Abstract Book Vol. 1 [International Conference on AIDS (16th: 2006: Toronto, Canada)]

MOPE0439 MOPE0441
Comparison of three methods to detect recent HIV- Incidence and prevalence of HIV and coinfections
1 infection in specimens collected cross-sectionally among injection drug users in Chennai,
in a cohort of female sex workers in the Dominican India - cause for concern
Republic

S. Gupta', E. Koenig2, G. Murphy3, C. Adon2, C. Beyrer4, S. Khawaja',
J. Parry3, W. Straus'. 'Merck Research Laboratories, Epidemiology
Department, West Point, United States, 2Instituto Dominicano De Estudios
Virologicos, Santo Domingo, Dominican Republic, 'Health Protection Agency
Centre for Infections, London, United Kingdom, 4Johns Hopkins Bloomberg
School of Public Health, Epidemiology, Baltimore, United States, 'Merck
Research Laboratories, Epidemiology, West Point, United States
Background: Interest in estimating HIV-1 incidence using specimens obtained
as part of cross-sectional surveys has led to the development of new methods
to detect recent HIV-1 infection through the testing of a single anti-HIV
positive specimen. These assays are based on quantitative and qualitative
differences in anti-HIV-1 antibodies between recent and established infection.
Although several different recent infection assays have been developed, to date
there have been few studies that have compared their performance utilizing
specimens collected in a field study.
Methods: An ongoing vaccine preparedness study enrolled female sex workers
in the Dominican Republic. Specimens from women found to be HIV positive
at the baseline visit were tested for recent HIV-1 infection using the following
three methods:
1) detuned assay
2) avidity index; and
3) BED-EIA assay. An unweighted K statistic in pair-wise comparisons was
used to estimate the correlation and 95% confidence intervals of recent HIV-1
infection detection by the three methods.
Results: Nineteen out of 536(3.5%) women were positive for HIV-1 infection.
The incidence of HIV infection was 1.3%(95% confidence interval (CI): 0.2,
4.9), 0.9%(95% CI: 0.1, 4.5), 0.9%(95% CI: 0.1, 3.7) using detuned assay,
avidity index and BED-EIA techniques, respectively. The overall agreement
between detuned assay and avidity index methods was 94% (K=0.8, 95%
CI; 0.3, 1.0). The correlation was highest between BED-EIA and avidity index
methods (100%; K =1.0) but remained high when comparing detuned assay
and BED-EIA methods (94%; K =0.8, 95% CI; 0.3, 1.0).
Conclusions: All three methods performed similarly in detecting recent HIV-1
infection in this region dominated by clade B HIV-1 infection; however, incidence
estimates were slightly higher using the detuned assay method. These assays
may be of value in both clinical research and practice. The utility of individual
assays will depend upon operating characteristics, HIV-1 subtype limitations,
and selection of appropriate assay cut-off values.
MOPE0440
Migrant workers and housewives are at increase
risk of HIV infection, an AMDA VCT experience in
eastern Nepal
N. Rimal', D.K. Aryal2'. 1Association of Medical Doctors (AMDA) Nepal, Public
Health, Birtamod, Nepal, 2AMDA Nepal, Central Office, Kathmandu, Nepal
Issues: According to the WHO estimates there are more than 60,000 people
infected with HIV and Nepal has been experiencing accelerated growth of the
HIV epidemic among the youth population. A concentrated epidemic of HIV has
occurred in high-risk group like FSW and IDUs but little data is available on
other risk groups. To find out the prevalence of HIV in different groups and to
respond the demand of HIV testing a quality VCT service was established.
Description: AMDA Hospital has been providing health service too more than
700,000 population in eastern Nepal. From January 2003- 2005 AMDA Hospital
implemented VCT service with support of USAID/PACT Grant. Community
sensitizing and advocacy, training, youth awareness and psychosocial support
and capacity building of CBOs/NGOs were major components of the program.
A total of 1444 blood tests performed and 80 (5.54%) were found positive.
Surprisingly HIV Prevalence in house wives 19.0%, Migrant worker 12.6%, and
IDUs was 10.6%. After project completion the service has been incorporated in
the regular service of the hospital for sustainability.
Lessons learned: Mobile VCT clinic is important to those people who cannot
to attend the VCT clinic because of their low economic status. STI treatment
service also incorporated with VCT program makes it more effective.
Awareness campaigns like street drams, video shows and song competitions
are very effective to sensitize general people. Women can play vital role to
reduce stigma and discrimination towards PLHAs in their communities.
Migrant worker and their spouse are at increase risk of HIV infection and needs
targeted intervention.
Recommendations: VCT service is the entry point for HIV prevention and
care. It will indicate target groups/areas for intervention. Prevailing stigma
and discrimination needs to be properly addressed for program success. Proper
planning is needed to mainstream the program in regular hospital service and
make it sustainable.

A.K. Srikrishnan', S.S. Solomon', C.K. Vasudevan', E. Thamburaj', C. Latkin2,
M. Suresh kumar3, K. Murugavel', H. Syed Iqbal', D. Celentano2. 'YR Gaitonde
Centre for AIDS Research and Education, Chennai, India, 'Johns Hopkins
Bloomsberg School of Public Health, Baltimore, United States, 'Consultant-YR
Gaitonde Centre for AIDS Research and Education, Chennai, India
Background: Though NACO sentinel surveillance in 2004 reported the highest
prevalence of HIV among IDUs in Chennai, little information is available on the
incidence of HIV and prevalence of other blood-borne infections among injection
drug users in South India.. This study estimates the incidence, prevalence and
risk factors for HIV among IDUs in Chennai, India and the prevalence of coinfection with HBV and HCV in our cohort.
Methods: 866 IDUs were screened and recruited from different zones of
Chennai for a longitudinal cohort study aimed at estimating HIV incidence. All
participants received risk reduction counseling at baseline and every six months
thereafter. Their test results and behavioral data were available for analyses.
Incidence was calculated using the Calypte HV-1 BED Incidence EIA. Univariate
and multivariate logistic regression were used to identify risk factors.
Results: The majority of the cohort comprised men from Tamil Nadu who
earned daily wages and had an average monthly income less than INR 3000
(USD 72). The prevalence of HIV, HBV and HCV were 30.7%, 11.7% and 63.6%
respectively. Of those infected with HIV, 87.2% were co-infected with HCV
and 9.8% were infected with HIV, HBV and HCV. The annualized incidence in
this cohort was estimated to be 4.66% (95% CI: 2.02, 7.3) using the Calypte
HIV-1 BED Incidence EIA. Concurrent HCV status, history of sexual intercourse
in the prior one month and injecting at the dealer's place were found to be
associated with the participants' HIV status in the multivariate analysis (all
p-value<0.05).
Conclusions: The above results clearly stress the urgent need to plan
appropriate intervention, both medical and behavioral, among the HIVinfected IDUs as well as their sexual and network partners. The high rates
of co-infections coupled with the limited access to liver-friendly HAART/ antituberculous therapy will complicate management of HIV.
MOPE0442
The prevalence of HIV, HBV and HCV among Filipino
blood donors and overseas work visa applicants
Y. Yumiko', C. Gill2, D. Agdamag3, P.S. Leafo3, T. Ohida'. 'Nihon University
School of Medicine, Department of Public Health, Tokyo, Japan, 'Boston
University School of Public Health, Center for International Health and
Development, Department of International Health, Boston, MA, United States,
'STD AIDS Cooperative Central Laboratory, San Lazaro Hospital, Manila,
Philippines
Background: In the Philippines, there are limited surveillance data on HIV,
HBV and HCV infections. Our aim was to estimate the prevalence of the three
blood born viruses among blood donors (BDs) and overseas Filipino worker
candidates (OFWCs); to contrast the prevalence of these viruses between the
two groups; and to explore the relationship between the prevalence of these
viruses and patient demographic characteristics.
Methods: We analyzed approximately 144,000 blood-screening results for
HIV, HBV and HCV among BDs and OFWCs reported from licensed laboratories
to national STD/AIDS Cooperative Central Laboratory in Manila. Data were
combined between 2002 and 2004.
Results: The HIV prevalence was 0.006% in BDs and 0.001% in OFWCs; the
prevalence of HBV was 4.2 % in both groups, and the prevalence of HCV was
0.3% in BDs and 0.9% in OFWCs. Males were at increased risk of both HBV
and HCV; among OFWCs, younger women were at increased risk relative to
older women. Laboratories that tested for all three viruses simultaneously, vs.
those that tested sequentially but stopped testing after the first positive result
(usually for HBV) were far less likely to detect HCV infections, indicating that
the sequential tester may underestimate HCV and HIV infections. OFWCs were
at low risk of HIV, and the risk of testing positive for HIV, HBV, or HCV was
not increased among OFWCs who were applying for a repeated work visa,
compared with first time applicants.
Conclusions: Because these data represent a convenience sample, they may
be vulnerable to biases that would underestimate prevalence. Nevertheless,
we still conclude that HIV is rare in patients outside of identifiable high-risk
groups in the Philippines. In contrast with prior reports, we found no evidence
that OFWCs constitute a high-risk group for HIV. Further research is needed to
understand why younger women are at increased risk of acquiring HBV.

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * ABSTRACT BOOK VOLUME 1