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Retrovirology 2012, Volume 9 Suppl 1
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MEETING ABSTRACTS
Open Access
Abstracts from the 17th International Symposium
on HIV and Emerging Infectious Diseases (ISHEID)
Marseille, France. 23-25 May 2012
Edited by Alain Lafeuillade
Published: 25 May 2012
These abstracts are available online at http://www.retrovirology.com/supplements/9/S1
INVITED SPEAKER PRESENTATIONS
I1
Managing antiretrovirals in co-infected patients in 2012
Jürgen Rockstroh
University of Bonn, Germany
Retrovirology 2012, 9(Suppl 1):I1
In patients with HIV and hepatitis B or C co-infection initiation of early
HAART therapy is clearly recommended by the international guidelines
reflecting the overall survival benefit with regard not only to HIV but also
clinical endpoints of liver disease in the co-infected patient population. In
patients with hepatitis C co-infection administration of successful HAART is
associated with less inflammation in liver biopsies and hence, over time
less fibrosis generation. Obviously, drugs which are dually active against
HIV and HBV do not only prevent HIV disease progression, but also
decrease the progression of chronic hepatitis B related liver disease.
Nevertheless, recent reports on the emergence of non cirrhotic portal
hypertension as a rare cause of upper gastrointestinal bleeding in HIV
patients most likely following prolonged didanosin exposure have raised
questions with regard to potential drug toxicity as sequelae of HAART
causing possible damage to the liver and the portal vascular system. Under
consideration of metabolic changes including dislipidemia and insulin
resistance caused by various components of different drug classes the
question also remains in how far risk for fatty liver disease may rise after
decades of HAART administration. Therefore, close surveillance programs
and monitoring are required to answer the long term safety questions
around HAART administration and liver safety. Nevertheless, the clear
demonstration of overall increased survival under HAART in patients with
concomitant hepatitis and HIV clearly underlines that the benefits of
HAART outweighs potential toxicity risks. Also with the knowledge
obtained around mitochondrial toxicity observed under D-nucleoside
therapy treatment algorithms for co-infected patients now specifically
refrain from using these drugs in particular. With the advent of new drug
classes with low hepatotoxicity profiles new combinations arise which
potentially improved liver safety profile over time. But again, long term
data will be needed to eventually decide what are the best HIV treatment
options in patients with concomitant liver disease.
I2
Clinical use of pharmacogenomics
Amalio Telenti
University of Lausanne, Switzerland
Retrovirology 2012, 9(Suppl 1):I2
The expanding list of antiretroviral drugs, the increasing possibilities in
therapy of HCV and other co-infections represent an attractive setting for
individualized prescription. However, there has been considerable hype,
and limited impact of pharmacogenetics in care.
The development of pharmacogenetic tools would be of interest considering
the complexity of treatment, the cost, and the expectation of long-term
exposure. It would also be desirable given the possibility of serious toxicity,
but also treatment intolerance, cumulative toxicity or the unfavorable
interaction of drugs and aging, metabolic, cardiovascular and bone disease
processes.
This presentation will review available tests, the position of agencies on
the inclusion of pharmacogenetic information in labels, and a perspective
on developments in genomic medicine.
I3
Gene therapy to cure HIV? Prospects and realities
Gero Hütter
Heidelberg University, Württemberg, Germany
Retrovirology 2012, 9(Suppl 1):I3
Introduction: HIV-1 can persist in a latent form in resting memory CD4+
cells and macrophages carrying an integrated copy of the HIV genome.
Because of the presence of these stable reservoir cells, eradication by
antiretroviral therapy is unlikely and in order to achieve eradication,
alternative treatment options are required.
Materials and methods: Recently, we have described a successful
hematopoietic stem cell transplantation in an HIV-1 infected patient
transferring donor derived cells with a natural resistance against HIV
infection. These haematopoietic stem cells engrafted, proliferated and
differentiated into mature myeloid and lymphoid cells.
Results: At present the patient is more than five years after allogeneic
transplantation without requirement of any antiretroviral treatment.
Analyzing peripheral blood cells and different tissue samples including gut,
liver, and brain, no viral load or proviral DNA could be detected.
Conclusions: There is a degree of optimism that gene therapy in
combination with SCT can improve HIV-1 treatment. After nearly 30 years of
research and progress HIV infection has become a chronic disease in
developed countries. However, the evolution of this infectious agent, due to
its rapid mutation, is quite unpredictable. Therefore, strategies to eliminate
the virus from the body to achieve cure are desirable. Currently, HIVtargeted gene therapy appears to have great potential as an effective
strategy that may eliminate or reduce the need for antiretroviral therapy
and achieve elimination of the viral reservoir.
© 2012 various authors, licensee BioMed Central Ltd. All articles published in this supplement are distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
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I4
Update on HIV pandemic
Anna Mia Ekstrom
Karolinska Institutet, Stockholm, Sweden
Retrovirology 2012, 9(Suppl 1):I4
The aim of this presentation is to present the state of the HIV pandemic. The
talk will start with an overview of current trends in HIV prevalence and
incidence, mode of transmission, and, access to prevention and treatment in
various regions of the world. Thereafter, the presentation will focus on three
main dilemmas related to the interpretation of HIV prevalence, treatment
coverage and recent policy guidelines for HIV treatment and prevention. The
first dilemma to be discussed is the difficulty in measuring HIV incidence
using current methodologies. HIV prevalence has become a poor estimate of
HIV incidence given the varying and rapidly changing access to antiretroviral
treatment (ART) as well as retention in ART programs affecting both survival
and incidence. The dilemma of selecting an appropriate population group for
monitoring HIV trends will also be mentioned. Neither antenatal clinic
measurements of point prevalence rates or demographic health surveillance
techniques are free of bias. Secondly, the dilemma of using coverage
measures to assess the success of scaling up access to ART and prevention of
mother to child transmission (PMTCT) will also be discussed. The problem of
identifying an appropriate denominator for a lethal disease is one problem.
Another one is the high drop-out from both ART and PMTCT programs,
making reported coverage estimates based on enrollment, rather than
completion, hard to interpret. Finally some recent policies related to HIV
treatment and prevention such as Test and Treat, couple testing and the new
WHO guidelines for PMTCT will also be briefly discussed in relation to country
GDP and health systems capacity.
I5
HIV prevention by vaccine
Robert Gallo
Institute of Human Virology, Baltimore, USA
Retrovirology 2012, 9(Suppl 1):I5
Page 2 of 54
successfully demonstrated in 2010 in the iPREX trial. Moreover, this
randomized placebo-controlled study showed that men who were
adherent in regard to the once-daily use of TDF/FTC were at low risk for
acquisition of HIV in comparison to both non-treated controls and men
who were not as adherent to their recommended drug intake (44%
protection overall but 92% protection among adherent populations).
Similar findings were obtained in a different study termed Partners/Prep
performed in two developing countries. Yet, despite these positive
results, the idea of PrEP remains controversial in some settings, and the
following concerns among others have been expressed.
1. The use of antiretroviral drugs in PrEP may deprive some people
already infected by HIV of the chance to benefit from these same drugs,
due to competition for resources and/or drug supply.
2. The use of PrEP will promote sexual promiscuity and lead to more STDs.
3. Although PrEP has worked in controlled trials, it will be less likely to be
successful in real world settings, where adherence and counselling may
be less than adequate,
4. PrEP may promote HIV drug resistance in real world settings if ARVs are
taken by people who may already be HIV-infected and don‘t know it.
5. Not all PrEP trials have been successful, e.g. VOICE and FEM-PrEP.
6. The daily consumption of ARVs may be toxic.
One potential solution to some of these concerns may be the use of PrEP
on an intermittent basis, in which ARVs are taken only on the day of
anticipated sexual relations and for two days after a sexual encounter.
This concept could have the advantage of lowering both costs and drugrelated toxicities.
I7
New antiretrovirals
Roy Gulick
Weill Medical College of Infectious Diseases, New York, USA
Retrovirology 2012, 9(Suppl 1):I7
Three major HIV vaccine efficacy clinical trials have now been completed.
Two failed, one of the two even increased infection and the third was
modestly successful. First: VaxGen, used conventional gp120 protein and like
in monkey trials it failed likely due to type specific Abs and perhaps
inadequate Ab titans; the second, by the Vaccine Research Center (VRC) and
Merck based solely on CMI and predictably failed. Less predictably it actually
increased the numbers infected. This was likely due to use as a vector of an
adenovirus strain already exposed to a sizeable percentage of people from
earlier infections, thereby leading to increased T-cell activation which is
accompanied by an increase in CCR5 co-receptor for HIV and consequently
to increased susceptibility to HIV infection. The third large efficacy trial
involved a novel gp120 delivered by the canary pox virus known as ALVAC
made by Sanofi as well as some other HIV genes and boosted by a gp120
containing a herpes virus small sequence known as Gd. This trial was run by
Colonel Dr. Nelson Michael and his co-workers in the U.S. Army AIDS
research group in collaboration with colleagues in Thailand and resulted in
modest success associated with Abs (not CMI) which binds V2 of gp120 and
without detectable neutralizing Ab activity. Of great interest to us was the
short duration of the Abs resulting in far greater success in the first half year
than in the remaining part of the study. This is typical for Abs to gp120, and
it is precisely what we have found in our primate challenge experiments
with our candidate vaccine, a complex of gp120 with binding region of CD4
which we (A. DeVico, G. Lewis, T. Fouts, and Y. Guan) call the full length
single chain (FLSC).
I will summarize our rationale for the FLSC, our updated primate results,
and our plans for clinical trials in collaboration with Sanofi, N. Michael
and his group, and the Gates Foundation.
There are 26 approved antiretroviral drugs available in 2012 in 6 mechanistic
classes: reverse transcripatase inhibitors (both nucleosides and nonnucleosides), protease inhibitors, entry inhibitors (both fusion inhibitors and
CCR5 receptor antagonists), and integrase inhibitors. Current antiretroviral
therapy combinations dramatically decrease HIV-related morbidity and
mortality. However, despite these advances, some current antiretroviral
regimens may be inconvenient, toxic, and/or have suboptimal antiretroviral
activity, particularly against drug-resistant viruses. Thus, newer compounds
are needed that improve convenience and tolerability, reduce toxicity, and
improve antiretroviral activity, particularly against drug-resistant viruses.
Additionally, new drugs may better penetrate tissue reservoirs (e.g. genital
tract, central nervous system), exploit new targets with new mechanisms of
action, or be administered in new formulations.
There are a number of HIV investigational drugs in development currently.
These include a new pharmacokinetic “boosting” agent, cobicistat (GS-9350)
and newer antiretroviral agents in a number of classes, including new
nucleoside reverse transcriptase inhibitors, non-nucleoside reverse
transcriptase inhibitors, protease inhibitors, entry inhibitors, and integrase
inhibitors. Of those in the pipeline, a few compounds are in advanced
stages of development: the nucleoside analogue GS-7340, a pro-drug of
tenofovir (phase 2); and the integrase inhibitors, elvitegravir (phase 3
completed) and dolutegravir (phase 3). In addition, there are drugs with new
mechanisms of action in development, including the CD4 attachment
inhibitor, BMS-663068 (phase 2), and the CCR5 antagonist, cenicriviroc
(phase 2).
Probably the greatest need in the HIV clinic today is compounds that
have activity against multidrug-resistant viral strains. Another important
need is alternative one-pill, once-daily formulations for both initial and
subsequent regimens. However, the clinical use of these newer agents
will depend on the results of phase 3 clinical trials, and the timeline for
development and availability.
I6
Pre-exposure prophylaxis against HIV: pros and cons
Mark Wainberg
McGill University, Montreal, Canada
Retrovirology 2012, 9(Suppl 1):I6
I8
New drug interactions in HIV and HCV
David Back
University of Liverpool, UK
Retrovirology 2012, 9(Suppl 1):I8
The successful use of the co-formulation of Tenofovir (TDF) and
Emtricitabine (FTC) to prevent HIV infection among gay men was
Drug-drug interactions (DDIs) remain one of the challenges faced by
health care professionals involved in patient management and by
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researchers seeking to understand the many different mechanisms
that may be involved. While in HIV treatment there has been an
understanding that checking for DDIs is part of routine management, the
development of directly acting antiviral (DAA) drugs is changing the
whole approach to the treatment of HCV. DDIs have not really been high
on the agenda while pegylated interferon and ribavirin have been the
standard of care for Hepatitis C; however the first generation HCV
protease inhibitors while representing a huge advance, also present new
treatment challenge of awareness and management of DDIs.
In this presentation, some of the key areas of DDIs with a) HIV drugs, b)
HCV drugs and c) co infected patients receiving both HIV and HCV drugs
will be discussed. While it has long been established that boosted
HIV protease inhibitors are likely to interact with other medications
metabolised by CYP3A4 (and other enzymes/transporters) to increase
drug exposure and that drugs like efavirenz, nevirapine and etravirine are
inducers of drug metabolism some of the current challenges are to
determine i) the likelihood of interactions where there are no study data
to guide us and ii) what happens when a patient switches therapy off an
enzyme inducing drug. In relation to the new DAAs, Boceprevir is
primarily metabolised by the enzyme aldo-ketoreductase (AKR) but also
undergoes metabolism by CYP3A4; telaprevir is metabolised by CYP3A4.
In addition, both boceprevir and telaprevir are strong inhibitors of
CYP3A4 and are substrates for P-glycoprotein. Co administration of drugs
that are highly dependent on CYP3A4 for clearance and for which
elevated plasma concentrations are associated with serious or life
threatening events means a contraindication with boceprevir and/or
telaprevir. However, many other interactions require close monitoring,
alteration of drug dosage or timing of administration and here we clearly
need help to understand the potential magnitude of an interaction and
strategies for patient management. Since targeted drug interaction
studies are done in the development programme and then post-licensing
there are a limited number of drugs for which there are actual study
data. Where there are no data, guidance can only be given based on
knowledge of the pharmacology of the respective drugs. This is the
approach being used in the resource http://www.hep-druginteractions.
org.
One particular area of concern is HIV positive patients who are receiving
antiretrovirals (ARVs) since they are relatively highly represented among
patients with HCV infection, and are at a high risk of DDIs. Recent drug
interaction data presented on telaprevir and boceprevir have reinforced
the initial suspicions that we are faced with a whole new challenge of
managing multiple interactions in co-infected patients.
Management of DDIs with these exciting new agents certainly poses a
challenge and awareness of the potential for DDIs is fundamental for safe
prescribing. Think DDIs for the DAAs. But we are still on a steep learning
curve and there are unanswered questions.
I9
Animal models of functional HIV cure
Guido Silvestri
Emory University School of Medicine, Atlanta, USA
Retrovirology 2012, 9(Suppl 1):I9
Developing new therapeutic strategies to achieve a functional cure for
HIV infection is a central objective for contemporary AIDS research. A key
obstacle towards a functional cure for HIV/AIDS is the paucity of
information regarding the establishment and maintenance of the
persistent reservoirs of latently HIV-infected cells which support the rapid
reactivation of virus replication when antiretroviral therapy (ART) is
stopped. Given the many and important similarities between HIVinfection of humans and SIV infection of macaques, it is very likely that
crucial information on the nature of HIV reservoirs may come from
studies conducted in SIV or SHIV-infected macaques that are treated with
ART. While this area of AIDS research is still in its early stages, it is
important to note that these studies have now become possible due to
the availability of antiretroviral regimens that successfully reduce SIV or
SHIV replication below detectable limits. Specific advantages of the nonhuman primate models for HIV latency, reservoirs and functional cure
include the following: (i) possibility to conduct extensive characterization
of the virus reservoirs and pathogenic processes in tissues (including
elective necropsy); (ii) performance of in vivo pilot trials of new
therapeutic approaches can be conducted in a timely and controlled
fashion; (iii) developing and testing of “risky” interventions (i.e., cell
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depletion experiments, stem cell-based interventions etc) that may pose
significant ethical challenges in humans; and (iv) possibility to control for
various clinical parameters that are very hard to control in humans (time
of infection, duration of ART etc). On the other hand, current limitations
to this type of studies are their cost and the lack of standardized research
resources (i.e., assays, virus stocks, etc). In this presentation, the potential
and limitations of animal models of functional HIV cure will be discussed
together with selected examples of therapeutic approaches that could be
developed and tested in non-human primates.
I10
Molecular control of HIV-1 postintegration latency: implications for
therapeutic strategies
Carine Van Lint
Gosselies Campus, Charleroi, Belgium
Retrovirology 2012, 9(Suppl 1):I10
The current antiretroviral therapy HAART is effective and life-prolonging
but does not eradicate HIV-1 from infected patients. A reduction of HIV-1
RNA levels in the plasma in HAART-treated individuals to less than
50 copies/ml is frequently achieved but residual viremia persists as
detected by ultrasensitive assays. The sources of this persistent viremia
are still not fully understood but could arise from ongoing cycles of
residual viral replication and/or from the reactivation of viral expression
from latently-infected cells. These latently-infected cells contain stablyintegrated, transcriptionally-silent but replication-competent proviruses,
thereby representing latent reservoirs of HIV-1. They are a permanent
source for virus reactivation and could be responsible for the rebound of
plasma viral load observed after HAART interruption.
HIV-1 transcriptional repression is crucial to the establishment and
maintenance of postintegration latency. Several elements contribute to
HIV-1 transcriptional repression including: 1) the site of integration and
mechanisms of transcriptional interference, 2) the absence of crucial
inducible host transcription factors, 3) the presence of transcriptional
repressors, 4) the nucleosomal organization of the HIV-1 promoter, 5) the
epigenetic control of the HIV-1 promoter (histone posttranslational
modifications, such as acetylation and methylation, and DNA methylation),
6) the sequestration in an inactive form of the cellular positive transcription elongation factor b (P-TEFb), composed of cyclin-dependent
kinase 9 (CDK9) and human cyclin T1, 7) the absence of the viral
transactivator Tat, which promotes transcription via recruitment to the HIV1 promoter of P-TEFb, histone-modifying enzymes and ATP-dependent
chromatin-remodeling complexes required for nucleosomal disruption and
transcriptional processivity. The involvement of these elements in
postintegration latency depends on the status of activation and
differentiation of the heterogeneous CD4+ T cell populations hosting the
HIV-1 reservoirs.
Further understanding of the epigenetic and non-epigenetic mechanisms
regulating HIV-1 latency and reactivation from latency should help devise
novel strategies to eliminate latent HIV-1 infection or to restrict the latent
pool to a size bearable by the host immune system.
I11
A roadmap to a cure
Mario Stevenson
University of Miami, Leonard M. Miller, Miami, USA
Retrovirology 2012, 9(Suppl 1):I11
Highly active anti-retroviral therapy (HAART) effects sustained suppression
of viral replication in infected individuals. Despite this, viral replication
rapidly resumes if therapy is interrupted. The prevailing view is that viral
persistence during HAART is sustained by a reservoir of latently infected,
quiescent CD4+ T-lymphocytes, a view that is supported by the apparent
lack of viral evolution in the resting CD4+ T cell reservoir and the apparent
lack of change in low level plasma viremia when therapy is intensified. A
less popular view is that viral persistence in HAART may be sustained by a
low level of ongoing or “cryptic” replication, a view that is supported in
part by our recent work measuring unintegrated cDNA and specifically
episomal cDNA in HAART-treated patients.
In order to characterize the reservoirs that persist in the face of HAART,
we have been examining the dynamics of HIV-1 in tissue viral reservoirs
and the virologic response to therapy in lymphoid tissue. Lymphoid
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tissue was obtained from patients at various intervals after HAART
initiation and the virologic response as well as intracellular drug levels in
cells from lymphoid tissue was examined. Our analysis indicates that
suppressive therapy is limited in its ability to curtail HIV-1 replication in
lymphoid tissue and that this may be a consequence of poor intracellular
sequestration of some antiretrovirals in cells of lymphoid tissue. These
results have implications for strategies aimed at limiting viral persistence
in the face of HAART.
I12
Towards a cure for HIV: a long road ahead
Tae-Wook Chun
National Institute of Health, Bethesda, USA
Retrovirology 2012, 9(Suppl 1):I12
Plasma viremia can be effectively suppressed and maintained below the
limits of detection for extended periods of time in most human
immunodeficiency virus (HIV)–infected individuals receiving antiretroviral
therapy (ART). However, it has not been possible to eradicate HIV by ART
alone, likely due in part to the persistence of various viral reservoirs in
lymphoid tissues. In this regard, the existence of latently infected, resting
CD4+ T cells carrying replication-competent HIV has posed one of the major
challenges to the long-term control or eradication of HIV in infected
individuals on ART. Consequently, there has been considerable focus on
therapeutic strategies to reactivate the latent viral reservoir using various
agents, such as cytokines, histone deacetylase inhibitors, and mitogens,
under the assumption that these cells would die due to HIV induced
cytopathic effects and antiretroviral drugs would prevent spread of infection.
However, such approaches have shown no clinical benefit to date. Moreover,
it also has become clear that HIV persists in subsets of CD4+ T cells in blood
and lymphoid tissues of infected individuals receiving ART. Recent data from
our laboratory will be discussed which will include potential mechanisms of
HIV persistence and prospects for eradication and new therapeutic
approaches in HIV-infected individuals receiving effective ART.
I13
Universal access to anti-HIV therapy
Yves Souteyrand
HIV/AIDS Department World Health Organization, Geneva, Switzerland
Retrovirology 2012, 9(Suppl 1):I13
WHO, in collaboration with UNAIDSs and UNICEF, report annually on
progress in the different HIV/AIDS interventions. In 2010, more than
6.6 million people had access to Antiretroviral Therapy (ART), in low-and –
middle income countries, representing a 17-fold increase in less than
7 years. This is one of the most successful public health achievements.
However, this represents less than 50% coverage of needs. The 2010
global commitment of Universal Access to ART has not been achieved.
The presentation will address determinants of progress and of inequalities in
access to ART, according to geographical and population criteria. West and
Central Africa as well as Eastern Europe and Central Asia are reporting low
coverage rates compared to other similar regions. Coverage among children
less than 15 years old is much lower than adult coverage (23% versus 51%).
Access to ART for intravenous drug users is very low in most countries. In
many settings, access for people in rural areas is much more limited than in
public area.
Closing the gap in access to ART will need implementing huge efforts to
reduce inequities in access. A comprehensive approach should include
improvement of health delivery systems, decentralization of care,
simplification of treatment and laboratory monitoring. It will need also to
address essential human right issues, including stigmatization and
discrimination of key populations who currently do not have access to
testing and counseling and other essential interventions.
I14
Primary HIV infection: the French experience
Cécile Goujard
General Hospital of Bicêtre, Kremlin-Bicêtre, France
Retrovirology 2012, 9(Suppl 1):I14
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The ANRS PRIMO is a prospective multicenter French Cohort which had
enrolled 1433 patients during primary-HIV-1 infection (PHI) since 1996,
with the objectives to improve pathophysiological knowledge on PHI,
to assess the impact of an early antiretroviral treatment and to
contribute to document the epidemiology of new infections in France.
Clinical and laboratory data are collected at inclusion, month (M)1, M3,
M6, and then every 6 months. All patients are antiretroviral-naïve at
inclusion.
Patients were included early after infection (median time, 31 days; 26%
acute infection); 84% were men. The % of patients infected with non-B
subtypes increased in the last decade, while the frequency of resistant
viral strains remained stable. At inclusion, median CD4 cell counts and
viral HIV load were 518/mm 3 and 5.1 log 10 copies/mL at PHI, with a
wide range of values in the whole population (IQR, 372-678/mm3 and
4.5-5.7 log respectively), depending only partially to the time from
infection. Median cellular DNA at inclusion was 3.4 log cp/10 6 PBMCs
(IQR, 2.9-3.7). Early immunological (CD4 counts) and virological
parameters (HIV RNA and DNA) could predict the risk of progression to
a CD4 count < 350 cells/mm3 in untreated patients and the chance of
spontaneous persistent control of viral replication after infection. 52% of
patients initiated an antiretroviral treatment at inclusion. Although a
transient treatment during PHI did not translate into a benefit in terms
of viral set-point compared to untreated patients, it could lead to long
term preservation of CD4 cell counts. Furthermore, we showed that rare
treated patients were capable of controlling viral replication after
treatment interruption, those patients had lower viral reservoir at
inclusion before treatment and at treatment interruption compared to
non controllers. Cellular activation was high during PHI and declined
substantially thereafter, with lower levels in patients treated early after
infection compared to patients treated during the chronic phase.
Antiretroviral treatment is now given in less advanced infection and even
discussed as a universal approach to prevent HIV transmission. The question
of treatment initiation in all patients diagnosed during PHI is relevant.
I15
Treating since the beginning?
Jean-Pierre Routy
McGill University, Montreal, Canada
Retrovirology 2012, 9(Suppl 1):I15
Like a pendulum, the therapeutic recommendations to initiate antiretroviral
therapy (ART) have changed over the last two decades. Indeed, initiation of
ART has swung from an initial “treat hard and early”, to a CD4 T cell count
spanning from 200 to 500 and recently to a “as soon as the patient is
ready”. Changes on the optimal timing to initiate ART were based on the
following 1) Availability of new ART with increased potency, improved
tolerance and reduced pill burden; 2) Evidence that controlled viral
replication on ART is associated with a dramatic decrease in HIV
transmission; 3) New insights on HIV pathogenesis and on the establishment
and maintenance of HIV reservoirs.
Recent findings on HIV pathogenesis concerning the relationships
between CD4 T cell counts, immune activation, non-infectious clinical
events and cancers will be presented. Specifically, the influence of CD4
nadir on the quality of long-term immune reconstitution and viral
reservoir persistence following ART initiation will be highlighted. We will
also focus on the clinical relevance of maintaining certain CD4 T cell
subsets like central memory pool for an optimal cytotoxic HIV-specific
and vaccination responses. We will also revisit the tissue and cellular
localizations of HIV reservoirs according to the time of treatment
initiation. Furthermore, ethical considerations on a “patient-centered
medicine” for early ART initiation will be discussed. Particularly, the
advantages and inconveniences of a life-long treatment on a patient’s
quality of life, drug-resistance development, long-term drug toxicity, cost
and observance issues will be presented. The very early ART initiation
reveals a new frontier 1) Allowing for some patients an ART-free viral
control post-drug discontinuation era 2) Selecting optimal patients
harboring a reduced HIV reservoir to be invited to participate in clinical
trials aiming to HIV eradication. We are entering in a new era where
“Treating early to be able to stop early” will be the focus of our future
collaborating research efforts to vividly improve the life of HIV-infected
people.
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I16
Anti-latency agents to purge HIV reservoirs
Santiago Moreno
Ramón y Cajal Hospital, Madrid, Spain
Retrovirology 2012, 9(Suppl 1):I16
The persistence of latent HIV-infected cellular reservoirs represents the
major hurdle to virus eradication with highly active anti-retroviral therapy
(HAART), since latently infected cells remain a permanent source of viral
reactivation. HIV establishes a persistent infection in CD4+ T lymphocytes
(and to a lesser extent in macrophages as well), creating a persistent
reservoir consisting mainly of latently infected resting memory CD4+
T cell. Although pre- and post-integration latencies have been described
in HIV-1, the reservoir that appears to be the major barrier to eradication
is composed of latently infected cells carrying an integrated provirus that
is transcriptionally silent.
It has been suggested that reactivation of the latent reservoirs could allow
effective targeting and possible eradication of the virus. Immunoactivation
therapy to reduce the latent pool of HIV by treatment with the anti-CD3
antibody OKT-3 alone or in combination with interleukin-2, substantially
failed to significantly decrease the viral reservoir. Non-specific T-cell
activation may induce high-level viral replication above a level that can be
fully contained by ART, while increasing the susceptibility of uninfected cells.
Selective targeting of HIV provirus via agents that induce the expression of
quiescent HIV, but have limited effects on the uninfected host cell is an
alternate approach to attack latent HIV. Activation from latency to
completion of the replication cycle should result in lytic cell death of CD4+
T cells. Multiple mechanisms that contribute to the maintenance of proviral
latency could be targeted to activate the latent virus. As examples of
potentially useful agents, IL–7 can reactivate HIV–1 in latently infected cells
in vitro through the induction of the Janus kinase–signal transducer and
activator of transcription (JAK–STAT) signalling pathway. The use of different
chemical compounds targeting the PKC signalling pathway (prostratin,
bryostatin) has also been proposed as a means of reactivating viral
reservoirs. Finally, HDAC blocking is an attractive potential means of
inducing broad reactivation of HIV–1 reservoirs, and promising results have
been achieved using the HDAC inhibitor vorinostat.
I17
Hepatitis C as a metabolic disease
Patrice Andre
Croix-Rousse Hospital, Lyon, France
Retrovirology 2012, 9(Suppl 1):I17
Before liver cirrhosis and hepatocellula carcinoma can develop, the early and
long lasting features of hepatitis C are host metabolism modifications with a
specific and so far unique metabolic syndrome that may associate insulin
resistance, liver steatosis and hypo-betalipoproteinemia. These metabolic
perturbations are directly induced by heptatitis C virus (HCV) replication and
regress after viral suppression. Symmetrically HCV depends on glucose and
lipid metabolism for its replication.
HCV induced insulin resistance is both hepatic and peripheral. The insulin
receptor pathway is impacted at several steps by viral proteins with
probable functional consequences. Mechanism of peripheral insulin
resistance remains obscure and the viral signals send to adipose tissue or
muscles have to be identified. One major IR metabolic consequence might
contribute to the mobilization of free fatty acids from periphery to the liver
and to the constitution of liver steatosis. Importantly, HCV modifies with
genotype-specific differences, the synthesis, degradation and secretion of
lipid in a coordinated fashion to promote the accumulation of neutral
lipids.
The lipid droplets (LD) that are the lipid storage organelles are mandatory
platforms for the assembly of infectious viral particles. In particular
localization of core protein and NS5A on LD and mobilization of the LD are
essential steps that control viral infectivity. Interestingly, the efficiency of
HCV to the LD disposal and use correlates to viral production and may
influences the extent of hepatic accumulation of lipids.
The most striking association of HCV with lipid metabolism resides in the
coincidence of the betalipoproteins and viral particles pathways with the
formation of unique hybrid viral particles. Indeed HCV depends on a
Page 5 of 54
functional very low density lipoproteins (VLDL) assembly and secretion
process to be secreted. HCV also modifies at different degree the VLDL
composition forming sub viral particles, which are minimally modified
VLDL that bear the viral envelop glycoproteins, or hybrid viral particles
known as lipo-viral-particles (LVP), which contain all the viral and VLDL
components that are highly infectious. Functions of these hybrid particles
on the disease features and progression as well as therapeutic targets
remain to be fully characterized.
Thus, HCV appears to have developed an original and so far unique way
with major clinical consequences to modify and use the lipid metabolism
to persist in the host.
I18
HCV resistance
Philippe Halfon
Ambroise Paré Hospital, Marseille, France
Retrovirology 2012, 9(Suppl 1):I18
The efficacy of Direct Antiviral Agents (DAAs) is limited by the presence of
Resistant associated virus mutations (RAVs) resulting in amino-acid
substitutions within the targeted proteins which affect viral sensitivity to
these compounds. Six major position mutations in the NS3 HCV Protease
(36, 54, 155, 156, 168, and 170), fifteen in the NS5B polymerase (96, 282,
316, 365, 414, 419, 423, 448, 482, 494, 495, 496, 499, 554, 559) and five in
the NS5 A region (28, 30, 31, 58 and 93) have now been reported in vitro or
in vivo associated with different levels of resistance.
The HCV NS3,NS5A, Pol (NNI) mutations occurred quickly (less than
15 days) and longer for Nucleosides Inhibitors in monotherapy and the
genetic barrier can be overcome by combination with PegylatedInterferon+Ribavirine in quadruple therapy. There is a long term
persistence of HCV NS3 Protease mutations after the end of therapy and
it is important to stop the NS3 protease inhibitor early in patients with
ongoing replication to avoid the selection of resistant variants with
increased fitness and a higher potential of long-term survival. Issues on
HCV archived mutations are not solved. Virological failure was more likely
in patients with genotype 1a infection than 1b and was associated with
the presence of resistant variants. Furthermore, the time taken for
resistant HCV variant populations to return to WT is longer for patients
with genotype 1a versus genotype 1b.
Selection of resistant variants that, in turn, could produce cross-resistance to
whole class of drugs with overlapping resistance profiles Combinations of
Protease Inhibitors with other class of antiviral with separate modes of
action & non-overlapping resistance profile is preferable. Additionally,
Ribavirine prevents viral breakthrough in combination with PegylatedInterferon and DAAs and the effect of ribavirin important seems limit the
DAA resistance.
The resistance profiling does remain a challenge for the next generation of
protease, NS5A, non nucleoside inhibitors and probably for nucleoside
inhibitors; thus, the lessons from HIV infection and the first clinical proof of
IFN-free regimen treatment indicate that combinations of drugs with
different mechanisms of action will be an attractive strategy for hepatitis C.
I19
What happens after hepatitis C eradication?
Stanislas Pol
Hepatology Unit, Cochin Hospital, Paris, France
Retrovirology 2012, 9(Suppl 1):I19
The treatment of hepatitis C virus infection (HCV) by a combination of
pegylated interferon and ribavirin, according to early viral kinetics, leads to a
sustained virological response (SVR) in more than 50% of patients with
chronic infection. This SVR is a complete recovery of the infection but more
than 50% of genotype 1-infected patients do not achieve SVR.
A better understanding of the viral cycle, and the characterization of viral
enzymes which are potential targets, resulted in the development of new
molecules, direct acting antiviral drugs (DAA) targeted against HCV, either
specific of genotype 1 (NS3/NS4A protease inhibitors and NS5B polymerase
inhibitors) or with a wider spectrum (NS5A or entry inhibitors), and nonspecific antivirals (new interferons, cyclophilin inhibitors). The results of
these phase II and III trials which clearly demonstrated a 20 to 30% increase
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in the SVR rate of genotype 1-infected patients, either naive or treatment
experienced.
These new drugs has now been approved by the end of 2011, after a
temporary approval for compassionate use in cirrhotic genotype 1 patients
with previous relapse or partial response to the combination therapy and a
new turn appears with the “interferon free regimens” which combine
different direct acting antivirals. The complete virologic recovery which is
achieved with all the antiviral treatments clearly reduces the rates of liverrelated morbidity and mortality but, in the absence of biopsy-proven
cirrhosis reversal, the risk of occurrence of hepatocellular carcinoma is still
present and requires a regular US follow-up in those patients with extensive
fibrosis or cirrhosis for an early screening. In the experienced patients with
active replication, new antivirals are mandatory to reduce the risks of
complications, including liver transplantation, which is high, especially in
patients with rapid fibrosis.
In the future, the main limitations of triple therapy will be safety (cutaneous
rash or anemia which may be controlled), cost, compliance, viral resistance,
and drug-drug interactions that must be avoided by educating patients
and physicians.
I20
Antiretroviral generics
Véronique Andrieu
Galenic Laboratory Faculty of Pharmacy, Marseille, France
Retrovirology 2012, 9(Suppl 1):I20
The current definition for generic medicinal products is found in Directive
2001/83/EC, Article 10(2)(b), which states that a generic medicinal product is
a product which has the same qualitative and quantitative composition
in active substances and the same pharmaceutical form as the reference
medicinal product, and whose bioequivalence with the reference medicinal
product has been demonstrated by appropriate bioavailability studies.
The different salts, esters, ethers, isomers, mixtures of isomers,
complexes or derivatives of an active substance are considered to be the
same active substance, unless they differ significantly in properties with
regard to safety and/or efficacy.
Furthermore, the various immediate-release oral pharmaceutical forms shall
be considered to be one and the same pharmaceutical form.
Concept of bioequivalence is fundamental: The purpose of establishing
bioequivalence is to demonstrate equivalence in biopharmaceutics quality
between the generic medicinal product and a reference medicinal product
in order to allow bridging of preclinical tests and of clinical trials
associated with the reference medicinal product.
In bioequivalence studies, the plasma concentration time curve is generally
used to assess the rate and extent of absorption. Selected pharmacokinetic
parameters and preset acceptance limits allow the final decision on
bioequivalence of the tested products.
AUC, the area under the concentration time curve, reflects the extent of
exposure. Cmax, the maximum plasma concentration or peak exposure, and
the time to maximum plasma concentration, tmax, are parameters that are
influenced by absorption rate.
In studies to determine bioequivalence after a single dose, the parameters to
be analysed are AUC(0-t), or, when relevant, AUC(0-72h), and Cmax. For
these parameters the 90% confidence interval for the ratio of the test and
reference products should be contained within the acceptance interval of
80.00-125.00%. To be inside the acceptance interval the lower bound should
be ≥ 80.00% when rounded to two decimal places and the upper bound
should be ≤ 125.00% when rounded to two decimal places.
Evaluation of Generic medicinal product is also based on the pharmaceutical
quality of the active substance: absence of impurities,.. and of the finished
product : reproducibility of the manufacturing process, stability,….
A table of the Antiretroviral drugs and of the Generics available in Europe
is presented.
I21
Impact of HIV minor species and tropism
Karin Metzner
University Hospital, Zurich, Switzerland
Retrovirology 2012, 9(Suppl 1):I21
Resistance against antiretroviral drugs is one challenge when treating HIV
infected subjects. Resistance occurs in consequence of mutations in the HIV
Page 6 of 54
genome, thus, viral proteins can no longer be inhibited by antiretroviral
drugs or, in case of the CCR5 inhibitor Maraviroc, the virus can also escape
through coreceptor switch. Drug-resistant viruses (1) can be rapidly selected
leading to virological failure, (2) can persist also in the absence of drugs, (3)
can be transmitted, and (4) their presence can limit further treatment
options. This is all known in the context of drug-resistant viruses
representing the majority of the virus population. Here, the focus will be on
minority drug-resistant HIV variants: Virus subpopulations not detectable
using standard genotype resistance testing based on population
sequencing, thus, representing less than 20-25% of the total virus
population. New technologies enable the detection and quantification of
minority drug-resistant HIV variants to levels far below 1%. However, their
impact on antiretroviral therapy is still controversially discussed. This
presentation will provide an overview of the current techniques to quantify
minority viral variants, the clinical studies investigating the prevalence and
impact of minority drug-resistant HIV variants, and the challenges and
potential benefits of clinical implementation.
I22
A global virus network and a perspective on viral infections in humans
Robert Gallo
Institute of Human Virology, Baltimore, USA
Retrovirology 2012, 9(Suppl 1):I22
During the flu pandemic of the 1910s, the polio outbreaks of the 1950s, and
the AIDS crisis of the 1980s, invaluable time was wasted and a large number
of people died or became seriously ill while authorities planned a response,
identified and concentrated resources, and developed a plan to prevent
others from becoming infected.
Each of these 3 pandemics of the last century as well as the smallpox
epidemics were caused by viruses. I have noted that often there are no
expert responsible medical virologists, and concomitantly I noted a decline
in newly trained medical virologists.
Without experts, initial responses to viral outbreaks can be needlessly harsh
and economically devastating. Fear replaces logical analysis, and entire
populations of healthy pigs and birds have been slaughtered simply
because they could potentially harbor swine or avian flu strains. These overreactions hurt small farmers and the economies in developing nations, and
make crafting a vaccine more difficult.
Public health authorities require a reliable source of experts on basic human
and animal virology to turn to for rapid answers. A select group of frontline
virologists is needed to work quickly to convert preliminary information into
advances in the laboratory to protect the blood supply when needed and
begin looking for clinical treatments and, ultimately, a vaccine.
Organizations involved in the surveillance of viruses, like the World Health
Organization and CDC, and those involved in the delivery of care during
emergencies, like the Gates Foundation’s GAVI Program, often do not have
the manpower for training initiatives and basic virus research which are
important parts of addressing any public health threat. The Global Virus
Network is uniquely positioned to utilize the expertise of its members to
bridge these efforts.
The overall aim of the network is to achieve accelerated, innovative
solutions to human viral diseases. The GVN also focuses on coordinated
virology training for junior scientists and developing scholar exchange
programs for recruiting and training the next generation of medical
virologists.
Today, the GVN is made up of 30 centers and 3 affiliates in 19 countries
on 6 of the world’s 7 continents. Its membership includes all 7 medical
virologists in the U.S. National Academy of Sciences, and others who are
members of their own countries’ national academies. Their collective
expertise covers all types of existing, emerging, and re-emerging viruses
which affect humans.
I23
Human papilloma viruses
Denise A Galloway
Fred Hutchinson Cancer Research Center, Seattle, USA
Retrovirology 2012, 9(Suppl 1):I23
A group of approximately 13 human papillomaviruses (HPVs) are
responsible for virtually all cervical cancers as well as the majority of
vulvar, vaginal anal and penile cancers, as well as at least half of
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oropharyngeal cancers. Currently two prophylactic vaccines are highly
efficacious in preventing HPV 16 and 18 associated disease, and the
quadrivalent vaccine also prevents HPV 6 and 11 warts. Currently
therapeutic vaccines targeting the viral E6 and E7 oncogenes are being
developed. One topic that will be discussed is whether the prophylactic
vaccine can have utility in any setting where individuals are already
infected. Secondly, this review will discuss the basis of long-term
immunity and whether it is afforded by both vaccination and natural
infection. Finally, strategies to provide more broad based coverage to
other HPV types will be discussed.
I24
Implications of influenza resistance
Laurence Calatayud
Marseille, France
Retrovirology 2012, 9(Suppl 1):I24
Antiviral treatment is an important tool in the clinical management of
severe or complicated influenza.
Two classes of antiviral agents for influenza are available: adamantanes
(amantadine and rimantadine), and neuraminidase inhibitors (oseltamivir,
zanamivir, peramivir, laninamivir). The currently circulating human
influenza viruses, influenza A (H1N1)pdm09, influenza A(H3N2), and
influenza type-B, are all resistant to adamantanes, but most are sensitive
to neuraminidase inhibitors.
From April 2009 to 5 October 2011, a total of 605 cases of oseltamivirresistant infections with influenza A(H1N1) pdm09 virus have been
reported to WHO from 32 countries. All resistant strains carry the H275Y
substitution in the neuraminidase glycoprotein, which is known to
confer a high level of resistance to oseltamivir. Of 468/605 (77%) cases
with available clinical information, 133/468 (28%) occurred among
patients who were severely immunocompromised. Of the patients who
were not immunocompromised, 211/335 cases (63%) occurred after
receiving treatment or prophylaxis with antiviral drugs. Four clusters of
oseltamivir-resistant viruses with person-to-person transmission have
been reported: 2 occurred among severely immunocompromised
patients, while 2 were in healthy adults. Most viruses carrying the
H275Y substitution remain sensitive to zanamivir. However reports
indicate that other virus variants have emerged resulting in a reduced
sensitivity to zanamivir and peramivir. Resistance to neuraminidase
inhibitors in influenza A (H3N2) and influenza type-B, has been reported
rarely, and has usually been associated with prolonged treatment in
immunocompromised patients.
The prevalence of resistance to neuraminidase inhibitors is still low, and
oseltamivir remains the first line treatment recommended for patients with
severe influenza or patients at a high risk of developing severe disease.
However zanamivir is a therapeutic alternative for patients infected with
a virus that is highly suspected to be resistant to oseltamivir, i.e.,
immunocompromised patients who have received oseltamivir, but still have
evidence of persistent viral replication; or people who develop illness
despite taking oseltamivir for a post-exposure prophylaxis. In addition
appropriate infection control measures should be implemented to prevent
spread of the resistant virus.
Although prevalence of resistance to neuraminidase inhibitors remains low,
reports of person-to-person transmission, and an increased prevalence of
resistant viruses in community-based cases in specific regions, emphase the
necessity of virological and epidemiological surveillance.
Page 7 of 54
Materials and methods: The HIV-1IIIB virus, U373-MAGI-CXCR4CEM,
HTLV-IIIB, Monoclonal antibody to HIV-1 gp41 (126-7), HIV-1 gp120
Antiserum (PB1 Sub 2), HIV-1 gp120 Antiserum (PB1), and HIV-1 gp120
Monoclonal Antibody (F425 B4e8) were obtained from the NIH AIDS
Research and Reference Reagent Program, Division of AIDS, NIAID. The
silver nanoparticles coated with 0.2 wt% PVP were obtained from
Nanoamor, Houston, TX. Stock solutions and serial dilution of AGNPs
were prepared in RPMI 1640 cell culture media. Cytotoxicity of AgNPs
was ascertained in U373-MAGI-CXCR4CEM cells. The cell viability was
assessed using a CellTiter-Glo® Luminescent Cell Viability Assay and
Glomax Multidirection System (Promega). The neutralizing activity of
AgNPs and NABs against HIVIIIB cell-free and cell associated virus was
evaluated in an assay involving U373-MAGI-CXCR4CEM cells, AgNPs and
NABs. Assessment of HIV-1 infection was performed with the Beta-Glo
Assay System using Glomax Multidirection System (Promega). The
percentage of residual infectivity after NABs, AgNPs, NABS+AgNPs, or
media was calculated with respect to the positive control. The 50%
inhibitory concentration (IC50) was defined according to the percentage
of infectivity inhibition relative to the positive control. The inhibition data
was statistically analyzed with the help of Wilcoxon rank-sum (WilcoxonMann-Whitney test) test.
Results: The four NABs used in the study inhibited HIV-1 cell free infection at
a dose response manner. They were however largely ineffective against the
cell-associated virus. AgNPs alone however were able to inhibit both cell free
and cell associated virus infection at a dose dependent manner. AgNPs when
mixed together with NABs significantly increased inhibition of Cell associated
HIV-1.
Conclusions: The addition of AgNPs to NABs has significantly increased the
neutralizing potency of NABs in prevention of cell-associated HIV-1
transmission/infection.
O2
Search for small molecule activators of latent HIV
Romas Geleziunas*, George Stepan, George Wei, Helen Yu, Michael Graupe,
Nikos Pagratis, Tiffany Barnes, Tomas Cihlar, Joe Hesselgesser
Clinical Virology at Gilead Sciences, Inc., Foster City, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):O2
Reservoirs of HIV that persist during ART represent barriers to eradication
of this virus. One well documented reservoir of latent HIV is found in
memory CD4 + T-cells. Identifying means to safely eliminate latently
infected memory CD4+ T-cells is an important goal that may contribute
to a cure for HIV. One approach toward this end is to activate latent
proviruses with the premise that viral particles emanating from these
cells will cause a cytopathic effect leading to the demise of the host cell.
We have optimized and automated a primary cell-based HIV latency
assay that can be used for high throughput screening of small molecule
libraries in search of HIV activators. Using this assay, we have identified
novel histone deacetylase (HDAC) inhibitors fromGilead’s compound
collection that activate latent HIV. Analysis of these inhibitors revealed
that the magnitude of HIV expression correlated with the breadth of
cellular HDAC inhibition. In addition, we have identified a variety of other
compounds that activate latent HIV such as kinase inhibitors which may
point to novel mechanisms that govern HIV latency. This screening assay
has the potential to identify novel molecular targets for drug discovery
and new chemical classes that could be optimized to create new drugs
to eliminate reservoirs of latent HIV.
ORAL PRESENTATIONS
O1
Inhibition of cell-associated HIV-1 by silver nanoparticles
Dinesh K Singh*, Humberto H Lara
Winston Salem State University, Winston Salem Nc, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):O1
Introduction: The glycoprotein gp120 and gp41 of HIV are the main targets
for neutralizing antibodies (NABs). It appears that silver nanoparticles (AgNPs)
also inhibit HIV-1 targeting same glycoproteins. In this study, we demonstrated that silver nanoparticles are efficient in neutralizing HIV-1 at non toxic
concentrations. We also found an additive effect between the four NABs and
AgNPs when combined against cell-associated HIV-1 infection in vitro.
O3
New transcription regulatory mechanisms of latent HIV LTR
Haleh Rafati1†, Yuri Moshkin1†, Tokameh Mahmoudi1*†, Maribel Parra2,
Shweta Hakre3, Eric Verdin3
1
Department of Biochemistry, Erasmus University Medical Centre, Rotterdam,
The Netherlands; 2Cancer Epigenetics and Biology Program (PEBC), IDIBELL,
Barcelona, Spain; 3Gladstone Institute of Virology and Immunology, UCSF,
San Francisco, CA, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):O3
Despite the effectiveness of antiretroviral medication, the HIV virus
persists in resting memory T cells of infected patients in a latent state,
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providing the main impediment to eradication of the virus. We are
interested in identifying the molecular mechanism responsible for the
establishment and maintenance of HIV latency and its re-activation. We
recently used a cell system reflecting HIV latency in my lab to determine
the high resolution nucleosomal landscape of the latent HIV LTR and
examine its dynamic changes upon re-activation (Rafati et al., Nov 2011
PLoS Biology). We combined mathematical predictions of nucleosome
positioning with a combinatorial biochemical approach based on
formaldehyde crosslinking of latent and activated HIV infected cells (using
FAIRE, ChIP and high resolution MNase nucleosomal mapping) to define
LTR nucleosome positioning and regulation during active and latent HIV
infections. We found that BAF, an ATP-dependent chromatin remodelling
complex generates a chromatin structure at the LTR that is energetically
unfavorable to its intrinsic histone-DNA sequence preferences. Specifically,
we find that BAF positions a repressive nucleosome immediately
downstream of the HIV transcription start site, abrogating transcription,
and in this way contributes to the establishment and maintenance of HIV
latency. Our data describe a novel molecular mechanism for the
establishment and maintenance of HIV latency, and we identify the
catalytic subunit of BAF, the enzyme BRG1, as a putative molecular target
to deplete the latent reservoir in infected patients. We will also present
preliminary data addressing the role of a novel signalling pathway in derepression of latent HIV, and the effect of small molecules and ligands,
which activate this pathway to study reactivation of latent HIV. We
anticipate these experiments will further our understanding of HIV
transcription regulation and identify both novel cofactors for targeting
and molecules with potential to purge HIV latency.
O4
Epigenetic modifications of HIV proviral LTRs: potential targets for cure
W Doerfler1, S Weber1, K Kemal2, B Weiser2, K Korn1, K Anastos3, H Burger2*
1
Erlangen University, Institute for Virology, Erlangen, Germany; 2Wadsworth
Center, New York State Department of Health, Albany, NY USA; 3Albert
Einstein College of Medicine/Montefiore Medical Center, Bronx, NY USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):O4
Introduction: HIV-1 cure remains elusive despite HAART due to the
reservoirs of proviral DNA integrated into the human genome. Efforts to
cure HIV-1 therefore need to aim at eliminating proviral DNA from
cellular reservoirs. The first epigenetic signal identified in virus infected
and uninfected cells has been promoter methylation. Compelling
evidence confirms that specific promoter methylation can lead to gene
silencing. Previous studies have examined HIV-1-epigenetics mostly in
vitro.
Materials and methods: We determined methylation patterns in HIV-1
proviral genomes from PBMCs obtained from 21 individuals with a
spectrum of disease progression. The CpGs in the long terminal repeats
(LTRs) of proviral DNA were investigated by bisulfite sequencing in up
to 85 genomic variants per individual. This approach facilitates the
study of the full range of CpG methylation and sequence variability of
HIV-1 proviruses under conditions of natural selection in human
populations.
Results: In patients with advanced disease, the HIV-1 proviruses remained
essentially unmethylated in their LTRs. In one long-term nonprogresssor,
the percentage of methylated proviruses varied from 0-77% at different
times after infection. More important and unexpected was the detection
of three specific LTR-located CpG dinucleotides that had been selectively
mutated to TpAs in >20 out of the 32 samples analyzed. Comparison to
11 HIV-1 LTR sequences in the Los Alamos HIV data base demonstrated
that mutations in the sites identified by our study occurred more
frequently than at other locations, although the mutations were different
from TpAs.
Conclusions: These specific CpGs, possibly including their abutting
sequences, might indicate weak spots in the proviral genomes whose
sacrifice by mutation to TpAs could enhance the HIV-1 potential for longterm proviral survival. These data suggest that the sites of the mutated CpGs
occurring at conserved sites may serve as potential targets for therapeutic
interventions to eliminate integrated proviruses.
(Grants: DFG-DO165/28-1; NIH-UO1-AI35004)
Page 8 of 54
O5
Hepatitis C virus fails to activate NF-kappaB signaling in plasmacytoid
dendritic cells
Ruzena Stranska*, Jonathan Florentin, Clélia Dental, Besma Aouar,
Francoise Gondois-Rey, David Durantel, Thomas F Baumert, Jacques A Nunes,
Daniel Olive, Ivan Hirsch
Centre de Recherche en Cancérologie de Marseille, Marseille, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):O5
Introduction: Plasmacytoid dendritic cells (pDCs) respond to viral
infection by production of interferon a (IFN-a), proinflammatory cytokines
and cell differentiation. The elimination of hepatitis C virus (HCV) in more
than 50% of chronically infected patients by treatment with IFN-a
suggests that pDCs can play an important role in the control of HCV
infection. pDCs exposed to HCV-infected hepatoma cells, in contrast to
cell-free HCV virions, produce large amounts of IFN-a.
Materials and methods: To further investigate the molecular mechanism
of HCV sensing, we studied whether exposure of pDCs to HCV-infected
hepatoma cells activates in parallel to interferon regulatory factor 7 (IRF7)mediated production of IFN-a also nuclear factor kappa B (NF-B)dependent pDC responses such as expression of the differentiation
markers CD40, CCR7, CD86, and tumor necrosis factor (TNF)-related
apoptosis-inducing ligand (TRAIL), and secretion of the proinflammatory
cytokines TNF-a and interleukin 6 (IL-6).
RESULTS: We demonstrate that exposure of pDCs to HCV-infected
hepatoma cells surprisingly did not induce phosphorylation of NF-B or
cell surface expression of CD40, CCR7, CD86, and TRAIL, or secretion of
TNF-a and IL-6. In contrast, CpG-A and CpG-B induced production of TNF-a
and IL-6 in pDCs exposed to the HCV-infected hepatoma cells, showing
that cell-associated virus did not actively inhibit toll-like receptor (TLR)mediated NF-B phosphorylation.
Conclusions: Our results suggest that cell associated HCV signals in pDCs
via endocytosis-dependent mechanism and IRF7 but not via NF-B
pathway. In spite of IFN-a induction, cell-associated HCV does not induce
a full functional response of pDCs. These findings contribute to the
understanding of evasion of immune responses by HCV.
O6
HCV full-length genome reconstruction with sequence independent
amplification combined with next generation sequencing
Barbara Bartolini*, Emanuela Giombini, Isabella Abbate,
Ubaldo Visco-Comandini, Gianpiero D’offizi, Gabriella Rozera, Marina Selleri,
Giuseppe Ippolito, Maria Rosaria Capobianchi
Virology at National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):O6
Introduction: HCV genome variability is related to both disease progression
and treatment response. De novo high-throughput pyrosequencing was
used to obtain full length HCV genome characterization directly from clinical
samples.
Material and methods: Plasma samples from 3 HCV-infected subjects
were analyzed (two patients with subtype 1b, one patient with subtype 2a/
2c; viral load: 6.0 x 106,20.8 x 106 and 7.3 x 106 IU/ml viral load, respectively).
All samples were analyzed in a single run, using sample-specific barcoding
adapters. Data were generated with a modified sequence-independent
single primer amplification followed by 454 sequencing (GS-FLX Roche,
Titanium version), using the shotgun approach. The reads were assembled
using cap3 program; HCV contigs were identified using BLAST against full
HCV genome database. Reads of HCV contigs were used for genome
reconstruction with gs Mapper (Roche software).
Results: A total of 297,493 reads were obtained (average length 267 bp).
Using a minimum read length cut off of 40 nt with >90% identity and
>40% overlapping, BLAST analysis classified a total of 27,107 reads (10,682
from patient 1, 11,920 from patient 2, and 4,505 from patient 3) as HCVspecific. In all patients, genome reconstruction was achieved for more than
98 % of the entire HCV genome. The mean coverage was 315, 307 and 142
reads per site for patients 1, 2 and 3, respectively (overall mean coverage:
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253 reads per site). Within-patient variability was calculated, resulting in E1
and E2 as the most variable structural genes in all patients, as expected.
Conclusion: The present study describes a unifying approach for HCV full
genome sequencing, based on sequence-independent amplification
combined with next generation sequencing. This may represent a relevant
innovation, since so-far HCV full genome direct sequencing was based on
genotype-specific multiple primer approach and conventional sequencing.
The possibility of performing simultaneous analysis of pooled samples may
represent a further advantage for cost saving.High coverage allows to
analyze virus variability along the entire genome providing important
information on possible viral variants which could impact on clinical and
therapeutic outcome.
O7
Raltegravir switch improves hepatitis C transaminitis in HIV-1 and
hepatitis C (HCV) co-infected individuals
Muge Cevik*†, Gurmit Singh†, Laura Dickinson, Andrew Scourfield,
Marta Boffito, Mark Nelson
Chelsea and Westminster Hospital, London, UK
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):O7
Introduction: HCV is one of the most relevant co-morbidities seen in HIVinfected individuals as evidenced by the negative impact that HIV exerts
on the course of HCV infection. Despite remarkable results on HIV infection
alone, the impact of highly active antiretroviral therapy (HAART) on liver
disease in co-infection remains unknown. We sought to explore the impact
of Raltegravir (RAL) on amino transferase (ALT) in HIV/HCV co-infected
individuals.
Methods: HIV-infected individuals co-infected with HCV within the last
5 years receiving non-integrase inhibitor containing HAART with a
subsequent switch to RAL-containing HAART were identified from a
retrospectively maintained outpatient database. Patient demographics were
extracted. Biochemical, virological and immunological parameters were
collated and individuals received pegylated interferon with ribavirin were
excluded. ALT levels at switch and post switch were compared using
Kruskal-Wallis test. Spearman’s Rank correlation was used to assess the
relationship between ALT and HCV-RNA.
Results: Twenty seven HIV-HCV co-infected individuals were identified
between January 2007 and January 2012 and seven individuals were
excluded. Median age was 44 years (range: 31-68). Five had acute and
fifteen had chronic HCV infection during the switch. Twenty (100%) had
HIV-RNA-1.
Conclusion: In our study, RAL had a favourable effect on the liver up to
24 weeks after switch in HIV/HCV infected individuals.
O8
Insect cell endocytosis of chikungunya virus adapted to Aedes
albopictus, a mosquito recently introduced into southern France
Christian Devaux*, Eric Bernard, Bernard Gay, Nathalie Chazal, Laurence Briant
Infectious Diseases at Cpbs (Centre d’Études d’Agents Pathogènes et Bio.
Santé), Umr5236 Cnrs, Um1, Um2, Montpellier, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):O8
Introduction: Since the first isolation of chikungunya virus (CHIKV) more
than 50 years ago in Eastern and Central Africa, CHIKV epidemics have been
repeatedly recorded from various countries. The 2005-2006 outbreak in
Reunion Island, was characterized by a genome microevolution in the E1
envelope glycoprotein gene (E1-A226V mutation) that enhances CHIKV
fitness for Aedes Albopictus vector. More recently, CHIKV caused explosive
outbreaks in India and propagated to temperate areas in Southern Europe,
including France in 2010. Along with Aedes albopictus colonization of new
geographical areas and climate change facilitating vector proliferation, the
epidemic risk for “tropical infectious diseases” represents a real threat for
naïve populations. It is therefore important to better understand the
replication cycle of CHIKV in cells from Aedes albopictus.
Materials and methods: CHIKV strains (the African reference strain of
CHIKV 37997; the LR-OPY1 (E1-226V) variant isolated from Reunion Island
and the LR-OPY1V226A bearing the reverse E1-V226A mutation were
Page 9 of 54
tested for replication in the C6/36 Ae. albopictus cell line. Experiments
were performed to assess the role of clathrin and dynamin-dependent
endocytic pathways implication of endosomal pH acidification and
requirement for membrane cholesterol in CHIKV infection of mosquito
cells.
Result and conclusions: Our data indicate that CHIKV uses a clathrindependent, caveolae-independent pathway to infect Aedes albopictus cell
cultures and requires membrane cholesterol as well as a low-pH environment for entry. These features, especially membrane cholesterol requirement, are modulated in some extent by the E1-A226V mutation. Altogether,
our data provide the first information regarding the pathways used by
CHIKV to infect Aedes albopictus cells and points the consequences of
recent genome microevolution on these entry routes.
O9
The adequacy of encephalitis surveillance for emerging infectious
diseases in Australia
David N Durrheim1*, Clare Huppatz1, Beverley Paterson2
1
University of Newcastle, Wallsend, Australia; 2Hunter Medical Research
Institute, University of Newcastle, Wallsend, Australia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):O9
Introduction: The acute encephalitis syndrome has heralded the
emergence of multiple virulent pathogens in Australia, including Murray
Valley encephalitis, and recently Hendra virus and Australian bat lyssavirus.
In Australia, the encephalitis syndrome in humans is not notifiable. The
burden of Australian encephalitis hospitalisations and deaths was not
known; encephalitis aetiology and trends had not been investigated at
population level; and the adequacy of neurological review in hospitalised
encephalitis cases to exclude emerging pathogens had not been
investigated.
Materials and methods: A series of studies was conducted to better
understand the status of encephalitis surveillance in Australia. Firstly,
Australian Bureau of Statistics mortality and population data for the period
1979–2006 were obtained and cause of death data were extracted using
ICD-9 (1979–1998) and ICD-10 (1999–2006). Secondly, rates of hospitalisation
for patients with encephalitis in Australia’s most populous state, New South
Wales (NSW), from January 1990 through to December 2007 were reviewed,
with encephalitis-associated hospital stays extracted using ICD-9-CM (1990–
1998) and ICD-10-AM (1999–2007) from the NSW Department of Health
Inpatient Statistics Collection library. Finally, a retrospective clinical audit was
performed, of all adult encephalitis admissions between July 1998 and
December 2007 to the three hospitals with adult neurological services in
northern NSW. Case notes were examined for evidence of relevant history
taking, clinical features, physical examination, laboratory and neuroradiology
investigations, and outcomes.
Results: Between 1979 and 2006 there were 1,118 encephalitis-associated
deaths in Australia, with an average annual death rate of 2.3 per million
population. The aetiology of 576 deaths was unknown and the proportion
of deaths due to ‘unknown’ encephalitis increased from 47.0% between
1979 and 1992, to 57.2% from 1993 to 2006. Encephalitis was the primary
discharge diagnosis for 5,926 hospital admissions in NSW with an average
annual hospitalisation rate of 5.2/100,000 population. Toxoplasma
encephalitis and subacute sclerosing panencephalitis showed notable
declines. The proportion of patients hospitalised with encephalitis and no
identified pathogen (69.8%, range 61.5%–78.7%) was stable during the
study period. Amongst patients admitted with an encephalitis diagnosis in
the NSW regional neurological hospital network, treating clinicians
suspected a specific causative organism in 18.9% of cases and a cause was
confirmed by laboratory testing in 12.1% of cases. However, only 14.9%
were tested for flaviviruses and tests for specific locally occurring zoonotic
encephalitis viruses were only conducted in 0.0-6.8% of cases.
Conclusions: The non-notifiable status of human encephalitis in Australia
and the high proportion of cases, including deaths, with no known
aetiology may conceal emergence of novel pathogens. Unexplained
encephalitis should be investigated, and encephalitis hospitalisations
should be subject to statutory notification to facilitate prompt public
health investigation and action as necessary. The utility of hospital
sentinel surveillance, and standardised diagnostic and testing algorithm is
currently being explored.
Retrovirology 2012, Volume 9 Suppl 1
http://www.retrovirology.com/supplements/9/S1
O10
Dengue virus-pandemic influenza virus co-infection results in enhanced
influenza virus replication through inhibition of apoptosis
Thomas G Voss*, Mei-Chun Chen, Gena J Nichols, Somanna K Naveen,
Benjamin T Bradley, Robert W Cross
Tulane University, School of Medicine, New Orleans, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):O10
Introduction: Dengue fever and Dengue Hemorrhagic fever in humans
are the result of infection with Dengue virus, a mosquito-borne member of
the Flaviviridae. In 2009, the appearance of a novel, swine origin,
pandemic (H1N1) influenza A virus in humans resulted in identification of
patients co-infected with dengue and influenza with enhanced clinical
disease. To elucidate potential mechanism(s) of enhanced pathogenesis
observed during human Dengue/Influenza co-infection, we examined the
effects of co-infection in cells (A549) and also in animals.
Materials and methods: A549 cells were infected with Dengue virus or
pandemic influenza A virus. Virus replication was measured by plaque
assay and immune fluorescence. Apoptosis was measured by multiple
assays including TUNEL, Annexin V expression, and Casapse 3 expression.
Ferrets were challenged with Dengue for 24 hours prior to influenza
challenge. Clinical disease was monitored for 10 days post Dengue
challenge. Nasal aspirates were collected and tissues harvested for
virology, immunology, and histology studies through the 10-day in life
period. Clinical chemistry and hematology were also measured on infected
ferrets.
Results: In A549, co-infection enhances influenza virus replication and
reduces dengue virus replication compared to singly infected A549.
Influenza-specific inhibition of dengue replication was dependant on
multiplicity of infection (moi) and timing of influenza infection with dengue
inhibition detected when influenza infection occurs up to 48 hours post
Dengue infection. Co-infected cell apoptosis was reduced suggesting a
mechanism for increased influenza virus loads. In ferrets co-infected with
dengue and pandemic influenza, influenza virus loads and clinical disease
signs compared to influenza infection alone were observed. In the lungs of
co-infected ferrets, apoptosis was reduced, confirming in vitro results. Our
results indicate a potential pathogenic interaction between dengue and
influenza viruses that models human co-infection cases.
O11
Potent suppression of HIV viral replication by a novel inhibitor of Tat
Guillaume Mousseau1, Mark A Clementz1, Wendy N Bakeman1,
Nisha Nagarsheth1, Michael Cameron2, Jun Shi3, Phil Baran3, Rémi Fromentin4,
Nicolas Chomont4, Susana T Valente1*
1
Department of Infectology, The Scripps Research Institute, Jupiter, Florida,
USA; 2Department of Molecular Therapeutics and Translational Research
Institute, The Scripps Research Institute, Jupiter, Florida, USA; 3Department of
Chemistry, The Scripps Research Institute, La Jolla, California, USA; 4Vaccine
and Gene Therapy Institute, Port St. Lucie, Florida, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):O11
Background: Tat, the HIV Trans-Activator of Transcription is a potential
antiviral target. Tat binds to the 5’ terminal region of HIV mRNAs stembulge-loop structure called the Trans-activation Responsive (TAR) element
and activates transcription from the HIV promoter. Plasma viremia
stubbornly persists in HIV-1 infected subjects despite receiving HAART,
suggesting that residual levels of viral production originate from an
integrated form of the HIV genome that is continuously transcribed at low
levels. As current antiretrovirals (ARVs) fail to inhibit transcription from
integrated viral genomes or viral production from stable cellular reservoirs,
novel classes of ARVs are needed to inhibit this process.
Results: Cortistatin A is a steroidal alkaloid isolated from the marine
sponge Corticium simplex. Here, we show that its analog didehydroCortistatin A (dCA) inhibits Tat-mediated trans-activation of the integrated
HIV provirus by binding specifically to the TAR-binding domain of Tat. dCA
reduces cell-associated viral RNA and capsid p24 antigen production in
acutely and chronically infected cultured and primary cells, at a half
maximal effective concentration (EC50) of 0.7 pM to 2.5 nM, depending on
the multiplicity of infection (MOI). dCA reduces both transcriptional
initiation/elongation from the viral promoter and alters the nucleolar
Page 10 of 54
localization of Tat. Termination of dCA treatment does not result in
immediate virus rebound as the HIV promoter is transcriptionally silenced.
dCA inhibits both HIV-1 and HIV-2, and displays high bioavailability. dCA
added to a combination of ARVs mediates a statistically significant
reduction in viral replication from primary CD4 + T cells isolated from
viremic patients compared to the ARVs alone, and abrogates low-level
virus replication from CD4 + T cells isolated from aviremic patients
undergoing HAART treatment.
Conclusions: With a therapeutic index of over 8000, dCA defines a novel
class of HIV anti-viral drugs endowed with the ability to decrease residual
viremia during HAART, and should be considered as a promising drug to
be included in therapeutic eradication strategies.
POSTER PRESENTATIONS
P1
In vitro study of the trans-epithelial crossing of HIV-1 through the
female genital mucosa and of the role of epithelial cells in the selection
of CCR5-tropic virus
R Terrasse*, O Delezay, A Brunon-Gagneux, L Heyndrickx, H Hamzeh-Cognasse,
B Pozzetto, T Bourlet
Gimap Ea3064, Saint-Étienne, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P1
Object: HIV heterosexual transmission mainly occurs by exposition of
female genital mucosa with infected male seminal secretions. The notion
of compartmentalization of HIV in the male genital tract is well established
by the demonstration of the existence of several viral populations between
blood and semen, especially in the gp160 viral envelope. The objectives of
the present work were (i) the study of the role of genital epithelial cells in
the heterosexual transmission of HIV and (ii) the in vitro modeling of this
crossing by using chimeric viruses (pBrNL4.3-eGFP/dsRedExpress) that
express the gp160 glycoprotein isolates from patients’semen.
Methods: Seminal samples that showed a positive viral load were selected
from 50 semen specimens obtained from 39 HIV-infected patients followed
at the University-Hospital of Saint-Etienne. Chimeric viruses were
constructed by cloning a pBrNL4.3 vector with a viral envelope containing
a GFP or a dsRedExpress fluorochrome. HEC genital epithelial cells were
infected by CXCR4-tropic (LAI) or CCR5-tropic (BaL) HIV-1 viruses (0.001
MOI per cell during 24h) in different conditions (presence or absence of
AZT or proinflammatory cytokines).
Results: Two days after infection, intracellular viral RNA was detected for
both virus strains (LAI and BaL) either in the presence or in the absence
of AZT. By contrast, the detection of proviral DNA (LTR) was observed
only for the CXCR4-tropic variant (500 ± 100 copies / 106 cells); the
addition of AZT abolished this infection. Neither intracellular viral proteins
nor extracellular viral RNA could be detected in infected cells.
Conclusion: These results confirm the selective sequestration of CXCR4tropic viruses by epithelial cells. Complementary analyses are ongoing for
determining the exact role of these cells in HIV-1 heterosexual transmission
and as a viral latency reservoir that could be reactivated under inflammatory
conditions. A confocal microscopy imaging using the chimeric viruses will
complete these preliminary results.
P2
MiRNA profile in CD4 positive T cells from HTLV-2 and HIV-1 monoand co-infected subjects
E Pilotti1*†, C Casoli1†, MV Bianchi1, F Bignami1, Francesca Prati2
1
GEMIB Laboratory, Parma, Italy; 2Hospital Santa Maria Nuova, Reggio Emilia, Italy
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P2
Introduction: The HTLV-2/HIV-1 co-infection has been shown to be
associated with a delayed progression to AIDS (Turci et al. 2007). Casoli
et al. (2007) have demonstrated the key role played by CCL3L1
chemokine, whose expression is induced by HTLV-2 infection, in slowing
down HIV-1 disease. MiRNAs (miRNAs) are small non-coding RNAs that
regulate fundamental cellular processes. Since HTLV-2 creates a cellular
environment favourable to itself and adverse to HIV-1, it is supposable
that host miRNAs profile can be modulated by HTLV-2 to this aim. Here,
we investigated the expression profile of miRNAs in HTLV-2 and HIV-1
Retrovirology 2012, Volume 9 Suppl 1
http://www.retrovirology.com/supplements/9/S1
mono-infected, in double infected, and HIV-1 exposed uninfected (MEU)
subjects.
Materials and methods: CD4+ T cells were purified from blood samples of
7 LTNP HTLV-2/HIV-1 co-infected, 5 HIV-1MEU, 7 HTLV-2/HIV-1MEU, 10 viremic
and 7 LTNP HIV-1 mono-infected individuals and 10 healthy donors as
controls. The expression profile of 377 miRNAs was obtained by real-time
quantitative PCR and 2-ΔΔCt method, by which the PCR signal of miRNAs
transcript in CD4+ T-lymphocytes from infected subjects were related to that
of healthy donors. By real time PCR, each cohort of subjects was also tested
for the expression of miRNA processing enzymes, Dicer and Drosha.
Results: Analyzing these miRNA identified by the comparison of the two
viral infection, 4 miRNAs (329, 337-5p, 379, and 503) were down-regulated
and 6 miRNAs (34a, 125a-3p, 155, 203, 449a, and 502-5p) were up-regulated
in both conditions, suggesting a retroviral exposure signature. HTLV-2/HIV1MEU subjects are characterized by a miRNA profile similar to that of healthy
donors, while a strong up-regulation of miRNA profile marked subjects
infected by o exposed to HIV-1. Dicer and Drosha expressions seem to
explain the miRNAs changes observed.
Conclusions: These findings enable us to better understand the potential
role of miRNAs in the development of resistance to HIV-1 infection by HTLV-2.
P3
Production and expression of recombinant anti-V3 scFvs from HIV-1
clade C infected Indian patient
Rajesh Kumar*†, Raiees Andrabi†, Ashutosh Tiwari, Somi Sankaran Prakash,
Naveet Wig, Durgashree Dutta, Anurag Sankhyan, Lubina Khan, Subrata Sinha,
Kalpana Luthra
All India Institute of Medical Sciences, New Delhi, India
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P3
Introduction: Neutralizing antibodies are an important component of the
humoral immune response directed against viral infections So far the few
available anti HIV-1 broadly neutralizing antibodies have a limited breadth
and potency against clade C viruses. More than 50% of the HIV-1 infections
worldwide belong to clade C. Clade C is the most prevalent subtype in India.
Materials and methods: A human scFv phage display library was
constructed from the peripheral blood mononuclear cells of an HIV-1 Clade C
infected Indian patient, having a good titre of serum neutralizing antibodies.
Diversity of the scFv library was checked by sequencing and DNAfingerprinting analysis of randomly selected clones from the preselected library.
One round of biopanning was done against V3 peptide of clade C and clade
B. Single chain fragments were checked for their soluble expression in E. coli
HB2151 and purfied using Ni+2 affinity colums. Specificity of the soluble scFvs
was checked by indirect ELISA. Single chain fragments were checked for their
stability in different agents like 30%DMSO. 4M NaCl, pH 2-11.
Results: 50 clones were randomly selected after biopanning and they were
checked for their binding to V3C and V3B peptides. In phage ELISA 15 out of
50 clones showed binding to both the V3 peptides. A 32kDa band was
observed in polyacrylamide gel electrophoresis as predicted. The expressed
product was confirmed by Western blot analysis using anti His Tag antibody.
Specificity of the purified scFvs was confirmed by their binding to V3 peptides
and no reactivity against other unrelated peptides. Further these scFvs
displayed a stable binding to V3 peptides in different denaturing agents.
Conclusions: This is the first study to generate human anti-V3 scFvs against
HIV-1 clade C. Further characterization of these scFvs for their neutralization
potential will help identify unique and shared epitopes responsible for
neutralization of clade C and non clade C viruses.
P4
Genetic variability and high proportion of HIV-1 BF1 recombinant
strains among vertically infected children in São Paulo, Brazil
Ana Carolina Soares de Oliveira*, Antonio Charlys da Costa,
Vanessa Pouza Martinez, Maria Teresa Maidana,
Giret Regina Celia de Menezes Succi, Ester Cerdeira Sabino Esper,
Georges Kallas, Sabri Saeed Sanabani
São Paulo Institute of Tropical Medicine, São Paulo, Brazil
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P4
Introduction: The enormous genetic variability of human immunodeficiency
virus type 1 (HIV-1) continues to present a major challenge for vaccine
Page 11 of 54
design and frustrate efforts to halt the epidemic. A proper understanding of
this phenomenon is a prerequisite for proper epidemiology, genetic
diagnosis, and successful drugs and vaccines. In this study, we undertook a
detailed molecular epidemiological investigation on HIV-1 vertically-infected
children born from 1993 to 2008 in the state of São Paulo, Brazil.
Material and methods: HIV-1 proviral DNA was extracted from the
peripheral blood mononuclear cells of 48 participants. The near full-length
genomic (NFLG) and partial fragments were determined by overlapping
nested PCR and direct sequencing. The data were phylogenetically analyzed.
Results: Of the 48 samples (median age 11.8 years, range 4-20.6 years)
studied, 3 (6.2%) NFLGs and 39 (81.2%) partial fragments were successfully
subtyped. Of the successfully subtyped sequences, 20 (47.6%) were subtype
B sequences, 17 (40.4%) BF1 recombinants, and 5 (11.9%) subclade F1. Two
of the partial BF1 chimeric isolates shared an identical recombination
structure. Predictions of viral tropism using the computer program
geno2pheno [co receptor] for phenotype prediction were determined for 15
subjects. X4 or X4 dual or mixed-tropic viruses were seen in 3 (20%) of
participants and the V3 sequences of 12 patient virus strains (80%) were
predicted to be R5-tropic virus.
Conclusions: Our data provided evidence of unexpectedly high proportion
of BF1 recombinants viruses transmitted from the first mother-to-child since
the earliest days of the epidemic to the present time in Brazil. These findings
offers additional insights to understanding the diversity of HIV-1 strains
currently circulating in Brazil, with future implications for diagnosis, therapy,
and efficient vaccine development.
P5
Next generation of antiretroviral agents targeting the RNA binding site of
the HIV-1 cellular cofactor DDX3: an innovative therapeutic approach
Giovanni Maga1*, Anna Garbelli1, Marco Radi2, Federico Falchi2,
Alberta Samuele1, Stefania Paolucci3, Fausto Baldanti3, Fabrizio Manetti2,
Sandra Beermann4, Ursula Dietrich4, Maurizio Botta2
1
Instituto di Genetica Molecolare, IGM-CNR Via Abbiategrasso 207, I-27100 Pavia,
Italy; 2Dipartimento Farmaco Chimico Tecnologico, University of Siena,Via Alcide
de Gasperi 2, I-53100 Siena, Italy; 3Molecular Virology Unit, Foundation IRCCS
Policlinico S. Matteo, piazzale Golgi, I-27100 Pavia, Italy; 4Georg-Speyer-Haus
Institute of Biomedical Research, Paul-Ehrlich-Str. 42-44, 60596 Frankfurt, Germany
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P5
Introduction: Efficacy of currently approved anti-HIV drugs is hampered by
mutations of the viral enzymes, leading invariably to drug resistance and
chemotherapy failure. Recent data suggest that cellular co-factors also
represent useful targets for anti-HIV therapy. We have recently provided
evidence for the possibility to block HIV-1 replication by targeting its cellular
cofactor DDX3.
Material and methods: Molecular modeling and in silico technologies
were applied to rationally design small molecules specifically targeting the
RNA binding site of human DDX3. Biochemical studies of mutated DDX3
enzymes were also used to identify additional potential drug binding sites.
Results: Optimization of compounds identified by application of a highthroughput docking approach afforded a promising lead compound which
proved to inhibit both the helicase and ATPase activity of DDX3 and to
reduce the viral load of peripheral blood mononuclear cells (PBMC) infected
with HIV-1. A novel interaction site has been also identified in DDX3, which,
when blocked, can reduce viral replication, representing an additional target
for small molecules inhibitors.
Conclusions: We have identified the first inhibitors of HIV-1 replication
targeting the RNA binding site of the cellular cofactor human DDX3. These
compounds may offer superior selectivity over the ATP-competitive inhibitors
previously developed. In addition, a novel RNA interacting motif specific to
DDX3 has been identified, opening new venues for HIV-1 drug development.
P6
Monoclonal antibodies that recognize important functional elements
of the HIV-1 integrase enzyme
Richard G Maroun1*, Farah Ammar1,2, Zeina Hobaika1, Loussinée Zargarian2,
Serge Fermandjian2
1
Unité de Biochimie, Faculté des Sciences, Université Saint-Joseph, CST-Mar
Roukoz, Beirut, Lebanon; 2ENS de Cachan, CNRS, Cachan, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P6
Retrovirology 2012, Volume 9 Suppl 1
http://www.retrovirology.com/supplements/9/S1
Aim: HIV integrase (IN) is a privileged target for antiviral treatments.
These induce the emergence of resistant strains, prompting the search
of new drugs. To better understand the relationships between
structure and function of IN and identify new anti-HIV inhibitors
we prepared antibodies recognizing the IN a4 helix that binds viral
DNA ends and contributes to the integration process and antibodies
recognizing a loop in between the a4 and a5 helices which participates
to the binding of LEDGF a protein that helps IN to anchor viral DNA.
Materials and methods: Polypeptide K159 (sequence 147-175 of IN)
was injected to mice. Several hybridomas producing monoclonal
antibodies (Mabs) were obtained Mabs were characterized by ELISA and
blotting techniques using peptide fragments, IN and viral DNA
sequences.
Results: We prepared two Mabs (Mab-a4 and Mab-loop) exhibiting high
affinities against the antigenic peptide K159 and IN. An epitope mapping
showed that Mab-a4 interacted with N-terminal segment (147-163) and
Mab-loop with the C-terminal (164-175). Mab-a4 blocked the interaction
of IN with viral DNA end, while the loop segment 164-175 recognized by
the Mab-loop constitutes a strong epitope also found in African
seropositive patients. Spectroscopic studies of the antibody-antigen
complexes are under progress. Crystallization of the Fab moiety of Maba4 has been recently obtained.
Conclusions: We showed that the important immunogenic properties
demonstrated by the a4 helix and the loop 164-175 coincided with
their important functional properties in IN. We wish to collect details on
the interactions and the energies stabilizing these complexes and
compare them with those stabilizing the complexes with their
biological targets (DNA, LEDGF). Finally at a medical level, these Mab
could be used as valuable tools for HIV diagnostics in ELISA or western
blot assays.
P7
The orally bioavailable allosteric CXCR4 HIV-1 entry inhibitor
AMD11070
Simon Fricker1, Renee Mosi2, Virginia Anastassova2, Jean Labrecque2,
Rebecca Wong2, Renato Skerlj1, Gary Bridger1, Dana Huskens3,
Dominique Schols3*
1
Genzyme Corporation, Framingham, MA, USA; 2Formally of AnorMED Inc.,
Langley, BC, Canada; 3Rega Institute for Medical Research, University of
Leuven, Leuven, Belgium
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P7
In order to enter and infect human cells HIV must bind to the CD4
receptor in addition to either CXCR4 or CCR5. AMD11070 was the first
orally available small molecule inhibitor of CXCR4 to enter the clinic.
Here, we report in detail the molecular pharmacology of AMD11070
which is a potent inhibitor of X4 HIV-1 replication in various CD4 + T
cell lines, CXCR4-transfected cell lines and in PBMC (IC50 values of 14
± 3 nM). In addition, AMD11070 potently inhibited cell fusion between
a CHO-K1 cell line expressing viral gp120 and the P4-R5 MAGI cells
which express CD4 and CXCR4 with an IC50 of 1.5 ± 0.3 nM. No
antiviral activity was observed with AMD11070 against CCR5-using (R5)
HIV-1 replication. Using CD4 + T cell lines that endogenously express
CXCR4 we demonstrate that AMD11070 is an antagonist of CXCL-12
(SDF-1a)-ligand binding (IC50: 12.5 ± 1.3 nM), inhibits CXCL-12mediated signaling (IC50: 9 ± 2 nM) and that it inhibits CXCL-12mediated chemotaxis (IC50: 19 ± 4 nM). AMD11070 does not inhibit
chemokine-induced Ca2 + -signaling in cells expressing CXCR3, CCR1,
CCR2b, CCR4, CCR5 or CCR7, demonstrating the compound selectivity
for the CXCR4 receptor. In addition, AMD11070 is able to inhibit the
SDF-1beta isoform interactions with CXCR4 and N-terminal truncated
variants of CXCR4 with equal potency as to the wild type CXCR4
receptor. These data indicate that AMD11070 is an allosteric antagonist
of CXCR4. A proof-of-concept clinical trial has shown that AMD11070
can reduce the viral load of X4 HIV-1 in HIV-1-infected persons.
Together these data further support to the potential beneficial role of
orally bioavailable CXCR4 inhibitors as a therapeutic option for HIV/
AIDS treatment.
Page 12 of 54
P8
Human beta-defensins induce APOBEC3G expression by interacting
with chemokine receptors, protecting highly susceptible cells from
HIV infection
Alfredo Garzino-Demo*, Mark K Lafferty, Jennifer Bharucha, Lingling Sun,
Walter Royal, Suzanne Gartner, Wuyuan Lu
Institute of Human Virology, U. Maryland School of Medicine, Baltimore, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P8
ß-defensins are antimicrobial peptides secreted by epithelial cells that can
bind to cellular receptors. CCR2 and CCR6 are the two cellular receptors
known to bind human ß-defensin (hBD) 2 and -3. Both of these receptors
are of crucial relevance in HIV infection. CCR6 is expressed, often in concert
with CCR5, on cells that are highly susceptible to HIV infection: memory
T cells, Th17 cells, a4ß7+ cells, and defects in CD4+CCR6+ cells have been
associated with faster AIDS progression. CCR2 is expressed on monocytes
and macrophages, cells that are reservoirs of HIV infection and that are
known to mediate central nervous system damage. Our studies show that
hBD2, hBD3, and CCR6 ligand MIP-3a/CCL20 inhibit HIV infection via CCR6
by increasing expression of the antiviral protein APOBEC3G. This increase is
due to a transcriptional mechanism mediated by intracellular signaling.
hBD2 also inhibits HIV replication in macrophages that express CCR2. Our
findings suggest novel therapeutic and preventive approaches that exploit
CCR6 and CCR2-mediated intracellular signaling to inhibit HIV infection in
highly susceptible cells.
P9
Three-dimensional modeling of DCIR and identification of new drugs
blocking HIV-1 attachment and propagation
Caroline Gilbert*, Arezki Azzi, Alexandra A Lambert, Sheng-Xiang Lin,
Geneviève Allaire, Karianne P St-Gelais, Michel J Tremblay
Laval University, Québec, Canada
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P9
Introduction: The HIV-1 pandemic continues to expand while no
effective vaccine is yet available. Finding new therapeutic targets and
drugs is therefore crucial. We have previously shown that the dendritic
cell immunoreceptor (DCIR), a C-type lectin receptor expressed in
dendritic cells (DCs), acts as an attachment factor for HIV-1 to DCs and
contributes to HIV-1 transmission to CD4+ T lymphocytes (CD4TL). Directly
involved in HIV-1 infection, DCIR is expressed in apoptotic or infected
CD4TL and promotes trans-infection to bystander cells. The aim of the
present study is to characterize the extracellular domain of DCIR and to
test chemical inhibitors of HIV-1 attachment thereto.
Results: We present the first three-dimensional model of DCIR structure.
Based on this structure, several inhibitors were selected to target
viral interaction with the carbohydrate recognition domain and the
EPS motif. Preliminary screening using Raji-CD4-DCIR cells identified
two inhibitors that decreased HIV-1 attachment and propagation. These
inhibitors did not affect the proliferation of peripheral blood
mononuclear cells.
Conclusions: The results of this study thus suggest structures for novel
molecules capable of blocking HIV-1 transmission by DCs and CD4TL.
P10
Nevirapine-associated liver toxicity and hypersensitivity reactions in
a cohort of HIV-1-infected patients,clinical analysis
Sylvie Jonckheere*†, JC Yombi†, Leila Belkhir, Anne Vincent,
Bernard Vandercam
Medecine Interne Infectiologie at Centre Refrence St Luc Ucl, Bruxelles,
Belgium
Retrovirology 2012, 9(Suppl 1):P10
Introduction: Antiretroviral drug-related liver injury is a common cause
of morbidity and treatment discontinuation in HIV-infected patients.
Nevirapine is incriminated as one of the liver toxicity inducer especially in
Retrovirology 2012, Volume 9 Suppl 1
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patients with high CD4-cells count. The purpose of our study was to
analyze the role of CD4 cell count at treatment initiation and that of
several co-factors (Hepatitis C or Hepatitis B virus co-infection, concurrent
use of protease inhibitors) on the incidence of liver toxicity and
hypersensivity reactions induced by Nevirapine in our HIV1-infected
patients.
Material and method: We analyzed retrospectively a cohort of 930 HIV-1
infected patients. Patients, who were started on NVP between 1998 and
2003, regardless of CD4-cells count, were included. We assigned patients
to two groups: (A) group with high CD4-cells counts (women with CD4
cells ≥ 250 cells/mm³ and men with ≥ 400 cells/mm³), and (B) group with
low CD4-cell counts. Liver toxicity is considered severe when at least a
grade 3 toxicity is observed (WHO classification).
Results: In total 108 patients were included. Eight (7.40%) and 15 (13.9%)
patients interrupted treatment because of severe liver toxicity and
hypersensitivity reactions respectively. There was no overlap between these
two groups, and hypersensitivity reactions tended to occur sooner (22 vs
45 days respectively). HCV and HBV co-infection rates were 7.4% and 8.33%.
Severe liver toxicity was seen in 15.74% of patients. Comparing group A and
B, rates of severe liver toxicity were 15.68% and 17.30% respectively. There
was no significant difference. In a multiple linear regression model, we
found viral hepatitis C co-infection to be the only independent risk factor in
the occurrence of liver toxicity (p<0.006).
Conclusion: In our study the rate of severe liver toxicity due to NVP was
high. HCV co-infection was an independent risk factor for liver toxicity,
contrary to CD4 cell counts at treatment initiation. These findings are in
keeping with recent published data. A careful analysis of the literature
shows that hypersensitivity reactions due to NVP are strongly correlated
with high CD4 cell counts. The limitation of our study is the low number
of patients included.
P11
Immunological response after initiation of second line anti-retroviral
therapy in HIV patients
Basavaprabhu Achappa*†, Keerthi Pillai†, John T Ramapuram, Satish B Rao,
Deepak R Madi, Unnikrishnan
Kasturba Medical College, Manipal University, Mangalore, India
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P11
Introduction: Treatment with second line ART is initiated when the first
line therapy fails. There is less experience with the immunologic response
for second-line ART for adults. Hence this study was done to find out the
immunological response after initiation of second line ART by analysis of
CD4 counts.
Methods: This retrospective study was conducted in a tertiary level
hospital attached to a medical college that caters to a large number of
HIV positive patients. The study population for this analysis included all
HIV positive individuals who were undergoing second line ART treatment.
The data was collected using semi-structured pre-tested proforma from
the hospital records of HIV positive individuals. The immunological
response after the initiation of second line ART was analyzed using the
CD4 cell counts taken at intervals of 3 months and 6 months after the
initiation.
Results: Out of the 32 patients studied, 27(84.4%) were males and only 5
(15.6%) were females. Mean age of the patients was 40.56±6.78 years.
The mean CD4 value at initiation was 152.35±142.89 cells/μL, which
significantly increased to 324.43 ±163.65 cells /μLby 3 months after
initiation (p value= .000) and to 348.21± 253.57 cells /μLby 6 months
after initiation.Around 91.3% of patients had a baseline CD4 T cell count
<350 cells L-6. After 3 months of therapy, 65.2% of patients and after
6 months 46.2% had a baseline CD4 T cell count <350 cells /μL.The mean
weight at initiation was 50.548± 11.37 kg, which very significantly
increased to 53.30± 11.1 kg by 3 months of therapy (p = .001, table 1)
and to 54.63 ± 10.29kg at the end of 6 months.
Conclusion: The CD4 counts increase very significantly within the first 3
months of initiation of second line therapy.The rise in CD4 count
between 3 months and 6 months is not as statistically significant as the
earlier one. Also, there is significant gain in weight within 6 months of
initiation of second line therapy.
Page 13 of 54
P12
Immunological effect of ten-year c-ART in treatment-naive and pretreated HIV-1 patients in Bulgaria
Ivaylo Elenkov1†, Maria Nikolova2*†, Ivanka Radeva1, Margarita Yankova1,
Nina Yancheva1
1
Specialized Hospital for Active Treatment of Infectious and Parasitic
Diseases, Sofia, Bulgaria; 2Clinical Immunology at National Center of
Infectious and Parasitic Diseases, Sofia, Bulgaria
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P12
Introduction: Highly effective combination anti-retroviral therapy (c-ART)
has been applied in Bulgaria since 1999. The aim of the present study
was to compare retrospectively the long-term immunological effect of cART in treatment-naïve and pre-treated HIV-1+ patients.
Patients and methods: The study included HIV-1+ patients (n=56) that
have started c-ART between March 1999 and December 2001, have been on
continuous treatment, with good adherence, death being the only reason
for ART stop. Of them, 27 had a history of irregular pre-treatment with AZT
or AZT/LMV for an average of 4.6 yrs (Group A), and 29 were ART-naïve
(Group B). CD4 absolute counts (AC) were determined by single-platform
flow cytometry (BD Biosciences). Viral load (VL) was measured by RT-PCR
(Roche). Comparisons were performed by unpaired t-test (SPSS 17.0).
Results: The demographic characteristics of groups A and B did not differ
significantly: mean age (yrs): 34 vs. 35; male to female ratio: 9 vs. 7,
respectively. Baseline CD4 AC (cells/ml) and VL (log HIV RNA copies/ml)
were comparable: mean 124 vs. 119, and 5.1 vs. 4.6, respectively, (p>0.05
for both comparisons). In the long term, suppression of viral replication
was observed in both groups: mean VL at 5 yrs 3.7 vs. 3.1 for groups A
and B, respectively, (p>0.05). However, treatment-naïve patients (group B)
had a better immune recovery than group A, and the difference became
significant in the long term: mean CD4 AC 177 vs. 252 after 6 months of
c-ART, (p>0.05), 391 vs. 240 at 2 yrs (p
Conclusion: Similarly to other studies, (SHM Monitoring report, 2009), a
more complete and lasting long-term immunologic response to c-ART
was observed in treatment – naïve patients. According to us, a previous
sub-optimal and irregularly applied ART regimen, may promote the
selection of gradually outgrowing drug-resistant viral strains,
compromising therapeutic efficacy in the long run.
P13
Use of new targets (D-Mannose receptor, sodium channel voltage
dependent) in a new effective, low cost HAART. Validation with the
presentation of a clinical case
Adrien Caprani1*, Guy MK Tran2, Laurent Roudiere3
1
Alternative Therapies-Basic Science at Association Positifs, Vidauban, France;
2
Clermont-Ferrand University, Hospital Hotel-Dieu, Public Health, ClermontFerrand, France; 3Hopital Pitie Salpetriere, Paris, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P13
Background: Neglected data more or less recent, showed that the
voltage-dependent sodium channel (Tran MKG) and the Mannose
receptor [Bandivdekar AH 14°ISHEID Toulon 2006 (PP 2.14); J Acquir.
Immune.Defic.Syndr.2008,Virology.2008] are involved in the transmission
of HIV. In particular, the mannose Receptor seem essential for contamination since in a discordant couple, the uninfected male partner
does not own this receptor (14° ISHEID, Bandivdekar A.H.). From these
facts we have experienced a patient of 68 years, HIV + since 28 years,
under active antiretroviral therapy (Epivir, Reyataz, resveratrol) (another
presentation at this conference), the following chemotherapy: Epivir
(150mg 2daily), resveratrol (500mg 2daily), D-Mannose (1 g 3daily),
Omacor (1 g 2daily). Indeed it is known that omega-3fatty acids bind the
Na+ channel. Resveratrol has an anti TaT activity (Zhang HS, 2009) and a
synergy with nucleoside analogues ((HerediaA, 2008.)
Methods: Measurements of viral load, CD4 and CD8 and other usual
blood parameters were followed during 9 months, every month.
Results: Our results show that over a period of 9 months the patient
remains undetectable and CD4 count increases significantly from the one
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of the previous therapy (557+/-43 vs 478+/- 35). Besides, it seems that the
CD4/CD8 ratio tended to increase (0.61 vs 0,56 ). Moreover strong
activation of the immune system almost always observed among patients
HIV+ is standardized at this patient (CD3+/HLADR+ 7%) and the NK
strongly increase (24%).
Conclusion: Our results show the feasibility of HAART including Epivir,
resveratrol, D-mannose, and omega3 fatty acids. In addition control of
dyslipidemia induced by orthodoxic anti retrovirals should be unnecessary.
These results paves the way for clinical trials with effective, low toxicity
and low cost agents. Moreover the fact that mutations on the Mannose
receptor and sodium channel (cell structures) are unlikely, make the
appearance of resistance to such therapies unlikely.
P14
Polymorphims of innate immunity genes influence disease progression
in HIV-1 infected children
Riccardo Freguja*, Ketty Gianesin, Marisa Zanchetta, Francesco Carmona,
Sandro Malacrida, Osvalda Rampon, Carlo Giaquinto, Anita De Rossi
Researcher at University of Padua, Padua, Italy
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P14
Introduction: Toll-Like Receptors (TLRs) and Defensins play a crucial role
in host’s innate immune response. Genetic variations in Defensins and
TLRs may affect host-virus interactions and impact HIV1 disease
progression, particularly in infants who acquire immune infection when
adaptive immune response is still under development.
Methods: The study was performed in 95 perinatally HIV1 infected
children followed since birth. The endpoint was the onset of disease (stage
C) or initiation of highly active antiretroviral therapy. The median
(interquartile) followup from birth to endpoint was 87 (46-134) months.
Single nucleotide polymorphisms (SNPs) on Beta-defensin1 (DEFB1
-44C>G;-52G>A), and TLR9 (1174G>A;1635A>G) genes were identified with
TaqMan allelic discrimination assay. The probability of acquiring disease
was calculated with Kaplan-Meier method. Hazard ratios and their 95%
confidence interval (95% CI) based on the Cox proportional hazards model
were estimated to test the association between genotypes, haplotypes and
risk of stage C.
Results: TLR9 1635AG genotype was associated with rapid disease
progression with both KaplanMeier (p=0.008) and Cox analysis (p=0.009),
while DEFB1 -44CG genotype was associated with slower disease
progression with both KaplanMeier (p=0.020) and Cox analysis (p=0.024).
Notably, TLR9 [G;G] haplotype, previously associated with a higher risk of
mother-to-child transmission of HIV1 (MTCT), was also found to be
associated with rapid disease progression (p=0.033). In addition, DEFB1 [G;
G] haplotype, found to be protective against MTCT, was associated
(p=0.016) with a better clinical outcome in HIV1 infected children.
Conclusions: Overall, these findings support the role of innate immunity in
pediatric HIV1 pathogenesis. Specific SNPs in DEFB1 and TLR9 genes may
affect the functional ability of their encoded proteins to modulate innate
immunity, thus contributing to the variability of clinical outcome in HIV1
infected children.
P15
Emergence of IFN-alpha TRAIL-expressing killer pDCs (IKpDCs) as a
consequence of a crosstalk with NK cells. Influence of HIV-1 infection
and implication of HMGB1
Marlène Bras*, Héla Saidi, Pauline Formaglio, Marie-Thérèse Melki,
Marie-Lise Gougeon
Institut Pasteur, Paris, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P15
Background: Plasmacytoid dendritic cells (pDCs) mainly contribute to
antiviral immunity through recognition of viral components resulting in
the production of type-I interferon (IFN), a powerful innate antiviral
cytokine. IFN-alpha production by pDCs is promoted by a cross-talk with
NK cells, that triggers in return the cytotoxicity of NK cells. Given the
essential role of pDCs and NK cells in viral control, we addressed the
Page 14 of 54
question of the impact of HIV on NK-pDC cross-talk, and the consequences
on viral innate immunity.
Methods: pDCs and NK cells were negatively sorted from PBMC of
healthy donors. NK cells were kept either unstimulated (rNK) or activated
with PMA/ionomycine for 2 hrs (aNK). pDC were either uninfected or
infected with R5-HIV-1 BAL (pDCHIV) and cocultured with NK cells at
different ratios for 24 h. The fate of both cell types was studied by
multiparametric flow cytometry combined to Multianalyte Profiling
technology.
Results: HIV-1-infection of primary pDCs induced their maturation,
characterized by the expression of maturation markers (HLA-DR, CD80,
CD83, CD86) and the homing receptor CCR7. In addition, HIV-1 triggered
the emergence of IFN-induced TRAIL expressing killer pDCs. The crosstalk
of pDCHIV with aNK cells strongly increased the differentiation of pDCs
into killer pDCs. Interestingly, the alarmin HMGB1, secreted by pDC upon
HIV-1 infection, seems to be important in this cross-talk, since its
modulation altered pDC maturation and the emergence of IKpDCs. At high
concentrations of HIV-1, pDCs were able to activate rNK cells, as assessed
by CD69 expression, and to induce IFN-gamma and TNF-alpha expression
as well as perforin degranulation by aNK cells.
Conclusion: We report for the first time that NK-pDCHIV crosstalk
potentiates the emergence of TRAIL-expressing IFN-alpha-producing pDCs,
and also triggers beta-chemokines synthesis and NK cell killing activity in a
HMGB1 dependent manner. Overall these data suggest that the dialogue
of HIV-infected pDCs with NK cells favors the emergence of both killer pDC
and cytotoxic NK cells and promotes host innate immunity through the
activation of potent antiviral effectors.
P16
Naive CD8+ T cells from ART respond to primary vaccination against
autologous HIV-1 antigen
Kellie N Smith1*, Robbie B Mailliard2, Weimin Jiang2
1
University of Pittsburgh School of Medicine, Department of Molecular
Virology and Microbiology, Pittsburgh, USA; 2University of Pittsburgh
Graduate School of Public Health, Department of Infectious Diseases and
Microbiology, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P16
Introduction: Antiretroviral therapy (ART) decreases HIV-1 viremia and
AIDS-associated mortality. Despite this, HIV infected patients are unable to
clear virus during treatment interruption due to insufficient cytotoxic T cell
(CTL) activity against the autologous reservoir. It is unclear if naïve T cells
from patients on ART can respond to immunotherapies that induce CTL
specific for their own, unique virus. Unfortunately, late-evolving virus and
the ART reservoir contain escape epitope variants that confer a lack of CTL
control. We hypothesize that a dendritic cell (DC)-based immunotherapy
during ART can induce CTL capable of eliminating the autologous
reservoir, despite their failure to do so during natural infection.
Materials and methods: We use a naïve T cell flow cytometry panel to
evaluate changes in the naive CD4+:CD8+ T cell ratio before seroconversion,
during untreated infection, and after ART in an HIV infected subject. We
then use this panel to isolate naive CD4+ and CD8+ T cells from this patient
during ART and from HIV negative donors. These purified naive T cells are
then used in an in vitro model of dendritic cell (DC) vaccination at their in
vivo ratios to induce primary IFNg-producing CTL against autologous HIV-1
Gag, Env, and Nef peptide antigens derived from ART.
Results: Although partial immune reconstitution occurs during ART, we
observed a disproportionate recovery in the naïve CD4+:CD8+ T cell ratio
compared to pre-infection. Despite this, we show that naïve CD4 + and
CD8+ T cells from ART, when primed at their skewed in vivo ratio against
late-acquired, “escape” epitope variants, differentiate into IFNg-producing
CTL comparable to those induced in pre-seroconversion T cells.
Additionally, we show that primary CTL responses induced during ART are
comparable to those observed in HIV negative donors. Figure 1.
Conclusion: These data indicate that, despite a disproportionate recovery in
the naive CD4+:CD8+ T cell ratio, DC vaccination of naïve T cells from ART
can induce CTL specific for autologous “escape” HIV-1 variants, and that
these naive T cells can respond to primary vaccination at a level similar to
pre-infection. These data support the use of DC immunotherapies in HIV
infected patients on ART.
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Page 15 of 54
Figure 1(abstract P16)
P17
Universal mapping of humoral immune response using a versatile
high-content and high-density peptide microarray
Ulf Reimer1*, Nikolaus Pawlowski2, Janina Seznec2, Tobias Knaute2,
Paul von Hoegen2, Holger Wenschuh2, Dan H Barouch2
1
Jpt Peptide Technologies, Berlin, Germany; 2Division of Vaccine Research,
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
02115, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P17
Background: Humoral immune responses are often the hallmark of
efficient vaccines. The recent RV144 vaccine trial has turned attention to
the stimulation of humoral immune response as a potential mode of
action for HIV vaccines. Therefore, detailed monitoring of antibody
reactivities in patient specimens before and after vaccination is crucial.
The determination of these reactivities on a sub-protein level provides
information on the site of antigen/antibody interaction. In contrast to
assays relying on whole antigens such as ELISA, peptide microarrays are
efficient tools to deliver such information. Besides, complex peptide
libraries can cover HIV sequence diversity, a special challenge provided
by this virus.
Materials and methods: Based on the sequence database of LANL a
complex peptide library of more than 6500 peptides was generated. The
peptides were synthesized and printed onto glass slides.
Initial incubations with serum samples of non-human primates from
vaccination studies were performed and evaluated.
Results: The peptides span the immunogenic regions of the HIV
proteome including full-length ENV, NEF and fractions of GAG, POL, TAT,
REV and VIF and allow an overall coverage above 50% of all HIV
sequences. Each clade (A, B, C, D, G, CRF1 and CRF2) is represented by at
least one sequence. Additional sequences were added to improve
coverage.
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Experimental data for serum samples from vaccination trials allow
the identification of antibody reactivities following vaccination. The
representation of different clades allows a detailed evaluation of
specificity for the raised antibodies.
Conclusion: High-density high-content peptide microarrays can tackle
the tremendous sequence diversity of HIV and deliver information on
clade-specific antibody response. This enables monitoring of humoral
immune response in HIV patients independent of geographical origin and
to study a broad range of different vaccines. The results can shed light
on the underlying protective mechanisms of vaccinations.
P18
Evaluation of the accuracy of primary CD4 gating in Senegalese
individuals coinfected with HIV and tuberculosis
Abdoul Aziz Diallo*, Aliou Niang, Géraldine Daneau, Joséphine Khady Badiane,
Makhtar Camara, Abdoul Almamy Hane, Luc Kestens, Souleymane Mboup,
Tandakha Dieye
Laboratory of Bacteriology, Dakar, Senegal
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P18
Background: The classic multiparameter measurement of CD4+ T cells
(standard method) by flow cytometry is complicated and expensive for
resource-limited countries. Simpler and less expensive methods like primary
CD4 gating have been described but must be evaluated in patients where
an overestimation of CD4 can be measured due to monocytes. To address
this issue, we compared primary CD4 gating with the standard method in
individuals coinfected with HIV and tuberculosis where the risk of CD4 T cell
overestimation exists.
Methods: Ninety eight patients were recruited, including 32 individuals
infected with HIV alone (control group) and 66 individuals coinfected. Each
fresh blood sample was analyzed within 6 hours with the fACSCalibur
cytometer (Becton Dickinson) in the laboratory of Bacteriology-Virology of
Le Dantec hospital in Dakar, Senegal. For each sample, 2 Trucount tubes
were used: one for the standard method containing anti-CD3 FITC, antiCD4 PE and anti-CD45 PerCP monoclonal antibodies, and the other tube
for the primary CD4 gating method containing only the anti-CD4 PE. Linear
regression and Bland-Altman tests were used for statistical analysis.
Results: The correlation of absolute CD4 T cell counts obtained by primary
CD4 gating and the standard method was high for the HIV control and
HIV-TB coinfected groups (R2 = 0.9897 and 0.9795, respectively). The mean
bias was 15 cells/μl for the control group and 16 cells/μl for the coinfected
group. For the interval < 200 cells/μl, the correlation is R2 = 0.9978 and
0.8327 (mean bias for both less than 7 cells/μl); for 200 - 500 cells/μl, the
correlation was R2 = 0.8112 and 0.9624 (mean bias for both less than
2 cells/μl); for > 500 cells/μl, the correlation was R2 = 0.9809 and 0.9841,
(mean bias for both less than 72 cells/μl).
Conclusions: Primary CD4 gating is an affordable and accurate method
for CD4 counting. With one antibody, it has the potential to be an
effective alternative to complex panels for resource-limited countries.
However, because of the intensive manual data analysis required, a
highly skilled operator is necessary.
P19
A high dimensional immune monitoring model of HIV-specific CD8
T cell responses accurately identifies subjects achieving spontaneous
control of viral replication
Zaza M Ndhlovu*, Lori B Chibnik, Jacqueline Proudfoot, Seanna Vine,
Ashley McMullen, Kevin Cesa, Donna Marie Alvino, Alicja Piechocka-Trocha,
Philip L de Jager, Daniel E Kaufmann, Bruce D Walker
Ragon Institute of Mgh, Mit and Harvard, Charlestown, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P19
Introduction: A major challenge in HIV vaccinology is the development
of appropriate immune monitoring models to determine vaccine efficacy.
Studies of HIV-specific CD8 T cells (CTL) suggest that these responses play
an important role in infected individuals capable of spontaneous viral
control (HIV elite controllers) and that they will likely play a role in
Page 16 of 54
immune interventions. However, no single CTL assay is uniquely
associated with the controller phenotype.
Method: We compared functionality of HIV-1-specific CTLs in individuals
with spontaneous viral control and subjects with treated or untreated
progressive infection. A model integrating multiple features of epitopespecific CTL responses that delineate HIV controllers from subjects with
treated or untreated progressive infection was built.
Results: Area Under the Receiver Operating Characteristic (ROC) Curve
showed that proliferative capacity, absolute early cytokine production and
kinetics of cytokine secretion were all associated with HIV control.
However, only integrated modeling of these different dimensions of data
allowed reaching the remarkable 90% accuracy, which was validated in
separate cohorts.
Conclusions: Our results suggest that while the search for a common
determinant of protective immunity remains elusive, combining
parameters generated by various well-established assays in models that
can be iteratively refined may have important applications for predicting
disease outcome and for immune monitoring of HIV-1 vaccine trials.
P20
The levels of apostosis markers in different HIV infected patients
groups
Ilze Eksteina*†, Valentina Sondore†, Baiba Rozentale, Andrejs Ivanovs,
Inga Januskevica, Gunta Sture , Ludmila Viksna
Infectologist at Infectology Center of Latvia, Riga, Latvia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P20
Introduction: HIV-1 infection is characterized by a progressive loss of CD4+
T cells. The role of apoptotic processes was identified recently, but a limited
information is available so far. The aim of this study was to compare levels
of apoptosis markers - cytokeratin 18 neoepitope (CK18) and cytochrome C
(CC) in different HIV infected patient groups.
Methods: There were 69 HIV infected patients enrolled in the study and
divided into four groups according to CD4+ T cell count and presence of
opportunistic infections (OI): 19 patients with CD4+ T cell count above
200 c/mcl without OI, 15 patients with CD4+ T cell count below 200 c/mcl
without OI, 7 patients with CD4+ T cell count above 200 c/mcl with OI,
28 patients with CD4+ T cell count below 200 c/mcl with OI. Opportunistic
infections included tuberculosis, cryptococcosis, CMV infection, PCP. The
serum levels of cytokeratin 18 neoepitope and cytochrome C were
determined. Comparisons between groups were made using paired T- test.
Results: CC levels were not significantly different between groups with
CD4+ cell count above and below 200 c/mcl (with opportunistic infections
0,5>p>0,4, without opportunistic infections p=0,5). Levels of CC were not
significantly influenced by presence of opportunistic infections (with CD4+
cell count above 200 c/mcl p=0,6, with CD4+ cell count below 200 c/mcl
p=0,7). We found significant diference of CK18 levels between group
without opportunistic infections and CD4+ cell count above 200 c/mcl
(210,58 ±26,98 u/l) and group without opportunistic infections and CD4+ cell
count above 200 c/mcl (132,95±14,09 u/l), p=0,02, as well as between group
without opportunistic infections and CD4 + cell count below 200 c/mcl
(132,95±14,09 u/l) and group with opportunistic infections and CD4+ cell
count below 200 c/mcl (174,56±20,83 u/l), 0.02>p>0.01.
Conclusion: The results obtained from our study demonstrate elevation
of levels of apoptosis serum markers early in HIV infection which
anticipate further decrease of CD4 cell count.
P21
Immune reconstitution inflammatory syndrome (IRIS) in HIV positive
patients initiated on antiretroviral therapy (ART)
Basavaprabhu Achappa*, Deepak Madi Unnikrishnan, B Anand Venugopal
Kasturba Medical College Hospital, Mangalore, India
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P21
Background: IRIS is defined as ‘occurrence or manifestation of new
opportunistic infections or existing opportunistic infections within six
weeks to six months after initiating antiretroviral therapy with increase in
CD4 count’. The objective of this study was to determine profile of IRIS in
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HIV Positive patients after initiation of ART and correlation of IRIS with
CD4 count.
Methods: This was a case control study done on HIV positive patients
newly initiated on ART at KMC hospital, Mangalore. IRIS was diagnosed
based on National Aids Control Organization Guidelines. Cases were
defined as those who developed IRIS after initiation of ART and controls
who did not develop IRIS.
Results: 40 cases and 80 controls were studied between May 2008 and
May 2010, who were newly initiated on ART during this period. The
cases and controls were compared based on age, sex, and initial CD4
count, final CD4 count, duration of ART, ART regimen, opportunistic
infections and their relationship to CD4 count were analyzed. Mean age
of patients who developed IRIS was 36 years. 75% of these patients were
men and remaining 25% were females. Initial mean CD4 count was 135
and CD4 count at development of IRIS was 239. The mean duration of
ART following which IRIS developed was 4 months. 65% of patients were
on Lamivudine+Stavudine+Nevirapine regimen, 25% were on Zidovudine
+Lamivudine+Nevirapine, 7.5% were on Stavudine+Lamivudine+Effavirenz,
2.5% were on Zidovudine+Lamivudine+Effavirenz.
Most common opportunistic infection occurring as IRIS was pulmonary
tuberculosis followed by tubercular lymphadenitis and pneumocystis
jheroveci pneumonia. Other opportunistic infections seen were
oesophageal candidiasis, isospora duodenitis, CMV Retinitis, cryptococcal
meningitis, herpes zoster. Tuberculosis accounted for 52.5% of cases of
IRIS.
Conclusion: Most common IRIS was tuberculosis followed by
pneumocystis. Tuberculosis as IRIS occurred 2.5 months after initiation of
ART. There was weak correlation between low CD4 count at ART initiation
and occurance of IRIS.
P22
A review of probiotics studies in HIV research suggests improved
immunological presentation and preservation of viral host restrictive
factors of TH17 in HIV patients
M Selbovitz*, Keller, Miller, Moore, Farmer, Bray
Health Action, Bronx, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P22
Background: Recovery of gut mucosal immune system is slow and
incomplete during HAART therapy, leading to elevated inflammation rates,
increased mitochondrial damage and the pathogenesis of replicatively
competent escape mutations. A recent study of Ganeden BC30, Bacillus
coagulans GBI-30, demonstrated safety, increased CD4+ counts in patients
on HARRT, and a significant increase in CD69 and maturation of dendritic
cells in vitro. Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14
demonstrate efficacy in treating naïve HIV patients against gastrointestinal
and urogenital infections . Restoration of viral host restrictive factors of
Th17 cell lines in GALT may prevent the evolving viral diversity, provoking
increased CD4 presentation and regulation of inflammatory cytokine levels
responsible for increased viral replication.
Methods: Metagenomic sequencing analysis has shown alternations in
intestinal microbiota in HIV patients. Measurements of immunological
parameters including Serum cytokine levels and total serum IgE levels
(CD4 lymphocyte count, CBC, levels of TNFα, NFAT, IL-12, IL-10, and G-CSF
[Kim, et. al. 2006]) were measured in studies reviewed here.
Results: A recent study of Ganeden BC30, bacillus coagulans GBI-30,
6086 demonstrated safety, and an increase in %CD4, a significant
increase in CD69 activation and maturation of dendritic cells in HIV
patients on HARRT and improvement in GI function. Lactobacillus
rhamnosus GR-1 and Lactobacillus reuteri RC-14 have demonstrated
efficacy treating naïve HIV patients gastrointestinal and urogenital
infections and prevent diarrhea and increased CD4 T-lymphocyte
percentages in HIV patients.
Conclusions: Intestinal microbiota are integral to the homeostasis and
functioning of immune cells. The loss of intestinal flora by HIV infection is
severely detrimental to the recombination of CD4 cells. Restoring proper
biodiversity in the gut by safe, efficacious probiotics demonstrates
promise in increasing Th17 cells by restoring GALT. GanedenBC30 may
down regulate TNF-a and other inflammatory cytokines and mitigate
ARV-related SAEs.
Page 17 of 54
Data suggests that replenishment of Th17 CD4 cells in the gut mucosa
during HAART correlates with improved function of the gut mucosal
immune system and its function. Studies by NIH of probiotics to lower
microbial translocation and immune activation in HIV-infected
adolescents.
P23
Alpha-1-proteinase inhibitor regulates CD4 lymphocyte levels and is
rate limiting in HIV-1 disease
Cynthia L Bristow*, Mariya A Babayeva, Michelle Labrunda, Michael P Mullen,
Jose Cortes, Ronald Winston
Weill Cornell Medical College, New York, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P23
Introduction: Adult stem cell migration through human hematopoietic
tissue requires the chemokine CXCL12 and its receptor CXCR4. In addition,
human leukocyte elastase (HLE) plays a key role. When HLE is located on
the cell surface (HLECS), it acts not as a proteinase, but as a receptor for
a1proteinase inhibitor (a 1 PI, a1antitrypsin). Binding of a 1 PI to HLECS
forms a motogenic complex. We previously demonstrated that a 1 PI
deficiency attends HIV-1 disease. Here we investigate the mechanism and
therapeutically address the a1PI deficiency of HIV-1 infection.
Materials and methods: Blood was collected from 30 HIV-1 uninfected
and 39 HIV-1 infected adults. Residual sera was obtained from 20 HIV-1
uninfected chimpanzees, 2 chimpanzees pre- and 42 months post-HIV-1
challenge, 12 HIV-1-immunized macaques, and 3 SHIV-infected macaques.
Three HIV-1 infected individuals received a1PI augmentation therapy.
Results: In HIV-1 uninfected individuals, CD4+ lymphocytes were correlated
with the combined factors a 1 PI, HLECS+ lymphocytes, and CXCR4+
lymphocytes (r2 = 0.91, p < 0.001, n = 30), but not CXCL12. In contrast, in
HIV-1 individuals with >220 CD4 cells/μl, CD4+ lymphocytes were correlated
solely with active a1PI (r2 = 0.93, p < 0.0001, n = 26). The monoclonal antiHIV-1 antibody 3F5 present in HIV-1 patient blood bound and inactivated
human a1PI. Chimpanzee a1PI differs from human a1PI by a single amino
acid which lies within the 3F5-binding epitope. Unlike human a1PI, neither
chimpanzee nor macaque a 1 PI bound to 3F5, nor was a 1 PI depleted
following HIV-1 challenge, consistent with the normal CD4+ lymphocyte
numbers of HIV-1 infected chimpanzees. The presence of IgG- a1PI immune
complexes correlated with decreased CD4+ lymphocytes in HIV-1 individuals,
and a1PI augmentation quadrupled the number of immunocompetent
CD4+ lymphocytes with no untoward effects.
Conclusions: An autoimmune component of HIV-1 disease was identified
and was overcome therapeutically. Results identify an achievable vaccine
modification with the novel objective to protect against AIDS as opposed
to the current objective to protect against HIV-1 infection.
P24
CD4.CD8 ratio decrease in AIDS, explained by a molecular mimicry
between African HIV-1 Nef and Notch-1. Nef as a target for vaccine
and NF-Kb inhibitors (salicylate, resveratrol,curcumin,
epigallocatechine-3-gallate)
Guy MK Tran1,2*, Adrien Caprani2, Laurent Gerbaud1
1
Clermont-Ferrand University, Hospital Hotel-Dieu, Public Health, ClermontFerrand, France; 2Association POSITIFS, Paris cedex 18, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P24
Background: The AIDS hallmark is the simultaneous fall in CD4 and rise
in CD8 T lymphocytes. Interestingly, this very pathognomonic but
unexplained decrease of CD4/CD8 ratio is also characteristic of a member
of the EGF family, Notch-1 function (Fowlkes BJ, 2002). Calenda V (1994)
found that Nef hampered drastically bone marrow progenitors cells
functionality. African HIV-1 strain NDK (Spire B, 1989), which induced a
fulminant AIDS killing the patient in only 15 days, decreases dramatically
CD4 counts. Nef is the most abundant HIV-1 protein in infected cells (85%
of mRNA). Nef is a superantigen, its action is amplified 10,000 times
compared to a common antigen.
Objective: We found previously Notch-1 in the LTR (Long Terminal
Repeat) of another retrovirus [Mouse Mammary Tumor Virus (MMTV)] (Tran
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MKG, Eurocancer, Paris, 1999). As Nef is located also in HIV-1 LTR, we
looked for Notch-1 in Nef.
Methods: Amino Acid (AA) alignment between Epidermal Growth Factor
(EGF) family members (including Notch-1) and Nef (Los Alamos HIV
sequences Database, 2002).
Results: Nef COOH-terminus of HIV-1 clade D African strains (from Congo
Democratic Republic, Chad, Tanzania, Uganda, South Africa, Kenya,…), but
not from other parts of the world (other non-D clades), was a perfect
molecular mimetic of Notch-1: They shared a heptapeptide (7 AA) SRLAFEH.
The homology between Nef (Poon AFY, 2009) and Notch (BLASTP on mouse
Notch-1) chimera was 67 AA long with 4 His, 1 Cys and 1 Trp (highly
significant): Nef : GWCFEVEEDTEGET NSLLHPISQHGMEDPERQVLVWRFNS
RLAFEHKARLMHPEFYKNC Notch : GWLLD…FEQDSEGETNSLPHLISQHAL
ANPEMQALA-HGKSRLAFEHQVRLSHLPVANNC It included the Nef LL and ED
doublets precisely implicated in CD4 down-regulation and EE in b-COP
recruitement(Benichou S.1994).
Conclusions: This opens new avenues for a vaccine targeted to NefNotch specific to Africa, a continent devastated by AIDS and tuberculosis
(in South Africa, about 60% HIV-1 infected patients had also tuberculosis).
P25
Abstract withdrawn
Retrovirology 2012, 9(Suppl 1):P25
Abstract withdrawn:
P26
Role of functional avidity in HIV-specific memory CD8 T cell effector
functions
Tiffany Lemon*, Donna Alvino, Zaza Ndhlovu, Bruce Walker
Louisiana State University - Dept of Biological Sciences, Baton Rouge, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P26
CD8+ T cells provide protective antiviral defense in HIV-1 infection.
Although studies demonstrate which effector functions are employed,
knowledge of the underlying mechanisms is lacking and inconclusive.
Here, we investigate the functional avidity of CD8 + T cells, based on
cytokine secretion and proliferation, to compare the effective antigen
concentration required to induce each response. Our preliminary data
Figure 1(abstract P26)
Page 18 of 54
suggests that the functional avidity of CD8+ T cells differs based on the
effector function used for measurement, indicating that the requirements
for activation differ within a single CD8+ profile. We also found that elite
controllers, individuals who control the virus without antiretroviral
treatment, require lower avidity interactions than chronic progressors.
These and future results will help to determine optimal doses of antigens
for the induction of effective responses in new vaccine formulations.
P27
Prevalence of, risk factors for, and oxidative stress associated with
Toxoplasma gondii antibodies among asymptomatic blood donors in
Egypt
Manar S Azab*, Nashwa K Abousamra, Mohammad H Rahbar,
Doaa M Elghannam, Douaa Raafat
Departments of Parasitology, and Clinical Pathology, Faculty of Medicine,
Mansoura University, Mansoura 35516, Egypt Divisions of Epidemiology and
Biostatist, Egypt
Retrovirology 2012, 9(Suppl 1):P27
Background: Since existing therapies are not fully effective, and no
Toxoplasma gondii vaccine is available, efforts to reduce toxoplasmosis
transmission are crucial to reducing the impact of this disease.
Objectives: To evaluate the seroprevalence of, risk factors for, and
oxidative stress associated with T.gondii antibodies in asymptomatic
blood donors in northeastern Egypt in a cross-sectional study.
Methods: Blood donors were recruited (169 men and 61 women) from
blood banks, Mansoura University Hospital, Egypt. We interviewed blood
donors about sociodemographic characteristics and potential risk factors for
T. gondii infection using a structured questionnaire. A venous blood sample
was taken to document their T. gondii antibody status using enzyme-linked
immunosorbent assay (ELISA). Also, serum level of malondialdehyde (MDA)
and activity of glutathione peroxidase (GSH-Px) and tocopherol fractions (a,
g, δ) was assessed.
Results: Overall, 155 (67.4%) of 230 blood donors were positive for anti-T.
gondii IgG antibodies and 24 (10.4%) of them were also positive for anti-T.
gondii IgG avidity antibodies, which is high compared to many countries.
Univariate logistic regression analysis showed an association between
T. gondii seropositivity and area of residence, blood type, older ages, level of
education, contact with cats, professional contact with farm animals,
agricultural activities, washing hands before meals, eating unwashed
vegetables, drinking raw milk, eating luncheon or shawerma. In a multivariate
logistic regression analysis, eating luncheon or shawerma showed a strong
significant association with T. gondii antibodies. T. gondii-seropositive blood
Retrovirology 2012, Volume 9 Suppl 1
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donors had significantly higher MDA level paralleled with significant decrease
in the level of GSH-Px and tocopherol fractions compared with T. gondii
negative blood donors.
Conclusion: This study highlights that T. gondii is prevalent among
healthy blood donors in northeastern Egypt, and that there is a need to
introduce T. gondii screening in the blood donation scheme.
P28
Near full-lenght genome characterization of a newly derived unique
recombinant form AG HIV-1 circulating in Siberia
Pavel Borisovich Baryshev, Natalya Matveevna Gashnikova*,
Vladislav Viktorovich Bogachev
State Research Center of Virology and Biotechnology VECTOR, Koltsovo,
Russia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P28
Background: Genotyping of HIV-1 variants isolated from patients of
Siberian region (Russia) in 2006-2010 revealed a sharp increase of 02_AG
recombinant variant proportion among HIV-1 genetic variants, circulating
in the Siberia, from 2% in 2006 to 52% in 2010. The majority of HIV
02_AG variants isolated in Siberia form a separate branch of phylogenetic
tree.
The objective of this analysis was to study structure of the near fulllength genome sequence of HIV-1 strains recombinant form AG rapidly
spreading in Siberia.
Material and methods: Sample 10.RU.6637 was collected in 2009 from a
28-year-old man, infected in 2008 through heterosexual contact. Three
regions of the viral genome were independently amplified using nested
PCR from the cDNA to contain a nearly full-length genome of HIV-1.
Sequencing of all amplicons was performed by using cycle sequencing
and dye termination on an automated sequencer, DNA sequences were
assembled using Sequencher software. Jumping profile hidden Markov
model (jpHMM) program was used to analyze the subtype assignment of
all sequences retrieved. The software Simplot v3.5.1 was initially used to
perform bootscanning analyses of a query sequence against a set of
other sequences. Phylogenetic trees were constructed with the program
PhyML v.3.0 using a maximum likelihood approach.
Results: Sequence 10.RU.6637 HIV-1 from Siberia was submitted to
Genbank under accession number JN230353. Points of recombination
were determined and uniqueness of 10.RU.6637 HIV-1 genome structure
was shown through in-depth genetic analysis. Recombinant breakpoint
analysis of 10.RU.6637 HIV-1 genome sequence revealed that it was
recombinant form between CRF 02_AG and sub-subtype A1. We will
designate this variant 02_AG/IDU A HIV-1, to reflect its close relationship
to the CRF 02_AG and A1 (IDU A) subtype from Russia.
Conclusion: The majority of HIV 02_AG variants circulating in Siberia
represented of a newly derived unique recombinant form 02_AG/IDU A
HIV-1. Wider spread of HIV-1 URF02_AG/IDU A is possible in the territory of
Russia in the coming years.
P29
Comparison of HIV-1 viral load based on RNA or reverse transcriptase
activity in patients with suspected viral load underestimation
Beatrice N Vetter*, Cyril Shah, Jürg Böni, Jörg Schüpbach
Swiss National Center for Retroviruses, Institute for Medical Virology,
University of Zürich, Switzerland
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P29
Introduction: In HIV diagnostics, viral load (VL) measurement is based on
viral RNA. Occasionally, untreated patients present with a low VL of ≤1000
copies/ml, in which case the VL may be underestimated. In Switzerland,
patients with suspected underestimation of VL by nucleic acid testing
(NAT) are offered VL assessment by the Product Enhanced Reverse
Transcriptase (PERT) assay. Here, we compared VL measurement by these
two methods in order to assess the frequency and magnitude of NATbased VL underestimation.
Material and methods: We compared VL by PERT and NAT for three
different patient groups: (1) newly diagnosed patients with suspected
Page 19 of 54
underestimation of VL by NAT (n=19); (2) patients receiving VL
monitoring by PERT based on previously confirmed underestimation
(n=28), and (3) a reference group of untreated, subtype B-infected
patients (n=16). The output of both assays was copies/ml viral RNA. For
the PERT assay, conversion to copies/ml was based on a reference
correlation of NAT VL and RT-activity (qPCR).
Results: In newly diagnosed patients approximately 4% have a suspected
VL underestimation by NAT (≤1000 copies/ml). PERT results were
available for 19 of 59 of such newly diagnosed patients (32.2%). The
median difference (log copies/ml) between PERT and NAT VL for this
group was 1.36, compared to 0.92 for PERT-monitored patients and
-0.004 for the reference group. In 74% of newly diagnosed and 68% of
PERT-monitored patients the VL by PERT was ≥5x higher compared to
NAT (reference group: 0%). Correlation between PERT and NAT was at
R2=0.02 for newly diagnosed patients, 0.63 for PERT-monitored patients
and 0.89 for the reference group. Patient groups (1) and (2) both
comprised a mixture of subtypes, including subtype B.
Conclusions: This analysis confirms that VL underestimation still
occasionally occurs, even with the improved contemporary VL tests.
Causes include sequence variations leading to impaired primer/probebinding during cDNA amplification. As inadvertent VL underestimation
may lead to further infections or inappropriate treatment decisions,
a sequence-independent test, like the PERT, remains valuable for
confirming a low VL.
P30
Molecular epidemiology and drug resistance prevalence of strains
from newly diagnosed HIV-1 patients in Northern Greece during
2009-2010
Zoe Antoniadou, Ioanna Kousiappa*, Johana Hezka, Lemonia Skoura,
Simeon Metallidis, Pavlos Nikolaidis, Nicolaos Malisiovas, Leondios G Kostrikis
University of Cyprus, Nicosia, Cyprus
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P30
Introduction: As part of a continuing effort to monitor the molecular
epidemiology of HIV-1 in northern Greece, in this study we determined
the genetic diversity and the prevalence of drug resistance transmission
among HIV-1 strains isolated from 94 newly-diagnosed untreated
consenting patients in the period 2009 to 2010.
Materials and methods: Peripheral blood mononuclear cells (PBMC’s)
and plasma were collected from the patients at the AIDS National
Reference Laboratory of Northern Greece. Plasma RNA encoding partial
pol(protease and reverse transcriptase) was amplified using TRUGENE
HIV-1 genotyping assay (Siemens). Antiretroviral drug resistance
prevalence was estimated by using the HIVseq program (HIV Drug
Resistance Database, Stanford University). PBMC’s DNA encoding partial
env(gp120) V3-loop region was amplified by nested PCR and
sequenced using an in-house tropism assay at the Department of
Biological Sciences, University of Cyprus. Phylogenetic analysis was
performed and trees were constructed for each region by using
neighbor-joining with Kimura two-parameter method by means of
MEGA v5.0 software.
Results: The media age of patients is 32 years with the percentage of
male infection at 89.4%. The main risk groups were homosexual contact
(73.4%) and heterosexual contact (17.0%). The phylogenetic analysis
indicated B and A1 as the dominant subtypes, 47.8% and 41.5%
respectively, followed by subtype C, CRF02_AG (3,2% each), CRF04_cpx
(2,1%) and subtypes F1 and G (1,1% each). Twenty-one clusters showed
epidemiologically linked HIV-1 patients. Resistance mutations to protease
inhibitors were found in three individuals, while high resistance
associated mutations to reverse transcriptase inhibitors (NRTI’s/NNRTI’s)
were shown in sixteen patients. Tropism testing indicated most of the
HIV-1 strains as R5-tropic (96%).
Conclusions: These newly found data demonstrate a heterogeneous
epidemiological status of HIV-1 in northern Greece during 2009-2010,
with subtype B and A1 being the dominant subtypes in relation to the
other subtypes. The prevalence of antiretroviral resistance mutations is
high among the newly diagnosed untreated patients (17%) in comparison
with other European countries (10%).
Retrovirology 2012, Volume 9 Suppl 1
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P31
Frequency of subtype B and F1 dual infection in HIV-1 positive,
Brazilian men who have sex with men
Sabri Saeed Sanabani*, Ana Carolina Soares de Oliveira,
Antonio Charlys da Costa, Mariana Melillo,
Sauer Katia Cristina Bassichetto Solange, Maria Santos Oliveira,
Priscilla Ramos Costa, Claudia Tomiyama, Helena Tomoko Iwashita Tomiyama,
Ester Cerdeira, Sabino Esper, Georges Kal
Instituto de Medicina Tropical de São Paulo, São Paulo, Brazil
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P31
Introduction: Co-infection, otherwise known as superinfection, with 2 or
more HIV-1 isolates, has been documented frequently. However, in Brazil,
few data are available regarding the frequency of HIV-1 co-infection.
Because various HIV vaccination studies are in progress, it is important to
understand often inter- and intra-subtype co/superinfection occurs in
different HIV-infected high risk groups. In this cross-sectional study, we
report the frequency of subtype B and F1 co-infection in a clinical group of
41 recently HIV-1 infected men who have sex with men (MSM) in São Paulo,
Brazil.
Material and methods: Proviral HIV-1 DNA was isolated from subject’s
peripheral blood polymorphonuclear leukocytes that were obtained at the
time of enrollment. Each subject was known to be infected with a subtype
B virus as determined in a previous study. A small fragment of the
integrase gene (nucleotide 4255-4478 of HXB2) was amplified by nested
PCR using subclade F1 specific primers. The PCR results were further
confirmed by phylogenetic analysis. Viral loads (VL) data were extrapolated
from the medical records of each patient.
Results: In the 41 samples from MSM who were recently infected with
subtype B virus, in five patients it was possible to detect subclade F1
proviral DNA, which represents a co-infection rate of 12.2%. In subjects with
dual infection the median VL was 5.3 X 104 (range, 1.5 X 104 - 12.5 X 104
copies/ml), whereas in MSM that were infected with only subtype B virus
the median VL was 3.8 X 104 copies/ML (range < 400 - 39.3 X 104 copies/
ml) (p > 0.8).
Conclusions: This study indicated that subtype B and F1 co-infection occurs
frequently within the HIV-positive MSM population as suggested by large
number of BF1 recombinant viruses reported in São Paulo, Brazil. We
conclude that the co-infection is a potentially important event that
significantly contributes to HIV-1 genetic variability with serious implications
for diagnosis, drug treatment and optimal vaccine development.
P32
A new unique recombinant HIV-1 revealed in Belarus
VF Eremin*, EL Gasich, SV Sasinovich
Briem, Minsk, Belarus
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P32
Material and methods: Blood plasma, EIA, western blot, RT-PCR,
sequencing, SeqScape, BioEdit, Mega4.1, statistica 6.0, software.
Results: In April 2010 we have performed resistance tests of plasma
sample obtained from patient Mos, 6 years old girl, born from HIVinfected mother. The phylogenetic analysis of the DNA fragment of
patient Mos had shown that sample has been clustered with HIV-1
subtype A on gene pol, but was different from other analyzed samples,
subtype A consensus IDU-A and reference sequences (AF004885). The
Mos isolate is the most similar to AF413987 from Ukraine (subtype A) the
p-distance was 0.066. The comparison of sequences from gag gene p17/
p24 region of Mos isolate with reference sequences HIV-1 of subtype A
demonstrates that average p-distance was 0.129, and with reference
sequences of subtype B was 0.075. Average p-distance on gag gene (the
Mos isolate) with CRF03_AB (AF414006.1, Belarus and AF193276.1
CRF03_AB KAL153) was 0.121 if compared with 0.013 p-distance between
reference sequences. The analysis of Mos isolate sequences on V3 loop
gp120 gene env region HIV-1 has shown that average p-distance with
reference isolates subtype B was 0.323, and with A subtype was 0.155.
Average p-distance sequence of Mos isolate with reference isolates
AF414006.1 and AF193276.1 (CRF-03_AB) was 0.308.
Page 20 of 54
Conclusion: Thus, it has been shown that Mos isolate is a unique
recombinant form, but differs in genome structure from the one
described earlier CRF03_ AB (AgagBpolBenv). The new recombinant HIV-1
has the following structure: BgagApolAenv. Sequences of new HIV-1
unique recombinant in gag, pol and env genes were submitted to EMBL/
Genbank/DDBJ under accession numbers: FR775442.1, FN995656.1,
FR775443.1.
P33
Molecular epidemiology of HIV-1 subtype B in the Basque Country
(Spain)
Juan Angel Patiño, Miguel M Thomson, Fernando González-Candelas*
Csisp-University of Valencia, Valencia, Spain
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P33
The goal of this work was to study the HIV-1 subtype B epidemic in the
Basque Country (Spain). For this, we used HIV samples submitted for
genotypic testing of anti-retroviral resistance mutations from 2005 until
2008. Consequently, 2115 HIV-1 sequences comprising protease and
retrotranscriptase (PR/RT) coding regions were analyzed. HIV transmission
groups were identified by phylogenetic analysis. The 10 largest such
groups were subsequently subjected to Bayesian phylogenetic and
coalescent reconstructions, using a relaxed molecular clock model.
The results obtained show that these groups have been long-standing:
most of them were originated in the late 70s or early 80s, and none after
the year 2000. Most of these groups comprise both intravenous drug users
(UDIs) and people who got infected through unprotected heterosexual sex
(HTs). MSM clades were also represented in the sampled population. By
comparing different demographic models, it was concluded that all the
transmission groups are growing in an exponential manner. Time between
infections was significantly lower in MSM groups than in those mainly
containing IDUs (P-value < 0.05 in the Mann Whitney test).
In conclusion, this work suggests that in the near future the HIV-1 subtype
B epidemics in the Basque Country will be characterized by a growth of
the existing transmission groups. Due to the high diversity of these
clusters, it is necessary to design campaigns for HIV prevention focused on
the different risk groups.
P34
Clinical consequences of persistent low level viremia
Toby Dyner*, Virginia Cafaro, Valby Chow
Hiv Disease at Shared Perspectives On Therapies (Spot), San Francisco, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P34
Introduction: Work done by this group nearly 7 years ago, evaluated a
cohort of patients who, for a variety of reasons, elected to remain on a
virologically failing ARV regimen. We re-evaluated these patients to
determine whether their earlier years living with low level viremia
impacted their future treatment options. In the absence of a cure and
with the goal of maintaining HIV infection as a chronic, yet manageable
disease, it is important to understand the consequences of persistent
immune system activation.
Materials and methods: Two community based HIV practices with
nearly 1000 patients evaluated a subset of 25 patients on stable ARV
regimens for >24 months who refused treatment change despite the
presence of low level viremia. Patients were counseled regarding the
need for change. They acknowledged a variety of reasons for their refusal
including fear of change and fear of the unknown; a comfort with their
current regimen; fear of “burning through options”, etc. Charts were
reviewed for CD4 counts, HIV bDNA levels, HIV related OIs or
malignancies, as well as other co-morbidities.
Results: As new HIV medications became available, patients agreed to
switch regimens. 19 of 25 patients were started on regimens which
resulted in virologic suppression below the level of quantification (BLQ). 1
patient died of an MI and 1 died of a neuroendocrine tumor and 4
patients were lost to follow-up. Given the potency of the new regimens
that were constructed, those patients who switched were able to
suppress without significant difficulties.
Retrovirology 2012, Volume 9 Suppl 1
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Conclusions: With the new paradigm of test and treat despite CD4 level,
we can expect to be treating many more patients for longer periods of
time. The issues of adherence and “pill fatigue” are well known and
contribute to patients’ potential inability to maintain fully suppressive
regimens for long and sustained periods of time. Our experience of
patients who refused to switch regimens despite low levels of virus and
yet, when ready, were able to fully suppress with a regimen change, is
encouraging.
P35
The dual (activating/suppressive) effect of extracellular TatHIV-1 is
driven by the infalmmatory microenvironment of infected lymphoid
foci
Hélène Le Buanec1,2,3, Thomas Sené1,2,3, Armand Bensussan1,2,3, Robert Gallo4,
Daniel Zagury5*
1
INSERM U976, F-75475, Paris, France; 2Université Paris Diderot, Sorbonne
Paris Cité, Laboratory of Immunology, Dermatology & Oncology, UMR-S 976,
F-75475, Paris, France; 3Service de dermatologie, Hopital Saint Louis, F-75010,
Paris, France; 4Institute of Human Virology, University of Maryland Baltimore,
Maryland, USA; 5Neovacs SA, Paris, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P35
It has been shown that HIV-1 infects activated but not resting CD4 +
T cells [1] and that CPE induced by viral replication together with the
immunosuppressive effect triggered by extracellular Tat protein [2] account
for the decrease of CD4+ T cell count in infected patients. In lymphoid foci,
dependent on the level of viral infection, the stromal microenvironment
surrounding immune cells could include, together with extracellular Tat [3]
and circulating antiviral IFN-a, inflammatory innate factors such as ATP and
derivatives released by CPE-derived dead cells.
We show that, according to its concentration and the presence of
inflammatory factors (IFN-a, ATP and ATP-derivatives), Tat protein may exert
either an activation with enhanced production of IL2 or an immune
suppression of stimulated CD4+ T cells subpopulations.
The double-edged sword of Tat activity on CD4+ T cells could account for its
immunopathogenic effects both at the early stage of infection (by allowing
CD4+ T cells activation and viral replication) and at late stages (by inducing
immuosuppression, source of opportunistic infections). Indications for
targeting Tat protein by therapeutic vaccines in subgroups of HIV-1 infected
patients will be discussed.
References
1. Zagury D, et al: Long-term cultures of HTLV-III–infected T cells: a model
of cytopathology of T-cell depletion in AIDS. Science 1986, 231(4740):85.
2. Viscidi RP, et al: Inhibition of antigen-induced lymphocyte proliferation
by Tat protein from HIV- Science. 1989, 246(4937):1606.
3. Ensoli B, et al: Release, uptake, and effects of extracellular human
immunodeficiency virus type 1 Tat protein on cell growth and viral
transactivation. J Virol 1993, 67(1):277.
P36
Genotype characterization of human papillomavirus in women infected
and uninfected with HIV in Ouagadougou, Burkina Faso
Florencia W Dkigma*, Djeneba Ouermi, Tani Sagna, Charlemagne Ouedraogo,
Cyrille Bisseye, Moctar Zeba, Simplice D Karou, Virginio Pietra,
Jean-Baptiste Nikiema, Jacques Simpore
Centre de Recherche Biomoléculaire « Pietro Annigoni » CERBA/LABIOGENE,
Ouagadougou, Burkina Faso
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P36
Introduction: Our study aims to compare the prevalence and genotypes
of HPV in HIV-positive and negative women in Ouagadougou, where HIV
and HPV prevalence are respectively estimated at 4.0% and 24%.
Materials and methods: The study involved 410 women: 205 HIVpositive followed by two sites of HIV/AIDS care in the eastern outskirts of
Ouagadougou, matched by age with 205 HIV-negative consulting the
gynaecological services in the same area. HPV genotyping was done by
PCR followed by reverse hybridization on nitrocellulose strips with the kit
“STAR HPV Blot” (Diatech®, Italy).
Page 21 of 54
Results: Prevalence of HPV was: 25.4% among HIV-negative women and
59.0% among HIV-positive women (p <0.01). Means of age was
respectively 33.6 (SD±8.6) versus 33.4 (SD±6.4). Prevalence of HPV
subtypes at low risk of oncogenicity (6,11,LR) among HIV-positive women
was 9.8% and 9.3% in the control group (p=ns). Prevalence of HPV
subtypes at high risk of oncogenicity was significantly(p<0.01) higher
among HIV-positive women for subtypes 50’S (22.0% versus 9.3%, OR=2.8 ;
CL95% 1.5-5.1), 18 (20.0% versus 2.9%, OR=8.3 ; CL95% 3.2–23.0), 30’S
(17.6% versus 1.5%, OR=14.3 ; CL95% 4.1–60.1) and HR ( 7.3%, versus 1.0%,
OR=8.0 ; CL95% 1.7–52.1) while no significant difference was observed for
high risk subtypes 16 and 45. Co-infections by two or more subtypes at high
risk were detected in 27/205 (13.2%) HIV-positive women and 3/205 (1.5%)
HIV-negative women (p<0.01; OR 10.2; CL95% 2.9-43.5). Among HIV-positive
women, prevalence of oncogenic subtypes was significantlycorrelated with a
lower CD4 count (P = 0.05).
Conclusions: HIV-positive women are at high risk of coinfection by HPV
oncogenic subtypes. This study confirms the need to integrate the
screening of cervical cancer in HIV care protocols in Burkina Faso. Further
investigations should be continued for the establishment of vaccine that
matches all genotypes circulating in the country.
P37
Tungiasis (jigger infestation) in Rural Kenya, an emerging infectious
disease
Nicholas N Njau*, Peter Wanzala, Marion Mutugi, Liana Ariza, Jorg Heukelbach
Kenya Medical Research Institute, Center for Public Health Resear, Nairobi,
Kenya
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P37
Objective: To describe the prevalence of tungiasis (jigger flea infestation)
and associated risk factors in a sentinel group (children 5-12 years of age)
in rural Central Kenya.
Methods: A cross-sectional study was carried out in Murang’a South
district during high transmission season (dry season, August –
September 2009). A total of 385 randomly selected households were
visited. Children were examined for presence of tungiasis, and a
questionnaire was administered to collect demographic, behavioral and
environmental data.
Results: Prevalence of tungiasis was 57% (218/385; 95% CI=51.7%-61.6%).
Itching (89.1%) was the most common associated symptom, followed by
pain upon pressure (67.3%), sleep disturbance (58.2%) and walking
difficulties (53%). In multivariate logistic regression analysis the following
independent factors were identified to be associated with tungiasis: living
in houses with an earthen floors (adjusted OR=3.84; 95%IC: 2.09-7.06),
walking barefooted (OR=3.28; 1.78-6.04), having a common resting place
outside the house (OR=2.36; 1.01-5.51) and presence of rats on the
compound (OR=1.69; 1.03-2.75).
Conclusion: Tungiasis is an emerging neglected disease found in Africa.
It is highly endemic in rural Central Kenya and associated with considerable morbidity. The disease is associated with poverty. Modifiable risk
factors were identified that should be the focus of sustainable and
effective control measures.
P38
Impact of macrophages on Balamuthia mandrillaris virulence properties
using human brain microvascular endothelial cells in vitro
Abdul Matin*, Khalid Mehmood, Suk-Yul Jung
Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P38
Introduction: Balamuthia amoebic encephalitis (BAE) is a serious human
disease almost always leading to death. An important step in BAE is
amoebae invasion of the bloodstream, followed by their haematogenous
spread. Balamuthia mandrillaris entry into the central nervous system
(CNS) most likely occurs at the blood–brain barrier (BBB) sites.
Macrophages are thought to be the first line of defense in many
infectious diseases and are present in high numbers during infections.
Retrovirology 2012, Volume 9 Suppl 1
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The objective of the present study was to determine the impact of
cytokines and macrophages on the virulence characteristics of
B. mandrillaris in vitro.
Materials and methods: In vitro, B. mandrillaris were used to demonstrate
the effects of cytokines and macrophages on the physiological and
morphological characteristics of amoeba. Using human brain microvascular
endothelial cells (HBMEC), which constitutes the BBB, adhesion and
cytotoxicity assays were performed. To investigate the engulfing property
and proteolytic activity of the amoeba, phagocytosis and zymography
assays were conducted respectively.
Results: It was observed B. mandrillaris exhibited >90 % binding and
>70 % cytotoxicity to HBMEC which was further enhanced in the
presence of cytokines and macrophages. It has also been observed that
cytokines TNF-a and TGF-b significantly increased the B. mandrillaris
numbers in the presence of macrophages. It is important to note that
amoebic numbers were more than doubled in the presence of cytokines
and macrophages within 24h. We have shown in the past the bacteria
uptake by B. mandrillaris is limited which is further significantly inhibited
in the presence of cytokines during phagocytosis assays. Zymography
assays revealed that cytokines and macrophages have no inhibitory
effect on proteolytic activity of B. mandrillaris. In addition the activated
macrophages did not show any vital effects on amoebic virulence
properties.
Conclusion: Overall we described for the first time that cytokines and
macrophages has no inhibitory effects on the virulence properties of
B. mandrillaris in vitro.
P39
Investigation of measles outbreak-Herena and Dawe-Serer Districts of
Bale Zone, Oromia Region, Ethiopia, February 2011
Abyot Bekele Woyessa*, Tesfaye Deti, Amanuel Yadata, Ashenafi Kenna,
K Addisalem, M Yesuf, M Abebe
Ethiopian Health and Nutrition Research Institute, Ethiopia, Addis Ababa,
Ethiopia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P39
Introduction: An estimated 10 million cases and 164,000 deaths from
measles occur worldwide each year. On 08 Feb 2011 Bale Zonal health
department reported suspected measles outbreak. We investigated to
identify the etiology of the outbreak and undertake appropriate
prevention and control interventions.
Materials and methods: Patient observation was made and active-cases
were searched house to house. Medical registration-books were assessed
and suspected measles cases were identified from 24-Nov-2010 to 15Feb-2011 in Herena and Dawe-Serar districts using the following case
definitions: maculopapular rash with fever ≥38.5°C with coryza,
conjunctivitis or cough or epidemiologically linked by contact with
laboratory confirmed outbreaks in neighboring districts. Immunization
coverage and vaccine-storage facilities were assessed. Descriptive analysis
was conducted using Epi-Info version3.5.1.
Results: A total of 329 suspected measles cases and 30 community
deaths (case fatality rate (CFR) 9.1%) were reported of which 159 (48.3%)
were from Dawe-Serar and 170 (51.7%) were from Herena. CFR was 25/
159 (15.7 %) in Dawe-Serar and 5/170 (2.9%) in Herena and higher
among females than males (12.2% vs. 6.1%). All deaths and 140/329
(42.6%) of the cases were not vaccinated against measles. Vaccination
coverage was 45.4% in Dawe-Serer and 54% in Herena. The attack rate
was highest among those 15 years of age. About 5/7 (71%) refrigerators
used for vaccine-storage were not functional. Prior to investigation
period, 110/159 specimens from 14 districts of the zone were tested
positive for measles-IgM.
Conclusions: An outbreak of suspected measles occurred in 2 districts
affecting primarily those <5 years of age. Low-vaccination coverage and
non-functional cold storage likely contributed to the outbreak.
Undertaking supplementary vaccination activities, enhancing routine
vaccination coverage and improvement in cold chain operation and
maintenance need to be emphasized in the districts to reduce measles
incidence.
Page 22 of 54
P40
Seroepidemiological feature of Q fever among sheep in Northern Iran
Ehasn Mostafavi*, Saber Esmaeili, Mahin Shahdordizadeh, Hadi Mahmoudi,
Hamid Liriayii, Fahimeh Bagheri Amiri
Department of Epidemiology at Pasteur Institute of Iran, Tehran, Iran
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P40
Introduction and aims: Q fever is a zoonosis caused by Coxiella burnetii,
which infects various hosts, including humans and animals. As Q fever is
considered an important factor in public health, and there is little
epidemiological information on the status of the disease in various parts
of Iran, this study has been carried out to evaluate the seroepidemiology
of Q fever among sheep in the province of Mazandaran, northern Iran.
Materials and methods: In this study, samples from sheep were
collected from western, central and eastern regions of Mazandaran in
2010-2011. Serum samples were analyzed by ELISA test.
Results: In this study, 253 serum samples were collected. The infection
rate with Q fever was 23.7%. The chi-square test showed a significant
statistical relationship between central (33.8%) and eastern (27.2%)
regions compared to western regions (8.5%). There was no significant
difference between the three groups of sheep with respect to age. No
significant statistical relationship was seen between infection rate and
age and gender.
Discussion: The infection rate of coxiella burnetii in this study, is similar
to the results of other research carried out in various parts of the country.
With respect to the fact that there is a higher infection rate in the eastern
and central regions of the province, compared to the western region, and
also in imported animals from Afghanistan, the hypothesis that the
disease is spreading from eastern boundaries becomes more probable. It
is recommended that complementary research be carried out on other
animals, on high-risk persons and on ticks, in order to reveal the status of
the disease in the province.
P41
Molecular detection of Rickettsia and Borreliosis pathogens in the areas
of Boumerdes and Tizi Ouzou (Algeria)
Afif T Chaouche*, I Bitam, K Amara, I Yahiaoui
Microbiologie at Université, Tlemcen, Algeria
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P41
Aim: Mediterranean spotted fever, and the Lyme disease are emerging
infectious diseases with significant impact on public health, a study of
their detection methods and transmission modes is very useful. As vector
diseases, this study consist of finding the agents in question on ticks
(vectors of these diseases) in the area of Boumerdes and Tizi-ouzou,
coastal areas in central Algeria, and checking the transmission of these
germs from generation of ticks to another.
Materials and methods: The investigation launched from December
2009 to June 2010, has raised ticks on dogs and cows in these areas, and
after the identification of genus and species of the 182 collected ticks, 56
of them were analyzed by PCR followed by electrophoresis. The detection
of Rickettsia was also done by the Gimenez stain from a drop of
hemolymph of a tick collected on a slide. A breeding of ticks has been
launched to track their life cycle and eventual transmission of Rickettsia
by ovarian trans-staidly.
Results: 11 of 56 ticks were found carrying Rickesttsia conorii conorii, (the
bacteria responsible for Mediterranean spotted fever), and no ticks
carrying Borrelia Burgdorferi (bacteria that causes Lyme disease) was
found. After analyzing the ticks of the first and second generation, the
presence of these bacteria has been found.
Conclusion: The results of this investigation allow confirm the presence of
Rickettsial diseases in the regions of Boumerdes and Tizi Ouzou, but also
the transmission from one generation of germs on ticks, the risk of
transmission to humans is certain in case of tick bite, from which the
necessity of the vector control. 1. Sahibi H. & Rhalem A. (2007) : Tiques et
maladies transmises par les tiques chez les bovins au Maroc, MADER/DERD
N°151 2. Doudier B., Pages F., Parola P., Socolovschi C., Tiques et maladies
Retrovirology 2012, Volume 9 Suppl 1
http://www.retrovirology.com/supplements/9/S1
transmises à l’homme en Afrique, Médecine Tropicale, Med Trop 2008, 68,
119-133 3. Bitam I., (2008) : Rickettsioses associées aux arthropodes, la
revue medicopharmaceutique N°48-3éme trimester, p38-39.
P42
Risk factors of Trichomonas vaginalis in women attending central
Sexually Transmitted Diseases Clinic Sri Lanka
Sathyadevi Herath*, Deepika Fernando, Saman Jayasinge
Ministry of Health, Sri Lanka, Colombo, Sri Lanka
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P42
Introduction: Trichomonas vaginalis is one of the common infections
among women attending Sexually Transmitted Disease Clinics (STD) of Sri
Lanka. Yet majority with symptoms don’t attend STD clinics and treated
syndromically. In this scenario this study was carried out to identify risk
factors of Trichomonas vaginalis in women inorder to review treatment by
signs and symptoms.
Methods: Three hundred and fifty new female clinic attendees were
recruited. Participants were interviewed on sociodemographic data, sexual
history, symptoms, knowledge on STI/HIV, and condom use. Laboratory
specimens were collected for theroutinescreening ofSTD diagnosis
including Trichomoniasis.
Results: Mean age of the sample was 32.8 years (SD ± 9.27). More than
half (223; 64%) were married. Approximately 53% had completed Grade
10. Almost 76% tested positive being in 21-45 years and 20% of positives
were unmarried. Trichomoniasis prevalence was 7.2% (25 out of 346).
Pruritus, vaginal discharge and vulvovaginal soreness, were significantly
higher amongst positives (P< 0.05 for all). Educated women had higher
risk (OR= 3.0; CI=1.28-7.26) of infection. Trichomoniasis was less common
among women engaged in sex work (OR= 0.3; 95% CI=.0.14-0.85),
reported multiple sexual partners (OR = 0.02; 95% CI= 0.073-0.408) and
women reporting extra marital relationship (OR = 0.3%, 95% CI= 0.123-0.
733).
Conclusions: These findings are the reflection of female clinic attendees
involving in commercial sex trade and high use of condoms amongst sex
workers. It further emphasizes that the primary prevention activities are
widespread especially among MARPs.
Findings also suggest that non use of condoms among women in
monogamous relationship may contribute for Trichomoniasis thus HIV
acquisition among housewives in Sri Lanka.
P43
A retrospective analysis among male and female infants EID results in
Cross River State, Nigeria
Onovo Amobi1,2
1
University Of Calabar, Nigeria; 2Monitoring and Evaluation Officer at ProHealth International, Calabar, Nigeria
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P43
Background: Early definitive diagnosis of HIV infection in infants is
critical to ensuring that HIV-infected infants receive appropriate and
timely care and treatment. The purpose of this study is to investigate the
possible determinant of EID test results among male and female infants
in south-south region of Nigeria.
Methods: A retrospective study was conducted in July, 2011 among male
and female infants receiving PMTCT intervention for Early Infant Diagnosis
in PHC’s at four different LGA’s of Cross River namely: Akamkpa, Calabar
South, Odukpani and Biase respectively. Relevant data of the HIV
infection status to male and female infants, whose samples were
collected and diagnosed using PCR, was obtained from the National
PMTCT-EID register. The data was analyzed using Cross-tabulation.
Results: About 42.9% male infants and 57.1% female infant’s blood
samples were collected using the DBS technology for diagnosis by PCR
assay. The age distribution of the infants ranged from 2 - 11 months with
the mean age of 5 months. EID samples (19.0%) diagnosed tested HIV
positive and 81.0% tested HIV negative by PCR. 7.1% (Male) and 9.5%
(Female) infants tested HIV positive by PCR. 35.7% (Male) and 47.6%
Page 23 of 54
(Female) infants tested HIV negative by PCR. There was a significant
association between infant’s ages at 9 months, 10 months and 11
months with the EID test results (Standardized residual of 3.7, 1.9, and 2.6
respectively). The test of model of gender as predictor was statistically
significant for female infants (Standardized residual of 1.6) and a Pearson
chi-square which appeared statistically significant (P=0.006).
Conclusion: From our study, there is a significant association between
EID test results and specific ages of male and female infants with gender
as a perfect predictor.
P44
In vitro antifungal susceptibility of Candida albicans isolates from oral
cavities of patients infected with human immunodeficiency virus in
Ethiopia
Nasir Tajure Wabe*, Jemal Hussein, Sultan Suleman, Kedir Abdella
Jimma University, Jimma, Ethiopia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P44
Summary objective: Oral Candidiasis is the most common HIV related
oral lesion. Most patients are infected with a strain originally present as a
commensal of the oral cavity. The chronic use of antifungal agents, in the
treatment of candidiasis mainly in HIV/AIDS patients leads to the
selection of strain resistant to this therapy. The objective of this study
was to evaluate the in vitro susceptibility of Candida albicans to
commonly used antifungal agents in Ethiopia.
Methods: In vitro susceptibility tests were performed using the broth
microdilution method following the National Committee for Clinical
Laboratory Standards (NCCLS) M27-A guidelines. Data were then analyzed
using SPSS for windows version 16.0. Tests of proportions were done
with Chi-Square, and a p value of <0.05 was considered as statistically
significant.
Results: A total of 42 oral C.albicans isolates from HIV-infected patients
were included in this study. Forty one (97.7%) of all isolates were
determined fully susceptible to amphotericin B, 40 (95.3%) to nystatin,
and 39 (92.9%) to ketoconazole and miconazole. On the other hand, the
isolates showed highest rates of resistance against fluconazole (11.9%)
relatively. There was little difference in the antifungal susceptibilities of C.
albicans isolated from patients who had a history of previous antifungal
therapy compared with those who had not received antifungal treatment.
Conclusion: The in vitro antifungal susceptibility testing of C.albicans in
this study showed relatively high resistance to commonly used azoles. As
with the prescribing of any antimicrobial agent, the use of a systemic
antifungal drug must be justified. Efforts must be maintained to avoid
inappropriate or unnecessary prescribing of these antifungal.
P45
Reproductive Tract Infections (RTI) among married women in Sri Lanka
Sathyadevi Herath1*, Pushpa Fonseka2, Sujatha Samarkoon1
1
National Sexually Transmitted Diseases, AIDS Control Program, Ministry Of
Health, Sri Lanka; 2University of Sri Jayawardenepura, Sri Lanka
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P45
Introduction: Feminization of HIV epidemic, and increasing in HIV
infection among house wives is seen in most of the world. Yet,
community prevalence data on RTI are sparse in Sri Lanka, and little is
known about rates among community women. The objective was to
describe the prevalence and risk factors of RTI in women aged 22–49
years, living in highly populated poor urban settlements of Sri Lanka.
Methodology: A community-based cross-sectional study was conducted
among 770 married women living in 116 urban slums of Colombo city,
Sri Lanka. Participants were interviewed on sociodemographic data,
sexual history, knowledge on STI/HIV, and condom use. Laboratory
specimens were collected for thediagnosis of RTI.
Prevalence was calculated with corresponding 95% confidence intervals
(CI). Analyses of risk factors were carried outseparately for the outcomes
of sexually transmitted infections: chlamydia, gonorrhoea, trichomoniasis;
and endogenous infections:bacterial vaginosis (BV) and candida.
Retrovirology 2012, Volume 9 Suppl 1
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Results: Ninety three percent of women had single life time partner, only
9% was previously screened for STI/HIV. Condom use was mainly decided
by the male partner and none of them used condom for prevention of
STI/HIV.
Endogenous infections were relatively common [BV 8.6% (95% CI: 6.6.10.6)candida 6.8 % ( 95%CI: 5.0-8.6)], and sexually transmitted infections
(STI) were infrequent (1.1%-95% CI: 0.34-1.86).
Of the risk factors investigated none of the factors were associated with
RTI on multivariate analysis.
Conclusion: Married women in this community had a low prevalence of
RTI and risky sexual behavoiurs were infrequent. Most of the population
burden of RTI is attributedto endogenous infections. However, education
and outreach screening facilities are needed to reduce the stigma,
embarrassment and lack of knowledge related to STI/HIV in order to
facilitate screening and condom use.
P46
Investigation of acute febrile illness outbreak- Asyaita and Dupti
districts, Afar Region, Ethiopia, February 2011
Abyot Bekele Woyessa*, Worknesh Ayele, Abdi Ahimed, A Nega
Ethiopian Health and Nutrition Research Institute, Ethiopia, Addis Ababa,
Ethiopia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P46
Introduction: Acute Febrile Illnesses (AFIs) due to different etiologic
agents are the most common causes of morbidity and mortality in
developing tropical and subtropical countries. Afar region reported
unidentified AFI outbreak on 10-Aug-2011. We investigated to identify
etiologic agent, risk factors and to recommend prevention and control
measures.
Methods: Unmatched case control study was employed. Study subjects
(57 cases and 57 controls) were obtained and interviewed. Cases were
defined as any person with fever ≥ 38.3C°, headache, pains in joints,
muscles and back, anorexia and weakness. Medical records were reviewed
and suspected AFI cases were identified from 07-Aug-2011 to 11-Sep2011in Asyaita and Dupti districts. Active cases were searched house to
house. Blood-samples, blood-serums and throat-swabs were collected and
analyzed for heamoparasites, bacterial-pathogens, hemorrhagic fevers and
respiratory viruses at national and CDC Kenya laboratories. Environmental
scanning was performed. Odd-Ratio (OR) in 95%Confidence-Interval (CI)
was calculated using Epi-Info version-3.5.1.
Results: A total of 12816 suspected AFI cases with no death were
identified. Of the cases 9107(71%) were male and 3709 (29%) were female.
Attack-Rate (AR) was 8.7% (11.5% in male and 5.4% in female) and 13.8%
among 15-44 age-groups. On bivariate analysis factors associated with
illness were living with sick family member (OR: 2.8; 95%CI: 1.3-6.2),
contact with patient (OR: 3.8; 95%CI: 1.5-9.6) and drinking deep-well water
(OR: 2.7; 95% CI: 1.2-5.8). However, on multivariate analysis only having
contact with patient (OR: 4.1; 95%CI: 1.5-11.3) was associated with illness.
Twenty-five specimens were tested negative for malaria parasites,
Salmonella species, brucella species, dengue fever, yellow fever and rift
valley fever.
Conclusions: An outbreak of suspected AFI occurred in 2 districts
affecting primarily males and older age. Having contact history with
patient was risk factor to contract the illness. Etiologic agent and source
of the outbreak was not identified yet. Large-scale investigation is
recommended.
P47
Acanthamoeba castellanii. antibody prevalence among diverse tribal
Pakistani population
Abdul Matin*, Muhammad Ismail, Khalid Mehmood
Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P47
Introduction: Acanthamoeba is opportunistic protozoan pathogen and is
known to be one of the most ubiquitous organisms that can produce
Page 24 of 54
keratitis and rare but fatal encephalitis. Infections due to Acanthamoeba
have increased over the year, which is due to presence of Acanthamoeba
in the natural environment and have a direct contact with human in
everyday life and is responsible for human diseases. Given the free-living
nature of the organisms, it is anticipated that we encounter Acanthamoeba during our normal life. The aim of the present study was to
investigate anti-Acanthamoeba antibodies in Pakistani healthy population
to combat this pathogen in normal situation.
Materials and methods: Acanthamoeba isolation from environmental
sources (water, soil and air samples) was done using plating assay.
Acanthamoeba identification from environmental samples was based on
the morphology of cyst and trophozoite forms by non-nutrient agar
plates seeded with E. coli K12 and PCR amplification with a genus
specific primer pair. The presence of anti-Acanthamoeba sIgA in
mucosal secretions of tribal Pakistani population (saliva were obtained
from healthy individuals) were determined using Enzyme-linked
immunosorbent assays (ELISA).
Results: Acanthamoeba was successfully isolated from the water sources
of Pakistan during this study. ELISA demonstrated the presence of
Acanthamoeba-specific sIgA in mucosal secretions of in different age
groups and both genders. A total of 524 samples of 45 tribes, were
collected from different age groups ranged from 15 to 60 years. The
overall prevalence was 78.8% in males and 73.8% in females. No
significant difference was observed between genders. The high level of
anti-Acanthamoeba antibodies was observed among the people in 25-30
years of age. Furthermore the prevalence of antibodies was observed
high in tribal population of Khyber Pakhtunkhwa province as compared
to rest of the country.
Conclusion: Here, we for the first time isolated Acanthamoeba from the
natural environment of Pakistan and presented the prevalence level of
anti-Acanthamoeba secretory IgA antibody in mucosal secretions of the
normal Pakistani population.
P48
Study of intestinal parasitic infections associated with HIV infection in
Douala, Cameroon
Leopold G Lehman, Lafortune Kangam*, Eveline Nguepi,
Marthe-Lilianne Mbenoun, Charles F Bilong Bilong
University of Yaoundé I, Douala, Cameroon
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P48
Aim: Gastrointestinal infections are common in people living with HIV.
Diarrhea occurred in 30 to 90% of them. However reports on the
prevalence of gastrointestinal parasites (GIP) and HIV infection are very
few in Cameroon. The purpose of this study was to assess the GIP
prevalence in the context of increasing availability of highly active
antiretroviral therapy (HAART).
Materials and methods: A prospective study was conducted from
January to December 2011 wherein stool and blood samples were
collected from 201 patients in 3 hospitals of Douala. The stool samples
were stained with Kinyoun and Safranin to identify coccidian oocysts.
Saline preparations were used to identify ova, cysts and larva. Preparations
were observed under UV light microscope CyScope® (Partec Görlitz,
Germany). CD4 + T lymphocytes were counted with a flow cytometer
CyFlow® (Partec Görlitz, Germany). Chi-square test was used for statistical
analyses and P-value <0.05 was considered significant.
Results: The global prevalence of intestinal parasites was 27.8%.
Seventeen (48.6%) out of 37 patients with diarrhea and 38 (23.2%) out of
164 without diarrhea were parasitized. The most frequent parasites were
Candida spp. (13.2%), Cryptosporidium spp. (7.4%) and Entamoeba
histolytica/dispar (3%). A significant correlation (p=0.002) was observed
between the presence of parasites and diarrhea. The highest parasite
counts (p=0.035) and diarrhea (p<0.0001) were found in patients with
CD4 + < 200 cells/μl. Srongyloïdes stercoralis, Trichuris trichuira and
Isospora belli were only found in diarrheal sample.
Conclusions: The overall prevalence of GIP is decreasing in Douala,
probably due to the growing avaibility of HAART. This study highlights
the importance of looking for intestinal parasite in HIV patient with low
immunity presenting with diarrhea in Douala, which is not the case in
our hospitals.
Retrovirology 2012, Volume 9 Suppl 1
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P49
Epidemiology of Hepatitis Delta Virus infection in HIV-infected
individuals in Taiwan
Hsi-Hsun Lin*, Susan Shin-Jung Lee, Ming-Lung Yu, Bo-Sean Hu,
Shiou-Haur Liang, Wen-Chien Ko, Jaw-Ching Wu, Fan-Ceng Zheng,
Chung-Hsu Lai, Jin-Long Lin
E-Da Hospital, I-Shou University, Kaohsiung, Taiwan, Province of China
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P49
Introduction: HIV-infected individuals are at higher risk for acquiring
HDV. We sought to study the prevalence, genotypes, and associated risk
factors causing HDV infection in HIV-infected individuals from an area
with high prevalence of hepatitis B virus infection.
Materials and methods: A multicenter study of 341 (22.1%) HBsAg+
from 1543 HIV-infected patients was conducted from 2005 through 2011.
Blood samples were collected and analyzed for the presence of antibody
to HDV and to determine the genotype of HDV.
Results: The overall prevalence of HDV infection among HBsAg+ carriers
was 54.8% (187/341). However, the prevalence among different risk group
was distinct. The prevalence of HDV was 73.6%, 13.5%, and 9.2% among
HIV-infected IDUs, heterosexual, and MSM, respectively. The main circulating
HDV subtypes in our study were genotype IV (60.5%), genotype II (27.6%),
and genotype I (11.8%). Multivariate logistic regression analysis revealed that
the major risk factor associated with HDV infection was injection drug use,
following by HCV infection, HBsAg titer >=250 IU/mL, and duration of
injection drug use. A significant increase of cumulative seroprevalence of
HDV with duration of IDU from 1 to 15 years was observed (OR: 1.20, 95%
CI: 1.09-1.32, P<0.01).
Conclusions: Our study demonstrated high prevalence of HDV infection
among HIV-infected IDUs. Effective strategies are needed to prevent
injection drug use and to educate ongoing IDUs about the avoidance of
practices that lead to infection with HIV, HCV, and HDV.
P50
Genetic variability of Hepatitis C Virus in Moroccan population
Ikram Brahim*, Abdelah Akil, El Mostafa Mtairag, Régis Pouillot,
Abdelouhad El Malki, Richard Njouom, Pascal Pineau, Sayeh Ezzikouri,
Soumaya Benjelloun, Salwa Nadir, Rhimou Alaoui
Faculty of Sciences Ain Chock Casablanca, Casablanca, Morocco
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P50
Hepatitis C virus (HCV) evolution is a highly dynamic process. There is little
information about molecular epidemiology of HCV isolates in Morocco, an
area known for an intermediate prevalence of HCV infection.
The primary aim of this study was to determine the subgenotype
distribution of HCV strains in patients with chronic HCV infection in
Morocco and an eventual association between HCV subgenotypes and
liver cancer. The secondary aim was to estimate the prevalence of amino
acid substitutions in the HCV core region in treatment-naive patients from
Morocco and an eventual association between amino acid substitutions
and liver cancer.
Serum samples from a total of 185 anti-HCV positive patients were
included in this study (81 males and 104 females). The identification of
HCV genotype and subtype was respectively performed by sequencing of
the 5’UTR and core regions and phylogenetic analysis of the NS5B region.
HCV demographic history was inferred using a Bayesian Monte Carlo
Markov chain analysis. Of the 174 patients with detectable viremia, the
core and the NS5B regions were amplified in 152 (87.4%) and 141 (81.0%)
patients respectively. Phylogenetic analysis based on NS5B region revealed
that most HCV strains were classified into subtypes 1b (75.2%) followed by
subtypes 2i (19.1%), 2k (2.8%). Subtypes 2a, 1a, and 4a were found in a
single patient. HCV subtype 1b had an even higher prevalence in liver
cancer cases (84.4% vs 67.5% in chronic hepatitis, P= 0.031). Using a
Bayesian approach, the mean date of appearance of the most recent
common ancestor was estimated to be 1910 for HCV-1b and 1854 for HCV2i. Based on core region, mutations at R70Q or L91M were detected in
more than one fourth of patients infected with HCV 1b.
Page 25 of 54
P51
Molecular epidemiology and genetic analysis of HCV infection in
Cyprus within an intravenous drug user study cohort
Demetris C Iacovides*, Johana Hezka, Natasa Savvopoulou, Athos Chrysanthou
, Leontios G Kostrikis
University, Nicosia, Cyprus
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P51
Introduction: The HCV genome is highly heterogeneous, owing to the
high mutation rate of RNA viruses. There are seven HCV genotypes, with
numerous subtypes and viral quasispecies. The prevalence and distribution
of HCV genotypes varies globally, and strains show highly variable
sensitivity to available therapeutics. Thus, genetic and epidemiological
studies of hepatitis C infection are significant, especially within high-risk
cohorts where viral evolution can be rapid and unpredictable.
Materials and methods: We collected blood samples from intravenous
drug users (IVDU) and performed ELISAs to determine HCV positivity. RNA
extraction, reverse transcription PCR and DNA sequencing were performed
in the Core-E1 and NS5B regions. Strain subtyping was performed using
the Oxford HCV subtyping tool v2.0. Phylogenetic analysis was done by
aligning and comparing the sequences of both regions to reference strains
from the Los Alamos database, using the neighbor-joining method and the
Kimura two-parameter distance estimation approach in MEGA v4. The
reliability of the phylogenetic clustering was evaluated using bootstrap
analysis with 1,000 replicates, and bootstrap values above 70 were
considered sufficient for subtype assignment.
Results: 21 out of 64 research subjects (32.8%) were positive for HCV, a
percentage much lower than the global average (60%) amongst IVDUs. All
individuals were infected with genotypes 3a (62%), or 1b (32%), and no
unique recombinants were identified. Interestingly, none of the subjects
were infected with the 1a strain, a genotype that is highly associated with
intravenous drug use, and is also prevalent in the general Cypriot
population. In contrast, 38% of the subjects were infected with strain 1b,
which is fairly uncommon amongst IVDUs. Finally, we observed three small
clusters within the IVDU group, suggesting possible sharing of injecting
equipment.
Conclusions: HCV infection within IVDUs in Cyprus is polyphyletic, with
high genetic heterogeneity, as seen by the limited clustering within this
group. Absence of large clusters also suggests that sharing of injecting
equipment is uncommon. HCV prevalence amongst IVDUs is significantly
lower than the global average, and only circulation of subtypes 1b and 3a is
observed, in contrast to the general population where all genotypes are
present.
P52
Living with hepatitis C, multiple issues to face
Mathilde Coudray*, Elisabete de Carvalho
Sida Info Service, Montpellier, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P52
Aims: Since 2010, viral hepatitis has been declared a public health priority,
although it remains little known to the general population. In France,
220.000 people are positive to the hepatitis C virus (HCV) and live with its
chronic form, but limited data exists. This study was undertaken to assess
the current face of the epidemic in France, and to identify the profiles of
people living with HCV and their specific challenges.
Methods: The survey consisted of a questionnaire accessible from
November 2010 to February 2011 on the Hépatites Info Service website, a
French hepatitis helpline. Callers meeting the criteria could also complete
the questionnaire with a professional counselor on the toll-free line. After
3 months, 165 questionnaires had been collected.
Results: Participants’ backgrounds are diverse with equal female to male
ratio, and an average age of 50. Women are older and more likely to have
been infected by blood transfusion prior to 1991 or by medical procedure
with early stage diagnosis. Men, however, frequently presume to have
been infected through intravenous drug use with late stage diagnosis. For
all participants, HCV treatment presents a major challenge. Almost all
(96%) undergoing or having concluded treatment emphasized difficult
Retrovirology 2012, Volume 9 Suppl 1
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side effects: 26% interrupted treatment early and 69% took sick leave.
Inadequate health insurance, solitude or addiction problems and coping
with the social stigma of HCV infection multiply general difficulties.
Conclusion: Living with HCV has major and multiple physiological and
psychological consequences, in part treatment-associated. Economic and
social precarity and solitude amid a context of discrimination combine to
increase the issues confronting HCV positive people. The study has
highlighted the diversity of profiles and problems which need to be
integrated into a comprehensive care approach.
P53
Factors associated with hepatitis C in residents of Sao Paulo, Brazil
Norma Farias*, Umbeliana Barbosa de Oliveira, Débora Moraes Coelho,
Iára de Souza, Claudia Afonso Binelli
Epidemiology at Secretaria de Estado Da Saúde de São Paulo- Brazil, Sao
Paulo, Brazil
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P53
Introduction: Hepatitis C represents a global public health problem. The
aim of the present study was to describe the epidemiological profile and
to assess exposure variables associated with hepatitis C in residents of
Sao Paulo, from the database of viral hepatitis at the National Databank
of Major Causes of Morbidity.
Material and methods: We analyzed 24,140 cases of hepatitis C notified in
residents of the State of Sao Paulo, among the 46,969 bank records of viral
hepatitis between 2007 and 2010. Suspected cases of hepatitis C have been
confirmed by the presence of HCV RNA using reverse transcriptionpolymerase chain reaction (RT-PCR). The variables selected from the
notifications files were sex, age, race, education, number of sexual partners,
history of sexually transmitted diseases, HIV/AIDS, intravenous drugs use,
inhaled or crack, injecting drugs, tattooing/piercing, acupuncture, blood/
products transfusion, surgical, dental treatment, hemodialysis,
transplantation and accidents with biological material. Factors associated
with HCV infection were identified with univariate and multivariate Poisson
regression and confidence intervals of 95%.
Results: The detection rate of hepatitis C was about 15/100000 inhabitants.
People aged 50 and over (PR=2,11;95% CI:1,96-2,27), history of blood
transfusion (PR=1,41;95% CI: 1,34-1,48), intravenous drugs use (PR=1,33;95%
CI: 1,25-1,42), inhalable drugs use or crack (PR=1,27( 1,20-1,35), HIV/AIDS
(PR=1,20;95% CI:1,13-1,28), surgical treatment in the past (PR=1,16;95%
CI:1,11-1,21) were the main factors independently associated with infection
by hepatitis C virus.
Conclusions: These findings reinforce the importance of preventing
hepatitis C in vulnerable populations such as drug users and the
implementation of drugs misuse related harm reduction programs
targeted these segments.
P54
Low reduction of HCV-RNA level at week 4 in HIV-1 infected patients
with acute HCV Infection
A Vincent, S Jonckheere*, B Kabamba, JC Yombi, D Wilmes, L Belkhir,
B Vandercam
Internal Medicine - Infectious Dieases at Cliniques Universitaires Saint Luc,
Bruxelles, Bruxelles, Belgium
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P54
Introduction: The epidemic of acute Hepatitis C-virus infection (AHC) is
an on-going issue, especially among MSM patients. Spontaneous HCV
clearance rates have been estimated to be between 5-40%, with lower
rates among HIV-1 co-infected patients. High rates of sustained virological
response have been observed (60-80%) when patients are treated within
24 weeks of AHC diagnosis. Moreover, a spontaneous 2log reduction in
HCV-RNA might be a good predictor of spontaneous HCV-RNA clearance
in HIV-1 co-infected patients. The aim of this study is to analyse the
incidence of 2-log-HCV-RNA spontaneous reduction in AHC in HIV-1
infected patients.
Materials and method: We reviewed medical files of 930 HIV-1-infected
patients from our Reference Centre. All patients diagnosed with AHC in
Page 26 of 54
Table 1(abstract P54) Demographic data (data shown in
numbers (%) or median)
Population
Male sex
9 (100%)
Age (median)
44 y
BMI (median)
Transmission risk-factor; MSM
23
9 (100%)
Ethnicity (Caucasian/Black)
9 (100%)
HIV results
CD4-cells count (median)
565
HIV-RNA (copies/mL) (median)
<37
HAART+
9 (100%)
HCV
Genotype 1a
7 (78%)
Genotype 4
2 (22%)
HCV-RNA To (copies/mL)
1049740
HCV-RNA T+4weeks (copies/mL)
552042
- 2 log at T+ 4w
3 (33%)
- 2 log at T+ 4w according to
genotype
3 (100%) genotype 1a / 0
genotype 4
Clinical features
AST (IU/L) T0 (median)
357
ALT (IU/L) T0 (median)
ALT (IU/L) T+4w (median)
654
131
2010-2011 were included. Diagnosis of AHC was based on seroconversion
and ALT elevation. HCV-RNA PCR data was collected at time of and on
week 4 after diagnosis.
Results: Eleven patients were included, but only 10 met our diagnostic
criteria. One patient was excluded because of missing data. Demographic
and clinical data are summarised in Table 1. All patients were MSM. All but
2 patients had genotype 1a HC-virus. On week 4, 3 patients presented with
a spontaneous 2log HCV-RNA reduction. All were diagnosed with
genotype 1a AHC.
Conclusion: Although completed on a small number of patients, this
audit suggests that only a low proportion (33%) of HIV-1 infected
patients presenting with AHC will meet a favourable 2log-HCV-RNA-drop
criteria. This is slightly lower than rates reported by NEAT (i.e. 48%). It
implies that these co-infected patients should benefit from a close followup in order to start treatment within 24 weeks of AHC diagnosis,
whenever it is needed and available.
P55
The results of a study on the prevalence of HIV, HCV and HBV
genotypes in some regions of Ukraine
Yurchenko, Tetiana Stepchenkova*, Iryna Karnets, Kenneth Ashworth,
Tetiana Cheusova
Kiev Regional Aids Center, Kiev, Ukraine
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P55
Background: Ukraine occupies a leading position in Europe on HIV, HCV
and HBV infections. 197083 cases of HIV infection and 2000000 cases of
viral hepatitis are officially reported among Ukrainians.
Specialists of the Kiev regional AIDS center and other regional AIDS
centers of Ukraine with the assistance of the “EW BIOPHARMA” company
(by order of “Aldima SA”) are conducting a study on genotyping HIV, HCV
and HBV.
Methods and test-systems: - ELISA testing (Genscreen ULTRA HIV AgAb; Monolisa HCV Ag-Ab ULTRA; Monolisa HBs Ag Ultra)
Retrovirology 2012, Volume 9 Suppl 1
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Page 27 of 54
- PCR testing (Versant HIV-1 RNA 3,0(bDNA); RMS CAP CTM HCV PCR;
Abbott Real Time HCV; AmpliprepCOBAS TaqMan HCV Test; AmpliSense
HCV Monitor FRT; RMS CAP CTM HBV PCR)
- Genotyping (Trugene HIV-1 Genotype; Versant HCV v2,0 (Lipa);
AmpliSense HCV- genotype FL;Quest HBV_Genotype)
Duration of a study - August 2011 - present time.
All patients gave their voluntary consent to involvement and publication
of the results. The study includes patients with HIV, or HCV, or HBV. Coinfected patients, which was confirmed by ELISA testing, were excluded.
200 samples have been tested during 4 mounths of 2011. Among them:
- HIV-58
- HCV-121
- HBV-21
In the genotyping of 58 samples of HIV patients were revealed:
- M,A -21 (36,2%)
- M,B -8 (13,8%)
- M-1 (1,7%
- no genotype - 28(48,3%) (undetectable viral load)
In the genotyping of 121 samples of HCV patients were revealed:
- 1a-2(1,6%)
- 1b-51(42,1%)
- 2a-1(0,8%)
- 2ac-1(0,8%)
- 3a-35(28,8%)
- 4-1(0,8%)
- no genotype - 30(25,1%) (undetectable viral load)
In the genotyping of 21 samples of HBV patients were revealed:
- A-3(14,2%)
- C-1(4,7%)
- D-11(52,4%)
- no genotype - 6(28,7%) (undetectable level of viral load)
Conclusion: Among the samples of plasma of HIV patients, the most
common genotype is -M,A (36,2%)
Among the samples of plasma of patients with HCV, the most common
genotype is 1b -(42,1%)
Among the samples of plasma of patients with HBV, the most common
genotype is D-(52,4%)
P56
Changes in immune activation in the T Cell compartments of HIV HCV
coinfected patients during PEG IFN RBV treatment
Amélie Menard*, Corinne Brunet, Véronique Obry, Patrick Dukan,
Sylvie Brégigeon, Olivia Faucher, Estelle Balducci, Anne-Suzel Ritleng,
Françoise Dignat-George, Isabelle Poizot Martin
Haematology-Aids Unit Hôpital Sainte-Marguerite, Marseille, France
Retrovirology 2012, 9(Suppl 1):P56
Chronic activation of CD8 T-cell compartment is critical during HCV-HIV-1
coinfection. The objective of this study was to evaluate the impact of
pegylated-interferon (PEG-IFN) in combination with ribavirin (RBV) on
immune activation in HCV-HIV-coinfected patients.
T cell phenotype (CD8+CD38+,CD8+DR+) was quantified using flow
cytometry analysis,. Measurements were performed at day one of
treatment (Baseline, BL), then at week (W)12,W24,W48 and W24 posttreatment. HVC viral load was measured using a PCR (COBAS TaqMan 48;
Roche), exhibiting a limit of detection at12 IU/ml. Statistical analysis was
performed with SPSS 17.0.
11 pts (64% of males; median age 47.4 [45.1-51]) with a median follow up
for HCV infection of 14.7y [11.7; 19.1]) were evaluated. All were treated for
HIV infection (PI- based regimen: 63.6%) with an HIV-VL < 40copies/ml.
Median CD4 and CD8 T cells count at BL was 886/mm3 [671; 1008] and
825/mm3 [530; 1843], respectively. HCV genotype was 1 for 63.6%, 3 in
27.3% and 4 in one pt. HCV VL at BL was 5.9 [4.6; 6.7] (log UI/ml). Up to
now, 2 pts stopped HCV treatment at W2 and W4, 9 pts have reached
W24, and 5 of them are between W24 and W48. The results at W12 and
W24 are presented in the table. We observed a significant decrease of the
number of circulating total lymphocytes and CD4T cells in absolute value
(p=0.008), but a significant increase in the percentage of CD4+ T-cells and
a significant decrease in the percentage of CD8+ T cells at W24. HCV VL
was negative for all of them.
These preliminary results show that the immune system hyperactivation
driving by HCV disease can be reduced with a control of HCV replication.
However, we observed a discrepancy in the evolution of CD8+CD38+ and
CD8+DR+ expression at W12 which remains at W24.These results have to
be confirmed with the next measurement performed at W48 and W24
post treatment.
P57
HBV and HCV genotypes distribution on the territory of Belarus
EL Gasich, VF Eremin*, SV Sasinovich, MG Tulinova
Briem, Minsk, Belarus
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P57
Materials and methods: 236 HCV and 158 HBV plasma samples
collected during 2004-2011 have been investigated. EIA, PCR, RT-PCR,
sequencing, SeqScape, BioEdit, MEGA4.1, statistica v.6 software have been
used.
Results: Of 158 HBV HBsAg positive specimens 17 (10,8%) were from
patients with acute hepatitis B and 141 (89,2%) from chronic hepatitis B.
Among surveyed were 83 (43,6%) women and 92 (56,4%) men at the age
from 15 till 90 years. Middle age has made 44,5±17,8 years. From 158
surveyed 11 persons have been HBV+HBC co-infected and 1 with HBV
+HCV+HIV. HBV genotypes has been defined at 61 (34,9%) patient. The
phylogenetic analysis of HBV preS fragment has shown that in 52 (85,3%)
cases come to light D genotype (D1 – 32.9%; D2 - 26,2%, D3 – 26.2%), in
7 (11,5%) – A (A2) and in 2 (3,2%) – C (C2) genotype. Of 236 HCV
infected patients prevailed 1b (53,8%, n=127) and 3a (28,8%, n=58)
genotypes. At 30 (12.7%) cases have been revealed 1a genotype and 2a
and 2b genotypes have been revealed in 8 (3,4%) and 3 (1,3%) cases
accordingly.
Conclusion: In the territory of Belarus a genetic variety of HBV and HCV
genotypes, caused both circulation before the brought viruses, and new
drifts from neighbouring countries, basically from Russia and Ukraine is
observed.
P58
Rapid cell-free CD4 enumeration using whole saliva
Cynthia L Bristow*, Mariya A Babayeva, Rozbeh Modarresi, Carole P McArthur,
Santosh Kumar, Charles Awasom, Leo Ayuk, Annette Nhinda, Paul Achu,
Ronald Winston
Weill Cornell Medical College, New York, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P58
Introduction: The determination of CD4 counts in patients with HIV/AIDS
is of paramount importance clinically to determine when to initiate antiretroviral therapy (ART). ART slows disease progression, reduces viral load
and significantly reduces HIV transmission. Currently, the only methods
Table 1(abstract P56)
BL
W12
p
W24
p
CD4+ T Cell (%)
27.0 [24.5; 37.1]
37.5 [26.8; 46.0]
0.008
43.0 [30.5; 47.3]
0.011
CD8+ T Cell (%)
46.0 [30.4; 51.0]
43.2 [25.9; 49.7]
0.110
37.4 [26.5; 46.9]
0.028
DR+CD8+ T Cell (%)
11.0 [6.4; 19.5]
5.2 [2.8; 9.9]
0.017
2.4 [1.4; 7.4]
0.008
CD38+CD8+ T Cell (%)
14.7 [6.8; 21.5]
43.2 [28.9; 48.9]
0.008
36.2 [15.7; 47.1]
0.015
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for obtaining CD4 counts use flow cytometry technology. Unfortunately,
the latter technologies require fresh cells, reliable and stable electricity, a
high degree of technical training for laboratory personnel, expensive
instrumentation, and calibrated pipetting which is often unavailable in
rural areas or in resource-limited environments. A rapid, inexpensive,
point-of-care method would overcome a critical barrier to HIV prevention
because it would have a major impact on the cost and health outcomes
of patients as well as the frequency of HIV transmission, all of which
markedly impact global economy. A commonly used cost-saving and
time-saving laboratory strategy is to calculate, rather than measure
certain blood values. For example, LDL levels are calculated using
measured levels of total cholesterol, HDL, and triglycerides. Thus,
identification of cell-free correlates that directly regulate the number of
CD4 + T cells could provide an accurate method for calculating CD4
counts due to the physiological relevance of the correlates. We have
recently determined that a 1 proteinase inhibitor (a 1 PI, a 1 antitrypsin)
participates in regulating the number of CD4+ T cells in blood.
Materials and methods: Stimulated saliva was collected from 20 female
and 11 male HIV-1 subjects attending clinic for routine care in Cameroon.
The a1PI Index was calculated as the ratio of a1PI activity versus protein
content in saliva and compared to CD4 counts determined by the standard
method, flow cytometry.
Results: The a1PI Index in saliva correlated with CD4 counts determined
by flow cytometry (r²=0.91, p<0.0001. n=31). An algorithm was developed
(the a-test) based on the a 1 PI Index. The precision of the a-test was
approximately 26 CD4 cells/ml, and the accuracy of the a-test was
approximately 95%.
Conclusions: The a-test is physiologically relevant to CD4 counts and can
be performed using saliva thereby providing a noninvasive, accurate and
precise point-of-care method for monitoring CD4 counts in endemic regions
with no instrumentation at a cost-per-test that is less than a dollar.
P59
Disclosure of HIV status outcome of regular counseling in a cohort of
patients attending HIV clinics
Livingstone Ssali1*, Francis Wasagami1, Agnes Kateeba1, Sophie Nantume1,
Andrew Kiboneka2
1
The Aids Support Organisation, Taso, Kampala, Uganda; 2Kampala
International University Teaching Hospital, Kampala, Uganda
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P59
Background: The African continent bears the greatest burden of HIV/AIDS
in the world. Efforts by scientists to find a vaccine for curing the pandemic
have proved futile to date. The prevalence in Uganda stands at 6.4% in
Adults and 0.7 % in Children, and about 1.1 million Ugandans are living
with HIV/AIDS. The AIDS Support Organization started in 1987. Non
disclosure of HIV sero status affects uptake of HIV/AIDS health services,
increases stigma and discrimination.
Methodology: A retrospective cohort study was done to review records of
patients newly registered between January and December 2007 from
Management Information System. We analyzed records of patients who
had not previously disclosed their HIV/AIDS Sero status at the time of entry
into TASO HIV/AIDS clinic. These patients routinely received counseling
services for a period of 36 months to assess their disclosure status.
Results: Out of 1413 patients counseled, 117(8.3%) patients had not
disclosed their HIV sero status, 27(23%) patients were sexually active.
During the first individual counselling sessions, patients were given
information on condom use 19%, septrine prophylaxis 18%, sexually
transmitted infections 15%, family planning 12%, and antiretroviral therapy
9%, safe water 8%, abstinence 5%, life skills 4%, prevention of mother to
child transmission 4%, Tuberculosis 4%, voluntary counselling and testing
2%, and faithfulness 1%. Significant number of these sessions focused on
opportunistic infections 39%, disclosure 15%, antiretroviral therapy 14%,
drug therapy 9%, STD and HIV prevention 5%, nutrition 4% and welfare
4%, discordance 2%, sexuality and abstinence 3%. Other indirect
interventions included HIV prevention sensitization through formation of
peer support groups, drama sensitizations, group counseling and health
talks during clinics. After 36 months of follow-up, 65-56% of 117 patients
had disclosed their HIV sero status. Disclosure of HIV status is statistically
associated with the number of counseling sessions (p=0.008). Average
Page 28 of 54
number of counseling sessions was 6 sessions. Patients who had not
disclose after 36 months recorded an average of 3 counselling sessions.
Revealing of HIV sero status is statistically associated by sex, more female
reveal their HIV Sero status in as short life span compared to males
(p=0.002).
Conclusions: The number of counseling sessions someone receives is
associated with supported disclosure. Female patients reveal their HIV
sero status in a shorter time span compared to males. Integration and
more frequent provision of counseling services to patients in HIV/AIDS
care and treatment enables them to make informed decisions regarding
disclosure of their HIV sero status to their family members, sexual
partners, friends and others. This has created support systems to clients
and therefore reducing further spread of HIV.
P60
Economic modeling in HIV for maraviroc in France in treatment
experienced patients. Results from the ARAMIS 2011 model
Nicolas Despiegel, Felicitas Kuehne, Monique Martin*, Ahmed Shelbaya
Vp Uk French Heor Operations at Optuminsight, Uxbridge, UK
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P60
Introduction: To update an existing and previously published economic
(micro-simulation model) in HIV (ARAMIS) to reflect current treatment
patterns and to evaluate the cost-effectiveness of maraviroc (MVC) in
France.
Materials and methods: A systematic literature review was carried out in
PubMed to identify all articles published in the past 5 years to provide new
data to update the existing model. A total of 1964 abstracts were identified
on opportunistic infections (OIs), health consequences (effects on health
over the longer term e.g. cancer), costs, quality of life, adherence,
resistance and efficacy of treatments. In addition, current guidelines were
identified and reviewed. New data were included for OIs, costs, treatments
and LT health consequences. Treatments focussed on maraviroc, etravirine
(ETR) and raltegravir (RAL) including optimised background therapy (OBT)
for treatment-experienced patients at the model’s start. All relevant trials
with these agents were identified, data were extracted and used in a metaanalysis (results not provided here) which provided relative efficacy data at
48 and 96 weeks. Treatment algorithms were updated based on guidelines
and expert opinion. Costs were at the 2011 level based on official sources.
There were insufficient data on adherence to include this in the model.
Results: The updated version of the ARAMIS model indicates that MVC
compared to RAL or ETR over a life time is associated with more QALYs (a
difference of 0.037 and 0.134 respectively) but higher total costs (a
difference of €1,439 and €4,766, respectively). The incremental cost
effectiveness ratio for MVC compared to RAL or ETR is €39,300 and
€35,700. Assuming a threshold of €50,000 MVC can be considered costeffective compared to RAL and ETR. Life expectancy with MVC was similar
to RAL (0.37 month difference) and higher than ETR (1.58 months
difference).
Conclusion: MVC is a cost-effective treatment option for CCR5 tropic
treatment-experienced patients in France.
P61
Project control- evaluation of a brief HIV counseling video to improve
risk reduction behavior of teenagers
Yvette Calderon1*, Cheng-Shiun Leu2, Ethan Cowan1, Jillian Nickerson3,
Christopher Brusalis3
1
Albert Einstein College of Medicine, Bronx, NY, USA; 2Columbia University,
New York, NY, USA; 3Jacobi Medical Center, Bronx, NY, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P61
Background: This study compared the effectiveness of a brief theorybased, youth-friendly HIV counseling video series with the standard
practice (an HIV counselor) in improving risk reduction behavior among
teens recruited in an urban Emergency Department (ED).
Methods: A two-armed randomized controlled trial was conducted on a
convenience sample of 203 non-critically ill, sexually active individuals
aged 15-21 in an urban emergency department. Participants in the
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control (counselor) group received HIV information and counseling from a
counselor while those in the intervention (video) group watched a series
of youth-friendly counseling videos tailored to patients’ stages of change.
All participants completed pre- and post-intervention measures on three
mediating variables hypothesized to reduce unsafe sexual behavior:
condom intention, condom outcome expectancy, and condom selfefficacy. HIV testing was optional for both arms.
Results: 203 patients were enrolled and randomized, 102 in the video
group and 101 in the counselor group. The groups were similar with
respect to age, gender, race, ethnicity, and sexual history. The video
intervention performed as well as in-person counseling at improving
several condom use measures. The mean difference between groups
(video-counselor) in improvement over time (from pre- to postcounseling) in condom self-efficacy was 0.26, CI(0.03,0.50), in male
outcome expectancy was 0.15, CI(0.02,0.28), and in female outcome
expectancy was 0.20, CI(-0.01,0.40). Participants in the video group
improved their condom use intention score significantly more than those
in the counselor group, with a mean difference between arms for change
over time of 1.02, p-value = 0.01, CI(.24,1.80). The intervention effect on
condom intention score did not differ by gender or ethnicity.
Conclusions: The use of theory-based, youth-friendly video can be a
valid means to provide post-test counseling education and prevention
messages within an urban ED. The theory-based prevention messages
can improve specific mediators representing risk reduction behavior
among teenagers immediately following the intervention.
P62
Relationship between health locus of control and sexual risk behaviour
Enejoh Aromeh Victor1*, Karick Haruna2
1
Umsom - Institute of Human Virology, Nigeria, Fct Abuja, Nigeria;
2
Department of Psychology University of Jos Nigeria, Nigeria
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P62
Background: Knowledge of the means of transmission and prevention of
HIV/AIDS has been rated as the most important foundational factor for
prevention. However studies have also shown that this knowledge does
not always translate into reduced sexual risk behaviour (SRB). Perceived
control over health status (“internal” locus of control) or attribution of
health status to chance or fate (“external” health locus of control), HLC, is
a psychological construct that has been shown to impact health
outcomes. This study investigated the relationship between HLC and SRB.
Hypothesis tested was, “individuals with an external locus of control will
engage in more SRB compared with internals”.
Methods: A cross sectional survey design was employed with 9
secondary schools in Jos,Plateau StateNigeria. Sample comprised of 361
students in senior secondary school. Health Locus of Control Scale
measured attitude regarding perceived control over personal health, with
individuals having either an internal or an external HLC while SRB was
assessed using the Brief HIV Screener (BHS). Data was analyzed using the
SPSS17.0. Descriptive statistics were computed while Analysis of variance
was used to determine difference in SRB by HLC categories.
Results: Respondents were 169 (46.8%) males and 192 (53.2%) females with
a mean age of 16.9, age range 12-24 years. Mean HLC score was 38.54.
When grouped into categories, 178 were internals while 183 were externals.
Mean score on the BHS was 1.58, with a significant effect of gender.
F (1,359) = 8.136, P < 0.01. Research hypothesis was supported; there was a
statistically significant effect of HLC on SRB F (1,359) = 4.15, P < 0.05.
Conclusion: Respondents who attributed their health status to chance or
fate (external locus of control) significantly scored higher on SRB
compared with internals. Prevention programs targeted at adolescents
should also aim at internalizing their health locus of control.
P63
Physical activity particpation and cardiovascular fitness in people
leaving with HIV. A one-year longitudinal study
S Fillipas*, FM Cicuttini, AE Holland, CL Cherry
Physiotherapist at the Alfred, Melbourne, Australia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P63
Page 29 of 54
Introduction: Physical activity (PA) and cardiovascular fitness (CVF) are
beneficial for HIV-infected individuals, however long-term effects are
unknown. This study aimed to document long-term habitual PA and CVF
in stable, HAART-treated individuals with HIV, explore relationships to
body composition, body image and cardiovascular disease (CVD) risk and
evaluate PA determinants.
Materials and methods: This was a 12-month prospective, longitudinal
cohort study. Eighty ambulant HIV-infected adults (aged ≥18 years) on
HAART were recruited from The Alfred Hospital Infectious Diseases clinic
and local HIV community clinics. PA was reported using the International
Physical Activity Questionnaire and CVF assessed using the Kasch Pulse
Recovery Test.
Results: 19-37% participants reported suboptimal PA levels at each study
visit, while PA and CVF were largely stable over the study period. Higher
CVF was associated with better body composition and this association
persisted over time (p=0.05). Greater total energy expenditure was
associated with improved body image (r=-0.325, p=0.027) but notCVD
risk. At baseline, the proportion of subjects in a permanent relationship
was higher among active versus inactive participants [47.7% versus 13.3%
(p=0.032)]. A similar trend was seen at six and 12 months.
Conclusions: In this stable, HAART-treated HIV–infected cohort a suboptimal level of PA participation was observed. CVF was associated with
improved body composition, suggesting HIV- infected individuals should
be encouraged to improve and maintain CVF. Increasing PA levels were
associated with improved perceived body image, supporting use of PA to
improve this aspect of psychological well being. Being in a permanent
relationship was associated with higher PA levels suggesting that social
isolation may be a risk factor for inactivity in those with HIV. Further work,
including larger cohorts and longer follow up is needed to explore factors
that influence PA and CVF in HIV. This study found benefits for both longterm PA and CVF for chronic HIV-infection however intervention studies
are required to define the benefits obtainable for improving long-term PA
uptake and CVF in this population.
P64
Consistency between clinician and patient perspectives on ARV
treatment commencement and switching examined
Jeffrey Grierson*, Marian Pitts, Rachel Koelmeyer
la Trobe University, Melbourne, Australia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P64
Introduction: In the context of multiple HAART treatment modalities it is
critical that common understandings regarding the motivators and
barriers to treatment commencement and switching are shared by both
prescribing clinicians and PLHIV.
Materials and methods: We conducted an online survey of 254 people
living with HIV (PLHIV) in Australia and structured interviews with 18
clinicians (HIV S100 prescribers). PLHIV had a median age of 47.5 years.
Overall, 87.4% of respondents were currently taking ARV; 5.5% had taken
ARV in the past but not currently, and 7.1% had never taken ARV. Clinicians
were a mix of high caseload experienced practitioners and newer low
caseload clinicians.
Results: When we examined the motivations for and barriers to treatment
commencement, PLHIV identified concerns about potential side effects and
the psychological consequences of acknowledging potential physical
decline. Clinicians were most likely to assess readiness in terms of ability to
maintain adherence. PLHIV relied on the clinician initiating and advising
treatment commencement. Clinicians identified process of clinical
assessment, ARV education and adherence training as the antecedents of
treatment initiation.
Similarly with switching treatments, PLHIV identified concerns about side
effect profiles, clinical markers and the potential limiting of treatment
options. Clinicians identified resistance patterns, regimen potency and
adherence concerns as primary motivators for treatment change. PLHIV
generally expected any discussion of switching to be initiated by the
clinician. Clinicians discussed the process in terms of resistance testing
and patient education around treatment options.
Both PLHIV and clinicians identified the relationship between them as the
critical component of the processes of commencing and changing ARV
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treatment. Clinicians were keen to involve PLHIV in the decision-making
process and PLHIV had a high degree of trust in their clinicians’
knowledge and judgement.
Conclusions: Treatment discussions need to occur frequently. There is
evidence of resistance on the part of patients to change unless they are
experiencing significant side effects. Clinicians may focus unduly on
adherence while PLHIV are more concerned about side effects and
disease progression. The valued relationship between clinician and PLHIV
provides a fertile basis for improved treatment discussion.
P65
Drivers of treatment change in PLHIV- psycho-social factors are more
important than considerations of adherence
Marian Pitts*, Jeffrey Grierson, Rachel Koelmeyer
la Trobe University, Melbourne, Australia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P65
Introduction: There are increasing options available for the effective
management of HIV. Treatment regimens have become simpler and more
manageable since the introduction of HAART fifteen years ago. In this
context it is important to understand how commonly PLHIV switch
treatment s and how the decision to change treatment is negotiated
between clinician and patient.
Materials and methods: We conducted an online survey of 254 people
living with HIV (PLHIV) in Australia. PLHIV had a median age of 47.5 years.
Overall, 87.4% of respondents were currently taking ARV; 5.5% had taken
ARV in the past but not currently, and 7.1% had never taken ARV.
Results: Two-thirds of respondents had changed ARV at some point: 14%
in the last 12 months. Respondents last changed treatment a median of
3 years ago. Most respondents (90%) had not used more than six
combinations in their lifetime.
Of those who had changed treatment, the most significant driver of the
decision was the advice of the physician (76%) the second most
important was the side effects of the previous regimen (49%). Fatigue/
loss of energy was the most prevalent side effect experienced by 74% of
all respondents. It was also rated as the most bothersome on the ACTGHIS scale.
Aspects associated with adherence were the lowest rated drivers of
treatment change. Only 7% of respondents identified problems with
taking doses at the correct time, and less than 5% reported missing
doses.
Given that the doctor’s advice was the most important driver of treatment
change we elicited the important characteristics of the clinician- patient
relationship using free text. The doctors’ interpersonal skills and
personality was most frequently identified (by 62% of respondents). This
was more than double the next most frequently mentioned characteristic
(competence- 37%). Open ended contributions from participants also
highlighted the importance of open communication and a robust
relationship with the clinician.
Conclusions: A focus on adherence and neglect of relational, psychosocial and somatic factors in assessing motivations for treatment
switching is likely to compromise robust patient-clinician relationships.
P66
A multidisciplinary staff for the optimisation of therapy in HIV-infected
patients treated for cancer
Julie Daigre1*, Meriem Mendjel1, Sylvie Bregigeon2, Catherine Tamalet3
1
APHM La Timone, Laboratoire de Pharmacocinétique et Toxicologie,
Marseille, France; 2APHM Sainte Marguerite, Service d’Immunohématologie
clinique, CISIH, Marseille, France; 3Pole des Maladies Infectieuses et tropicales
Clinique et Biologique, Fédération de Bactériologie Hygiène Virologie,
Marseille, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P66
Introduction: With the improvement of HAART, life expectancy of HIVinfected patients sharply increased. The incidence of cancerous diseases is
therefore increasing in this population. This raises the problem of drugdrug interactions between HIV treatment and cancer chemotherapy poorly
Page 30 of 54
understood because few data are available. However, the potential risk of
interactions is important because of the involvement of similar metabolic
enzymes and transporters between these drugs and due to the inhibitory
and/or inducer effects on different CYP450 isoforms of the PI and NNRTI.
These interactions may both lead to inefficiency and/or an increased risk of
toxicity of the chemotherapy which can be life-threatening for the patient.
Materials and methods: We set up since January 2010 amultidisciplinary
staff “AIDS-cancer-transplantation” to optimize the management of HIVinfected patients diagnosed for a tumour disease. Demographic,
virological and immunological characteristics and therapeutic decision
issued from the staff for these patients have been retrospectively
analyzed.
Results: As of today, data of 28 patients have been evaluated. A therapeutic
adjustment had to be proposed for 14 patients (50%), mainly corresponding
to a modification of the antiretroviral therapy (11/14). The new cART
therapeutic option was defined according to HIV resistance profile, ART
history and after additional biological analyzes if requested. In few cases
(4/14), the cancer chemotherapy was adjusted according to the different
therapeutic options proposed. The main reasons for such therapeutic
adjustment were, for 57% (8/14), related to a metabolic interaction through
the CYP3A4 because of the presence of a boosted PI or NNRTI and for 36%
(5/14) to an increased risk of nephrotoxicity due to the concomitant
administration of tenofovir with a potent nephrotoxic anticancer drug.
For all patients, opportunistic infections prophylaxis (PCP) and screening
for PCR CMV have been prescribed according to French recommendations.
Conclusion: The implementation of the multidisciplinary staff “AIDScancer-transplantation” highlights a high frequency of the risk of drug
interactions between antiretrovirals and antitumoral agents. This allows us
to optimize the management of HIV patients treated for malignant
diseases by apprehending the risk of drug interactions.
P67
Correlates of HIV Stigma in prison guards and case workers in a
national prison system
Carmen E Albizu-García*, Cynthia Pérez-Cardona, Salvador Santiago-Negrón
School Public Health University Puerto Rico, San Juan, Puerto Rico
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P67
HIV is over-represented in correction facilities. Health organizations have
provided a framework for effective response to HIV/AIDS in prisons yet
many countries lack prison-based HIV prevention and treatment. Prison
workforce’s fears of HIV contagion and stigma have been identified as
barriers to appropriate responses. We explore the magnitude of stigma
towards HIV in correctional officers and case workers in prison system
across workforce categories, sex, and HIV knowledge.
A self-administered, anonymous questionnaire was completed by 95 case
workers and 214 correctional officers from 26 of the 39 penal institutions in
Puerto Rico (PR) selected multi stage random sample design. Stigma
towards HIV was assessed with a Spanish measure of stigma towards HIV
among health professionals containing 18 items measured with 6 categories
agreement scale. Predictor variables include demographics, work experience
in corrections, and HIV knowledge. The study was approved by the IRB. We
report the scale’s reliability and the weighted mean and standard deviation
of responses to the stigma measure for the total sample and by workforce
category, sex, and HIV knowledge.
Of the 309 respondents 58% were male and 68% report 5 or more years iof
employment. Scale reliability as measured with Cronbachs alpha was 0 .81.
The values of the stigma towards HIV measure ranged from 18-108, with
higher scores corresponding to greater stigma. The mean of the stigma
score for the total sample was 69.5 (SD 15.6). The means did not differ
significantly when compared for correctional officers vs. case workers or by
sex, yet an inverse relationship was found between stigma and HIV
knowledge.
Stigma scores fell within the second highest quartile suggesting that HIV
stigma is high in this sample. The availability of a culturally sensitive
instrument in Spanish contributes to work in the field and the findings
underscore the need to address stigma towards HIV in the prison
workforce in this and other contexts. Research should be conducted on
the effect of HIV knowledge gains on stigma reduction in this population.
Retrovirology 2012, Volume 9 Suppl 1
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P68
Knowledge, risk perceptions and attitudes of nurses towards HIV in a
tertiary care hospital in Mangalore, India
Anand Venugopal*, A Basavaprabhu, B Unnikrishnan
Radiology at Kasturba Medical College Hospital, Mangalore, India
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P68
Introduction: Infectious diseases like HIV are on rise in developing
countries like India which puts heavy burden on health care needs.
Nurses have a key role and spend considerable time taking care of HIV
positive patients admitted in hospitals. Hence a study was conducted in
our hospital to have an insight into their knowledge about HIV, their
apprehensions while taking care of such patients and their attitudes and
willingness to take care of them.
Methods: It’s a cross sectional study done among 200 nurses of KMC
Hospital, Mangalore. They were given validated questionnaire comprising
of 67 items which included knowledge of spread of HIV, universal
precautions, risk perceptions and their attitudes towards HIV positive
patients. Their responses were analysed using SPSS software.
Results: Of the 200 Nurses selected, 152 completed the questionnaire.
Regarding knowledge of HIV transmission, the correct response for widely
advertised modes of transmission were higher-sexual contact 97.4%, vertical
transmission 88.8%. However, 11.2% did not know about mother to child
transmission and 28.9% about transmission by breast feeding. 90.1% felt HIV
could be transmitted by sharing of plates and 83.6% felt by mosquito bites.
93.4% knew about universal precautions and 78.3% routinely practiced it.
80.3% were aware of post exposure prophylaxis.79.2% described caring HIV
Positives as rewarding,86.5% were willing to assist operations on hiv
patients and 84.9% were willing conduct deliveries. 13.4% felt they have
right to refuse caring HIV patients and 97% felt surgical patients need to be
routinely tested for HIV.
Conclusions: This study demonstrates that there are deficiencies in
knowledge about HIV and false beliefs exist among nurses about spread
of HIV. There is need to improve awareness about HIV and HIV patient
care through training programmes to clear misconceptions amongst
Nurses so that HIV positive patients are not discriminated against and are
treated without discrimination.
P69
Problems of HIV positive tuberculosis patients’ health care in Latvia
Ludmila Viksna*, Inga Januskevica, Valentina Sondore, Baiba Rozentale,
Ilze Eksteina, Andrejs Ivanovs, Tatjana Kolupajeva, Vija Riekstina
Department of Infectology and Dermatology at Riga Stradins University,
Riga, Latvia
Retrovirology 2012, 9(Suppl 1):P69
Introduction: The number of patients with HIV/TB alliance has increased
recently. There were 1055 TB/HIV cases registered in European Union (6%
out of 17 650 TB cases tested for HIV) in 2010, among them 71 in Latvia
(9.5% out of all TB cases in 2010, in comparison with 0.5% in 2000). The
treatment for TB/HIV cases is provided in Latvia according to WHO
recommendations, including DOTS strategy. However the TB treatment
results for HIV positive cases are concerning due to increasing resistance
to HIV/AIDS drugs and to TB drugs.
Methods: The treatment results for 7761 new smear and/or culture positive
pulmonary TB cases were analyzed, 234 among them were HIV positive. In
HIV/AIDS naive patients in general the resistance is found in 5.3% of cases.
In treated patients the resistance to different groups of drugs is detected in
41% of cases: to all -3%, to NRTI – 14%, to NRTI+NNRTI – 9%, to NRTII+PL –
6%, to NNRTI – 6%, to NNRTI+PI – 1%, to PI – 2%. Multidrug resistance
(MDR) was diagnosed in 14% of TB cases. Molecular biological, immunofluorescence, bacteriological and bacterioscopic methods were used for
detection of initiating agents. The TB treatment results for HIV positive and
HIV negative cases from the period 2000-2007 were compared with the
results reported in 2010. Data for 2000-2007 was grouped together due to
small number of HIV positive cases within the period.
Results: The treatment success for HIV positive cases was lower in both
periods (60-61%) in comparison with HIV negative cases (78-76%). The
level of MDR TB cases among HIV positive patients was higher (15%) than
Page 31 of 54
in HIV negative patients (8%) during the years 2000-2007, but similar in
both groups (9-10,6%) in 2010. Despite improvements in HIV/AIDS
treatment since 2000, the death rate among HIV positive cases in 2010
was higher (18%) than during the years 2000-2007 (11%).
Conclusions: The resistance to HIV/AIDS drugs is a factor influencing the
TB treatment results.
P70
One body, one test, two lives.. patient centered strategy to increase
HIV testing in pregnant women and their partners
Larisa Kudryashova-Hernandez
Ancillary HIV Services at Neighborhood Health Services Corporation,
Plainfield, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P70
Background: NHSC, an urban community-based health center in New
Jersey, USA, provides prenatal services, labor/ delivery to 750 uninsured/
impoverished/minority women annually. Given that NJ has the third highest
number of HIV women in USA and the highest number of HIV children, early
HIV detection/ intervention in pregnant women become paramount. NHSC
historically struggled with sub-optimal OB HIV testing rates (60%) and needed
to make radical program changes to comply with CDC recommendations to
ensure HIV testing is offered to 100% pregnant patients.
Methods: PDSA (Plan-Do-Study-Act) was conducted to test a new HIV
testing approach: HIV Counselors are located in OB department; HIV
counseling/ Rapid testing is done at OB registration; daily registration
schedules are available to HIV Counselors; HIV results become part of OB
records upon result availability; educational DVDs are utilized in patient
areas to increase awareness/ interest.
Results: Per PDSA-improved strategy, NHSC sustained 100% compliance
with CDC recommendations over the last three years. Rapid HIV testing and
Rapid-on-Rapid positive result confirmation allow for smooth/timely
transition from HIV testing to care/treatment for newly diagnosed HIV
pregnant patients/partners.
Conclusions: The collected/analyzed data suggests that coordinated,
patient-centered approach helps to: identify HIV positive pregnant patients
in the first/second trimesters; immediately connect them to prenatal/HIV
care to minimize vertical HIV transmission; provide prevention/treatment for
partners including prevention for positives.
P71
Scaling up HIV treatment-Karnataka, India experience
Salma Fahim1*, Suresh Shastri1, Reynold Washington2
1
Karnataka State Aids Prevention Society, Bangalore, India; 2Karnataka Health
Promotion Trust, Bangalore, India
Retrovirology 2012, 9(Suppl 1):P71
Background: Karnataka a high HIV prevalence state in south India is
home to 10 percent India’s HIV infected. The Government of India
sponsored HIV treatment program was initiated on 1st April 2004. A
systematic approach to scale up of the ART services is followed in
Karnataka where Government is the lead agency to implement the
program and all the donors/NGOs compliment the program.
Methods: A donor supported technical consultant was identified and
located within the State AIDS Society. A logistic Management Information
System is established to track procurement, distribution and supplies.
Human resource recruitment, training and retention at the ART centres are
decentralized to the district AIDS prevention and control units (DAPCU).
Centralized classroom based training is complemented with field based
onsite training and mentorship. A Google group is created for technical
updates. DAPCU conducts coordination meetings to geographically
distribute and allocate responsibility to all field level workers in HIV
prevention and care programs to minimize loss to follow up.
Results: By Sept 2011, 189,179 persons living with HIV (PLHIV) are
registered at ART centres and 64,104 are currently on ART. This was possible
thanks to a scale up in the numbers of ART centres from 17 to 44 and CD 4
testing machines from 5 to 32 during the period 2008-2011. The proportion
of PLHIV detected at Integrated Counseling and Testing Centres and
registered in ART centres rose from 46% to 96% in this period. 122 link ART
Retrovirology 2012, Volume 9 Suppl 1
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centres are established to decentralize drug distribution for those stable on
ART. Lost to follow up among those on ART reduced from5.5% to 3.5%.
However, death rates among those on ART remain high at around 17 %. The
commonest cause of death is TB (21%), while unknown remains high (26%).
Conclusions: Despite a rapid scale up, loss to follow up of those initiated
on ART has been significantly reduced and stabilized. This was possible
because of coordination between government and civil society partners.
The high death rates indicate the need for better integration between
HIV and TB programs, strengthening clinical competencies, laboratory
diagnostic facilities for opportunistic infections and operations research.
P72
Acute retroviral syndrome mimincs dengue in Singapore, a dengue
endemic country
JH Tan*, A Verrall, S Archuleta
Infectious Diseases at National University Singapore, Singapore, Singapore
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P72
Introduction: The differential diagnosis for dengue-like illnesses is broad.
However, World Health Organization (WHO) recommended confirmatory
testing may not always be feasible. Acute human immunodeficiency virus
type-1 (HIV-1) presents similarly to dengue and is an important diagnosis
that may be missed when dengue confirmatory testing is not performed.
Methods: Cases of acute HIV-1 in adults >15 years diagnosed between
January 2010 and December 2011 were identified through HIV service
records at our institution. Medical records were reviewed for admitting
diagnosis, clinical and laboratory features.
Results: Eight patients with acute HIV-1 were identified in the study period,
seven of whom were clinically diagnosed as dengue and met the WHO
dengue case definition. The duration of illness and clinical features were
indistinguishable from dengue: fever, myalgias, nausea and rashes. Five had
thrombocytopenia and three had leukopenia. During the same period,
emergency physicians at our hospital assigned a dengue diagnosis using
prespecified ICD-9 based coding for 276 persons over 15 years old. The ratio
of acute HIV-1 cases to those with presumed dengue was 0.025.
Conclusion: Acute HIV-1 infection can mimic symptoms of dengue fever.
This case series adds to the single case report in the published literature.
The ratio of 0.025 is concerning as not all patients with presumed
Figure 1(abstract P73)
Page 32 of 54
dengue undergo confirmatory testing. This high rate of acute HIV-1
among dengue-like presentations needs further prospective investigation.
Physicians in endemic areas like Singapore should test for acute HIV-1 in
cases of presumed dengue where dengue confirmatory testing is
negative.
P73
Integral HIV-STI diagnosis at the first VCT visit as strategy to prevent
late ART initiation in the HIV-AIDS program of Mexico City (HIVPMC)
L Juárez-Figueroa*, A González-Rodríguez, E Rodríguez-Nolasco
HIV Laboratory at HIV-Aids Program of Mexico City, Mexico City, Mexico
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P73
Introduction: HAART and laboratory monitoring of PLWHIV are available
in México. Nevertheless, lack of opportune detection impeded early ART
initiation, thus favoring HIV transmission and increased incidence of
morbidity and mortality due to AIDS conditions before ART starts.
Methods: On 2010 HIVPMC started faster HIV/STI diagnosis at first VCT
visit combining a rapid HIV test and parallel blood analysis with
automated HIV 4th generation/STI serology (Abbott Architect). Since fall
2011, initial CD4 counting (Becton Dickinson FacsCalibur) in HIV+ clients,
also done at the first visit, favoured a rapid HIV infection staging. On
2012 HIV viral load analysis (Abbott RT-PCR), required in Mexico for ART
initiation, was added at the first VCT visit.
Results: The integral HIV/STI diagnosis at the first VCT visit reduced
dramatically the time elapsed before, between the first HIV detection
with a rapid test or ELISA and the completion of laboratory studies
necessary for starting ART. The attendance of vulnerable groups to VCT at
Condesa Clinic scaled up with 51% detection increment during 2011. A
60% of new detected PLWHIV did not return for follow up and treatment
as shown by the national HIV data base SALVAR. Figure 1 shows the
distribution of new infections on 2011 (UNAIDS model).
Conclusions: Integral HIV/STI diagnostic self promoted the HIV VCT
increasing VCT demand while reducing desertion of number new patients.
This model should be expanded to HIV clinics in 31 Mexican States.
Depending on the size of the population to be serviced a combination of
serial HIV rapid tests, ELISA and simplified point of care CD4 counting
could be used.
Retrovirology 2012, Volume 9 Suppl 1
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The quantity of non-returning patients highlights the need of education
oriented to people at risk of HIV infection while individual post-test
counseling/accompanying could be also individually addressed.
P74
Cadillac care for the poor... addressing local health emergency around
STDs and HIV in an urban community-based medical home
Larisa Kudryashova-Hernandez
Ancillary HIV Services at Neighborhood Health Services Corporation,
Plainfield, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P74
Background: NHSC, an urban community-based health center in Plainfield,
Union County, NJ, USA, provides services to 25,000 uninsured/minority/
impoverished patients. Plainfield consistently ranks first and second among
the 29 Union County municipalities for Syphilis, Gonorrhea and Chlamydia.
Plainfield ranks second for the numbers of HIV/AIDS. There is, therefore, a
dire need to address the existing health emergency around STDs and its
correlation with HIV.
Methods: NHSC incorporates a coordinated, proactive, patient-centered
approach to integrating STD screening/prevention with primary care in a
medical home environment. Risk assessments/screenings are done by
clinicians. Those identified suspicious for STD or with STD symptoms/
diagnosis receive on-the-spot HIV counseling and Rapid testing. Patients
receive immediate treatment intervention for suspected STDs. There are ongoing prevention efforts including development of Risk Reduction Plans
agreed upon/signed by patients.
Results: Resulting from the integrated STD/HIV prevention approach: 100%
of patients presenting with symptoms/suspicion for STDs received HIV
counseling/Rapid testing; 100% received prevention education and free
condoms; 100% had Risk Reduction Plans developed and agreed upon; 19
persons were identified STD and HIV positive and were immediately linked
to care.
Conclusions: Integration of STD/HIV prevention with outpatient care under
the umbrella of Early Intervention Services allowed to: identify extend of
STD/HIV correlation; allow for a seamless one-stop shop preventiontreatment service delivery model; improve patient awareness of on-site
prevention/treatment resources.
P75
Access to HIV treatment and care in Armenia
S Grigoryan*, A Mkrtchyan
National Center for Aids Prevention, Yerevan, Armenia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P75
Introduction: ART has become available in Armenia since 2005. To evaluate
progress in the response of the National Programme to PLHIV’s needs since
last evaluation time, UNAIDS country office requested WHO/Europe HIV/
AIDS treatment and care expert for a country mission. The purpose of the
mission was to evaluate access of PLHIV to HIV/AIDS treatment and care and
other related services.
Materials and methods: Prior to the mission some background documents
had been reviewed. During the mission key-informant interviews were
conducted with a range of stakeholders. Also, a focus group discussion was
conducted with PLHIV representing two NGOs. Visits were made to a
number of institutions and activities in Yerevan, the capital.
Results: As of end 2010, cumulative 971 HIV cases were registered by the
National Center for AIDS Prevention (NCAP), 231 persons died. Of 740 PLHIV
542 (73%) were seen for HIV care in 2010. Armenia has accepted a higher
threshold of ART initiation (CD43), as recommended by recent WHO
guidelines. There is no waiting list for starting ART. By the end 2010, 250
PLHIV (46% of seen for care) were on ART. Adherence to ART is pretty high.
Of all 294 PLHIV ever started ART, only 44 (14.9%) dropped it out. However,
more than a half of them (25) died, due to late presentation. About a
quarter of newly identified HIV patients had CD43at the time of diagnosis.
Conclusions: NCAP has demonstrated high coverage with HIV care and
ART. PLHIV are satisfied with the range and quality of services they receive.
However, low level of CD4 cell count in more than a half newly diagnosed
Page 33 of 54
HIV cases (57.7% PLHIV had CD4 <350cells/mm3 at time of diagnosis) in
combination with the highest proportion of PLHIV identified due to clinical
symptoms compared to other reasons for HIV testing (39.8%), indicates late
presentation and raises concern of the health system’s inefficiency to
diagnose HIV at early stages and thus to early enroll in HIV care. The expert
has made appropriate recommendations to improve early HIV detection for
optimal care and patients’ survival.
P76
MMT of HIV positive patients in Georgia
Khatuna Todadze*, Eka Kavtiashvili
Research Institute On Addiction, Tbilisi, Georgia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P76
Introduction: The main route of HIV transmission is injective drug use in
Georgia (58-60%). The most popular injective narcotics are opioids. Although
prevalence of HIV among drug users is only 1-3%, the high number of IDUs
and high prevalence of hepatitis C (from 65 to 80% according to the
different studies) in this population could be the predictor of HIV increase.
Methadone maintenance treatment (MMT) has been implementing
throughout the country since 2005 as one of the important strategies to
decrease drug related risky behavior, increase adherence to ARV treatment
among HIV+ persons and improve the physical and psycho-social status of
the patients.
Materials and method: 42 randomly selected HIV positive drug users
undergoing MMT with intensive psychological counseling have been
studied for 3 years. They received ARV therapy before inclusion in MMT at
least 6 month. Risky behavior, quality of life, level of depression, anxiety and
other data were measured before starting MMT and after 3, 6, 12, 18
months. The illegal use of psychotropic-narcotics was checked through
random urine-testing 3 times per patient per month.
Results: The study showed significant improvement of patients’ status. The
remarkable decrease of depression and anxiety was observed (dynamic of
average scores of depression - 24, 14, 14, 13, 14 and anxiety-46, 40, 40, 41,
39). Life quality increased in comparison with the starting data (76, 85, 86,
88, 93). The positive answers on psychotropic-narcotics were observed in
6.7% on average and even those patients didn’t admit any kind of injectionrelated risky behaviors.
Conclusions: The analyses of data showed that combination of MMT, ARV
and psychological counseling significantly improves the physical and
psycho-social status of HIV positive IDUs, improves life quality and treatment
adherence , dramatically decreases use of illegal psychotropic-narcotic drugs
and decreases the risk of spread of HIV and other blood-transmitted
diseases among injecting population in Georgia.
P77
AIDS patients family knowledge and behavior toward their patients
before and after counseling
Behnam Honarvar
Communicable Diseases at Shiraz University of Medical Sciences, Shiraz, Iran
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P77
Background: This study was aimed to measure the effect of ongoing
counseling program at behavioral counseling center (BCC) of Shiraz,
southern Iran on changing the knowledge, attitude and behavior of AIDS
patients’ family members toward them.
Methods and materials: 125 members of HIV/AIDS patients’ family were
interviewed individually by filling questionnaire before and after performing
counseling for them. The findings were analyzed in SPSS.
Results: The age of the participants was 40±13 years. Forty four percent
had spousal relationships with their patients. Their knowledge about the
main routes of HIV transmission were 9.76±2.59 and10.64±0.88 before and
after counseling, respectively (P=0.028). Supportive behaviors of families
toward their patients reached to 79 % after counseling compared with 44%
before that (P=0.004). Belief to isolate the patients and the practice of this
approach at home dropped from 71% to 15% and from 29% to 7% after
counseling, respectively (P<0.05). In 30% of participants fear of getting HIV
from patients was not changed by counseling, and 24% of patients’ spouses
Retrovirology 2012, Volume 9 Suppl 1
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did report to avoid protected sex with their HIV infected husbands even
after taking part in the counseling program (P>0.05).
Conclusion: Ongoing counseling for HIV/AIDS patients’ families at BCC of
Shiraz did advance their knowledge about AIDS and improved their
attitude and behavior toward their patients. However, in some aspects
such as the removal of fear about HIVspread in the family or the change
of the patients’ wives attitude to have protected sex with their HIV
infected husbands, the counseling program did not show remarkable
success.
P78
Pregnancy and contraception - the perspective of HIV-positive and
negative women
Chinedu O Oraka*, Tochukwa S Egbunu, Samuel C Ani
Build Africa Research Capacity, Lagos, Nigeria
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P78
Objective: To understand pregnancy intentions and contraception
knowledge and use among HIV-positive and negative women in the
prevention of mother-to-child transmission (PMTCT) program.
Design: A cross-sectional survey of 236 HIV-positive and 162 HIV-negative
postpartum women interviewed within 12 months of their expected delivery
date in a public-sector health facility providing PMTCT services.
Methods: Bi-variant analyses explored fertility intentions, and family
planning knowledge and use by HIV status. Multivariate analysis identified
socio-demographic and service delivery-related predictors of reporting a
desire for additional children and modern family planning use.
Results: HIV-positive women were less likely to report wanting additional
children than HIV-negative women (8 vs. 49%, P < 0.001), and although a
majority of women reported discussing family planning with a health worker
during their last pregnancy (HIV-positive 79% vs. HIV-negative 69%, P = 0.0),
modern family planning use remained low in both groups (HIV-positive 43%
vs. HIV-negative 12%, P < 0.001). Condoms were the most commonly used
method among HIV positive women (31%), whereas withdrawal was most
frequently reported among HIV-negative women (19%). In multivariate
analysis, HIV-negative women were 16 times more likely to report wanting
additional children and nearly 85% less likely to use modern family
planning. Women who reported making two or less antenatal care visits
were 77% less likely to use modern family planning.
Conclusion: Our results highlight success in provision of family planning
counseling in PMTCT services. As family planning use was low among HIVpositive and negative women, further efforts are needed to improve uptake
of modern methods, including dual protection, in the PMTCT settings.
P79
The relation between hemispheric lateralisation and measures of
immune competence and adherence in Human Immunodeficiency Virus
Type 1 (HIV-1)
Rachel C Sumner*, Alexander V Nowicky, Andrew Parton, Carolien Wylock,
Renata Cserjesi, Patrick Lacor, Yori Gidron
Brunel University, Manchester, UK
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P79
Introduction: Communication from the brain to the immune system is
influenced by hemispheric lateralisation (HL). Left-HL is immunopotentiating,
right-HL is immunosuppressive. Only one study has examined the effects of
HL on the progression of HIV (Gruzelier et al., 1996). That study included a
small sample with very little control over third variables. The present study
tested whether left HL predicted higher CD4 and CD8 levels, statistically
controlling for confounders.
Methods: Employing two neuropsychological assessments of HL (line
bisection task and Zenhausern’s Hemispheric Preference Test), 69 HIV-1+
patients were followed prospectively. Numerous exclusion criteria and
confounder assessments were employed (e.g., age, sex, mode of
contraction, medication adherence) to provide a more rigourous and
controlled analysis.
Results: The present work corroborated the theory of asymmetrical
influence on HIV immunity by HL via a moderator: ethnicity. The main
Page 34 of 54
analysis of the research findings did not attain statistical significance in the
whole group of patients. However, among African patients, left-HL
predicted better immunity, while no such relationship was seen in
European patients, independent of confounders. Further observations were
made between HL and HIV-relevant behaviours. Left HL was related to
higher number of sexual partners in Europeans. A near-significant
relationship was observed between left HL and longer periods between
HIV clinic attendances in Africans.
Conclusions: The present study adds new information concerning a
moderating factor of the HL-immunity relationship in HIV. As expected,
left-HL predicted higher CD4 and CD8 counts, but only in African
patients. Further, the added methodological and statistical control
employed, extend the validity of the HL-immunity relationship. Moreover,
the present study has uncovered behavioural implications of HL in HIV
disease. Potential explanations for neurobiological pathways in the
relationship between HL and immunity are discussed.
P80
Antiretroviral therapy (ART) adherence and correlates to non-adherence
among people on ART in Estonia
Anneli Uuskula1, Kaja-Triin Laisaar1*, Mait Raag1, K Rivet Amico2,
Anjali Sharma3, Jack DeHovitz3
1
Department of Public Health, University of Tartu, Tartu, Estonia; 2Center for
Health Intervention and Prevention, University of Connecticut, Storrs, CT,
USA; 3Division of Infectious Diseases, State University of New York
Downstate Medical Center, Brooklyn, NY USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P80
Introduction: There is limited data on antiretroviral therapy (ART)
adherence among patients in Eastern Europe, despite the high incidence
of HIV infection and the growing number of HIV-infected individuals who
are being prescribed ART. We conducted a study to measure rates of
adherence to ART and factors associated with non-adherence among
patients receiving care at an outpatient HIV clinic in Estonia.
Materials and methods: The study was based on cross-sectional data from
a convenience sample of 161 patients receiving outpatient HIV care. Data
were obtained via interviewer administered surveys and data abstraction
from clinical records. Adherence was measured from 3-day patient selfreport.
Results: Among the 161 participants (mean age 33 and 55% male / 45%
female), two thirds (64%) had been infected with HIV through intravenous
drug use. Most (74%) were co-infected with hepatitis C (HCV). Perfect
adherence over the last 3-days was commonly reported [87% (95% CI 80 −
92%)], with non-perfect adherence associated with greater concerns about
the potential negative consequences of taking ART [AOR 5.8 (95% CI 1.3 −
45.7)] and fewer antiretroviral medications (ARVs) in one´s current regimen
(2 or fewer different ARVs vs 3 or more different ARVs: AOR 17.0 (95% CI 3.7
– 97.6).
Conclusions: Self-reported ART adherence in this sample of Estonian HIVinfected patients in clinical care was similar to rates observed in Western
Europe and other developed countries. The results suggest that adherence
education and support could be most beneficial, if specifically targeting the
development of positive beliefs, reduction of negative expectations towards
ART and when helping patients manage negative treatment experience,
particularly with regimens including multiple ARVs.
P81
HIV-AIDS stigma and discrimination in health care sector in Belarus
Vera Ilyenkova1*, Svetlana Kunitskaya2, Irina Eramova3
1
World Health Organisation, Regional Office for Europe, Communicable
diseases, Minsk, Belarus; 2Belarusian State Medical University, Public Health,
Minsk, Belarus; 3World Health Organisation, Regional Office for Europe,
Communicable diseases, Copenhagen, Denmark
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P81
Background: Stigma and discrimination are barriers to effective HIV
treatment and care in Belarus. Results of the Stigma Index Survey conducted
among people living with HIV (PLHIV) reveal that 40.5% of respondents
Retrovirology 2012, Volume 9 Suppl 1
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experienced disclosure of their diagnosis and confidentiality breach by
health care workers (HCW); 15.5% were refused medical care.
Methods: Public health department of Belarusian State Medical University
and NGO “Fialta” investigated the extent and possible reasons of HIVrelated stigma in health sector, by conducting a survey on knowledge,
misconceptions, attitudes and motivations regarding HIV/AIDS among 40
HCW not routinely involved in HIV-care. This was followed by two one-day
sensitizing workshops addressing Belarusian law on HIV/AIDS, emphasizing
medical rules/regulations, patients’ rights and confidentiality, stigma and
discrimination, including sensitizing role plays.
Results: Though the sample size was small, research findings indicate needs
to address levels of stigma and discrimination among HCW in Belarus: a
quarter of respondents are not willing to provide services to PLHIV at all;
more than half are inclined to violate patients’ rights and test patients for
HIV without informed consent; majority revealed some negative stereotypes
in regards to PLHIV that lead to discrimination outside their professional
duties (for example, changing HIV-positive hairdresser, advising their
children to reduce contacts with HIV-positive schoolmate); about 2/3 would
isolate PLHIV if they are not their friends or relatives. Possible reasons from
workshops’ findings: HCW don’t realize what stigma is and don’t know their
actions/attitudes are discriminative; lack of knowledge about HIV-infection
resulted in fear of contact with PLHIV; negative stereotypes regarding PLHIV
exist among population as they “traditionally” represent risk-groups
(injection drug users, commercial sex workers, etc.), thus, “they are immoral
and dangerous”.
Conclusions: Introducing stigma-reducing interventions (sensitizing
workshops, educational briefings) in health sector would help to improve
the situation. Conducting in-depth interviews among HCW is necessary to
analyse stigma-related issues more thoroughly.
P82
Decentralizing treatment services with link ART centres- experience
from Karnataka, South India
Salma Fahim1*, Suresh Shastri1, Bharat Rewari2
1
Karnataka State Aids Prevention Society, Bangalore, India; 2National AIDS
Control Organisation, India
Retrovirology 2012, 9(Suppl 1):P82
Background: Prior to 2007-08, ART services in Karnataka state, India were
delivered through ART centres, located mainly in medical colleges, and
tertiary and district hospitals. This led to high rates of defaults, increased
travel time and cost and loss of working hours. To make treatment services
more accessible to PLHIV, link ART centres (LACs) were developed at subdistrict primary and secondary care levels, co-located with HIV voluntary
counselling and testing centres.
Methods: After a thorough needs assessment based on existing ART and
HIV testing data which included load in ART centre, HIV prevalence, distance
and accessibility, sites were identified, health personnel trained, and patients
sensitized about the centres.
Results: Currently there are 122 LACs attached to 29 nodal ART centres in
the state. The LACs provide services to 5,498 PLHIV.Default rate has come
down from 3.5 % in ART centres to less than 0.5% in LACs.The average
patient travel distance has declined from 70 to 30 kms, saving travel cost
and time. Waiting times for refilling prescriptions have declined from four
hours to one hour, which has improved patient adherence. Health care staff
at primary and secondary level care centres are gradually taking the lead in
HIV care and treatment service delivery.
Conclusions: The establishment of LACs at primary and secondary care
levels has helped improve drug adherence and service access. They save
travel cost and time, and more importantly, help strengthen primary and
secondary health care services, which is beneficial for program sustainability.
P83
An assessment of cultural values contributing to antiretrovial therapy
adherence among patients on antiretroviral therapy adherence among
patients
Kaona AD Frederick*, Sikaona Lenganji, Miti Esnart, Siziya Seter
Mwengu Social and Health Research Centre, Ndola, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P83
Page 35 of 54
Background: The study was conducted in 2007, in the Northern Province
of Zambia, to assess the impact of cultural values contributing to ARV
non-compliance among elderly patients afflicted by AIDS. Providing care
for sick child, loss of income by the family, caring for the orphans,
seeking treatment were studied. Parental experiences and impact of
caregiving during the time of child illness that led to poor compliance
are examined.
Methods: A community-based survey was conducted in three randomly
selected catchment areas of Nakonde, where 250 out of 682 patients
receiving ARVs within the twelve months period, were recruited through the
District’s Health Management Board Zonal Health Centre. All patients were
interviewed using a pre-tested structured questionnaire, consisting of: Sociodemographic characteristics, Socio-economic factors, Knowledge about HIV
transmission and prevention. Cultural beliefs regarding ARVs in Zambia and
the social taboos surrounding treatment and actual drug adherence were
observed.
Results: Most male AIDS patient respondents tended to be older and
more educated than the female patient respondents. Overall, 32.6% of
the patients stopped taking their medication. There were 49.1% of the
females and 23% of the males, who reported that AIDS patients stopped
taking their medication within the first 4 months of commencing
treatment. Age, marital status and educational levels were not
significantly associated with compliance. The major factors leading to
non-compliance included patients beginning to feel better (55% and
48.6%), lack of knowledge on the benefits of completing a course
(25.7%), running out of drugs at home (25.4%) and ARVs drugs too
strong (20.1% and 20.2%). There was a significant difference [OR = 1.66,
95% CI 1.23, 2.26] in HIV knowledge, with more males than females
reporting shaking hands as a means for HIV transmission, after adjusting
for age, marital status and educational levels.
Conclusion: This study established that 32% of AIDS patients failed to
comply with AIDS drug taking regimen once they started feeling better.
Providing means and knowledge for primary caregiver to administer
effective drugs and ARVs or to prevent and treat opportunistic infections, TB
and pneumonia, would help reduce caregivers distress.
P84
Concomitant sexually transmitted diseases in patients with newly
diagnosed HIV in Sri Lanka
SD Dharmaratne*, K Buddhakarale
National STD AIDS Control Program, Sri Lanka
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P84
Introduction: Diagnosing and treating STI are important both for the health
of HIV infected persons, their sexual partners and for HIV prevention efforts.
STI following an HIV diagnosis or STI co-infection can serve as a surrogate
indicator of continued risk behaviors.
Objective: To determine the prevalence of concomitant STI in newly
diagnosed HIV positive patients.
Method: Data was extracted from randomly selected individual clinical
notes of patients who are attending the Central HIV clinic, Colombo.
Results: A total of 187 subjects were included to the study of which 106
(57 %) were males and 80 (43 %) were females. The mean age of the
sample was 37 years (SD =9.3) and the median CD4 count at diagnosis
was 320 cells/μl. Routine STI screening had been done only in 90.3%
(169) of the sample. Among the screened subjects for STIs, over one in
every four (28%) had an STI. Ulcerative and non-ulcerative STIs were
present in 18.2% and 10% of subjects respectively. Syphilis was positive
in 9.5% (N=16), symptomatic Herpes simplex infection in 7.7% (N=13),
non gonoccocal urithritis /cervicitis in 6.5% (N=11) and symptomatic
genital warts in 3% (N=5). There was a statistically significant association
between the number of life time partners and STI prevalence (P=0.011)
and sexual orientation and STI prevalence (P=0.005). In contrast gender,
marital status and age did not show any statistically significant
association with STI prevalence.
Conclusion: Significant numbers of HIV patients are co-infected with at
least one ulcerative or non-ulcerative STI at the time of their HIV
diagnosis which enhances HIV transmission. Therefore, careful and
continued screening and management of STIs in HIV positive patients is
an important HIV prevention intervention.
Retrovirology 2012, Volume 9 Suppl 1
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P85
Surgical dental implants in people living with HIV-AIDS
A Sparaco, M Ghezzi*, G Donati, K Andriella, A Montebello, C Luraghi,
G Romanoni, V Rania
Dentistry at Luigi Sacco Hospital, Milan, Italy
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P85
Introduction: The introduction of HAART has considerably improved life
expectancy and quality of life of people living with HIV/AIDS (PLWHA).
If in the first years HIV infection was considered an absolute contraindication
to implantology, it is now possible to employ implants positioning which
allows a more complete functional and aesthetic rehabilitation of the oral
cavity also in these patients; howewer there is still fear and prejudice in
using this technique in PLWHA.
We present the experience of Department of Dentistry of Luigi Sacco
Hospital of Milan in over twenty years of implant surgery to evaluate the
possibility of using implantology techniques in PLWHA without exposing
them to greater risks of developing infections both during and after
surgical intervention.
Materials and methods: The study considers a consecutive series of 21
HIV-positive patients (for a total 80 implants) and 91 HIV-negative patients
as control group (for a total 245 implants), treated in the dental clinic of
the Luigi SaccoHospitalfrom 1998 to december 2011.
The pre-surgery phase included a collection of anamnesis, clinical
examination data, diagnostic radiology evaluation and assessment of
blood tests.
We used the surgical technique of submerged fixture implants and
mobile and fixed prostheses for the final prosthetic rehabilitation.
Results: Several failures occurred in both groups and were attributable to
local factors related to receiving bone or to exceedingly invasive surgical
techniques.
We detected no lesions in the oral cavity in these subjects concomitant
with the plants loss nor changes in their overall health conditions.
Conclusions: Patients enrolled in this study presented both functional
and aesthetic dental problems.
The comparison between the success/failure rates in the two groups
shows that implant surgery can be employed without risk for the patient
and with success rate comparable to the general population, nevertheless
it is important to assess the level of immune competence of the patient.
Finally, the prosthetic rehabilitation of the oral cavity, in addition to the
clear local benefit, has an important psychological effect on patients and
on your quality of life.
P86
Improve the quality of counseling for HIV in the district of Guédiawaye
Sakho D Maty*, Seck Karim, Ouattara Baly, Gaye Alioune, Sylla Bintou
Médecin Spécialiste du Vih at District Sanitaire de Guédiawaye Synergie pour
l’Enfance, Dakar, Senegal
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P86
Objectives: HIV counseling and testing for several years working in the
district of Guédiawaye. A situation analysis has revealed shortcomings in the
organization of the service given the many other activities of the health
center. This is why the medical team decided to use the collaborative model
of quality improvement that is based on the implementation of a package
of changes and the measurement of indicators of improvement.
Methodology: It consisted of a situational analysis of the Board Search, the
development of process maps and identify targets for improvement.
Improvement targets were selected to make the results of all HIV tests to
clients within two hours, to provide the reference of all patients positive for
medical care. The changes have been to extend the opening hours of the
laboratory, to assign a specific staff for testing and to ensure continuous
availability of a pool of consultants. Better communication was established
and the customer’s circuit has been reduced.
Results: From January to December 2010, the proportion of tests performed
in two hours has risen by an average of 35% to 99%, also the proportion of
patients actually referred for medical care rose from an average of 33% to
97%.
Page 36 of 54
Conclusions and recommendations: The process of improving not only
affects the indicators of improvement but the effects on teamwork and a
consideration of the basic needs of patients.
P87
Estimated numbers of cases with HIV from 1990 to 2010 in Fars
province by capture recapture method
M Marzban*, H Joulaee, P Kazeroni
Epidemilogy at HIV Reseach Center, Shiraz University of Medical Science,
Shiraz, Iran
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P87
Background: HIV is potential risk in different countries of the world.
According to UNAIDS, estimated HIV-infected people in Iran 4 times more
than the cases have been recorded. Full details of the cases with HIV is
one of the most essential tool for planning. The aim of the study is to
estimate numbers of infected patients during the selected time.
Method: All information contained in three sources hospital, voluntary
counseling and testing center (VCT) and prison from 1990 to 2010 were
used. Then by record linkage identify common cases finally log-linear
methods were fit for eight models.
Result: 5167 cases entered to the study. The proportion of men 10 times
women also most patients belong to the age group 15 to 44 years old. The
main source of recorded cases is voluntary counseling and testing center by
3347 patients. As expected the lowest source is the common cases between
prison and hospitals. annually average of 550 patients have been added.
The lowest estimate belong to the common cases between prison and
hospital but most of them are the presence of three sources. Estimated
number of cases in the province are approximately 18914.
Conclusion: Low coordination between the various components of the
health system, along with social issue such as stigma and discrimination
of HIV positive patients is the most important weakness in information
systems. Therefore constitutional arrangements for providing high quality
information is essential for HIV-infected cases and should be the priorities
of health policy investment.
P88
TB and HIV among hill tribe marginalized vulnerable population,
Thailand
Tawatchai Apidechkul
School of Health Science, Mae Fah Luang University, Chiang Rai Province,
Thailand
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P88
Introduction: Since 1982, Thailand had been reported 372,874 cases of
HIV/AIDS, and 98,153 deaths. The north of Thailand has been report as
the highest prevalence areas. There were almost 600,000 hill tribe
populations live there as a marginalized and vulnerable people under
lacked of access to health care and limited education. Most of them
emigrated from China last 200 years ago. Chiang Rai Province is the most
favorite living area of hill tribe people.
Materials and methods: The retrospective cohort study design aimed to
investigates the TB and HIV situation among hill tribe marginalized and
vulnerable population. The systematic data collection with the completed
questionnaire was conducted in the 12 hospitals, Chiang Rai Province. All
questionnaires had been tested for reliability and validity before use.
Survival and Cox’s regression were analysis.
Results: Of 629 cases of TB reported during 2009-2011 form 12 hospitals
were recruited into the study. 60.7% were male 23.8% aged 51-60 years old,
and followed by 41-50 years old (20.2%) (min=1, max=93). Of 84.6%were
pulmonary TB and extra pulmonary 15.4%, 44.6%recieving AFB testing,
77.4%new cases. The results of treatment found that 22.7% were cure,
28.6%complte, 4.3%defults, 8.1%death, and 1.9% failure. Prevalence of HIV/
AIDS among hill tribe TB cases was 17.2%. Of 88.1% had treatment on CAT1,
and 4.6%CAT2, and 2.3%CAT4. Male had greater pulmonary TB (pvale=0.044), and HIV+ than female (p-value=0.023). Survival analysis found
that being male (p-value=0.01), non-HIV (p-value<0.01), and CAT1 had
Retrovirology 2012, Volume 9 Suppl 1
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greater success treatment. Cox’s regression found that only aged 11-20 years
old had related to success treatment (HR=2.11, 95%CI=1.05-4.26).
Conclusion: Active screening program and increasing the rights of access
to care are immediate needed for hill tribe vulnerable people for coping
TB problem in Thailand.
P89
HIV epidemic in Bulgaria
Simon Shamas
Merical University of Sofia, Sofia, Bulgaria
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P89
Background: To identify the groups of highest risk of infection and
understand the HIV dynamic in Bulgaria.
Methods: By analyzing data presented by ‘’The National Center of
Infectious and Parasitic Diseases’’ about HIV/AIDS reported cases between
1986 and 2011.
Results: During the period from 1986 to 2011 the number of registered
patients is 1438 people. Last year the number of registered cases was 166,
from which 81% are men. The annual number of officially registred
HIV-infections increased from 49 in 1986 to 127 in 2007. We observe a
development of HIV concentrated epidemics among the highest risk groups.
Between 1986 and 2011 109 infections were due to Injecting drug use (IDU),
the prevalence rate in this group was increased from 0.97% in 2004 to 7.29%
in 2011. During the same period in the group of homosexuals the prevalence
rate was increased from 0.99% to 1.6%. Romanies people are considered as a
risk group because of their low social and economic status. Their prevalence
rate reaches 2,9%. The newly diagnosed HIV-infections among prisoners in
bulgarian jails increased 7,4 times between 2004 and 2007. In 2010 the
lowest age limit of infection reached 15.
Discussion: In Bulgaria HIV prevalence among the general population is
below the national average for the countries of the EU. However, the
country is facing a serious challenge in the form of rapid development of
concentrated epidemics among some groups at higher risk. In order to
protect the people there are some steps that should be taken as in
motivating the groups of highest risk to use the services of voluntary free
testing and counseling for HIV, rapid expansion of testing services through a
network of Cabinets for anonymous and free counseling and assuring the
access to knowledge about HIV/AIDS.
P90
Procalcitonin as a marker of bacterial sepsis in immunocompromised
patients
Lana Gatserelia*, Lali Sharvadze, Marine Karchava, Nino Babridze,
Tengiz Tsetvadze, Natia Dvali, Lela Dzigua, Nika Chxartishvili
Head of Virology Lab. at Infectious Diseases, Aids and Clinical Immunology
Research Center, Tbilisi, Georgia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P90
Introduction: Procalcitonin (PCT) is a recently described marker of severe
sepsis. It was decided to assess the value of PCT as a marker of secondary
infection in patients infected with HIV in Georgian AIDS Center.
Materials and methods: PCT plasma levels were measured by quantitative
assay BRAHMS-Biomérieux using the VIDAS analyser in a prospective study
in 135 HIV-infected individuals: 87 asymptomatic and 48 with lever or
suspected secondary infections.
Results: The baseline plasma level of PCT was (0.5 ng/ml +/- 0.5), even in
the latest stages of the disease, and did not differ from the values of
healthy subjects (0.54 ng/ml +/- 0.1). EDTA-treated whole blood was
collected from patients before starting specific antimicrobial therapy. No
elevation of PCT level was detected in HIV-infected patients with evolving
secondary infections including PCP (n = 4), cerebral toxoplasmosis (n =
5), viral infections (n = 9), mycobacterial infections (n = 4), localized
bacterial (n = 13) and fungal infections (n = 4), and in various associated
infectious and non-infectious febrile events (n = 15). All these plasma
values were lower than 2 ng/ml. In contrast, high PCT plasma levels were
detected in one HIV-infected patient with a septicaemic influenza
infection (17 ng/ml) and another one with a septicaemic Pneudomonas
Page 37 of 54
aeruginosa infection (46 ng/ ml), PCT values decreased rapidly under
appropriate therapy.
Conclusions: We found that PCT is a specific marker of bacterial sepsis in
HIV-infected patients, as no increase in other secondary infections could
be detected in those patients. A rapid determination of PCT level could
be useful to verify or refute bacterial sepsis for a better management of
febrile HIV-infected patients.
P91
The medicalization of disease as a factor of abandonment and
dissatisfaction with HIV treatment services
Carmen Rodríguez Reinado*, Teresa Blasco, Hernández Jesus, Nzang Esono
University of Huelva, Huelva, Spain
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P91
Introduction: Medicalization of the disease is a social phenomenon not
exclusive of industrialized societies. In countries with medium and low
human development indexes and developing economies, this process is
prevailing due to the expansion of the biomedical model. This is the case
of many African countries and more concretely in Equatorial Guinea.
Methodology: Qualitative research, based on the application of semistructured interview (30) as the technique for gathering information. Ambit:
Bata, Equatorial Guinea. Purposeful sampling: homogeneous type by
subgroup; 1. HIV-positive people who abandoned diagnostic and treatment
services. 2. HIV-positive people who are utilising HIV treatment services.
Location: General Hospital and Outpatient Treatment Centers. Unit of
analysis: utilization of diagnostic and treatment services.
Method of analysis: Grounded Theory Method. Data triangulation:
internal by two observers and theoretical.
Results: - Drugs are a central topic on the discourse about the disease.
- Regardless of the population profile, all the informants share a
medicalized view of HIV and its treatment
- In the asymptomatic phase of HIV, avoiding to prescribe drugs
reinforces the process of non-acceptance of the disease leading the
patient to question his positive diagnosis.
- Within the profile of HIV-positive respondents still in treatment,
medication is the element of the care process that takes on more
importance. Avoiding to prescribe drugs is an element of dissatisfaction
with health services.
- In the profile of HIV-positive respondents who abandoned HIV
diagnostic and treatment services, no prescription drugs was one of the
reasons for abandonment.
Conclusions: The medicalization of the disease has affected the social
construction of HIV as a disease and is one of the reasons for
abandonment and dissatisfaction with the care received in diagnostic and
treatment centers. It therefore represents a factor for intervention and to
modify in order to reduce the rates of abandonment for such services.
P92
Group psychotherapy for HIV patients. A different approach
Michele Battuello*, Paolo Roma, Giovanna Celia
University of Rome Sapienza, Italy. Sant’Andrea Hospital, Rome, Italy
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P92
Introduction: HIV is often related to psychological distress, after the
diagnosis and the beginning of HAART. Brief Psychological approaches
are important but they give only support, enhancing the relationships of
the patients. In many cases these relationships are disfunctional too.
Psychotherapies don´t focus on the indidvidual´s autonomy but on the
support from the others.
Objectives: A brief-grouppsychotherapy focused on major objectives of
each person but with the main common objective to enhance the
psychological individual indipendence and to promove a self- maturation;
understanding the disfunctional dynamics realized in the past that are
enhanced by the HIV-status, to promove individual indipendence with
the objective of focusing the good and valid relationships and change
the disfunctional ones and to allow the person to be able to open to the
world again.
Retrovirology 2012, Volume 9 Suppl 1
http://www.retrovirology.com/supplements/9/S1
Method: A brief group psychotherapy, supportive but mostly expressive. a
small group 3 male, 1 female: were choosen for group psychotherapy after
2-3 individual meetings. 16 psychotherapy meetings, weekly, lenghth 1 hour
40-45 minutes.
Results: First time patients worked on their disfunctional affective part, that
was pre-hiv. In a second time they worked promoting their possibility of
indipendence to find their lost self esteem. in the last time they focused to
improve their relationships where possible but mostly to think that they can
go out alone from the darkness after HIV diagnosis.
Conclusions: Quality of life of HIV patients can be focused on changing
their disfunctional parts, first enhancing the process of indipendence and
individual esteem of the person.
P93
Late detection of schizophrenia patient VIH-VHC
Karine Bartolo*, Nathalie Labrune, Isabelle Jaquet
Chu Sainte Marguerite, Marseille, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P93
Introduction: After several years, some patients on TSO, became
custumers of BZD (40 tablets per day).
During the maintenance with these patients, we can notice that this
consummations are rythmed by periods where there is a new outbreak of
productives symptoms.
Auditory and visual hallucinations with influence syndrom, persecution
syndrom, tense boarder, social isolation, peculiarity contact, mutilations
to-himself, disjointed thought.
These symptoms can’t be withdrawal symptoms or a decrease of their
consummation.
Methode: Case report: HDM: He is man, 41 years, co-infected patient
(VIH and VHC).
ATCD: He’s poly-addict with BZD in first line drug.
Symptoms: - persecution
- tense boarder
- suicidal ideas
- decrease motivation
- decrease memory
- violent acting
Treatment and observance: He was having TSO from ten years
(buprenorphine 16 mg per day) and a large number of hospitalisation
before starting the psychiatric disease treatment.
When the diagnosis was established, the treatment LAAA is administrated
and the patient progressively gave up the BZD consummation.
The symptoms progressively disappeared. The only time he was
hospitalised is because the withdrawal of BZD was too violent.
Diagnosis: The diagnosis of schizophrenia with deficit disorders was
imput to this patient when the symptoms are stand out ,specialy , when
he had no drugs: the BZD, taken in exes.
Results: We observe that the number of hospitalisations has decreased
from 2 since the begining of the new long acting atypical antipsychotics
(LAAA).
Conclusion: We must make a difference between psychiatrics symptoms
and associated drugs withdrawal clinic signs when we consider poly-drug
users who are partially stabilized by a TSO.
P94
HIV pre-exposure prophylaxis (PrEP)- knowledge and attitudes among a
New York City emergency department patient population
Yvette Calderon1*, Jason Leider1, Ethan Cowan1, Christopher Brusalis2,
Joanne Mantell3, Theo Sandfort1
1
Albert Einstein College of Medicine, Bronx, New York, USA; 2Jacobi Medical
Center, Bronx, New York, USA; 3Columbia University, New York, New York,
USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P94
Background: HIV Pre-exposure Prophylaxis (PrEP), in which HIV-negative
individuals receive antiretroviral medications to prevent HIV acquisition,
has shown potential as a means to reduce HIV incidence among high-risk
Page 38 of 54
persons. The acceptability of PrEP among at-risk persons will strongly
impact the effectiveness of PrEP. This study aimed to assess knowledge
and attitudes towards PrEP within a demographically-mixed community
with high HIV prevalence.
Materials and methods: A cross-sectional study was conducted with a
convenience sample of Emergency Department (ED) patients at two New
York City municipal hospitals. Eligible participants completed an
anonymous written survey about knowledge and acceptability of PrEP.
Means and standard deviations were calculated for continuous variables
and proportions for categorical variables. Standard bivariate methods
were used to compare acceptability and knowledge by race, ethnicity
and gender.
Results: 474 ED patients agreed to participate. The study population was
40.9% male, 40.7% Latino and 38.2% non-Hispanic Black. 7 participants
(1.5%) self-identified as MSM. Mean age was 35.3, SD +/- 13.1 years. 66.4%
reported inconsistent condom use and 78.4% had previously had an HIV
test. 13.3% reported knowledge of either the term “PrEP” or the use of
antiretroviral medications to prevent HIV acquisition. More people indicated
they were unlikely or extremely unlikely to use PrEP (40.1%) than indicated
they would likely take PrEP if available (32.2%). Many (27.7%) were unsure if
they would or would not take PrEP. 44.4% thought that individuals would
stop using condoms if on PrEP, while 27.0% thought that individuals would
continue using them. Some participants (28.4%) incorrectly thought that
PrEP needed to be taken only prior to sex. There were no differences in
knowledge or acceptability of PrEP by gender. Latinos were more likely
(17.6%) than blacks (8.8%) and others (12.4%) to report knowledge of PrEP.
Conclusions: Potential providers of PrEP must consider limitations in
acceptability to this HIV prevention strategy. Future administration of
PrEP must incorporate patient education to ensure user understanding of
the technology and its potential limitations.
P95
HIV experts on the decision to use early ART for prevention in France:
are we there yet?
Bertrand Lebouché1, Kim Engler1*, Joseph Josy Lévy2, Gimore1, Bruno Spire3,
Willy Rozenbaum4, Jean-Pierre Routy1
1
Mcgill University Health Centre, Montreal, Canada; 2Université du Québec à
Montréal, Canada; 3INSERM-SESSTIM UMR912, Marseille, France; 4Hôpital
Saint-Louis, Paris, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P95
Introduction: The finding that successful antiretroviral therapy (ART) can
almost eliminate the risk of heterosexual HIV transmission is the scientific
breakthrough of 2011 according to Science Magazine. This potential of ART
has generated novel approaches to prevention including “Test and Treat”
(T&T). Our qualitative study, drawing on the perspectives of French HIV
experts, aims to better understand if, and how, a T&T approach might be
applied in France and to generally learn more about concerns raised by
prevention with early ART.
Materials and methods: In 2011, 19 French HIV experts participated in a
semi-structured interview on implementing T&T in France. Expertise was
typically defined on the basis of contribution to the 2010 French ART
guidelines (Rapport Yeni 2010). Participants’ HIV expertise included clinical
care, epidemiology, virology, and community activism. Interviews lasted an
hour, on average, and explored opinions on T&T, who, how and whether to
test and treat, and what public health discourses and evaluations should
accompany it. Analyses of interview content pertaining to who or whether
to treat early for prevention are presented here. A content analysis of the
transcribed interviews was supported by the software Atlas.ti version 5.2.
Results: The decision to treat earlier than current guidelines recommend
(CD4 >500) was generally associated with uncertainties and involved
weighing the risks and benefits, whether potential or known, primarily in
terms of patient health, the risk of transmission, patient choice, population
health and/or cost. Perspectives on each of these aspects varied as did
experts’ position on treating early for prevention.
Conclusions: Despite ART-based HIV prevention’s status as evidence based
medicine (EBM), French experts had uncertainties about early preventive
treatment of HIV-infection which often translated into a weighing of
benefits and risks to varying effect. Our findings suggest fostering a culture
of dialogue and debate between care providers, community organizations
Retrovirology 2012, Volume 9 Suppl 1
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and recipients of care on the complex considerations of implementing
strategies of ART as prevention in France can help translate EBM into
improvements in health and new HIV guidelines towards the eradication of
HIV.
P96
The research on female partners of injecting drug users-gender aspect
and risk of HIV
Miljana Grbic*, Verica Lela Ilic, Sladjana Baros, Vesna Ciprus, Jelena Tadzic,
Rade Grbic, Gordana Jurican, Milan Parlic, Svetomir Samardzic
Unaids Focal Point for Serbia at Undp, Belgrade, Serbia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P96
The goal of this research is to assess whether there is an increased risk of
HIV infection based on gender among female partners of IDUs and to what
degree is this risk present. The research has been conducted using
quantitative and qualitative methodology. For the purpose of collecting
the research data among the female partners of IDUs and male partners
who are IDUs, a qualitative methodology was used (in-depth interviews)
complemented with a quantitative methodology (survey). Within the
research 50 male injecting drug users (IDUs) have been reached and 50
steady female partners of the injecting drug users, regardless of the fact
whether they themselves use drugs or not. Research findings indicate the
following: Gender aspect is very important in initiation into drug use. Girls
and women often start with drug use practice with their partner. Out of 19
IDU males who are in a relationship with a female partner who is an IDU,
eight male subjects reported that their female partners had the first
contact with drugs through them. On the other hand, out of 50 male
participants, only one had the first experience with drugs during a
relationship with a woman IDU. Sharing of injecting equipment is still
present . In most cases a male partner has priority in distribution and
taking drugs. Traditional understanding and acceptance of gender roles is
reflected in attempts to explain or “justify” a man’s violent behaviour with
the withdrawal crises or need for drugs. Sex work is one of the frequent
activities for procuring money, or sex services are offered to drug dealers
in exchange for drugs. The decision on purchasing and using a condom is
mostly left to a male partner, and women and girls are not enough
empowered to impose the use of a condom. Men are more prone to
changing partners. Women prove their devotion to a partner by agreeing
to risky behaviour (for ex. intercourse without a condom) or even by
willingness to get infected with HIV. They tend to remain in a relationship
with a person who is HIV positive, even when that person has infected
them. In conclusion, the research findings have to a great degree
confirmed gender specific risks for women that have been stated in the
professional literature: unequal power relations and often weaker
economic position of a woman. Women are in a weaker position when
they make a decision about when, with whom and under what conditions
they would have a sexual intercourse. The research findings, although they
are not representative due to the size and sampling method, are certainly
indicative – confirm to a great degree the thesis about the specific
vulnerability of women and girls, both related to situations that lead to HIV
infection, and related to availability and specific content of services offered
to women living with HIV.
P97
Impact of educational program on knowledge, attitude and preventive
behaviors related to HIV STIs in female sex workers in Shiraz south Iran
Mahmood Amini Lari*, Minoo Ali pour Sakha, Farbod Ebadi Far Azra,
Parvin Afsar Kazerooni, Mehrab Sayadi
Shiraz HIV/AIDS Research Center, Shiraz, Israel
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P97
Background: Female sex workers (FSW) have been well identified as core
groups that play an important role in the effluence of sexually transmitted
diseases (STD) and HIV. The purpose of present study was to assess the
impact of educational intervention on promoting STIs /HIV related
knowledge, attitude and preventive behaviors among female sex workers
In Shiraz Iran in 2009.
Page 39 of 54
Methods: In this quasi-experimental study with a pre-test -post-test
design which was conducted from February to July 2009, 80 female sex
workers were selected from 5 Shiraz Drop in Centers using the classified
random sampling technique. At the beginning FSWs´ HIV/STI related
information was assessed in a safe place by interview, using standard
questioners as pre-test and then educational intervention program
(lecture, face to face education, pamphlet, educational movie, role
playing health educational competition) have performed. After 2 months
post test was administered to evaluate the effect of interventional
program.
Results: The average age of the participants was 32.62± 9.11 and the
average number of participants´ partners was 4 (range 1-15).After the
educational intervention, there was a significant difference between
the pre-test and post-test knowledge scores ,it means that the mean
score of general knowledge related to HIV/STI increased from 13.7±0.95
to 19.47±11.62 (P < 0.01). Similarly, there was a significant improvement
in the sex workers´ attitude and their sexual preventive behaviors such as
safe sex and condom use (P < 0.01).
Conclusion: According to results of this study, the educational program
was successful in increasing and promoting the HIV/AIDS-related
knowledge and attitudes of the participants and enhancing their HIV
sexual risk behaviors. More interventional studies should be developed
for other high risk population.
P98
Influx of uncommon HIV-1 strains from Eastern Europe and
identification of a new unique recombinant strain among young
Cypriot MSM in Cyprus
Ioanna Kousiappa*, Yiota Lazarou, Katerina M Othonos, Johana Hezka,
Leondios G Kostrikis
University of Cyprus, Nicosia, Cyprus
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P98
Introduction: The polyphyletic picture of HIV-1 infection in Cyprus is a
fact, as new variants and unique recombinant forms were found in the
recent past. As part of a growing effort to monitor any changes in the
molecular epidemiology of HIV we studied two notable cohorts of the
known HIV-1 population diagnosed in 2010 to 2011. Near full-length
genome sequencing and phylogenetic analysis was carried out to
determine the heterogeneity among HIV-1 strains isolated from
patients, 10 originated from eastern European countries (mostly
Romania) and 8 young Cypriots (<25 yrs), all men who have sex with
men (MSM).
Materials and methods: Sequence of the near full-length genome was
amplified by RT-nested PCR from all HIV-1 seropositives and sequenced.
Detailed phylogenetic and bootscanning analyses were performed by
MEGA v5.0 to determine phylogenetic associations and subtype
assignments. To explore putative recombination patterns in the
sequences we performed a bootscanning analysis using Simplot, version
3.5.1.
Results: Phylogenetic analyses of the obtained viral sequences showed
genetic diversity. In the eastern European cohort, subtype F1 was the
dominant subtype (40%), followed by subtype C (20%), A1, A2,
CRF02_AG, and CRF03_AB (10% each). In the young MSM cohort subtype
B was the main subtype (50%), followed by subtype A1 (25%), CRF01_AE
(12.5%) and one HIV-1 isolate that was not classified in any known
subtype or recombinant form (12.5%). Complete recombination analysis
revealed that this isolate had a new recombinant pattern, comprising
segments of subtypes A1 and B, and is distinct from any reported
recombinant.
Conclusions: These findings exhibit an influx of infrequent HIV-1 genetic
forms from eastern European countries in Cyprus, and a stable circulation
of B and A1 subtype among the young Cypriot MSM cohort. A unique
recombination event between A1 and B subtypes has occurred and the
parental strains seem to be formerly characterized Cypriot MSM patients.
For the first time, these data show an impact on the evolutionary
progress of HIV-1 epidemic of the island. The significance of this study
along with the earlier variable epidemiological status of HIV-1 infection in
Cyprus reflects the contribution to HIV classification, and the important
implications for HIV-1 disease control and surveillance.
Retrovirology 2012, Volume 9 Suppl 1
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P99
HIV risk in an urban American population
Josephine F Wilson
Boonshoft School of Medicine, Wright State University, Kettering Oh, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P99
Introduction: Investigations of specialized populations in the United States
have revealed multiple risk behaviors for HIV infections. Identification of
significant risk factors for specific populations enables tailoring interventions
to populations. The present study examined risk behaviors in a general
urban population in order to determine the need for HIV interventions in
subgroups of the general population.
Materials and methods: HIV testing tied to a small remuneration was
offered to adults in a small city in Ohio. Testing was conducted in
churches, public health sites, and in a van that was parked at various
public housing sites. A total of 3,290 individuals were tested for HIV. At
the time of testing, demographic and risk behavior data were collected.
Data were analyzed using logistic regression to determine the
populations most at risk for HIV infection in this large sample of poor
urban residents.
Results: The sample tested ranged in age from 18 to 85 years, was 80.2%
Black and 18.8% Caucasian, and 43.6% male. Altogether, 0.4% of the sample
tested was HIV positive. In this largely African American sample, 77.3%
admitted to condom use, 4.9% had sex with an intravenous drug user (IDU),
4.2% used intravenous drugs, 2.1% had sex with a MSM, and 11.4% had sex
with 3 or more partners in the past 30 days. Logistic regression indicated
significant associations between a positive HIV test and having sex with a
MSM, no condom use, being an IDU, having sex with an IDU, and having sex
with someone who is HIV positive. Odd ratios were calculated for each of
the identified significant risk factors.
Conclusions: These data indicate where intervention efforts are needed
in our community. Studies of this sort enable public health administrators
to conserve valuable prevention funds by targeting interventions to
populations at greatest risk. This study revealed that, in this largely
African American population, men and women were equally at risk for
HIV, thus mandating the development of HIV interventions for men and
women in this urban population.
P100
Uptake of PMTCT sites for increasing accessibility of services in
prevention of mother to child HIV transmission program in Rwanda,
January 2005 June 2010
Ange Anitha Irakoze*, Placidie Mugwaneza, Sabin Nsanzimana,
Jennifer Mbabzi, Jean Pierre Nyemazi, Eric Remera
Hiv Division, Former Trac Plus, Kigali, Rwanda
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P100
Background: In Rwanda, the Prevention of Mother to Child Transmission of
HIV program (PMTCT) started in 1999 as a pilot project; a positive evaluation
conducted 1 year later lead to national scale-up. The integration of the
PMTCT program into existing antenatal care (ANC) services was done
gradually. Nationally, HIV testing is routinely offered to all pregnant women
at the time of enrollment in ANC. Political commitment and involvement of
key stakeholders in program implementation; public awareness campaigns,
especially for pregnant women; and the involvement of local authorities,
care providers, and community health workers have greatly contributed to
the scale-up of the PMTCT program in Rwanda.
Methods: We analyzed routinely reported facility-level data on HIV testing
among pregnant women in the national PMTCT program from January 2005
to June 2010.
Results: The number of PMTCT sites increased from 209 (46%) at the end of
2005 to 382 (84%) sites in June 2010 (209 in 2005, 234 in 2006, 285 in 2007,
342 in 2008, 377 in 2009 and 382 June 2010) out of 452 health facilities
providing ANC services. Overall, 1,623,079 women received ANC services; of
these, 1,554,387 (95.76%) accepted HIV testing. The acceptance rate of HIV
testing among pregnant women in ANC increased from 89% in 2005 to
98,3% in June 2010. Of women tested, 99,4 % received their HIV test result.
HIV prevalence among pregnant women tested decreased from 4.8% in
2005; to 4.4% in 2006; to 3.8% in 2007; to 2.9% in 2008 and 2.6% in 2009
and 2010.
Page 40 of 54
Conclusions and recommendations: These results demonstrate that
many efforts were done regarding the increasing of PMTCT sites in the line
of scale-up of the national PMTCT program in Rwanda, as indicated by
increases in number of sites offering PMTCT services, in uptake of HIV
testing for pregnant women. Despite the high uptake of PMTCT sites, it is
still below the national target of 100% of coverage of PMTCT sites, thus
enhanced efforts to increase availability of PMTCT services are warranted.
P101
A decade of investment, HIV prevention research and development
funding from 2000 through 2011
K Fisher, E Donaldson*, LM Green, T Harmon, P Harrison, R Lande, M Warren
Avac - Global Advocacy for Hiv Prevention, New York, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P101
Introduction: Since 2004, the HIV Vaccines and Microbicides Resource
Tracking Working Group has employed a comprehensive methodology to
track resource trends in R&D for biomedical HIV prevention options,
including HIV vaccines, microbicides, PrEP, treatment as prevention,
vertical transmission prevention and adult voluntary medical male
circumcision.
Materials and methods: Data were collected on annual disbursements by
public, private and philanthropic funders for product development, clinical
trials and trial preparation, community education and policy advocacy
efforts in order to estimate annual investment in HIV prevention R&D.
Investment trends were assessed and compared by year, prevention
technology type, type of funder and geographic location.
Results: Since 2000, there has been significant growth in funding support
for HIV prevention research and development. However, in 2011 HIV
prevention research began to face increased funding pressures as
governments worldwide decreased or flat-lined budgets in many areas of
global health and as philanthropic donors worked to revise their investment
strategies. Competing funding priorities affected funding for HIV prevention
R&D. Still, despite those various funding pressures, the field of HIV
prevention research progressed significantly in 2011, with new findings that
advanced the field and promising new trials underway.
Conclusions: Monitoring funding trends for HIV prevention research is
particularly important at this time of critical juncture between economic
uncertainty and the point at which the scientific community has articulated a
much clearer pathway to the end of the HIV epidemic. Monitoring funding
provides the fact base for policy advocacy around spending levels and
allocations that will sustain investments in the research required to build on
the success of recent trials; bring novel HIV prevention candidates into the
pipeline; and support the follow-on clinical trials needed to assure the safety,
immunogenicity, efficacy and acceptability of new HIV prevention products.
P102
Sexual behavior and reproductive health among HIV infected
adolescents in RBC, IHDPC, Clinic during 2011 therapeutic holidays
Ange Anitha Irakoze*, Diane Tuyishimire, B Ami Bugingo, Sabin Nsanzimana,
M Josee Maliboli, Melanie Muhizi, Angelique Nkuliza, Simon Niyonsenga,
M Gasana, Ciprien Baribwira, Jackson Sebeza, Laetitia Umulisa
Rbc, Ihdpc, Hiv Division.Former Trac Plus, Kigali, Rwanda
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P102
Background: Access to SRH services for adolescents in general and for
HIV infected specifically is still challenging , resulting in low level of
awareness , unsafe sex practices, risk of pregnancies, STI , contamination
or super infection.
Objectives: To determine the patterns of sexual behavior, reproductive
health among HIV infected adolescents followed at IHDPC/RBC HIV clinic.
Methods: During 2011 therapeutic holidays for HIV adolescents followed in
RBC/IHDPC/HIV Clinic, 151 of them (73 girls and 78 boys) were assessed
about sexual behavior and SRH using a modified HEEADS assessment selfadministrated questionnaire and interviews. Parental permission was sought.
Results: The mean ages (+/-SD) of the girls and boys were 16.3 +/- 0.165
years.
About disclosure: 8.7% of the adolescents were not willing to disclose
their HIV status to their sexual partners, yet 76% of interviewed have a
partner.
Retrovirology 2012, Volume 9 Suppl 1
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About safe sex: Overall, 8.4% of adolescent are sexually active all above
15years (4.4% of the girls and 12% of the boys). Boys are three times more
sexually active than girls and 66.7.1% of sexually experienced boys had used
condoms. Among sexually experienced girls only 33.7% used condoms,
surprisingly 96.6% of interviewed declared not willing to have protected sex.
About Contraception and pregnancy: among sexually experienced girls
36.7%, had ever used contraception and prevalence of adolescent
pregnancy was 2.6%.
Information about sexuality: 81.12% of adolescents have ever learnt about
sexuality (51.7 % aged 15-19 years), 49.6% can discuss sexual issues,
among them 55% are girls and 45%; are boys.
Conclusion: In this adolescent cohort, sexual activity seems to debut after
15 years old, safe sex practice is not optimal, and contraception among
sexual actives girls is low and information level about SRH need to be
improved, underling the urgent need of implementing SRH program for HIV
adolescents.
P103
Gendered sexual risk patterns and polygamy among HIV serodiscordant couples in Uganda
Sarah Khanakwa*, Moses Ngolobe, David Moore, Robert Mwesigwa,
Josephine Birungi, Rachel King, Kate Shannon
Aids Support Organization (Taso) Uganda, Jinja, Uganda
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P103
Background: Multiple sexual partnerships and HIV sero-discordant
relationships are among the most at-risk for HIV transmission. Polygamy is a
common form of multiple-partnered relationships in Eastern Uganda. We
investigated the association between HIV risk patterns and polygamy
among HIV sero-discordant couples at The AIDS Support Organization in
Jinja, Uganda Methods Participants were enrollees in a prospective cohort of
HIV sero-discordant couples, the Highly Active Antiretroviral therapy as
Prevention (HAARP) Study at TASO Jinja. Descriptive and bivariate analyses
to compare sexual risk patterns among HIV sero-discordant men; in
polygamous as compared to single-spouse relationship.
Results: Polygamous Vs Single-spouse couples ≥2 wives 1 wife P value N =
241 56 185 Male HIV+ve 38 (68%) 99 (54%) 0.065 Male-controlled sexual
decision making 34 (61%) 66 (36%) 0.001 Male-controlled condom use 33
(59%) 51 (28%) <0.001 Condom last time had sex 45 (80%) 128 (69%) 0.086
Financial support 45 (80%) 152 (82%) 1.00 HIV positive partner on ART 24
(37%) 88 (48%) 0.143 Median age (IQR) 44 (39– 50) 43 (37– 50) 0.451.
Conclusion: This study demonstrates continued gendered risks for women
in HIV sero-discordant relationships in sub-Saharan Africa. In particular, men
with 2 or more wives are more likely to make decisions about when to have
sex or when to use a condom. However, we found no differences in
condom use at last sex by polygamy status.
P104
Relying on injection drug users to prevent HIV in Ukraine - follow-up
results of peer-driven interventions
Oleksandra Datsenko*, Pavlo Smyrnov, Robert Broadhead
International Hiv-Aids Alliance-Ukraine, Kyiv, Ukraine
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P104
Introduction: Conventional harm reduction (HR) projects overlook IDUs’
capabilities in offering them services but no active roles to play in
preventing HIV. In contrast, “peer-driven interventions” (PDIs) offer IDUs
rewards to educate and recruit peers for services. All IDU-recruits receive
the opportunity to play both roles.
Methods: In 2010, the International HIV/AIDS Alliance-Ukraine
implemented PDIs in 12 Ukrainian cities that relied entirely on IDUs to
access and teach IDUs who either had: (a.) never received HR services, or
(b.) former PDI/HR-respondents eligible for a one-year follow-up (FU)
intervention. IDU-recruiters were trained to administer two completely
different bodies of prevention information: one to new recruits, the other
to FU-recruits. Recruits from both groups were administered an 8-point
knowledge test (KT) at their appointment that measured how well their
recruiters educated them.
Results: In 6 months of operation, the 12 PDIs recruited 8,115 IDUs:
2,782 (34%) new recruits
Page 41 of 54
5,333 (66%) PDI-FU-recruits
- New recruits: 87% scored 7 or higher on the first KT
- FU-recruits were administered both KTs at the follow-up appointment.
86.4% scored 7 or higher on the 1st KT
89.6% scored 7 or higher on the 2nd KT
(One year earlier, only 81.5% of the FU-group scored 7 or higher, which
underscores how the PDI’s repetitive features improved respondents’
retention rate.)
Conclusion: The PDIs documented that IDUs can play active roles in
preventing HIV by recruiting IDU-peers who have never received HR
services, or IDUs eligible for FU intervention. They are also able to deliver
two entirely different bodies of prevention information. Compared to HR
projects that relied on traditional staffs of salaried outreach workers, the
PDI proved to be far more powerful and cost-effective model. AllianceUkraine now plans to broaden its investment in PDIs even more heavily
by further expanding projects targeting IDUs, but also female sex workers
and homeless/runaway street children.
P105
Awareness and attitude of the general public toward HIV AIDS in
coastal South India - a community based crossectional study
B Reshmi*, B Unnikrishnan, P Mithra, T Rekha
Manipal College of Allied Health Sciences, Manipal, India
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P105
Background: Acquired Immunodeficiency Syndrome (AIDS) is one of the
most dreaded entities that modern medicine has ever had to tackle. Adult
HIV prevalence in India is approximately 0.36%. HIV-related stigma and
discrimination remains an enormous barrier to effectively fighting the HIV
and AIDS epidemic, There are several reasons for the stigma toward
PLWHA among the general population, one of them could be inaccurate
information about the transmission of HIV; creating irrational behavior and
misperceptions of personal risks.
Objective: To assess the awareness and attitude of the general public
toward people living with HIV/AIDS (PLWHA) in Mangalore, a city in
Coastal Karnataka.
Methods: The study population included 630 individuals aged 18 years and
above. The information was collected using a semi structured pre-tested
questionnaire. Statistical package SPSS version 11.5 was used, Chi-square
test was conducted and P< 0.05 was considered as statistically significant.
Results: About one-third of the study population thought that one could get
infected by merely touching an HIV positive individual. Approximately 45%
stated that they would dismiss their maid on finding out her HIV positive
status. About 54% were willing to undergo the HIV test. The respondents
with less than secondary school education had a discriminatory attitude
toward HIV positive people, with regard to them deserving to suffer,
dismissing a HIV positive maid, hesitating to sit next to a HIV positive person
in the bus, divorcing the infected spouse, and willingness to get tested for
HIV, which was found to be statistically significant.
Conclusion: Stigma among the general public was mostly due to fear of
contracting the illness. Stigma does exist to significant degrees among the
educated people, which was suggested by about 45% of the participants
being willing to undergo the HIV test.
P106
Sexual behavior and perceived risk of HIV AIDS among returnee labor
migrants from Overseas in Nepal
Sushma Dahal*, Paras Kumar Pokharel, Birendra Kumar Yadava
School of Public Health and Community Medicine, BPKIHS, Dharan, Nepal
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P106
Introduction: Nepal is a popular country of origin for labour migrants.
Migrant workers are risk group for HIV. In Nepal studies on labour migrants
have mainly focused on those going to India. Not enough studies have
focused on sexual behaviour of migrants going to overseas.
Materials and methods: A cross sectional study was done among 110
returnee male labour migrants in Nepal who were interviewed about their
sexual behaviour while in overseas and their perceived risk of HIV/AIDS.
Recruitment agencies were selected purposively to identify returnee
migrants. Snowball technique was also used to trace some migrants in
houses and hotels.
Retrovirology 2012, Volume 9 Suppl 1
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Results: Saudi Arabia, Malaysia, UAE and Qatar were found to be the popular
countries of destination. Among respondents returning from Gulf countries,
41.6% had sex with paid/unpaid partner which was 66.7% for those from
Non-Gulf countries. Among 21 respondents who didn’t always use condom,
15 were from Gulf countries and 6 were from Non-Gulf countries.
Respondents for whom difficulty in finding condom was the reason for non
use were from Gulf countries. Co-working female friends were the non
spousal unpaid partners for majority of the respondents. There was not
much difference in risky sexual behaviour of migrants based on law of
destination country regarding sex work and respondent’s habit of drinking
alcohol. AIDS was perceived to be a very dangerous killer disease by more
than 2/3rd of the respondents; even though, more than 40% perceived
themselves to be at some risk and more than 75% perceived their friends to
be at some risk of HIV. Only 7% had ever heard and used VCT service.
Conclusions: Labour migrants going to overseas are at risk of HIV. HIV
related awareness raising activities should focus on migrants. HIV prevention
programs in destination and origin country should target both male and
female labour migrants.
P107
Controlling the spread of Hiv among long haulage workers in Nigeria
Evans Benjamin*, Taiwo Kelvin Igie, Monday Udoh
Foundation Aid Solution for Talent Empowerment and Development, Ikeja
Lagos, Nigeria
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P107
Introduction: The study investigated the effect of the transport industry on
the transmission and spread of HIV/AIDS. Transport workers are highly
mobile and spend long intervals away from the comforts of their homes.
They are often involved in risky sexual behaviours that make them
vulnerable to HIV infection, and so constitute carriers in the spread of the
pandemic.
Method: The study entailed interviewing more than 1,000 long haul drivers
and workers with the objective of inducing frank talk to assess their sexual
habits enroute their long hauls. The limitation of this study was their
insistence on anonymity to avoid adverse effects on their social status and
marriage stability.
Result: More than 80% of interviewees had more than 20 female friends
stationed at the villages on highways across the country. 60% of the
promiscuous group knew about condoms but never used them. To them,
what was the use doing it if you could not have the real thing. Sadly, some
of the interviewees stated they had no other pleasurable indulgences in life
other than sex, and if they were to die doing the only thing they enjoyed
then who is complaining.
Conclusion: The NURTW was advised:
Create rest stations along the nation’s highways, with lodging, canteen,
games, TV/Video sets, and other recreational facilities for drivers and
motor boys.
Provide GSM phone facilities for workers on long distance engagements
to allow them keep in touch with their families.
Organize seminars to educate workers on the implications, prevalence
and management of HIV/AIDS.
Provide medical test and care facilities at those rest stations for the quiet
testing of workers for HIV/AIDS and dispensing of necessary drugs to
sufferers.
P108
Comparing knowledge, attitudes and sexual practices of Female
Commercial Sex Workers (FCSW) and the general female population in
Brazil
Célia Landmann Szwarcwald*, Ana Roberta Pati, Pascom Paulo,
Roberto Borges de Souza Júnior
Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P108
Introduction: The aim of this study was to compare knowledge and risk
behavioural practices among female commercial sex workers (FCSW) and
the general female population in Brazil.
Page 42 of 54
Material and methods: Information on 2523 FCSW were collected in a
RDS study carried out in 10 Brazilian cities in 2009. A method for
estimating proportions and their variances was proposed, which takes
into account the dependency structure of observations. Both the inverse
of network size and the size of the city were considered in the estimation
of RDS weights. The 2008 Behavioural Surveillance Study provided
information of the general female population. The sample design of the
BSS was a typical three stage-selection (census tracts, households and
individuals), stratified by macro-region. In the statistical analysis, tests of
proportions were performed taking into consideration each study sample
design.
Results: FCSW are less educated than the general female population
aged 18 to 64 years. Knowledge of HIV transmission is always worse
among FCSW, even after controlling for educational level. As to sexual
practices, the onset of sexual activity is much earlier among FCSW and
38% reported sexual abuse at least once during lifetime. Although
protected sexual practices showed a slightly more favourable scenario
among FCSW, the proportion who would never fail to use a condom was
very low (23%). Higher use of drugs among FCSW was another point of
note. In relation to prevention measures, the coverage of gynaecological
exam in the last three years was much higher in the general female
population even though STI signs were more frequently reported among
FSW. Similar proportions of HIV testing in the previous 12 months were
found.
Conclusions: The results showed that there are still shortcomings in
preventive care among FCSW in Brazil. Measures specifically aimed at
increasing knowledge of HIV transmission, coverage of gynaecological
exam and annual HIV testing among FCSW could contribute to the
reduction of STI transmission in the Brazilian population.
P109
Condom use among long-term intimate partners using drugs baseline
results from a randomized trial in Ukraine
Liudmyla Shulga1*, Tatiana Andreeva2
1
ICF International HIV AIDS Alliance in Ukraine, Kiev, Ukraine; 2National
University of Kyiv Mohyla Academy, Ukraine
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P109
Introduction: Ukraine faced changes in HIV transmission routes and in
2007 sexual transmission exceeded parenteral way. In response to
situation change couple’s counseling for IDUs was introduced. Data
presented in the abstract are part of the randomized trial to test couple’s
counseling as a mean of HIV prevention among IDUs.
Methods: Baseline data were collected in June - September 2011. 560
IDU couples in 10 cities were surveyed and screened for HIV and
Hepatitis C. Participants were recruited using respondent-driven sampling
method.
Results: Age of respondents varied between 30 and 33 years old with
women being about 3 years younger compared to men. On average,
duration of relationship was 3.7 years. Only 15% of respondents were
married, while majority (64.9%) lived in a civil marriage; 20% declared
having close intimate relationships. At the same time women tended to
consider living together as “marriage” while men differentiated between
these two categories. Men had regular jobs more often compared to
women (23.8 vs 15.8%), as well as odd jobs (53% vs. 31% respectively). Data
showed that there was no difference observed between men and women in
sexual activity with regular partners. But men reported having more
occasional sexual partners (3 partners/30 days), and women were more
often engaged into commercial sex (19 partners/30 days). Condom use with
occasional (80%) and commercial (88%) sex partners took place more often
compared to sexual intercourse with regular partners (44%). Condom use
during anal and oral intercourse was much lower and varied between 8%
with regular partners and 25% with occasional partners. The most common
reasons for avoiding condom use were sensitivity decrease (28%).
Conclusions: Intimate partners are often not engaged into sexual
relationships, even if they live together; drug use is sees as a more
intimate process. Sex education for IDUs should account for nature of
intimate relationsips; focus on reasons of condom non-use; and promote
protected anal and oral intercourses. Education should also teach to
understand risks related to own or partner’s extramarital sex.
Retrovirology 2012, Volume 9 Suppl 1
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P110
HIV situation in the Greater Mekong Sub-Region bordering Thailand
Tawatchai Apidechkul
Professor at Mae Fah Lung University, Chiang Rai Province, Thailand
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P110
Introduction: Greater Mekong Sub-region (GMS) is composing of the
border of Thailand-Myanmar, Republic Lao, and China with various of
geographic and cultures and more than 200 million people live there.
The migration of population is simple scenario at these areas. Last few
decades Thailand has been reported of the highest prevalent of HIV/AIDS
particularly in the northern of Thailand. The study aimed to investigate
the effect of HIV/AIDS at the areas of GMS.
Materials and methods: This retrospective cohort study design aimed to
investigates the HIV situation among the people who immigrated into
Thailand in GMS. The systemic data extraction from the medical records
from 19 hospitals which located in the border of Thailand during 19902009 was analyzed. The instruments had been detected in validity and
reliability. Chi-square test was used for identifying the statistical
significant at the alpha=0.050.
Results: Totally 1,303 cases had been detected. Of 84.50% were still alive,
57.27% were male. Myanmar were 56.52%, 26.44% were unknown, and
11.10% were Republic Lao, 5.24%were Chinese, and 1.00% was
Cambodian. Of 37.53% were aged 21-30 years old, 33.15% were aged 3140 years old, and 12.89% were aged 41-50 years old. Of 38.94%were
agricultural, 34.56% were employee, 4.15%were student, and 3.46% were
young children. Of 51.65% were full bone AIDS, and 28.32 were
symptomatic AIDS. Of 92.31% had infected by sexual intercourse, 6.06%
were mother to child, and 1.63% were IDU. Distribution of age by sex
was statistical difference (p-value<0.001). Being female had a longer live
than male (p-value=0.002). The live status was different according to
nationality (p-value<0.001) and risk factor (p-value<0.001).
Conclusion: The cooperation between countries to control the HIV
spreading is immediately need for the GMS region especially the free
trade market in 2015.
P111
Risk behaviors and reasons for not getting tested for HIV among men
who have sex with men in Peru
Magaly M Blas*, Isaac E Alva, Robinson Cabello, Cesar Carcamo, Ann E Kurth
Cayetano Heredia Peruvian University, Lima, Peru
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P111
Introduction: Men who have sex with men (MSM) account for the
greatest burden of the HIV epidemic in Peru. Given that MSM are frequent
users of the Internet, understanding the risk behaviors and the reasons for
not getting tested among MSM who surf the Internet may improve the
tailoring of future online behavioral interventions.
Methods: From October 2007 to April 2008, we conducted an online
survey among users of seven Peruvian gay websites.
Results: We received 1,481 surveys, 1,301 of which were included in the
analysis. The median age of the participants was 22.5 years (range 12-71),
67% were homosexual, and the remainder was bisexual. Of survey
respondents, 49.4% had never been tested for HIV and only 11.3% were
contacted in-person during the last year by peer health educators from the
Peruvian Ministry of Health and NGOs. Additionally, 50.8% had unprotected
anal or vaginal sex at last intercourse, and a significant percentage reported
a condom broken (22.1%), slipped (16.4%) or sexual intercourse initiated
without wearing a condom (39.1%). The most common reasons for not
getting tested for HIV among high-risk MSM were “I fear the consequences
of a positive test result” (n = 55, 34.4%), and “I don’t know where I can get
tested” (n = 50, 31.3%).
Conclusions: A small percentage of Peruvian MSM who answered our
online survey, were reached by traditional peer-based education programs.
Given that among high-risk MSM, fear of a positive test result and lack of
awareness of places where to get tested are the most important reasons
for not taking an HIV test, Internet interventions aimed at motivating HIV
Page 43 of 54
testing should work to reduce fear of testing and increase awareness of
places that offer free HIV testing services to MSM.
P112
Social and contextual factors that influence HIV risk behaviors among
indigenous MSM in the Peruvian Amazon
Isaac E Alva*, E Roberto Orellana
Universidad Peruana Cayetano Heredia, Lima, Peru
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P112
Introduction: Men who have sex with men (MSM) face a significantly
higher risk of HIV infection than the general population around the globe.
In Peru, HIV prevalence among MSM range from 14% to 23%, with Lima,
the capital, and port cities in the Amazonian region being the most
affected. Recent studies found that indigenous MSM who leave their
villages for cities along the Amazon River and its tributaries, engage in
high risk behaviors such as high alcohol consumption and unprotected sex
with mestizo (non- indigenous) MSM. This study examined social and
contextual factors associated with risky behaviors among indigenous MSM
in the Peruvian Amazon.
Materials and methods: During a 5-month period in 2009-2010, we
purposively recruited indigenous MSM. The study took place in several
port cities throughout the Amazon region. Semi-structured in-depth
interviews were conducted with indigenous men, who consented to
voluntarily participate in the study.
Results: We interviewed 34 MSM with an average age of 26 years. They
represented 8 different ethnic groups. In most situations, when family and
community members learned about the participants’ sexuality,
discrimination and violence ensued. Participants reported being beaten up
by their relatives. Sometimes, community councils were held to decide on
their fate. Council decisions ranged from forcing the person to hard
(manly) labor, to undertake traditional medicine treatments, to expulsion.
Participants saw their migration to the city as an escape from oppressive
forces in the community. In the city, many reported being in abusive
relationships with other men. Lacking appropriate education and technical
skills, many participants engaged in sex work as a way of making a living.
Conclusions: A great deal of discrimination, isolation and lack of social
support was experienced by most participants. Besides individual-level
interventions, HIV prevention programs should take these factors into
account and design programs that increase social support, enhance
community building and reduce stigma.
P113
Once a man tests, the partner tests as well. A comparison by gender
for HCT and STD clinic attendance
Maria Nambira*, Lydia Mwolobi
Monitoring and Evaluation Specialist at African Medical and Research
Foundation, Kampala, Uganda
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P113
Introduction: Since its outbreak in 1986, Uganda has registered a
tremendous decline in HIV prevalence rates from 15% in 1991 to 5% in 2002
though up again to 6.4% in 2006 (2006 UDHS). Currently, an estimated
100,000 new HIV infections occur annually. In recent years, the uptake and
practice of preventive behavior have declined, particularly among men.
Currently, almost 40% of people with HIV are not diagnosed until they
already have developed AIDS. That can be up to 10 years after they first
became infected with HIV. Finding out whether a person is infected with HIV
is the first step to improving their health and that of their partners and their
families. The study aimed to assess the contribution, role of men in the fight
of HIV/AIDS through HCT.
Methods: The project monitored all individuals attending STD and ART
clinics. The project sought to check whether when requested, males
brought their female counterparts for testing and vice versa during the
September 2010 to Sept 2011 at Luwero health centre IV in Luwero
district, Uganda. Clinical data was used.
Results: In the reporting period, we estimated that 1,230 people were
attending ART clinics and about 3,200 people attending STD clinics. More
Retrovirology 2012, Volume 9 Suppl 1
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males once tested brought more spouses for testing. The numbers were
much less vice versa. For every 1 man tested at least 3 women were
tested. This was also recorded in polygamous relationships. Clinic Type
Males Females Total Attendants Attendants Who Brought Spouses Males
Females STD 1,091 2,109 1,230 567 (52%) 111 (5.3%) ART/HCT 383 847
3,200 146 (38%) 57 (6.7%).
Conclusion: HCT needs to emphasized in the struggle to reduce HIV
incidence and males contribute to this trend setting. Due to the poor
health seeking behavior of males compared to females, low HCT is done.
The impact of HCT can be greater when men are targeted to attend ART
and STD clinics since they have a bigger ability to bring their spouses to
test as well. Health facilities should design ways to attract more males for
HCT and STDs.
P114
Effectiveness of PMTCT Programme at Mogwase Health Centre, South
Africa
Iryna Chaparanganda
University of KwaZulu Natal, South Africa
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P114
Introduction: Today, HIV/AIDS-related conditions are a major
contributor to childhood morbidity and mortality in South Africa. The
PMTCT Unit, Antenatal Clinic (ANC) at Mogwase Health Centre (MHC),
North West (NW) Province in South Africa runs a prevention mother-tochild transmission (PMTCT) programme aimed at reducing the number
of HIV-infected babies born to HIV-positive mothers. The PMTCT Unit
also undertakes polymerase chain reaction (PCR) test for surrounding
clinics.
Materials and methods: The abstract analyses the effects of PMTCT
programme within the 2010 period. 626 (100%) pregnant women
booked during this period were tested for HIV with pre- and posttesting counselling. 200 (31.9%) of them were tested positive. 117
(58.5%) of the HIV-positive women received dual therapy (AZT from 14
weeks of pregnancy (before 01.04.2010 – from 28 weeks) and sdNVP at
onset of labour) and 83 (41.5%) were initiated on highly active
antiretroviral therapy (HAART) (CD4 ≤350 cells/mm3 (before 01.04.2010
- ≤200 cells/mm3) or stage 4) – 200 (100%) in total. 200 (100%) of HIVpositive mothers also were counselled on safe infant feeding at least
once.
Results: 133 HIV-exposed babies were born at the clinic, and 130 (97.7%)
of them received nevirapine syrup whilst 3 (2.3%) did not receive and
transferred to hospital. PCR tests around 6 weeks were done on 161
babies inclusive of those from other clinics. 4 (2.48%) infants got infected
with HIV through MTCT of which, 1 (25%) was transferred from another
clinic; 1 (25%) was from a late booked mother, and 2 (50%) from
unbooked mothers.
Conclusion: Although more effort is needed to encourage prevention of
unplanned pregnancies, early pregnancy testing, and early booking at
ANC site PMTCT programmes can be effectively implemented in rural
clinics in South Africa, reducing the number of HIV-infected babies born
to HIV-positive mothers.
Source: ANC register. MHC, NW Province, South Africa.
PMTCT register. MHC, NW Province, South Africa.
Dispensing book. MHC, NW Province, South Africa.
PCR register. MHC, NW Province, South Africa.
P115
High incidence of occupationnal blood exposures (OBE) in the health
care workers sector of low income countries, using the example of
bangui, central African Republic (CAR)
HD Mossoro-Kpinde*, CD Mossor-Kpinde, E Gbangba-Ngai, CG Kamalo
Bangui, Central African Republic
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P115
Introduction: CAR has been heavily affected by HIV (6.2%) and hepatitis
B (15%) and C (3%), but has not yet developed a prevention plan against
OBE, even though its health care staff, already low in numbers, is
Page 44 of 54
overwhelmed by a massive patient load.This study aims to assess the
current OBE situation and develop a national plan for the management
of these accidents.
Methods: A preliminary cross-sector study was conducted in 2009
amongst 3 health care facilities groups in Bangui. The parameters being
studied were collected using a standard form including serological status
for HIV, HBV and HCV, vaccination against hepatitis B, incidents of OBE
and their subsequent management.
Outcomes: Three hundred members of the health care staff were
included in the study. 9.2% had been vaccinated against hepatitis B.
Thirty six percent (36%) had already been tested for HIV, with 7.3% of the
tests performed within the last three months. Fifty four percent (54%)
cited an incident of OBE within the last six months. Sixty eight percent
(68%) of these were from accidental needle stick injuries. At the time of
the accident, 39.9% knew their HIV serological status, and 22% their HBV
status. Three percent had been vaccinated against hepatitis B. Three per
cent (3%) of the accidents received subsequent care. The post-OBE care
management did not cover hepatitis B.
Conclusion: There is a high prevalence of OBEs in the sites studied. The
number of health care staff receiving subsequent care is low. As this
study was limited to Bangui, it could be interesting to conduct an
exhaustive evaluation throughout CAR. Meanwhile, given the current
results and the aim of safeguarding the over-stretched pool of health
care staff from OBEs, efforts are required to strengthen staff capacities,
manage OBEs and improve hospital hygiene in the sites studied.
P116
Achieving zero new HIV infection, unsafe sexual practices of out of
school border youths
AO Sekoni*, AT Onajole
College of Medicine, University of Lagos, Lagos, Nigeria
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P116
Background: Young people aged 15 to 24 account for more than 50
percent of all new HIV infections worldwide, majority are those who
engage in unsafe sex (unprotected casual sex and multiple sex partners),
unsafe injection drug use, exposure to contaminated blood and blood
products or unsterilized skin piercing procedures. Border towns have an
admixture of vulnerable population including uniform personnel, out of
school youths, traders, drivers, commercial sex workers and migrants as
well as risky sites such as bars, hotels, brothels and truck parking areas.
Methodology: This cross sectional study was carried out among border
youths to assess knowledge and practices of safer sex and use of HCT
services. One in two systematic market stall sampling was used in the
border market between Nigeria and Republic of Benin to select
participants for the study, in each of the selected stalls all the youths 15
to 24 years were interviewed using a validated structured questionnaire
until sampling size of 120 was achieved.
Results: The mean age was 19years, majority were female (62%) & single
(73%). Half of them had at least secondary school education, 22% had no
formal education, 93% were Nigerians, 25% live on their own, while 36%
were financially responsible for themselves. Two third (68%) did not know
what safer sex means although 43% have had sexuality education, mean
age at sexual debut was 16yrs, 64% have had sex while 63% were still
currently sexually active. The main reason for having sex was to have fun
(56%), more than a quarter engage in multiple sexual partnerships, 61%
use condoms, among which only 15% were consistent users and 18%
have accessed HCT services. Those who consume alcohol were more
likely to be sexually active as well as have multiple sexual partners.
Conclusion: The out of school border youths in this study engage in
risky sexual behavior that can put them at risk of HIV infection, uptake of
HCT (a prevention strategy) is poor.
P117
Piloting work of outreach nurses in Harm Reduction projects in Ukraine
Natalya Dvinskykh*, Sergiy Botvin
HIV AIDS Alliance in Ukraine, Kyiv, Ukraine
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P117
Retrovirology 2012, Volume 9 Suppl 1
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In Ukraine, despite growing sexual way of transmission of HIV, drug use
remains the driving force of the epidemic. Prevalence of HIV among IDU
is the highest compared to other risk groups - 21.6%, according to
biobehavioral study conducted in Ukraine in 2009. However IDU often do
not have access to most of the needed medical services because of
stigma, discriminative attitude, and lack of resources.
To address these issues and to bring basic medical services to the
places and at a time convenient for drug isers, a project “outreach
nurses was piloted in 2011. The aim of the project was to introduce
work of medical professionals (nurses) as a part of Harm Reduction
Program. The project was led by All-Ukrainian Harm Reduction
Association, supported by HIV/AIDS Alliance in Ukraine and
implemented in 5 regions of Ukraine. 3 nurses from each region were
trained on two workshops: Harm Reduction Basics and VCT. The nurses
provided basic medical services and consultations at mobile clinics,
fixed NEPs, outreach routs and clients’ houses. They changed bandages,
applied ointments, checked body temperature etc., as well as provided
information on various health improvement issues and referred to other
services.
The intervention proved to be extremely popular among IDU 1732 clients
were reached by the services during the project’s work. The most popular
services included: veins treatment, bandaging, anticeptics dissemination,
and medical consultations, including HIV counseling. Those nurses who
had not worked in Harm Reduction programs before reported that their
attitude changed a lot during the project implementation: from fear to
being ready to help and being proud on the ability to help people in
need. The new services also gained the most positive feedback from the
clients.
The project piloting showed that work of outreach nurses can be useful
for any Harm Reduction program and can improve quality of its services.
There are several factors that are important for the success of the
intervention. Among them: adequate training for outreach nurses, ‘nurse social worker’ team work, project’s cooperation with local medical
institutions.
P118
Accessing and educating female sex workers in Ukraine via a peerdriven intervention
Oksana Matiyash*, Pavlo Smyrnov, Robert Broadhead
International HIV-AIDS Alliance-Ukraine, Kyiv, Ukraine
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P118
Introduction: A peer-driven intervention (PDI) for female sex workers
(FSWs) was implemented in harm reduction projects in two Ukrainian
cities. The goal was to recruit and interview 500 FSWs in 6 months who
had never received services before, and to measure how well FSWrecruiters educated FSWs in a body of fresh HIV prevention information.
Recruiters were rewarded by earning tickets to win special prizes in a
weekly lottery.
Methods: A PDI relies on respondent educating and recruiting peers for
services. All recruits also get to serve as peer-educator/recruiters. Each
recruit’s score on an 8-item knowledge test, measuring how well the
recruiter educated her, determined how many lottery tickets the recruiter
earned. A weekly lottery was held each week offering prizes to 4 lucky
winners.
Results: The two PDIs in 6 months recruited 532 and 437 FSWs never
seen before, 2-3 times more new FWSW-recruits than the number
recruited 6 months prior to the PDIs’ start-up. Both projects held 23
lotteries with an average attendance of 8 FSWs. Very significant
differences in levels of drug- and sex-related risk behaviors were found
between FSW drug-users and non-users, heavily shaped by education,
knowledge, and other social variables, suggesting more targeted types of
intervention.
Conclusion: The FSW-respondents were eager to serve as peereducators/recruiters. The lottery proved to be a cost-saving and
effective reward system that was highly motivating. The PDI offers harm
reduction projects an entirely new model for accessing and educating
FSWs, as well as a new method for targeting special sub-populations of
FSWs.
Page 45 of 54
P119
A qualitative study on HIV positive women experience in PMTCT
program in Indonesia
Martiani Oktavia1*, Anita Alban2, Prisca AC Zwanikken3
1
IMPACT Program with Padjadjaran University and Hasan Sadikin Hospital
Bandung, Indonesia; 2University of Copenhagen, Denmark; 3Royal Tropical
Institute, The Netherlands
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P119
Introduction: Indonesia has one of the fastest growing HIV epidemics in
South-East Asia, which was largely driven by injecting drug users (IDUs). A
projection model suggests that there will be a shifted of HIV epidemic from
contaminated needles among IDUs to their sexual partners via heterosexual
contact. At present, women are accounted 25% of all reported AIDS cases
cumulatively. Despite the growing need for prevention mother to child
transmission (PMTCT) of HIV is emerging, coverage of intervention for HIV
test and ARV prophylaxis among HIV pregnant women are still low. This
study calls for more client-oriented PMTCT program based on women’s
need and demand in a changing HIV epidemic.
Material and method: Mixed study design, which consists of a literature
review and a qualitative study with in-depth interview among HIV
positive women with history of PMTCT (purposive sampling).
Results: Nine women aged 25 to 33 years old were selected as
respondents for qualitative study. Majority of them had contracted HIV
from their spouse, who formerly injected drugs. All of them perceived low
or no risk factor for HIV. HIV positive women valued high acceptance of
HIV testing in primary health care with conditions; ensure confidentiality
and quality of counselling. Lack of information about PMTCT and
unintended pregnancies presumably correlated with late initiation of ARV
prophylaxis among HIV infected pregnant women. Despite almost all of
the respondents were expressing no intention to have more children,
there was unmet need for contraception. Stigma and discrimination
remain exist in various forms; fear of being isolated/separated from friends
and family, sub-optimal treatment in hospitals by healthcare workers.
Conclusions: Findings from this study provide a basis for establishing
PMTCT program responsive to the need and demand of women as subject
of intervention. Comprehensive interventions need to be integrated into
existing health systems and utilize resources at the locals disposal. A
successful and sustainable PMTCT of HIV program requires a close
collaboration with stakeholders e.g. governmental institutions, nongovernmental organisations, and civil society representatives.
P120
Perceptions of sexual practices among the old people in Sub-Saharan
African largest City, Nigeria
Odor King*, Isaac Olaseha
Public Health at University of Ibadan, Abuja, Nigeria
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P120
Introduction: Most studies on sexual behaviour in Nigeria focus on
young people and adults, limited attention is paid to elderly people.
Hence there is dearth of information about elderly persons’ reproductive
health challenges and involvement in risky sexual activities.
Aim: This study examined the perceptions of sexual practices among the
elderly in Ibadan, Nigeria.
Methods: The study was cross sectional in design, 400 elderly persons aged
65 years and above were selected using a three-stage sampling technique.
Main outcome measures Both qualitative (FGD) and quanti-tative
(Questionnaire) methods of data collection were used to collect relevant data
on participants, sexual perception, practices and problems. The FGDs were
recorded and analysed using the thematic approach, while the data from the
questionnaires were analysed using descriptive and Chi-square tests.
Results: The participants’ mean age was 71.8 (± 6.7) years. Slightly more
than half, (50.5%) were males. Few (18.3%) had sex two years preceding
the study. A total of 30.0% of the participants had had extramarital sex
since they attained the age of 65 years. Among this subgroup, very few
(7.3%) used condom. Half (50.1%) of the respondents were of the
perception that condom was not meant for the elderly. Moreover, majority
Retrovirology 2012, Volume 9 Suppl 1
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(68.8%) were of the perception that sex with virgin could boost immunity
against STIs/HIV. Lack of interest for sexual intercourse (59.5%) was the
reported main sexual problem of the respondents. Moreover, FGD
participants were unanimous in their opinion that sexual dysfunction was
due to ageing.
Conclusion: Many of the elderly were involved in risky sexual practices.
Therefore, health education intervention programmes such as training on
safe sex practices and counselling services are needed to address the
problem.
homosexual-bisexual and people with no risk factor. The information area
of interest for people-users about the method of transmission of infectious
agents of STDs (60%) (figure 1).
Conclusions: These data would seem to suggest the need for interventions
aimed at prevention of STDs populations of youth, as well as information
strategies able to reach and engage the female target. The value added of
telephone counseling for STDs is to provide the person-user cognitive tools,
to help you avoid risky behavior and enable empowerment processes aimed
at protecting the health of the individual and his community.
P121
Modelling HIV modes of transmission in Iran
Maryam Nasirian*, Ali-Akbar Haghdoost*, Fardad Doroudi,
Mohammad Mehdi Gooya, Abbas Sedaghat, Eshagh Dortaj Rabbori
Kerman University of Medical Science, Kerman, Iran
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P121
P123
Motivating men who have sex with men to get tested for HIV
Magaly M Blas*, Luis Menacho, Isaac E Alva, Roberto Orellana
Cayetano Heredia Peruvian University, Lima, Peru
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P123
Introduction: There is inadequate information on high-risk populations
even though prevention programmes are the mainstay of the national
response to the HIV epidemic in these populations. We used the mode of
transmission (MOT) model to understand the sources of new HIV
infections and use this information for programme planning.
Material and methods: We systematically searched published and grey
literature to find the best values for the input parameters required by the
MOT model. The data were discussed by a group of national experts before
being fed into the MOT model. Using the Monte Carlo technique, we
computed the 95-percent uncertainty level (UCL) for the outputs of the MOT.
Results: The MOT model estimates that 9136 new HIV infections will occur
in Iran in 2010 (UCL 6831-11757). Fifty-six percent (UCL 47.7–61.6%) of new
infections were among injecting drug users and 12 percent (UCL 9.5–15%)
among their sexual partners. The major routes of direct and indirect HIV
transmission in Iran are unsafe injection (68%) and sexual contact (34%
heterosexual and 10% same-sex). If current coverage for safe injection
among IDUs increased from 80 to 95 percent, the number of new HIV
infections in this group would decrease by almost 75%.
Conclusion: IDUs remain the key population at highest risk of HIV
infection in Iran, so programme coverage for IDUs and their spouses
needs to be increased. And as the sexual transmission of HIV increasingly
contributes to the pool of new infections, serious measures are required
to reduce sexual transmission of HIV among the relevant key populations.
P122
STDs help line and prevention
Filippo Maria Taglieri*, Pietro Gallo, Anna Colucci, Anna Maria Luzi, Rudi Valli,
Francesca Botta, Eleonora Lichtner
I.S.S., Rome, Italy
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P122
Introduction: Sexually Transmitted Diseases (STDs) are a public health
problem worldwide, each year about 340 million people, aged between 15
and 49, who contract an STDs (WHO). The Research Unit psycho-sociobehavioral, Communication, Training – U.O. RCF (Department of Infectious
Diseases, Parasitic and Immunomediated – National Institute of Health in
Italy ) initiated in 2010 under a project funded by the Ministry of Health, a
specific STDs prevention activities through the intervention of telephone
counseling. This action is already used by researchers at the U.O. RCF since
1987 for the prevention of HIV infection and AIDS.
Materials and methods: The data collected, anonymously, during the
telephone counseling intervention were entered and stored in a data-entry
software that has allowed, through statistical analysis, to define some
personal characteristics of those users who choose the telephone to get
information on STDs, and to identify their information needs.
Results: In the period 21 June 2010 - June 20, 2011 U.O. RCF received
2,017 phone calls during which it as focused attention on STDs. The 91.1%
of the people-users are male, 77.3% were on no more than 39 years. The
greatest number of calls coming from the North Italy (46%), followed by
the Centre (30%), South (18%) and the Islands (6%). Data analysis can
distinguish three main groups of people-people: heterosexual,
Introduction: Although men who have sex with men (MSM) have the
highest HIV prevalence in Peru, they are underserved by traditional
preventive programs. Interestingly, in Peru the Internet and cell-phones
have emerged as a convenient tool to reach this population.
Methods: From October 2010 to February 2011, we conducted eight
focus groups with gay and non-gay identified MSM, and eight in-depth
interviews with key informants in order to identify key features and
preferences to be used to tailor culturally-appropriate behavioral
messages that could be delivered through Internet and cell-phones to
motivate MSM to get tested for HIV.
Results: Participants reported that in order to motivate HIV testing among
MSM, interventions need to be based on motivational messages that
encourage participants to overcome the fear of getting tested. Messages
should increase the HIV risk perception (of participants who do not
consider themselves at risk) by eliciting risky situations usually experienced
by MSM. Messages should emphasize the confidentiality, professionalism
and respect of the personnel conducting the counseling and testing. A
thorough explanation of the process of HIV testing, including information
about the type of information will be collected, types of tests that will be
available (rapid or ELISA), level of pain participants may feel, time to get
the results back, and cost of the testing should be included. Additionally,
detailed information about the steps participants have to follow if they test
positive or negative should be provided. Messages should also contain
detailed information about the venue where the test will be conducted in
terms of type of clients who attend, location, hours of operation and
personnel. Finally, stigmatizing and stereotyped messages or images about
“being gay” should not be included, as they act as deterrents for getting
tested.
Conclusions: Interventions aimed at motivating HIV testing among MSM
should include motivational messages that reduce the fear of getting
tested and increase the risk perception of participants. They should also
market the venue where the testing will be conducted, the professionals
who will perform the tests, and the test itself. Stigmatizing messages or
images should be avoided.
P124
The HIV infection and telephone counseling, the experience of Italian
National Institute of Health
Anna Maria Luzi, Anna Colucci, Filippo Maria Taglieri*, Pietro Gallo, Rudi Valli,
Francesca Botta, Eleonora Lichtner
I.S.S., Rome, Italy
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P124
Introduction: In the context of HIV prevention interventions, counseling
has proved a valuable operational tool. This method is characterized by
the application of knowledge, personal qualities, skills (active listening,
self-awareness, empathy) and communication techniques (reformulation,
clarification, investigation skills). The interview give the person counselinguser to make choices and changes in situations perceived as difficult to
deal with his problems in an active way and its difficulties. The above
constitutes the methodological basis of HIV / AIDS Helpline telephone
counseling done by the National Institute of Health, established in 1987.
Retrovirology 2012, Volume 9 Suppl 1
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Materials and methods: The intervention of telephone counseling
provided by AIDS HELP LINE Italian is structured in three phases: initial,
intermediate and final. The actions that characterize the three phases of
the telephone counseling are as follows:
- Accommodating the person / service user and present the Service
- To focus the problem and find a shared goal
- Provide information scientifically accurate, current and customized
- Propose and agree on possible solutions
- Summarise and check what has emerged and what has been agreed
- Saying goodbye properly, make themselves available for further contacts
and enter into the relationship
The Italian AIDS Helpline uses a data-entry software that allows you to
collect data on calls received. The data are handled anonymously and
analyzed in aggregate form.
Results: People - users in over 24 years, have turned to the AIDS Helpline
Italian ISS are 671,823, of these 73.9% were males aged between 20-39
years (78.0%), reside in Central Italy, declare themselves heterosexual
(55.1%) and raise questions regarding information on the procedures for
transmitting HIV (27.2%) and ITER diagnostics (25.3%).
Conclusions: The intervention of telephone counseling conducted by the
AIDS Helpline Italian while placing no longer in a state of emergency and as
a social alarm in the ‘80s, however, the data show that a significant number
of people are taking advantage of telephone counseling intervention to
express their information needs, clarify doubts and get information about
the psycho-social-health services on national territory involved in the
prevention, diagnosis and treatment of AIDS.
Introduction and objectives: AIDS is an acquired syndrome of immunity
damage caused by body immunity damaging virus. As our population is
young and consciousness raising has an essential role in prevention of a
disease and also the young people are the main victims of it, so it is
necessary to determine student’s knowledge and attitude as a symbol of
young population to understand their ability in campaign against the AIDS
and distinguish appropriate educational programs.
Materials and methods: This semi experimental study was performed on
150 engineering students of Islamic Azad University of Zanjan Branch.
Samples were chosen by random systematic method. The data collection
tool was a questionnaire concluding three parts of demographic
characteristics, knowledge level, and attitude questions. After performing
the pre-test, the educational program was held during three weeks and
then the post–test was held. The data was analyzed by SPSS software and
the scores which were achieved by samples before and after the
educational program were compared using t-test and paired t-test.
Results: This study showed that 64/6 % were male and 36/4 were female.
The knowledge rate of the students about risk factors of the disease before
and after intervention were 16/03 2/04 and 18/02 1/44 respectively. The
mean and standard deviation of attitude score of the students also
increased from 90/16 10/6 to 96/60 10/33 after the education.
Conclusions: Findings of this research show the positive effects of
education on knowledge and attitude of the students, and providing
education and appropriate background in educational environment seems
necessary for employing effective behaviors. Keywords: AIDS, Attitude,
Education, knowledge.
P125
Level of knowledge on risks to HIV and AIDS among secondary school
students in the Kisumu District
JT Ongwara1*, Obadha Odenyo2
1
Maseno University, Private bag Siriba Maseno, Kenya; 2Institute of Tropical
Medicine, Kisumu, Kenya, Kisumu, Kenya
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P125
P127
Faculty members of Islamic Azad University of Zanjan’s knowledge
regarding AIDS and preventing it
Vida Sadeghzadeh*, Eshrat Sadeghzadeh
University Department of Nursing, Zanjan Branch, Islamic Azad University,
Zanjan, Iran
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P127
Objective(s): The objectives of the study were:
1) To assess the General knowledge and awareness among secondary
school students in Winam Division, Kisumu District on: a) Modes of
transmission of HIV and AIDS b) Signs and symptoms c) Prevention
methods against HIV and AIDS.
Design: The study design was descriptive and cross-sectional and was
carried out in the study area between September and November 2007.
Setting It covered a sample of student population of 405 drawn from 9
out of 30 schools in Winam Division. Simple random and Probability
proportional to size sampling methods were used to sample the schools
and the actual participants from each class.
Subjects or participants Students attending secondary schools in the
study area.
Results: About (99%) indicated that they had heard about AIDS compared
to only 4 (1%) who had not. Knowledge had no statistically significant
relationship with risk of HIV and AIDS. About 53.3% of the respondents
reported to have had sex with males being more likely to have an early
sexual debut. Sexual activity was higher among peri-urban respondents
(37%) who also had more than 3 sexual partners. About 71.4% of the
respondents were willing to change their behaviour to avoid contracting
HIV. On bivariate analysis, exposure to risk factors was dependent on gender
(p < 0.05), perceived risk and condom used were related (p < 0.05).
Conclusion: This study concluded that despite their high knowledge and
awareness on HIV and AIDS, not all students who were exposed to risk
perceived themselves to be at risk.
Introduction: According to UNAIDS estimates, there are now 33.3 million
people living with HIV, including 2.5 million children. During 2009 some 2.6
million people became newly infected with the virus and an estimated 1.8
million people died from AIDS. By mid 2011, 23125 people were infected
with HIV, from which, 4311 people died in Iran. The vast majority of people
with HIV and AIDS live in lower- and middle-income countries. But HIV today
is a threat to men, women and children on all continents around the world.
Since there is no vaccine for AIDS and there is no certain cure for AIDS,
curing, prevention and secondary infection is essential. This study was
conducted to determine the level of knowledge on AIDS and the way of
preventing it among faculty members of Zanjan branch, Islamic Azad
University.
Materials and methods: This descriptive study involves 90 people. Data
was collected by a questionnaire in five parts (Demographic questions,
factors related to transmission, pathology, complications, and finally
prevention of AIDS). Analysing of data was conducted by SPSS software.
Results: Findings revealed that awareness of faculty members of Islamic
Azad University of Zanjan about transmission of disease was 72.2, regarding
pathology of disease was 67.7, related to complication of disease was 73.3,
and about prevention of disease was 74.4.Finally, the level of knowledge of
faculty members of Islamic Azad University of Zanjan was higher than
moderate (average %70).
Conclusion: It can be concluded that the rate of awareness is almost
satisfactory but it is not enough and it is necessary to perform
educational programs. Key Words: AIDS, Faculty member, Knowledge,
Prevention.
P126
The effect of teaching on awareness and attitude of the students of
Zanjan Branch, Islamic Azad University, about AIDS
SeyedehSusan Raoufikelachayeh
University Department of Nursing, Zanjan Branch, Islamic Azad University,
Zanjan, Iran
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P126
P128
HIV AIDS and substance abuse primary prevention in minority
adolescents
John Wodarski*, Sam MacMaster
University of Tennessee, Knoxville, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P128
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Introduction: The research prevention project entitled “HIV/AIDS and
Substance Abuse Primary Prevention in Minority Adolescents”, funded by
the Substance Abuse and Mental Health Services Administration
(SAMHSA), targets minority male and female adolescents 12-17 years old
in the implementation and evaluation of a program designed to prevent
adolescents from engaging in substance abuse and sexual activities
which place them as risk for contracting the HIV/AIDS virus. The five-year
intervention will serve 750 adolescents and 750 parents.
Materials and methods: The program combines the effects of a program
that consists of two evidence-based primary components: 1) refusal skills
training and education for the adolescent focusing on issues relating to
sexuality and substance abuse; and 2) a family prevention educational and
skills component involving the parent(s) of the participating adolescents.
The small group educational techniques employed with the adolescent
component are based on the Teams-Games-Tournaments (TGT) Alcohol
Prevention curriculum, cited as a Model Program in SAMHSA’s National
Registry of Effective Programs and Practices (NREP) and as a Model Program
by the Office of Juvenile Justice and Delinquency Prevention, and the
Reducing the Risk (RTR) curriculum, both of which have been empirically
evaluated as effective methods of teaching adolescent skills development in
the areas of substance abuse and high-risk sexuality prevention. The parent
prevention component is based on extensive research in which problemsolving skills and communication procedures have been used effectively
with parents of adolescents.
Results: The evaluation component of the project assesses participants
(adolescents and parents) at baseline, post participation, and at 6-month
follow-up periods. Dependent variables include the adolescents’ and
parents’ knowledge of, attitudes toward, and behavior related to HIV
AIDS and substance abuse. Additionally, adolescents’ self-efficacy and
quality of peer and parental relationships are assessed. For all
participating family members, conflict and communication measures are
secured.
Conclusion: Significant differences have been shown for adolescents and
parents between baseline, post participation, and 6 month follow-up for all
dependent variables. Training manuals provide program implementation
requisites and materials to facilitate dissemination at local, state, and
international levels.
P129
Meeting the HIV prevention needs of substance using young adults in
the United States Virgin Islands
Samuel MacMaster*, John Wodarski
University of Tennessee, Nashville Tn, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P129
Introduction: The need for comprehensive HIV prevention in the United
States Virgin Islands is tremendous. HIV rates in the Carribbean region of
the world is second only to sub-Saharan Africa, and the USVI has one of
the highest rates in the United States. The primary mode of transmission in
the USVI is heterosexual contact fueled by substance using risks. The
presenation will provide an overview of a model program designed to
increase HIV testing access and reduce HIV infections.
Materials and methods: The project is a collaboration between local
entities and the Univeristy of Tennessee and Norfolk State University. The
program seeks to provide culturally appropriate early intervention, HIV
testing, and substance use services to young adults at high risk for
contracting HIV.
Results: Over the first two years of the project over 160 individuals have
participated in the project and have experienced statistically significant
improvements in HIV risk behaviors and levels of substance use.
Conclusions: The project serves as an example of culturally appropriate
interventions for high risk young adult populations.
P130
Behavioral factors associated with HCV and HIV co-infection in
residents of São Paulo, Brazil
Norma Farias*, Umbeliana Barbosa de Oliveira, Iára de Souza,
Débora Moraes Coelho, Claudia Afonso Binelli
State Secretary of Health of São Paulo, São Paulo, Brazil
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P130
Page 48 of 54
Introduction: To date, there are no surveys in Brazil on the occurrence of
co-infection hepatitis and HIV in the general population. The aim of the
present study was to investigate factors associated with HIV/HCV coinfection among residents in the State of Sao Paulo, Brazil, notified at the
National Databank of Major Causes of Morbidity.
Material and methods: We reviewed 3,032 cases of HIV/HCV coinfection among 46,969 bank records of viral hepatitis from January
2007 to March 2010. The hepatitis C cases were confirmed by the
presence of HCV RNA using reverse transcription-polymerase chain
reaction (RT-PCR) in anti-HCV-positive samples. The diagnosis of HIV/
AIDS and data on demographic and behavioral aspects were collected
through epidemiologic investigation forms. Variables associated with
HCV/HIV co-infection were identified with Poisson regression model and
confidence intervals of 95%.
Results: The majority were male (73%), white (65%) and had less than 50
years (65%). In a adjusted analysis, the prevalence ratio was 1.27 (CI
95%:1.04-1.55) for sexual contact with patients with HVB or HCV, 1.48(CI
95%: 1.27-1,73) for 3 or more sexual partners, 1.73 (CI 95%: 1.38-2.16) for
STD, 2.95 (95% CI:2.42-3.59) among IDU and 1.78(95% CI:1.49-2.17) among
inhalable drug users or crack.
Conclusions: These data show that illicit drug use is the main factor
associated with co-infection HCV / HIV in São Paulo. Sexual transmission
suggested to play a role in co-infected HCV / HIV.
P131
Effective HAART reduces the incidence of high grade cervical neoplasia
in HIV positive women
Deborah Morris-Harris1*, Charmaine Miller-Spencer1, Clara Jones2,
Song Zhang3, James Luby3
1
Parkland Health and Hospital System, HIV Services, Dallas, Texas, USA; 2Tufts
University School of Medicine, Boston, Massachusetts, USA; 3University of
Texas Southwestern Medical School, Dallas, Texas, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P131
Introduction: Highly active antiretroviral therapy (HAART) has been shown
to restore immunity and reduce the burden of Human Immunodeficiency
Virus (HIV) in patients with HIV infections. Co-infection with HIV and the
Human Papilloma Virus has been estimated to be as high as 51% in HIV
positive women. Recently effective HAART has been shown to reduce the
prevalence of HPV and intraepithelial lesions on Papanicolaou (pap) smear. It
is unclear if HIV viral suppression can reduce the incidence of high grade
cervical neoplasia .
Materials and methods: A retrospective cohort of 1090 women, in care
from 2005 through 2008, had 389 referrals to colposcopy clinic. 142 women
mean age of 31.2 (range 17-54); 66.2% Non -Hispanic black,9.9% NonHispanic white, and 23.9% Hispanic with HIV, median baseline CD4 283(IQR
87.75-508) had a colposcopy and a second procedure, either colposcopy or
excisional biopsy after a baseline abnormal Pap smear. Follow-up biopsies
were performed with a median of 11.9 months (IQR 4.4-22.5) There were no
significant baseline differences in clinical or demographic parameters
between patients who were suppressed with VL.
Results: Of 125 cases in which HAART was started before the first
colpsocopy; 26 had a normal colposcopy and 48 had CIN1. From the normal
and low grade group, 19 women developed high grade CIN (7, suppressed
and 12, not suppressed.) Effective HAART reduced the risk of CIN2-CIS on a
second biopsy by 83.2% (AHR 0.168; C.I. = 0 .057 -.498; p< 0.001) adjusted
for age at diagnosis, race, smoking and baseline CD4. Higher baseline CD4
was associated with a reduced risk of high grade neoplasia (AHR=0.996; C.I.
0.993-0.999; p
Conclusions: Reducing HIV viral load and preserving CD4 cells early in
the course of HIV and HPV co-infection decreases the incidence of high
grade cervical neoplasia.
P132
Subclinical atherosclerosis in young persons horizontally infected with
HIV-1 during infancy
Augustin Cupsa, Florentina Dumitrescu*, Dina Maria Cupsa,
Andreea Cristina Stoian, L Giubelan, Irina Niculescu, Cristina Iocu
Infectious Diseases at University of Medicine and Pharmacy From Craiova,
Craiova, Romania
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P132
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Objectives: To evaluate subclinical atherosclerosis and to identify the
cardiovascular risk (CVR) profile in young adults horizontally infected with
HIV-1 during infancy.
Methods: Retrospective randomized study carried out between 31.12.2009
and 30.06.2010 on 56 HIV infected persons(HIP) parenterally infected with
HIV-1 during 1988-1990, following ART, under surveillance of HIV/AIDS
Regional Center – Craiova. Variables followed: history and clinical data,
traditional and additional CVR factors, metabolic, immunological and
virusological parameters, inflammation markers (hs-CRP), ultrasound data
regarding carotid intima-media thickness (IMT). Twenty-six HIVseronegative young adults were assigned as control group (CG) for
metabolic parameters, hs-CRP and IMT.
Results: General characteristics of the group: average age = 20.82 ± 1.1
years, equal distribution by gender, 47 HIP (83.93%) classified as clinical
and/or immunological AIDS, 26 HIP (46.43%) with CD4>500/mm3, 40 HIP
(71.43%) with undetectable RNA-HIV when evaluated, average ART
duration = 9.09 ± 3.2 years, average number of ART regimens = 3.2 ±
1.63, 40 HIP (71.43%) experienced to protease inhibitors (PIs). In HIP – hsCRP = 2.17 mg/l, equivalent with a moderate CVR, statistically different
compared with CG (p<0.0001); IMT = 0.76 ± 0.12 mm in HIP vs 0.6 ± 0.11
mm in CG. From the traditional CVR factors dyslipidemia levels were
higher in the HIP group vs. CG (p<0.0001). In HIP, linear analysis of the
evaluated parameters identified direct correlations between hs-CRPerytrocites sedimentation rate (ESR) (p=0.04), number of ART regimens
and PIs exposure (p=0.007), IMT (p=0.000) and HIV-RNA (p=0.000) and
also between IMT – triglycerides (p=0.004), PIs exposure (p=0.004), CD8+
(p=0.0000) and HIV-RNA (p=0.001).
Conclusions: Young HIP have had an average value of hs-CRP
equivalent with a moderate CVR; the CVR profile in young seropositive
infected with HIV-1 during infancy includes elevated triglycerides, ESR,
CD8+, HIV-RNA values and long time of PIs exposure. IMT in young HIP
experienced to ART suggests a premature “aging” of the vessel by
about two decades.
P133
Positive predictive value of Interferon-gamma release assay for incident
active tuberculosis in HIV-infected persons
Susan Shin-Jung Lee*, Hsi-Hsun Lin, Hung-Chin Tsai, Yen-Yun Ni,
Yao-Shen Chen, Chi-Tai Fang
Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Province of China
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P133
Introduction: Tuberculosis (TB) is the leading cause of death in HIV/AIDS.
The incidence of active TB is 30 times higher in HIV-infected persons.
Treatment of latent TB infection (LTBI) is pivotal to the control of TB. We
aim to determine the positive predictive value of an interferon-gamma
release assay, QuantiFERON-TB GOLD test (QFT), for incident active TB in
HIV-infected persons.
Materials and methods: This prospective, 5-year, cohort study enrolled
HIV-infected adults without active TB. Demographic data, past exposure
to TB and previous TB disease, HIV risk factors, CD4 counts, and HIV viral
loads were recorded. QFT tests were done at entry. Cases of incident TB
disease were ascertained by linking to our national TB database registry.
Results: We recruited 774 HIV-infected adults, with a mean age of 36.9
years, mostly men (96.8%). HIV risk factors included intravenous drug user
(67.2%), men-who-have-sex-with-men (24.2%), and heterosexual (7.9%).
QFT was positive in 90 (11.6%,95% CI: 9.5-14.1%) and indeterminate in 31
(4.0%). On multivariate logistic regression analysis, significant risk factors
for QFT positivity included older age, females, past TB disease and
exposure to TB.
Fifteen incident active TB cases (rate: 5.19/1000 person-years 95%CI:3.138.61) occurred during a mean follow up time of 3.73 person-years, with
the majority (91.3%) followed up for over 2 years. Incident active TB
disease occurred in 5.6% (5/90) of those with a positive QFT result, 3.2%
(1/31) indeterminate results, and 1.4% with a negative QFT result
(p=0.03). Hazard ratio for developing active TB was 3.10 (95%CI:1.03-9.30,
p=0.04) for a positive QFT and 1.72 (p=0.60) for an indeterminate QFT
result.
Conclusions: Our study demonstrated that QFT test predicted incident
active TB disease in HIV-infected persons, with a hazard ratio of 3.10. QFT
can be used for diagnosis of LTBI in HIV-infected persons, to allow
targeted treatment in this high risk group.
Page 49 of 54
P134
Nocardiosis - an emerging complication in the clinical management of
HIV infected patients
Chioma Onyinye Nwuba*, Gabriel Kogo, Ngozi Ogbu, Oluwafemi Abolarin,
Robert Okonkwo
Pro-Act, Msh, Ilorin, Nigeria
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P134
Introduction: In Nigeria as well as other parts of Africa, little is known
regarding the prevalence of nocardiosis among HIV positive patients.
Nocardiosis is usually not considered in the differential diagnosis for
tuberculosis (TB) since it is not regarded as an AIDS defining illness.
The aim of this study is to determine the prevalence of nocardiosis in HIV
positive patients suspected of having tuberculosis.
Materials and methods: In this prospective study, sputum samples of
234 HIV positive patients with suspected cases of pulmonary tuberculosis
were analyzed for Mycobacterium TB and Nocardia specie. Each sample
was processed by conventional Ziehl Neelsen stain and examined for the
presence of acid fast bacilli (AFB). AFB negative samples were streaked on
slopes of Sabouraud’s dextrose agar and paraffin coated glass rods which
acted as bait for Nocardia was introduced into each of these inoculated
media and incubated at 37°C. Cultures were examined after two weeks for
the presence of cream/orange tufts around the rods suggestive of
nocardia. The isolates were scraped and further identified using
biochemical tests. The CD4 cell count of each patient was estimated using
Becton Dickenson FACS count system.
Results: Of the 234 patient samples examined, 8 had positive culture for
Nocardia. The prevalence of TB was 10.3% while that of Nocardia spp was
3.4%. All cases of nocardiosis detected was found in patients with CD4
count of <200cells/ul with 75% of these cases having CD4 count below
100cells/ul.
Out of the 8 patients diagnosed with nocardiosis in this study, 7 (7.4%)
were not receiving antiretroviral therapy (ART) while 1(0.7%) with a CD4
count of 109 cells/ul had already commenced ART. We also observed that
all 8 patients diagnosed with nocardiosis all had a negative AFB result
after producing three sputum samples for TB analysis.
Conclusions: In Nigeria where HIV-related tuberculosis occurs frequently,
some patients diagnosed as having sputum smear-negative pulmonary
tuberculosis actually have nocardiosis. It is pertinent that TB laboratories
include gram staining during routine investigations of sputum samples
especially for patients who present with typical features of active
tuberculosis but whose smears are repeatedly negative for AFB.
P135
Marginal zone lymphomas in HIV patients
Philippe Genet*, Christine Fourcade, Virginie Masse, Bouchra Wifaq,
Laurent Sutton, Dris Chaoui, Ahmad Al Jijakli, Nina Arakelian
Hématologie at Centre Hospitalier Victor Dupouy, Argenteuil, France
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P135
Incidence of Non-Hodgkin’s Lymphoma (NHL) remains high in the context
of HIV infection. High-grade NHL are the sub-types commonly seen.
Indolent lymphomas have been rarely described although several cases
of follicular or marginal zone lymphoma (MZL) have been published.
Among MZL, MALT lymphomas are predominant. We describe 3 cases of
MZL with leukemic presentation.
In our on-going cohort of 580 HIV-patients, 3 cases of MZL were identified.
The following characteristic were recorded: clinical exam, thoracoabdominal
CT-scan, cytological aspect of the peripheral blood smear, immunologic and
cytogenetic analysis.
There were 2 male and 1 female. Duration of HIV infection was 8, 13 and 18
when MZL was diagnosed. HCV serology was positive in 2 cases with pcr
negativity in one case. In all cases, MZL was diagnosed during the occurrence
of a mild hyperlymphocytosis: 5000, 6000 and 9000/mm3 respectively while
hemoglobin and platelets remained normal. All patients were received
HAART for more than 8 years and all have CD4 above 500/mm3 and viral load
under 50 copies/ml. All patients were asymptomatic without peripheral
adenopathy neither hepatosplenomegaly. On thoracoabdominal CT scan,
only infracentrimetric adenopathy were detected. On peripheral smears,
several lymphocytes with a villous aspect were detected for each patient.
Retrovirology 2012, Volume 9 Suppl 1
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In all cases, immunologic phenotype by FACS was consistent with the
diagnosis of MZL. Karyotype of the peripheral lymphocytes was normal in
one case, revealed an isochromosome 3 in the second case and showed 46,
XX, der(1)t(1;?), t(8;14;18)(q24;q32;q21) in the last case. After a follow-up of 2,
2 and 5 years, all patients are alive with a stable disease without
chemotherapy.
These data suggest that, as for non-HIV infected patients, MZL have an
indolent course in HIV patients.
P136
HIV-associated multicentric castelman disease, a report of 5 cases
Sylvie Jonckheere*, Jean-Cyr Yombi, Anne Vincent, Leila Belkhir, Dunja Wilmes,
Bernard Vandercam
Medecine Interne Infectiologie at Centre Refrence St Luc Ucl, Bruxelles,
Belgium
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P136
Introduction: Multicentric Castleman’s disease (MCD) is a rare, non-clonal
lymphoproliferative disorder characterized by constitutional symptoms,
anaemia and generalised lymphadenopathy.
Aim: The present study intends to compare demographic features,
clinical presentation, laboratory studies, imaging results as well as
treatment regimens and out- come in our MCD patients to those of
larger reported series.
Method: We reviewed the files of 930 HIV-1-infected patients from our
AIDS Reference Centre. Data was collected from the operating software
for the patients’ medical records of our institution.
Results: We report a series of five cases of MCD among our HIV/AIDS
patients’ cohort. Three were of African origin. They were diagnosed after
2003, after a mean duration of 85 months of HIV-seropositivity. All presented
with characteristic clinical features and laboratory findings (table 1), and all
but one patient were started on HAART only a few months before or upon
MCD diagnosis. Four patients were treated with chemotherapy, and one
with HAART only. One patient who was given Adriamycin/Bleomycin/
Vinblastin is in continuous remission after 6 years of follow-up. Two are
alive, with good symptom control, regardless of the treatment they
received. One recently relapsed, and one unfortunately died before
completing the intended 6-courses chemotherapy regimen.
Conclusion: MCD is a rare, but rising issue among HIV-infected patients.
The clinical and paraclinical features of our series of five patients are in
keeping with those of larger reported series. Currently, treatment is mainly
chemotherapy-based, but a wide variety of protocols have been used,
mainly because of the lack of available evidence. New approaches such as
anti-CD 20 antibodies seem highly effective, and the role of HHV-8 needs
to be further investigated, as it might be an important target for future
treatment.
P137
Study of depression and its associated factors among women living
with HIV AIDS in coastal South India
B Unnikrishnan*, V Jagannath, JT Ramapuram, S Hegde
Kasturba Medical College (Manipal University), Mangalore, India
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P137
Backgound: Depression is one of the most prevalent psychiatric diagnoses
seen in HIV-positive individuals. Women with HIV are about seven times
more likely to be depressed than those who are not infected, Depressive
symptoms in women are associated with impaired adherence to
antiretroviral therapy (ART), higher HIV plasma viral loads, higher mortality,
less social support and a worse quality of life.The study was carried out with
the objective to assess the sociodemographic and clinical correlates of
Depression among Women living with HIV/AIDS.
Method: The crossectional study was carried out in one Public and one
Private hospital in Mangalore, Coastal South India. The study subjects
included 137 HIV Positive women enrolled after obtaining written informed
consent. The data was collected using a pretested semi structured proforma
which elicited information about socio demographic variables, HIV related
Page 50 of 54
clinical and laboratory data .Depression was assessed using BDI (Becks
Depression Inventory), Lubben Social Network Scale was used to assess
social support. The data was analyzed using SPSS Version 11.5, for univariate
analysis chisquare test and t test were used and for multivariate analysis
step wise logistic regression model was used. The study was approved by
the Institutional Ethics Committee of Kasturba Medical College, Mangalore.
Results: Among 137 HIV positive women, 51% were depressed. The mean
(SD) age of the subjects was 35 (7) years. The mean (SD) CD4 count among
those with Depression was 328 (125). Majority (63%) of the subjects were
not on ART and 16% were having moderate to high risk for isolation. In
multivariate regression model, living in rural area, Widowed, Lower socio
economic status were significantly associated with depression.
Conclusion: Depression is highly prevalent among women living with HIV
and there is a need to incorporate mental health services as an integral
component of HIV care.
P138
Adverse pregnancy outcomes in HIV positive women. A study from a
District General Hospital in the UK
Priya Thayaparan*, Mohanarathi Kawsar, Thambiah Balachandran
Luton and Dunstable Hospital, Luton, UK
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P138
Background: Increasing number of women with HIV are choosing to
become pregnant as there is reduction in vertical transmission. However,
management of HIV in pregnancy still poses a variety of challenges and
adverse pregnancy outcomes are still common. We aimed to explore the
factors associated with adverse outcomes of pregnancy in our HIV cohort.
Methods: It is a retrospective case notes review of all the women attended
to our unit and had the HIV care from 2008-2011. A total of 87 women were
followed up. Three women had two pregnancies during the study period.
Data collected from Genitourinary Medicine and maternity records were
analysed by using SPSS program.
Results: Mean age was 34 yrs ranging from 20-43 yrs. Majority (91%) were
of African origin; 67% had HIV subtype C; 26% resistant to one or more
class of HIV drugs; 55% had a nadir CD4 fewer than 350; 44% diagnosed at
an antenatal setting and 62% were planned pregnancies. Prior to the
current pregnancy, these women had 121 children: 5% of the children
have HIV and 33% not tested for HIV.
None of the children born during the study period were infected with
HIV; there were 3 sets of twins; one still birth and one child died soon
after birth.
Around 46% were on anti retroviral therapy (ART) during conception, 6%
had miscarriage and 16% had emergency caesarean section.
38% of the women experienced an obstetric complication, premature
labour 9%; premature rupture of membranes and gestational diabetes
both accounted to 4% whilst 3% had post partum haemorrhage.
On ART during conception and late HIV diagnosis, nadir CD4, less than
350 cells were significantly associated (P< 0.05) with having a foetal
complication such as prematurity 8%, low birth weight 7% or having a
foetal abnormality 2.3%. More analysis is awaited as to drug exposure
and adverse outcomes.
Conclusion: Late diagnosis of HIV and ART during conception is
significantly associated with adverse outcomes of pregnancy. Widespread
HIV testing is essential and has to be extended to non traditional settings.
P139
Gastric adenocarcinoma is not an HIV related malignancy
Violet Kayamba1*, Akwi Asombang2, Mpala Mwanza1, Edford Sinkala1
1
Tropical Gastroenterology and Nutrition Group, University of Zambia School
of Medicine, Zambia; 2Washington University School of Medicine in St Louis,
Missouri, USA
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P139
Introduction: HIV infection has been shown to increase the risk of
developing some malignancies. We evaluated the possibility of an
association between gastric cancer and HIV infection in patients seen at
Retrovirology 2012, Volume 9 Suppl 1
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the University Teaching Hospital, Lusaka, Zambia. Other known risk factors
such as infection with Helicobacter pylori (H. Pylori), presence of CagA,
serum pepsinogen 1 to 2 ratios, smoking and alcohol intake were also
evaluated.
Methods: This was a prospective case-control study with cases being
patients with gastric adenocarcinoma confirmed by histopathology while
controls were patients without visible mucosal abnormality. Two controls
were enrolled for each case after matching for age and sex. The presence of
HIV and H.pylori antibodies, the virulence factor CagA and serum
pepsinogen 1 and 2 levels were determined using ELISA. Odds ratios were
calculated to determine the presence of any association. Results were
analysed using STATA 10.
Results: A total of 38 cases and 76 controls were enrolled. There was
no association between gastric cancer and HIV infection (Odds Ratio
1.41, 95% CI 0.3-6.4; P=0.73). Smoking and alcohol were found to
increase the odds of developing gastric cancer, with P values after
multivariate logistic regression of 0.04 and 0.02 and odds ratios of 3.5
and 3.1 respectively. Overall, 81% of the patients were found to be
positive for H. pylori infection, with no significant difference between
the cases and the controls (P=0.24). The presence of antibodies to CagA
was also not different between the two groups (P=0.79). Serum levels
of pepsinogen 1 were not significantly different between the two
groups (P=0.45). However, the presence of a low pepsinogen 1 to 2
ratio was more discriminating, with a higher proportion among the
cases (P=0.009).
Conclusions: No association was found between gastric cancer and HIV
infection. Alcohol and smoking increase the odds of developing gastric
cancer. Patients with gastric cancer have lower pepsinogen 1 to 2 ratios,
although there is no difference in the levels of pepsinogen 1, H.pylori
infection and CagA between gastric cancer patients and healthy controls.
P140
Treatment outcome and survival for HIV and AIDS patients coinfected
with Mycobacterium Tuberculosis in Nava Kiran Super Speciality Center
for AIDS care in Nepal
Ujjwal Baral*, Prakash Yogi, Anita Pradhan, Ramesh Pandey
National Association of People Living With Hiv and Aids in Nepal,
Kathmandu, Nepal
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P140
Topic: Treatment outcome and survival for HIV and AIDS patients
coinfected with Mycobacterium Tuberculosis in Nava Kiran Super
Speciality Center for AIDS care in Nepal.
Introduction: Tuberculosis (TB) is a frequent disease among People
Living with HIV/ AIDS (PLHAs) in Nepal.Prevalence is more than 70% and
TB is still a major killer in PLHAs and first Oppertunistic Infection (OI)
among PLHAs. We intend to assess prevalence, clinical features,
treatment outcome, resistant to first line antitubercular drugs and
survival of PLHAs with TB.
Method: A longitudinal retrospective-prospective study of clinical records
from co-infected before and after Antiretroviral Treatment (ART) with
confirmed TB diagnosis or clinical suspect was done. Sensitivity of drugs
performed in cases of Treatment failure or epidemiological issues. Treatment
success was defined as cure; poor outcome included incomplete treatment,
failure or death.
Results: 8913 patients since 2007 to 2009 admitted at Nava Kiran Super
Speciality Center, 680 clients were co-infected. TB incidence was 68.9%.
Age ranged from 16 to 61 years, 75% were under 40 years and 520
clients that is 76.47% were male. HIV infection route; intravenous drug
users 59.26%, heterosexual 28.32%, MSM 8.15%, and others were 28.32%.
Mean CD4 was 150 cells/cml. TB was first incident in 59.6%. Pulmonary
TB account 590 (86.76%) with acid fast smear positive in 87% and
extrapulmonary TB counted 90 (13.23%). Multiple Drug Resistant (MDR)
TB account 52 (8.8%) of pulmonary TB. In pulmonary TB complete cure
was obtained in 64.03% and 22.97% in MDR TB inspite of adequate
treatment. Success was high in Pulmonary TB.
Conclusion: TB is devastating situation in PLHAs of Nepal. A high
suspect, early diagnosis and documented sensitivity improve the
outcome and diminished sequel and mortality.
Page 51 of 54
P141
Depression, testosterone concentration, sexual dysfunction and
methadone use among men with hypogonadism and HIV infection
Mahmood Amini Lari*, Hosain Faramarz, Mesbah Shams, Maryam MarzbanA,
Nader Parsa
Shiraz Hiv Aids Research Center, Shiraz, Iran
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P141
Background: Hypogonadism is known to be prevalent among patients with
HIV infection. Low testosterone levels are associated with depression and
impaired sexual performance. The purpose of this study was to determine
the impact of hypogonadism on sexual function and depression among
men with HIV infection in Shiraz, Iran.
Material and methods: A total of 237 patients referred to voluntary
counseling centers were recruited based on convenience sampling. All
patients provided informed consent and completed the Beck Depression
Inventory and Brief Male Sexual Function Inventory (BMSFI) from May to
October 2009. Early morning fasting blood samples were collected to
measure free testosterone (FT) concentration.
Results: According to FT level, 67.8% of the participants had hypogonadism.
About 68% had moderate and severe depression. According to the t-test,
serum FT levels were significantly lower in patients with depression (t=1.97
& P=0.046). By univariate regression analysis the odds ratio of having a
higher depression score was 1.96 times higher in men with hypogonadism
than in eugonadal one (CI: 1.09-3.58). Methadone use was significantly
associated with FT (OR = 1.8, 95% CI: 1.01-3.21). We found a significant
inverse relationship between sexual drive, erectile and ejaculatory function
domains of BMFSI with hypogonadism. In an analysis of four subgroups we
investigated the effect of methadone and depression on BMSFI domains. An
inverse association was found in methadone non-user and non-depressed
patients were seen between hypogonadal and eugonadal men in three
domains of BMSFI. However, there was no significant association between
methadone user status and depression.
Conclusion: Depression and hypogonadism had a reciprocal effect.
Depression and methadone use were associated with hypogonadism and
had significant effects on sexual function.
P142
Intellectual quotient score comparison between HIV-infected and HIV
exposed children at the Peruvian National Institute of Child Health,
Lima Peru
Peggy C Martinez1*, Silvia M Montano2, Julio Flores3, Viviana Granados3,
Jose Rodriguez1
1
Instituto Nacional de Ciencias Neurologicas, Lima, Peru; 2U.S. Naval Medical
Research Unit-6 Lenka Kolevick; 3Instituto Nacional de Salud del Nino, Lima,
Peru
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P142
Introduction: Pediatric HIV encephalopathy includes motor and cognitive
deficits and can result in poor school performance, borderline intelligence
or mental retardation. We compared intellectual quotient (IQ) between
HIV-infected children and a group of HIV-negative children at the
National Institute of Child Health in Peru. In addition, we studied the
relationship between verbal and executive function and the clinical stage
of HIV infection (CDC classification), HIV viral load, CD4 count and other
potential risk factors.
Materials and methods: We evaluated 28 HIV-infected children and 28
HIV-uninfected children matched by age and sex. The second group was
exposed to HIV during pregnancy. Neuropsychologic testing to determine
the intellectual quotient (IQ) included the Wechsler-Revised (WPPSI-R) for
children between 3 - 7 years and 3 months, and the Wechsler Third
Edition (WISC-III) for children older than 7 years and 4 months. Clinical
records were reviewed to gather medical history, clinical and
demographic data. T-test and Pearson’s correlation (R) were used to
compare groups. IQ score was categorized as average or above average,
low average, and borderline intellectual function or below for IQ scores >
90, 80-89, < 80, respectively.
Retrovirology 2012, Volume 9 Suppl 1
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Results: The average IQ among HIV positive children was lower than the
control Group (84.6 vs. 91.7, p =0.05). This difference was driven by the
verbal sub test (81.2 vs. 90.3, p =0.05). The percentage of children with
average IQ or higher was higher among the control group (57.1%) in
comparison with the cases (32.1%); more HIV-infected children scored in
the borderline intellectual function or below range (35.7% vs. 17.9%,
respectively), but these differences were not statistically significant.
Children with advanced HIV infection had lower IQ scores and verbal
performance than children with less-advanced HIV infection, but these
differences were not statistically significant. Verbal test scores were
negatively correlated with HIV viral load (R=- 0.424, p=0.024).
Conclusions: HIV positive children show lower IQ scores in comparison
with HIV negative children. Further studies are needed to confirm our
findings.
P143
Adrenal insufficiency in patients with acquired immunodeficiency
syndrome-an underestimated problem
Deepak R Madi*, Shashidhar Khanapure, John Ramapuram,
Basavaprabhu Achappa, Sathish Rao
Manipal University, Mangalore, India
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P143
Introduction: Adrenal insufficiency is a serious complication of AIDS.
Usually the integrity of HPA (Hypothalamo pituitary) axis is assessed by
measuring cortisol response to 250μg of ACTH. Recent studies have
shown that lower ACTH dose increases the sensitivity of the procedure. In
the present study we have tried to estimate prevelance of adrenal
insufficiency using low dose ACTH test (1μg).
Primary objective: To estimate the prevelance of adrenal insufficiency in
AIDS patients using low dose ACTH test.
Research design and methods: 50 patients with confirmed diagnosis of
HIV were included in the study. History and physical examination were
recorded. Lab investigations included Cd4 count, serum cortisol and low
dose acth stimulation test. Data of patients with adrenal insufficiency
(GROUP 1) was compared with those without adrenal dysfunction
(GROUP 2). Stastical analysis was done using appropriate tests.
Results: 37/50 (74%) of study subjects had adrenal insufficiency. Basal
cortisol in (GROUP 1) and (GROUP 2) was 10.09μg/dl and 21.95μg/dl (P < .05).
Cortisol post Acth stimulation test in (GROUP 1) and (GROUP 2) was 9.49 μg/
dl and 19.93μg/dl (P < .05). Mean Cd4 count in (GROUP 1) and (GROUP 2) was
138.7±56.17 cells/μl and 171.8.7±25.41cells/μl (P < .05). Blood glucose, serum
sodium was low and serum potassium, eosinophil counts were high in
(GROUP 1) when compared to (GROUP2).
Conclusion: Adrenal insufficiency in patients with acquired
immunodeficiency syndrome is a common problem in clinical practice.
P144
Causes of death in vertically infected paediatric HIV-seropositivesKarnataka experience
Suresh Shastri*, Bharat Rewari, Pavithra Boregowda
Karnataka State Aids Prevention Society, Bangalore, India
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P144
Background: Children represent a population at higher risk of HIV-1
infection and AIDS-related death. Tuberculosis is a common cause of severe
lung disease and death in children infected with HIV, particularly those living
in areas of high tuberculosis prevalence. We investigated the causes of
death in HIV-infected paediatric patients.
Methodology: A retrospective survey conducted in 29 ART centres in
Karnataka, India. Medical records of all deaths that occurred between
January and September 2011 amongst paediatric patients were reviewed.
Immediate and underlying causes of death were described.
Results: Ninety-seven deaths occurred between January-September 2011.
55% of the deceased were males. The mean duration of survival on
antiretroviral therapy was 36 weeks. Median age at time of death was 10
years (range 1-19) median CD4 count was 210 cells/μl (7-2500); 57% had CD4
Page 52 of 54
cell count <250 cells/μl. In all, 64 causes of death were reported. In 44% (28/
64), the causes were WHO clinical stage IV AIDS-defining illness, 36% (23/64)
and 2% (1/64) were stage III and stage II conditions, respectively. Adverse
effects to anti retrovirals were noted in 6% (4/64) of patients. Multiple causes
were also reported in 6% (4/64). Other immediate causes of death were
cardio respiratory arrest (2), suicide (1) and intra-cerebral haemorrhage (1).
Infections were noted in 22% (14/64) patients. 43% (23/64) patients had
tuberculosis at the time of death. Patients dying from AIDS-related events
were more often men (17 out of 31).
Conclusion: Although antiretroviral therapy has substantially and
dramatically decreased AIDS-related opportunistic infections (OIs) and
deaths, prevention and management of OIs remain critical components
of care for HIV-infected children.
P145
Clinical, brain imaging and therapeutic evaluation of toxoplasma
encephalitis in HIV-infected patients in Yaounde
Annick Mélanie Magnerou*, V Sini, P Ongolo-zogo, JY Fonsah, AK Njamnshi,
L Kaptue
Université des Montagnes, Douala, Cameroon
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P145
Introduction: Toxoplasma encephalitis is very common in patients with
AIDS. The diagnosis is based mainly on the response to medical
treatment.
Objectives: To evaluate clinical diagnosis, CT-scan findings, therapy and
evolution of AIDS patients with toxoplasmic encephalitis.
Material and methods: It was a descriptive cohort study with a
prospective and a retrospective phase. Neurologic deficit was scored by
using the NIHSS (National Institute of Health Stroke Scale).
Results: Sixty consenting patients were recruited, the mean age was 38.7 ±
9.7 years. The F/M sex ratio was 1.6. The mean CD4 cell was 53.5 ± 42.6 /μl.
The main presenting complaints were motor deficits (65 %), seizures (40 %),
headaches (31.7 %), language and the speech disturbances (35 %). Signs of
meningeal irritation and raised intracranial pressure were found in 21 % and
10 % of the cases respectively.
The brain lesions were all heterogeneous with contrast enhancement in 80.8
% of cases. Most lesions were supratentorial in 92.3 % of cases, and
multilobar in 69.2 %of cases. Abscesses were multiple in 51.7 % of cases,
and associated with brain herniation in 61.5 % and hydrocephalus in 30.8 %.
With adequate treatment, 61.7% had complete resolution and 13.3 % of the
patients, had persistence of neurologic signs at the end of the intensive
treatment period. The neurologic deficits improved by 50 % by the 7th day
of treatment and even more by the 14th day. The most encountered
treatment options with comparable outcomes were sulfadiazinepyrimethamine in 61.7 % of the cases, followed by Trimethoprimesulfamethoxazole in 31.1 %.
Conclusion: Focal neurologic deficits of progressive onset, with or
without headache and seizures, are the signs and symptoms that alert
the suspicion of toxoplasma encephalitis in HIV-infected patients.
Adequate treatment leads to improvement in neurologic deficits from the
first week of treatment, measured with the NIHSS.
P146
Profiles of opportunistic infections in people living with HIV followed at
the Military Hospital of Kinshasa Reference (Camp Kokolo), DRC
NE Kamangu*, NH Situakibanza, LG Mvumbi, IL Kakudj, TD Tshienda, TG MESIA
Université de Kinshasa, Kinshasa, Congo
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P146
Introduction: In the Democratic Republic of Congo (DRC), Opportunistic
Infections (OI) are still a major problem in the care of People Living with
HIV (PLHIV). Through the military medical program, few data are available
regarding the treatment and prevention of OI. Because of their high
mobility and the environment in which they live, the security forces may
be considered a population at risk. This study aims to determine the
profile of opportunistic infections encountered in PLHIV supported the
Military Hospital of Kinshasa Reference (Camp Kokolo / DRC).
Retrovirology 2012, Volume 9 Suppl 1
http://www.retrovirology.com/supplements/9/S1
Methodology: This study was conducted at the Military Hospital of
Kinshasa Reference (HMRK). It is a literature review that focused on issues
of HIV adult patients 18 years followed in the course of January 1st to
December 31st 2010. The elements of interest were: age, sex, infections
diagnosed. Records that did not contain all of these data were not
included.
Results: Tuberculosis (43.2%), candidacies (oral (16.7%), vaginal (2.3%)
and esophagus (1.5%)) prurigo (15.9%), pneumonia (11, 4%), malaria
(10.6%), herpes zoster (9.8%), isosporiasis (5.3%), condyloma (3.8%) and
salmonella (3.8%) infections were found in patients with HIV attending
HMRK.
Conclusion and recommendations: Tuberculosis, oral candidacies,
prurigo, pneumonia and malaria are the opportunistic infections found in
these patients. We believe it is necessary to systematize the search for
co-association of tuberculosis in any PLHIV.
P147
Disparities in the prevalence of AIDS related opportunistic infections in
Nigeria- implications for initiating prophylaxis based on absolute CD4
Count
Chioma Onyinye Nwuba*, Robert Okonkwo, Oluwafemi Abolarin, Ngozi Ogbu,
Pauline Modebelu
Pro-Act Msh, Ilorin, Nigeria
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P147
Page 53 of 54
Introduction: Coinfection with viral hepatitis (VH) and some opportunistic
infections (OI) can decrease HIV-infected patients’ survival. The purpose of
this study was evaluation of humoral immunity factors in the commonest
concomitant and OI.
Materials and methods: 110 HIV-infected patients were involved in the
study. Among them 76% had candidiasis, 74% VH, 23% HSV-infection.
Determination of IgG, IgM, and IgA was performed by immune turbidimetry
method by using Human test kits, Germany. Statistic analyses were
performed by parametric and non-parametric procedures for paired samples
T-test.
Results: There was no significant difference in serum IgG levels
between overall study population and individual patient groups. The
most significant difference in IgM concentrations was found in the
group with HSV. Thus, IgM level in patients with HSV was significantly
lower in comparison with group without HSV (p=0.014) as well as with
patients with both HSV and VH (p=0.029). IgA level was higher in
patients without candidiasis (p=0.022) in comparison with general study
population. With purpose to clarifying the degree of intra-group
heterogeneity in Ig parameters patient were additionally divided into
subgroups. It was revealed that IgG concentration in patients with oral
candidiasis (1663±59 mg/dl, n=32) was different from that in the
patients with not only oral candidiasis, but other localizations (1945±89
mg/dl, n=48, p=0.05). It is important to mention that higher IgM и IgG
were enrolled in VH with moderate and high activity of ALT and AST.
Figure 1
Conclusions: Difference in humoral immunity disorders in HIV-infection
depend on certain associated infections as well as on their severity.
Introduction: The differences that exist between the CD4 count strata at
which certain opportunistic infections occur in sub Saharan Africa suggest
that targeting prophylaxis at HIV patients in this part of the world based
on data generated from developed countries may be one of the reasons
why there is high HIV-related morbidity in Africa.
The aim of this study was to investigate the changing incidence of some
AIDS defining illnesses in Northern and Southern parts of Nigeria, relating
them to different CD4 count strata.
Materials and methods: In this study, sputum samples of 234 HIV
positive patients were analyzed for Mycobacterium tuberculosis and
Pneumocystis jiroveci while 202 stool samples of HIV patients were
analyzed for the presence of opportunistic intestinal parasites. We
considered five CD4 strata (0 to 99, 100 to 199, 200 to 399, 400 to 499
and > 500 cells/μL). Incidence of the various opportunistic infections and
their occurrence within each CD4 strata were estimated using simple
statistical method. CD4 count of each patient was estimated using the
Becton Dickenson FACSCount system.
Results: The prevalence of Mycobacterium tuberculosis, Pneumocystis
jirovecii, Cryptosporidium parvum, Isospora belli and Cyclospora spp were
10.3%, 41.9%, 30.8%, 24.2% and 4.4% respectively. All the opportunistic
infections occurred at higher rates in CD4 counts less than 200cells/ul (p
< 0.0001) except for tuberculosis which occurred highest at CD4 counts
>200cells/ul (16 out of the 24 positive sputum smears were recovered in
patients with CD4 counts >200 cells/ul). Despite pronounced
immunosuppression, P. jiroveci was not detected in sputum samples of
8% patients with CD4 count <200 cells/ul.
Opportunistic parasites occurred almost exclusively at CD4 count <200
cells/ul. However, 6.4% of these parasites were isolated in patients with
CD4 >200 cells/ul. Cryptosporidium parvum (30.8%) was the most
frequently encountered opportunistic parasite, followed by Isospora belli
(24.2%) and Cyclospora specie (4.4%).
Conclusions: Although HIV related opportunistic infections are often
reported to occur exclusively at CD4 count <200 cells/ul in patients; the
result of this study shows that disparities exist and so, the possibility of
opportunistic pathogens must remain in the differential diagnosis of
infections in HIV patients independent of absolute CD4 count.
P148
Immunoglobulins concentration in HIV-infected patients’ with viral
hepatitis, candidiasis and herpes simplex viral infection
Narina Sargsyants*, Tigran Davtyan
Armenicum Clinical Center, Yerevan, Armenia
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P148
Figure 1(abstract P148)
Retrovirology 2012, Volume 9 Suppl 1
http://www.retrovirology.com/supplements/9/S1
P149
Clinical, diagnostic and Cryptococcosis neuroméningées evolutionary
aspects in HIV infection
Rais Mounira*, Amel Ouyahia, Abedelkader Gasmi, Wahiba Guenifi,
Houda Boukhrissa, Abdelmadjid Lacheheb
Maladies Infectieuses at Chu Setif Algerie, Setif, Algeria
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P149
Context: Cryptococcosis is a deep Mycosis of reserved in AIDS prognosis
Goal. The objective of our study is to analyze the characteristics of
clinical, diagnostic and scalable of the NJC in the PVIH.
Materials and methods: Descriptive and retrospective study conducted
from medical records of positive HIV patients hospitalized for neurological
disorders of 2000-2009 in the service of infectious diseases CHU of Sétif.
Results: In 12 patients hospitalized for neurological disorders, four cases of
meningitis, cryptococcal (02 men and 02 women) have been diagnosed.
The average age of our patients is 45 years; the HIV contamination was
sexual in 100% cases. The NJC was the fact of discovery of the HIV
infection in 01 case. All our patients had clinical events ranking stage C,
CD4 performed in all patients were < 100/mm3. The clinical presentation
was variable and the clinical signs most frequently encountered were
headache, neck stiffness, the alteration of consciousness, fever and the
seizures. Examination of CSF to the ink was contributing to the diagnosis
in all cases. The culture of CSF made all our patients was positive. The total
lymphocyte count showed lymphopenia with an average number of
lymphocytes à 800 /mm 3 . Cases of co-infection were recorded (with
Mycobacterium tuberculosis in 1 patient, and pneumocystis jirovecii in
another) Amphotericin B (0, 7 mg/kg/day) monotherapy was used in all
patients in first intention with relay by fluconazole, or in addition to
treatment, or for drug intolerance. The evolution of the NJC has been
marked by the death of 04 patients.
P150
Toxoplasma encephalitis among AIDS patients in a tertiary care
hospital in Mangalore, India
Anand Venugopal*, Basavaprabhu Achappa Unnikrishnan, B Deepak Madi,
Vishak Surendra, John T Ramapuram
Kasturba Medical College, Mangalore, India
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P150
Background: Toxoplasmosis associated with HIV infection is caused by
reactivation of a chronic infection and manifests primarily as toxoplasmic
encephalitis. This study was done to determine clinical presentations and
outcomes of CNS toxoplasmosis and to find out their association with CD4
counts at time of diagnosis and initiation of ART.
Materials and methods: Retrospective study done by reviewing medical
records of HIV-positiveS diagnosed with toxoplasmosis from Jan 2000 to Dec
2010. Diagnosis was based on clinical features, demonstration of elevated
IgG by ELISA and associated CT findings. Data obtained was correlated with
CD4 count and whether or not patient was on ART. Analysis was done using
SPSS version 11.5.
Results: 2826 HIV positives attended Infections Disease Cell from 2000 –
2010, of which 33 (1.12%) had CNS Toxoplasmosis. Among 33 cases, 29
were males (88%) and 4 females (12%). Mean age was 37.33 yrs. 10 cases
(30.3%) had CNS toxoplasmosis as the initial manifestation of HIV. Most
common clinical presentations were fever(58%) and headache (52%).
Mean CD4 at diagnosis of toxoplasmosis was 160.6. Mean level of IgG
Page 54 of 54
was 255.69. CT / MRI finding of ring enhancing lesion or cerebritis was
seen in 79 % of the cases with 18% of lesions in both basal ganglia and
parietal lobes. Cerebritis was most common lesion in CT/MRI, seen in 16
cases while ring enhancing lesions were seen in 10 cases. 82% improved
with treatment and 18% expired.
Conclusions: The possibility of cerebral toxoplasmosis should be
considered in every HIV-positive patient with neurological symptoms. In
our study, Toxoplasmosis occured at CD4 levels >150, which should
warrant prophylaxis for Toxoplasmosis at higher CD4 count. Parietal lobe
lesions were common in our study, contrary to other existing data which
say toxoplasma lesions are usually midline lesions.
P151
Prevalence of ulcer forming STIs among HIV-positive women clinic
attendees in two Nigerian hospitals
Victoria Awolade*, Fajuyi Cantonment, Odogbo Ibadan, Onogbogi Olarewaju,
UCH Ibadan
Health Initiatives for Safety and Stability in Africa, Ibadan, Nigeria
E-mail: [email protected]
Retrovirology 2012, 9(Suppl 1):P151
Background: The presence of an untreated STI also increases the risk of
both acquisition and transmission of HIV by a factor of up to 10. Human
Immunodeficiency Virus (HIV) is one of the most common and most
dreaded Sexually Transmitted Infection (STI) worldwide. In order to
reduce the prevalence of HIV/AIDS infection and subsequently reduce
morbidity and mortality among adolescent women, there is need for
proper exploration of the relationship between STIs and HIV infection.
This study however sought to determine the association between ulcerforming locally endemic STIs and HIV infection.
Methods: A seven year retrospective review of 300 case notes of female
patients attending the STI clinics of two Nigerian hospitals was done.
Those with ulcer-forming sexually transmitted infections were then
reviewed to determine age at sexual debut, number of sexual partners
and overall sexual behavioural pattern. The results of laboratory tests
taken by the patients were also reviewed. Data was analyzed with the
use of the SPSS data editor. Chi square tests (95% confidence) were used
to determine whether the level of association observed was of statistical
significance.
Results: Fifty-two patients had been treated for ulcerative STIs (17.3%).
The mean age at sexual debut was 16.7±1.3years. Thirty - one cases
(59.6%) of those confirmed by laboratory tests to have ulcerative STIs
were also found to be HIV+. Patients that had 3 sexual partners or more
had the highest incidence of STIs and HIV (23.6%). Syphilis was the
highest reported ulcerative STI 28.8% followed by Chancroid 21.1%. There
is a significant association between ulcer-forming STIs and HIV infection
(p=0.01).
Conclusions: Ulcer producing STIs are associated with HIV infection. An
aggressive management of STIs and a more effective contact tracing is
needed to reduce new infections of HIV and transmission especially in
women.
Cite abstracts in this supplement using the relevant abstract number,
e.g.: Awolade et al.: Prevalence of ulcer forming STIs among HIV-positive
women clinic attendees in two Nigerian hospitals. Retrovirology 2012, 9
(Suppl 1):P151