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

Monday
14 August
Oral
Abstract
Sessions

MOABO403 MOABO405
The role of selenium as adjunct to haart among Impact of HIV status on patterns of mortality
HIV-infected individuals who are advanced in their in HIV-infected severely malnourished children,
disease admitted to 3 nutrition rehabilitation units in the
central region of Malawi

N.N. Odunukwel, D. Onwujekwel, O.O. Ezechi', P. Ezobi', T. Gbajabiamila',
R. Anyanwu', E. Iloka1, R. Adu', O. Nwogbe', R. Audu', E. Herbertson',
E.O. Idigbe', P. Kanki2. 'Nigerian Institute of Medical Research, Clinical Science
Division, Yaba, Nigeria, 2Harvard School of Public Health, Boston, United
States
Background: In developing countries, HIV-1 infection impact on people is devastating. Poor nutrition and HIV-related adverse health outcomes contribute to
a vicious cycle that should be slowed down by nutritional supplements. Past
studies document decreased levels of antioxidants and selenium in people living with HIV/AIDS. Low serum micronutrient levels in HIV-positive individuals
have been associated with immune impairment, disease progression, and increased mortality. This study examined the role of selenium supplement among
HIV-positive individuals who were advanced in their disease and are receiving
HAART.
Methods: A follow-up study of all HIV positive individuals with advanced disease recruited for HAART programme between February 2002 and June 2005.
One hundred and seventy were on HAART plus Selenium supplement and 170
were on HAART only. Their viral load, CD4 cell count, Haematological and Biochemical indices were analysed at base line and 12 weekly intervals. At each
visit adherence and nutritional counselling were given. Data generated were
analysed using SPSS statistical software
Results: Of the 340 subjects recruited, 66% had CD4 cell counts < 50cells/pl.
A comparison between those on HAART plus Selenium and those on HAART only
showed that the rate of CD4 cell recovery was higher among the HAART plus
Selenium group. The median CD4count increments from baseline to 64 weeks
were +120cells/pl and +50cells/pl (P=0.02). Less hospital visits for treatment of
Ols were recorded for individuals on HAART plus Selenium compare to those on
HAART only. Weight gain was significantly higher in Selenium group (P 0.004).
Median Haemoglobin increments from baseline to 64 weeks were +30g/l and
+10g/I (Plus Selenium and non Selenium groups respectively).The median time
for undetectable viral load was similar for the two groups (P 50.2).
Conclusions: Selenium supplementation resulted in higher CD4. This supports
Selenium supplement as an adjunct to HAART in HIV positive individuals with
severe immune suppression.
MOABO404
Growth and body composition in children beginning
or changing antiretroviral therapy
C. Chantry', M. Hughes2, C. Alvero2, J. Cervia3, J. Hodge4, P. Borum5,
J. Moye6, PACTG 1010. 'University of California Davis Medical Center,
Pediatrics, Sacramento, California, United States, 2Harvard School of Public
Health, Center for Biostatistics in AIDS Research, Boston, Mass, United
States, 3Albert Einstein College of Medicine, Clinical Medicine and Pediatrics,
East Hills, New York, United States, 4Frontier Science & Technology Research
Foundation, Amherst, New York, United States, 5University of Florida, Food
Science and Human Nutrition, Gainesville, Fla, United States, 6NIH, NICHD,
Bethesda, Maryland, United States
Background: Determinants of growth and body composition in HIV+ children
on antiretroviral therapy (ART) are poorly understood. Objectives of this study
were to describe changes in growth and body composition in HIV+ children
after initiating or changing ART and correlate these changes with viral load (VL)
and CD4%; and to describe changes in and correlates of insulin-like growth
factor-1 (IGF-1) and binding proteins-1 and - 3 (IGFBP-1 and -3).
Methods: A prospective, observational study of 100 HIV+ children ages 1 mo
to <13 yrs over 48 wks upon beginning or changing ART. Criteria included: a)
beginning any ART if nalve, b) beginning protease inhibitor (PI) if PI naive, or
c) changing ART with 2 new drugs. Anthropometry and bioelectrical impedance analysis at wks 0-48 were compared to age/sex/race-matched controls
from NHANES to generate z-scores. Plasma VL, CD4%, IGF-1 and IGFBP-1 and
-3 were measured. Multivariable stepwise regression identified significant correlates of z-score changes.
Results: All anthropometric and BIA measures of lean and fat mass were significantly below age/sex/race-adjusted norms; weight, height, and total body
water (TBW) z-scores increased significantly over the study. In multivariate
analysis, both lean and fat mass measures increased more with lower entry CD4% [wt, p=0.003; triceps skinfold, p=0.010; body mass index (BMI),
p=0.002; TBW, p=0.049]. BMI and % body fat z-scores increased more in
PI-naive children. Body composition changes were not associated with virologic
response, increase in CD4%, or current ART class. IGF-1 increased (p=0.020)
while IGFBP-i decreased (p=0.007).
Conclusions: HIV+ children beginning or changing ART demonstrate greater
gains in weight, height and lean mass than age/sex/race-adjusted norms. Baseline characteristics, but not virologic response to therapy, immune reconstitution nor specific ART class(es) in the new regimen are associated with growth
or body composition changes. IGF-1 increases and IGFBP-1 decreases in these
children may relate physiologically to growth and body composition changes.

J. Chinkhumbal, P. Fergusson2, S. Thurstans', G. Nyirendal, H. Mafupal,
A. Tomkins4. 'Action Against Hunger, HIV research, Lilongwe, Malawi, 2Action
Against Hunger, University of Chester, HIV and nutrition, Chester, United
Kingdom, 3Action Against Hunger, HIV and nutrition, Lilongwe, Malawi,
4Institute of Child Health, London, United Kingdom
Background: The objective of the study was to ascertain the impact HIV
status has on death patterns in severely malnourished children admitted for
therapeutic feeding in Nutrition Rehabilitation Units (NRUs).
Methods: A nested study auditing deaths in a cohort of 295 severely
malnourished children recruited over a ten month period. Upon admission, all
severely malnourished children were treated with F75/F100. Routine medical
care including systematic antibiotics and anti- malarials was provided. Upon
discharge, the children received supplementary rations for 16 weeks.
Results: Overall mortality was 15.9% (47/295). Mean age on admission was
22 months (range 7-52), Average number of days from admission to death was
19 days (range 0-170). HIV positive children had a mean admission of 20 days
(SD39.6) compared with 11.7 days (SD22) for HIV negative children. Overall
HIV prevalence was 17%. 50% of children who died were HIV positive: 65%
male and 38% female. 67% of HIV positive children were marasmic compared
to 33% in HIV negative children (P<0.05). 47% of HIV positive children had
Kwashiorkor compared to 53 % of HIV negative children (P >0.05). 67% of the
HIV positive children died in phase 1 compared to 33% HIV negative (P<0.05).
No marked differences existed among transitional and phase two nor was there
a significant difference as to whether a child died in the hospital or home.
Conclusions: HIV positive severely malnourished children have a greater
risk of dying in early rehabilitation and the average admission in the NRU
is nearly twice as long in HIV positive children than HIV negative. There is
need for prompt referral of malnourished children to NRUs and need for early
identification of HIV status in children and caretakers for essential access to HIV
treatment. More effective treatment regimes for HIV positive children in early
rehabilitation need to be developed and tested.
Track C
MOACO101
Surveillance of HIV prevalence among populations
of men who have sex with men in Thailand,
2003-2005
F. van Griensven', A. Varangrat2, S. Naorat2, C. Sinthuwattanawibool2,
J.M. McNicholl', P.A. Mock2, T. Siraprapasiri2, R. Jommaroeng3, P. Phanuphak4,
J.W. Tapperos, the Thailand MSM Study Group. 'Thailand MOPH-U.S. CDC
Collaboration, Nonthaburi, Thailand; Division of HIV/AIDS Prevention, Centers
for Disease Control and Prevention, Atlanta, GA, United States, 2Thailand
MOPH-U.S. CDC Collaboration, Nonthaburi, Thailand, 3Thai Red Cross
Society; Rainbow Sky Association of Thailand, Bangkok, Thailand, 4Thai Red
Cross Society, Bangkok, Thailand, 5Thailand MOPH-U.S. CDC Collaboration,
Nonthaburi, Thailand; Global AIDS Program, Centers for Disease Control and
Prevention, Atlanta, GA, United States
Background: HIV prevalence among Thai populations of men who have sex
with men is not well described. This information is important to target and
inform HIV preventive interventions.
Methods: Identical cross-sectional surveys, using venue-day-time sampling,
enrolled 1,121 men from Bangkok in 2003 (response rate: 90.2%) and
2,049 from Bangkok, Chiangmai and Phuket in 2005 (response rate: 97.3%).
Participants were Thai, _15 years old, and had had sex with another man
in the past 6 months. Palmtop computer-assisted self-interviews collected
demographic and behavioral data; EIA tested oral fluid for HIV infection. Our
study population consisted of general men who have sex with men (MSM), male
sex workers (MSW) and transgendered persons (TG).
Results: 1,121 MSM enrolled in 2003; and 821 MSM, 754 MSW, and 474 TG
in 2005. In Bangkok, HIV prevalence among MSM increased from 17.3% in
2003 to 28.3% in 2005; among 22 year olds it increased from 12.9% to
22.3% and among those older from 19.1% to 30.2% (all p<0.05). Prevalence
at bar/disco's increased from 13.0% to 23.0%, at parks from 16.9% to 29.6%
and at saunas from 22.0/o to 319% (all p<0.01). In 2005, HIV prevalence
among MSM in Chiangmai was 15.3%/ and in Phuket 5.5%/. Among MSW, HIV
prevalence was 18.9% in Bangkok, 11.4% in Chiangmai and 14.4% in Phuket.
HIV prevalence in TG was 11.5% in Bangkok, 17.6% in Chiangmai and 11.2%
in Phuket.
Conclusions: Data show that by 2005, HIV was widespread in Thai populations
of men who have sex with men. Among MSM in Bangkok, HIV prevalence
increased over 50% between 2003 and 2005. In 2005, more than 20%0/ of
Bangkok MSM <22 years old were HIV-infected, suggesting high underlying
HIV incidence. Thai populations of men who have sex with men should be
considered for the implementation and evaluation of preventive interventions.

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