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

rapid HIV testing regardless of symptoms or risks and those 15-25 years were
also offered gonorrhea and chlamydia (testing (nucleic acid amplification).
Screening was offered Monday-Friday, 11AM-8PM. Infected patients were
referred for treatment and care.
Results: Among 3,030 patients offered HIV testing, 1447 (47.8%) accepted, 8
(0.6%) tested positive, and 3 (37.5%) were linked to care. Among 791 patients
offered gonorrhea and chlamydia testing, 386 (48.8%) accepted, 320 provided
urine (82.9%), 48 (15.0%) tested positive, and 42 (87.5%) were treated. The
program cost was $71,402. Costs per HIV-infected patient identified and linked
to care were, respectively, $8,925 and $23,801; costs per STD-infected patient
identified and treated were, respectively, $1464 and $1,700. Screening for
both HIV and STDs cost $13,192 more than screening for HIV only.
Conclusions: Through ED-based HIV/STD screening, we identified and
treated many STD-infected patients, but identified few HIV-infected patients.
Identifying and linking to care more infected pathents would increase the
effectiveness of HIV screening. STD screening can be added to HIV screening
at a reasonable cost
MOPEO083
Visual dipstick detection of HIV-1 genome in
resource-limited settings
M. Dineval, D. Candotti2, F. Fletcher-Brown', J.-P. Allain', H. Lee1. 'University
of Cambridge, Cambridge, United Kingdom, 2National Blood Service,
Cambridge, Cambridge, United Kingdom
Background: The effective management of HIV infection and monitoring of
antiretroviral therapy in resource-limited settings require access to simple
nucleic acid-based tests (NAT) for HIV RNA detection. We did a survey at 32
district and local hospitals and clinics involved in the care of 18,000 HIV/AIDS
patients in developing countries, showing that 70% of these sites lack basic
resources and infrastructure to perform NAT with currently available assays. A
semi-quantitative or a qualitative test would give the necessary information for
infant diagnosis and HAART monitoring.
Methods: We have developed the technology of rapid and visual detection of
nucleic acid hybridization by dipstick. Dipstick assays have not been used for
the nucleic acids detection, because of the inherent insensitivity of this format.
To overcome this limitation, a signal amplification system was developed which
enabled the rapid and sensitive visual detection.
Results: Dipstick HIV RNA detection has been validated both, by testing a
panel of HIV-1 subtypes (NIBSC, UK) and by blind testing 237 plasma HIV
positive or negative samples from West Africa. The performance of the dipstick
detection was compared with fluorescent TaqMan probe detection in Q-PCR
System and showed 97.2% sensitivity and 100% specificity, as opposed to
97.2% and 98.5% for TaqMan PCR in African samples (36 HIV+ samples, viral
load range 200 - 2000000 copies/ml and 201 negative samples). The dipstick
assay detected all members of the subtype panel (subtypes A through H) and
CRFO2 recombinant forms of HIV-1 with sensitivity equal to TaqMan PCR.
Conclusions: These results demonstrate feasibility of an instrumentindependent and sensitive method for the detection of HIV-RNA. A new HIV
NAT system is under development integrating this visual detection technology
into a closed disposable, complemented by simple instrumentation that can be
battery driven.
MOPEO084
Influence of cytotoxic cells functional activity on the
mother-to-child HIV-1 transmission
A.B. Shemshura', L.V. Sveshnikova', S.Y. Poddubskaya', T.E. Kalinina2,
S.R. Saukhat1. 'Rostov Research Institute of Microbiology and Parasitology,
Rostov-on-Don, Russian Federation, 2Rostov regional AIDS-Center, Rostovon-Don, Russian Federation
Background: Cellular immune responses play a important role in mother-tochild HIV-1 transmission. The influence of both altering functional activity of
cytotoxic cells and viral replication on frequency of the mother-to-child HIV-1
transmission was assessed.
Methods: CD4, CD8 T cell counts, CD56CD16 NK count, CD95, HLA DR,
FasL expression on various lymphocytes subpopulations and HIV-1 plasma
viral loads were measured in 55 HIV-infected women patients before delivery
without ARV prophylaxis.
Results: Patients who had transmitted HIV-1 to children exhibited lower level
of CD8+FasL+ (95% CI, 2-4%), CD56+CD16+FasL+ cells (95% CI, 2-11%),
and higher level of CD8+CD95+ cells (95% CI, 13-19%), in comparison with
the group who didn't transmit HIV-1 to their children (95% CI, 6-10%; 13-18%
and 6-12%, respectively). In the last group there were registered higher viral
load, than in the first group. The correlation ratio between CD56+CD16+FasL+
count and viral load made 0.81.
Conclusions: Our results suggest the possible role of cytotoxic cells functional
activity in supression of viral replication and in probability of mother-to-child
HIV-1 transmission. The evaluation of cell activation and apoptotic markers can
provide diagnostic and prognostic benefits.

MOPEOO85
Point of care lactate testing is an effective measure
in supporting the WHO first-line regimen in settings
with a high incidence of stavudine-related toxicity
S. Mathee, M. Abrahams, N. Jackson', G. Van Cutsem2, Z. Szylagyil,
T. Krombein', K. Hilderbrand2, A. Boulle3. 'Provincial Government of the
Western Cape, Metro District Health Services, Cape Town, South Africa,
2Medecins Sans Frontieres, Cape Town, South Africa, 3University of Cape
Town, School of Public Health and Family Medicine, Cape Town, South Africa
Background: The Khayelitsha ART programme began in 2001 and since late
2003 has started all new adults on stavudine in line with national protocols.
As patients have been on stavudine for longer, the number presenting with
suspected sympomatic hyperlactataemia or lactic acidosis (SH/LA) has
increased markedly, with many patients being referred to hospital for this to be
confirmed or excluded. Traditional lactate measurement - sample storage on
ice and tests run within 15 mintes - is impractical in resource-limited settings.
In early 2005, point of care venous lactate testing of symptomatic patients
with a hand held device was introduced. This study describes the experience
with this technology.
Methods: Prospective cohort study of of all regimen substitutions since 2001,
combined with a register started in 2006 of point-of-care lactate testing (Roche,
AccutrendTM), documenting values and subsequent management. Patients with
lacatate values above 4 mmol/l were referred to hospital, and those between
2.5 and 4.0 substituted within the primary care system if clinically stable.
Results: Of 34 patients who had stavudine substituted due to SH/LA, 19 were
substituted within the primary care system (changed to zidovudine) based
on point-of-care testing, with one of these patients subsequently referred
to hospital after the lactate levels failed to resolve. 39/63 patients tested on
symptomatic grounds had levels above 2.5, 18 of whom had levels above 4.0
and were referred to hospital. Symptoms most closely correlated with markedly
elevated values were, in order of importance, acute weight loss, peripheral
neuropathy and abdominal pain.
Conclusions: Point-of-care lactate testing, if based on appropriate
clinical indications, is a rational and effective tool for early detection of
hyperlactataemia. The ability to rapidly rule out or confirm hyperlactataemia in
symptomatic patients has contributed enormously to clinician confidence, and
saves patients referral resources. Costs of current tests are however too high,
and more producers are needed.
MOPEOO86
Saving the cost of CD4 determination by diluting the
monoclonal antibodies
S. Sadoh', T. Pankam', C. Suphatchara2, S. Sirivichayakul3, S. Tantipaibulvut2,
P. Phanuphak2. 'The Thai Red Cross AIDS Research Centre, Laboratory,
Bangkok, Thailand, 2The Thai Red Cross AIDS Research Centre, Bangkok,
Thailand, 3Chulalongkorn University, Bangkok, Thailand
Background: Immunologic (CD4) monitoring is essential for initiating
antiretrovirals and for monitoring treatment outcome. Cost is a limiting factor
in most resource-limited coumtries. Here, we reported the results of diluting
CD4 monoclonal antibody as a means for cost saving.
Methods: One hundred HIV-infected individuals with different ranges of CD4
counts{CD4<200(N=48), 201-400(N=36)and > 400(N=16)cells/cumm}
from the Thai Red Cross Anonymous Clinic were enrolled for the study. Three
dilutions (undiluted, 1:2, 1:4) of Cytostst 45/4/3 monoclonal antibodies
(Beckman Coulter, USA) were used for CD4 staining. The CD4 counts were
accomplished by EpicXL (Beckman Coulter, USA). The paired t-test was used
to evaluate the correlation.
Results: We found that a more diluted reagents for CD4 staining could be
reliably used. As a groups, the means of %CD4 among different dilutions of
Cytostst 45/4/3 are 12.81+8.81,12.68+8.88 and 12.62+8.85 for undiluted,
diluted 1:2 and 1:4, respectively. The means of absolute CD4 were
237.03+189.05, 235.26+191.06 and 234.75+189.84 for undiluted, diluted
1:2 and 1:4, respectively. The correlation ( r ) among these comparisons were
0.997 between for undiluted and diluted 1:2 and 1:4 both % CD4 and absolute
CD4 counts. The correlation did not differ whether absolute CD4 was above or
below 200 cell/cumm.
Conclusions: By using less amount of Cytostst 45/4/3, the costs of staining
reagents for CD4 evaluation can be reduced from US$ 9.8 if undiluted to US$
4.9 and US$ 2.4 if diluted 1:2 and 1:4, respectively. Such cost-saving approach
is extremely important for resource-limited counters.
MOPEOO87
State-of-the-art HIV testing - combined rapid
and HIV RNA testing in a public STD clinic, San
Francisco, 2004-2005
S. Philip, K. Ahrens, G. Nieri, R. Kohn, B. Louie, S. Liska, C. Kent,
J. Klausner. San Francisco Department of Public Health, San Francisco, United

States
Background: STD clinic patients are at increased risk for HIV infection, but
may not return to receive conventional testing results. Persons with acute HIV
infection (HIV antibody negative but detectable HIV ribonucleic acid (RNA)) are
at increased risk of transmitting HIV because of high viral loads and unknown
infection status. Advances in HIV testing technology allow for highly sensitive
testing for HIV RNA, ensuring identification and counseling of patients with
acute infection.

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