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

Tu.B.2252 - Tu.B.2256

Tuesday July 9, 1996

symptomatic group at first study was 25 months compared to 13 months for the nonsymptomatic group.
Results: Of 21 HIV exposed children studied, 17 or 8 I% were found to have low levels of
vitamin A (normal range of 20-80 pg/dl), significantly lower than age matched controls
(p<0.05). Of II HIV+ children. 10 had low levels from 0 to 19pg/dl. Correlation with
immune abnormalities was observed. Of I10 asymptomatic, seroreverter children with an
intact CD4+ T cell compartment, 70% showed low vitamin A levels from 5 18 pg/dl. Mean
levels were not different in the two groups at first study Vitamin A levels normalized by 15
months in the seroreverters but not in infected children where vitamin A levels continued
to remain below the lower end of the normal range.
Conclusions: These studies provide the first demonstration that infants born to HIV+
mothers are highly likely to have low vitamin A levels whether or not they are HIV infected.
Maternal vitamin A deficiency has been reported to be a risk factor in maternal fetal transmission and for progression in HIV+ drug abusers.Vitamin A is an essential cofactor for the
development of lymphocytes, immune response to infectious pathogens, and deficiency may
have especially critical effects in the HIV+ child.
S. Cunningham-Rundles, New York Hospita -Cornell Medical Center 525 East 68th Street,
NewYork, NY 1002 1.Telephone: [phone] FAX: [phone], email:
scrundlerimail.med.cornell.edu
Tu.B.2252
USE OF ZIDOVUDINE (ZDV) PERINATAL PROPHYLAXIS IN PREGNANT WOMEN
AND NEWBORN INFANTS IN ARGENTINA.
Coll Patricia, Perez M. S, Rolon M, Cando O,Votto L, Cahn P Hospital Fernandez, Buenos
Aires, Argentina
Objective: To evaluate efficacy and safety in prevention of vertical transmissionr of HIV infection.
Methods: During the period I12/94 - 12/95. 68 pregnant woman were assisted Counseling
and ZDV prophylaxis was offered to couples underscoring risk of vertical transmission of
HIV. ZDV prophylaxis was performed following CDC guidelines (MMWR 94.43 RR/I I1), but
beginning treatment on the 24th week of pregnancy Monthly differential blood counts, CD4
counts at entry and postpartum, were performed to pregnant women. HIV I antibody tests
(Elisa and W. Blot) were performed at birth and on a 6 month basis. Newborn CD4 were
studied at 30, 180 and 365 days. Blood counts were performed at birth and post-treatment
Results: A total of 68 patients were assisted, 14 were excluded because of: symptomatic
disease 6 pts, voluntary abortion 1, 24th week of pregnancy not reached 5. prenmature
delivery I, severe anemia I before ZDV treatment. Among 53 eligible pts 39 (73.5%)
received ZDV.The intrapartum component was given orally to 22 pts and IV ir I I, because
of unavailability of the IV drug A total of 14 pts refused ZDV (26%). PretreInment median
maternal CD4:443/mm3 (241 1292), post-treatment 759 (216- 218). Median pretreatmenrit maternal hemoglobin (Hb) II 3g/dl (9.2- 13.5), post-treatment I12 (I I.4 - I5.3).Infant median CD4:3000 (1447 - 378), median Hb post ZDV 12.9 (7.7 - 15.3). No discontinuation of treatment was necessary in any case.A total of 33 deliveries with 34 newborns
were assisted as of January 22, 1996. Median children follow up: 5 onths (I - 1)), all
asymptomatic, 3 cases seroreverted
Conclusions: Use of ZDV in pregnant and newborn was well tolerated in our population.
Counseling to couples early in pregnancy allows to achieve an important level of agreement
for ZDV prophylaxis. Efficacy evaluation will be possible with a longer time of follow up.
Patricia Coll, Gascnant and newborn was well tolerated in our population. Counseling to
couples
Tu.B.2253
EVOLUTION AND PROGNOSIS VALUE OF IMMUNOGLOBULINS IN WOMEN
DURING PREGNANCY AND FOLLOW - UP
Ciraru-Vigneron Nicole, Lefevre ElbertV, Giraudeaux V., Launay J.H., Ravina J.H.- C.H.U.
Lariboisiere - University of Paris VII -France
Objectives: To establish long term evolutive profile of immunoglobulins in HIV positive
women.To evaluate pregnancy influence.To assess predictive value of the observed mrodifications.To determine incidence of gammapathies and lymphoma.
Methods: Ponderal dosage of IgG, IgA, IgM and imrmunofixation of IgG were performed
each trimester during pregnancy then every 6 months during follow up. Results of
immunofixation were given as: normal, heterogenicity restriction, monoclonal gammapathy,
lymphoma.
Results: A cohort of 123 patients was studied: group A (54 patients) with only one year
follow up (pregnancy and 3 months post partum), group B (69 patients) with larger follow
up (mean 37 months). For the 123 patients mean values of IgG, IgA and IgM are steady
during pregnancy with a significant rise of IgG values in post partum. Follow up in group B
shows an IgG regular rise but not as important as seen in immediate post parturm.IgG
mean values are corrolated with immnunofixation data: normal (20 g/I), restriction (28 g/I)
monoclonal (33 g/I). At inclusion or during the first year of observation (group A and B) 3 I1
(25%) immunofixation abnormalities were seen: 24 (19%) restrictinons, 5 (4%) gammaipathies. Only in group B acquired immunofixation pathology could be observed, and was
present in 36 (52%) patients; 25 (36%) went fiom normal to restriction, I0 (8%) from normal (2) or restriction (8) to monoclonal gammapathy and only one from restriction to lymphorna.
Conclusions: Pregnancy do not much influence women immonoglobulins status. Our study
suggest a high incidence of asymptomatic immunoglobulins pathology although not often
reported. As for grafted patients emergence of monoclonal gammapathy may witness
immune deficit aggravation and should be considered in therapeutic management.
N. Ciraru Vigneron, Dep. of obstetrics and gynecology - CHU Lariboisiere - 2, rue A. Pare -
75475 Paris cedex FRANCE - tl. 33 I 49 95 62 78 Fax 33 I 49 95 62 15
Tu.B.2254
VULVAR INTRAEPITHELIAL NEOPLASIA IN WOMEN WITH HIV INFECTION
Kern, A., Abercrombie, Priscilla DeRemer, Foster A. University of California, San Francisco,
U.S.A
Objective: To cormpare the response to treatment for vulvar intraepithelial neoplasia (VIN)
2-3 in women with and without HIV infection.

Methods: A I cases ofVIN 2 3 at an inner city hospital over a 4 year period were reviewed.
The following information was abstracted fromrn the clinical records of women with VIN:
demographic irforation tobacco use, injection drug use, results of HIV testing, t cell count,
stage of HIV infetion, coirposcopic and cytological findings, treatment of lesions, and follow
up.
Results: Eight of the 26 women (31 %) with VIN 2 3 during the study period were HIV
infected.The reative rk. for recurrence or persistence ofVIN 2 3 after treatment was 8.8
(95% confidence interval 1.3-60) in the HIV positive group compared to the HIV negative
group.
Conclusions: There was a nigh rate of HIV infection among this group of women with VIN
2-3,This finding supports the recommendation that women with high grade lower genital
tract neoplasia be offered HIV testing. In addition, these findings emphasize the importance
of examining women with HIV infection carefully for vulvar lesions. Finally, further study is
needed to determine the optimal treatment forVIN in women with HIV infection.
Priscilla D. Abercrombie, 349 Playa del Rey, San Rafael, CA. 94901. U.S.A. ( 115) 457 321 8
email: [email protected]
Tu.B.2255
RESULTS OF ROUTINE COLPOSCOPIC EXAMINATIONS (COLPO) IN WOMEN
ENROLLED IN THE HIV EPIDEMIOLOGY RESEARCH STUDY (HERS)
Anderson Jean-, Cohen 5, Kelly W1, Shah K I, Christensen C2. Schuman P2 I Johns
Hopk ns, Baltimore. MD: 2Wayne State, Detroit, MI (USA)
Objective:To evaluate the use of routine colpo in screening for cervical dysplasia in HIV +
women and women at risk for HIV
Methods: Cross-sectional analysis of women undergoing screening colposcopy at 2 HERS
sites. Pap and CVL for HPV detection and typing by PCR were performed on 598 women
at core visits; women receiving colposcopy within 3 months were evaluated. Abnormal
(abnl) pap was defined as ASCUS or SIL. Biopsies (bx) were performed when colpo was
abnl. HPV results are for presence of high risk types 16, 18. 31, 45. Comparisons were made
using Chi square, or Ttest and logistic regression (p values were adjusted by race, age, and
injection drug use (IDU) status.
Results: 337 women (219 HIV +) received colposcopy: Mean age 33.9 yrs(range 18 -53):
Race: Black 89%:W9.2%: Hx IDU -54%. HIV + were more likely to be older- (p=0.056), to
be Black (p=.027), and to have hx IDU (p=.046). CD4 breakdown for HIV + women
(n=219): 0 200 17.5%; >200-500 44.7%: >500 37.9% (median 306) 32 women had
abnl bx (HIV + I I% / HIV-6%, p=0.19): Koilocytosis/L GS5L:27: HGSIL:5. All women with
HGSII_. had at least LGSIL on pap.

HIV+
Abnl Pap/HPV+(N) Abnl bx
+ a +(95) 15/73(20.6
+ (23) 5/19 (26.3%
+( 16) 2/13 (15.4
(201) 31 12 (2.7~

HIV
Abnl bx
3/22 (13.6%
2/4 (50%)
0/3 (0%)
2/89 (2.3%

0.56
1 00
1.00

In womren with ASCUS on pap and HPV present, there was no difference in bx results by
HIV status (HIV + 4/ 15(26.7%) vs. HIV I/4(25%))
Conclusion: In this cohort of women with little immune comnpromise, abrl paps were common (35%) but bx revealed mainly low grade lesions. Abnl paps generally predicted abnl bx:
only 3% of women with nl paps had abnl bx. No significant difference in bni bx was found
between HIV + and HIV women. Our data fail to support the need or routine colpo for
HIV + women.
Jean Rene Anderson, M.D., 600 N.Wolfe Street, Harvey 319 Baltrimore, MD, USA 2 1287,
Telephone: [phone] Fax: [phone], irabikerfowelchlink.welch Iu.eI
Tu.B.2256
HIV-RELATED CERVICAL CANCER (CA) IN ITALY:A REPORT OF 54 CASES FROM
THE ITALIAN COOPERATIVE GROUP ON AIDS AND TUMORS (GICAT)
Vaccher Emanuela, Spina M, Sopracordevole F, Sandri S, Santarossa 5. BoccalonI, M.Torresn
A, Rizzardini G. Conti M, Mangioni C, Scarabelli C Tirell U
Italian Cooperative Group on AIDS and Tumors, C.R.O., Aviano, Italy
Objective: To better characterize the natural history of cervical ca in HIV rnfected women.
Methods: Fifty four cases, including 35 (65%) carcinoma in situ (CIS) and 19 (35%) invasive
ca, collected by the GICAT between November 1986 to April 1995 were retrospectively
analysed. Clinical data included HIV status, histology, stage, sites of disease, initial treatment
and response, development of HIVassociated conditions and survival
Results: The median age was 28 years (range 19- 38).The majority (70%) of patients (pts)
were intravenous drug users and a history of sexual promiscuity and anogenital
HPV -disease was reported by 55% and 56% of pts, respectively Among pts with invasive
ca, 63% had stage I according to FIGO, 2 I% stage II and 16% stage Ill IV. The main clinical
characteristics of pts are reported in the table.
Cis Invasive Ca p value
(35 pts)(19 pts)

Mean CD4 count
(/mm3) (+SD)^
Prior AIDS (%)
Therapy (%)

279.8 (+221.7)
15
Surg. 85
Other 15

455 (+270.4
18
Surg. 53
RT 24
Other 23

0.03~
N.S.'

CR** rate (%) 97 81 0.09*
Ol (C I) at follow up (%) 52 57 N.S.
Relapse (%) 13 20 N.S.*
Median survival 66 I 0 1 N.S.
"Standard deviation, " Mann Whitney test; L Fisher exact test; " Complete remission

309