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

404 Abstracts 23311-23316

12th World AIDS Conference

attitudes toward HIV testing even if the intervention programs differed. Five studies had an overall acceptability rates >70%, with high return rates and a large
number of VCT centres available for the whole population, with the majority of
the clinic staff of the projects involved in general antenatal care services as well.
The main common reason for refusing HIV testing was "want to discuss with the
partner". In the 5 studies who provided the information, women who were finally
included in the projects and who benefited from an intervention accounted for
1-4% of all women who were offered HIV testing and 11-35% of the HIV infected
women (one of these studies offered vitamin A supplementation, four offered
antiretroviral therapy interventions).
Conclusion: Acceptability of VCT and interventions to reduce MCT are likely
to be different if interventions were translated into a public health program with
a real cost and known benefits. Increasing access to VCT and interventions to
reduce MCT requires an offer of HIV services to both child and adults infected by
HIV, a fight against HIV discrimination, VCT training of health care professionals
and management of HIV+ persons, development of premarital counselling and
education regarding MCT.
23311 Main difficulties in the reduction of HIV vertical
transmission in Rio de Janeiro, Brazil
Norma P.M. Rubini1, J. Arabe, D.W.C. Leal, R. Rocco, A.J. Lima,
C.A. Morais-de-sa. University of Rio de Janeiro; Rua Leite Leal, 135/Apto.
505/Bloco 1 Laranjeiras, Rio De Janeiro, RJ, Brazil
Objectives: Investigate the factors which influence or hamper the access of HIV
infected pregnant women to therapy with zidovudine (ZDV) to reduce the vertical
transmission of HIV.
Methods: We studied all the mothers of children classified in the categorie E
(CDC) which were born between 1995 and 1997, in follow-up at the Pediatric
Immunology Clinic. The mothers were divided into two groups: A - mothers that
receive ZDV therapy during pregnancy/birth and B - mothers that were not treated
with ZDV during pregnancy/birth. We analysed: demographic characteristics, access to pre-natal examination, presence of STD during pregnancy, offering of
anti-HIV serology during pre-natal exam, and knowledge of HIV diagnosis before
pregnancy. For statistical analysis we used Fischer's exact test.
Results: We analysed 61 HIV infected women. Twenty (32.8%) had been
treated with ZDV during pregnancy/birth, of which 10 (50%) had previous knowledge of their HIV+ status, 6 (30%) found out they were HIV infected during
pregnancy via diagnosis of HIV infection in their sexual partner, and 1 (5%) developed AIDS during pregnancy. Median of age, ethinics and mode of acquisition
of HIV were similar in both groups. Twenty women (100%) in group A and 35
(85.4%) in group B (p = 0.0810, NS) performed prenatal exams, where as 10
(50%) in group A and 10 (24.4%) in group B knew their HIV+ status before
pregnancy (p = 0.9883, NS). The presence of STD during pregnancy ocurred in
3 women (15%) of group A and 2 (4.9%) of group B (p = 0.1931, NS). Anti-HIV
serology was offered during the pre-natal period to 3 women in grup A and none
in group B. ZDV therapy for reduction of HIV vertical transmission was not offered
to any of the 10 women in group B who knew they were infected by HIV.
Conclusions: The main factors which hamper the reduction of vertical transmission were the non-identification of 49.2% of HIV infected pregnant women,
due to reduced offering of anti-HIV serology during pre-natal exams, and the
non-referral to ZDV therapy of 33.3% of pregnant women who already knew that
they were HIV+. These data demonstrate the need for education/training of health
providers who attend women.
23312 Viral and host genetic characterization of possible
transient infections in perinatally exposed infants
Marcia Kalish1, T.M. Brown1, E. Schoenbuam2, E.J. Abrams3, G. Lambert4,
R.W. Steketee1, K.E. Robbins1, D.M. Thea5. The NYC Perinatal HIV
Transmission Study; 1 Centers for Disease Control & Prevention, 1600 Clifton
Road, CDC Mailstop G19, Atlanta, Georgia 30333; 2Albert Einstein College of
Medicine, New York, NY; 3Harlem Hospital, New York, NY; 4Bronx-Lebanon
Hospital, New York, NY; 4Medical and Health Research Assoc., Inc., New York,
NY, USA
Objective: To evaluate possible cases of transient infections in infants born to
HIV-infected mothers.
Methods: In a prospective cohort from the NYC Perinatal HIV Transmission
Collaborative Study, 8 (0.5%) of 611 exposed but uninfected infants were identified who had early HIV proviral DNA positive tests on only one occasion. Multiple
specimens from each of the 8 infants with discordant PCRs were tested for identity
at the HLA DQac allele (AmpliType, Perkin Elmer, Foster City, CA). Discordant
HLAs were considered to be the result of specimen mix-up. Infant specimens with
concordant HLA but discordant PCR were sequenced with the matching maternal
delivery specimen.
Results: In 5 of the 8 cases, specimen mix-up was responsible for discordant
PCR results. Repeat PCR of the proviral DNA from a sixth infant was negative
using multiple primer sets, suggesting a data recording error or contamination

during initial PCR. From the remaining 2 infants, no phylogenetic linkage was
observed between the infants' and mothers' HIV-1 strains.
Conclusion: Viral and host genetic characterization should be utilized to critically evaluate possible cases of transient HIV-infections in perinatally exposed
infants. This study suggests that transient infections, if they occur at all, are rare.

23313 1Risk of mother to infant transmission of HIV among
attendees of a maternal and child health clinic in the PR
of China
Tian Yue Wen1, A.S.M. Abdullah2, F.Q. Guan'. 'Shenzhen Maternal and Child
Health Hospital, De Xing Hua Yuan, Defu Bldg.-1, NO. 803, Buji, Cao Pu, Long
Gang District, Shenzhen - 518112; 2The University of Hong Kong, Hong Kong,
PR China
The rate of heterosexual transmission of human immunodeficiency virus (HIV)
infection is on the increase in the PR China, as elsewhere in the world. This leads
to the increase of mother to infant transmission of HIV infection. Transmission of
HIV from mother to infant can be minimised by increasing risk perceptions among
women of child bearing age. The aim of this study is to assess the risk perception
of HIV among women attending for obstetric examination in a Maternal and
Child Health (MCH) clinic in the southern China. A structured self-administered
questionnaire were used for data collection during November 1997. The preliminary analyses of the 200 completed questionnaire indicated that a substantial
proportion of women have knowledge gap and inappropriate beliefs about HIV
infection. Even though a substantial proportion of women knew the high risk
behaviour of their husbands, they were reluctant in using condoms during sexual
intercourse. High risk behaviour were also indicated by a substantial proportion of
respondents. All of these findings will be explored in details during presentation.
123314 Impactof zidovudine on perinatal HIV transmission in
Mallorca Island, Spain
Luis M. Ciria. C/B Pons i Coll, 3C-10E, 07015-Palma de Mallorca, Spain
Objectives: To describe the inpact of prenatal (pre), intrapartum (intra) and
neonatal (neo) zidovudine (ZDV) on perinatal HIV transmission in Mallorca Island
(Spain). Previously the perinatal transmission rate was 14%.
Design: Prospective, controlled study.
Methods: At Hospital Son Dureta, data were collected from infant medical
records on pre, intra and neo ZDV for children born 4/95 through 1/98 to HIVinfected women.
Results: From April-95 to January-98, 42 pregnant HIV-infected women were
offered ZDV in order to diminish HIV vertical transmission. 39 (93%) accepted to
receive ZDV.
At the present time the HIV infection status is known in 34 children and it
is yet undetermined in 5. 27/34 children have received the complete protocol
(pre+intra+neo) and only one was infected (3.7%). 7/34 received a partial protocol (pre or intra, and or neo) and two were infected (28.6%). No children was on
ZDV if the mother had not received the drug pre or intra.
Conclusion: There is a significant reduction in vertical HIV transmission with
ZDV use during pregnancy, delivery and the first 6 weeks of life. This reduction is negligible if the complete protocol is not used (pre+intra+neo). Intensive
nurse care management of the pregnant HIV-infected women and their children
is necesary in order to complete a therapeutic protocol with ZDV.
S23315 Antiretroviral therapy in pregnant women in Canada:
Access and outcome, 1995-1996
Joel Singer, N. Lapointe, J. Forbes, S.M. King, U.D. Allen, S.E. Read. Canadian
HIV Trials network 620-1081 Burrard St., Vancouver., B.C. Canada1 Hospital Ste.
Justine Montreal PQ Canada2BC Women's Hospital Vancouver BC
Canada3 Hospital for sick Children Toronto ON, Canada
Objective: To assess the predictors of receiving antiretroviral treatment and the
outcome of treatment for Canadian women known to be HIV+ at time of birth of
an infant in 1995-96.
Methods: All HIV pediatric centres in Canada provide a yearly update on the
status of all their perinatal cases. Information collected included maternal HIV risk
factors, country of origin and race and infant place and date of birth and date of
diagnosis.
Results: About 50% of pregnant women were on antiretroviral therapy. The
proportion receiving therapy was not influenced by risk group or maternal race.
Women who were treated were much less likely to have an HIV infected infant.
In British Columbia 75% of pregnant women received treatment, compared with
only 59% in Ontario and 15% in Alberta. In women not receiving antiretroviral
therapy, the proportion of HIV-infected infants was 5 of 11 (45%) among injection
drug users compared to 14 of 20 (70%) among women whose primary risk factor
was heterosexual exposure. These numbers do not reach statistical significance,
but suggest that women whose risk was heterosexual exposure were more likely
to be missed and not receive treatment.
Conclusions: Many HIV+ women in Canada are still untreated during pregnancy. The evidence suggests that many HIV+ women who have HIV-children
continue to go undetected, and that women who contract HIV through heterosexual exposure are more likely to go undetected.

S23316 Vertical transmission of HIV-1 in the north of Portugal
Antonio Mota-Miranda1, Rui Marques', Mota-Miranda2, Vasconcelos3, Sarmento
E. Castro3. 'School of Medicine-Hospital De S. Joao, AL. Prof. Hernani
Monteiro; 2 Hospital S. Joao, Porto; 3Hospital De Joaquin Urbano, Porto, Portugal
Objective: to evaluate the risk of maternal transmission and the impact of the
AZT therapy' during pregnancy and perinatal period on the rate of vertical HIV-1