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

Tu.C.2566 - Tu.C.2571

Tuesday July 9, 1996

Results: HLA haplotype sharing among the 125 total pairs and by infection strata (-/-, +/+,
+/) did not differ significantly from expected Mendelian inheritance (25%, 50%. 25% for
share 0,1,2, respectively).There was a trend towards sharing 0 haplotypes if the pair was
HIV discordant [9/20 (45%), p<. 10]. ICCs increased with HLA sharing: -.22 (share 0);.37,
p<.05 (share I): and.59, p<.05 (share 2). There were 34 HIV neg and 73 HIV pos caucasian
sibs with HLA class I typing. Two antigens postulated a priori were significantly more frequent in HIV neg sibs thain in HIV-pos sibs: HLA-A2 (71% vs 45%, p-.01I) and HLA-B27
(21% vs 7%, p-=.04). Forty-six percent and 8% of the general caucasian population have
HLA-A2 and HLA B27, respectively.
Conclusions: These data suggest that HLA affects susceptibility or resistance to HIV-I infection. HLA A2 and HLA-B27, which have high plasticity for anchoring HIV- I peptides and
favorable AIDS free survival after infection, may be particularly influential.
Barbara L. Kroner, PhD Research Triangle Institute, 6101 Executive Boulevard, Rockville, MD
20852 USA Phone: [phone] Fax: [phone] Email: BYK(@RTI.ORG
Tu.C.2566
TEMPORAL TRENDS IN THE PREVALENCE OF HIV AMONG BLOOD DONORS IN
SAO PAULO/BRAZIL
Ester C.Sabino, Salles N, Murta M, Chamone D, Saez Alquezar A Fundagao PrO-Sangue/
Hernocentro de Sao Paulo
Objective: To determine the trends in the prevalence of HIV among blood donors in Sao
Paulo/Brazil.
Methods: All donors were tested for HIlV I antibodies using two different ELISA tests. If
repeated reactive to any of the ELISA test the unit is discarded and the donors are asked
to return when a second sample is collected and Western blot is performed.We have
found that the Western blot test confirms 99% of the individuals reactive to 2 ELISA. So to
establish the prevalence of HIV -i infection we present here the yearly percentage of individuals reactive in both ELISA tests f6orri 199 I to 1995.
Results:
1991 1992 1993 1994 1995
n' of blood donors 166,128 187,920 193,200 217,200 236,947
% of units reactive to 0.36% 0.30% 0.24% 0.24% 0.22%
two ELISA tests
Conclusion: Data about the prevalence of HIV infection among blood donors is difficult to
obtain in Brazil because public blood banks only perform confirmatory test among those
individuals who return for medical counseling. Hence trends in the prevalence of HIV
among blood donors have not been described. We show here that different then Thailand
where the prevalence of HIV among blood donors has increased dramatically the prevalence of HIV infection among blood donors in Sao Paulo is decreasing.
Ester Cerdeira Sabino. Av Dr Eneas de C iarvalho Aguiar 155 I andar Sao Paulo/Brazil.
05403000. Fax [phone]. Enail: sabinoecdtusp.br
Tu.C.2567
LONG-TERM NON-PROGRESSION IN HEMOPHILIACS:VIROLOGICAL FINDINGS
AND OUTCOME AFTER 3 YEARS OF FOLLOW-UP
Altisent C Soriano V*, Ruiz I, Heredia A**, Mas A*,Vallejo A**, Bravo R*,Tusell J, Hewlett
1**. Hospital Val Id'Hebron, Barcelona. Instituto de Salud Carlos Ill, Madrid, Spain. Lab
Molecular Virology FDA, Bethesda, USA.
Background: The duration of clinical latency vanries widely in HIV- I infected persons. In one
extreme, there is a group of individuals whose HIV disease does not progress over an
extended time. In the opposite, some persons show a very rapid immunologic deterioration after been infected with HIV. Although factors influencing the rate of disease progression in HIV infected subjects are nriot well known; at the end all act throughout an enhancement of viral virulence or host defenses, causing a harmful or beneficial effect, respectively.
We analyzed different virological features, both genotypic and phenotypic, in a cohort of 32
hemophiliacs who remain with CD4+ counts above 500/mm3 for more than 13 years of
infection in the absence of antiretroviral therapy (Long-term non-progressors, LTNP).They
were identified in 1992 in two reference centers for hemophilia placed in Spain, in which
168 patients are ongoing follow-up. A new evaluation of the immunological and clinical status aftrer 3 years was performed.
Methods: The virological studies performed in blood samples from these patients included:
viral culture from PBLs, MT 2 phenotype, serotyping, DNA PCR on PBLs, quantitative plasma irermia using both a colorirnetric RTPCR method (Roche) and the bDNA assay
(Chiron).
Results: Globally virus isolatiorn from PBLs was found in 64% of patients. None carried out
synoctium-inducing (SI) str ains. Plasma viremia was not detectable by the bDNA assay in
these individuals, although one sample had more than 104 copies/ml using the RT-PCR
method. Six subjects had no detectable levels of HIV I RNA in plasma by any technique;
and isolation by virus culture was negative in 5 of them. DNA-PCR yielded positive results
in all patients, although high DNA inputs and examine of more than one genomic region
were required for some specimens. HIV I serotyp ng was done using 3 peptides from the
V3 loop. All samples could be typed and all belonged to the B clade. After 3 years of follow-up, 17 persons (53.2%) remained with high CD4+ counts, 5 (I 5.6%) showed a CD4+
decline above 15% although they remained with CD4+ counts >500 mm3, and 10 (31.2%)
hemophilics showed a dechne below 500/mm3.The last group was no longer fulfilling criteria for LTNP
Conclusion: In HIV I + hemophfibacs who remain free of immunological deterioration for
many years, the viral plasma load is undetectable or very low despite a latent replicative
provral infection can be demonstrated in most of them. NSI strains are carried out for
most, if not all these ndivduals. After 3 years of follow up, progression was recognized in a
third of patients.
Dr Indira Hewlett, Lab. Molecular Virology CBER/FDA/HFM-315, 1401 Rockville Pike,
Roclville, MD 20852-1448, USA. Phone: [phone]. Fax: [phone]

Tu.C.2569
CHARACTERISTICS OF PREGNANCY IN A GROUP OF HIV-INFECTED WOMEN
Acosta, Maria A, Lupo S,Vitola P Bortolozzi R,Taborda M. Clinical Research. CAICI (Center
of Attention in Immunocompromised). Rosario, Argentina.
Objective: Describe the principal epidemiological, clinical and psychological characteristics in
a group of pregnant HIV-positive women.
Patients: We studied 18 Caucasian pregnant women. Average: 25.2 years old (range: 17-35).
Risk factors: Heterosexual 10 (55.5%), Intravenous drug user (IVDU) 6 (33.3%), IVDUHeterosexual 2 (1 1.1 I%). Nine (50%) married, 7 (38.8%) unmarred, I (5.5%) divorced and
I (5.5%) widow. All had school studied. Occupation: 8 (44.4%) housekeepers. 6 (33.3%)
employees, 2 (11I.1%) professionals and 2 (1 1.1%) sex-workers
Results: 14 (77.7%) were in couple, 10 of them had HIV positive partners. 7 had previous
pregnancies (10 births and I abortion). 16 women (88.9%) continued with the pregnancy
and 2 (11.1%) aborted. One had caesarean delivery and 3 patients had complications after
giving birth (hypertension, genital haemorrhage and puerperal infection). All infants were
born alive; 7 (43.7%) were HIV-positive, 7 (43.7%) HIVnegative and 2 (12.5%) unknown.
Three children died, 2 due to AIDS complications and I in an accident. 14 (77.7%) knew
their HIV-infected condition and 13 had information about possibilties of vertical transmission. Nine (50%) didn't use conception-control methods.Two patients progressi d to stage
IV of disease. In 3 cases the CD4 cell counts decreased. Five received previous treatment
with antirretroviral drugs (AZT and ddl) and 6 started during pregnancy (AZT 500
mrg/day).
Conclusions: I) The group of pregnant women studied were at the second decade of file,
with good instruction level and with a stable partner in the majority of cases. 2) The greatest part knew their infected condition and had information about the vertical transmission
but didn't use conception-control methods. 3) The majority of women didn't progress in
the stage of disease or decrease their CD4 count. 4) 43.7% of infants were HIV infected.
Acosta Maria A., Rodriguez I 2 I 5. (2000) Rosario, Santa Fe, Argentina Tel: [phone] Fax
54-41-248045
Tu.C.2570
HIV VERTICAL TRANSMISSION IN RIO DE JANEIRO: RATE AND RISK FACTORS
RubiniN.P.M., Arabe J., Cordovil A.VD.P, Sion F.S., Morals-de-SA,C.A., Lima,.A.J., Linares J.C.,
Rocco R., Borges M.R. Gaffree and Guinle University Hospital - University of Rio de Janeiro,
Rio de Janeiro, Brazil.
Objectives: To estimate the rate of HIV vertical transmission in Rio de Janeiro, Brazil and
investigate risk factors involved in this form of transmission.
Methods: We studied I105 HIV infected pregnant womem and their offsprings. prospectively
from January 1987 to September 1994.The HIV infection/AIDS diagnosis met the criteria
set by the Centers for Disease Control (CDC).The children were followed-up from birth
until at least 2 years of age or until death.The following risk factors for mother to child
transmission of HIV were analyzed: maternal clinical status, mode of delivery, and breastfeeding. Statistical analysis was conducted using Fischer's exact test.
Results: Of the 105 children born to HIV infected mothers, one was lost to follow-up and
another died without a definitive diagnosis. Of the remaining 103, 41 (39.8%) were infected
by HIV. In the asymptomatic mothers group, the rate of HIV vertical transmission was
32.9% (26/79),whereas in the symptomatic mothers group the rate was 62.5% (I 5/24)
(p=0.0097). In relation to the mode of delivery, the rate of HIV transmission was 37.5%
(27/72) in those children delivered by the vaginal route, and 45.2% (14/3 1) in the children
delivered by cesarean section (p-=0.8286, NS.). Of the children who were breast-fed 49.3%
(37/7 I) acquired the HIV infection, whereas only I 8.8% (6/32) of the children bottle fed
were infected (p=0.0027).
Conclusions: The rate of HIV vertical transmission (39.8%) was high and similar to that
described in the African studies. As for the risk factors, we observed that those children
born to symptomatic mothers and/ or were breast-fed have a higher risk of acquiring the
HIV infection. Breast-feeding by HIV infected mothers, as permitted in developing countries,
may be one of the factors determining the high HIV vertical transmission rates reported in
these countries.
Norma de Paula Motta Rubini University of Rio de Janeiro. Gaffree and Guinle Hospital,
Rua Mariz e Barros, 775/Tijuca/Rio de Janeiro.Tel. [phone] Fax: [phone]
Tu.C.257 I
HIV TESTING FOR PREGNANT WOMEN IN A PUBLIC MATERNITY HOSPITAL
LOCATED IN INNER CITY RIO DE JANEIRO, BRAZIL
Joo Esau C*, Menezes,J.*, Resende,O**, Aleixo;P**, Souza,J]**, Lourenco.N*, D' Ippolito,M*,
Anderson,J.***, Lambert,J***, H.S.E-RJ*, Pro-Matre**. Jonhs Hopkins University Fogarty
Postdoctoral training program, Baltimore, MD
Introduction: Rio de Janeiro has the second highest number of AIDS cases in Brazil; HIV
infected women are being increasingly recognized. Since over 90% of Pediatric AIDS cases
in Brazil are acquired by perinatal transmission, an optimal strategy for HIV prevention in
th s population is identification and treatment of HIV infected pregnant women.
Objective: To study the feasibility of an HIV testing program for low income pregnant
women attending a Maternity Hospital in Rio de Janeiro City
Methods: In July of 1995 a collaboration between the AIDS Program of Servidores do
Estado Hospital (General Hospital) and Pro-Matte Maternity Hospital was established,
which involved educating the Ob/Gyn caretakers about issues of universal precautions, and
educating regarding treatment options to interrupt maternal-fetal transmission of HIV infection. A referral system for women and children identifed as HIV infected to the General
Hospital has been established.
Results: Between August and December of 1995, since the initiation of HIV testing of pregnant women at Pro-Matre Maternity Hospital, 742 (95%) of pregnant women have acceptec HIV testing.Twenty (2.7%) women tested positive by Abbott EIA. Only 10 (55%)
returned for confirmatory Western-Blot testing; of these, 9/I 0 (90%) were diagnosed as
HIV infected. One woman refused confirmatory WB testing. Only 4 (44.4%) of the women
diagnosed with HIV infection returned for subsequent followup and all 4 of these accepted
thn use of AZT during their pregnancy. A coordinated effort between the Infectious
Diseases Specialist and Ob/Gyn staff was necessary to optimize post test counseling and
discussion of the use of ACTG 076 results with the patient.

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