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

12th World AIDS Conference

Abstracts 13361-13364 159

Results: In the HOOD, 34 individuals (1.8%) of the 1891 with no missing data
met the criteria for LTNP. Thirty were male and 4 were female. Mean age = 43
yrs. (SD 7.86, range 31-61 yrs). Mean number of years HIV+ was 9.0 yrs, range
= 7-12 yrs. Risk categories were: MSM: 70.6% (n = 24) vs. 77.2% (n = 1538),
MSM/IDU 5.9% (n = 2) vs 9.4% (n = 188) IDU 8.8% (n = 3), heterosexual 8.8% (n
= 3), other 5.9% (n = 2). Ethno-racial categories were: Caucasian 77.3% (n = 17),
Aboriginal 9.1% (n 2), Asian 9.1% (n = 2), and other 4.5% (n = 1). In the HOOD,
208 people had CD4+ cell count -500, mean = 638 cells/mm3. The mean CD4+
cell count for LTNP was higher: 686.97 cells/mm3. In the MOH database, 228
(3.3%) individualswere identified as possible LTNP for prospective study (CD4+
cell counts -500 copies/mm3, viral load <500 copies/mm3 and ART naive).
Conclusions: A very small proportion of the HIV-infected population meet
the criteria for LTNP. Most studies of LTNP are limited by sample size and absence of viral load and immunologic data from early disease. Large observational
databases are an effective means to identify "true" LTNP to increase samples in
ongoing studies. By identifying 228 potential LTNP, a cohort can formed to characterize the immunologic and virologic changes in early disease which distinguish
true LTNP from normal progressors.
13361 Pattern of HIV-1 RNA load from birth to school-age in
perinatally HIV-1 infected children
Lars Naver1, A.-B. Bomlin2, E. Belfrage3, A. S6nnerborg2, G. Lidin-Jansson4,
B. Christensson5, A. Emrnst6. 1Department of Pediatrics, Muddinge Hospital,
14186 Muddinge, 2Muddinge University Hospital Stockholm; 3Danderyds
Hospital Stockholm; 4Samlgrensua University Hospital/East Gothenburg; 5Lunds
University Hospital Lind; 6Karolinsua Institutet Stockholm, Sweden
Background: There is little information about the natural history of viremia in
vertically HIV-1 infected children beyond the first years of life.
Methods: We studied viral load in plasma and/or serum in 31 perinatally HIVinfected children, 20 of them prospectively followed from birth. The children's age
at last sampling varied between 5 and 139 (median 61) months. For detection of
HIV-1 RNA copies in plasma or serum we used the NASBA HIV-1 RNA QT kit,
from Organon Teknika.
Results: 144 samples were analysed, 1-14 (median 3) from each patient. The
highest numbers of HIV RNA copies were seen at 1.5 months (0-8.1 x 106
copies/ml, median 210 000, n = 7) and at 3 months of age (0-510 000, median
270 000, n = 7). This peak was followed by lower levels during the remaining
part of the first year. Thereafter the HIV-1 RNA numbers remained at relatively
high, although slowly decreasing levels, for several years. When analysing the
last available sample from each patient after one year of age (n = 29) we found a
gradual reduction of HIV-1 RNA with increasing age, with a slope of -0.164 log
copy/ml/year (p = 0.0009, 95% confidence interval -0.26 to -0.07). The HIV-1
RNA levels of children with early (-6 months) HIV associated symptoms were
compared with those of long term (.5 years) asymptomatic children. At 12-18
months and 3-4 years of age children with early symptoms had significantly (p
= 0.043) higher HIV-1 RNA levels than the long term asymptomatic children.
However, also in the long term asymptomatic children the HIV-1 RNA levels were
relatively high and fluctuating during several years.
Conclusion: Knowledge about the natural history of the viremia in perinatally
HIV-infected children is important for interpretation of the results from quantitative
viral measurements with regard to therapeutic and prognostic considerations.
The slow decrease in viral load over several years could possibly reflect that the
children's immune system is less effective than the adult's in combating the viral
infection.
13362 Increase based AIDS-free survival among children with
recent perinatal HIV-1 infection
Vadim Pliner', E.J. Abrams2, E.A. Schoenbaum3, G. Lambert4, M. Bamji5,
R.J. Simonds6, D.M. Thea1. Medical and Health Research Association; 'NYC
Perinatal HIV Transmission Study, 125 Worth St., Box 44, New York, NY 10013;
2Harlem Hospital Center, New York, NY; 3Albert Einstein College of Medicine,
New York, NY; 4Bronx Lebanon Hospital Center, New York, NY; 5Metropolitan
Hospital, New York, NY; 6Centers for Disease Control and Prevention, Atlanta,
GA, USA
Objectives: To test the hypothesis that HIV-1 disease latency has increased in
recent years among perinatally infected children.
Study Design: An observational cohort study of perinatal transmission and disease progression among children born to HIV-infected pregnant women enrolled
into the NYC Perinatal HIV Transmission Collaborative Study.
Methods: A statistical survival analysis of 190 HIV-1-infected children born
1986-1997 at 8 medical centers in New York City.
Results: Year of birth was significantly associated with AIDS-free survival
(log-rank test p - 0.01), and remained significant after adjustment for maternal characteristics that have changed over time: timing of enrollment (pre vs
post-partum); and ZDV, alcohol or hard drug use during pregnancy (p < 0.01 in
Cox proportional hazards model). Age at AIDS onset was significantly greater

among children born later in the epidemic (1992-1997) than earlier (1986-1991)
(log-rank test p. 0.01). Kaplan-Meier estimates of AIDS-free survival were as
follows:
Age in years: 0.5 1 2 3 4 5
Born 1986-1991 (n = 73) 78% 64% 49% 40% 40% 37%
Born 1992--1997 (n 117) 88% 75% 68% 62% 62% 62%

The increased use of PCP prophylaxis (Mantel-Haenszel chi-square test p <
0.01) and of ZDV before AIDS (p < 0.01) over the study period may partly explain
the increased recent survival to AIDS.
Conclusions: A significant increase in AIDS-free survival among perinatally
infected children was observed during this 12 year prospective study. More
widespread use of prophylactic treatments, antiretroviral medications, and increased experience of clinicians in treating HIV-infected pediatric patients appear
to be responsible for a substantial improvement in disease progression among
perinatally infected children in recent years.
175*/13363 Aging cohort of perinatally HIV-infected children in
New York City (NYC)
Pauline Thomas1, Thomas Mundy1, E.J. Abrams2, K. Bornschlegel',
A. Brooks1, T.P. Singh1, J. Bertolli3. 1NYC Dept. of Health Rm. 706 Box 44 346
Broadway, New York, NY; 2Harlem Hosp. Columbia Univ., New York, NY;
3Centers for Disease Control & Prevention, Atlanta, GA, USA
Background: Declining births to HIV-infected women in NYC, declining perinatal
transmission due to ZDV prophylaxis, and increasing survival due to medical
therapy should lead to an older cohort of perinatally infected NYC children.
Objective: This paper describes factors contributing to this aging cohort of
perinatally HIV-infected children.
Methods: Data are abstracted on HIV-infected children diagnosed <13 years
old and followed at 10 NYC sites in CDC's Pediatric Spectrum of HIV Disease (PSD) project. Data include antiretroviral (ARV) and prophylactic therapy,
and CD4+ counts. New York State blinded newborn HIV serosurvey data are
examined for PSD sites.
Results: One-third of NYC births to HIV+ women are at PSD sites, 299 in
1996, a decline of 33% from the peak 447 in 1990. Among 1,959 children born
1989-96 and identified as HIV-exposed by 3 months of age, HIV infection status
is known for 1605. Of these, proportion HIV-infected declined by year of birth from
32% 1989-91, to 18% 1994-96. Median age at AIDS diagnosis increased from 2
years in 1989 to 4 in 1996. Median age of HIV-infected children in care increased
from 4 years in 1990 (n = 436) to 7 in 1997 (n = 645 including 72 teens).
Therapies in 1997 for PSD children by level of immunosuppression (IMSUP) based on CD4+
count
IMSUP level N (%) % no ARVs % 1-2 ARVs %--2ARV % TMP-SMX
None 72(11) 35 25 40 12 (not including infants)
Moderate 208 (32) 22 58 20 22
Severe 360 (56) 7 58 35 67
Conclusions: Based on PSD data, current median age of perinatally-infected
NYC children is 7 years. Median age at AIDS diagnosis is rising, due both to
falling numbers of HIV infected newborns (resulting in a smaller contribution of
young patients), and to aggressive care as shown by proportion on multiple
ARVs and PCP prophylaxis, delaying onset of severe immunosuppression and
opportunistic illness. Pediatricians in NYC are preparing for new issues in the
care of an increasingly preadolescent and adolescent HIV-infected group.
S13364 CD45RO+ and CD45RA+ cells in HIV-infected children,
observation before and after therapy
Desiree Caselli1, A. Maccabruni2, G. Gorolli3, R. Gulminetti4, K. Klersy5,
I. Pacati2, L. Minoli2. Pediatric Department IRCCS Policlinico San Matteo A2
Golgi 2 27100 Pavia; 2Department Inf. Dis IRCCS Pol. San Matteo Pavia, 3lnfect
Dis. Laboratory Research IRCCS Pol. S. Matteo; 4Biotechnology Research
Laboratory IRCCS Pol. S. Matteo Pavia; 5Direzione Scientifica IRCCS Pol. San
Matteo, Italy
Background: some studies suggest current therapy of HIV infection may improve
immunological function in HIV infected children. In order to evaluate this issue
we investigated a group of HIV infected children before and after combinated
antiviral therapy.
Patients and Methods:between 1994 and 1997 103 children (41 females,
mean age 36 months, range 0-158 months) were prospectively followed. Of
them, 23 were vertcally HIV infected (I) with mild diesease, 55 were seroreverted
(SR), and 25 were health controls (N); 11 of the infected children were followed
until today, 9 of them were studied also on antiretroviral therapy, including 4
who received protease inhibitors for more than 3 months (range 3-8 months).
CD4, CD8; CD45RA+, CD45RO+ peripherial blood lymphocitis were counted
using commercially avaiable monoclonal antibodies by the flow-cytometer (Ortho
Cytoron Absolute).
For statistical analysis: a generalized linear model was fitted to compare the 3
groups. Intrapatient correlation was accounted for while building the model.
Results: based on 236 observation (48 in I, 34 in SR and 154 in N) CD45RO+
values were not different in the 3 groups (mean values: I 6.09%, SR 6.4%, N
6.9%), on the contrary CD45RA+ were significantly higher in the infected group
(mean values: I 23.9%, SR 12.8, N 6.9% p = 0.017). Preliminary observation of

pre and post tretment data did not show any modification during therapy.
Conclusion: despite preferential infection of CD45RO+ cells and their depletion
observed in adults, HIV infected children have stable CD45RO+ and increased
CD45RA+ subsets. This may suggest a different kinetic of HIV infection in children.
This pattern is not affected by antiretroviral therapy.