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

XIV International AIDS Conference

Abstracts ThPpC2143-ThPeC7404 439

Conclusions: the contribution of HIV/AIDS to the hospital morbidity and mortality
was high, as well as the burden on hospital services. However, no upward trend
in its impact was estimated in 1992-98.
Presenting author: Massimo Fabiani, Istituto Superiore di Sanitb, Lab. Epidemiologia e Biostatistica, Viale Regina Elena 299, 00161 Rome - Italy, Italy, Tel.:
[phone], Fax: [phone], E-mail: fabiani @iss.it
ThPpC2143 The predominance of HIV-1 CRFO2_AG in west and
west central Africa is not related to difference in
pathogenesis: a four-year prospective multicentre
study
A. Bourgeois1, C. Laurent1, M.A. Faye2, R. Mougnutou3, M. Seydi2, M. Gueye4,
F. Liegeois1, C. Toure Kane5, C. Butel1, J. Mbuagbaw3, L. Zekeng6, E. Mpoudi
Ngole3, M. Peeters 1, E. Delaporte1. lnstitut de Recherche pour le
Ddveloppement (IRD, UR36) and University [email protected], France;
2Fann University Teaching Hospital, Dakar, Senegal; 3 Presica Project, Military
Hospital, Yaounde, Cameroon; 4Military Hospital, Dakar, Senegal; 5Le Dantec
University Teaching Hospital, Dakar, Senegal; 6Laboratoire d'Hygiene Mobile,
Yaounde, Cameroon
Objective: To compare HIV-1 disease progression between patients infected by
the predominant strain (CRFO2_AG) in west and west central Africa, and patients
infected by other strains in the same region.
Methods: This prospective multicentre cohort study was conducted in Cameroon
and Senegal. HIV-1-infected patients attended quarterly medical examinations.
HIV-1 isolates were genotyped in the envelope V3-V5 region by sequencing and
phylogenetic analysis. CD4+ cell counts were determined at baseline and every 6
months. Three endpoints were studied: 1) survival; 2) clinical disease progression
based on change in CDC class; and 3) the decline in the CD4+ cell count.
Results: A total of 335 patients were recruited between 1996 and 1999, and were
followed for 4 years. Broad HIV-1 group M subtype diversity was observed (subtypes A-D, F-H and J, and strains CRF01_AE and CRFO2_AG). Strain CRFO2_AG
predominated in both Cameroon and Senegal (61.2% and 62.9%; p<0.8). Multivariate analyses showed no difference between patients infected by CRFO2
strains and patients infected by other strains in terms of survival (adjusted hazards ratio [HR] 1.16; 95% confidence interval [CI] 0.76-1.78; p=0.5), clinical disease progression (HR, 0.79; CI, 0.50-1.25; p=0.3) or the square root CD4+ cell
count decline (regression coefficient -0.01; CI -0.82 to 0.81; p=0.9). In contrast,
older age and advanced-stage disease and profound immunodeficiency at baseline were pejorative factors.
Conclusion: This study suggests that the rate of disease progression does not
differ between patients infected by the predominant CRFO2_AG strain and patients infected by other strains circulating in west and west central Africa.
Presenting author: Anke Bourgeois, [email protected], France, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
ThPpC2144 Impact of HIV-1 viral subtype on disease
progression
RP.J. Easterbrook, M. Smith, A.M. Geretti, N. Osner, S. Murad, S. Oshea,
I. Chrystie, J. Mullen, A.M. de Ruiter, M. Zuckerman, GKT HIV Virology
Collaborative group. GKT School of Medicine, Department of HIV/GU Medicine,
GKT School of medicine, WEC, Cutcombe Road, SE5 9RJ, United Kingdom
Background: To compare the rate of disease progression prior to antiretroviral
therapy (ART) and the initial response to ART in patients infected with B versus
non-B HIV-1 subtypes in an ethnically diverse population of HIV infected patients
in South London.
Methods: 900 HIV-1 infected patients from Kings and St. Thomas hospital HIV
clinics have been subtyped using an in-house EIA assay. 306 (34%) were infected
with a non-B subtype, of which subtypes A and C were the most common. Env
gene sequencing is ongoing to confirm the precise distribution of subtypes A, C,
and D and various mosaic strains. Rate of disease progression was determined
using rate of CD4 cell decline (initial 2 years after diagnosis) stratified according to initial CD4 count (?100, 101-200, 201-400 >400 cells), and pre-treatment
viral load profile; response to ART was assessed on time to a viral load?400
copies/mi.
Results: Preliminary analyses were based on 457 patients with complete data.
157 were non-B and 204 were B subtype; 40 were of mixed reactivity and 56
were non-reactive. The majority of non-B subtype found in black African from
sub-Saharan Africa (most commonly Uganda, Zimbabwe, Nigeria, Ivory Coast,
and Ghana). B subtype patients were mainly Caucasian. 56% of non-B vs. 17%
of B subtypes were female. The initial rate of CD4 decline was similar for B and
non-B subtypes for each baseline CD4 cell strata. However, after initiation of ART,
the % with a VL?400 copies/mi was higher among B (51.8%) vs. non-B (35.7%)
subtype patients, p=0.045.
Conclusions: Based on this preliminary analysis, we found no evidence for B
vs. non-B subtype specific differences in disease progression, but non-B subtype

patients had a lower initial virological response to antiretroviral therapy.
Presenting author: Philippa Easterbrook, Department of HIV/GU Medicine, GKT
School of medicine, WEC, Cutcombe Road, SE5 9RJ, United Kingdom, Tel.: + 44
207 848 5770, Fax: + 44 207 848 5769, E-mail: [email protected]

ThPeC7403 What can be learned from chronic, non-infected
injection drug users (IDUs): factors associated with
long-term HIV and HCV seronegativity.
J. Bruneau1, S. Brogly2, F. Lamothe1, J. Vincelette1. Centre de Recherche du
CHUM, University of Montreal, H6pital Saint-Luc du CHUM, 1058 Saint-Denis,
Montrdal, Qu6bec h2X 3j4, Canada; 2Epidemiology and Biostatistics
Department, McGill University, Montreal, Canada
Background: HCV is highly transmissible among IDUs. Overtime, the vast majority of IDUs will become infected. The objective of this study was to examine
drug use patterns, sociodemographic profiles and other characteristics of active,
established IDUs who remained HCV and HIV seronegative.
Method: A cross-sectional sample of currently active IDUs who reported having injected for at least t 7 years was identified from a cohort of IDUs in Montreal.
IDUs completed interview-administered questionnaires, which elicited information
on socio-demographic characteristics, drug behaviours and health-related issues.
Serum was tested for HIV and HCV antibodies. HCV+ve IDUs were compared to
HCV -/HIV - IDUs, using logistic regression.
Results: Among the 552 participants eligible for this analysis, 74 (14%) tested
negative for both HCV and HIV. 490 (88%) were male, the mean age was 40
and 37 years for males and females respectively. In bivariate analyses, younger
age, having a regular sexual partner, being in addiction treatment, not using IV
cocaine, while frequently using crack were associated with HCV seronegativity
In multivariate analyses, being less than 40 years (OR= 1.8, 95%Cl= 1.1-3.2),
not using IV cocaine, either occasionally OR=2.6 (1.4-4.9) or frequently OR=2.1
(1.3-4.9), and using crack frequently (OR=3.3, 95%CI=1.6- 6.8) were associated
with seronegativity, even when controlled for the intensity of IV use.
Conclusion: Not using IV cocaine was strongly associated with remaining
seronegativity, regardless of the frequency or intensity of use. Smoking crack regularly was protective against HCV and HIV infections in our setting. Local macrosocial processes related to different routes of administration should be better understood. These findings may also support interventions aimed at a transition
from injection to other routes of administration as a new harm reduction intervention tool.
Presenting author: Julie Bruneau, H6pital Saint-Luc du CHUM, 1058 SaintDenis, Montreal, Quebec h2X 3j4, Canada, Tel.: [phone] ext 35882,
Fax: [phone], E-mail: [email protected]
ThPeC7404I Longitudinal risk patterns after notification of HIV
seroconversion among injection drug users: The
ALIVE study 1998-2000
N. Galai1, M. Safaeian2, D.D. Celentano2, D. Vlahov3, S.A. Strathdee2.
'Ben-Gurion University, 627 N. Washington St, Baltimore, Maryland, 21205,
Israel; 2Johns Hopkins Bloomberg School of Public Health, Baltimore, United
States; 3 Center for Urban Epidemiologic Studies, The New York Academy of
Medicine, New York, United States
Background: While the focus of past research has been on the assessment of
risk factors associated with HIV seroconversion, there has been little longitudinal
evaluation of the risk presented by injection drug users (IDUs) following seroconversion. The objectives of this study was to evaluate the longitudinal patterns of
drug injection following notification of HIV seroconversion and to assess the risk
of transmission of HIV presented by this group.
Methods: 321 IDU seroconverters were identified in the ALIVE Study since 1988
and followed up to 2001, with semi-annual visits. The analysis included 263 with
at least 4 visits post notification of HIV seroconversion. Risk behaviors associated
with potential transmission included sharing needles, attending shooting galleries
and prostitution. Predictors of these risk behaviors reported at any time post notification were obtained from the first HIV positive visit and assessed using logistic
regression.
Results: Following seroconversion, only 24 (9.1%) of the seroconverters stopped
injecting, 63 (23.9%) remained persistent injectors and 176 (66.9%) had repeated
relapses. Overall, compared to the pre-notification visits, the frequency of risk
behaviors tended to decrease: sharing needles from 42 to 20%, galleries from
15 to 5% and prostitution from 16 to 8%. Significant predictors of risk behavior
with transmission potential were sharing needles (OR=3.7), injecting speedball
(OR=2.8), being male (OR=2.2) and an annual income less than $5000 (OR=2.1).
Conclusions: IDUs who seroconverted to HIV reduce their risk behaviors following notification but substantial risk of transmission remains, both sexual and
parenteral. Together with existing prevention programs, limiting the spread of HIV
requires focused efforts among HIV positive IDUs to reduce the risk of transmission to others.
Presenting author: Noya Galai, 627 N. Washington St, Baltimore, Maryland,
21205, United States, Tel.: [phone], Fax: [phone], E-mail:
[email protected]