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

386 Abstracts ThPeB7195-ThPeB7199

XIV International AIDS Conference

ThPeB7195 IHIV-1 infections undetected by antibody testing in
men with urethritis in Malawi
S.R. Galvin', M. Price', S.C. Kaydos', E. Msowoya2, N. Chikunga2, E. Kip2,
M.S. Cohen'1. 'University of North Carolina, 104 Hidden valley drive, Chapel hill,
nc 27516, United States; 2UNC Project, Lilongwe, Malawi
Background Information regarding rates of acute HIV infection in African areas
of high HIV-1 prevalence is sparse. We present data that shows the prevalence of
HIV undetected by antibody screening in a population of men attending a sexually
transmitted disease clinic in Lilongwe, Malawi.
Methods The subjects are men enrolled in a study evaluating Trichomonas vaginalis as an agent of urethritis in Malawian men. All men enrolled in the urethritis
study had HIV testing performed on site using the Capillus HIV-1/HIV-2 rapid test
(Cambridge Diagnostics, LTD., Ireland). A subset of these men who had urethritis
were studied for the presence of specific HIV lymphocyte responses, and all of
these men had HIV viral PCR tests performed, regardless of HIV antibody status.
HIV viral PCR testing was performed on plasma that was frozen and sent to the
University of North Carolina (Nuclisens HIV-1 QT, Organon Teknika Corp., North
Carolina).
ResultsEighty-six HIV antibody negative men had plasma tested for HIV RNA.
One subject had an invalid test. Of the eighty-five remaining, eighty-two had undetectable viral loads and three subjects (3.5%), had detectable viral loads of 360,
870,000, and 4,800,000 copies. One patient had a very low level of 360 copies.
This level of RNA in the blood would be unusual for an acutely HIV infected person
in the antibody negative window period and may represent either a false positive
PCR result or a false negative HIV capillus result. Excluding this subject leaves 2
of 84 persons (2.4%) with lab results consistent with acute HIV infection.
ConclusionsAcute HIV was found in 2 of 84 persons attending a STD clinic in
Malawi. Given this finding, testing schemes that detect HIV positive persons in
the antibody negative window period may be warranted for this population.
Presenting author: Shannon Galvin, 104 Hidden valley drive, Chapel hill, nc
27516, United States, Tel.: [phone], Fax: [phone], E-mail:
shannongalvin @ med.unc.edu
ThPe B7196 Factors predicting the uptake of HAART in primary
HIV infection (PHI)
K. Porter, A.S. Walker, on behalf of CASCADE Collaboration. MRC Clinical
Trials Unit, MRC CTU, 222 Euston Road, London, United Kingdom
Background: Guidelines for the initiation of antiretroviral therapy (ART) have always suggested that, if ART is to be considered in PHI, it should be initiated within
6 months of infection. We aimed to describe secular trends in and predictors of
ART initiation in PHI.
Methods: Pooled data from persons with known or well- estimated times of HIV
seroconversion (SC) from 20 cohorts in Europe and Australia were used (CASCADE). We estimated time to initiation of ART in 2438 seroconverters aged 13
years or more at SC presenting during PHI in four calendar periods (prel1990,
91-96, 97-98 and 99-2001) using cumulative incidence methods. We also used
logistic regression models to identify factors associated with the initiation of ART
within 6 months of PHI for persons presenting within 4 months of estimated SC,
adjusting for age at SC, sex, route of infection, and HIV test interval (interval between negative and positive test dates).
Results: The cumulative probability of initiating ART by 6 months from estimated
SC increased over time (0.10, 0.21,0.65 and 0.72 in prel990, 91-96, 97-98 and
99-2001 respectively). Of 1385 seroconverters presenting within 4 months of SC,
257 (19%) had started ART within 6 months. 15%, 84% and 95% of those starting ART in 91- 96, 97-98 and 99-2001 respectively started HAART regimens.
Other than year of SC (p<0.0001), HIV test interval less than 1 month (p<0.001;
OR=2.8, 95% CI= 2.3-3.3) and the presence of a SC illness (p=0.07; OR=1.8,
95% CI= 0.96-3.6) independently predicted initiation of ART, adjusting for sex
(p=0.7), age (p=0.3) and route of infection (p=0.3). Similar results were observed
when we restricted analyses to those initiating ART after 1996 when HAART became more widely available.
Conclusions: apart from calendar period, only SC illness and short HIV test interval appear to influence whether seroconverters receive ART during PHI.
Presenting author: Kholoud Porter, MRC CTU, 222 Euston Road, London,
United Kingdom, Tel.: [phone], Fax: [phone], E-mail: k.porter
@ctu.mrc.ac.uk
ThPeB7197 Renal abnormalities associated with human
immunodeficiency virus infection among police
officers in Dar-es-Salaam, Tanzania
M.Y. Janabi', S. Chale2, P Magao', R. Jossiah', M. Bakari3, E. Lyamuya3,
F Mugusi3, A. Swai3, F. Mhalu3, K. Pallangyo3, N. Pallangyo 4, G. Biberfeld5,
E. Sandstrom6. ' Muhimbili National Hospital, postal box 1315 dar-es-salaam

tanzania east africa, Tanzania; 2Muhimbili National Hospital, Tanzania;
3Muhimbili National Hospital, Muhimbili University College of Health Sciences,
Dar es Salaam, Tanzania; 4 Tanzania Police Force, Dar es Salaam, Tanzania;
5Karolinska Institute, Stockholm, Sweden; 6Karolinska Institute, Sodersjukhuset,
Stockholm, Sweden
Background: HIV-associated nephropathy (HIVAN) and other glomerular lesions
are frequent complications of HIV infection. These renal diseases usually present

as a nephrotic syndrome with progressive loss of renal function and an increased
risk of mortality. The physical and laboratory changes among HIV infected individuals remain largely undefined; however, most studies agree that African race
is a major risk factor for nephropathy.
Methodology Samples for this study were obtained from 587 healthy, unrelated,
HIV-1 negatives and 127 different unrelated, HIV-1 infected subjects, identified by
HIV ELISA. The HIV free and HIV infected study subjects were matched for age
and sex. A questionnaire with specific questions on renal symptoms was administered and biochemical, hematological and urinary tests were performed.
Results: Clinical profiles: Overall, the frequency of renal symptoms and laboratory abnormalities was significantly higher among HIV positive subjects: dysuria
3.9% versus 1.4% (p<0.05), genital ulcers 1.6% versus 0% (p<0.001), suprapubic pain 2.4% versus 1.4% (p<0.05), loin pain 1.6% versus 1% (p<0.05), facial
puffiness 0.8% versus 0.2% (p<0.05), renal angle tenderness 0.8% versus 0.1%
(p<0.01). Laboratory profiles: albuminuria 28.4% versus 16.8% (p<0.06), leucocyturia 14.2% versus 11.6% (p<0.062), haematuria 1.6% versus 0.2% (p<0.01),
urine culture+ 1.6% versus 1.5% (p<0.05), elevated serum creatinine 0.8% versus 2.74% (p<0.05), hyperuricaemia 8.7% versus 2.2% (p<0.01). Median CD4+
value = 289 for HIV infected compared with CD4+ count of 1000 among HIV free
subjects (p< 0.001)and median CD4/CD8 ratio =0.3 among HIV infected compared to a ratio of 1.1 among HIV free subjects (p<0.05).
Conclusion: Our data suggest that HIV-1 infected adults have more renal associated abnormalities than HIV negative referents. In this era of HAART, extra
caution should be taken in selecting antiretrovirals some of which have adverse
renal complications
Presenting author: mohamed janabi, postal box 1315 dar-es-salaam tanzania
east africa, Tanzania, Tel.: [phone], E-mail: [email protected]
ThPeB7198I NNRTI based therapy for the treatment of acute and
early HIV-1 infection. Clinical issues and
immunological studies
S.D. Portsmouth', N. Imami2, A. Pires2, J. Hand', F. Gotch2, M. Nelson1,
B.G. Gazzard1. 'Chelsea and Westminster Hospital, London, United Kingdom;
2Imperial College School of Medicine, London, United Kingdom
Background A campaign in the gay press and for local general practitioners
aimed to increase the number of individuals with acute HIV-1 infection presenting
to HIV services. Patients presenting have been offered treatment with an NNRTI
based regimen.
Methods 21 patients have been prospectively followed during treatment of acute
and early HIV-1 infection with combivir and efavirenz. Clinical, virological, and
immunological data have been collected.
Results 18 patients attended following an illness that had features recognizable
as acute HIV-1 seroconversion and were HIV-1 antibody positive by ELISA, 3 patients were ELISA negative but had a positive p24 antigen and HIV-1 RNA viral
load. Median baseline CD4 was 493 cells/mm3 and viral load 200,000 copies/ml.
In 3/21 patients at baseline CD4+ T-cell virus-specific proliferative responses to
HIV-1 or virus-specific intracellular IFN gamma responses were seen. All patients
were commenced on combivir and efavirenz. Treatment was started a median of
40 days (range 9-120) after the illness thought to be seroconversion illness. 20
patients are continuing on ART 50% of patients described symptoms related to
efavirenz, one patient discontinued therapy and two were switched to alternative
regimens. At 52 weeks all patients on therapy had a viral load of <50 copies/ml,
and the median CD4 count was 634 cells/mm3. Time to reach <50 copies/ml was
a median of 12 weeks (range 4-36). Transient T-cell responses to at least one
HIV-1 antigen were observed during 24 weeks of follow up in each of the patients
tested.
Conclusion Identifying patients with acute HIV-1 infection is difficult and most
patients will start therapy more than 40 days after infection. NNRTI based combination therapy for early HIV-1 infection is tolerated and effective at controlling
HIV-1 viraemia and there is little restoration of HIV-1 specific immunity
Presenting author: Simon Portsmouth, 27 Ingestre Court, Ingestre Place, London, W1F 0JL, United Kingdom, Tel.: [phone], E-mail: simonportsmouth
@hotmail.com
ThPeB71 99 The burden of mental illness in an urban HIV
population
M.E. Theodore, H. Wolfe, V. Sharp. St. Luke's-Roosevelt Medical Center-Center
for Comprehensive Care, 31 west 12th street, suite le, new york, new york
10011, United States
Issues: Evidence exists that psychiatric disorders are common in patients with
HIV infection and that they may not receive optimal medical care because their
psychiatric disorders area barrier to effective HIV treatment. We designed a study
to measure the "burden of mental illness among our patients.
Description: We designed a 40-item questionnaire to quantify the 'burden" of

mental illness among all the patients who underwent a psychiatric evaluation during March of 2001.
Lessons learned: Questionnaires were completed on 50 of 54 patients (87percent).
Two-thirds of the patients were male, a quarter were female and 2% were transgender. The majority of the patients evaluated were of African-American (n= 18;
36%) and Hispanic descent (n= 15; 30%).