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

12th World AIDS Conference

Abstracts 13371-13375 161

virus parameters in infected infants receiving mother/infant prophylactic ZDV and
infants not receiving prophylaxis.
Methods: 167 HIV infected infants were followed from birth to at least 1 year of
age. 146 infants had data to evaluate endpoints (HIV-related death, CD4 decline,
growth failure or AIDS defining condition) occurring in 1st 18 months of life. 93
mother/infant pairs received no prophylactic ZDV; 30 received 076-like regimen,
14 received maternal ZDV only, and 1 pair received infant ZDV only.
Results: Of 113 infected infants with culture/PCR in 1st 7 days of life, 24
(30%) were virus positive in 1st 7 days (EARLY) and 79 (70%) were virus positive
only after 1st 7 days of life (LATE). EARLY virus detection was associated with
significantly increased risk of RP (OR = 3.21, 95% C.I. 1.24-8.29). Virus load was
not appreciably higher after 2 weeks of age in infants with EARLY detection vs
those with LATE detection. RP had significantly higher peak log10 RNA than SP
in 1 st 3 months of life (med 5.82 vs 5.37, p =.0001) and 1st 18 months of life (med
6.08 vs 5.58, p =.0001). EARLY virus detection, longitudinal trajectory of infant
RNA, and peak RNA were not different with ZDV prophylaxis of mother/infant.
Conclusions: Early predictors of RP are virus detection during first 7 days
and high peak RNA in first 3 months of life. High peak RNA in first 18 months
is also associated with RP. Study limitations: 3 of 4 cohorts are nonrandomized,
observational studies; differences in RNA levels among cohorts.
13371 Disease progression in perinatal HIV-1 infection
Maurizio De Martino', P.A. Tovo 2, L. Galli, C. Gabiano2, M. Zappa3. 1Dept. of
pediatrics-Via L. Giordano 13 50131 Firenze, Italian Reg. HIV Infect. In Children,
Dept of Pediatrics; 2Dept of Pediatrics-PZZA Polonia, 94, Torino; 3Epidemiology
Unit-ASL 10, Italy
Objective: To define the course of perinatal HIV-1 infection at 8 years.
Methods: Survival and smoothed hazard curves of 366 children derived
prospectively were plotted and the person and sojourn-time in clinical and
immunological categories, transition probability, and life expectancy were determined.
Results: Survival was 49.9 (40.6-58.5) % at 8 years of age. Highest risk of
death was before the age of 2 and after 7 years. Category A selected children had
a longer life expectancy [160.2 (116.2-227.6) months]. Children spent most time
in category B and category 3. The probability of entering category C at 8 years of
age was 62 (34-70)%. The probability of entering category 3 was 57 (60-74)%.
Long-term non-progressors (N1 or Al) were 2.9 (0.6-5.8)%. Survival 5 years
after entering category C was 18.5 (11.3-27.1)%, and after entering category 3
was 18.5 (8.2-28.7)%. Longer permanence in each of the categories was associated with Pneumocystis carinii pneumonia chemoprophylaxis and antiretroviral
treatment.
Conclusions: Infection progresses slow, but the risk of death is high in infancy
and late childhood, and long-term non-progression is exceptional. Children do
not advance through the categories in sequence.
13372 Epidemiology of the children born to HIV-infected
mothers in Valencia (Spain)
M. Carmen Otero Reigada', Miguel Angel Calvo Bermudez2, D. Perez-Tamarit2,
R. Sirera3, J.L. Lopez-Hontangas4, D. Moya2, A. Gonzalez-Molina3, F. Asensi2.
'Albacete, 43-43 Valencia; 2lnfecciosos Hospital Infantil La Fe, Valencia;
3lmmunologia-Centro Invest. Hospital La Fe, Valencia 4 Microbiologia-Hospital
La Fe, Valencia, Spain
Objectives: A study of the epidemiology and the evolution of 372 patients controlled in the Children's Hospital La Fe in Valencia (Spain) during the last 11 years
(1986-1997). At present 367 children are followed (5 HIV-infected children are
controlled by another hospital).
Methods: 367 children born to infected mothers were enrolled. Clinical, serological (antigen, antibodies, PCR) and immunological evaluations were carried
out.
Results: 258 children were seroreverters; the mean age at seroreversion was
11.8 + 3.2 months (range between 3 and 20 months). 24 children were perinatally exposed). From the middle of 1994 up to now, the vertical transmission
rate among the treated pairs mother-infant dropped to 6.7% (5 cases out of 70)
against 20% among the non-treated (4 cases out of 20).
Of the 85 HIV-infected children (23.4%) controlled, 32 died (37.6%). Of the dead
children 22 cases, (68.7%) were under one year of age. The causes of mortality
were: pneumonia/sepsis in 18 cases (56.2%), 4 of them by pneumocystis carinii
pneumonia (12.5%), wasting syndrome in 7 (21.8%), heart failure in 2 (6.2%),
lung bleeding in 2 (6.2%), tumors in 2 (6.2%) and liver failure 1 case (3.1%). The
living infected children (53 cases) were classified (CDC-94): A1:11; A2: 6; A3: 4;
B1: 3; B2: 11;B3: 15; Cl: 0; C2: 1; C3: 2). At present, 37 children (69.8%) have
a protease inhibitor associated with their antiretroviral treatment with a better
clinical, immunulogical, and virological response.
Conclusions: 1) 70% of the children were seroreveters at the end of the first
year of life; 2) Perinatal treatment clearly reduced vertical transmission; 3) 68%
of the infected children died during their first year of life. This emphasizes the

importance of an early diagnoses and intensive treatment; 4) Prophylactic treatment is very important in children born to infected mothers; 5) Protease inhibitors
have a very good future in the treatment of pediatric AIDS.

419*/13373 AIDS orphans in direct support
Rose Florence Atibuni Drop', Alia Penin Ah2, Mary Andiandu2, Alice Olea2.
'Arua Hospital PO. Box 4 Arua; 2PWAFSA Orphans Foundation, Uganda
Issue: AIDS orphans in poor social backgrounds are exposed to social stigma
causing them to have low self esteem especially the girl children.
Project: People with AIDS Family Support Association (PWAFSA) Orphans
Foundation was started in 1994 as a child to child social support group for children
orphaned by AIDS between 6-18 years old in Arua Regional Hospital. The main
aim of the project was to provide an opportunity for the children to interact with
their peers and learn to live with challenges when they lose one or both parents.
Membership of the girl children has been encouraged more than the boy because
girls often become mistresses of the their late parents homes, they are even
exposed to sexual harassment and abuse. The children are taught facts about
HIV/AIDS and they have a performing Drama group to give AIDS education to the
local community. Their membership has been rising from 28 in 1994 to 42 in 1997.
Results: The children have learnt facts about HIV/AIDS, they have developed
a sense of belonging and esteem. Through their activities they are able raise
funds for the group.
Lesson Learned: Children affected by HIV/AIDS can learn to support one
another to survive therefore communities could promote such groups to improve
their quality of life.
13374 Maturational changes in peripheral lymphocyte subsets
pertinent to monitoring HIV-infected Chinese paediatric
patients
Kai Man Kam', M.Y. Kwok", W.L. Leung, K.H. Wong2, K.O. Yu', S.L. Wong'
M.Y. Hung'. 'Inst. of Pathology, Sai Ying Pun Clinic, Hong Kong; 2AIDS Unit,
Dept. of Health, Yaumati CLinic, Hong Kong, China
Objectives: To study the maturational changes in peripheral lymphocyte subsets
that are pertinent to monitoring HIV-infected Chinese paediatric patients.
Design: Prospective, blinded study.
Methods: Consecutive healthy HIV-1 negative ethnic Chinese paediatric patients seen in a hepatitis B vaccine follow- up clinic and as routine outpatient
health check were included. Fresh peripheral venous blood was taken and tested
with a flow cytometer (FACScan) using SimulSet software, staining for CD3+,
CD3+/CD4+ (CD4), CD3+/CD8+ (CD8) cells and expressed as % lymphocytes
and CD4+/CD8+ ratio (H/S ratio). Those with any evidence of acute or recent infections or were put on medications were excluded. Control panels were set up similar
to those used in establishment of adult lymphocyte subset reference ranges.
Results: A total of 104 patients were tested aged, in years, A: 0-1 (9), B: 1-2
(18), C: 5-7 (37), D: 9-12 (40). CD4 (SD) dropped from A: 44.9% (10.1%) to B:
41.5% (4.8%) and then more steeply to C: 34.4% (6.9%), and relatively stabilized
until D: 34.2% (5.2%), while CD8 increased steadily from A: 25.1% (4.6%), B:
27.2% (4.5%), to C: 28.6% (6.0%), D: 29.5% (5.1%). CD3 increased from A:
65.1% (10.3%) to B: 69.2% (6.0%), more slowly to C: 70.1% (6.1%), and then
slightly decreasing to D: 68.6% (6.4%) before attaining adult levels. H/S ratio
dropped from A: 1.8 (0.4) to B: 1.6 (0.4), then appeared to stabilize at ages C:
1.3 (0.4) and D: 1.2 (0.3).
Conclusion: We studied the maturational changes in lymphocyte subsets
which are most relevant to monitoring HIV-infected Chinese paediatric patients,
and provided a set of values that will be useful in establishing reference ranges
for clinical immunology laboratories, as well as in interpretation and application
of relevant treatment and prophylaxis guidelines for this group of HIV- infected
paediatric patients.
13375 Disease patterns and survival in children with AIDS in
Buenos Aires, Argentina
Rosa Bologna, Patricia Trinidad, Luis Carniglia, Liliana Czornyj,
Cecilia Procak-Psaros, Julia Redondo, Jose Torolla. CNEL Diaz 1846 8C, 1425,
Hospital Garrahan Buenos Aires, Argentina
Objectives: to assess the clinical course and estimate post-AIDS diagnosis
survival in a cohort of children with perinatal. AIDS diagnosed in Buenos Aires.
Methods: Disease patterns and survival after the diagnosis of AIDS were
studied in 279 children who were followed prospectively over 108 months in a
referral center in Buenos Aires. The length of survival and the impact of different
variables were determined using Kaplan-Meier product limit method and Cox
proportion hazards regression.
Results: The median age at diagnosis was 10 months. Most frequent first
AIDS conditions (ADC) were: Recurrent Bacterial Infections (RBI, 33%), HIV encephalopathy (32%), Lymphoid Interstitial Pneumonitis (22%) and Opportunistic
Infections (01, 13%). The overall median survival from diagnosis was 86 months.
For 01 and RBI, the median survival post-diagnosis was 63 months and 86
months, respectively. The overall case fatality rate was 31 percent. Mortality was
highest among those children younger than 48 months (53% vs 16%; p < 0.0001).
Survival did not differ significantly by sex or pattern of disease. By Cox regression

analyses age at diagnosis and antiretroviral therapy were significantly related
to survival. The impact of treatment was significant in children younger than 48
months.
Conclusion: Median post-AIDS diagnosis survival time in this cohort was 86
months. Although survival estimates improved for those receiving antiretroviral
treatment, early age at diagnosis of AIDS was still found to be and indicator of
poor prognosis in children with AIDS.