Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

142 Abstracts WePeC6249-WePeC6252

XIV International AIDS Conference

Results: Of 1929 persons interviewed, 355 (18%) reported missed doses in the
past 48 hours. Missing doses was associated with > 20 months of therapy (vs 0-5
months, AOR 2.0, CI 1.4-2.8); 4 or more prescribed medications (vs 1 medication,
AOR 2.3, CI 1.1-5.0); age 18-29 years (vs > 50 years, AOR 1.9, C1.2-3.2); black
or Hispanic race (vs white, AOR 1.8 and 1.7, C11.3-2.6, 1.1-2.5, respectively);
and use of alcohol (AOR 1.8, CI 1.4-2.4) or crack (1.8, CI 1.3-2.6) but not injected
drugs (AOR 1.4, Cl 0.8-2.5) in the past year. Missing doses was less common
among persons who reported that their physician had discussed viral resistance
with them (AOR 0.6, Cl 0.4-0.8).
Conclusions: Many persons in care for HIV infection reported missing doses of
antiretroviral medication in the 2 days before interview. Recent alcohol and crack
use were strongly associated with sub-optimal adherence. Clinicians may improve
adherence by addressing substance use issues and discussing viral resistance
as part of management of persons with HIV infection.
Presenting author: Patrick Sullivan, 1600 Clifton Road NE, MS E-47, Atlanta,
GA 30333, United States, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
SWePeC6249 Antiretroviral therapy and AIDS mortality in the
urban poor: the REACH cohort study
A.R. Moss, S. Perry, E. Riley, D. Bangsberg. UCSF San Francisco, CA, United
States
Background: We studied access to therapy and mortality in the REACH prospective cohort of HIV-positive homeless and marginally housed persons recruited in
San Francisco.
Methods: We followed a representative sample of 330 HIV-positive adults, recruited 1996-2000 in major lunchlines and homeless shelters and a random sample of SRO hotels. We carried out quarterly interviews and blood draws. Those
on HAART received monthly adherence measurement and viral load studies.
Results: 75% were male, 51% nonwhite, 25% had a history of mental health hospitalization, 64% an IDU history and 78% a crack cocaine history. At a median 28
mos followup, 44 have died(9% per person year of followup (ppy)) 31 have diedof
AIDS or 6% ppy The proportion on HAART rose to 55% in the second half of
2001; the proportion virally suppressed rose to 28%. 217/330 have recived at
least one month of antiretroviral therapy and 169 (51%) at least 12 mos. Average
pill count adherence in those with more than 12 mos was 68%. Subjects with
more than 12 mos therapy had an adjusted relative risk of 0.15 for death (p<.01)
and death was independently predicted by baseline CD4 count, Caucasian ethnicity, and having Medicare or Medical health insurance. Average annual mortality
was 5% overall and 2% from AIDS for those receiving 12 mos of HAART It was
13% overall and 10% from AIDS for all others
Conclusions: Half of the HIV-positive urban homeless have received at least a
year of HAART Those receiving at least a year of HAART had sharply reduced
mortality. Although penetration of therapy is incomplete and adherence remains
an issue, HAART has had a major efffect on AIDS mortality in the urban indigent.
Presenting author: Andrew Robert Moss, 504 Liberty St, San Francisco, Ca
94114, United States, Tel.: [phone], Fax: [phone], E-mail: amoss
@epi.ucsf.edu
WePeC6250 Readiness to use antiretrovirals by HIV-infected
patients in Trinidad and Tobago
N. Jack1, H. Smith1, J. Daniel', M. Telfer-Baptistel, K. Fergusson1,
A. Gonzalez, F. Cleghorn2, C. Bartholomew1. 1Medical Research Foundation,
Trinidad and Tobago; 2Institute of Human Virology, UMB, MD, United States
Background: Antiretroviral costs have been reduced in Trinidad and Tobago.
However, adherence to antiretroviral regimens can be challenging with daily treatment required for the rest of one's life.
Methods: Between October to December 2001, HIV infected patients presenting
to our clinic for treatment were assessed as to readiness to begin antiretroviral
treatment using a short questionnaire. 108 patients were registered and complete
intormation was available for 101.
Results: There were 44 males and 57 females, 68 (67.3%) were between the
ages 20 to 40. 50 (49.5%) had their first HIV test greater than three years ago and
32 (31.7%) had clinical AIDS. 96% were willing to take antiretrovirals, 88 (87.1%)
for the rest of their life, 83 (82.2%) believed they were capable of keeping a strict
regimen. 47 (46.5%) were willing to take medication between 2 to 4 times a day
and 40 (39.6%) as prescribed. If unpleasant side effects occurred, 44 (43.5%) will
contact the doctor, 34 (33.6%) will continue with treatment, 23 (22.8%) would stop.
All were willing to attend clinic to collect medication, 62 (61.4%) once a month.
However only 51 (50%) were willing for a nurse to visit them to give medication,
and only if they were sick or unable to come and not in uniform.
Conclusion: HIV infected patients were willing to use multiple doses of antiretrovirals daily, keeping a strict regimen for the rest of their life with less than 25%
stopping treatment if side effects occurred. However, the majority of patients were

unwilling to attend clinic more than once a month for medications and did not want
a nurse visiting to give medications. Directly observed therapy will not be an option to improve adherence for these patients.
Presenting author: Noreen Jack, medical research foundation, 7 queens park
east, port-of-spain, Trinidad and Tobago, Tel.: [phone], Fax: [phone], E-mail: [email protected]

WePeC6251I Skeletal muscle damage during HIV disease:
frequency, possible causes, clinical and
laboratory features, and consequences
R. Manfredi, L. Calza, F. Chiodo. University of Bologna, Department of Infectious
Diseases, S. Orsola Hospital, Bologna, Italy
Background: Skeletal muscle anomalies are novel HIV disease complications,but causes and consequences are still debated.
Methods: A 1:3 case-control study was performed in -1000 HIV-infected patients
(p) followed in the 2nd semester of 2001, provided that they had >2 laboratory
exams. To assess the frequency, risk factors,clinical and therapeutic impact of
muscle damage, the 131 p who had >1 altered CPK testing (>195 U/L), were
compared with 393 controls randomly selected among all other p, according to
some demographic, epidemiologic, clinical, and therapeutic features.
Results: A 15% crude frequency of CPK abnormalities was seen among the 875
p who underwent >=2 studies in 6 months. This alteration was transient in 98 p,
who had values of 196-3463 (mean 256.2+62.3) U/L,but was found >2 times in
32 p (24.4%), 25 of them (78.1%) had concurrent high aldolase levels (3.1-10.8
U/L). Among the 131 p with altered CPK levels, 125 were males (p<0.0001 vs
controls), while no difference was found as to age, exposure to HIV, iv drug use,
HIV disease duration and stage, length and type of prior anti-HIV therapy (including selected nucleoside analogues), mean CD4 and HIV-RNA levels, eventual
lipodystrophy syndrome, increased glucose and lipid levels,concomitant therapies with possible muscle toxicity (i.e. hypolipidemic drugs), as well as present
anti-HIV therapy (taken by 121 p vs 355 controls), as expressed by a multivariate analysis. A mild fatigue was sometimes reported, but signs and symptoms
suggesting myopathy or rhabdomyolisis, or prompting further investigation were
recognized in 5 p only. Increased lactic acid levels were found in 3 p. Histopathologic and ultrastructural studies confirmed an autoimmune myositis in 1 p.
Conclusion: Skeletal muscle damage, though often asymptomatic, is an underestimated HIV-associated toxicity Further investigation is needed, including the
study of antiretroviral-related metabolic damage (i.e. mitochondrial toxicity), in order to prevent and cure this emerging problem.
Presenting author: Roberto Manfredi, University of Bologna, Department of Infectious Diseases, S. Orsola Hospital, Bologna, Italy, Tel.: [phone],
Fax: [phone], E-mail: manfredi @ med.unibo.it
WePeC6252 Effects of different protease inhibitors on
apolipoprotein B and plasma lipid profile of
HIV-infected patients
P. Domingo, J.A. Arroyo, M.A. Sambeat, A. Perez, J. Ordonez, J. Cadafalch,
M. Fuster, M. Gurgui, G. Vasquez. Hospital de Sant Pau, Hospital de Sant Pau,
Internal Medicine, Av. Sant Antoni M Claret, 167, 08025 Barcelona, Spain
Aim of the study: To determine the differential effects of PIs on plasma lipid levels
and apolipoprotein B levels.
Patients and Methods: This was a cross-sectional study of lipid abnormalities related to highly active antiretroviral therapy. To be included in the study the patient
had to be treated with HAART that included a PI for at least 6 months and have
a plasma lipid evaluation. Lipid evaluation included cholesterol and its fractions,
triglycerides, apolipoprotein A, apolipoprotein B, lipoprotein a, and glucose and
insulin. Statistical analyses were performed with the StatView 4.5TM (Abacus
Concepts Inc. Berkeley, CA).
Results: One hundred and fifty nine patients were included in the study. There
were 120 (75.5%) men and 39 (24.5%) women, with a mean age of 38.7 + 8.6
years (range: 21-69). One hundred and ten patients (71.9%) were taking indinavir,
22 (14.4%) saquinavir, 13 (8.5%) ritonavir, and 8 (5.3%) ritonavir+saquinavir. The
mean duration of PI use was 11.7 ~ 5.8 months. The influence of each PI on the
plasma lipid profile is seen in the following table:
Chol* LDL* VLDL* HDL* ApoB* ApoA Lp (a) RGI
IDV 5.1~1.5 3.1~1.2 1.0~0.7 0.9~0.3 1.1~0.3 1.1~0.2 244~303 0.06~0.06
SQV 4.9~1.4 3.1~1.3 0.8~0.6 1.1~0.4 0.9~0.3 1.3~0.3 235~275 0.06~0.04
RTV 7.1+2.1" 4.4~1.6 1.7~0.8 1.0~0.2 1.4~0.4 1.3~-0.3 296~286 0.10~0.16
RTV+SQV 5.9+2.0 3.4~1.7 1.2~0.9 0.9~0.3 1.2~0.5 1.2~0.2 522~756 0.06~0.01
P < 0.05
There were no significant differences between groups with respect to triglyceride
levels.
Conclusions: Apoliprotein B levels are increased most by ritonavir, followed by
dual IP therapy, indinavir and saquinavir. Consequently, the different PIs induce
different changes in the lipid profile, being mostly affected by ritonavir or combinations thereof, and less affected by saquinavir.
Presenting author: Pere Domingo, Hospital de Sant Pau, Internal Medicine, Av.
Sant Antoni M Claret, 167, 08025 Barcelona, Spain, Tel.: [phone], Fax:
[phone], E-mail: pere.domingo@ uab.es