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

Tu.B.231 I -Tu.B.2316

Tuesday July 9, 1996

recruitment, compliance and retention of patients in clinical trials.These strate ie should be
focused in elirminating the access barriers, making research protocols available to all ellegit e
wonmen, children and adolescents with HIV infection.
Eleanor Jimenez, MD Dept. of Pediatrics, SJCH4. CMMS # 128 GPO Box 70344 Sai Ju.a
Puerto Rico 00936
Tu.B.231 I
AIDS - RELATED KAPOSI SARCOMA IN CHILDREN IN CONSTANTA DISTRICT -
ROMANIA
Dr Rodica, Matusa M.D., Dr Georgeta lTudor, Dr Margareta Ilie, Dr. Mariana Marnescu
Municipal Hospital
Objective: To determine AIDS -related k.s. relations with aids evolution and death.
Method And Result: There are 5 diapgnosed K.S. cases from among I 200 cases of HIIV
infected-AIDS sick children in constanta district. Four of therm are boys and I girl onlyThe
way of HIV transmission was nosocomial for 3 of them (unsterile syringes and blood transfusion) and vertical transmission for the fourth. The location of tumour lesions (in size of I
1,5 cm.) was under and on the skin on various body regions (face, neck, arms. legs, genitals)
and on mucosae (ocular and oral).fhe diagnosis was made through clinical and histopathologycal data (biopsy and anatomo-pathology) based on the characteristic appearance of vascular spindle celled tumour (double proliferation).The evolution of K.S. was rapidly unfavorable (since the onset took place after being diagnosed with AIDS. Death followed after several months (2-5).
Conclusions: We consider children-AIDS-related K.S. to be rather frequent, to have a very
poor prognosis and a rapid lethal evolution in our cases but this requires more deep studles in the future.
Dr Rodica Matusa Spitalui Municipal, Stefan Cel Mare 133 -8700 Constanta, Romana
Tu.B.2312
CLINICAL AND IMMUNOLOGICAL CHARACTERISTICS OF FAILURE TO THRIVE
(FTT) IN PERINATALLY-HIV (P-HIV) INFECTED CHILDREN
Dunn, Ann-Marparet, Cervia JS, Burgess A, Grassey C, Hinds G, Cunningham-Rundles S.
Noel GJ. Cornell University Medical College The New York Hospital, New York, New York
Objective:-To examine the imm unolopic and clinical characteristics of P-HIV children who
fail to thrive and compare those characteristics to a cohort of P-HIV children with normal
growrh.
Methods: Analysis of I165 children born to HI V-infected mrothers was conducted over a 19
monte period assessing the following, variables: age, sex, weight, height, serum alburin, CDC
immunologic staging, use of anti-retroirals, presence of a consistent primary caretaker, and
development. FTT was defined as weight & height < 5th% for age and a consistent primary
caretaker was defined as an adult figure providing > 90% of the patient's care.
Results: P -HIV infection was diagnosed in 89 children in this cohort. FTT occurred in I 6
(18.0%) of 89 P hIV children. Armong seroreverters FTT occurred in only 4 children (5.3%;
P<O.C ). Clinical and immunologic characteristics of P HIV children with FTT -iand of P-HIV
children with normal growth is shown in the table. Only I child in each group was hypoalbuminemic (<3.0 gm%).
Variables FTT n=16 Control n=61 P
Mean age 5.9 yrs 5.7 yrs NS
Sex % male 56.3% 47.7% NS
CDC Immune
Stage I or 2 37.4% 63.4%
Stage 3 62.5% 36.5% NIS
Antiretrovirals 81.3% 71.4% NS
% yes
Consistent I~ 81.2% 96.7% <05
caretaker
Developmental 62.5% 32.5% 0.05
delay
Conclusions: FTT is more frequent in P-HIV infected children than in non--infected children
born to HIV-infected mothers. Greater immunologic de ficiency imay be associated with FTT
in P- HIV infants although differences b etween FT and infants with normal g rowth were
not statistically significant. the irti factorial eteiology of FTT in P-H IV infarnts is underscored
by the observation that lack of a consistent caretaker and developmental delay are significantly greate r in P-HIV chidren who fail to thrive when compared to P-HIV children with
Aneo Mrgart Dune, d25 hat w8th St., box 296, NY, NY 10021 (212) 746-.3326
Tu.B.23 13
QUANTITATION OF L-SELECTIN IN HIV - INFECTED CHILDREN USING FLOW
CYTOMETRY
Ibe~bu, C, Ciar ter A, Korctis A, Lce [-K, Nestherre 5, Nihiat A. [mory Ueiver sit> School of
Medicine, Depatment of Pedfratic Isfectiouis Diseascs, Atlanta, Doorpta
Objective: To iise I_-selectis (a cell adhesion erolecule) at a prognostic imesunologc esarker
re HIV infeeted children.
Methods: Multi-paransetric Slow cytorretr y was used to quantrtatc f-Selectrn in I16 whole
blood and 6 separated peripheral blood mononuclear cells from HIV infected children and
30 age matched controls. We measured the L Selectin (CD62L) on CD4 and CD8 naive
(CD45RA) and memory" (CD45RA) Tcells using 3 color analysis.The data were analyzed
using te FACS Lysis II sobtwate (Bectoe Dickinson, CA).
Results: Diui prelitninary studies rn applying tis new esarker to CD45PA+ CD8+ T
Lymphocytes revealed a signifcant decrease in the L Selectin positive cells in HIV - infected
children, when compared to non infected age matched controls. Using whole blood, the
mean absolute numbers ranged from 20 to 300/cu mm in IV infected children versus

300 to I,0I,'c,.ri, i. ntrlols.When we comnpared results using whole blood versus separated n is ' t -ram HIV infected children, the mean percent ranged frorm 5% to
48% in whol bl..cd,eri s 21% to 60% in separated mononuclear ceils.The fuorescent
intensity wa. d, e,e sed wshen whole blood was used. 5 rmilr di fferences between
whole blood,n(d t!-i,., nuclear cell were also found in the number of CD45RA + CD4+ Lselectin positive c is.
Conclusions:Thrre s siniticant decrease in L selectin+ RA+,CD8+ r CD4+ T cells during HIV ifection in chidrcn probably due to loss of newT cell generation by the thymus.
The differences between use whole blood versus separated mononuclear cells are likely
due to soluble I -sele:tin in the blood known to be released from even normal lymrphocytes. Results of on going studies wil validate further the usefulness of L selectin as a prognostic marker durnng HIV infections in children.
Dr. Christian Ibegbu. Dept. of Pediatrics, Emory University School of Mtedicine, 69 Butler St.,
SE., Atlanta, GA 30303, USA
Tu.B.2314
PLASMA L-SELECTIN AS A PROGNOSTIC MARKER IN PEDIATRIC HIV INFECTION
Lee Francis, Kourtis A. Henderson 5, Nesheimrn 5, Ibegbu C, Nahmias A. Divsion of Pediatric
Infectious Diseases. Emrory University School of Mediane, Atlanta, GA, USA
Objective: Human L-Selectin (LS) is a glycoprotein expressed or the cell surftace of granulocytes, lymphocytes and monocytes, that regulates the horning of lymnphocytes to lymph
nodes and the extravasation of leukocytes into sites of inflammation. I S is shed from the
surfaces of leukocytes after activation and can be detected in the p asna. We studied plasma s- LS level in HIV inifected infants and evaluated it as a possible 0agnotic or prognostic
marker:
Methods: We used a solid phase ELISA (R&D Systems, MN) to imeasure serumn levels of sLS in 2 infants (0-36 mos) with perinatally transmitted HIV infection, compared with I 8
HIV exposed noninfected controls. Descriptive statistics (means, medians) and Kruskal-Wallis
tests were used to compare different groups. Correlation with pattern of disease progression was analyzed using Chi-square test statstics.
Results.The median value in the uninfected controls was 2 336 ng/n!, which is higher than
normal adult level (I 33 ng/rnl). HIV infected patients had significantly elevated values
(median 3730, p=0.0I).Among infected infants 12mos, a subgroup of 6 individuals with
ccnomitant decreases of CD4 and C D8 cell counts, indicating thym ic dysfraction, had
lower valies than the other i0 infants (3496 ng/ral vs 4713 ng/ml, p -0.039). All eight
patients with s LS values>3000 ng/ml in the first six months deve loped AIDS within 2 years
of age, corpared with 2/5 of those with value <3000np/ml. (p=0.03). There vaas no sgnificant correlation of s-LS values with the lymphocyte, CD4 or CD8 cell cotnt
Conclusions: Prasma levels of s-LS are higher in normal infants than in adults. HIV-infected
infants had significantly higher levels of s-LS than uninfected control infants. Early elevation
of s-LS levels mray correlate with rapid progression to AIDS.
De Francis Lee, Dept. of Pediatrics, Emiory University, 69 Butler St SE.. Atlanta. GA 30303,
USA (404) 616 -4997
Tu.B.2315
IMMUNOPHENOTYPIC SIMILARITIES OF A GROUP OF INFANTS WITH EARLY PROGRESSIVE AIDS WITH INFANTS WITH CONGENITAL DEFECTS OF THE THYMUS
Kourtis, Athena, Ibegbu C, Lee FK, Clark W, Nesheim S, Nahmias A. Division of Pediatric
Infectious Diseases, Emory University Atlanta, GA, USA
Objectives: AIDS (and death) within the first year; unique in pediatric population, might
reflect viral interference in the development of the imrmune systemn. Our study in children
with DiGeorge nornaly (DGA) identified a peripheral blood lymphoc/te im munophenotypic (IPT) pattern characteristic of thymric deficiency This new marker allows us to evaluate
the role of thymnic involverment in HIV disease progression.
Methods: We studied the IPT profile in 59 infants with maternally transmitted HIV compared with six infants with D)GA. Joint distribution analyses of CfD4 i+ and CD8+ T cells
from I68 non-infected infants established the normal range.The selection criteria for presumrnable thymic defect consist of concurrent reduction in bothT cell subsets (CD4 < 1900
and CD8 <850), and decreased CDS+ B ceils (when tested). Correlation of clinical disease
progression patterns with different early IPT profiles were established by Kapan-Meier survival analysis.
Results: Seventee n of the 59 IV-infected nfants, less than sx month of ae, demonstrat
ed ansIP profile sirni arr to that of infints with DGA.The risk of deverc png AIDS by 2
months and by 24 months for the 'thyrnic defecte' infants (Group A),,as 75% and m92%
respectivelyr, comipared to 4% and 33% for the otters (Group B, p 0.001). Fifty- two pecent in Group A died by six months after AIDS diagnosis, contrasting itI 8% in Group B
(p0.005). Even amo ng early progressorswho developed AIDS Ibefore one ear of age,
survisal in Gr oup B (only I death, at 31 months) was signifi cantly longer than those in
Group A (median 18 months). PCP was the pr incipal cause ofAiS end death in those
with the thyinic praofile.
Conclusions: Some rapid Isroyresser s have IPT profilec ppmgelive sf1 t.ni dcsruption by
[HIV possibly in utero.The inability of the infected thynans to Strednt n in ypho cyto rsatatree, together with!--lV-asscidated periphseal destruction of (1-1+ cells, osay lord to their
rapid depsletion, recalling in early disease progression.
A. Kourtis, M.D. 1404) 61 6-49Q7 De. of Pedratirmrs Fmr nn Diversitm S a Buler in St..
Atlanta, GiA 30303 USA
Tu.B.23 16
ACCESS TO THE SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR WOMEN,
INFANTS, AND CHILDREN (WIC)AT A PEDIATRIC INFECTIOUS DISEASE CLINIC.
Mluthec fragquelne Tn, Gaston, J.', Neshe in, S.a, Saw,,yer: Ml.'- inediatirec/Aboleseenrt
F-IIV/AIDS Progras, Grady Health System red fmriin University Scrisool.f hMedicie
Atlaeta, Georgia. USA
Issue: Parents of HIV-expose and -infected chicen are most yinr asocly and economirally dopre d faroilieor who oben have difficunlty acresstrap seesiccs that th eir ih rdren need
such as WIC.This federally financed program provides low-income famlies with vouchers to
purchase essential foods.

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