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

400 Abstracts 23292-23296

12th World AIDS Conference

women. Only two children had to be diagnosed as HIV-1 infected, which means
a reduction of vertical transmission in this subgroup to 2.5%. The elective CS
without zidovudine treatment reached a transmission rate of 10.8%, the vaginal
deliveries with zidovudine alone a mother to child transmission of 7%.
Conclusion: Mother to child transmission of HIV type 1 was considerably
decreased (2.5%) in the German perinatal cohorts when combining the antiretroviral therapy (zidovudine) in pregnancy with an elective CS before onset of labor
between week 36 and 38 of gestation.
23292 1 The relative importance of antepartum antiretroviral
therapy versus intrapartum and neonatal treatment in
preventing maternal infant HIV transmission
David Burdge1,2, Deborah Money2, J. Forbes2, D. Patrick2. 1 Oak Tree Clinic B4,
4500 Oak Street, Vancouver, British Columbia V6H 3N1; 20ak Tree Clinic and
the University of British of Columbia, Vancouver, BC, Canada
Background: Antiretroviral therapy (ART) decreases rates of maternal infant (MI)
HIV transmission when given ante and intra partum to the pregnant woman and
post partum to the infant. This study was undertaken to better define the relative
importance of each component of ART in prevention of MI Transmission.
Methods: All MI pairs cared for in our HIV centre from Mar 1993 through Dec
1997 were reviewed regarding HIV outcome, maternal characteristics, obstetrical
details and ART received. Rates of MI Transmission were compared between (1)
MI pairs that received full antepartum ART from 34 weeks (or earlier) through
to term (regardless of intrapartum and postpartum ART), (2) MI pairs that did
not receive full antepartum ART from 34 weeks till term, but did receive other
(intra or postpartum) ART, (3) MI pairs that received no ART. Statistical analyses
were performed using chi square and Fisher's exact test and logistic regression
modeling.
Results: 73 MI pairs were reviewed. Rates of MI Transmission were: pairs
receiving full antepartum ART (regardless of other ART received) 1/32 (3.1%);
pairs that did not receive antepartum ART but did receive other ART (intra
+/postpartum) 4/19 (21%); pairs that received no ART 5/22 (22.7%). There was a
statistically significant difference in transmission rates between MI pairs receiving
antepartum ART and those receiving any other ART (P = 0.05) and those receiving no ART (P = 0.02). There was no significant difference between the groups
receiving any ART other than the antepartum component and those receiving no
ART. After stepwise multivariate logistic regression, only the antepartum component remained significant (P-0.04; odds Ratio = 0.12). These parameters were
not significantly changed when all components of therapy were forced into the
model.
Conclusions: These data suggest that the antenatal component of ART may
be significantly more important in preventing maternal infant HIV transmission
than the intrapartum and/or postpartum components of therapy. Further study
of ART in pregnancy is required in order to clarify this relationship and further
improve maternal and infant outcomes.
23293 Maternal-infant transmission of HIV, hepatitis C and
hepatitis G virus in women with triple infection
Pier-Angelo Tovo, A. Bairo, E. Palomba. Dipartimento Scienze Ped.
Adolescenza P ZZA Polonia 94 10126 Torino, Italy
Background: HIV-1, hepatitis C virus (HCV) and hepatitis G virus (HGV) are parenterally transmittable agents, which share other routes of transmission, including
perinatal transmission. Our previous analyses have shown that in Italy about one
third of HIV-1-positive women are coinfected with HCV and HGV, including those
without parenteral exposure to blood. The object of this study was to evaluate
the maternal-infant transmission of HIV-1, HCV and HGV in women with triple
infection.
Methods: An unselected population of HIV-1-infected parturients was tested
for markers of HCV and HGV infection by reverse transcriptase polymerase
chain reaction (RT-PCR) assays and specific seroreactivity. Transmission of each
virus was evaluated in 20 children whose mothers were HIV-1, HCV and HGV
RNA positive and did not receive prophylactic treatment with zidovudine during
pregnancy.
Results: Nine (45%) children acquired HGV, including 2 (10%) who were
coinfected with HCV and 1 (5%) with HIV-1. The HGV RNA was found in 100%
of infected children at 9-12 months of age, in 78.8% (7/9) at 2-4 months, but
in none of the 5 tested by three days of life. Also for HCV and HIV-1, PCR
analysis was positive from the second month of life onward in infected children.
At the latest control (mean 35.8 months, range 9-89) seven children were still
seronegative HGV RNA carriers, 1 was both RNA- and antibody-negative, while 1
RNA-negative had developed E2 antibody. Both children with HCV infection were
still viremic at the latest control. Whereas patients with HIV-1 or HCV infection
showed signs of hepatitis, no abnormalities in clinical findings and ALT levels were
observed throughout the follow-up in the 6 children with HGV infection alone.
Conclusion: Maternal-infant transmission of HGV is much higher than and
occurs independently from that of HIV-1 and HCV in women with triple infection.

All three viruses seem to be mainly transmitted around the time of delivery. In
contrast to HIV-1 and HCV, perinatal HGV infection usually results in a persistent,
asymptomatic infection without biochemical signs of hepatitis, at least over the
first years of life.

23294 Needs assessment/training community and migrant
centers: Prevention of HIV perinatal transmission
Sue Lemme, J. Gates. Pacific AIDS Ed. and Training Center 1420 San Pablo St.,
PMB-B 2065, L.A., CA, USA
Issues: Reducing HIV perinatal transmission of HIV through training healthcare
professionals at Community and Migrant Health Centers (CMCs), federally funded
clinics in both urban and rural areas of the US which serve the uninsured and
the poor, offer several challenges. Clinics sometimes resist HIV/AIDS training:
i.e. rural clinics because of a lower incidence of HIV. Needs assessments reveal
relevant differences between urban and rural CMC clinics.
Project: The US Bureau of Primary Care contracted with the Pacific AIDS Education & Training Center to provide training for CMC clinic staffs. We conducted a
needs assessment before initiating training. The clinic's administrator or medical
director provided demographic and training needs information during in-person
visits or by mail when distances were too great to travel.
Results: Thirty-five urban and 51 rural clinics completed the needs assessment: average monthly visits for all female patients was 1,870 and 1,744 for
urban and rural clinics, respectively. In a typical month the average number of
prenatal visits was 266 for urban and 178 for rural clinics. Urban clinics had
an average of 516 monthly family planning visits and 30 visits for STDs; rural
clinics had an average of 370 monthly family planning visits and 66 STD visits per
month. In urban clinics 6% of all women patients received HIV test counseling;
in rural clinics 2% of women received HIV test counseling. In urban clinics 36%
of pregnant patients received HIV test counseling and 17% were tested; in rural
clinics 5% of pregnant patients were counseled and 7% were tested, indicating
some pregnant patients may have been tested without counseling.
Lessons Learned: Completion of a clinic needs assessment, development
of a relationship with each organization, and face-to-face visits between clinic
administrators and a senior professional from our staff were essential. We approached and worked with each clinic organization in a spirit of partnership, a
positive effect since we represent a respected institution (the medical school).
Finally, these programs were developed and scheduled flexibly to accommodate
individual clinic needs.
23295 ý The challenge to reduce HIV vertical transmission in
Brazil
Valdilea Santos, C.S.C. Cunha, A.L.R. Vasconcelos, E. Sudo, P.J.N. Chequer.
Brazilian AIDS Program - MOH Espl. Ministerios BI. G Brasilia - DF, USA
Issue: HIV/AIDS epidemic in Brazil is growing fast among women in childbearing
age, resulting in an increase in the number of HIV infected children.
Project: Based on the results of the 076 study, the Brazilian Ministry of Health
established in July 1996 a special program to reduce vertical transmission. The
program includes: 1- A policy to offer universally HIV testing to pregnant women
(voluntary test with counseling); 2- Provision of AZT (capsules, IV and syrup)
free of charge, among the other antiretroviral drugs; 3- A policy to discourage
breast feeding for HIV infected women and provision of the milk formula to babies
born from HIV infected women; 4- Training program for health care providers
(obstetricians, pediatricians and nurses); 5- Publication of official guidelines to
reduce HIV vertical transmission.
Results: In spite of all efforts, the number of HIV infected pregnant women
receiving IV AZT still low, even after 18 months of the program. One of the major
problem faced by this program is to deal with the deficiencies that characterize
the maternal and perinatal care in Brazil. The severity of this problem is reflected
on the rate of maternal mortality which can be in some areas of the county as high
as 160/100.000 born alive. Some identified deficiencies: 1- Overloaded health
care services; 2- A very interventionist pattern of assistance to delivery; 3- Lack
of continuous education opportunities for health care providers. Another problem
identified during the training program is the lack of familiarity with HIV/AIDS issues
by the maternal and child health (MCH) care providers.
Lessons learned: In a developing country, a strategy to reduce HIV vertical
transmission may face other problems no directly related with the HIV/AIDS epidemic. These problems could be a significant barrier and should be addressed in
the global strategy to manage the problem of HIV vertical transmission. HIVAIDS
is a new issue for the majority of MCH care providers and this points out the need
of training programs specially designed for them.
23296 | Monitoring the trend of HIV vertical transmission rate at a
population level: Italy, 1990-1995
Enrico Girardi1, L. Rava1, P. Pezzotti2, V. Puro1, G. Ippolito1. 1'Ctr. Rif. AIDS
IRCCS L. Spallanzani Via Portuense 292 00149 Rome; 2COA Istituto Superiore
Di Sanita Rome, Italy
Objective: To monitor the transmission rate of vertically acquired HIV infection
at a population level. To evaluate the temporal trend of HIV vertical transmission
rate in Italy, during the period 1990-95.
Methods: The method is based on the data provided by the Anonymous Un
linked Seroprevalence Study among newborns and by the Italian National AIDS
Registry. The annual vertical transmission rates were estimated by dividing, for
each 1990-95 birth cohort, the number of individuals with vertically acquired HIV
infection, as estimated through a simplified Back-calculation method, by the estimated number of children born to HIV infected mother. Seven different incubation
period distributions estimates were used.