Final Program and Oral Abstracts [International Conference on AIDS (8th: 1992: Amsterdam, Netherlands)]

TRACK B: CLINICAL SCIENCE AND CARE

TuB 0510-TuB 0515

Tu B 0510 mEV ATIN OF CIMNCAL AND IABORATORY
S OF c ICITIS IN S PATINS IN MAIAI. Dallabetta Gina*,
Miotti P*, Liomba G**, Chlphangwi J***, Wangel AMW,Nyirenda M**,
Saah A*, Meyers L*, Graham N*; *Johns Hopkins University,Baltimore,
U.S.A., **Ministry of Health, Malawi, ***Malawi Medical School,
Blantyre.
OBJECTIVE: to establish the diagnostic utility of cervical friability (CX FRIAB) and
cervical discharge (CX DIS) on physical exam and leukocyte esterase dipstick (LED)
for cervicitis caused by N.gonorrhoeae (GC) or C.trachomatis (CT) in an STD clinic.
METHODS: 505 consecutive women presenting to an STD clinic had a pelvic exam; women
were assessed for presence of endo-cervical discharge (after removal of ectocervical
discharge), for cervical friability (bleeding with the first endocervical swab), and
for genital ulcers (GUD). Cervical samples were obtained for GC culture, CT ELISA
and LED, vaginal fluid for wet mounts, and blood for syphilis serology.
RESULTS: the prevalence of STD in these women was: GC 14%, trichomonas 26%, CT 5%
(175 women only), syphilis 25%, and GUD 6%. The sensitivity (SENS), specificity
(SPEC) and positive predictive value (PPV) of markers for cervicitis was as follows:
POS GC (N-505) POS GC or CT (N-175)
SENS SPEC PPV SENS SPEC PPV
LED.49.70.21.48.76.27
CX FRIAB.14.90.19.15.90.22
CX DIS.01.99.33 - -
The performance characteristics of LED remained unchanged when stratified by
presence or absence of inflammatory vaginitis (trichomonas or yeast on wet mount)
CONCLUSION: LED was only able to identify about one half the women with GC or CT,
but had a much higher sensitivity than the classic clinical indicators of
cervicitis. LED may be useful for detection of cervicitis in peripheral settings
where other diagnostic tests are unavailable. LED should be evaluated in an
algorithmic approach to the diagnosis of lower genital tract infections in women.
Dr. Gina Dallabetta, c/o The Johns Hopkins University,
624 N. Broadway, Room 894, Baltimore, Maryland, 21205, U.S.A.
Phone: [phone], FAX: [phone].
TuB 051 2 Early Detection of HIV-1 Infection in Infants of
Seropositive Mothers by Acid Dissociated HIV p24 Antigen. Miles, Steven A.*, Baldwin,
E.*, Magpantay*, L., Wei, L.*, Stiehm, R.*,Toedter, G.**, Hofheinz, D.**, Bryson, Y.*
*UCLA CARE Center, Los Angeles, CA and Coulter Immunology, Hialeah, FL, USA
Objectives: Early identification of HIV-1 infection in infants born to seropositive mothers is important. We
evaluated a rapid, simple serologic assay for its ability to correctly identify HIV infection in this population.
Methods: Coulter HIV p24 antigen assay was performed with glycine-HCI dissociation and tris-buffer
neutralization (ICD prep). We examined 99 plasma samples from 31 HIV seropositive mother-infant pairs (31 infant
cord bloods, 28 mothers with samples close to delivery). Additional neonatal and early childhood samples were tested
and correlated with infection outcome in the infant. Samples (n=72) from a separate well studied cohort of HIV infected
and uninfected children were assayed for sensitivity and specificity.
Results: The cord blood plasma ICD p24 antigen correctly identified 5 of 9 children as infected and 21 of 22 children as
uninfected. The relative risk (RR) for HIV infection of a positive ICD p24 Ag was 4.28 (p=0.005). One infant had a
positive cord blood sample but all subsequent samples from that infant were negative. In the HIV infected infants with an
initial negative ICD p24 antigen in cord blood, 3/3 were positive on follow-up at 2 weeks and 4 months of age. A
diagnostic strategy of using a cord blood sample with confirmation by an early follow-up sample from the infant
correctly identified the infection status of all the children tested. All of the non HIV-infected control cord blood samples
(n=6) and children samples (n=35) were negative. Using a cut off value of 0.110 (O.D. units), the overall sensitivity
was 80.5% and specificity was 97% in these samples. Discordant mother-infant results suggest that cord blood HIV ICD
ag was not necessarily a result of passive transfer. Moreover, HIV ICD p24 antigen positive mothers (n=9) were at an
increased risk for transmission of HIV to their infants (5/9 (55%) for ICD ( versus 4/15 (27%) for ICD e, RR=2.5).
Conclusions: HIV ICD p24 antigen is a rapid, simple, reproducible assay that may be of value in the diagnosis of
HIV infection early in life in infants born to HIV infected mothers. It may also be of use in predicting mothers at higher
risk of transmission to their infants and may have implications about the timing of infection (intrauterine vs.
intrapartum).
Miles, Steven, UCLA CARE Center, BH412C CHS Code:179320, Los Angeles, CA 90024 -1793, USA, Telephone [phone], Fax: [phone].
TuB 0514 EFFICACY AND TOLERANCE OF ZIDOVDINE (AZT) IN HIV1 INFECTED CHILDREN:
THE ITALIAN MULTICENTER STUDY
Castelli G.,Benaglia G,Campelli A,Caselli D,Chiodo F,Duee M, Elia L,
Fundar6 C,Giaquinto C,Guzzanti E,Ippolito G,Loy A,Plebani A,Principi N
Stegagno M,Timpano C,Zuccotti G and italian pediatric AZT trials group
OBJECTIVE: A nationwide programme has been set up to investigate the tolerance and the
efficacy of long term oral AZT administration in HIV infected children.
METHODS:In 45 centers partecipating in the programme 272 patients (2 mths to 14 years)
with symptomatic HIV infection (CDC-P2) have been enrolled in an open phase II trial.
RESULTS: Up to now we evaluated 201 children (101 M, 100 F) with vertically
transmitted HIV infection, treated with oral AZT (dosages from 300 to 720 mg/mq). The
mean age was 35 months (range 2-93),and the mean time of treatment was 47 weeks (range
4-116). At entry 84 were AIDS. Out of the 16 patients that died, 14 were AIDS at
entry. Kaplan-Meier survival analysis performed for AIDS patients at the time of
diagnosis was 96% and 88% at week 24 and 52. During the first 6 months all the
children gained weight, particularly those with a base line defect, but weight recover
disappeared in the third semester. A significant reduction of infectious episodes was
observed in the second quarter of therapy. Levels of IgG, elevated at enrollment in
88% of patients, show a progressive decrease. Mean levels of CD4+ cells increase after
three months maintaining higher levels for the next 6 months. 100/142 (709) children
had p24 antigenemia at entry, 15% became negative at 12 weeks and 30% was negative at
24 and 48 weeks.Out of the 42 negative children 10% became positive. Tolerance: The
major adverse effects were haematological abnormalities: 19% had a decline in Hb to <8
g/dl; neutropenia(GN <750 cell/mm3) was observed in 12%. Haematological toxicity was
significantly higher in patients with AIDS at entry (p<0.01).Basal dosage
modifications were necessary in 45/53 (85%) and permanent suspension in 2 patients.
Possible clinical adverse effects occurred in 10%.
CONCLUSION: Children treated with AZT showed beneficial effects using as markers survi
val,growth, immunological function and p24 antigen.Matched controls are not available
for comparison, but the survival of children appears to be higher than expected.Anemia
and neutropenia were the most common laboratory adverse effects noted and seem to be
more frequent in the late stages of infection, as well as been dosage independent.
Castelli Gattinara Guido - Ospedale Bambino Gese I.R.C.C.S.
P.S. Onofrio 4 00165 Roma - ITALY - FAX. [phone] TEL.[phone]

Tu B 0511 355 VIRAL CULTURES AND ANTIGENEMIA FOR THE DIAGNOSIS OF HIV INFECTION
IN NEWBORN: A THREE YEARS EXPERIENCE.
M. Burgard*, C. Rouzioux*, S. Blanche*, M.. Mayaux**, C. Griscelli* and the French
Collaborative Study Group on HIV infection in newborns. *H6pital Necker-Enfants Malades,
Paris, ** Hopital Bicetre, le Kremlin-Bictre, France.
Objectives: To assess the diagnostic value of viral culture and antigenemia in neonates included in the French Pediatric
Prospective Study since 1988.
Patients: From April 1988 to August 1991, 355 samples from neonates born to HIV-1 mothers were tested in the
Virology's Laboratory of Htpital Necker, 145 infants had a second specimen before the age of 3 months. Among these
355, the number of infected children is estimated at 66 children (from a transmission rate of 18.8 % in this study); 197
children are now older than 18 months of age.
Methods: Lymphocytes coculture were performed in real time on fresh sample. Viral replication was detected by using a
p24 Ag assay (ABBOTT Laboratories) on supernatants (after high speed centrifugation) and on plasma.
Results:
Sensitivity before
Sensitivity at birth 3monthsofage
355 NEONATES Viral culture 38% 77%
Antigen 11% 32% _
Specificity
197 children Viral culture 43% 68% 100%
> 18 months
Antigen 16% 25% 100%
For the 355 children, the sensitivity was calculated using the transmission rate. For 197 children > 18 mpis, the sensitivity
at 3 months of age is minimal since only 24 of the 44 infected children have been tested twice (22 were positive).
Conclusions: This technique is easy to perform in routine for large series. The sensitivity of 43 1 at birth may be
explained by a low viral load (while the same technique had a sensitivity at 95 % for adults and older'infected children).
These results rise the question of the timing of viral transmission from mother to child.
BURGARD, Marianne, Laboratoire de Virologie, Hopital Necker-Enfants Lialades, 149 rue de
S6vres, 75015 Paris (France).
Telephone: (33.1.) 42.73.88.41, FAX: (33.1.) 42.73.88.44
TuB 0513 MEASLES VACCINE RESPONSE AND CLINICAL MEASLES IN HIV-INFECTED
CHILDREN. Hovt, Laura; Palumbo, P.; Demasio, K.; Oleske, J.; and Connor, E.
Department of Pediatrics, UMD-New Jersey Medical School and Children's Hospital of New
Jersey, Newark, New Jersey, USA.
Objectives: To describe measles serostatus, vaccine responsiveness and the course of measles infection in a cohort
of HIV-Infected children during an epidemic in Newark, New Jersey 1990-91.
Methods: Medical records of HIV-infected children followed at the Children's Hospital AIDS Program were reviewed
to obtain results of measles serology, details of measles immunization & cases of clinical measles during 1990-1991.
Results: As of June 1991, 146 children were identified who had measles serology performed at least once; 94 of
whom had documentation of immunization (IM) with MMR during 1990-91. For 51/94, measles serology was
available which permitted analysis of vaccine response. Of these, 13 children (26%) responded to IM and were
measles immune (EIA OD >1.0), while 35 (69%) failed to respond (3 children had equivocal responses). Absolute
CD4 counts for responders (mean 865 cells/mm3) and non-responders (mean 348 cells/mm3) were significantly
different (p=0.0022). Ninety percent of children with CD4 counts <200 cells/mm3 failed to respond to IM while 54%
with CD4 counts >200 responded. There were no significant differences between groups with respect to age, total
IgG, or antiretroviral Rx. During the 1990-91 epidemic, 6 HIV-infected children were documented to revert from
measles-immune to measles-susceptible status and 6 cases of clinical measles were identified. Three of the latter
patients died of measles pneumonia, representing all the measles-associated deaths in HIV-infected children in NJ
during this period. Four had received MMR prior to clinical measles, and 3 had documented protective measles
antibodies 2-12 months prior to the onset of clinical illness. None of the children with measles was receiving monthly
intravenous immunoglobulin (IVIG). Two received intramuscular gammaglobulin within 72 hrs of measles exposure.
Four received IV ribavirin as acute treatment.
Conclusions: Measles represents a significant threat to HIV-infected children. Many such children do not develop
protective levels of measles antibodies following IM and some patients may lose protective antibodies over time.
While children with CD4 counts <200 infrequently responded to IM, significant numbers of non-responders also
occurred in patient with higher CD4 counts. Since measles in HIV-infected children is associated with high mortality
and response to IM is unpredictable, measles serostatus should be carefully and repeatedly monitored. Protection
of susceptible children with IM and/or monthly IVIG during periods of risk is indicated. Studies to evaluate the role
of ribavirin and other agents in preventive and therapeutic regimens are necessary.
Laura Hoyt, MD
Children's Hospital of New Jersey, CHAP
15 South 9th Street Newark, New Jersey 07107 USA
[phone] Fax [phone]
TuB 0515 CLINICAL DESCRIPTION OF 650 CHILDREN WITH AIDS
IN CONSTANTA- ROMANIA
Matusa. Rodica*; Ilie, M.** *,** Spitalul
Municipal, Constanta, Romania
Objective: to describe the epidemiologic and clinical features
between 2 month and 5 years old of 650 cases of paediatric
AIDS identified in Constanta district in Roumania since
September 1989.
Methods: because of the lack of opportunistic infectious
diagnosis with exception of TB, it was found better to use a
modified version of the WHO clinical definition with both
clinical and serological evidence of HIV infection.
Result: 50% of these children were infected by blood
transfusions, 35% seem to be infected by IM injections and
only 15% by materno-foetal transmission. The most frequent
and severe pathologies are pulmonary (86%), neurological
(23%), severe diarrhea (18%) and skin lesions (90%). 5% of
these children presented mycobacterium infections and 26%
have hepatitis B infection. Among these 650 children 250 are
dead.
Conclusions: Poorly sterilized equipment can clearly be
responsible for the spread of HIV. Main route of transmission
was through blood transfusions so in future great HIV
problems will be in adults.
Matusa, Rodica, Spitalul Municipal Constanta,
str. Stefan cel Mare 133, Constanta, Romania
Telephone: [phone], Fax: [phone]

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