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

12th World AIDS Conference

Abstracts 12168-12172 45

parallel to such delay it is expected to exist a relation between bone growth
delay and global development. The results suggest that infants pertaining to the
school age and mid teenagers who evolute chronically will have a predictable
poundering-stature deficit.
S12168 Vertical transmission of hepatitis C in children born to
HIV-infected mothers
Esther Ruiz-Chercoles1, J.T. Ramos1, J. Ruiz-Contreras1, C. Alvarez2,
M.J. Domingo2, A. Fuertes1, V. Rodriguez-Cerrato. 1 CTRA De Andalucia KM5,
4 Madrid 28041 Hospital 12DE Octubre DPTO Pediatria; 2Microbiologist
Hospital 12 DE Octubre Madrid, Spain
Background: The rates of vertical transmission of hepatitis C virus (HCV) have
been variable among the populations studied. Mother to child transmission of
HCV is more frequent from women coinfected with HIV-1 and from women with
detectable serum HCV-RNA.
Objectives: To determine the rate of vertical transmission of HCV in children
born to intravenous drug users (IVDU) HIV-infected mothers. To assess the
relationship with the mother's serum RNA-PCR.
Methods: We prospectively followed from birth a cohort of children born between 6/1990 and 12/1995 to HIV-1 and HCV coinfected mothers with at least 18
months of follow-up. HIV and HCV infection status was assessed by persistence
of specific antibodies beyond. Qualitative RNA-PCR for HCV was determined by
Amplicor (Roche) Blood sample were obtained from mother at the time of delivery.
Results: Overall 57 pairs of mother-infants pairs were identified in the cohort.
All mothers had a history of IVDU. There were no differences in the degree of
immunosupresion nor obstetric events among the HCV transmitting and nontransmitting. HCV RNA-PCR was positive in 73.6% of the mothers. Only 3 children
were HIV-infected and 2 were also HCV coinfected. Seven children were infected
with HCV (transmission rate 12.2%). All HCV infected children were born from
mothers in whom serum PCR-RNA was positive, whereas no child born from
HCV PCR-RNA negative mothers become infected.
Conclusions: The vertical transmission rate of HCV in the studied cohort of
children born to HIV-coinfected mothers has been 12%. Our study confirms that
a detectable HCV PCR-RNA in the mother's serum at delivery is associated with
a higher transmission rate.
174*/12169 How often can signs, symptoms and
immunological abnormalities predict perinatal HIV
infection in Brazilian infants?
Marisa M. Mussi-Pinhata, M.C. Cervi, M.L. Isaac, O.A.L. Cintra. Universidade
De Sao Paulo, Ribeirao Preto, SP Brazil
Objectives: To evaluate the utility of signs and symptoms suggestive of HIV
infection and detection of immunological abnormalities in the diagnosis of HIV
infection in infants younger than 9 months (mo) of age.
Design: Comparison of clinical and immunological findings of a cohort of infants perinatally exposed to HIV-1 Methods: 27 infants confirmed to be infected
(HIV+) and 43 HIV-uninfected (HIV-) were studied. Clinical evaluations were done
monthly from birth. IgG, M and A, CD4 and CD8 cell counts were done at 7 ~ 1 mo.
Results: All HIV+ and HIV- infants had one or more findings during the
first 9 mo. The respective frequency was: lymphadenopathy (LY) (56% vs 26%),
splenomegaly (SPL) (63% vs 19%), hepatomegaly (HEP) (85% vs 51%), diarrhea
(DIA) (70% vs 35%), oral candidiasis (CAN) (67% vs 16%), failure to thrive (FTT)
(82% vs 30%), upper respiratory infection (URI) (93% vs 74%) or pneumonia (PN)
(59% vs 14%). Most (87%) of the infants were asymptomatic by 1 mo when only
CAN was more frequent in HIV+ infants (9/27 vs 3/43, p < 0.05). Excluding DIA
by 3 mo, all the remaining isolated findings were more frequent (p < 0.05) in HIV+
infants by 3 mo, by 6 mo and by 9 mo of age. By 9 mo 19/27 (70%) HIV+ and 8/43
(19%) HIV- infants had any two of LY, SPL and HEP (specificity = 58%). Higher sensitivity (100%) was found with detection of any two of DIA, PN, URI, FTT, CAN but
specificity was also low (40%). Low CD4+ counts were found in 13/23 (57%) HIV+
and 5/30 (18%) HIV-infants (specificity = 83%). At least two abnormal levels of IgG,
M or A were detected in 14/23 (67%) HIV+ and 4/30 (13%) HIV- infants (specificity
= 87%). The combination of SPL, CAN, FTT and at least 2 Hyper IgG, M or A was
found in 17/21 (81%) HIV+ and in none of 30 HIV- infants (specificity = 100%).
Conclusion: Although occurring at higher frequency in HIV-infected than HIVuninfected infants, none of the isolated clinical findings or immunological abnormalities can discriminate between HIV-infected and HIV-uninfected infants.
Association of findings of splenomegaly, oral candidiasis, failure to thrive and
abnormal levels of 2 immunoglobulins had the highest sensitivity (81%) and
specificity (100%) for diagnosis by 6 months of age.
12170 Pertussis immunization does not affect HIV-1 progression
in perinatally infected children
Pier-Angelo Tovo, C. Gabiano, M. De Martino, L. Galli. Dipartimento Scienze
Ped. Eadolescenza P ZZA Polonia 94 10126 Torino; Clinica Pediatrica III

Firenze; For "The Italian Register for HIV Infection in Children", Italy
Objective: To evaluate the impact of pertussis immunization on the clinical and
immunologic course of perinatal HIV-1 infection.
Methods: In Italy, pertussis vaccination is not mandatory and is available only
combined with the diptheria-tetanus vaccine, which must be administered during
the third month of life. Among children enrolled in the "Italian Register for HIV

infection in children", those perinatally infected who 1) were identified by three
months of age, 2) by that age did not develop clinical manifestations of CDC
category "B" or "C" or immunosuppression (CDC category "2" or "3") or die, and
3) had a regular follow-up were included in this analysis. They were divided in
two groups: group A included 88 children who underwent pertussis immunization,
group B 244 who did not. No selection criteria were followed in vaccinating children. Conditional probabilities of progressing to CDC categories "B" or "C" and
"2" or "3" were retrospectively compared in group A and group B babies by the
Breslow method.
Results: The two groups of children were similar as regards: maternal HIV-1
disease stage at delivery, gestational age, mode of delivery, birth weight, gender,
type of feeding, length of follow-up, start and duration of antiretroviral therapy, IV
IgG treatment, and Pneumocystis carinii prophylaxis. No significant differences
were observed between group A and group B children in cumulative probabilities
of developing severe or moderate clinical manifestations as well as intermediate
or profound immunosuppression.
Conclusion: Pertussis vaccination does not affect clinical deterioration and
drop in CD4 cell count in perinatally HIV-1-infected children. The lack of a significant impact on HIV-1 progression by the repeatedly vaccine-induced T cell
activation endorses the current recommendations for routine immunizations in
children with perinatal infection.
121711 Heart, lung, and immune abnormalities and high viral
burden in rapid pediatric HIV-1 disease
William T. Shearer1. P2C2 HIV Study Group; National Heart Lung & Blood
Institute Bethesda MD; 1 TX Children's Hosp, 6621 Fannin MC 13291 Houston,
TX 77030-2399, USA
Objectives: To quantitate the impact of assignment of pediatric HIV-1 disease
progression categories (rapid progressors [RP], intermediate progressors [IP],
long-term survivors [LTS]) upon detection of heart, lung, and immune abnormalities and high HIV-1 burden in children with HIV-1 infection.
Design: Five-year longitudinal and prospective natural history study.
Methods: We studied 205 infants and children with established vertical
HIV-1-infection (Group I) and 93 HIV-1 infected infants (Group Ila) enrolled
from birth in a prospectively followed cohort of 600 liveborn infants, 463 of which
were non-infected infants (Group Ilb) and 44 were HIV-1 indeterminate. Interval
measurements were made of the cardiac, pulmonic, and immunologic systems
and of HIV-1 RNA levels by PCR.
Results: Group Ila RP demonstrated increased five-year cumulative death
rates (p < 0.001) compared to IP and significantly elevated serum HIV-1 RNA
over the first 2 years (p < 0.001) and 4 years (p = 0.002). At one year of age,
RP had elevated mean heart rates and respiratory rates and decreased mean
cardiac fractional shortening when compared to non-infected children (p < 0.001).
Significant differences were also observed between II RP and II IP over the first
2 years of life in mean heart rates, respiratory rates, and fractional shortening.
Similar trends were observed among the older Group I cohort (median enrollment
age - 23 months). Moreover, Group Ila RP had significantly lower CD4+ and
CD8+ T-cell counts vs. Group Ila IP, suggesting a loss of helper and cytotoxic
T-cells. Group Ila RP had significantly higher serum IgM but equal or low serum
IgG, suggesting a loss of IgG switching. Group Ila RP also demonstrated suggestive evidence of increased tachypnea, 02 desaturation, and increased nodular,
reticular, or bronchovascular markings on chest x-ray, as compared to Group lib.
Conclusions: Rapid disease progression in a cohort of 205 HIV-1 infected
infants with established diagnosis and in a cohort of 93 HIV-1 infected infants
prospectively enrolled at birth is associated with abnormalities of heart and lung
function by either retrospective or prospective analysis. These abnormalities also
correlate with altered cellular and humoral immunity and high serum levels of
HIV-1-RNA in rapid progressors and are, themselves, important signposts of
pediatric HIV-1 disease progression.
S12172 Protease inhibitors in children with HIV infection
Jose Tomas Ramos Amador, R. Bastero Gil, J. Saavedra Lozano, A. Bodas.
J. Ruiz-Contreras, J. Alcami. Hospital 12 De Octubre Dpt 0 Pediatria Ctra De
Andalucia KM5, 4 28041 Madrid, Spain
Background: There are scant data on the use of protease inhibitors (PI) in
HIV-infected children.
Objectives: To determine the short-term safety and effectiveness of P1 in
terms of clinical, virologic, and immunologic response in children with perinatally
acquired HIV-infection.
Patients and Methods: Retrospective chart review of open-label PI-containing
combination therapy. Only PI-naive children treated with one PI in combination
with two nucleoside analog reverse transcriptase inhibitors (RTI) for more than 6
months were analyzed. There were 4 antiretroviral naive children. Patients had
been on RTI treatment for a median of 37 months. Mean age at the initiation of
PI was 78 ~ 41 months. 59% of children were on class C or 3 at the initiation of
PI.
Results: Overall 32 children were treated with PI: 14 ritonavir (R), 6 indinavir

(I) and 12 saquinavir (S). Intolerance requiring a switch on therapy was observed
in 3, 2 and 1 patients respectively. Among the 26 patients who completed at least
1 month of therapy, mean body weight gain from baseline was 7.8 ~ 5.7%. Mean
increase at 4-6 months after the initiation of PI on CD4 percentage was 6.6 ~ 8.8,
2.7 ~ 2.1, 7.2 ~ 7 for R, I, and S, respectively. Mean drop on viral load (Amplicor,
Roche) at 4-6 months was 1.04 ~ 1.33, 1.48 ~ 0.67, 0.86 ~ 0.73 for R, I, and S,