antibody concentration, lymphocyte
proliferation, and delayed-type-hypersensitivity responses.
Results: Median current CD4+ T-cell counts were comparable in
patients with CD4+ T-cell nadirs below (744 cells/pL) or above
(724 cells/pL) the median CD4+ T-cell nadir of 250 cells/pL. The
median IRS was significantly lower in patients who started
HAART with CD4+T-cell counts <250 cells/pL when compared to
patients who started HAART with CD4+ T-cell counts >250
cells/pL (o.4 vs o.67; p<o.oo5) or to HIV(-) controls (o.4 vs 0.7; p
Corresponding author: Lange, Christoph, Medizinische Klinik,
Forschungszentrum Borstel, Parkallee35, 23845 Borstel,
Germany, Tel: [phone] o, Fax: [phone],
Email: [email protected]
LBOR10
Development of genetically protected T-lymphocytes from
transduced hematopoietic progenitors in human
immunodeficiency virus-1 infected patients
Amado, Rafael1, Mitsuyasu, Ronald', Rosenblatt,
Joseph', Ngok, Frances', Bakker, Andreas', Cole, Steve', Chorn,
Nathalie, Lin, Lii-Shin', Bristol, Gregory', Miles, Steven', Boyd,
Maureen2, MacPherson, Janet2, Fanning, Gregory2, Todd,
Alison, Ely, Julie2, Zack, Jerome', Symonds, Geoff
(United States; 2Australia)
Background: The cellular introduction of genetic elements that
inhibits HIV is conceptually attractive as a new treatment
paradigm for AIDS. By ex vivo retroviral transduction, we have
introduced a HIV-1 (tat gene) targeted ribozyme (RRz2) and a
control construct (LNL6) into G-CSF mobilized CD34+
hematopoietic progenitors.
Methods: Transduced autologous CD34+ cells (RRz2+LNL6)
were infused in equal numbers in ten patients in this Phase I
study. At entry each patient had CD4+ counts between
300-700/mm3 and viral loads of <1o,ooo copies/mi. Median
follow-up is 2.5 years. Gene presence was detected by a
sensitive PCR assay. Relative amounts of vector were analyzed
using mixed-effect linear regression.
Results: We observed no toxicity related to gene transfer. The
degree (o.1 to o.oi%) and persistence of gene marking in
progeny cells was dependent on the cell dose infused (range
o.o1-5.34x1o6/kg) with a minimum dose of o.5xio6/kg
required for log-term gene persistence (>2.5 years). Expression
of both constructs was detected in peripheral blood
mononuclear cells obtained over one year after CD34+
infusion. Marking persisted in granulocytes, monocytes, lymph

22 Program Supplement