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

162 Abstracts 13376-13380

12th World AIDS Conference

1133761 Children with HIV/AIDS in Russia
Elena Vedmed. Oktyabrskya Nab. 84 Corp. 4 Apt. 9, St Petersburg, 193079,
Russia
Issue: HIV-positive children and their families in Russia are one of the most
vulnerable groups. Families suffer from discrimination and a hostile environment,
and often break up under the pressure. The number of neglected and abandoned
children is growing, along with the rapid growth of the epidemic.
Project: Together Against AIDS Fund is a hospital-based NGO in St. Petersburg. Many patients in the hospital are children with HIV/AIDS who were either
infected in hospitals in early 90-s or born of HIV+ mothers; 10 children who were
abandoned by their parents live in the hospital.
Results: Together Against AIDS Fund offers legal, social and material assistance to HIV+ children and their families; finds families suitable for adopting HIV+
children and supervises the adoption process; organizes educational sessions
for parents of HIV+ children, and yearly Christmas vacations for the families.
Lessons Learned: A medical institution and an AIDS NGO can be complementary in providing comprehensive care, support and assistance to families and
children affected by HIV.
S13377 Playing again: Psychology and affection in an
intervention with children affected by AIDS in poverty
stricken area
Harley Nascimento Henriques', M.T. Vilaga2, M.B. Schmalb2. 1R. Manoel Dias
Moraes 25 JD Apipema Ondina Salvador - Bahai; Grupo de Apoio A 2Prevengao
A AIDS-Bahia, Salvador, BA, Brazil
Issue: In the Northeast of Brazil, 90% of the children affected by HIV/AIDS live in
a very needy social and financial situation, reflecting in their nourishment, which,
together with a permanent condition of deep depression, form a set of factors
impairing their therapeutic process.
Project: GAPA-BA (Support Group for the Prevention of AIDS in Bahia, Brazil)
has set up a programme to care for children affected by HIV/AIDS. This programme aims at a better and more effective therapeutic process for these children
which would reflect in their higher quality of life. The work tries to re-insert them
into children's realm through the use of recreational therapy strategies which
strengthen their self-esteem, and protect their right to express their fantasies and
feelings.
Other strategies which comprise the project methodology are: psychological
care for the children and their families; training courses on nutrition, nursing,
psychological and affective aspects offered to families and housing institutions;
and the organising of a network to donate food for the poorest children.
Results: The programme has an ever-growing acceptance among medical
doctors, families, and particulary, children. It was noted that about 80% of them
(about 90 children) has showed a crescent interest and participation in the activities offered which work as an auxiliary therapy supplementing medical and
nursing care.
During the first six months of the projects, 45 families were registered and attended to, 160 monthly - food-supply baskets were distributed among the poorest
twenty children, and thirty health professionals took part in first training course
offered by the programme.
Lessons Learned: This programme shows the need to set up recreational
activities for children with HIV/AIDS through which we can manage children's
stress, help medical intervention as well as promote the reunion of different
publics involved in caring for them.
13378 Mother-to-child transmission: Survival analysis of 1,066
cases from 1987-1994, Sao Paulo, Brazil
Luiza H. Matida', L.K. Marcopito2. 'STD/AIDS Program, R Antonio Carlos
122-Sao Paulo CEP:01309-010, San Paulo; 2Escola Paulista De Medicina, Brazil
Objective: To determine changes in time until diagnosis (DDX), and risk factors
for death, in AIDS-disease from mother-to-child transmission, from 1987 to 1994,
in children aged 0-12 years at the date of diagnosis, in cases reported to the
State of Sao Paulo epidemiological surveillance system.
Method: Cohort analytical study with secondary data. Setting: The State of So
Paulo, Brazil. Entered the study: 1.066 children with AIDS-disease ascertained to
be from mother-to-child transmission, diagnosed until December 31, 1994, and
whose individual reporting forms reached the official system by December 31,
1995. They were followed up to June 30, 1996; 116 children were right-censored
due to losses to follow-up. Statistical methods: Kaplan-Meier and Cox proportional hazard analysis. Were considered: time in months (mo) elapsed from birth
(DOB) to DDX, according to year of birth. Eighteen-month survival time after
DDX, according to gender, year of DDX, and age at DDX.
Results: The median time from DOB to DDX decreased from 31.6 mo for those
born in 1987 and earlier, to 2.9 mo for those born in 1994 (p = 0.0000). For death
in 18-months, the Hazard Ratios (and 95% CI) are persented in the table.

higher risk of death than boys. The risk of death in 18 months decreased with the
diagnosis made in more recent years, and with increasing age at diagnosis.
13379 Gender-specific differences in HIV-1 RNA level in a
longitudinal study of HIV-1 seroconverters
Timothy Sterling1, C. Lyles2, T.C. Quinn2, J. Astermborski2, J. Margolick2,
G. Macalino2, D. Vlahov2. 1Ross Bldg Room 1159 720 Rutland Ave Baltimore
MD 21205; 2Johns Hopksins Univ School of Hygiene Baltimore MD, USA
Objective: HIV-1 RNA level (VL) at the time of seroconversion (SC) is an independent predictor of progression to AIDS in men, but has not been well studied
in women. We assessed the natural history of HIV infection after SC in women
and compared it to that in men.
Design: Nested case-control study.
Methods: Cases and controls from a longitudinal cohort study of HIV infection
among 2,960 injection drug users in Baltimore, MD. Between 3/89 and 7/96 there
were 215 HIV-1 seroconverters. Cases were seroconverters who developed AIDS
prior to 7/1/96 who had at least 3 VL's between the date of SC and diagnosis of
AIDS. Controls were AIDS-free seroconverters with at least 3 VL's after conversion. There were 24 cases and 47 controls, matched for date of SC, age at SC,
and follow-up time after conversion. VL was quantified using RT-PCR (Roche).
There has been no difference in the cohort between the % of women and men
who receive antiretrovirals.
Results: Data in table: 1st visit after SC. Length of follow-up similar for women
and men. In regression analysis, controlling for case-control status, months after
SC, and CD4 at SC, VL remained lower among women compared to men (p
= 0.001). This difference persisted when all VL's after SC were included in the
analysis.
Conclusions: Initial VL after HIV seroconversion was significantly lower among
women compared to men, and this difference persisted throughout follow-up. This
suggests a sex-specific difference in VL. The current recommendations regarding
the appropriate HIV-1 RNA level at which to initiate antiretroviral therapy may
need to be reassessed for women.

Median
VL @ SC
CD4 @ SC
Mos p SC
Age @ SC
1133801

Males (51) Females (20)
69,020 14,918
724 787
4.5 4.3
33 32

p value
0.001
0.18
0.63
0.18

CCR5-genotype and CC-chemokine levels are not
significantly different in infected and uninfected
recipients of a HIV-1 contaminated clotting factor
concentrate

Rolf Kaiser1, B. Kupfer', J.K. Rockstroh2, P. Beicht', H.H. Brackman3, B. Matz',
K.E. Schneweis'. Institute of Medical Microbiology, Sigmund Freud Str 25,
Bonn; 2Department of Medicine, Bonn; 3lnstitute of Experimental Hematology
Bonn, Germany
Background: In 1989/90 seven hemophiliacs were clonally HIV-1 infected by a
virus-inactivated clotting factor concentrate in Bonn. Ten hemophiliacs, who were
recipients of the same lot were not infected.
Objectives: A) To investigate whether the uninfected recipients were protected
by a genetic defect in the CC chemokine receptor 5 (CCR5) -gene and/or by
significantly higher levels of the CCR5-ligands RANTES, macrophage inflammatory protein 1 alpha and beta (MIP-le, MIP-1/I). B) To investigate whether
the differences in the course of disease in the HIV-1 infected patients can be
explained by the CCR5 genotype or different levels of CC chemokines RANTES,
MIP-la and MIP-1.
Methods: The CCR5 gene from 6 HIV-1 infected and 7 uninfected hemophiliacs
was amplified by PCR. The resulting DNA fragments were separated by agarose
gel electrophoresis and stained with ethidium bromide. RANTES, MIP-la and
MIP-1/P levels were determined using commercial ELISAs. Plasma viral load was
measured by NASBA'" HIV-RNA QT System. CD4+ T cells were quantified by
flow cytometry.
Results: None of the uninfected recipients of the HIV-1 contaminated clotting factor lot had the delta 32 deletion within the CCR5 gene. Levels of CC
chemokines RANTES, MIP-la and MIP-1/p in the plasma were comparable to
those of healthy controls. One of the HIV-1 infected hemophiliacs had the heterozygous CCR5 genotype (CCR5/Accr5), but neither viral load nor CD4+ T
cell count were significantly better in this patient than in the patients with the
(CCR5/CCR5) genotype. Furthermore, we could not find a correlation between
viral load and CD4+ T cell count on the one side and the levels of the CCR5
ligands on the other side.
Conclusions: A genetic defect in the CCR5 gene and/or increased levels of
RANTES, MIP-la, and MIP-1/p are not the reason for protection of 7 investigated
hemophiliacs against HIV-1 infection by a contaminated clotting factor concentrate. The different courses of HIV-infection of 6 clonally infected hemophiliacs
are caused by host specific factors other than CCR5 genotype or CC chemokine
levels.

Gender
Male = 1.00
Female = 1.26 (1.07-1.49)

Year of DDX
1987 = 1.00
1988-91 = 0.59 (0.37-0.96)
1992-94 = 0.45 (0.28-0.72)

Age at DDX
<6 mo = 1.00
6-9 mo = 0.44 (0.33-0.58)
>9 mo = 0.26 (0.22-0.31)

Conclusion: There was a great reduction in the time until diagnosis of AIDSdisease from mother-to-child transmission from 1987 to 1994. Girls were at