Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 61000-61004 1183

within 12 weeks of HAART initiation; 19 had a significant ( 1 log) drop in plasma
viral load.
Conclusion: Some patients who respond to HAART are at risk of activation or
reactivation of an 01 or neoplasm and respond poorly to medical interventions. It
has been suggested that restoration of cell-mediated immunity by antiviral therapy
could lead to disease activation by return of responsiveness to antigenic stimili.
Prospective case controlled studies with immunologic correlates are needed to
evaluate the incidence and nature of the syndrome.
61000 Long-term suppression of plasma viremia despite
antiviral discontinuation for 14 months
Joseph Gathe Jr., Didier F. Piot, E.W. Stool, C.C. Mayberry. 1200 Binz, Suite#
120, 77004, Therapeutic Concepts, PA., Houston, TX, United States
Objective: To demonstrate durable suppression of plasma viremia in a patient
despite antiviral discontinuation.
Design: Retrospective chart review of patient follow prospectively by the authors.
Method: 58 year old male HIV positive for 8 years was begun on AZT and
delavirdine as part of Upjohn protocol 021. Medications were taken from July
1994 until July 1996 when DDI was added.
Results: In November 1996, all medications were discontinued due to cardiomyopathy. THe patient has remained free of plasma viremia (25 Roche
Ultrasensitive Assay) for 14 months despite multiple acute internal medicine
problems (heart failure, hyperparathyroidism). CD4 counts have remained stabe
in the 400-500 range.
Conclusion: Though uncommon, it is possible that antiviral therapy can lead
to prolonged suppression of plasma viremia despite medication discontinuation.
Evaluation of clinical as well as viral specific and immunologic correlates is
warranted.
61001 Antiretroviral therapy prescription profile in a multicenter
cohort of HIV+ pregnant women in Rio de Janeiro, Brazil
Guilherme Calvet. Rua Antonio Basilio 519/702, Tijuca, Rio de Janeiro,
CEP-20511-190, Brazil
Introduction: In Brazil, combined antiretroviral therapy is the standard of care
for HIV-infected patients since March 1996. AZT monotherapy, however, is still
accepted to reduce vertical transmission when HIV+ pregnant women do not fit
other criteria to start antiretroviral therapy or deferral use of other antiretroviral
therapy.
Objectives: In order to describe antiretroviral therapy prescription profile and
occurrence of side effects to mothers and newborns in a multicenter cohort of
HIV+ pregnant women in Rio Janeiro, Brazil.
Methods: Data from a HIV+ pregnant women multicenter open cohort were
analyzed using Epilnfo 6.0. Women who delivered between July/1995 and December/1997 were included in the study. Data about ARV prescription, CD4 count,
clinical status before ARV therapy, side effects to mothers, fetus and newborns
were collected.
Results: A total of 136 pregnant women were included in a multicenter cohort
between July/1995 and December/1997. 106 pregnant women delivered in this
period, mean age was 29.7 years (SD 6.0) and mean gestational age 24.6 weeks
(SD 9.2). CD4 counts were available for 87 (82%) patients, mean CD4 was
464.1 cells/mmm3. 35 (40.2%) pregnant women had CD4 - 500 cells/mm3, 43
(49.4%0 had CD4 between 200 and 500 and 9 (10.3%) CD - 200 cells/mm3.
Seventy-seven pregnant women received AZT monotherapy, 28 received double
therapy and 1 received triple therapy including a protease inhibitor. All but 2
newborns received AZT during 6 weeks after birth. Congenital malformations
were observed in one RN. No changes in treatment were necessary both for
mothers and newborns.
Conclusions: 1. The increase in the number of pregnant women receiving
combined therapy is in accordance with the concept that women should receive
the best treatment in spite of her pregnant condition. 2. Combined ARV therapy
was well tolerated in this group. 3. In spite of the short time of observation, congenital defects were rare and, in the group that is associated with combined therapy,
even among those newborns from mothers who became pregnant already using
ARV.
61002 Feasibility of AZT use to reduce HIV vertical transmission
in Rio de Janeiro, Brazil
Esao Joao. Rua Alzira Cortes 5/308, Botafogo, CEP 22260-050 Rio de Janeiro,
Brazil
Introduction: HIV epidemic is a serious problem in Brazil. The evidence that
AZT can significantly reduce vertical transmission (VT) led the Brazilian Federal
government to provide oral and i.v. AZT to pregnant women and AZT syrup to
their newborns as a strategy to reduce HIV VT.

Objective: To evaluate the feasibility of administrating oral, i.v. and syrup
AZT to HIV-infected pregnant women, as well as their newborns in 3 HIV/AIDS
reference center in Rio de Janeiro (Vertical Transmission Study Group).
Methods: Form a multicenter open cohort of HIV-infected pregnant women
conducted at 3 reference centers for HIV/AIDS data about those who had delivered between January/1996 and December/1997 were analyzed using Epilnfo
6.0 software. All pregnant received information about HIV VT, benefits and re
strictions of AZT use, and recommendations for newborn formula feeding. AZT
capsules, i.v. and syrup were provided at no cost for the patients.
Results: From January/1996 to December/1997 136 pregnant women were
included in the cohort, 8 (5.1%) were lost from follow-up in any time before delivery
and data about them was not analyzed; 106 gave birth to 107 live infants. Most
of the pregnant were asymptomatic 101/136 (89%), 122 (90%) were infected
through sexual exposure. The mean gestational age at cohort inclusion was 27
weeks. All of them received oral AZT during pregnancy and 96 (91.5%) i.v. AZT
during labor and delivery. 102 (96.2%) newborns received AZT syrup at least
during hospitalization. The 4 newborns who did not receive AZT syrup were born
out if reference centers. Identified reasons to have not received i.v. AZT were:
no availability of the drug at the time of delivery (5/10), delivery out of reference
centers (3/10), hospitalization at late stage labor (2/10).
Conclusions: 1. The acceptance rate by pregnant women was high as well as
compliance to treatment. 2. Although complex, administration of oral and i.v. AZT
to HIV pregnant women and AZT syrup to their newborns is feasible at least in
reference centers for HIV/AIDS in Rio de Janeiro.
S61003 Molecular epidemiology of HIV/AIDS in southern Brazil
Carlos Antunes. Parasitologia - ICB-UFMG, Caixa Postal 486. 31270-901 Belo
Horizonte, Brazil
Objectives: More than 90% of sub-typed Brazilian HIV belongs to the B group,
slightly different from US HIV B. Previous preliminary reports from anonymous
testing indicated the occurrence of a higher than expected proportion of sub-type
C (30%) in southern Brazil. This epidemiological study (1) identifies the HIV
sub-types isolated from a random sample of HIV/AIDS patients diagnosed in Rio
Grande RS, southern Brazil, and (2) investigated the issue of host characteristics
and different modes of HIV transmissions and possible association with the HIV
sub-type.
Methods: One hundred patients were interviewed regarding HIV infection and
AIDS risk factors (age, sex, sexual preference, i.v. drug use, among others); their
medical records were abstracted for clinical and laboratory data (incubation period
for AIDS development, opportunistic infections, CD4, among others). Blood was
obtained from 86 patients and treated with Ficoll-Faque density gradient media
for PBMC separation. The resulting lysate was used for DNA extraction, which
was amplified by PCR (gp 120 and 41). The sub-type identification was done by
the heteroduples technique (HMA).
Results: The study population had a mean age of 32.5 years and 805 were
male. Being homo/bisexual was reported by 27%, heterosexual with several partners by 36% and i.v. drug use by 28%. HIV infection was the diagnosis for 62%,
whereas AIDS was reported from 38%; among those, tuberculosis was the AIDS
defining condition in 60%. Prophylaxis against Pneumocysts and Toxoplasma
was reported for 68%, whereas 64% were receiving AZT. CD4 less than 500
was found for 27%. HIV sub-type B was identified in 93%, sub-type C in 6% and
sub-type C/F in 1% of the samples, respectively.
Conclusions: Over 90% of HIV-infected patients in Rio Grande, southern
Brazil, were found to belong to the Brazilian sub-type B, similar to the country
distribution. Among the risk factors investigated, none appeared to be associated
with sub-types C or F. The discrepancy with the results from the preliminary reports
(anonymous HIV testing) is probably due to the non-existence of epidemiological
information from those volunteers.
61004 STD and other gynecological manifestations -
A cross-sectional study in a cohort of HIV-infected
women in Rio de Janeiro, Brazil
Beatriz Grinsztejn. Rua Alzira Cortes 05/308, Botafogo, Rio de Janeiro
CEP-22260-050, Brazil
Objective: 1. To estimate the prevalence of STD and other gynecological manifestations in HIV-infected women. 2. To describe their clinical and immunological
profile.
Methods: From 04/96 to 12/97 a cross-sectional study was conducted in a
cohort of HIV-infected women followed at Evandro Chagas Hospital (HEC). Participants were submitted to clinical od pelvic examination and to colposcopy.
Chlamydial and GC screening in urine were performed using LCR. Wet mount,
gram stain, Ph, whiff test and cultures were performed as well as screening for
syphilis and hepatitis B and C. Cervical swabs were collected for HPV diagnosis
by hybrid capture.
Results: As of Dec/97, 175 women were recruited into the study. In this abstract
we report results for the first 92 women. Mean age was 33.4 years (SD 8.3); 73%
were sexually infected, 3.2% through blood transfusion and 2.1% reported IVDU.
A bisexual partner was reported by 13% and a IVDU partner by 18.4% 61.5% had
only one partner in the last year and 23.1% had none. Mean CD4 count was 437
cells/mm3 (SD 291.9). Disease stage at first visit was G-Il/Ill in 25.8 and G-IV in
41.3% 73.6% were taking antiretrovirals. Recurrent vaginal candidiasis was the
most frequent manifestation associated with HIV infection whereas tuberculosis
was the most frequent AIDS defining illnesses. Vaginal candidiasis was diag
nosed in 37%, bacterial vaginosis in 31.5%, genital warts in 10%, GC cervicitis,
chlamydial cervicitis, CMV vulvovaginitis and trichomoniasis in 1%, each syphilis
serology was positive in 6.5%, hepatitis B in 10% and hepatitis C in 8.9%. PAP
smear revealed HPV in 18%, NIC I in 16%, NIC II in 2.6% and NIC III in 5.3%
Conclusions: 1. Except for HPV, syphilis and hepatitis, a relatively low prevalence of other STD was observed. This finding may be associated with the low
number of sexual partners and the frequent use of antibiotics by HIV-infected