• Poster 297: Gender and Neurological Functioning in HIV Infection (Authored by K. Robertson, B. Vaughn, C. Kapoor, W. Robertson, J. Kalkowski, S. Fiscus, R. Helms, and C. Hall. Univ. of North Carolina, Chapel Hill)
  Click here to view the original abstract

• Poster 298: Feasibility Study of the Disease Management Assistance System: A Potential Adherence Enhancement Device (Authored by A. Andrade, A. Wu, O. Selnes, C. Hill, A. Letzt, R. Seifert, D. Kaseman, W. Myers, J. Lefkowitz, J.C. McArthur. The Johns Hopkins Univ., Baltimore, MD, and Adherence Technologies Corp., Burke, VA)
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• Poster 299: Clinical and Virological Correlates of Longer Survival in AIDS-Associated Progressive Multifocal Leukoencephalopathy (Authored by A. De Luca, M.L. Giancola, A. Ammassari, S. Grisetti, M.G. Paglia, M. Gentile, A. Cingolani, R. Murri, A. D'arminio Monforte, and A. Antinori. Clin. Malattie Infettive, Univ. Cattolica, IRCCS "L. Spallanzani," Roma, and Malattie Infettive e Tropicali, Univ. di Milano, Italy)
  Click here to view the original abstract

Poster 297: Gender and Neurological Functioning in HIV Infection

This is a long-term ongoing study of neurologic function in HIV-positive men and women, with a comparison group of HIV negative women. Subjects are studied by physical examination and neurophysiologic tests at baseline and yearly. Essentially, the study showed that both HIV-positive men and women had somewhat poorer functioning than their HIV-negative female counterparts at baseline.

Baseline plasma and CSF viral loads were equivalent in men and women, but the males had a statistically significant decline in plasma viral load after one year compared to HIV-positive women. Also, there was an improvement in the males' neurologic score. This may be explained by a tendency toward greater antiretroviral use in men as compared to women. Overall, very little difference was seen in neurologic functioning at one year between HIV-positive men and women. These results need to be followed out over time.

Poster 298: Feasibility Study of the Disease Management Assistance System: A Potential Adherence Enhancement Device

Adherence to often-complicated antiretroviral therapy is perhaps the most important factor in overall success. Failing to remember to take drugs is one factor, which one might guess would be even more likely in the setting of HIV-associated dementia. Any system that can reliably and cost-effectively increase adherence would be welcome by many. The authors conducted an eight-week pilot study to test the feasibility of an electronic device that provides a verbal reminder to take medications. They enrolled 25 patients, four of whom were identified as having moderate dementia. Half of the patients were male, 80% were African-American, and the mean educational level was 12th grade. Adherence scores (AS) ranged from 73-100% in the first two weeks, and 0-100% in the last two weeks. In those with AS >96%, two had dementia, five had depression, and one was hospitalized. Only hospitalization seemed to be a significant risk factor for non-adherence, as two of the four patients with dementia had AS >95% during most of the study. The system was well accepted by the vast majority of subjects, and a larger trial is planned.

Poster 299: Clinical and Virological Correlates of Longer Survival in AIDS-Associated Progressive Multifocal Leukoencephalopathy

PML is a devastating and usually fatal neurologic disease, which can be seen in persons with AIDS. The optimal therapy is unknown. Patients are sometimes offered chemotherapy, which seems to help in some cases. The JC virus is the likely cause of PML in immunocompromised patients. This study examined characteristics of 56 patients seen at three tertiary care centers, to determine correlates of better outcome. Patients were stratified by treatment with HAART or mono/bi-drug therapy plus or minus one of two other chemotherapeutic regimens. Mean survival was 75 days (400 days if HAART used). The following correlated with longer survival:

1. JC virus DNA (viral load) in CSF of three log or less.

2. Undetectable JC virus DNA at follow-up in two months.

3. No progression during the first two months.

4. Use of HAART (not just one or two drugs) before and after diagnosis.

Survival was most strongly influenced by the use of HAART, which probably helps to control the JC virus in the CNS by increasing inherent immune capabilities. It didn't correlate directly with CD4+ count, or HIV viral load in the CNS or plasma at baseline or follow-up.