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

XIV International AIDS Conference

Abstracts ThPpB2137-ThPeB7177 381

Diagnostic value methods (EEM = gold standard)
Prevalence Sensitivity Specificity False + False - + Pred - Pred Accuracy
NC result result value value
Self-report:
(T1) intake med 17% 27% 90% 10% 73% 67% 62% 63%
(T1) regularity 41% 40% 58% 42% 60% 43% 55% 50%
(T3) 5% 6% 96% 4% 94% 50% 61% 60%
Collateral report:
(T1) 25% 24% 76% 24% 76% 40% 59% 55%
(T3) 28% 29% 73% 27% 71% 42% 61% 56%
Conclusions EEM emerges as the most sensitive and reliable measurement
method to assess adherence. Yet, triangulation of different methods is recommended both in research and clinical practice.
Presenting author: Ann Deschamps, University Hospitals of Leuven, Department of Internal Medicine, Herestraat 49 secretariaat verpleging fase 3
70 verdieping, 3000 Leuven, Belgium, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPpB2137 Dynamic of adherence to antiretroviral therapy and
its impact on virological and immunological
response after 3 years of treatment
B. Spire1, P. Carrieri1, V. Journot2, H. Portier3, V. Cailleton1, V. Cham4,
C. Leport4, P. Massip5, J.R Moatti1, F. Raffi6. IlNSERM U379, INSERM U379,
23 rue Stanislas Torrents, 13006 Marseille, France; 2INSERM U330, Bordeaux,
France; 3Dijon Hospital, Dijon, France; 4Faculte X Bichat, Paris, France;
5 ToulouseHospital, Toulouse, France; 6Hotel-Dieu, Nantes, France
Background: to describe the evolution of adherence to Antiretroviral therapy
(ART) over a 36 month period among patients (pts) of the APROCO cohort and
evaluate the impact of different adherence patterns on virological and immunological response to ART.
Methods: APROCO is a French multi-centre cohort which enrolled pts started on
a protease inhibitor containing regimen. Adherence assessment was measured
at 4(M4), 20(M20) & 36(M36) months after initiation of ART (MO) using a selfadministered questionnaire. At each visit, pts were classified as adherent if they
reported high adherence criteria in all 5 questions pertaining adherence. Pts were
classified as always, sometimes and never adherent. Pts who were sometimes
adherent were split into 2 groups according to adherence at M4.
Results: among the 608 pts who were regularly followed-up until M36, 302 pts
who answered all self-questionnaires were selected for the analysis. The proportion of adherent pts was 58%, 62% and 65% at M4, M20 and M36, respectively.
Pts who were always, sometimes and never adherent were 99 (33%), 168 (56%),
35 (11%), respectively. A significant association (p=0.001) was found between
the viral load at M36 and the persistence of adherent behaviour over time, since
the proportion of pts with undetectable viral load at M20 was 71%, 75%, 61% and
37% among the always, sometimes whether or not initially adherent at M4, and
never adherent pts, respectively This result was confirmed after multiple adjustment for baseline CD4 cell-counts and being antiretroviral naive. Among the 174
pts who had CD4 cell-counts <350 at MO, initially adherent pts at M4 (58%) were
more likely to obtain a CD4 gain > 200 cells (OR[95%CI=2.1[1.1-4.3]).
Conclusions: The majority of patients have an irregular adherence behaviour
over 3 years of follow-up. For pts who can not maintain adherence behaviour,
maximal efforts should be made in the early months of ART to assure long-term
virological and immunological success.
Presenting author: Bruno Spire, INSERM U379, 23 rue Stanislas Torrents,
13006 Marseille, France, Tel.: [phone], Fax: [phone], Email: [email protected]
ThPpB2138 Failure to maintain adherence to HAART in a
cohort of French HIV-infected injecting drug users
P. Carrieri1, M.A. Chesney2, B. Spire1, A. Loundou3, A. Sobel4, G. Lepeu5,
J.P. Moatti1. 1INSERM U379, INSERM U379, 23 rue Stanislas Torrents, 13006,
Marseille, France; 2Center for AIDS prevention studies, University of California,
San Fransisco, United States; 30bservatoire regional de la sante, Marseille,
France; 4Creteil Hospital, Creteil, France; 5Department of Hematology, H.
Duffaut Hospital, Avignon, France
Objective: To assess the impact of social environment, drug use, psychological
status and characteristics of the prescribed regimen on adherence failure among
HIV-infected IDUs enrolled in the MANIF 2000 Cohort started on a HAART regimen.
Methods: All patients adherent at their first visit after HAART prescription and
with a second evaluation of adherence during follow-up were considered for
analysis (N=96). An adherence failure episode was defined as a declared nonadherence behaviour at any visit before the 18-th month of HAART. A random

effect logistic regression based on generalised estimating equations (GEE) was
used to identify factors associated with adherence failure.
Results: Among the 96 initially adherent patients, 22 (22.9%) experienced adherence failure before the 18-th month of treatment and these patients accounted
for 27 episodes of non-adherence. Living in a stable relationship with a partner
(OR= 0.4, 95%CI[0.2 - 1.0]) active drug injection (OR=3.3, 95%CI[1.0 -10.3]) and
depressive mood (OR=2.5, 95%CI[1.0-6.0]) were associated with adherence fail
ure in multivariate analysis. Other patterns of drug use, the number of HIV-related
symptoms, somatic anxiety symptoms, regimen to be ingested on an empty stomach were associated with adherence failure but only in univariate analysis.
Conclusions: Psycho-social interventions for improving adherence should not
be exclusively targeted for those patients who exhibit patterns of non-adherence
behaviour soon after initiation of HAART. Patients' counselling included in such
interventions should focus on prevention of drug use, provision of social support
and take into account the potential impact of difficulties with treatment on psychological well-being.
Presenting author: Patrizia Carrieri, INSERM U379, 23 rue Stanislas Torrents,
13006, Marseille, France, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeB71 76 Iranian HIV positive patients in masih daneshvari
hospital: epidemiology, immunology and
complications
D. Mansoori, S. Arami, M. Zadsar, K. Alaie. Shahid BahonarDarabad, postal
code19556 Tehran, Islamic Republic of Iran
Background: Now, at the start of a new millennium, HIV infection has a worldwide
distribution and number of cases is increasing rapidly particularly in the developing countries. In recent years, the rate of HIV infection seems to be increased in
Iran particularly among intravenous drug abusers, being infected in prisons and
rehabilitation centers.
Methods: From September 1998 to August 2001, we reviewed 44 cases of HIV
positive patients that have been presented to Masih Daneshvari hospital, Tehran,
Iran. Epidemiological factors, immunology status, associated infections and complications were evaluated.
Results: Of total 44 patients, 4 (9%) were female and 40(90%) were male. The
mean age was 38. The most frequent route of infection was intravenous drug use
(75%), followed by heterosexual route (16%) and contaminated blood transfusion
(9%). Flow cytometric tests in 39 patients revealed that 16 of them had lymphocyte CD4 count less than 500. PPD was 5 mm or more in 10 of 30 cases (33%).
HBs Ag was positive in 8 of 39 cases (21%) and HBs Ab in 17 of 39 (44%),
none of them had been vaccinated against HBV. Anti HCV was positive in 29 of
39(81%) cases. 5 patients had clinical tuberculosis. Serologic tests (Ig G) for toxoplasma was positive in 15 of 27 cases (55%). VDRL test was positive in 2 of
26 cases (8%). Four cases had oral candidiasis. One case of necrotising pneumonitis and five cases of bronchitis and bronchiectasis were detected. Besides
applying appropriate treatment to all patients with opportunistic infections and
achieving satisfactory results, 5 patients are on "HAART". Totally 4 (9%) patients
died.
Conclusions: Our results are important for the setting of priorities and rationalization of prevention and treatment availability, particularly among IV drug
abusers, in our country Multidisciplinary and multi-level approaches, both by the
government and private health-care providers will have a positive impact on the
HIV status in Iran.
Presenting author: Siamak Arami, Shahid Bahonar,Darabad, postal codel19556
Tehran, Islamic Republic of Iran, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
ThPeB7177I Relationship of immunological markers and thymic
index to CD4 T cells and HIV RNA at baseline in
treatment naive HIV-infected patients
M. Noktal, M. Pu2, J. Spritzler2, B. Gross3, R. Shafer4, G. Robbins5,
R.B. Pollard6. 1 University of Texas Medical Branch, Galveston, TX, United
States; 2Harvard School of public Health, Boston, United States; 3University of
Michigan Medical Center, Ann ArborMI, United States; 4Stanford University
medical center, Stanford, CA, United States; 5Massachusetts General Hospital,
BostonMA, United States; 6University of California at Davis, Davis, United States
Background: HIV infection cause gradual depletion of functional T cell subsets.The aim of this study was to identify immune correlates of viral suppression
in HIV infected patients. A number of immunological markers and their relationship to thymic index (TI), CD4 counts and HIV viral load were examined. This is a
substudy of ACTG 384 (980 treatment naive patients, receiving HAART).
Methods: 78 patients participated in the substudy (ACTG A5007). Peripheral blood CD4/CD8 lymphocyte subpopulations were evaluated for their
naive/memory phenotype, activation and apoptosis by flow cytometry. HIV RNA
(VL) was measured by PCR and TI by computed tomography scans of the chest.
Results: The subjects' ages ranged 19-65 (median=35) years. At baseline their
CD4 counts were 8-921 (median=313) cells/mm3 and VLs were 2.9-6.43 (median=4.82 log10) copies/ml.
These parameters were not statistically significantly different from those of the
parent study. There was a positive correlation between naive CD4 (r=0.87,
p=0.0001) or CD8 T cells (r=0.53, p=0.0001) and CD4 counts, and an inverse cor
relation between naive CD4 (r=-0.58, p=0.0001) or CD8 cells (r=-0.39, p=0.0006)
and VL. In addition, an inverse correlation between activated CD4 cells and naive
CD4 cell count (r=-0.73, p=0.0001) and a positive correlation with VL (r=0.47,
p=0.0001) were detected. There was a weak correlation between % apoptotic
CD4 cells and CD4 counts (r=-0.3, p=0.0402). A positive correlation between TI
and naive CD4 (r=0.38, p=0.001) or CD8 cells (r=0.36, p=0.0025) and an inverse
correlation with age (r=-0.52, p=0.0001) were observed. Moreover, the TI corre