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

12th World AIDS Conference

Abstracts 32446-32450 611

Methods: 22 cosyntropin stimulation tests were performed on 13 HIV+ children
receiving MA (15 mg/kg/day) in a randomized double-blind placebo controlled
trial of MA for FTT (n = 11) or receiving MA (8.3 and 10.8 mg/kg/day) off-study
(n = 2). Tests were performed at baseline, at 8-12 weeks on blinded treatment
(rx), at 8-12 weeks on open-label rx if applicable, and at 3 months post-rx. Not
all points were available on any patient. Adrenal insufficiency (Al) was diagnosed
for AM cortisol level -_6/ug/dl or at 60 mins. after cosyntropin <18p/g/dl.
Results: 2 of 5 patients tested at baseline had Al, one with low AM cortisol and
the other without response to cosyntropin. All 9 receiving open-label MA had Al,
6 severely so with AM cortisol level 1/g/dl; all 9 had inadequate response to
cosyntropin. 2 of 3 patients on double-blind rx had Al, one profound. All 5 patients
tested on follow-up had normal adrenal function. No patient had symptoms.
Discussion: Nearly all patients had some degree of Al; 7 had severe Al. This
included 1 patient on chronic MA at the lower dose of 8.3 mg/kg/day. These
findings suggest Al may be more common than previously recognized at baseline
in HIV+ children with FTT. MA use in these patients is often associated with
marked, reversible Al.
Conclusions: We recommend HIV+ children receiving MA rx be tapered off
such therapy. Practitioners are advised to consider stress doses of glucocorticoids
for acute illness in patients with current or recent MA rx. Further study of adrenal
function in HIV+ children with FTT, particularly those currently or previously on
MA rx, is warranted. Adrenal function with MA therapy given on alternate days is
under investigation.
32446 Integrating HIV/AIDS child counselling in community
health services
Jane Nabalonzi1, C. Somoka2, M. Byangire2, D. Mawejje3, S. Katwesigye4.
'Joint Clinical Research Centre PO. Box 10005 Kampala; 2STD/AIDS Control
Programme Entebbe; 3Save the Children Fund Kampala; 4 The AIDS Support
Organisation Entebbe, Uganda
Issue: As the epidemic continues a number of children get affected physiologically, pschologically and socially. In Uganda 25% of children are born with
HIV, out of whom ahalf die before the age of 2 years. As of December 1996 a
cumulative total of 3,789 AIDS cases aged below 12 years had been reported to
the STD/AIDS Control Programme.
Project: The STD/AIDS Control Programme of the Ministry of Health in Uganda
trains counsellors and counsellor assistants. These are hospital-based health
workers selected from the 39 districts, through the District Medical Officers,
aimed to link well the community to the most accessible health care facility in
each area. Since June 1996 a new approach of peadiatric counselling has been
intergrated in the original syllabus. Trainers were selected from various AIDS and
child support NGOs as facilitators and resource persons.
Results: 85 counsellors and 30 counsellor assistants selected from 12 districts
have been trained so far and are practising the skills very well in their respective
communities. Antenatal clinics in the targeted health centres have reported over
75% mothers who have been counselled and tested for HIV in the last one year.
More mothers and foster parents have increasingly referred their children (8 years
and above) for counselling and health education, resulting into a reduction in the
rates of child stigmatisation, infant mortality and "child headed homes" in the
communities.
Lessons Learned: There is need to train more health, social and community
workers in paediatric counselling, so as to address issues concerning HIV/AIDS
in children through counselling and communicating.
32447 Pilot study on attitudes and knowledge about HIV/AIDS
from a group of medical students on their pediatric clinic
rotation
Laura D. Ortiz, M. Carlo, I. Salabarria, M. Areces, E. Crouch, M. Caceres,
C. Diaz. U. Puerto Rico Medical School Ped Hosp. San Juan, University Ped
Hospital 4th Floor Southwing PO Box 365 067 San Juan PR00936 5067, USA
Introduction: As future physicians, medical students will use their acquired
knowledge and pre concerned attitudes as reference points in order to approach
the clinical, psychosocial and ethical management of patients with AIDS. Misconceptions may conduct to prejudice and discrimination toward HIV/AIDS patients.
We designed a descriptive pilot study to evaluate knowledge and attitudes of a
group of third year medical students before and after their rotation on the pediatric
HIV clinic.
Methods: The sample consists of 90 voluntary third year medical students. A
questionnaire was designed to collect demographic data, level of knowledge and
attitudes toward AIDS/HIV. Questionnaire reliability and face validity (x, = 0.82)
was obtained from a sample of 60 students. Voluntary anonymous questionnaires
were administered before the beginning of their Pediatrics Clinical Rotation. The
students are exposed to conferences, written material and the assignment of an
HIV infected patient or family for evaluation. The questionnaire is given again,
after the clinical rotation. Descriptive analysis was used to study the information
gathered, utilizing computerized statistical programs (SPSS 7.5 for Windows).

Frequencies and percentages were obtained and correlations between attitudes
and level knowledge were performed.
Results: A pre and post questionnaire was administered to 30 students. A
total of 24 completed study requirements and were analyzed. When reviewing
specific items that measure basic skills toward caring for HIV pediatric patients
and the attitude toward risk of infection when attending this population there was a
significant difference (t-test = 4.48, p = 0.000) in pre and post test analysis.The

attitude and knowledge of each student was evaluated, pre and post testing
scales showed no statistical significant difference (t = 0.319, p = 0.753).
Conclusions: There were measurable changes from medical students on attitudes toward HIV positive patients on specific items evaluated. The overall results
up to date show moderate change in attitude or knowledge in the studied population. The analyzed sample is too small and further analysis is needed to confirm
these results. Other interventions toward attitude and knowledge assessment and
modification may be needed to obtain significant changes.
32448 Diagnosis of HIV infection in children is still a
controversial issue
Carmen Soler Claudin1 4, Maria del Carmen Basualdo Sigales2, Jose
Carmen Gudiho Rosales3. Unidad de Investigacion En Retrovirus H. Carpio
470 Col. Sto. Tomas, Mexico; 2Universidad Nacional de Mexico F Quimica
Mexico DF; 3lnstituto Nacional de Diagnostico Mexico City DF; 4Facultad de
Quimica Unam Mexico City Mexico
Background: Using viral isolation, IgG and IgA serology (ELISA and immunoblot),
HIV antigen detection in plasma, gag-PCR, plasmatic viral load and "in vitro" induced antibodies (Shiloov tube), important discrepancies have been observed in
the diagnosis of HIV-1 infection of children born to seropositive mothers.
Methods: Commercial and standardized methods for all the assays were used.
Results: Throughout the last 5 years, we have studied 470 children (anging
from 1 day to 5 years of age) born to HIV positive mothers. More than one sequential sample is available for most of the children. Discrepancies and inconclusive
results were found in 54 children. Our observations are as follows:

Assays

HIV-Ag in plasma only
PCR only
HIV isolation only
IgA only
In-vitro Ab only

Positive
2
19
0
3
3

Assays Positive
IgA and in vitro Ab 1
IgA and HIV isolation 2
PCR and viral load 2
Ag and HIV isolation 1
IgA and PCR 8
IgA and HIV Ag 3

Assays Positive
IgA, HIV Ag and PCR 3
IgA, HIV isolation and PCR 1
PCR, IgA and viral load 1
IgA, PCR and HIV Ag 3
IgA, HIV isolation and PCR 1
IgA, PCR, in vitro Ab and viral 1
load

Conclusions: Cumulative data on HIV diagnosis in children born to seropositive mothers show that in at least 10% of the children none of the currently
available assays gives a conclusive result even in 2 sequential samples. Several
IgG negative children can be proven to be infected by other assays and are
confirmed as such along the follow up time.
32449 Safety and immunogenicity of preexposure rabies
immunization in HIV-infected children
Chitsanu Pancharoen', U. Thisyakorn1, K. Ruxrungtham1, S. Ubolyam1,
P. Kwaplod2, P. Phanuphak1, H. Wilde2. 1Chulalongkorn Hospital, 1873 Rama
IV Street, Bangkok; 2QSMI Thai Red Cross Society, Bangkok, Thailand
Objectives: To determine safety and immunogenicity of human diploid cell vaccine (HDCV) in HIV-infected children, the issue that has not been reported in both
children and adult.
Design: Prospective, controlled study.
Methods: Preexposure rabies regimen using HDCV on days 0, 7 and 28 was
studied in 13 perinatally HIV-infected children and 9 controls. CD4+ and CD8+
cells, and plasma HIV-RNA titers were measured on day 0, 7 and 28. Serial
antibody assays were performed on days 0, 7, 14, 21, 28, 60, 90 and 180.
Adverse reactions of vaccines were obtained by interviewing parents.
Results: The rabies antibody was significantly lower in the study group especially on days 14, 21, 28, 60, 90 and 180 (p-value -- 0.05). The level of antibody on
days 14, 21, 28, 60, 90 and 180 were significantly lower in children whose CD4+
cells were lower than 15 percent (p-value <0.05). Vaccine failures were found in
four cases of the study group and the average CD4+ cells of these patients were
6.25 percent. The increase of plasma HIV-RNA titers -0.5 loglo was observed
in 4/13 cases (30.8%) after vaccination. However, there were neither clinical
deterioration nor significant changes on serial measurement of CD4+ and CD8+
cells. No adverse reactions of vaccines were noted.
Conclusion: In HIV-infected children, HDCV could be used safely. However,
the immunogenicity was not as high as that found in the control group. The
seroconversion was significantly lower in HIV-infected children especially those
with CD4+ cells below 15 percent. The rate of vaccine failure was approximately
30 percent.
32450 Is incomplete 076 ACTG protocol useful in reducing
vertical HIV-1 transmission?
Liliana Martinez Peralta, Diana Ines Liberatore1, A. Ceballos1, M. Biglione1,
M.M. Avila1, O. Libonatti2, M. Martinezt, M.L. Celadilla3. Facultad Medicina,
University of Buenos Aires, Paraguay 2155 Piso 11, Buenos Aires; 2Cosme
Argerich Hospital, Buenos Aires; 3Alvarez Hospital, Buenos Aires, Argentina
Introduction: ACTG 076 protocol decreased HIV vertical transmission from 25%
to 8%. Since 1995 it was initially offered to the HIV-1 infected pregnant women
in Argentina. However, different factors make a full compliance to the regimen a
difficult matter.