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

610 Abstracts 32441-32445

12th World AIDS Conference

symptomatic (7 in class B and 6 in C) and all had a severe immunosuppression
(CDC class 3). Viral load (VL) measurements (quantitative HIV polymerase chain
reaction assay - Roche) were performed at baseline and at 2, 4, 8, 12, 24 and 48
weeks of therapy, with clinical and immunologial evaluations. NSI/SI phenotype
was evaluated on MT2 cell line colture.
Results: A significant improvement of clinical and immunological state was
observed in all patients during the follow-up period. All patients gait weight and
felt better. We noticed a progressive increase of CD4+ starting from a baseline
mean count of 120 x 106/1 (median 71, SD 120 x 106/1) and ranging a mean
value of 274 cells x 106/1 at 12 weeks (median 284, SD 160 x 106/1) and a mean
of 436 cells x 106/1 24 weeks (median 415, SD 280 x 106/1); the immunological
improvement was mantained at 48 weeks in the 9 evaluable patients with mean
level of CD4+ of 496 cells x 106/1 (median 472, 176 x 106/I SD) and a significant
reduction of the number of infections and hospitalizations. A decrease of viral
load values (>0.5 logio copies/ml) was observed after 2-4 weeks of treatment in
all the 12 patients starting with more than 15,000 copies/ml, with a mean decrese
of 2.3 logio copies/ml (median 3, SD 1.3 x 106/1). The only patient showing no
viral load decrease started with 5000 copies and maintained that level during
the follow-up. In 9 children the value decreased under 400 copies (undetectable)
but all the patients showed a rebound in viral load, that often reached values
comparable to those at baseline. Twelve patient are affected from a NSI virus but
three of them acquired a SI strain.
These data suggest that triple combination therapy with protease inhibitors lead
to a steady immunological and clinical improvement in children, but also to short
term virological response in cases of long term pretreated children.
32441 Treatment education, activism and advocacy for parents
of HIV+ children: The experience of the Pediatric Study
Group
Susan Rodriguez1, P. Berrios2, M. Diaz3, S. Cooper2. 1246 Van Brunt St.
Brooklyn, New York 11231; 2PWA Health group Bronx NY; 3Just Kids
Foundation New York NY, USA
Issue: There is limited information in the US on pediatric HIV medications, nutritional guidelines and clinical trials available to parents in order for them to
make informed decisions in treatment for their HIV+ children. Our health care
environments are not "people friendly" and parents rarely have access to recent
data or data that is presented in an understandable form, leaving parents feeling
confused, isolated and overwhelmed.
Project: The Pediatric Study Group (PSG) was started in February 1997 at
the PWA Health Group, a community -based AIDS service organization. Meetings
are held every two weeks and pediatric information is exchanged. The PSG is actively led by HIV+ mothers of HIV+ children. By educating caregivers, parents are
empowered and become knowledgeable about all dimensions of their children's'
health.
Results: 1) Since many of the adult antiretroviral options are not available
for children, many children have used up their options in approved treatments.
The PSG has accessed information on compassionate use programs, off-label
drug use, and/or clinical trials that parents may enroll their children in. 2) The
future availability of treatments is discussed, improving long-term strategizing. 3)
A pilot program for an after school nutrition/exercise intervention is in the proposal
stages between the PSG and a New York City hospital. 4) A local shortage of
IVIG prompted the PSG to take action with governmental authorities to facilitate
resolution of the problem. 5) Two of the co-authors have expanded the PSG
by targeting others in the local Hispanic community. 6) The PSG has been an
instrumental part of the steering committee for New York City's first local treatment
conference for parents of HIV+ children, scheduled for 3/14/98.
Lessons Learned: Understanding the complexities of illness and treatments
for HIV+ children promotes active parental involvement and facilitates essential
communication between parent and providers. Parents are eager to learn more
about research and clinical care issues for their HIV+ children. The empowered
parents regain control of the delicate and highly individualized HIV treatment
decision-making process of the health of their children. The PSG is a helpful,
inexpensive, in-depth self-help group that can be run out of any agency.
32442 Heat-denatured p24 antigen testing compared to PCR for
diagnosis of pediatric HIV-1 infection and quantification
of virus load
Jorg Schupbach1, J. B6ni2, D. Nadal3, Z. Tomasik4, C. Kind5. 1Zurich University,
Natl. Center Retrovir., Gloriastrasse 30, Ch-8028 Zurich; 2Swiss National Center
for Retroviruses, Zurich; 3University Children's Hospital, Zurich; 4Swiss National
Center for Retroviruses, Zurich; 5Division of Neonatology, Kantonsspital, St.
Gallen, Switzerland
Objective: To evaluate a simple and low-cost alternative to PCR for early diagnosis of pediatric HIV-1 infection and viral load monitoring.
Design: Retrospective evaluation of results obtained 1994-1997 from children
of the Swiss Neonatal HIV Study. Tests had been done and results communicated

prospectively to the treating pediatricians.
Methods: Blood samples were subjected to Ficoll separation. Tests included
(a) heat-denatured p24 antigen (HD-Ag), consisting of boiling the 1: 6 diluted
plasma for 5 min followed by the Du Pont HIV-1 p24 Core Profile ELISA and
tyramide signal amplification; (b) PCR for viral DNA in PBMC with primers from
gag, envand LTR; (c) qualitative RT-PCR for viral RNA in plasma using the same
primers; (d) Roche's Amplicor HIV-1 Monitor for viral RNA load.

Results: Diagnostic sensitivity in infected infants was as follows: age: <10
days: HD-Ag, 6/12 (50%) neutralized positive with range 1-10 pg/ml and neutralization 52-100% (2 more were reactive with 1.3 pg/ml, but not neutralizable); DNA
PCR, 5/12 (42%); RNA RT-PCR, 3/7 (43%). After 10 days, all tests were 100%
sensitive on a total of 220 samples from untreated children. Among 627 samples
from 246 infants considered uninfected, initial reactivity of samples for HD-Ag was
6.2% and specificity after neutralization 99.2%. Four infants showed transient, in
one child repeated and decreasing, neutralizable antigenemia early after birth.
Quantitative results of HD-Ag and Amplicor in 270 samples including children
under antiretroviral treatment correlated with R = 0.66 (p <.0001). 33 samples
were negative by Amplicor and 30 by HD-Ag. The two parameters showed similar
courses in most children.
Conclusion: Heat-denatured, signal-amplification-boosted antigen testing may
be used for diagnosing pediatric HIV-1 infection and for virus load monitoring.
PCR may be restricted to few unclear cases.
32443 1Management of malnourished children: Comparison of
weight gain in children infected or not with HIV
Jean-Pierre Beau'3, Lucile Imboua-Coulibaly2. 1ORSTOM 04 BP 293 Abidjan
04; 2Chu de Treichville Abidjan; 30rstom 04 BP 293 Abidjan 04, Cote D'lvoire
Objectives: Weight loss in children infected with HIV is a major complication during the course of the disease. In comparison with adult and in developing countries
in particular, very few studies have been devoted to the nutritional care of these
HIV seropositive malnourished children. The aim of this study was to compare,
on the basis of HIV serology, the impact of nutritional management on weight gain
of malnourished children monitored in 1996 at an infant home in C6te-d'lvoire.
Methods: This retrospective analysis was conducted on 31 malnourished children above 15 months of age (16 were HIV seropositive) who received a milk
supplement enriched with oil and sugar.
Results: After 1 month of this diet, weight gain was significantly lower among
HIV seropositive children (seropositive: 2.6 ~ 4.5 g/kg./d; seronegative: 6.3 ~ 4.1
g/kg/d; p < 0.05) and the rate of failure (weight loss) was higher in HIV seropositive children. Among the various pathologies observed in these malnourished
children, only diarrhoea was a discriminating factor for HIV infection.
Conclusions: These results confirm the difficulty of nutritional management
among malnourished children infected with HIV and emphasize the high rate
of diarrhoea among these children. Studies allowing a better understanding of
nutritional care modalities among HIV infected children appears to be a priority in
developing countries.
S32444 Protease inhibitor (PI) use in women and children treated
at sites of the Pediatric AIDS Clinical Trials Group
(PACTG)
Valerie Bartlett1, Beth Roy2, B.A.G. Griffin2, S.A.S. Spector3, K.R.L. Luzuriaga4.
16101 Executive Blvd Suite 350 Rockville MD 20852; 2Social & Scientific
Systems Inc. Rockville MD; 3Univ. of California, San Diego Med. Ctr. La Jolla
CA; 4Univ. of Massachuserrs Med. School Worcester MA, USA
Objective: To describe the use of PI therapy in pregnant women and children at
PACTG sites.
Method: A multi-site survey was conducted at PACTG sites. The survey was
designed to collect information on PI use in HIV-infected children under the age
of 2 years and over the age of two years, and also on the number of babies born
to HIV-infected mothers in the last 12 months whose mothers were treated at
PACTG sites. Data was collected over a one month time period from September
1997-October 1997. A 88% response rate was achieved.
Results: PACTG sites reported a total pediatric population of 4,378 patients.
Of the 487 HIV-positive babies under the age of 2 years, 286 (58.73%) were naive
to PIs. Of the 3,891 HIV-infected children over the age of 2 years, 2,300 (59.11%)
were naive to Pis. In the under 2 years of age category, (1.64%) were treated with
saquinavir, (18.48%) with ritonavir, (21.56%) with nelfinavir, and (.62%) with indinavir. For children over the age of 2 years, (3.44%) were treated with saquinavir,
(17.71%) with ritonavir, (17.71%) with nelfinavir, and (5.11%) with indinavir. There
were 1,518 babies born to HIV-infected mothers in the past 12 months at PACTG
sites. Of these, 1,425 (93.87%) of the mothers has not been treated with PIs. Of
the mothers who had been treated with PIs, (1.05%) were treated with saquinavir,
(.92%) with ritonavir, (1.91%) with nelfinavir, and (2.83%) with indinavir.
Conclusion: There were 2,586 HIV-infected children at PACTG sites who were
naive to PIs. The results suggest that drugs that are available in pediatric formulations (nelfinavir, ritonavir) are more likely to be used in pediatric populations.
The results also indicate that very few women are receiving PI treatment while
they are pregnant.
S32445 Adrenal insufficiency secondary to megestrol acetate
therapy in HIV-infected children

Caroline Chantry', Irma Febo2, C.J. Chantry2, L. Gonzalez De Pijem2, L. Lugo2.
1University PED Hospital 4th Floor, Southwing, PO Box 365067, San Juan, PR;
2U. Puerto Rico Medical School Ped Hosp., San Juan, USA
Introduction: Megestrol acetate (MA), a progesterone derivative used for
cachexia, has glucocorticoid activity and can cause central suppression of the
pituitary-adrenal axis in adults. The effect of MA therapy on adrenal function in
HIV+ children with failure to thrive (FTT) is reported.