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

46 Abstracts 12173-12177

12th World AIDS Conference

respectively. Side-effects were common in children on R and I, whereas S was
well tolerated.
Conclusions: PI in combination with RTI is associated with a maintained
clinical, immunologic and virologic response in children with perinatally acquired
HIV-infection, although lower than in adults. The rate of intolerance and adverse
events is of major concern. Further treatment options are needed to achieve a
better tolerance and a more potent virologic suppresor effect.
12173 Experience with ritonavir in HIV+ pediatric patients
Patricia Coll', Pedro Cahn', M.J. Rolon', S. Perez Macri1, F. Vesperoni1,
M. Avila2, P. Martinez2, D. Liberatore2. 1Infectologia, Hospital Fernandez, Angel
Peluffo 3932 (1181), Buenos Aires; 2Buenos Aires University, Buenos Aires,
Argentina
Objective: To evaluate safety and efficacy of Ritonavir in HIV+ patients
Methods: A total of 25 patients less than 13 years old were treated with
Ritonavir plus two nucleoside reverse transcriptase inhibitors (NRTI) Inclusion
Criteria: Pediatrics patients with detectable viral load and/or disease progression.
We evaluate: survival, new AIDS defining events, pretreatment viral laod (b-DNA),
at the first month, and every three months. CD4 counts were evaluated by flow
citometry.
Results: Triple therapy was well tolerated and no relevant adverse effects
were recorded. Age Range: 1 month - 11 years. NRTI used: AZT + 3TC: 17
patients; D4T + 3TC: 8 patients. CD4 Median: 600/ml (r = 35-1770). Viral load
pre treatment.: Median: 32100 copies/ml (log 4.5) (r = 960-3260000). Viral load
at 4 weeks was below 500 copies/ml in 48% of cases. At 12 weeks reduction
of at least 1 log. was obtained in 12 out of 17 patients tested (70.5%). Updated
information at 6 months will be presented.
Conclusions: Ritonavir in capsules has been well tolerated, showing good
short term virologic response. A longer period of observation is required to
validate these data.
12174 The effect of HIV on gastro-enteritis in children admitted
to a large urban hospital in South Africa
Saul Johnson1, W. Hendson2. 1Perinatal HIV Research Unit CH Baragwanath
Hospital PO Bertsham 2013; 2Paediatric Dept, University of Witwatersrand,
Johannesburg, South Africa
Background: Studies on HIV-infected adults with gastro-enteritis (GE) have
shown atypical presentations and unusual organisms. Little is known about the
pathogenesis and the etiology of GE in HIV-infected children in an urban African
setting. The aims of this study were to compare the clinical and microbiological
differences between children admitted with GE who were HIV infected and HIV
uninfected.
Methods: A prospective unmatched case-controlled study was undertaken at
the Chris Hani-Baragwanath hospital in Soweto over a period of a year (8000
paediatric admissions in 1996). Children (3 months-5 years) were recruited from
a short-stay GE unit, and from one of the paediatric wards.
Demographic details, GE history, examination, stool culture and HIV ELISA's
were performed after obtaining voluntary informed consent.
Results: 23% of GE admissions were HIV positive. There was no significant
difference between the two groups for duration of breastfeeding, age at hospital
admission, duration of GE, clinical severity of dehydration, or mortality (3 deaths
in each group) between the two groups. Significant differences were found in the
duration of hospital stay (10.4 days vs. 5.8 days, p < 0.001), admissions to ward
(p < 0.001) and co-diagnosis of pneumonia (p < 0.001). There was no difference
in organisms cultured in the two groups.
Conclusion: Mortality for GE in this setting is low for both groups. However,
a quarter of all patients admitted for GE are HIV-infected, and co-infection with
pneumonia appears to increase morbidity.
S12175 1 Soroconvertion in infants of positive mothers to HIV total
breastfeeding impact
Maria Teresa Nishimoto1, A.S.P. Gibbons2, A.M. Segall-Correa3, K.M. Teruya4,
R.L. Hayden1. 1 RVA Oswaldo Cruz 197 Santos Sado Paulo 11045-904; 2NIC
STD/AIDS Municipal Program Santos SP; 3Unicamp Faculdade Cidncias
Medicas Campinas SP; 4Lactation Center FCMS-Fundagao Lusiada Santos SP,
Brazil
Objectives: To estimate breastfedding risk in the mother to infant transmission in
a cohort of children born in Santos SP Brazil; to analyse breastfedding length effect in soroconvertion; to estimate survival of total breastfed versus non breastfed
children.
Methods: A historic cohort with HIV positives mother's infants was assisted
at NIC - Santos SP Brazil (Nucleo Integrado da Crianga) from January 1993 to
December 1997. The children were stratified in two groups Breastfed and Non
breastfed. The HIV infection was determined by the antibody test after 18 months

of age or by AIDS clinical diagnosis at any age.
Results: The results of antibody test in the two groups were:
HIV+ HIV -
Total Breastfed 45/64 (70.3%) 19/64 (29.6%)
Non breastfed 35/72 (48.6%) 37/72 (51.3%)
X2 = 6.6 P value = 0.01

25% of women had knowledge of their HIV positive status and decided to
breastfed their children despite of the strongly health professional warning to the
risk of their choice. The total breastfedding average was 30 days at seropositive
group and 0 days at the seronegative group.
Conclusions: Breastfedding is meaningful factor to HIV mother to infant transmission. The Kaplan - Meier analysis suggests greater survival of the total
breastfed infants group, however the difference has not showed to be statistically
meaningful. Would breast milk have a protector effect over HIV infected children?
S12176 The 24-Hour hormonal profile in HIV-Infected children
Mariangela Rondanelli1, D. Caselli2, A. Maccabruni3, M. Maghnie2,
S.B. Solertel, E. Ferrari1, L. Minoli3. 1Department of Internal Medicine and
Medical Therapy Chair of Geriatrics University of Pavia; 2Pediatric Department
I.R.C.C.S. Pol San Mateo 27100, Pavia; 3Dept. Infect. Diseases I.R.C.C.S. Pol
San Mateo 27100, Pavia, Italy
Background: Several endocrinologic abnormalities, related to the well recognised HIV-driven failure to thrive, has been documented in HIV-infected children.
Because of the episodic pattern of hormone secretion, incidental hormone concentration measurements provide inadequate information about the amount of
hormones secreted over a longer period. Therefore, to study the hormonal regulation of growth, it is necessary to evaluated the rhytmicity of hormones involved
in the regulation of growth's process. At present no data are available on the
hormonal circadian rhythmicity in HIV-infected children. Because the chronobiological approach to disease could offer new information for better understanding
the pathophysiology of the endocrine abnormalities demonstrated in AIDS children, the aim of the present study was to investigate spontaneous 24-hr secretion
of GH, IGF-I, cortisol ACTH and TSH in HIV-seropositive children, and to compare
these variations with those of healthy sex and age matched children.
Methods: The patients group consisted of 14 children HIV infected (6 M, 8 F,
ranging in age from 3 to 13 year); 10 of them had paucisymptomatic disease,
while 4 had symptomatic expressions of HIV infection. No active opportunistic infections or neoplastic processes and evidence of endocrinopathies were present
in patients. Thirteen clinically healthy sex and age matched children were chosen
as control group. Sampling was performed every 4 hr from 04:00 to 20:00 and
every 2 hr from 20:00 to 04:00. Rhythmometric data were analyzed by single and
population mean cosinor methods according to Halberg and by ANOVA.
Results: A statistically significant circadian rhythm for GH, IGF-I and cortisol
was detectable in HIV-seropositive children, however the mean basal IGF-I levels
were below the normal range for age in 12 patients. A statistically significant
circadian rhythm was not detectable for pl. ACTH and TSH.
Conclusion: These results show that there is a loss of the synchronous pattern of GH and IGF-I secretion and a derangement of 24-hr TSH profile in our
HIV-infected children. These abnormalities may be involved in the altered growth
mechanism during paediatric HIV infection.
12177 Efficacy of switching to continuous intravenous AZT
therapy in oral AZT treated children with HIV
encephalopathy
Vincent Guigonis1, Catherine Dollfus1, D. Douard2, M. Damay3, P. Ferre4,
F. Aubier5, C. Courpotin6. 1Pediatric Hematology Hopital Trousseau 26, Avenue
Du Dr Arnold Netter 75012 Paris; 2Hopital Pellegrin, Bordeaux; 3Centre
Hospitalier Du Mans, Le Mans; 4 Hopital A. Gregoire, Montreuil; 5Centre
Therapeutique Pediatrique, Margency; 61mmunohematology Hopital Trousseau,
Paris, France
Background: HIV encephalopathy remains a major concern among HIV infected
children (19 to 31% of children with AIDS). In 1988, Pizzo reported neuropsychological improvement in 13 AZT naive children with encephalopathy treated
with continuous intraveinous infusion of AZT (CIV-AZT). No current alternative
yet demonstrated any efficacy on neurological complications. We present our experience of administering CIV-AZT in 7 vertically infected children, all previously
treated with oral AZT, with HIV related encephalopathy.
Results:
AZT-PO AIDS Neurol. CD4*/ml CIV-AZT CIV-AZT Dose CIV-AZT #
age at age at S. age at (%) age at duration mg/kg/h efficacy weeks to
onset diag. diag. onset (mo) efficacy
(mo) (mo) (mo) (mo)
1 6 6 9 870 (34) 11 14 0.4 + 4
2 3 7.5 7.5 47 (2.9) 9 7 1.2 + 2
3 11 36 54 16(6.1) 90 8 0.7 + 4
4 4.5 4.5 14 20 (2.6) 20 240 0.8 0
5 birth 18 18 750 (20) 32 2 1.25 + 6
6 5 24 24 300 (25) 26 6 1 + 3
7 19 29.5 29.5 152 (19) 32 4.5 1 - 0
at CIV-AZT beginning; o child under total parenteral nutrition; t short term efficacy

Conclusion: CIV-AZT led to neurologic improvement in 5/7 cases without any
significant complications. We observed one complete recovery and two failures.
Neurologic benefit of CIV-AZT persisted beyond IV treatment cessation in most
patients. Even if this strategy seems aggressive, it is feasible in outpatient settings with portable infusion pumps. Amelioration of neurologic status resulted in
improved quality of life outweighting the costs of therapy.