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

12th World AIDS Conference

Abstracts 23326-23330 407

study which also looks at the viral load necessary. HIV infection, lactation and
breastfeeding is a complex issue.
23326 Zidovudine reduces HIV-1 perinatal transmission even if
only the oral component administered to pregnant
women is used
Jorge Pinto', J.B. Souza2, R.S. Prado2, I.R. Carvalho2, A. Luchesi2,
M.L. Jeronymo2, D.B. Greco2. 'Rua goitacazares 14/408, Belo horizonte, MG
30190-050; 2Federal University of Minas Gerais, Belo Horizonte MG, Brazil
Objective: To evaluate the effectiveness of the different components of the zidovudine (ZDV) use in reducing the risk of perinatal transmission of HIV-1 in a
cohort of vertically exposed infants in Belo Horizonte, Brazil.
Design: Retrospective cohort study
Methods: A total of 103 infants born from HIV-1 infected mothers between
January 1994 and August 1997 have been enrolled in a natural history study.
According to a standard protocol, the baseline visit included information about
ZDV use in antenatal, intrapartum and neonatal periods. Infants were followed
monthly for the first 6 months of life and every three months thereafter. Infection status was defined in any of the following occurrences: 1) development of
AIDS-associated symptoms at any age; 2) persistence of serum HIV-1 antibodies
beyond 18 months of age; or 3) serum or plasma p24 antigen detection in two
occasions beyond neonatal period. Serorreversion was established after 2 negative EIA performed in a three-month interval. Infants <18 months who remained
seropositive and had not presented clinical and laboratory evidences of infection,
had their HIV status classified as indeterminate.
Results: At the time of analysis, 33 (32.0%) of the 103 infants were infected,
40 (38.8%) were serorrevertors and 30 (29.1%) were indeterminate. Infants
whose HIV-1 status was indeterminate were excluded from the analysis. Females
comprised 50.5% of the population. The mean age at entry in the study was
4.5 months (SD:3.8 months). Use of any combination of ZDV components was
reported by 2 of 33 (6.1%) transmitting and 17 of 40 (42.5%) non-transmitting
mothers {relative risk (RR): 2.10; 95% CI: 1.49-2.97}. Use of oral ZDV in the
antenatal period alone was reported by 1 of 32 (3.1%) transmitting and 7 of 30
(23.3%) non-transmitting mothers (RR: 2.05; 95% CI: 1.37-3.08). The vertical
transmission rate was 12.5% and 57.4% respectively, in mothers reporting and
not reporting ZDV use (p = 0.024).
Conclusions: In this observational cohort study, oral ZDV used only in the
antenatal period was correlated to a 78.22% reduction in the vertical transmission
rate. These data indicated that a more simply approach of ZDV use, applicable
in less developed countries, might have an efficacy comparable to the complete
ACTG076 regimen.
233271 Prenatal care and birth outcomes of HIV positive
pregnant women
Ewa Firlag-Burkacka, A. Piasek, A. Horban, T. Niemiec, K. Krzywdzirski. 37
Wolska St. Warszawa 01-201 AIDS Diagnosis & Therapy Center, Poland
Objectives: To reduce of HIV vertical transmission the 57 of HIV+ pregnant
women were involved in following perinatal and birth care: zidovudine treatment
according to the ACTG 076 protocol, cesarian section, episiotomy
Methods: Since 1990 the 57 HIV positive women were supervised by AIDS
Diagnosis and Therapy Center, Warsaw in time of pregnancy and delivery. From
this group 39 were infected by IVD (7 active IVD in a time of pregnancy), 18
infected by sexual transmission. 31 was treated according to the ACTG 076
protocol. The cesarian section was done for 12 pregnant women (8 on ACTG
076 program), and 32 episiotomies (14 on ACTG 076 program). The vertically
transmitted HIV was diagnosed in the first months of newborn babies life by
PBMC cultures and estimation of p24 in culture medium as well as proviral DNA
in cultured cells by PCR (Amplicor, Roche)
Results: Among 32 infants born from mothers treated according to the ACTG
076 29 have been diagnosed (2 HIV positive (6.4%), 3 died) in the first week of life
- undiagnosed (one twin). From zidovudine untreated mothers 27 children have
been delivered (one twin). The 8 were diagnosed as HIV positive (30.7%). The 12
children from both group of HIV positive pregnant women, treated and untreated
with zidovudine, delivered by cesarian section were diagnosed uninfected. The 5
children delivered by episiotomy were found infected: one from zidovudine treated
mother and four from untreated.
Conclusions: The most efficient in prevention of vertical transmission of HIV
we found a treatment according to ACTG 076 protocol and cesarian section.
We didn't found episiotomy as a successful tool in prevention of HIV vertical
transmission
S23328 Social vulnerability in HIV prevention of perinatal
transmission
Laura Avelina Pedrosa Islas', Silvia Pane Abianco-Labbe2,

Carlos Magis-Rodriguez2, Fernanda Martinez Salazar3, Claudin Soler3. 'Dr.
Garcia Diego 218 Col. Doctores C.P 06720; 2AIDS National Council Mexico;
3Diagnostic & Epidemic. Reference Nat. Inst. Mexico, Mexico
Objective: To detect social vulnerability situations in pregnant women who were
tested for HIV antibodies determination in a perinatal transmission detection and
prevention pilot program in Mexico.

Methodology: This is a part of a larger quantitative and qualitative study, which
use social sciences and epidemiological methodology, with participant observation, interviewees and a close questionnaire. The questionnaire was applied with
pre counseling.
Results: From December 1996 until October 1997, 3,721 women were tested.
The studied population fluctuates among 11 to 48 years old, average of 24 years
old. 17% has less or equal than eighteen years old. 87% works at home and
the rest have mostly not well paid jobs or are studying. More than half (56%)
completed or exceeded the high school. 44% began with this pregnancy her
reproductive life. The principal aim for being tested is their child's health in 68% of
cases. Only 5% recognize actual infection risk and 11% in the past. Nevertheless
they refuse any risk possibility, 44% wanted to be tested for "peace of mind".
More than half (57%) have less than one year with the actual partner; 13% will be
single mothers, and more than one third made something for avoiding the actual
pregnancy. One third had Papanicolaou test. 5% said to have suffered a rape.
Conclusions: This early results propose a context in which women apparently
have little decision over their bodies, and the main risk are their life conditions,
cultural and gender constructions, and not having access to quality reproductive
health care services. These are the major vulnerability conditions. To emphasize
the risk in every woman, without true protection possibilities is a senseless when
is not followed by structural and cultural changes for improving the women status.
233291 Occupational exposures resulting in HIV infection in
health care workers - United States
Ann Do, R. Metier, J. Li, J. Jones, P. Fleming. 'Centers for Disease Control 1600
Clifton Rd MS E47, USA
Background: Although rare, occupational HIV transmission continues to occur in
the health care setting, despite the availability of prevention guidelines. To help direct preventive efforts, we examined the circumstances surrounding occupational
exposures resulting in HIV infection in health care workers (HCWs).
Methods: We reviewed cases of HCWs who had documented evidence of occupationally acquired HIV infection and were reported to CDC's national surveillance
system from 1991 through 1997.
Results: Of 54 HCWs, there were 22 (41%) nurses, 5 (9%) physicians, 19
(35%) laboratory workers, 1 (2%) medical student, 1 (2%) maintenance worker
and 6 (11%) other ancillary personnel. In 44 (81%) cases, the source patient was
known to have clinical AIDS at the time of the HCW's occupational exposure.
Percutaneous injuries occurred in 48 (89%) cases, of which 18 (38%) were
related to sharps disposal (e.g., injured while placing sharps in disposal container,
during clean-up, or because sharps were left in unusual locations), 5 (9%) involved
unexpected patient movement during a procedure, and 4 (8%) involved needle
recapping. Occupational exposures occurred in a hospital or clinic setting in 40
(75%) cases and in a hospice or patient's home in 3 (6%) cases. Of the 27 HCWs
who had an occupational exposure after recommendations for post-exposure
prophylaxis (PEP) first became available in 1990, 7 (28%) received PEP (all with
zidovudine), which was initiated 30 minutes to 8 days following the exposure; the
total duration of PEP ranged from 1 day to 8 weeks.
Conclusions: Because the highest frequency of HIV infection is related to percutaneous injuries, preventive efforts should focus on sharps disposal procedures
and the use of safety devices. Furthermore, considerations should be given to
the potential for occupational exposures outside of a hospital or clinic setting.
23330 Preventability of occupational exposures resulting in
human immunodeficiency virus (HIV) postexposure
prophylaxis
Denise Cardo, S. Campbell, P. Srivastava. Nash Surveillance Group; CDC
Mailstop E-68 Atlanta Georgia 30333, USA
Background: Although postexposure prophylaxis (PEP) is an important element in workplace safety, preventing blood exposures is the primary means of
preventing occupationally acquired HIV infection.
Objective: To evaluate the preventability of exposures for which HIV PEP was
prescribed.
Method: We assessed the circumstances of exposures resulting in HIV PEP
reported to the National Surveillance System for Hospital Health Care Workers
(NaSH).
Results: During June 1995-September 1997, the six hospitals in NaSH reported 1710 exposures to blood/bloody fluids; 245 (14%) resulted in the exposed
health care worker (HCW) taking HIV PEP. These exposures included 218 (89%)
percutaneous injuries (PIs), 19 (8%) mucous membrane exposures, 6 (2%) skin
exposures, and two (1%) bites. The PIs involved 153 hollow-bore needles, 29
suture needles, 17 scalpels, and 19 other sharps. At least 108 (50%) Pis could
be classified as potentially preventable as follows: 65 occurred during or after
disposal (i.e., while placing the device in the disposal container, while in transit to container, during clean-up, or because the device was left in an unusual
location), 38 during or immediately after the use of hollow-bore needles that
could ble safety devices, and five during recapping. The

mucous membrane exposures included three exposures to mouth and eyes and
16 to eyes only. In 15 (79%) exposures, eye protection was not used. Five skin
exposures involved hands, and gloves were used in three (60%).
Conclusion: At least 126 (51%) of the occupational exposures that resulted
in the use of PEP could have been prevented by the use of appropriate work
practices, including barriers and safety devices, by HCWs.