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

Track B: Clinical Science

Tu.B.2317 - Tu.B.2322

Project: In 199 I, a WIC Clinic began operating in conjunction witi e IP ediatric Infectious
Disease Clinic (PIDC), a comprehensive clinic caring for HIV exposed rand infected children.
Infants of exposed women are enrolled directly into ourWIC clini at b' ith.The nutritionist
is available full-time in the clinic for routine nutrition education (required by'NWIC 4 times a
year) and in-depth assessment and counselling for nutrition problms as needed.The WIC
caseload of 270 participants represents 83% of the age eligible cnrilidri i r followed in the
PIDC and includes several siblings of clients as well.The results of a," eil ition instrument
will be presented which assesses the client's participation choices.
Lessons Learned: A WIC clinic can be successfully operated within redical clinic, with the
two programs reinforcing each other in such areas as compliance -d i.articipation. Clients
see a nutritionist as part of the "team" of care providers and client f i,inies feel comfortable
consulting her when in-depth nutritional problems arise.
Jacqueline T. Muther Infectious Disease Program, 34 1 Ponce de Leon A'e. Atlanta, Georgia
30308 Telephone 404/6 I 6-9786 Fax [phone]
Tu.B.2317
INJURIES IN HIV-INFECTED CHILDREN COMPARED TO A GENERAL POPULATION
OF AFRICAN-AMERICAN CHILDREN
Turner BJ*, Casey R**, Cocroft, James R.*, Christian C**, Gibson E", FarningTR.***.
*Thomas Jefferson University; **Children's Hospital of Philadelphia, Philadelphia. PA., U.S.A.;
***New York State (NYS) Department of Social Services, Albany NY, U.S.A.
Objective: Because HIV+ children may be at increased risk of injury due to neurologic disease and their social environment, we compared the rates of injuries for an H-IIV+ cohort in
NYS to previously reported rates for African-American children from Philadelphia.
Methods: HIV+ children enrolled in NYS Medicaid and delivered by HIV+ women from
1985-90 were identified by a tested case finding method. Clinicians specified ICD-9-CM
codes for injuries and all unique injury events were identified from coded diagnoses from
in- and out-patient claims for care of the HIV+ children.We calculated inlury events per
100 child-years and compared these to reported rates for Philadelphia children (Schwarz
DF et al. JAMA. I1994;271:755-60.)
Results: 420 HIV+ children were studied, of whom 40.0% were African-American and
35.2% were Latino.The rates of injuries/100 child-yrs. in children <24 mos. were 22.7 for
the HIV+ cohort compared to 21.3 for the general cohort.The rate of burns was lower for
the HIV+ cohort than the general group (I.58 vs. 2.09/100 child-yrs., respectively).
However, the rate of poisoning was higher for the HIV+ cohort than the general group
(2.73 vs. 1.73/100 child-yrs.). Poisoning from medications in the IHIV cohort constituted
one-third of all poisonings (0.86/100 child-yrs.). Six HIV+ children in this age group had a
diagnosis of child maltreatment which is highly suspicious for child abuse. Six additional
HIV+ children suffered three or more injuries in their first two years.
Conclusions: The overall rate of injuries in our cohort of HIV+ childi en is similar to the
rate reported for a general inner city pediatric population but poisonings may be more
common in HIV+ children. Clinicians should counsel parents and caregivers of HIV+ children regarding the poisoning risk. As for all children, providers should be diligent in detecting any signs of abuse.
James R. Cocroft, Jefferson Medical College, 1025 Walnut St. Ste. I 9 Phila., PA 19107 tele:
[phone]; fax: (2 I15) 923-6939
Tu.B.2318
CHANGE OVERTIME IN NEOPTERIN (NPT) & BETA-2 MICROGLOBULIN (B-2M) IN
HIV-INFECTED CHILDREN FOLLOWED IN THE NICHD IVIG CLINICAL TRIAL:
CORRELATION BETWEEN MEASURES & ASSOCIATION WITH MORTALITY RISK
Pahwa Savita*, Mofenson L**, Korelitz J***, Meyer W****, Rich K** ", Bethel J***, Nugent
R**. *North Shore Hospital, Manhasset, NY: **NICHD-NIH, Bethesda, MD; ***Westat,
Rockville, MD; ****MD Medical MetPath, Baltimore, MD, *****U. of Illinois, Chicago, IL
Objective: To evaluate levels of NPT & 13-2M in stored samples from HIV-infected children
with mild-moderate HIV disease prospectively followed in the NICHD IVIG ClinicalTrial.
Methods: Blood was collected for central storage at entry & 3 month intervals during the
trial. Frozen specimens from children with 03 samples available were retrieved and tested
for NPT and 13-2M. Changes during the study were calculated as difference (final-entry
level) and slope (average monthly change). Mortality rates were clculated by grouping children into quartlies based on difference and slope in their NPT and 13 2M levels.
Results: Assay results were available from 7 I 2 13-2M specimens (mean level [S.E.] = 2.98
[0.05] mg/L) and 631 NPT specimens (mean level [S.E.] = 3.56 [0. 16] ng/ml) from 140 children who had been followed for 6- 18 months (mean follow-up - 14. I months). In multivariate regression models including treatment (IVIG or placebo), timens on study AZT use,
TMP/SMX use, serious bacterial infections, age at entry and entry CD/3 count, only age was
significantly associated with change in 13-2M (increasing levels with increasing age); increase
in NPT was associated with increasing age and lower entry CD4 count.Values of 13-2M and
NPT at entry showed significant correlation (Pearson correlation coefficient, r = 0.72); a
lesser but moderate correlation was seen for change over time in the two measures (difference final-entry level); for 3-2M mortality rate by quartile were 2.9% 1 1.4%, 2.9%, 25.7%,
respectively (x for trend = 6.5, p - 0.01); for NPT mortality rates were 0%, 12.1%, 5.9%,
25.0% (p = 0.005). A similar association was observed for slope (NPT p - 0.0 I; B-2M. p =
0.04).
Conclusions: A moderate correlation was observed between NPI nd lt2M levels in
infected children, and increases in both over time were associated with increased mortality
risk.
Savita Pahwa, M.D., North Shore University Hospital. 300 Community Dice, Manhasset,
New York 11030 Telephone: 5 I 6-562-464 I Fax: 5 I 6-562-2866
Tu.B.23 19
TUBERCULOSIS IN BRAZILIAN HIV INFECTED CHILDREN - REPORT OF 20 CASES
Sakane, PedroT, Hamamoto L A, Aquino M Z, Ramos S RT S, Mar ques H H S, Sato H K.
Depto of Pediatrics - Universidade de Sao Paulo - So Paulo - Brazil
Objective: Since 1985 our institution has attended HIV infected child-ei (n=205 cases, P2
or PIB) and because of the high incidence of tuberculosis in ouir state (50 cases/105inhabitants) the authors have a persistent suspicion for tuberculosis when HIV children have respiratory symptoms.

Methods: The authors designed a protocol for evaluation of clinical, laboratory and epidemiologic features for children with pulmonary manifestations and/or adenopathy associated with fever without response to conventional antimicrobial therapy Culture and acid-fast
stain of gastric aspirates, sputum, tracheal aspiration and/or bronohoalveolar lavage, skin
testing (PPD) and clinical response to antituberculous drugs were included.
Results:Tuberculosis was diagnosed in 20 HIV patients, despite I I of them having been
vaccinated perinatally Fourteen of them had positive cultures for M.tuberculosis and the others had clinical and epidemiological features and clinical response to antituberculous therapy. Side effects were observed in five children, when it was necessary to modify dosage or
drug schedules. Sixteen children had pulmonary manifestations, eight had adenopathy two
had disseminated disease and one had tuberculous meningitis.
Conclusion: Tuberculosis is a highly significant coinfection in HIV-infected children, especially
in developing countries.
PT Sakane, Rua Afonso Jose de carvalho. 62 Sao Paulo CEP: 0545 I 000 - Brazil. phone: 55
- II - 2634996 fax:[phone]
Tu.B.2320
PEDIATRIC AIDS IN A BRAZILIAN POPULATION: 10 YEARS OF FOLLOW UP
Sato. Helena K, Grumach A S, Jacob C M A, Pastorino A C, Sakane P T, Aquino, M Z,
Gutierrez P L, Marques H H S. Depto of Pediatrics - Universidade de Sao Paulo - Sao
Paulo - Brazil
Objective: Since 1985 we have been following an increasing number of children affected by
AIDS (n=205).The objective of the present study is to describe clinical data and evolution
of pediatric AIDS in a Brazilian population.
Methods: We reviewed the charts of 205 children with AIDS, admitted to Instituto da
Crianta during the last 10 years.
Results: Among 205 children, 118 (57,6%) were male, 87(42,4%) female, 156 (76,1%) perinatally infected, 36 (17,6%) infected by blood products and 13 (6,3%) were indeterminately
infected. Among perinatally infected, only 5 are asymptomatic (range 25mo-94mo). Among
the symptomatic ones, the median age at the first symptom was 12,6 mo (range I mo82mo).The age distribution at diagnosis was: 28,9% < I yr 47,7% I yr-4yr, I 8,8% 4yr-8yr and
4,6% >8yrThe main clinical manifestations at diagnosis were: failure to thrive (48%),
hepatomegaly (38,5%), recurrent pneumoniae (35,5%), diarrhea (33%), splenomegaly
(28.5%), adenomegaly (27,5%), intermittent fever (23%), parotiditis (8,5%) and thrombocytopenia (4%).The most frequent or severe complications were pulmonary and gastrointestinal disorders, severe malnutrition and fungal infections. Eighty-three (40,5%) patients had
died and only 5.8% left follow up.The clinical management were supported by antiretroviral
therapy (AZTDDI or AZT+DDI), IVIG and SMX-TMP when the clinical and laboratory
findings require.
Conclusion: This group represents I 6% of pediatric AIDS in S.o Paulo and these results
may be comparable to the Brazilian total data. Sao Paulo is the state in Brazil with the higher number of HIV infected people (60% of the total), including HIV infected children.
H. K. Sato, Rua Afonso Jose de Carvalho, 62 Sio Paulo CEP:05451I - 000 - Brazil. phone:
55- I1 - 2634996 fax: 55-I 1-30665703
Tu.B.232 I
ACUTE TOXICITY STUDY ON A NEW ANTI HIV LIPOSOME COMBINATION
PREPARATION
Gabev. Eugene E* Gabev EB**, Mitcheva M**, **Astroug H, **Karaivanova M.**.
*Bulgarian Academy of Sciences, Sofia, Bulgaria.
Objective: To determine the acute toxicity of previously in vitro proven highly effective
(above 60 times as compared to AZT) anti HIV preparation FTUAZT/PEBA. (EE Gabev et
al. 7th International Conference on AIDS, Italy, 199 I,WA. 1003).
Methods: Freeze Thawed Liposomes, containing AZT and Presumably Enzyme Blocking
Agent were prepared by hydration of egg yolk lipid film followed by three/thawed cycles at
minus 196 C and 38 C~ respectivelyThe acute 21I day toxicity was performed on 280
experimental animals (mice and rats from both sexes) via single i.p. and i.v. injection.The
tested preparation contained x 100 and x 10 the dose suggested for human treatment.
Relative to AZT and PEBA this was 300 and 30 mg per kg body weight and 130 and I 3 mg
per kg body weight respectively Non liposome encapsulated combination of AZT and
PEBA and sodium saline alone were tested as a control under the same experimental conditions.The accepted toxicity criteria observed were: labored breathing, decreased motor
activity, ptosis, body mass weighted weekly, death and gross pathology examination.
Results: Transitory labored breathing, decreased motor activity and ptosis appeared within
the first 30 minutes and disappeared within I120 minutes post injection.These changes were
dose, type of preparation, route of administration, animal species and sex dependant. No
permanent changes in the experimental animals for both FTL/AZT/PEBA and free
AZT/PEBA with respect to species, sex and route of administration in comparisson to the
sodium saline control were evident. Body mass, food consumption and gross pathology
were unaffected. Four rats and one mouse among the 280 experimental animals died
between day I and 9 from unidentified reason most probably not related to the treatment.
Conclusion: The obtained results give evidence that FTLJAZT/PEBA is not toxic under the
specified experimental conditions, warranting further chronic toxicity studies..E. Gabev, Block 25, Acad. George Bontchev Street, Sofia I I 3, Bulgaria Telephone: [phone] Fax; 359-2-7 10107, e-mail; [email protected]
Tu.B.2322
SERUM PAROMOMYCIN LEVELS IN AIDS PATIENTS TREATED FOR
CRYPTOSPORIDIOSIS
Gilquin Jacques-2-, Piketty C1, Kitzis MD2, Cormier P2, Kazatchkine MD I, Acar JF.2. I Unit8
d Immunologie, hbpial Broussais; 2Service de Microbiologie, h6pital St Joseph, Paris, France.
Objective: High dose of paromomycin has been proposed for the treatment of cryptosporidiosis in patients with AIDS.This aminoglycoside antibiotic is poorly absorbed after
oral administration. Howevec in order to ensure the lack of systemic toxicity, only limited
data are available concerning the serum levels of paromomycin in high dose. long-term oral
treatment.
Methods: We measured residual serum paromomycin levels by a micro-biological procedure in eight patients with AIDS, treated for cryptosporidiosis.Two patients had impaired

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