Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Mo.B.1312 - Mo.B.1317

Monday, July 8, 1996

Mo.B.1312
IMPROVED FOLLOW-UP FOR INFANTS BORN TO HIV-INFECTED MOTHERS AT
USAMC, MOBILE,AL.
M. Mancao, B. Estrada, C. Hoff. Department of Pediatrics, University of Souti Alabra,
Mobile, Al
Issue: From 1989 to 1993, 17 infants were born to HIVinfected women at 1lhe Universay
of South Alabama Medical Center (USAMC) in Mobile. AL. Only 7 of 17 (42%) infants late,
reported for follow up at the USA Children's Medical Center (USACMC). USAMC and
IJSACMC( are tertiary fiaclities which are main providers for the under insured, underserved, and high-risk population of Mobile couny. AL.
Project: A multidisciplinary and inter agency collaboration among the university pediatri
cians, obstetricrinanr ad the public health dlinics in Mobile was initiated. In addition, the fo
lowing measures were established: a pediatric infectious disease clinic, a tracking system to
follow the infants born at USAMC, and HIV screening of high risk pregnant women.
Results: There were 20 infants born to HIV infected women at the USAM( from Janruary
1994 through December 1995. Eighteen of the 20 (90%) infants have reported for follow
up at the pediatric infectious disease clinic.The improved follow up rate has facrlitated
carly diagnosis and interventionr for infants noted to be infected. For the infants who
serorever ted, early ex lusiorn of HIV infection has alleviated the anuish of most of the
family rrember
Lessons Learned: Effective follow-up of infants born to HIV-infected women can be
achieved with a collaboraltive effort and a tracking system that can read t_ improved delivery of care Io children who are perinataliy infected with HIV.
Mary Y. Mancao, Md, Dept. Of Pediatrics, University Of South Alabama, Rin224, 1504
Springhill Ave., Mobile, Al 36604 Tel [phone] fax (334) 40,-5 120
Mo.B. 1313
DEATH ANXIETY & SELF-ESTEEM: HEALTHY VS.AIDS-DIAGNOSED CHILDREN
IrelandMlary. * National Development & Research Institutes, Inc., NewYork, NY USA
Objective: To analyze differences in levels of death anxiety and self esteem in AIDS diag
nosed and healthy children
Methods: Following parent/guardian consent, African-American and Latino children, 4, 5, and
6 years of age were administered the Peabody Picture Vocabulary Test-Revised (PPVTR)(Dunn & Dunn, 1981). Seventy children who were English dominant and scored at the
age-appropriate range on the PPVT-R were evenly divided into 2 groups AIDS-diagnosed
and healthy and individually administered the Thematic Instrument for Measuring Death
Anxiety in children (TIMDAC)(Ireland, 1994) and the Pictorial Scale of Perceive
Competence and Social Acceptance (PSCA)(Harter & Pike, 1984). Each child told stories in
response to 4 TIMDAC pictures and pointed to children most like themselves in the 24
PSCA pictures presented.
Results: One way ANOVAs showed that the groups were not different in death anxiety F(I
68).46, p.50 and self esteem F( I, 68) - 1.24, p -.27. Chi-square revealed that the
AIDS-diagnosed children had a lower percentage of responses in the death anxiety categories
Being Abandoned or Separated from Significant Figures x2(I, N = 70) = 4.1I57 p <.05 and
Feehlings of Sadness or Fear About Being Abandoned or Separated from Significant Figures
x2(I, N = 70) - 7.835 p -.0 A one way ANOVA showed that the AIDS diagnosed group
scored lower in the PSCA subscale, cognitive competence F(I, 68) =- 6.93, p --.01
Conclusions: Findings are in contrast to most reports that fatally ill children have higher
death anxiety and lower self-esleem.They convey a sense of hope in an atmosphere of
despair, stigma, guilt and tr agedy which has surrounded pediatric AIDS.
M Ireland,3 Washingtorn Square Village, New York, NY 10012 USA
Telephone: [phone] Fax: [phone]
Mo.B. 1314
IMPACT OF HIV EDUCATIONAL MENTORSHIP ON HIV KNOWLEDGE AMONG
CARE PROVIDERS OF CHILDREN
Uonkochlk UonnaiKi, Rirtstern P'5., Harwvell *, Ricksecker M5, Spernte M1, Rudy 9.
S oMedical College of Pennsylvania -nd Hahneman University Pennsylvania AIDS ETC:*-The
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
Objective: To evaluate the impact of intensive educational mentorships on the HIV knowledge base, skills abilities, and willingness of health care personnel caring for children.-To cornpare the level of HIV knowledge and skills of the participants of this clinical educational prograrn with non prticipants caring for children in the community.
Methods: Results of a 4 -part survey completed by I 9 childrens primary care providers
were compared to a study group of 19 childrens primary care providers who had completed an intensive, individual cinical mentorship program lhe 4 part survey assessed respondents demographics, practice characteristics knowledge of HIV pediatric clinical ar, and
skills arind ability, and willingness to provide HIV care.
Results: The study group had significantly higher knowledge scores (x 15.5 SD 1 I vs. x 8.8
SD 3.7, p <0.001).The study group scored significantly higher on the section on Perceived
Skills, Ability and Willingness (mean 45.8 vs 33.9, p 0.00 I). Study group scores were significantly hgher on all Skill items (p <0.001); orn 4 of 5 Ability items; and on the two
Willingness items (p <0.001). Controlling for other factors using logistic regression, both
study group (OR 4.49, 95% CI 1.92 10.50) and control group members from public clinics
(OR I.92, 95% CI L.0 i -3.65) were more likely to have higher knowledge scores (-75 percentile toriet). Study group particpants were also more likely tt have higtrer perceived
skills, ability and willhngness scores (OR 3.55. 955% CI I.90-6.63).
Conclusions: Parriscpants in an intensive program of HIV clinical education had significantly
higher knowledge scores as well as higher perceived skills, ability and willingness scores.
Outreach to cormunity providers, and the developnent of HIV clinical education p5ograms
is crucial in assuring access to competent community HIV care.
DK. Donkochk, PA AIDS ETC, 1302 Race Street, Philadelphia, Pennsylvania. USA Ielephone.
215-557-2101 Fax: [phone]

Mo.B. 1315
REVIEW OF SCIENTIFIC LITERATURE TO ESTABLISH SAFETY GUIDELINES FOR THE
ADMINISTRATION OF NUTRIENTS IN PEDIATRIC SUB-POPULATIONS FOR THE
POSSIBLE TREATMENT OF HIV/AIDS
Wild. fainn, Pn i.. Onstott, Michael.'". *Center New Jersey Pediatric AIDS
Program, Robet W ed ir -. New Brunswick, New Jersey:"DA.A.I.R, New York, NY
**National AIDS Nul, -l -tri, San Francisco, CA
Objective:To detle!i fin ith,. upper safe limits of vitamin, rineral, latty acid and namino acic
supplementation used in the tr eatment of various non-deficiency disease states, irn order to
create safety criteria for the possible treatment of pediatric HIV/AIDS by both clinicans.
parents and caregiver
Methods: Several thou:,and journal articles were reviewed forom National Library 01
Medicine (US) whichi incorporated the therapeutic use of high dose nutrient supplementa
tion in the attermipted treatment of a wide variety of pediatric diseases and disorders.
Search categories included phar mokenetics, therapeutic use, toxicity, metabolism, adverse
effects, administrationi ani dosage, poisoning, hypervitanmirosis and others.
Results: Based on the conrclusion from several hundred peerreviewed journal articles, an
easy to use chart was constructed showing dosage parameters for safe and chronic use of
high dose: vitamin A, beta carotene, thiarmine, riboflavin, niin, pyridoxine. vitamin B I 2, vit
min C, pantothenic acid, vitamin D, vitamin E, folic acid, vitamin K, catum, NAC. iron, zinc,
phosphorous, selenium, carnitine, cysteine, glutathlone, nmethionine, lyssine, and fatty acds.- he
use of high dose nutrients are charted by age with ranges from: neonates younger than one
month, one month to six months, six months to orine year; one year to tree year s, three
year-s to six years, and six ye.rs to twelve.
Conclusion:While Ihis chart does sot address efficacy, it does supply useful information to
guide both the researche: clinician, and parent in the safe and potential therapeutic use of
high. chronic nutrient supplementation. It is hoped that these guidelines wil nurther define
opportunities, including controlled studies, for high dose nutrient suppiermentation in the
pediatric populations.
Jaime Wild, I 6 Clover Lane, I incoln Park, NJ. 07035 USA Telephone: [phone]
Mo.B. 1316
PROBABILITY OF SURVIVAL FOLLOWING AIDS DIAGNOSIS IN THE FIRST YEAR
OF LIFE
Farley, Iohn:*, Bamji *M, Nesheim 5*, Palumbo P**-i,Thea D", Simonds RJ -** and
the Perinatal AIDS Collaborative Transmission Studies (PACTS). *Univ. of Maryland; *"NYC
Perinatal HIVTransmission Collaborative Study; *'*Emory Univ.; r""Univ. of Medicine and
Dentistry of New Jersey; " ' "*Centers for Disease Control
Objective: To determine facters associated with survival among a cohort of children following AIDS diagnosis in the first year of life.
Methods: Children born to H-IV- women were enrolled t birth and followed prospective
ly in this multicenter study HIV/AIDS associated mortality rates were obtiined using
Kaplan-Meier methods. Strata were comnpared using the log rank and Wilcoxon tests.
Results: 61I children in the cohort met the CDC cnriteria for AIDS in the first year of life
and were included in the analysis. Inrtial AIDS-defining diagnoses were as follows.
Pneurocystis carinii pneumornia (PCP) 22(36%), encephalopathy 18(29%). recurrent bacterlai
infections 8(1 3%). lymphoid interstitial pneumonitis 3(5%), wasting 2(3%), other opportunis
tic infection 6(14%). 37(6 I%) developed one or more subsequent AIDS conditions. Age at
AIDS diagnosis was: < 3mo: 13(2 I%), 4-6mo:22(36%), 7-9mno: I 2(20%). i0-12mo: 14(23%).
29(48%) children died in the course of follow-up at a mnedian age of 355 days (range 92
1078), with median time to death following initial AIDS diagnosis 134 days (range 5 831 )
Overall, 9(15%) died within 60 days of AIDS diagnosis, and 23(38%) within i yearn Suriving
children were followed to a median age of 877 days (range 176 2606). Brth dunng or after
1990 was associated with increased probability of survival after AIDS (median 83 1 days,
mean 586~50, compared with median 156 days, mean 257~70, p<.01 ). CD4 coount prior to
3reo of age <2000, AIDS diagnosis <6me of age, PCP as rnitial AIDS condition, or birth
weight <2000g, were rot issociated with probarbillty of survival.
Conclusions: Increased probability of survival following AIDS diagnosis in the first year of
life was associated with birth during or after- 1990. but not with common clinical or labora
tory parameters, suggesting that advances in patient care may be responsible
John Farley University of Maryland at Baltimore, 120 Penn St., Baltimore, MD, 2120!, U S A.
Telephone [phone]. Fax: [phone]., emtail: [email protected]
Mo.B.1317
SERUM VITAMIN A LEVELS IN A U.S. COHORT OF HIV-INFECTED CHILDREN
Read, Jennifer S-, Mofenson L, Bethel Ji, Moye J*, Meyer W~, Nugent R*, Korelitz J', Rich
K:), Pahwa S *: *NICfHD-NIH, Bethesda MD; (Westat. Rockville MD: ~MD Medical
MetPath, Baltimore MD): (U of Illinois, Chicago IL;"* North Shore Hosp. Manhasset NY
Objective: To describe changes in serum Vitamin A levels over timre in HIV-infected children
inn the U.S. enrolled in the NICHD IVIG Clinical Trial (NEJM 1991:325:73).to investigate
whether Vitamin A deficiency is associated with increased mortaluty because of the previous y
reported association between Vitamin A deficiency and mortahty in HIV-infected chldren.
Methods: Blood was collected for central repository storage at entry and at 3 month inter
vals during the trial. Ultra frozen serum specinmens from children with 3 samples were
hexane-extrdCted and assayed by HPLC. Changes over time were analyzed by carculating
the difference (final initial log l0 values) and slope (average yearly lo 10 rate of change)
within each sublect
Results: Serum Vitamin A (mtg/I) was measured in 706 samples from I41 subjects (65 from
IVIG group and 76 from placebo group).The mean (standard error) initial values for the IVIG
and placebo groups were similar (0.32 (0.01) versus 0.32 (0.02). p - 0.83).There was a significant change n Vitamin A levels during the study period for the IVIG group as measured
by their mean diffenene 1+0.046, - 0.03) and slope (+0 049 0.05), but the change
was not significant for the placebo gnoup (difference 0 -..04, (- 0.38: slope -- +0.009,
pr-0.79). In multivariate analysis controlling for time on study AZTTMP/SMX, age, and entry
CD4 +, the difference was signifcantly greater in the IVIG group than in the placebo group
(p = 0.03), but not the slope (p - 0.35). Mortality did not vary singnificantly by quartule of difference (10.8%, I 1.8%, 2.9%, 17.1%; p = 0.67), by quartile of slope (I 3.9%, 5.7%. 2.9%, 20.0%;
5 = 0.52), or by quartile of nitial level (8. 1%, I2.2%, 6.7%, I5.2% - 0.50).

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