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

12th World AIDS Conference

Abstracts 23307-23310 403

23306: Table
Birth Yr # Live Births No. AIDS' <1 yrof age Rate per 100,000 births SCBW Rate per 100 HIV+CBW No. PCP <1 yr of age PCP Rate 100,000 births PCP:AIDS rate ratio <1 yr
1992 4,065,014 364 8.95 6990 5.21 174 4.28.48
1993 4,000,240 328 8.20 6530 5.02 148 3.70.45
1994 3,952,767 275 6.96 6145 4.48 129 3.26.47
1995 3,899,589 195 5.00 not available 93 2.38.48
Wang adjusted estimates.

In HIV reporting states, of 2058 exp+inf children born '95-'96, 83% were evaluated for HIV by age 2 mos.; 88% of mothers were tested before birth, 62% of
whom had prenatal ZDV. Of 762 children born in '95 and evaluated by 2 mos.,
11% (46/415) who had ZDV were HIV-infected vs 26% (36/137) who did not. In
contrast, of 263 PA AIDS born '95-'96: 37% were evaluated by 2 mos; 42% of
mothers were tested before birth, 16% had prenatal ZDV.
Conclusions: There was a steep decline in PA AIDS incidence in US, especially
among infants and since 1994. This decline is principally due to declining perinatal
transmission because of increasing maternal/neonatal ZDV use. Changing births
to HIV+CBW, and effects of therapy on progression to AIDS also contribute.
Recent perinatal HIV transmission highlights populations of mothers and infants
that did not receive timely HIV testing or ZDV. Population-based surveillance can
assess the impact of perinatal prevention on HIV/AIDS incidence.
23307 No evidence of vertical transmission of HTLV-I and
HTLV-II in children at high risk for HIV-1 infection from
Sao Paulo, Brazil
Adele Caterino-De-Araulo, E. Santos-Fortuna. Instituto Adolfo Lutz. Dr. Arnaldo,
335, Andar, San Paulo, SP, Brazil
Background: In order to determine perinatal transmission of human T-cell lymphotropic virus types I and -II (HTLV-I and -II) in blood specimens obtained from
children born to HIV-1 infected mothers from Sao Paulo, Brazil, we searched
for specific antibodies in plasma samples, and for provirus DNA sequences in
peripheral blood mononuclear cells.
Methods: One hundred seven children that were not breast-fed were evaluated. Fifty-five specimens were from HIV-1 infected children, 28 from HIV-1
non-infected children, and in 24 cases the HIV-1 status could not be defined.
HTLV-I and HTLV-II specific antibodies were searched by two ELISA kits and WB
2.3. Cases that resulted positive or inconclusive on WB analysis were tested by
PCR using primer pairs specific for env, tax-rex, and LTR regions of HTLV-I and
-II.
Results: ELISA screening tests detected HTLV-I/II antibodies in 54.5% of HIV-1
infected children, in 17.9% of HIV-1 non-infected children, and in 37.5% of cases
with HIV-1 undefined status; given an overall ratio of 41.1%. Western Blot 2.3
analysis disclosed 17 specimens with some HTLV reactivity: 3 were classified
as HTLV-I/II, two confirmed HTLV-I WB profile, and the last 12 samples showed
reactivity to only one gag or env components. In 11 out of 17 cases molecular
approaches were used to confirm HTLV infection in children; no case of HTLV-I
or -II was detected. In contrast, when 13 mother-child pairs specimens were
analyzed, three mothers' plasma samples which resulted seropositive confirmed
HTLV infection by PCR analysis: one case of HTLV-I and two cases of HTLV-II
infections were detected.
Support: Fundaqao de Amparo a Pesquisa do Estado de S ao Paulo (FAPESP),
grants # 94/1033-7 and # 96/10100-5.
Conclusions: No case of HTLV-I and -II infections among children was detected. Taking in account the age of children and their WB profiles, it could be
detected passive maternal antibodies until the age of 15 months. Indeed, after
age 18 months children seroreactivity on ELISA and WB assays suggests the
presence of maternal antibodies that resist degradation and/or antibodies that
cross-reacts with rgp21 or p19 antigens. These results emphasize the lack of
HTLV- I/11 vertical transmission in children at high risk, in the absence of breast
feeding.
23308 Mother-to-child transmission of Pol mutant T215Y HIV-1
isolates related to a high viral load under AZT treatment
Christopher Payan', P. Fialaire2, D. Vitour', J. Loison2, J.M. Chennebault2,
X. Rialland2, F. Lunel'. 'Laboratoire de Virologie Chu Angers 4 Rue Larrey,
Angers Cedex; 2Service De Malandies Infectieses, Angers, France
Objective: To predict AZT resistance in HIV-1 infected pregnant woman in relation with mutant Pol T215Y HIV-1 isolate detection prior treatment and the risk of
transmission to child.
Methods: Six women have been followed during their pregnancy. CD4 cell
count and viral load (VL) (NASBA system, Organon Teknika, France) were measured in the first 3 months of pregnancy, then during AZT treatment at 6 months
and at the child birth. Pol T215Y mutation was detected in the plasma viral RNA
extracted for the VL measure (Payan et al., CROI 1997).
Results: In the first case, VL was over 5 log/ml and did not vary under AZT
treatment, in relation with T215Y mutation. This isolate was detected in the child
plasma at birth, with a similar VL and AZT resistance. In 3 cases, VL was below
4 log/ml, reduced more than 1 log with AZT, in relation with a wild T215Y isolate.
In the 6th case, VL was higher (4.5 log/ml), with T215Y mutation, but a combined AZT and ddl treatment was taken before pregnancy was declared. During
pregnancy, CD4 cell counts were less than 50/mm3 in case 1 and 6 and about
400/mm3 in the 3 other cases; they were at about 2000/mm3 in children at birth.

Five out of 6 children were free of virus, and for 2 cases get seronegative at 1
year, whereas, in case 1, the child died 8 months later, with a high VL (6.2 log/ml)
and a decreasing CD4 (600/mm3).
Conclusion: It seems that Pol T215Y HIV-1 mutation detection related to a
high VL during pregnancy could predict the risk of AZT resistance and viral
transmission to child. Furthermore, a combined antiretroviral therapy in pregnant
women with VL higher than 4 log/ml and with a T215Y HIV-1 isolate may reduce
the risk of viral transmission.
S23309 Prevention of perinatal transmission: IHO-Wadia model
Puja N. Ambwani', I.S. Gilada2, J. Karkare3, S.M. Changedia4. 1Project
Supervisor, I.H.O. Bombay; 2Secretary General, I.H.O. Bombay; 3Social Worker,
Wadia Hosp., Bombay; 4House Physician, I.H.O. Bombay India
Background: With the objectives of studying HIV prevalence among pregnant
women and to prevent perinatal HIV transmission, this study was initiated in
1993, when HIV prevalence among women and perinatal transmission rates were
unknown in India.
Methods: Women attending in a OPD of a Women's Hospital in Bombay were
selected for study, after 'group counseling' and informed consent. HIV ELISA test
were done by 'pooling' method. (Initial positives were reconfirmed with individual
test). Seropositive women were encouraged to bring their spouses and provided
'individual' and 'couple' counseling and testing of the spouse. Post-test counseling
included providing option of Medical Termination of Pregnancy (MTP) for those
with less than 20 weeks gestation, modified ACTG-076 protocol for others and
contraception to avoid any future pregnancies. Babies followed up quarterly and
subjected to HIV test at 9 and 15 months.
Results: Among the women of mean age 23 years, graded middle class housewives, without any specific high risk behaviour and identical demographic profile,
only 30/514 (6%) spouses were uninfected, 19 women were infected via blood
transfusion and 11 via extra-marital sex.

Period Women
Tested
Jan.93-Dec. 93 12,394
Jan.95-Dec. 95 11,557
Jan.97-Dec. 97 12,352

Women
HIV+
80
111
148

% Period Women
HIV+ Tested
0.64 Jan.94-Dec.94 12,996
0.97 Jan.96-Dec. 96 12,250
1.20

Women
HIV+
120
148

HIV+
0.92
1.21

26/616 women with less than 20 weeks of pregnancy, 15 opted for MTP; VDRL
reactive 581/56,912 (1%) and 3.8% were dually infected with HIV and Syphilis.
Two women, 19 spouses and 19 babies died out of the 307 women who followed
up. 13 women opted for tubectomy, six went for second and 2 went for third pregnancy. Rest all opted for barrier contraception. Among 560 seropositive women
delivered, 122/386 (31.6%) children have been found to be HIV infected at or
after 15 months, in natural history follow-up.
Conclusion: The largest, innovative, cost-efficient and replicable model of
perinatal HIV intervention for busy hospital settings in Asia has emerged. Though
HIV prevalence in pregnant women is high, it seems to be stabilising. Apart from
set objectives, additional gains were: evolution of pool testing as cost-saving
strategy, integrated HIV care for women, pediatric HIV/AIDS care and HIV prevention through ACTG-076 protocol. The study has been now extended to two
other states.
23310 Acceptability of voluntary HIV counselling and testing
(VCT) and interventions to reduce mother-to-child
transmission of HIV in Africa
Michel Cartoux1, N. Medal, P. Van de Perrel, M.L. Newell2, I. de Vincenzi3,
F. Dabis4. 'Centre Muraz, BP 153 Bobo Dioulosso, Burkina Faso; 2lnstitute of
Child Health London, United Kingdom; 3UNAIDS Geneva, Switzerland;
4Universite Victor Segalen Inserm U330 Bordeaux, France; Ghent Working
Group, European Commission - UNAIDS Ghent, Belgium
Objective: To assess acceptability of VCT and interventions to reduce
Mother-to-Child Transmission of HIV (MCT) in different cities in Africa in the
context of ongoing or completed clinical trials.
Method: In october 1997, thirteen studies located in west (Abidjan, BoboDioulasso), east (Addis Abeba, Nairobi, Mombasa, Dar Es Salaam) and southern
Africa (Blantyre, Lusaka, Harare, Soweto, Durban) were included in a cross-sectional mailing survey about the acceptability of VCT and interventions in antenatal
clinics. Acceptance rate, return rates, overall acceptability of VCT (both acceptance of the pre- and post VCT sessions) and acceptability of intervention were
obtained by a standardized questionnaire.
Results: The median overall acceptability of VCT was 65%, ranging from 33%
to 95%. Overall acceptability of VCT most frequently depended on return rates
as acceptance rates were generally high. Where several studies were conducted
in parallel in the same city or the same country, pregnant women had similar