• Poster 677: Weekly Treatment for Prophylaxis of Candida Vaginitis (Authored by A. Williams, C. Yu, K. Tashima, J. Burgess, K. Danvers, and J. Winfrey. Yale Univ., New Haven, CT; and Brown Univ., Providence, RI)
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• Poster 682: Causes and Rates of Death among HIV-Infected Women 1993-1998: The Contribution of Illicit Drug Use and Suboptimal HAART Use (Authored by D.K. Smith, R. Phelps, M. Hamburger, C. Carpenter, R.S. Klein, D. Vlahov, P. Schuman, and S.D. Holmberg. CDC, Atlanta, GA; Brown Univ., Providence, RI; Montefiore Med. Ctr., Bronx, NY; Johns Hopkins Univ., Baltimore, MD; and Wayne State Univ., Detroit, MI)
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Poster 677: Weekly Treatment for Prophylaxis of Candida Vaginitis

This randomized, placebo-controlled trial of weekly intravaginal clotrimazole 100-mg tablets or lactobacillus acidophilus gelatin capsules demonstrated the benefit of both regimens for the prevention of candida vaginitis. 164 women were enrolled and followed for a median of 34 months. Both treatments reduced the incidence of candida vaginitis by about one-half (relative risk: 0.4 clotrimazole, 0.5 lactobacillus).

This study demonstrates the benefit of local prophylaxis for this common infection. Previous studies have demonstrated the benefit of systemic therapy, but in the age of multidrug therapy, topical therapy is preferable -- due to the risk of drug interactions and increasing pill burden associated with antiretroviral regimens.

Poster 682: Causes and Rates of Death among HIV-Infected Women 1993-1998: The Contribution of Illicit Drug Use and Suboptimal HAART Use

The HERS study followed 871 HIV infected women and 14 seroconverters from April 1993 to December 1998. This study looked at causes of death, as ascertained by the National Death Index and other local sources. During this time, 196 deaths occurred and 44% were due to non-HIV associated causes. Of these, one third were associated with drug use (overdose 7%, hepatitis 2%, endocarditis/sepsis 5%). It is notable that the availability of HAART made no impact on death rate in this population, with only 24% of women taking HAART regimens in 1998. Factors associated with death were no HAART, bDNA viral load >10,000 c/ml, and CD4+ cell count <200 cells/µl, public rather than private insurance, and no PCP prophylaxis.

It is tragic that the benefits of HAART on decreased mortality were not seen in this cohort of women. Clearly, additional efforts must be made to understand the reasons that women took HAART at such low frequencies, and to target appropriate interventions to address these issues. Drug use is a significant factor influencing all-cause mortality and must be addressed simultaneously with HIV treatment in order to improve overall outcome.