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

XIV International AIDS Conference

Abstracts WePeB5974-WePeB5977 73

pants were currently on HAART Hospitalizations were due mainly to infections
(75%), renal disorders (8%), malignancy (4%), and others (13%). Only 1% had
not been previously hospitalized at JMH, 14% once, 45% 2-4 and 40% had multiple (>5) hospitalizations (MH). After controlling for HAART, no significant associations were observed between MH and current CD4, years with HIV, tobacco use,
or drug use history Women with MH tended to have higher viral loads compared
to men with MH (0.07). Univariate analyses indicated that women were 8x more
likely to have MH and 3x more likely to have >10 previous hospital admissions.
Multivariate analyses, controlling for HAART, revealed that patients with MH were
more likely to be female (OR=2.3, p=0.02), black (OR=3, p=0.02) have high current viral loads and an associated renal disease (OR=7.2, p=0.001).
Conclusions: Viral burden, but not CD4, and renal disease appear to be sensitive
predictors of MH. The gender differences in higher hospitalization rates require
further exploration. Support: Florida Tobacco Research and Fogarty
Presenting author: Harry Archer, University of Miami School of Medicine, Dept.
of Psychiatry (D21), 1400 N.W. 10th ave., 6th floor, Miami, Florida 33136, United
States, Tel.: [phone], Fax: [phone], E-mail: m.miguez@miami.
edu
WePeB5974 Effectiveness and durability of non-PI vs. PI
containing combination therapy in anti-retroviral
(ARV) naive urban indigent population
F Visnegarawalal, J.A. Wright 1, T Giordano1, A. Anooka2, M.Q. Hasan2,
E.A. Graviss'. 'Baylor College of Medicine, #424, Thomas Street Clinic, 2015,
Thomas Street, Houston, TEXAS, United States; 2University of Texas Health
Science Center, Houston, United States
Background: There are limited data on the use of non-PI/ NNRTI therapy among
the urban indigent who have poor adherence. We hypothesised similar effectiveness of non-PI vs PIs as initial therapy for urban indigent newly entering care.
Methods: We conducted retrospective cohort study using observational
database of all new pts seen at an urban clinic from 4/1998-9/2000. Median f/up
was 18 m. We compared rates of viral suppression: VS (VL <400 c/mL by 8 m)
between NO PI vs.PI after stratifying by BL viral load (VL) & CD4. Among pts with
at least one VL <400, time to viral rebound (TVR) (>2 VL >400, or one VL>400
with lost to f/u) was analyzed using Kaplan-Meier survival, adjusting for temporal
bias.
Results: Of 714 ARV naive pts; 422 were on HAART Of these 273 (65%) on PIs
+2 nRTIs (Single PI: NLF 79% &IND 10%; Dual PI: 11%); & 149 (35%); NO PI
+2 nRTIs (EFV 62%; NVP 17%; ABC 21%). Median age (37 yrs) gender (F28%),
race (70% AA) median BL logVL (5.0 vs. 5.2 c/mL, P=0.2) IDU (11%) were not
different; but more MSM (71 vs. 29% p=0.04), pts with AIDS (70 vs. 30% p<0.01)
received PIs; NO PI pts had higher BL CD4 counts (177 vs. 94, p<0.05). By
intent-to-treat analysis (missing=failure), rates of VS were similar (58%) in each
group, even when stratifying for BL VL & CD4. Median CD4 increase:153 NOPI
vs 98 PI(p=0.06) trended to significance even in pts with BL CD4 <200. The rates
of VS (%)with EFV; NLF; dual PIs were 67; 58 & 61. Median TVR was similar between grps (NO PI 52 vs PI 58 wks; p<0.5 log rank sum). On multivariate analysis
(adjusted for other covariates); only use of EFV (OR: 2.3 Cl: 1.1-4.5 p=0.02) was
associated with VS.
Conclusions: In an unselected ARV naive indigent cohort, we found no difference in the effectiveness and durability of PI (single/dual) vs non PI initial regimens. Surprisingly greater increment in CD4 was seen with non-PI regimens.
Only the use of efavirenz was associated with higher likelihood of viral suppression.
Presenting author: Fehmida Visnegarwala, #424, Thomas Street Clinic, 2015,
Thomas Street, Houston, TEXAS, United States, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
WePeB5975 Physicians and nonphysician clinicians: Is there a
difference in virologic response to antiretroviral
therapy (ARV)?
D.L. Johnson, S. Jasuja, M.A. Leal. University of Southern California, Los
Angeles, United States
Background: As nonphysician clinicians (NCPs) become increasingly prominent
as health care providers, studies looking at clinical outcomes need to be done.
This study looked at the differences in the prescribing patterns between physicians (MDs) and NCPs using virologic outcome of less than < 50 copies/mL as
the criteria for successful ARV therapy. NCPs were licensed PA and NPs.
Methods: This study was an observational, cross-sectional study conducted on
all of the HIV+ patients who presented for their care during April 1999 to a large
hospital based HIV+ clinic. A total of 420 patients were included in the analysis.
Results: The mean age was 39 + 9.1 (range 19-67), 84% were of an ethnic
minority and 60% had an AIDS defining diagnosis. MDs provided the ARV management for 203 patients with a mean CD4 T-cell count of 300 cell/mm3 (range

2-1347) with 59% of the patients demonstrating a HIV RNA < 50 copies/mL.
The NCPs effectively managed 218 HIV+ patients with a mean CD4 T-cell of
290 (range 5-1581) with 71% of these patients demonstrating an HIV RNA < 50
copies/mL. NCPs were more likely to prescribe a dual-PI containing regimen and
MDs were more likely to delay ARV therapy, however this was not significantly
different.
Conclusion: This study demonstrated that there were no significant differences

between the ARV prescribing habits of MDs versus those of the NCPs. Although
AIDS defining patients comprised more than 60% of this study population, this paper did not evaluate the management of opportunistic infections or other disease
management. However, this study would suggest that NCPs do provide comparable ARV management with similar outcomes to MDs based on virologic response.
At a time when the HIV epidemic continues to increase, especially in undeveloped
countries and the HIV+ population continues to live longer, NCPs may provide alternative health care without compromising health outcomes. Additional studies
are needed.
Presenting author: DL Johnson, 10931 Grovedale Drive, Whittier, California,
90603, United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB5976 Importance and characteristics of immigrants from
Sub-Saharan Africa in the Swiss HIV Cohort Study
H. Furrer', C. Staehelin', M. Egger', B. Ledergerber2, M. Battegay3,
M. Rickenbach4. ' University Hospital Berne, Berne, Switzerland; 2University
Hospital Zurich, Zurich, Switzerland; 3University Hospital Basel, Basel,
Switzerland; 4Swiss HIV Cohort Study, Lausanne, Switzerland
Background: To analyze the importance of immigrants in the Swiss HIV Cohort
Study (SHCS) and their access to anti-retroviral treatment.
Methods: 1) Descriptive analysis of changes of registration within Swiss HIV Cohort Study (SHCS) with regard to region of origin of participants before 1989;
1989-1992; 1993-1996; 1997-2001. 2) Description of the characteristics of the
emerging population of immigrants from Sub-Sahara Africa. 3) Evaluation of access and clinical response to potent antiretroviral treatment (ART) of immigrants
from Sub-Sahara Africa using Cox proportional hazards analysis.
Results: 651 (5.5%) of a total of 11'741 SHCS participants are of Sub Saharan
origin. This proportion increased steadily from 0.9% before 1989 to 11.8% during
1997-2001 and was more pronounced in women (23% during 1997-2001).
As compared to participants of North Western Europe Sub-Saharan immigrants
(i) were more likely to be infected by heterosexual route (male 87 vs. 15%; female
92 vs 45%), (ii) had a lower age at registration, (iii) had a lower CD4 count (median 269/p (IQR 143-440) vs. 320 (137-544) p<0.01) and similar Plasma HIV
RNA levels at registration, (iv) were more likely to be in CDC stage A (65% vs
60%, p=0.01).
Among participants with CD4 below 350, Sub Saharan patients were more likely
to receive ART: Hazard ratio 1.6 (95% CI 1.4-1.9, p=0.001) adjusted for HIV RNA,
CD4, clinical stage, sex, transmission group and age. Survival was not different
but progression to AIDS was increased, attributable entirely to tuberculosis.
Conclusion: The proportion of participants of Sub-Saharan origin increases
steadily within the new participants of the SHCS. Access to ART is not hampered by origin in the SHCS and survival is not worse in patients of Sub Saharan
origin. Tuberculosis is the most frequent AIDS defining event in this population.
Presenting author: Hansjakob Furrer, Div. Infect. Diseases, University Hospital,
CH-3010 Bern, Switzerland, Tel.: [phone], Fax: [phone], E-mail:
hansjakob.furrer@ insel.ch
WePeB5977 Predictors of persistent use of newer antiretroviral
agents over time in a low-income U.S. population
with HIV/AIDS
S. Crystal, U. Sambamoorthi, R Moynihan, E. McSpiritt. Rutgers University,
AIDS Research Group, Rutgers University, 30 College Avenue, New Brunswick,
NJ 08901, United States
Background: Adherence to HAART regimens over time is often challenging. This
study examines persistence on treatment over time and its association with patient characteristics.
Methods: Medicaid paid claims merged with HIV/AIDS surveillance data were
used to analyze use of protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) over time. Multivariate analyses were used to determine predictors of persistence on PI/NNRTI therapy among those who initiated
therapy. The study population consisted of 2,459 New Jersey non-HMO adult
Medicaid beneficiaries with AIDS.
Results: A multivariate survival analysis of time-to-treatment indicated that
African Americans, injection drug users and those who did not receive case management initiated treatment later than others. Among those initiating PI/NNRTI
use, 35% had discontinued it by end of followup. Among treated individuals,
PI/NNRTI use as a proportion of followup time was lower for African Americans
and Hispanics, and higher for older individuals and for those receiving case management through a Medicaid waiver program, while IDU history was not associated with persistence. Controlling for other characteristics,
African American race and Hispanic ethnicity were each associated with a significant 8% reduction in the proportion of time on PI/NNRTIs following initiation of
treatment.

Alternative approaches for modeling persistence produced similar results.
Conclusions: Results suggest that consistent longitudinal use is difficult for many
patients. Persistence of use was lower for minority beneficiaries despite comparable coverage for pharmacy and other health services through Medicaid. Our findings suggest the need to examine non-financial barriers to appropriate HAART
use, and to develop and test programmatic strategies for supporting patients in
remaining on these regimens consistently.