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

THURSDAY, 23 JULY 1992

ThC 1520-ThC 1524

ThC 1520 RISK FACTORS FOR VERTICAL TRANSMISSION OF HIV-1
INFECTION. M.L. Newell for the European Collaborative
Study, Institute of Child Health, London, UK.
Objectives: to determine maternal factors influencing the rate of
vertical transmission
Methods: In 19 European centres children born to women known to be
HIV-infected before the time of delivery were followed prospectively
from birth, using a standard protocol. Information was collected on
both mothers and children.
Results: The rate of vertical transmission, based on 721 children of
701 mothers, was 14.4% (95% confidence interval 12-17%). There was no
trend over time, nor was there significant variation between centres.
Transmission was associated with maternal p24-antigenaemia and a CD4
count of less than 700 per mm. Transmission was also associated with
breastfeeding (odds=2.25, 95% CI 0.97-5.23), delivery before 34 weeks
gestation (odds=3.8, 95% CI 1.62-8.91). Transmission was higher in
vaginal deliveries in which scalp electrodes, episiotomy, forceps or
vacuum extractors were used, but only in those centres where these
procedures were not routine. There was a suggestion that the rate of
transmission was lower in children delivered by caesarian section.
Conclusion: Women who are p24-antigenaemic or who have a low CD4 count
are at an increased risk of transmission. The higher infection rate in
children born before 34 weeks gestation could reflect inadequate
immunity at that age and substantial transmission during labour or
delivery. The balance of evidence now suggests that breastfeeding is
an important route of transmission.
M.L. Newell, Epidemiology & Biostatistics Unit,
Institute of Child Health, 30 Guilford St., London
WC1N 1EH, UK. Tel. [phone] Fax. [phone]
ThC 1522 PREVENTION OF MATERNAL-INFANT HIV-TRANSMISSION BY WEANING.
Kuznetsova Irina I.; Porkhachova T.M.; Pokrovsky V.V. Central Research Institute
of Epidemiology, Moscow, 111123, Russia.
Objective: to determine the influence of breast-feeding on HIV-seroprevalence among newborns of
HIV-infected mothers.
Methods: All the examined HIV(+) women which had delivery after May 1988 were suggested to wean
their infants.
Results: Among 32 observed 'mother-child' pairs 2 children died in perinatal period, 2 - emigrated, 28 -
were enrolled in the survey. 5 children under 12 months of age are still being followed up. Among 23
pairs 6 children were breast-fed, 17 - bottle-fed. Out of those 17 bottle-fed, 16 infants were found HIV(-)
in 12 months, I - HIV(+) at the age of 15 months (P=0,021). 5 of the 6 breast-fed were confirmed sero(+),
being known that 2 got infected via breastfeeding as their mothers had been infected via hemotransfusion
after delivery (P=0,089). The 6th breast-fed was found sero(-), the duration of his breast-feeding was
only 1 month. Thus, HIV-seroprevalence among bottle-fed newborns was significantly less than in those
which were breast-fed by their mothers prior to May 1988 (p < 0,05).
Conclusions: We believe our investigation has revealed that breast-feeding presents a high risk for
maternal-infant HIV- transmission. Bottle-feeding may be suggested as a preventive measure for
HIV-seroprevalence among children.
Kuznetsova Irina, Central Research Institute of Epidemiology, 3-a, Novogyreyevskaya,
Moscow, 105275, Russia. Telephone [phone].
ThC 1 524 DETECTION OF HIV-1 IN BREAST MILK, MULTIPLE SEXUAL PARTNERS, AND
MOTHER-TO-CHILD TRANSMISSION OF HIV-1: A COHORT STUDY. Bulterys,
Marc*'**; Chao, A.***; Farzadegan, H.*; Nawrocki, P.***; Dushimimana,
A.**; Habimana, P.**; Kurawige, J."; Musanganire, F."; Burnley, A.*;
Saah, A.* *Johns Hopkins Univ., USA; "University of Rwanda, Butare.
Objectives: 1) To examine a possible association between detection of HIV-1 proviral
DNA in milk and mother-to-child transmission (MCT). 2) To study MCT and detection
of HIV-1 in milk in relation to a recent history of multiple sexual partners.
Methods: Prospective cohort study of 304 HIV-1 sero(+) and 298 sero(-) women enrolled
during pregnancy and followed for a mean of 15 (range 1-27) months. Milk samples were
collected soon after birth and at 14 weeks postpartum. A subset (154 samples) were
tested for HIV-1 DNA by polymerase chain reaction (PCR) using 2 sets of primers.
Results: Among 102 children born to HIV-1 infected mothers (survived the neonatal
period and followed for at least one year), 30 were classified as HIV-1 infected and
72 as non-infected (MCT=29%). HIV-1 DNA was detected more frequently in milk collected
within 14 days after birth (36% PCR+ and 14% equivocal) than in milk obtained at 14
weeks postpartum (5% PCR+ and 7% equivocal). Detection of HIV-1 in milk was associated
with a 50% MCT rate versus 21% if milk was consistently found PCR negative (p=0.016).
A recent history of multiple sexual partners was also strongly associated with MCT
of HIV-1 (58% for > 3 partners versus 16% for 1 partner; trend p<0.001), independent
of HIV-1 detection in the milk. Low maternal CD4 count (<200) and CD4/CD8 ratio (<0.5)
were also associated with MCT but could only explain a small part of the above
associations. In multivariate analyses, MCT was not associated with age, parity,
income, history of STD, or HIV-1 related symptoms in the mother.
Conclusion: Both the detection of HIV-1 by PCR in breast milk and a recent history
of multiple sexual partners were strongly correlated with mother-to-child HIV-1
transmission. Maternal immune status could not explain these findings.
DR. MARC BULTERYS, B.P. 399, BUTARE, RWANDA
TEL: [phone] FAX: [phone]

ThC 1521 MU HIV-1 gGSA AND M IN A COHORTOF HV-1 INFECED MOTHES.
KIGALI, RWANDA (1988-1990).
VandePerrePhilie (), SimonomA('), HitimsaaDG("), KaitaE(*), MsllatiP(+),
Mukmbano B ("), Van Goethem C ("), Debis F (+), Lepge P (*).
A(9M Ima sleatvy, ntiAmls cI,ml pmia, 11pa, ma; (*9 D esane of
Patars, Cun oal&, Xila, Rwah; RS ME U 30 80, UkUhV"l at Brm,; pFsm.
Objecives l.To sim the frequencyofHIV-1 antibodies inmilkfinfected mathnrsvarto timesin the post
Metho:In a cohot o215 HIV- infected motemiisples were ected atday 15, moth 6nd month 18
postptm.HV-l 4G, SccetoyA(SA)and IM were detected by Westembl.t inthe lmtterto amn.I,
were euimu Iby.prec tprO G. The G 218 childreborto the 215 wom e breared for
firefTdyperiod. The iafecioPur tat intech drenas determined tordHInV,
atibodies beyond iSmoah orthe ppemer iof m/smpomsu euII HIVifeto bore tlis dme.
RecltliFreqency of detection of milk HIV-1 ibodiafdffen a btype acodi to the timepotpm.
Time HIV-1 lgG HIV-1 SgA V-1IgM
n(%) a(%) n(%)
Day 15 168/176(95%) 37/162(23%) 110/167(66%)
Month 6 150/153(98%) 40/142 (28) 119/153(78%)
Month 18 101/104(97%) 39/95(41%) 35/85(41%)
Indchldrenwleho mothersprovided h aU 3 milk maples(a-M~ 21 wescosdered a HV- fected Inthese
chlreen, theikelihoodofbei infectedwasinverdlyreltdtothe namberofilmplespositiveforigM(chi
Qpw for trend, p0.Ol). This masodio wasot obwseed for milkIgG and gA.
C 1. Milk SIgArespoa seems aweakandfrequentlydeaedas compared with manyothervral
infections whre SkgA purldminte.
2. Milk HIV-1IgMcoaddeiuerbeprotecivei o arnsmisaiuiof 1IV-i bybreasteedig
orbe an iiermedite maternal factor reflecting low trmI.
Philipe VAN DE PERRE, Natiaol AIDS Cotrol Pr m, AIDS Reference Labortory,
BP 780 Kigali, Rwanda. Phe (250) 73153;Fax [phone]
ThC 1523 PREVALENCE OF HIV IN BREAST MILK AND
S 1 CORRELATION WITH MATERNAL-INFANT TRANSMISSION. Ruff, Andrea*i
Coberly, J.*; Burnley A.*; Boulos, R.**; Desormeaux, J.**; Halsey,
N.*; Farzadegan, H.*; and the CDS/JHU AIDS Project Team*. *Johns
Hopkins Univ, Baltimore MD; **Centers for Development and Health,
Port-au-Prince, Haiti.
Obiective: To determine the prevalence of HIV DNA and/or p24 antigen (p24) in
breast milk and the association with maternal-infant HIV transmission.
Methods: Milk was collected at three month intervals from 40 HIV + and 15 HIVwomen. Cells were tested for HIV DNA by PCR and aqueous phase for p24 by EIA.
Sequential milk specimens are being tested blindly as they become available.
Results: 28 of 40 (70%) of milk specimen collected from HIV+ women 0 to 7 days
after delivery were positive by PCR and 5 of 30 (17%) were p24 antigen positive.
The prevalence of HIV DNA in milk decreased to 43% at 3 months, and 33% at 6 and
9 months following delivery. The prevalence of p24 positive milk was 14% at 3
months, 7% at 6 months and 0% at 9 months. Women with PCR or p24 positive milk
were similar to women with negative milk regarding fulfillment of the WHO case
definition for AIDS, beta-2 microglobulin levels and CD4 counts. 5/20 (25%
infants born to women with PCR positive breast milk are infected, compared to 1/10
(10%) infants born to women with PCR negative milk (p-0.33, OR=3).
Conclusions: HIV DNA and p24 antigen were detected in breast milk. Colostrum
appears somewhat more likely to contain HIV DNA and p24 antigen than does later
milk. Although HIV in breast milk did not correlate with the stage of maternal
infection, the presence of HIV DNA in breast milk shortly after delivery may be
associated with maternal-infant HIV transmission.
Andrea Ruff,M.D., Johns Hopkins University, Department of
International Health, 615 N. Wolfe St., Baltimore, MD 21205
[phone] FAX [phone]
NOTES

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