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

Track C: Epidemiology and Public Health

Tu.C.2604 - Tu.C.2609

Tu.C.2604
CHARACTERISTICS OF VERTICAL TRANSMISSION OF HIV- I IN THAILAND
Tawee Chotpitayasunondh*, Naris Waranawat*, Salinee Panakitsuwan', Sumlee
Duangchandra*, La-or Champuk*, Wattana Auwait**, Panasda Isa'angkur Na Ayuthaya*,
Nonglak Saipradit, Amorntip Muanpom#, Suthon Wongcheree#, a/it Warachit#, Satoshi
Naganawa# #, Mitsuo Hornda# #, Kikuko Miyamura# #, Shudo Yarnaaki# #. * hildren's
Hospital, Department of Medical Services, *5Health Science Researc)h I stitute and Virus
Research Institute, Department of Medical Science, Nonthaburi I 000,Thailand and
##National Institute of Health, Japan.
Objective: Vertical transmission of HIV accounts for majority of the virus infections among
children and rate of the seroprevalence has been rapidly increased in Thailand. In our studies, we analyzed characteristics of mother-to-child transmission, HIV-infected b bies arind
ong-term survivors of the infected children in a cohort attendir'g the dtives, enter and
its clinic in Bangkok. Thailand.
Methods: Thirty-nine pairs of HIV-infected mothers and infants, and 8 cases of children
were enrolled in this study. All 39 mothers were asymptomatic and 29 of 47 children were
symptomatic.
Results: Blood specimens from the cohort were examined for clinical status, serological
data by Western blot and peptide-based ELISA, and genetical d ta by DNA sequencing of
the virus genome. Among 47 children studied 34 were diagnosed positive for HIV I (72%),
and 19 of the 34 categorized serotype E by the ELISA (56%). Among II paired cases that
could be analyzed by sequencing, 7 samples occurred vertical transmission of the clade E
virus (64%). Interestingly, among 3 of 22 paired mothers were double-positive for clade E
and B virus by sequence analysis, moreover 2 infants from the paired 3 mothers were also
double positive for the boe- viruses and the other one paired infant was negative for HIV.
One infected mother with lade B virus, delivered an infected baby withi the same clade of
the virus. Further, long-sursved children for more than 2 years were accumulated to be 7
of 47 children (I5%) and the 5 of 7 children were symptomatic, suggesting the rapid progression to trfbe disease states in HIV-infected children.
Conclusion: In the study of vertical transmission of HIV- I in Thailrnd, we clinically and virologically studied 47 children, 39 of that were paired with HIV-positive mother: Interestingly,
double infected children with clade E and B virus were detected fronm the double-infected
mothers.We are following the paired cases for study the course of the disease progression.
Tawee Chotpitayasunondh, Rajavith Rd. Payathai, Bangkok, 1104 Tel.: [phone]; Fax: [phone]
Tu.C.2605
ADDITIONAL HIV INFECTION IN CHILDREN BORN TO HIV-INFECTED WOMEN
AND NOT INFECTED AT BIRTH OR IN THE FIRST WEEKS OF LIFE.
Miotti, Paolo G, Taha TE*, Chiphangwi JD *, Mtimavalye L**, Broadhead RLi'f, Biggar RJ*,
Liomba, NG *.* School of Public Health. Johns Hopkins University USA; * National Cancer
Institute, USA; ** College of Medicine, University of Malawi, Malawi.
Objective: To determine the rate of post-natally acquired HIV infection in children of HIV infected mothers, tested by PCR at birth and in the first few weeks of life and found HIV-uninfected.
Methods: Women delivering in a tertiary care hospital in Blantyre, Malawi, were enrolled in
a birth canal wash trial. Infants of HIV-infected mothers had baseline HIV PCR at 6 weeks
and confirmatory serology at 15 months. Serologic follow-up is scheduled for 21I and 24
months. Filter paper blotted blood samples were collected every 6 months to determine
the time of infection in children with positive serology at 15 months. In post--natally infected
children careful history review was done to rule out HIV infection due to causes other than
breastfeeding.
Results: The combined in-utero and intrapartum rate of mother-to-infant HIV transmission
was 27%. A total of 446 enrolled infants of infected mothers were HIV uninfected at baseline. Preliminary results on post-natal transmission are available for children who, as of
January 1996, reached 15 months of age and were tested for HIV by serology Of 251 children who were initially HIV PCR negative, 24 (9.6%) were found to be HIV infected at a
later time. Specifically, 14/251 (5.6%) children were HIV PCR negative in cord blood and
HIV PCR positive between 7 and 18 weeks, 7/25 I (2.8%) were HIV PCR negative at 3
months and HIV serology positive at 15 months and 3/25 I (I.2%) converted from HIV
PCR negative to HIV PCR positive between 4 and t weeks.
Conclusion: These results suggest that a non-negligible proportion of children not infected
during gestation and delivery acquire HIV postnatally by breast feeding.The subset of infants
with HIV PCR negative cord blood, but subsequent HIV PCR positive venous blood may
have acquired HIV either intrapartur or through breast feeding. HIV serology through 24
months will allow to quantify late vs. early postnatal HIV transmission. The breast feedingrelated risk of infection at various time intervals will be accurately estimated as PCR tests
are completed on samples obtained before serologic seroconversion. Determining quantity
and time of postnatal risk of HIV transmission is necessary to devise selective strategies
applicable to breast-feeding populations in high HIV prevalence situations. Careful risk-benefit analysis will be necessary before any changes in established breast feeding policies are
considered.
Paolo G. Miotti, 624 N. Broadway Rm 893 Baltimore MD 2 I 205, USA tel. [phone] fax
410-955-1836
Tu.C.2606
ZDV RESISTANCE (ZDVR) MUTATIONS IN ZDV EXPOSED MOTHER INFANT PAIRS:
PRELIMINARY FINDINGS FROM THE WOMEN AND INFANTS TRANSMISSION
STUDY (WITS)
japout Anthony J*,Welles S~, Mcintosh Ki, Colson A*, Chung P5, Lockman 5, Davenny K-,
Fowler MGt, Hansen IC), Kalish L [, Moye Ji, Rich K-, Zorilla C-, Pitt J [. *+Larvard Medical
School, Boston, MA, ~University of Minnesota, Minneapolis, MN; tWITS Study Group,
National Institutes of Health, Bethesda. MD, USA
Objective:To determine the prevalence of mutations conferring Z[VR among women
treated with ZL3V during pregnancy and among HIV-infected infants born to women treated with ZL3V during pregnancy.
Methods:Viral isolates at delivery h-on -8 women treated with ZDV d ri, g pregnancy and from
the 9 DIV-infected infants born to these mothers were analyzed for the presence of DIV reverse
transcriptase (PT) mutations associated with ZDVR. RNA was esxtracted and reverse transcribed
cDNA was implified using nested PCR.The DNA was sequenced usnr clye-primec chemistry
(ABI).The 6i mutations of interest were M41 IL, D67N, K70R, L210 VsfT21I5Y K2 I 9Q.

Results:IThe HIV RT was successfully amplified in 45/48 (94%) of the women and 9/9
(100%) of the infants.Thus far we have sequenced DNA from 14 women and 6 infants.
Three of 14 (219%) women were found to carry a mutation at one or more of the six
codons of interest. K70R alone (n=2) and M4 IIL andT2 1 5/y(n= I).Viruses from an index
mother infant pair in this cohort had previously been found to carry ZDVR mutations.
Sequential isolates of the index mother and infant were analyzed:

41 67
Mother@ 16 wk L D
Mother (a delivery L D
Baby @ I st + cx L D

70
K
K
K

210
W
W
W

215
T/S
S/Y

219
K
K
K

SI/NSI If
NSI
NSI
NSI

Conclusions: ZDVR mutations were prevalent imong mothers in the WITS cohort who
were treated with ZDV during pregnancyThe occurrrence of maternal virus with a sige
mutation at codorn 70 suggests that one should scr een for this mutation in addition to the
4 I/I 25 codons. Sequential analysis of HIV isolates from one mother showed the evolution
of the HIV quas-species ofT/S at codon 2 15 to Y during gestation.
AJ Japour, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 0221S5, USA Tel: [phone] Fax: [phone] I, email: tfapour qbih.harvard.edu
Tu.C.2607
TREND OF HIV INFECTION IN NEWBORNS IN ITALY: 1990-1994
Ippolito G, Girardi E, Rava Lucilla, Stegagno M, Costa F. Aebisher ML, Guzzanti E. The Italian
collaborative study group for HIV prevalence in newborns* Coordinating Center: Centro di
Rifenimento AIDS Ospedale Spallanzani-Roma-Italy
Objective: To estimate nationwide the prevalence of HIV-Ab in newborns
Methods: Anonymous unlinked prevalence survey. Newborn's blood samples, collected on
filter paper for routine metabolic and hormonal screenings were analyzed. Since 1990 the
program is carried out in all the 2 I Italian regions.
Results: The overall results of the study for the years 1988 1994 are shown in the
Table.There was a positive correlation between observed prevalence and cunmulative incidence of AIDS in single regions.

Year
1988
1989
1990
1990
1991
1992
1993
1994

n. of regions
8
7
3
21
21
21
2.1
21

n.samples
20682
55406
20493
97658
143280
152972
161812
149600

n. HIV+
18
91
41
121
143
130
156
153

prevalence %
0.087
0.164
0.200
0.124
0.100
0.085
0.096
0.102

CI 95%
0.052 -0.14
0.132-0.202
0.144-0.271
0.103 0.148
0.084-0.118
0.070-0.099
0.082-0.111
0.073-0.1 10,,o
ONl
L_
O
t)
sa
u
C
0
(1a
U
na
0
C
0
0
cc
na
t
cx
37

Conclusions: The data evidenced nationwide a significant downtrend in prevalence
between 1990 and 1992. In 1993 HIV a relevant increase, confirmed in 1994, was observed
in regions with low and high AIDS cumulative incidence.This may reflect an increased
spread of HIV infection among women of childbearing age. Approximately 3000 infants
born to HIV seropositive mother have been delivered in Italy in the years 1990-1994 and in
the near future there will be about 550 paediatric AIDS cases, due to vertical transmission,
among children born in 1990-1994.
* U Angeloni, I Antonozzi, R Beghini, A Bracco, R Ciannamea, M Cioni, L Chiovato, C
Corbetta,VD Damato, C Del Carpio, GC Fiorucci, AM Germana, D Gullo, A Menna, A
Misserini, G Parlato, E Pasquini, S Piazzi, C Corbetta, A Pignero, C Pintor; G Pugliese, C
Romano,V Rossolini,A Span6
L. Rava', Centro di Riferimento AIDS Ospedale Spallanzani-Roma-ltaly Via Portuense. 292
00149 RCtMA Phone [phone] Fax [phone] Supported by italian Ministry
Health - AIDS Research Project
Tu.C.2609
HIV AND HEALTH CARE WORKERS, SURVEILLANCE OF OCCUPATIONAL
EXPOSURE IN S.MARTINO HOSPITAL, GENOA, ITALY:AN UPDATE (1989-1995)
Crovari P. De Stefani M., Lazzereschi M., Nelli M., Poll A.,* Fontana L.
Institute of Hygiene and Prev. Medicine, Genoa University, *Occupational Medicine Dept.,
S.Martino Hospital, Genoa, Italy
Objective: Decree by law No 626, 09-19-94 is the most recent national rule in hygiene and
work safety: it establishes the fulfilment of some guidelines concerning "Improvement of
safety and health at work".The evaluation of the risk and, therefore, planning of preventive
measures and health surveillance are the basis for the general protection measures provided by decree.Thus, the surveillance programme for the evaluation of exposure to biological
risk in Health Care Workers in Italy becomes more and more important.
Methods: With this objective fi-om 1989, S.Martino Hospital in Genoa, which is the major
Ligurian Hospital, has agreed to the national program. During the period under study 140
accidental exposures to HIV infected material have been reported. At the same time of the
accident, a schedule for anamnestic and professional data of the HCW and details of the
accident itself is fulfilled; the HCW is requested to under go blood drawing for anti-HIV
antibodies and HIV antigen detection and a follow-up at 1,3,6 months is proposed. AZT
therapy is evaluated in each single case.
Results: Exposures involved 92 nurses (65.7%), 39 physicians (27.9%), 3 housekeeping/maintenance workers (2.1%), I lab technicians (0.7%), 5 others (3.6%).
Distribution by type of exposure was: 74 needlestick (52.8%), 25 intact skin contact
(I 7.9%), 25 non-intact skin contact (I 7.9%), 16 mucosal contact ( I.4%). Fourteen of 74
reedlesticks (I 8.9%) were due to recaping. Among HCWs 60.7% only observed the
Universal Precautions (UP) asnd 10.6% didn't observe even if they knew the seroposivity of
source patient. Follow-up was completed in 89.5% cases. No anti-HIV seroconversion has
been registered.
Conclusion: The increased number of subjects who completed the clinical-serological follow-up shows that HCWs become more sensitive towards the control program suggested