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

380 Abstracts ThPpB2133-ThPpB2136

XIV International AIDS Conference

releasing IFN-gamma after mitogen-induced or Gag-specific stimulation were
both highly increased following HAART discontinuation. However, these CD8 T
cells were mainly composed by pre-terminally differentiated CTL expressing a
CCR7- CD45RA- phenotype and a reduced content of cytotoxic factors such as
perforin.
Conclusion: These data indicate that an expansion of immature CTL with poor
cytotoxic activity is associated to the failure to control viremia during STI. Thus,
monitoring CD8 T cell dynamics during STI could be clinically relevant and useful
to design new terapeutic strategies aimed to restore CTL effector funtions.
Presenting author: Fabrizio Poccia, National Institute for Infectious Diseases,
Lab. Immunopathology -, Via Portuense 292, 00149 Rome, Italy, Tel.: +39 06
55170 904/958, Fax: [phone], E-mail: [email protected]
ThPpB2133 Effect on patients' quality of life (QoL) of starting
HAART at different CD4 cell counts
PT. Nieuwkerk1, M.E. Hillebrand2, R. Vriesendorp3, P.H.J. Frissen4, F. de
Wolf1, J.M.A. Lange', M.A.G. Sprangers1. 1Academic Medical Center, Dept. of
Medical Psychology (J4-416), Amsterdam, The Netherlands; 20LVG,
Prinsengracht, Amsterdam, The Netherlands; 3 Westeinde Hospital, Den Haag,
The Netherlands; 4OLVG, Amsterdam, The Netherlands
Background: The optimal time of HAART initiation in chronic HIV-infection is
controversial. HAART may have a negative effect on QoL due to toxicities and inconveniences.The extent to which these potential negative effects are outweighed
by positive effects may depend upon the timing of HAART initiation. We investigated the effect of HAART on QoL among pts starting HAART at different CD4
cell counts.
Patients: Naive pts initiating HAART enrolled in the ATHENA-cohort.
Methods: Pts completed the MOS-HIV health survey at enrolment and after 6, 12
and 18 months. Pts were categorised according to their baseline CD4 cell count
into >350, 201-350 and <200 CD4 cells/uL. We investigated whether there was
a different pattern of change over time in QoL between the 3 baseline CD4 cell
count groups using repeated measurements analysis of variance.
Results: 142 pts were enrolled. At baseline, pts who started HAART at <200
cells/uL (n=56) had significantly worse physical health compared to those who
started HAART at 201-350 (n=43) and >350 (n=43) CD4 cells/uL. We found a
significantly different pattern of change in physical health over time between the
3 groups. Physical health improved among pts who started HAART at <200 CD4
cells/uL, whereas it did not change among those who started HAART at 201-350
or >350 CD4 cells/uL. As of 6 months after HAART initiation, physical health had
become comparable in the 3 groups. No difference in pattern of change over time
was found for mental health with all 3 groups showing improvement.
Conclusion: Pts who started HAART at <200 CD4 cells/uL showed more pronounced improvements in QoL compared to those who started HAART at >200
CD4 cells/uL. We found no clear advantage regarding QoL of starting HAART
at 201-350 compared to >350 CD4 cells/uL. Although QoL should be taken into
account when deciding about HAART initiation in the individual patient, it will not
likely be a decisive factor on a group level among pts with more than 200 CD4
cells/uL.
Presenting author: Pythia Nieuwkerk, Dept. of Medical Psychology (J4-416),
Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands, Tel.: [phone], Fax: [phone], E-mail: p.t.nieuwkerk@amc.
uva.nil
ThPpB2134 Physical and psychological impacts of structured
treatment interruptions
M.L.B. Le Braz1, C.F Fagard1, C.S. Schneider2, V.W. Werder3,
J.V. Voggensperger3, D.T. Toscano4, A.C. Christen4, S.G. Gallant5,
H.W. Weyermann6, M.R. Russoti7, B.H. Hirschel1. 1Hopital Cantonal,
Consultation VIH/SIDA, Geneve, Switzerland; 2Universitatsspital, Zurich,
Switzerland; 3 Kantonsspital, Basel, Switzerland; 41nselsspital, Bern,
Switzerland; 5 CHUV Lausanne, Switzerland; 6 Kantonsspital, Saint Gallen,
Switzerland; 70spedale Civico, Lugano, Switzerland
Background: The Swiss Spanish Treatment (Rx) Interruption Trial (SSITT) involved 133 patients (97 in Switzerland) who stopped Rx for two weeks, were
re-treated for 8 weeks, during four cycles. At week 40, Rx was suspended for at
least 12 weeks.
Methods: Patients were offered a written questionnaire regarding side effects,
difficulties with taking Rx and compliance, at different time points, e.g. when ART
was started ("first ART"), or when Rx was started again after interruption ("restart"). We also explored their motivations for participating in SSITT.
Findings: 89/97 (92%) patients answered the questionnaire. Motivations for participating in the trial were: "hope not to need drugs anymore" (76%), "let their body
have a rest" (68%), "vacation without having to take pill at set times" (46%), "take
part in HIV research" (62%), "personal challenge" (16%). Side effects were less

frequent at "re-start" (111 SE reported) than at "first ART" (177 SE). GI complains,
the most frequently SE reported (50%), were rated significantly less severe at "restart" (p=0.005). 14/83 (17 %) patients said that taking ART after an interruption
was more difficult, 61/83 (73%) said it was the same as before and for 8/83 (10%)
it was easier. During first interruption, 20% dread missing Rx, but 80% did not. At
study screening 22,5% of the patients reported to feel psychologically bad (score
(iU5, scale 0 to 10), 19% felt physically bad, compared to respectively 8% and

5,6% during Rx interruption (p=0.005). When asked whether they would be ready
to participate in a similar experiment of STI, 72% said yes, 25% said may be and
2% said no.
Conclusions: Contrary to concerns that have been voiced, participants in SSITT
did not report greater difficulties with taking Rx after STIs than before. Side effects
recrudesced but were milder at "restart" than at "first ART". Most participants
viewed their experience positively.
Presenting author: Michelle Le Braz, Consultation VIH/SIDA, Hopital cantonal,
24, rue Micheli du Crest, 1211 Geneve 14, Switzerland, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
ThPpB2135 Quality of life and emotional status of HIV-1+
patients with viral load suppression in structured
treatment interruptions
C.R. Fumaz1, A. Tuldral, M.J. Ferrer1, M. Barcel61, J. Miranda1,
J.C. Martinez1, L. Ruiz2, B. Clotet2. 1Fundacid Lluita SIDA-UnivHosp Germans
Trias i Pujol, Ctra. Canyet s/n 08916 Badalona, Spain; 2Fundacid IrsiCaixa-Univ
Hosp Germans Trias i Pujol, Badalona, Spain
Background: Structured treatment interruptions (STI) may be an adequate alternative for patients (pts) to preserve a good quality of life (QOL) and a positive
psychological reinforce for the periods in which pts have to take medication again.
Methods: Twenty-four-week (wk) prospective study in which pts with long-term
viral load suppression were randomised to: stop their antiretroviral treatment (n=
23; group 1; Gl) or continue treatment (n=21; group 2; G2). At baseline (BL), wk
12 and wk 24, these variables were assessed: self-reported adherence (ADH)
in pts taking medication, QOL (evaluated with the MOS-HIV questionnaire) and
anxiety/depression (STAI questionnaire).
Results: No statistical differences were found at BL between groups. At wk 24,
QOL had improved in G1 (n=14) in these dimensions: General health perceptions
(BL: 60~23.2 vs wk 24: 76~24.6; p=0.05), Pain (BL: 80~19.9 vs wk 91.4~11.7;
p=0.05), Social functioning (BL: 89.1~15.2 vs wk 24: 98.8~11.01; p=0.04), Mental health (BL: 70.04~14.5 vs wk 24: 79.7~14.1; p=0.05), Energy/fatigue (BL:
66.1~16.2 vs wk 24: 77.7~21.7; p=0.05), Cognitive function (BL: 77~14.9 vs wk
24: 88.7~13.8; p=0.02) and General QOL (B
L: 64.8~16.6 vs wk 24: 74.4~19.9; p=0.03). QOL was better in G1 when compared with G2 (n=17) at wk 24 (p=0.05). Levels of anxiety/depression were higher
in G2 (Gl: 30.1~17.8 vs G2: 42.9~19.7; p=0.04). At wk 24, 89% of pts taking
medication (including those who had to take medication again for a viral load
rebound) reported an ADH 395% of consumption of medication prescribed.
Conclusions: STI periods seem to improve pts' QOL and diminish levels of anxiety and depression. High levels of adherence were reported in the study, even in
those pts who had to reinitiate treatment.
Presenting author: Carmina R. Fumaz, Ctra. Canyet s/n 08916 Badalona,
Spain, Tel.: [phone], Fax: [phone], E-mail: [email protected].
es
ThPpB2136 Diagnostic value of measurement methods of
adherence to HAART in HIV-infected persons
A. Deschamps', V. De Saar2, V De Graeve2, E. Van Wijngaerden 1, A.M. Vandamme3, K. Van Vaerenbergh3, H. Ceunen1, H. Bobbaers', S. De
Geest4. 1University Hospitals of Leuven, Department of Internal Medicine,
University Hospitals of Leuven, Department of Internal Medicine, Herestraat 49
secretariaat verpleging fase 3 7' verdieping, 3000 Leuven, Belgium; 2Centre for
Health Services and Nursing Research, School for Public Health, Faculty of
Medicine, University of Leuven, Leuven, Belgium; 3Rega Institute for Medical
Research, University of Leuven, Leuven, Belgium; 4 Institute of Nursing Science,
University of Basel, Basel, Switzerland
Background Non-adherence to HAART is associated with poor clinical outcome.
Valid and reliable measurement of adherence is thefre indicated.
Methods Using a longitudinal descriptive design, adherence to HAART was assessed at three consecutive time points in 43 HIV+ patients: 36 in., 7 f.; mean
age 42 y (~8.5).
TI: (inclusion): adherence in view of intake and regularity was assessed during
the last 4 weeks using self-report and collateral report by physicians.
T2: adherence was assessed using Electronic Event Monitoring (EEM) during 3
months and operationalized multidimensionally: (1) taking compliance (TaC); (2)
dosing compliance (DC); (3) timing compliance (TiC); (4) N drug holiday/ 100
days (DH= no med. intake for > 24 h).
T3: (end EEM): adherence in the past 4 weeks was assessed through self-report
and collateral report. Virological outcome parameters were the evolution in CD4
cell-count and viral load, and the development of genotypic resistance between
time 1 and 3.
Results Median TaC, DC and TiC were 98%, 91.5% and 86% respectively. Mean
number of DH was 0.8/100 days. Based on a clinically validated algorithm using

EEM data (< 90% TaC, or <75% DC and >1 DH, or <80% TiC and >1 DH, or> 6
DH per 100 days) patients were categorized as adherent (60%) or non-adherent
(40%). The prevalence of non-adherence using the EEM algorithm, self-report to
intake and regularity, self-report and collateral report (T1 and T3) was 40%, 17%,
41%, 5%, 25% and 28% respectively, showing the superior sensitivity of EEM to
assess non-adherence. Using EEM as gold standard, diagnostic value of different
adherence measures was calculated and is indicated in the table.