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

Tu.C.2588 -- Tu.C.2593

Tuesday July 9, I1996

Tu.C.2588
ASSOCIATION OF GROUP-SPECIFIC BUT NOT TYPE-SPECIFIC NEUTRALISING
ANTIBODY IN PERINATALTRANSMISSION OF HIV-I SUBTYPE E IN THAILAND
S I otiirirotchanakui, R Cheingsong Popov. S Beddows, N Shaffer*,TD Mi stro5, S
Likanonsaku*, C VWasi ', and ] Weber St. Mary' s Hospital Medical Schoo', London, UK.
I IV/AIDS Collaborating Centre. Nonthaburi, Thailand, and CDC, Atlanta *Siriraj Hospital,
Maitridol niversity Thailand
Objective: investi gate the role o eutralizing antibodie and antibody responses to HIV I
epitopes in the transmission of tlV-I subtype E in infected mothers in Thailand
Design and methods: iwo perinital cohorts enrolled between 1991-94 at a large Bangkok
UJnivesity Itospitali were studied Plasma collected fiom mothers infected with HIV I subtype E during their fi rst visits after deliver y were analysed for neutralizing antibodies against
h,ri E and B isoates; anitbodies o rative gp120 (B and F); antibody which inhibits native
GP 20 (B and E) b nding to sC D4; and antibodies to V3 Thai E peptide and gp4 I epitopes.
Results were alyseci with transmission of HIV I from these mothers to their babies
(transmtiers n26, non trnsiniters n 32).
Results: I teie,rveie no siirfiant differences in tie distribution of antibodies binding to
either (.P 1t20 env P (p i00) or B (p0. t 5), to CD4/GPi20 E (p-0.63) or B binding inhibition (p-.2 i),V3 (p-.23), an iPt 1 (p =0.85) epitopes. Neutralising antibodies to aThai E
solate (SL/ Srpl I) idervied thse F subtype sera showed i highly significant association
between higher neutralisation titres to a B subtype virus (IN/H9) in the non-transmtting
isottieLs (p 0.0006).
Conclusion t hee is a i ihl/ s/gificat protective eifect oi group-specific, but not type-specific. neutralisation in materno foetal tiansmission.This effect is not demonstrated in binding
studies, sriggestirig a non linear confornitonal epitope is involved.
S. t aisioti sanakul, St NMary s I ospitai Medical School, Praed St. London, W2 I NY UK.Tet:
44 71 725 6787 Fax:4 17 I 725 6787.
Tu.C.2589
HEPATITIS C INFECTION AND CONCURRENT DRUG USE IS ASSOCIATED WITH
INCREASED VERTICAL TRANSMISSION OF HIV
Vallano Stephen A'.itionis D*, Ciaing B, tershow R, Mofenson, Lew J], Davenny K,
Cotton D ianson,Tang B. tllyer G, andesman 5, Quinn T*. 'Johns Hopkins University
Baltim e, MD; Investigato s of the Women and infant Transmission Study (WITS), sponsored by NtH, Betihesda, MD)
Objective: Po determine the' efftect ofi Htepatitis C virus (HCV) infection on mother to infant
transmission of HIV
Methods: Fi on 1989 to 1994, 540 IIV infected pregnant women were enrolled in a multi(enter prospective study of HIV vertical transmission (WITS). Infant HIV infection was
determined by culture positivity at two or more time points. HCV antibody (anti-HCV, second generation El tSA) arid Ht CV RNA (quantitative PCR, Roche Molecular Systems) were
measured in peripart:r i mi siaternsl plasma.
Results: Of 487i tIV positive mothers who could be evaluated for this investigation, 161
(33 %) were anti HCV positive. HIV vertical transmission occurred from 42 (26 i %) antiHt V po itive moth ers coi iped to 53 (16.3 %) anti-HCV negative mothers (P =.01).
Afe s dijivst ng fo factors previousy associated with HIV vertical transmission (CD4 %, HIV
ci lt.i i postivity, and duration of ruptured mnenmbranes), anti-HCV positive mothers who
used iicit d rugs duinig pregnncy were 2.6 times more likely to transmit HIV to their
infants ftin anti- HCV negttive nmothers who did not use drugs (P=.003). Mothers positive
foreither factor alone (anti II(V or iicit drug use during pregnancy) did not transmit HIV
more frequentl y(P - 2) than mroithers without the conditions, although fewer cases were
avaihable forathis analysis, sin dsi iiite r anti- HrV status and illicit drug use were themselves
hsw h!/oireated. Ain,, anti t ICV posite a aothers, the median HCV RNA concentration
was giigher in 42 nothe ris ho ert.ically transri itted HIV than among 120 who failed to
trnnit IIII (72,251 vs 33,56 I copiesirnL; P.01), and CD4 % was inversely correlated
with I-I V RI'A titer (P =.04).
Conclusions: tt a-CV (oinfection ppears to increase vertical transmission of HIV in rmothers
ising illicit drugs. Further studies of the effect of ICV on HIV viral load may indicate
whether t here is a direct effect or i tHCV is a marker for another cofactor
Stephatn A.Villano, 720 Rtiand I Avenue, Ross I 59, Baltimore, MD, 21205 USA Telephone:
41 0- 955 3152 Fax: [phone] ema:il:villan(welchlink.welch.jhu.edu
Tu.C.2590
A COLLABORATIVE APPROACH TO EDUCATING PROVIDERS ABOUT REDUCTION
OF PERINATAL HIV TRANSMISSION
BrLC aro lr K. Bsrtelli, I)*, Avenck, D., Gross, E5^, Bardeguez, A.^. *National
Pediatric & Family IfIV Resoutrce Center: **iNJ AIDS Education & Training Center,; Newark,
NJ; " 'J Aadem of Mecdicine, Princeton, NJ; ^New Jersey Medical School, Newark, NJ,
USA
Issue: \/hen results of ACei IG trial 076 in 2/94 showed significant reduction of penrnatal HIV
transminssion fio motier ito infant when a regimen of zidovudine was given during pregrass, sihit rnCtiatsn te-ded to be qupickl and systematically shared with wonren's health
care providers
Project: The National Pediatic & Famnil IlV Resource Center (NPHRC), in collaboration
with 'te New Jerse7 AIDS Lducation a Ti i-rining Center (NJAETC), and the New Jersey
A iad, M e -a) daiP ed a tr t o rteach provd ers araoss the state
wiserea thet- IlV asietii ic-iece is wassien giving diirthi a 3.5/lOOP. A needs assessment of
593 women s health care poviders in 3/95 found that 6 1% were unaware of the results of
AC t 076 A tra in the- trainer approach using adult learning strategies was adopted to
the esatest nmber of providers with a flexible educational approach. 47 providers
inlii Ml)s, Rit, ass cse rnan gr s atteaded two educationa programs developed by
NPIli/C isa 7/95 wshvers e/ rroi ed irniostation on reduacton of perinatal LtlV transmission, d s uss ons on non coercie counselin/ with pregnant women, and strategies for teachis g ie dovle igrec-h-a ninsse d Le iportanre of helping providess thick ciitirally
adouit boath clinirat niainagoerent issar assditheiir own attitudes adout choices which HIV
positi so woe csa rissnta pi egnitsy. Par ticipaisis received a complete curriculum including Isire sets ansi case Liehr for se r ' presenat iions asnd extensive bibliographies.
Results: t-rassnrd phgysi ir rn n crs ashave prsnted to I / conferences, gsrard runds, and

workshops ac s the ista te coordinated by NJAETC and NJAOM through 12/95. An esti
mnated 250 pi ode, have, already been directly reached and numerous presentations are
scheduled.
Lessons Learned. sr OR:n the expertise of each organization, NPHRC, NJAETC. and
NJAOM h,,v, ', -i, curriculum and an effective strategy to reach providers across
New Jersey with nt --n mton on reduction of pennatal HIV transmission tca to the
health of women with HI V and their children.
Carolyn K. Bu; RN, P-S: NPHRC, 15 So 9th St., Newark, NJ 07107 Ph# (201) 268-825 I
Fax#[phone] e mil cburr rdaiid.umdni.edu
Tu.C.259 I
ANTI-HIV-I p24 ANTIBODY REACTIVITY AS A PREDICTOR OF MATERNAL-INFANT
HIV- I TRANSMISSION
Povolotsky J, Ba or P Polsky Bruce and the Ariel Project Cohort Investigtor
Memorial Sloan-Ketternng Cancer Center, NewYork, NY USA; Ariel Project. isldi t
AIDS Foundation, SaniFrancisco, CA, USA
Objective: To determine whether anti-HIV- I p24 antibody reactivity in p asma of HIV I
infected preinant women is predictive of HIV I vertical transmission.
Methods: An ti-HIV I p24 antibody reactvit in plasma from 189 HIV-I -infecteid women
during the second trime sters of pregnancy was determ ned usinged a new snethod for mPieasureme nt of anti HIV-I p24 antibody de veloped in our loratory. In a modfCition of he
OrganonsTeknikaVirono I ka HIV- I Antigen M icroeis sa S ysterm. p24 antigen A) g as
adlded to we lls conated with mouse monoclonal anti-HIV- I p24 a dntioes,rI l cng p2
Ag by formins g an immrune complex. Plas ma sampl es were subsequently added to wells and
the assay was complet ed per ma nufactiurer's specifications. Ant-HIV- I p24 antibdy h '-eactv
ty was determined according to percent neutralization of the target antigen, and cutoffs
were estabished as follows: very high (i or00% neutralization),high (>85< 100%a rd low
(<85%). HIV- infection status of children born to HIV-I-infected mothers was determined
bdy anti-HIV- I antibody HIV- culture and DNA PCR.
Results: Among the 189 women tested, 35 (18.5%) had very high, 5 /(270%) hi gtnd -I
(54.5%) low antiHIV- I p24 antibody reactivity levels. CD4+ cell counts avais ble f om is
patients, at tim e of deliveransy, were as follow: 36/62 ( 58. I%) of women w ith very higrh and
hih anti-HIV pI 24 antibody reactivity and 18/74 (24.3/%) with l ow reanct I ty had 3 500
CD4+ cells/mm3 (median CD4: 558/mm3 for very high/high and 310/inm3 for low ani
bodyi Aevels).Very high and hi pgh anti-HIV- I p24 antibody reactivity was detected in 8-A 70
(48.8%) HIV- I rLon-transmitting and 3/19 (15.8%) transmitting mothers. Median CDi+ cells
were 447/mm3 for transmitting and 4i0/mm3 for non-transmitting mothers.The incidence
of HIV- I vertical transmission flom HIV-I-infected pregnant women wth very hgh, nigh ind
low anti-HIV- p24 antibody reactivity was 0/35 (0%), 3/5 1(5.9%), and I6/ 103 -(5.5%),
respectisely.
Conclusion: Anti-HIV p24 antibody reactivity, as detected by a modified ELISA, i -ihe
plasma of HIVI infected pregnant women, may be predictive of HIV- I vetcal trasnissic
The mechanism underlying the apparent protective effect of p24 antibody requires further
investigation.
B. Polsky, Memorial Sloan-Ketterin Cancer Center, 1275 York Ave NY NY 1002., USA
Telephone: [phone] Fax: [phone] email: polskybruceofstrforg
Tu.C.2592
SERUM VITAMIN A AND PERINATAL TRANSMISSION OF HIV AMONG A COHORT
OF HIV-INFECTED WOMEN IN THE UNITED STATES
Greenberg BL', Semba RD2, Vink Peter E3, Schoenbaum EE, Farley JJ3, Weedor J
Perinatal AIDS Collaborative Transmission Study (PACTS). I Montefiore Med iC r-/Albert
Einstein College of Mec, Bronx NY 2Johns Hopkins U, Bait MD, 3U of Ma-yhit nP3mit Mi[
4bled & Health Research Assn, NY
Objective: To determine whether vitamin A deficiency is associated with petinat trans -
son of HIV among a cohort of HIV-infected women n the United States.
Methods: Women wh o deivered during 5/86-5/94 infants of known infection status we, e
evaluated.Third trimester serum vitamin A levels were measured using HPLC tin 41 HIVinfected women who transmitted HIV to their infants (transmitters,TR) and 89 who did not
(nontransmitters, NTR)
Results: 16% of the-R and 5% of the NTR had severe vitamin A deficiency (<0.70 pmoi)
23% of theTR and 24% of the NTR had marginal deficiency (0.70-1.04 rmcl/i). Penrli
transmission was associated with severe vitamin A deficiency (p=0.05), ruptured mernbrane
of >4 hours (p=0.05) and gestational age <37 weeks (p=0.02) by univanate analysis. CD4+
count (stratified at 200 and 500 cells/pl), type of delivery age, body mass i ndex and r ace
were not associated with transmission.Two (5%) of theTR and six (7%) of the N TR took
zidovudine some time during the pregnancy In a multivariate logistic regression model
severe vitamin A deficiency (ORadj 3.69; 95% CI:1.04-13.25) and gestation i al age < 37 weeks
(ORadi 2.58 95% CL:I.03 6.43) were independently associated with transmission after controlling for- CD4 count and duration of ruptured membrane.
Conclusion: Increased risk of perinatal transmission was assoaated with senvere v"itam in A
defciency arnong this cohort, consistent with results among Afrcan women. It s eknown
whether maternal vitamin A deficiency plays a true role in perinatal transmssion or i
marker for increased risk of transmission. Clinical trials are in progress to determine
whether antenatal vitamin A supplementation will reduce perinatal transm son.
Peter ink, M.D., Unsve sity of PMaryland at Batimore, 310 Howard Hall.660 West Redwood
5Se, Baltimose, MD /1/P1 Pdone. 410 7069//PL AY: I 0706-033/e ea~l
[email protected]
Tu.C.2593
A DECLINE IN THE INCIDENCE OF PERINATALLY ACQUIRED (PA) AIDS IN THE
UNITED STATES
Linde en ML-, Byers B, Fleming CThomas P/, Davis S, Ssmonds RJ I,Vaapl T-,Ward
JW I. ICUCAlanta, GA.: 2New cork sty Dept ot Hemath N. UsA
Objective: To exantine trends in the incidence oL PA-AIDS in light of metest ilS. Furlh
Health Seirvice (USPHS) recosmendhatsons Lot- PCP prophylaxis fan- chi-rrn, -s of niate
nalinconata zihovudine (ZDV) to mcdivce perinata tr-anmmasor (Aug!991I mad a sir isr'
HIS counseling arid testing Los pregnant worsen (July I 995).

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