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

12th World AIDS Conference

Abstracts 12178-12183 47

12178 Molecular characterization of human inmunodeficiency
virus type 1 - Infected individuals from Bolivia reveals
presence of two distinct genetic subtypes
Kety G. Velarded', Monica L. Guimaraes2, Raul A. Arevalo3, Mariza
G. Morgado3. 1Av. Heroes Del Pacifico #1382 Miraflores; 3Ministerio de Salud,
La Paz, Bolivia; 2Fiocruz Laboratories, Rio de Janeiro, Brazil
Objetives: To analyze the prevalence and molecular diversity of HIV-1 subtypes
in samples from infected individuals residing in diferent cities from Bolivia.
Methods: HIV subtyping was conducted on 30 DNA samples obtained from
peripheral mononuclear blood cells of seropositive individuals from Bolivia, obtained between May and september 1996. Molecular caracterization has been
based in the polymorphism of the C2-C3, V1-V3 and V1-V5 gp 120 regions
amplified by the plimerasa chain reaction (PCR) method. DNA samples were PCR
amplified using a nested protocol and the amplified meterial was characterized
usinq a hetero-duplex mobility assay as described (Delwat et al. 1993. Science
262: 1275-1261).
After subtype determination, subtype B PCR amplified samples werw digested
with Fork I restriction enzyme and electroforesed through 2% agarose gels for 1
h in 1XTBE. Genetic sequencing was performed for 12 specimens.
Results: From this group, twenty aight (93.3%) werw clasified as B subtype
while 2 (6.7%) were identified as F subtype. DNA from HIV-1 subtype B infected
patients was screned for the tipycal Brazilian GWGR V3 LOOP MOtif. After
subtype determination, the C2-C3 amplified samples were digested whith Fok
I restriction enzyme and electrophoresed through 2% agarose gels. The typical
410 bp and 230 bp Fok I restriction frament pattern could be detected in 3 subtype
Bsamples (10.7)
Conclusions: HIV-1 subtype B is predominant in Bolivia, as described to
other South Amarican countries. HIV-1F subtype and the typical Brazilian subtype B variant are also circulating in this country, The results obtained suggest
that most Bolivian HIV-1 B strains have antigenic properties similar to North
American/European strains.
S12179 | Pediatric AIDS in a Brazilian population: 12 years of
follow-up
Heloisa Helena Marques1, Marcelo G. Vallada2, H.K. Sato2, M.Z. Aquino2,
M.C.A. Moreira2, A.S. Grumach2, P.T. Sakane2. 'Rua Dr. Virgilio De Carvalho
Pinto 306 Apt. 34; 2 nstituto Da Crianca-HCFMUSFP Sao Paulo, SP, Brazil
Background: Since 1985 we have been following an increasing number of children, 294 affected by AIDS and 137 HIV-exposed infants, 43 of the latter have
already beeing discharged as sero-reverted. This study describes clinical data
and the evolution of pediatric AIDS in a Brazilian population.
Methods: The charts of every children with AIDS admitted to the "Instituto da
Crianqa" during the last 12 years were reviewed.
Results: The male gender represented 154 (52%) and the female 140 (48%)
of the 294 cases; 241 (82%) patients were infected perinatally, 39 (13%) were
infected by blood products and in 14 (5%) of the cases the source of HIV infection
could not be determined. Among perinatally infected children, only 8 remain
asymptomatic (range 25 to 126 months); in the symptomatic group, the median
age at the first symptom was 11.5 months (range 1 to 82 months). The age distribution at diagnosis was: 27.3% < 1 yr, 49.6%1 yr-4 yr, 18.7%4 yr-8 yr and 4.4%
- 8 yr. The clinical manifestations at the time of diagnosis were: failure to thrive
(40%), hepatomegaly (39%), recurrent pneumonia (33%), adenomegaly (31%),
diarrhea (26%), splenomegaly (25%), intermittent fever (23%), parotiditis (8%),
and thrombocytopenia (5%). The most commonly seen complications were in the
Respiratory Tract, followed by Gastrointestinal disorders, severe malnutrition and
fungal infections. During this period, 100 (34%) of the children died and only 18
(6%) abandonned the follow-up, while 12 (4%) patients were transferred. The
other 164 cases are still being followed together with 94 exposed children whose
diagnosis is still indetermined. The management is supported by antiretroviral
therapy, IVIG, and PPC prophylaxis when required.
Conclusions: This group represents 14% of the Pediatric AIDS in the State of
Sao Paulo and these results may be comparable to the Brazilian total data. Sao
Paulo is the state in Brazil with the higher number of HIV infected people (60% of
the total), including HIV infected children.
|12180 |Different rates of CD69, CD25, HLA-DR and CD45RO
expression, Interleukin-2 synthesis and apoptosis in
fresh or cultured lymphocytes from HIV-infected
children
Constantin Voiculescu', C. Avramescu2, E. Radu2, M. Balasoiu2,
A. Turculeanu2. 1Petru Hares Street, 1100 Craiova; 2Faculty of Medicine
Craiova, Craiova, Romania
Objectives, Methods: In two groups of HIV-infected children, aged from 7 to 10
years (AIDS-related complex-ARC, and AIDS disease-AIDS, respectively), the
following immune markers, in unstimulated, PHA-stimulated or dually PHA/IL-12

- stimulated T cell cultured, were tested: % expressionof activation surface cell
determinants, i.e. CD69, CD25, HLA-DR and CD45RO; interleukin-2 (IL-2) synthesis; rate of apoptosis.
Results: In all HIV-originated cells, a decrease of CD69 expression, associated
with an increase of CD25 and HLA-DR expression, was found. As concerned
CD45RO expression, only a slight reduction of positive fresh CD4+ cells within
the AIDS-group was noticed, whereas in PHA-, and particularly in PHA/IL-12

supplemented cultures, CD4+CD45 RO+ - cell levels were markedly decreased.
AAA strong correlation could be also made between the clinical stage of the AIDS
infection, on one hand, and the in vitro IL-2 production and the percentages of
apoptotic cultured cells, on the other hand. IL-12 supplementation of PHA-stimulated cell samples restored the IL-2 synthesis and reduced the apoptosis rates
only in the ARC-geoup, but not in the AIDS-group.
Conclusion: The actual significance of the present data on some activation
markers, IL-2 synthesis and apoptosis in cultured T cells, for the clinical and
therapeutical monitoring of HIV infection among low-aged people needs further
studies, in order to be fully evaluated.
12181 Neurologic manifestations in a Puertorican pediatric HIV
infected population
Ivonne Fraga1, M. Vazquez2. Cond Doral Plaza, Apt 7K, Guaynabo; 2University
of Puerto Rico, San Juan, Puerto Rico, USA
Objective: To determine the neurological findings in HIV-I infected children from
San Juan, Puerto Rico and compare our results with those of other similar studies.
Design: Retrospective, observational study.
Methods: We reviewed the records of all children with risk factors for HIV
infection referred to the Pediatric Neurology clinics at San Juan City Hospital
from 1991-1997. Reasons for referral included seropositive mothers or children
already identified as infected with HIV. A total of 116 children were identified, of
which 82 were HIV infected and 34 negative. All patients were evaluated at least
three times by a Board Certified Pediatric Neurologist.
Results: Among the 82 HIV infected children, age range was 0 to 15 years.
Mode of transmission was maternal-infant (vertical) in 90% of cases; associated
to blood transfusion in 5%; sexual exposure in 2% and undetermined in 3%.
The most frequent neurological finding was developmental delay, present in 37
of the 82 patients. Language delay occurred more frequently than motor delay.
Neurobehavioral problems such as hyperactivity and/or ADHD were found in
8 patients and school underachievement in 15. Abnormalities in neurologic examination included: head circumference below second percentile in 22 patients;
cranial nerves dysfunction in 7; hypotonia in 35; spasticity in 18 and movement
disorder in 2. Seizures were not observed in our population. The majority of
the patient studied (71/82) followed a non-progressive neurologic course and 11
showed progressive neurologic decline.
Conclusion: Neurologic manifestations in our population were found to be
similar to that described in previous studies being developmental delay the most
common finding. However in contrast to other studies, static encephalopathy
was seen more often than progressive encephalopathy and seizures were not
observed. Careful neurodevelopmental evaluation is important to identify those
patients with early onset of neurologic dysfunction in order to provide prompt
treatment and asess its response.
12182 Two antiretroviral drugs regime efficacy followed by the
use of progression predictors
Adrian loan Toma1'3, Adina Elena Stancescu2. 'Bd. 1 Mai 104, bl. 85, sc. B, ap.
28; 2Celentina Infectious Diseases Clinic; 3 Universitary Clinical Hospital,
Bucharest, Romania
Objective: to determine the efficiency of a combination of 2 Reverse Transcriptase
Inhibitors in the treatment of HIV infected children.
Methods: Sample formed of 100 children (ages: 8-11 years old) randomly
selected, half of them treated with a combination of zidovudine and zalcitabine
and half not receiving any treatment. They were parenterally infected children. We
used a set of two surrogae-markers proved to have a good predictive value (CD4
lymphocytes count; hemoglobin value) to estimate the efficacy of the therapy.
Kaplan-Meier estimations were used for the statistical interpretation of the data.
Log- Rank test was used to prove the significance of the results. There were
figured Kaplan-Meier plots for each group and marker.
Results: The values of the predictors at the end of the follow-up perioud were
significantly grater in treated patients versus the untreated ones. (CD 4 counts -
p < 0.001; hemoglobine value p < 0.006)
For the patients diagnosed with AIDS, at the beginning of the study the differences in the values of the predictors were also segnificant. (CD4 count p <
0.002; hemoglobin value p < 0.001) between the two groups.
Conclusion: The study proved the improvement realised by the combination
therapy in HIV infected children and demonstrated the possibility to conduct such
a work in Romania, by using the available parameters in the conditions of a
developing country.
| 12183 HIV/AIDS infection characterization of the pediatric
patients attending the University Hospital, Honduras
Maribel Rivera Medina', J. Alger2, R.J. Soto3. 1P.O. Box 3051 Tegucigalpa,
Honduras; 2Clinical Laboratory University Hospital, Tegucigalpa; 3STD-AIDS
Department, MPH, Tegucigalpa, Honduras

Objective: To obtain a clinical and epidemiologic characterization of the HIV/AIDS
infected children attending the University Hospital in Tegucigalpa between January 1st, 1990 and November 30, 1997.
Design: Transversal, descriptive study.
Methods: Clinical histories of hospitalized patients with the diagnosis of
HIV/AIDS infection were reviewed and information was collected on a form