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

42 Abstracts 12153-12157

12th World AIDS Conference

214*/ 12153 Influence of maternal HIV-1 and HIV-2 on child
survival in Gambia
Martin Ota, D. O'Donovan, L.K. Yamuah, E. Harding, K. Ariyoshi, P. Milligan,
H.C. Whittle. Medical Research Council Laboratories, PO Box 273, Banjul,
Gambia
Objective: To compare the survival of children born to HIV infected and those
born to HIV uninfected mothers.
Methods: 110 HIV-1 positive, 251 HIV-2 positive, 11 dually positive women,
and 488 age/parity/health centre matched HIV negative controls, were enrolled
in a perinatal transmission study. After delivery the children were seen at 2 and 6
months of age and subsequently followed 3 monthly up to 18 months of age. HIV
infection in children was diagnosed by PCR at 2, 9 or 18 months and by antibody
serology assays at 18 months.
Results: Transmission rates were 23.5% (95% Cl 13.8, 33.1) and 4.0% (95%CI
1.7, 7.7) for HIV-1 and HIV-2 respectively. The rate of stillbirths did not differ between the groups but deaths in children of HIV-1 infected mothers (16%) were
significantly higher than in HIV-2 infected (7%, p = 0.04) and control mothers
(6%, p = 0.008). These differences were due to high mortality (35%) in HIV-1
infected babies whereas none of the 8 HIV-2 infected babies died. Maternal
death increased child mortality significantly, independent of mother to child HIV
transmission (p < 0.001).
Mother Babies
Mother to child transmission Died
Infected MCT rate % (95% CI) Infected n (%) Uninfected
HIV-1 90 17/81 23.5 (13.8, 33.1) 6(35) 8(11)
HIV-2 217 8/201 4(1.7,7.7) 0(0) 16(7)
HIV 1&2 11 0 0 0(0) 0(0)
Control 419 0 0 0 (0) 27(6)
Conclusions: Maternal HIV-1 infection as well as maternal death independently contributed substantially to the mortality of children while maternal HIV-2
infection did not. To improve child survival, intervention measures to decrease
mother-to-child HIV transmission and the HIV epidemic which is claiming lives of
women at the child bearing age should be urgently applied.
12154 Viral load studies in untreated infants from Africa
Robert J. Biggar1, M. Janes2, E.T. Taha3, F. Yellin4, R. Broadhead5,
N. Kumwenda5, S. Cassol2. 1 Viral Epidemiology Branch, NCI EPN/434 6130
Executive BLVD. Rockville, MD 20852; 3Johns Hopkins University Baltimore MD;
4 Computer Sciences Corporation Rockville MD, USA; 2University Of Ottawa,
Canada; 5 University Of Malawi Blantyre, Malawi
Objective: To relate the viral load in untreated infants to the age at HIV-1 infection
and to whether the mode of infection was perinatal (by cord blood (CB) status) or
postnatal (breast milk).
Methods: Infants were enrolled at birth in Blantyre, Malawi in 1994. Infected
infants were grouped by the time and probable route of infection. Infection (clade
C) was assumed to be at birth for infants whose first postnatal sample was +, if it
was within 6 month of birth. These subjects were then stratified by CB+, CB- or
CB? status. Infants with a negative test at > = 1 month but later + were considered
infected by breast feeding; none had transfusions during the conversion window.
The onset of infection for converters was the midpoint between the last negative
and first + result. Sampling dates derived from this date and were then grouped
for analysis. Levels (10x per ml) were measured from dried blood spots by a
modified NASBA assay. Statistically, the exponents were averaged (+ SD) and
compared by a T-test, and then re-translated.
Results: Viral loads were 100,000 (105.0 + 0.57) in 17 CB+ samples. In comparison, among 52 infants with CB- samples, the loads on the first + sample
(av. age 9.5 wks) was 251,000 (105.4 + 0.61) (p =). Among 15 infants infected
by breast feeding in the first 6 months, the first + sample (average time from est.
infection date: 15 wks) was 158,000 (105.2 + 0.9), whereas in 9 infants infected
later (average time from est. infection date: 65 wks), the average viral load was
79,000 (104.9 + 0.7). Viral loads appeared to rise to a plateau at 4-15 weeks
after the estimated infection onset, even in infants who were CB+.
Conclusions: This works demonstrates clade C viral loads can be obtained
from dried blood spots. CB+ infants showed a distinct rise from the CB to the
first positive later sample, suggesting that infection is very recent. Since breast
feeding exposure is continuous, it is difficult to establish exactly when breast
feeding infections occurred. However, infants infected by breast feeding had a
similar viral load profile to those infected perinatally, including those who were
CB+ and could not have been infected by breast milk.

Methods: We offered zidovudine (ZDV) during pregnancy to all HIV+ women
attending our service after september 1994, irrespective of their clinical status
and CD4 count. The regimen followed is that described in ACTG 076 except
all HIV~ women are eligible and some women discontinuing ZDV intrapartum or
postpartum to the newborn. All babies are formula feed. Uninfected status was
defined as at least one negative HIV-1 DNA polimerase chain reaction (PCR)
beyond the neonatal period and 2 HIV-antibody negative ELISA performed at
6-18 months of age. Infected status was defined as one positive HIV-1 DNA
PCR and 2 HIV-antibody positive ELISA performed after 18 months of age and
confirmed by immunofluorescence assay.
Results: Out of 111 seropositive women, 58 agreed to the therapy and 53
did not. 8/58 (13.7%) infants whose mothers had received ZDV were found infected versus 18/53 (33.9%) whose mothers had not received (p = 0.022). This
corresponds to a 59.6% relative reduction in the risk of HIV transmission.
Conclusion: The use of ZDV in pregnant women and newborn is well tolerated
and reduces the maternal-infant transmission of HIV eventhough the complet
protocol has not been used. This is very important for poor countries where all
protocol is very expensive to be applicated.
S12156 The potential role of intrapartum and neonatal zidovudine
treatment in reduction of perinatal HIV-1 transmission
Pilmolrat Thaithumyanon1, U. Thisyakorn2, S. Limpongsanulak2,
S. Punnahitananda2, K. Ruxrungtham2, S. Ubolyam2, P. Virutamasen2. 1Dept. of
Pediatrics, Faculty of Medicine, 2Chulalongkorn University, Bangkok, Thailand
Objective: To evaluate the efficacy of ZDV administered during labor and to the
infants in the first 6 weeks of life in reduction of perinatal HIV-1 transmission.
Design: This is a pilot, non-randomized, open label clinical trial.
Method: A total of thirty five HIV-1 infected pregnant women with no prior
antiretroviral treatment who had either late or no prenatal care were given ZDV
300 mg. orally every 3 hours during intrapartum period until delivery. Maternal
blood were tested for CD4 cell count and plasma HIV-1 RNA (Chiron" assay
and/or Amplicor assay) before treatment. Zidovudine 2 mg/kg orally every 6
hours were given to the infants immediately after birth for 6 weeks. Breast feeding
was not allowed. HIV-1 DNA detected by the use of nested PCR was measured
in infant's blood at age 1 day, 1, 3 and 6 months old. Infants with positive PCR
test performed at least twice were classified as HIV infected.
Result: Twenty-five infants were analysed at 3 months old. Short term toxic
effect of ZDV with anemia and diarrhea were observed in one infant whose
treatment had to be discontinued at age 7 days old. HIV-1 DNA was detected in
2 infants. The HIV-1 transmission rate is approximately 8% (95% CI, -2 to 18%).
Conclusion: This preliminary study suggests that intrapartum oral ZDV treatment in asymptomatic HIV-1 infected mothers together with ZDV treatment in
their offsprings for 6 weeks, may reduce the rate of perinatal transmission to
approximately 8 percent. Further controlled trials in larger groups of pregnant
women are needed.
12157 Use of zidovudine to reduce the risk of perinatal
transmission of HIV infection in the Washington
metropolitan area
Tamara A. Rakusan', V. Temple2, L. Hart3, B. Loechelt1, S. Rana3, M. Young4,
J. Bertolli5. 1George Washington University School of Medicine; Children's
Hospital, 111 Michigan Av., NW Washington DC 20010; 2Children's National
Medical Center, Washington DC; 3Howard University Hospital, Washington DC;
4District of Columbia General Hospital, Washington DC; 5Centers for Disease
Control, Atlanta GA, USA
Background: Use of zidovudine (ZDV) for prevention of perinatal transmission
of HIV was recommended in 1994 by the US Public Health Service. Our study
examined implementation of the recommendations and their effectiveness in the
Washington, DC area.
Methods: Chart review of HIV-exposed infants born between December 1994
and December 1996, enrolled in the Pediatric Spectrum of HIV Disease Project,
who presented for follow-up prior to 1 year of age at the Washington, DC site.
HIV DNA PCR and/or cultures were used to determine the child's HIV status.
Results: 248 infants were enrolled: 24 of these were infected with HIV. Of
126 children born between December 1994 and December 1995 (the 1995 birth
cohort), 42 (33%) received the full regimen (ZDV antenatally, intrapartum and
after birth); 63 (51%) of 122 children born in 1996 received the full regimen. In
the 1995 birth cohort, 15/126 children received only neonatal ZDV and 22 (17%)
received no treatment. In 1996, 7 children (5%) received only neonatal ZDV
and 7 (5%) received none. The remaining children received partial or unknown
treatment. Overall, when 1995 and 1996 birth cohorts data were combined, of
105 children on full treatment, only 3 (2.8%) were infected compared with 7 (9%)
of 76 on partial treatment and 9 (31%) of 29 children who were not treated at all.
Conclusions: ZDV administered in pregnancy, during delivery and neonatally
prevents mother-to-infant transmission of HIV. Only half of the infants born in our
area in 1996 received the full regimen which appears to be the most protective.

S121551

Reduction of maternal-infant transmission of human
immunodeficiency virus type 1 with zidovudine (ZDV)
treatment

Nilo Alfonso Galvaao1, Carmen Lucia Silva2, P.S.V. Naud2, E.B.M. Chaves2,
S.A. Zachia2, M. Larangeira2, F. Dubina2, F.M.L. Hartman2. 1Rua Conego Viana
Rio Branco Porto Alegre RS; 2Hospital De Clinicas de Porto Alegre, Porto
Alegre, RS, Brazil
Objectives: To compare the HIV vertical transmission rate between 2 groups of
HIV+ women.
Design: Prospective, controlled study.