Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

394 Abstracts ThPeB7229-ThPeB7233

XIV International AIDS Conference

Presenting author: Bouchra Zerhouni, Children's Research Institute, 700 children's drive, w535, Columbus, OHIO, 43205, United States, Tel.: [phone]
722 2683, Fax: [phone], E-mail: [email protected].
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ThPeB7229 HIV-related health care utilization and charges in a
public health care facility: trends in relation to the
introduction of highly active antiretroviral therapy
(HAART)
C.A.M. Rietmeijer, A.J. Davidson, D.L. Cohn. Denver Public Health, 605
Bannock Street, Denver, Colorado, 80204, United States
Background: HAART has profoundly changed the natural history of HIV disease.
We studied the impact of HAART on trends in inpatient and outpatient care at
Denver Health (DH), a public health care facility in Denver and the largest HIV
care provider in Colorado and the Rocky Mountain region.
Methods: A database of HIV-infected persons accessing DH was cross-matched
with the DH billing system for the years 1991-2001. The following variables were
computed for each year: number of patients in care, per patient number of hospitalizations, days hospitalized, and outpatient visits, as well as per patient inpatient,
outpatient, and total charges. Results were averaged for 2-year intervals (except
1991) and expressed in 2001 U.S. dollars.
Results: See Table.
1991 1992-93 1994-95 1996-97 1998-99 2000-01
No. Patients 1271 1450 1479 1349 1468 1439
Hospitalizations/ Patient 0.42 0.40 0.44 0.32 0.27 0.22
Hospitalized Days / Patient 2.94 2.54 2.56 1.92 1.66 1.35
Outpatient Visits / Patient 10.9 11.7 13.6 13.4 13.7 13.5
Inpatient Charges $ / Patient 7,382 5,720 6,181 4,737 4,077 3,074
Outpatient Charges $ / Patient 2,865 3,054 3,329 3,210 4,272 4,694
Total Charges $ / Patient 10,247 8,774 9,510 7,946 8,349 7,768
Conclusions: The number of per patient hospitalizations and hospitalized days
decreased over time, while the number of outpatient visits increased. In parallel,
inpatient charges fell and outpatient charges increased, resulting in an overall decrease in total charges. Inpatient utilization started to fall before the availability
of HAART and continued to decrease thereafter, but outpatient charges accelerated after HAART became widely available. After the introduction of HAART, HIV
disease appears to be increasingly managed on an ambulatory basis.
Presenting author: Cornelis Rietmeijer, 605 Bannock Street, Denver, Colorado,
80204, United States, Tel.: [phone], Fax: [phone], E-mail: krietmei @dhha.org
ThPeB7230 Reduction in morbidity and mortality in
HIV-infected children in the era of highly active
antiretroviral therapy
R.M. Viani, M.R. Araneta, CX. Romero, S.A. Spector. UCSD, University of
California San Diego, Stein Clinical Research Building, Room 434, 9500 Gilman
Drive, La Jolla, CA 92093-0672, United States
Background: AIDS defining events, hospitalizations and mortality have diminished among HIV-infected adults receiving HAART; however the impact of HAART
on HIV disease progression in perinatally infected children has not been well documented. The aim of this study is to identify the effect of evolving antiretroviral
therapy (ART) from 1994 to 2000 on the immunologic, virologic status, hospitalizations and mortality of perinatally HIV-infected children.
Methods: Children receiving outpatient care at 2 pediatric HIV programs in San
Diego (UCSD) and Fresno, California, were followed longitudinally for CD4%,
plasma HIV RNA (VL), ART, PCP prophylaxis and hospital admissions.
Results: 81 children (UCSD: n=60, Fresno: n=21) were followed during the study
period; 57% were girls, 49% Hispanic,26% Black, 22% White and 2% Asian. The
mean CD4% and use of HAART increased from 22.2% and 0% (1994) to 31.5%
and 89% (2000; P<0.01 for both). The mean Log10 plasma HIV RNA decreased
from 4.41(1996) to 3.16 (2000; P<0.01) as did the use of PCP prophylaxis (58%
to 17%, P<0.01). The proportion of children requiring hospitalization per year
decreased from 39% (1994) to 9% (2000; P<0.01), as did the number of hospitalizations /1000 person-months from 16.4 (1994) to 2.06 (2000; P<0.01). The
number of children hospitalized for opportunistic infections, other infections or
other CDC clinical category B diagnoses decreased over time (P<0.01). Concurrently, there was a decrease in mortality from 15% (1994) to 0% (2000; P<0.01).
Multivariate regression analyses identified CD4% as independently associated
with decreased hospitalizations after adjusting for VL, PCP prophylaxis and year.
Conclusions: These data indicate that there has been a substantial decrease in
morbidity, hospitalizations and mortality in perinatally HIV-infected children concurrent with the expanded use of HAART. The reduction in morbidity and mortality
correlates with an improvement in CD4%.

Presenting author: Rolando Viani, University of California San Diego, Stein Clinical Research Building, Room 434, 9500 Gilman Drive, La Jolla, CA 92093-0672,
United States, Tel.: [phone], Fax: [phone], E-mail: rviani
@ucsd.edu

ThPeB7231I Follow up of babies born to nevirapine treated HIV
positive mothers in Yaounde Cameroon:
Preliminary results
G. Tene1, F. Tietche1, A. Ayouba2, E. Nerrienet2, M. Tejiokem2, I. Kago1,
J. Thonnon2, M. Monny Lobe1. '1Fondation C Biya, PO Box 13230, Yaounde,
Cameroon; 2Centre Pasteur Cameroun, Yaounde, Cameroon
Background: A program for the reduction of mother to child transmission of HIV
based on HIVNET 012 protocol has been going on in the MCC of CBF since January 2000. Babies born within the framework of this program are followed up. We
present an analysis of the results got so far.
Methods: This longitudinal study started in June 2000. HIV seropositive mothers'
babies are included from birth. The follow up of babies is scheduled over a period
of 18 months, initially on monthly basis, three monthly thereafter. It comprises:
complete clinical examination, monitoring of growth, psychomotor development,
vaccinations, looking for pathologies, side effects of Nevirapine, the assessment
of HIV viral load at 6 weeks, 6 months and HIV serology by Elisa at 18 months.
Results: 136 babies have been included so far. 103 HIV viral loads were performed at 6 weeks out of which 13 babies were shown to be HIV contaminated
while 72 others did not. The remaining 20 babies had uncertain results. These
will be made clearer after the 6 months viral load assessment and the 18 months
serology. The transmission rate therefore is comprised between 7.2 and 20.1% at
95% C.I.
There was no significant difference between mothers who had transmitted the
virus and those who had not concerning the CD4 count (p = 0.5), the duration of
the rupture of membrane (p = 0.29). On the contrary, the following clinical features
were significantly different between infected and non infected babies: thrush (p =
0.0005), skin diseases (p = 0.00007), respiratory infections (p = 0.0024), recurrent fever during mother's pregnancy (p=0.045). These could indicate a higher
proportion of severe, rapidly evolving forms of the disease for which babies contamination took place early in pregnancy.
Conclusion: At the age of 6 weeks, HIV mother to child transmission rate is
comprised between 7.2 and 20.1% at 95% I.C. in our study.
Rapidly evolving forms of the disease seem to be common among our babies.
Presenting author: Gilbert Tene, PO Box 13230, Yaounde, Cameroon, Tel.: +237
999 02 23, Fax: [phone], E-mail: [email protected]
ThPeB7232 Duration of antiretroviral use in pregnancy and
vertical transmission of HIV in Rio de Janeiro,
Brazil
E.C. Joo, M.L. Santos Cruz, H. Matos, GA. Calvet, SR. Ribeiro, SM. Santos
Silva, F.M.A. Oliveira Mello, L.A. Salgado, R.C.C. Braga, J.A. Menezes. Hospital
dos Servidores do Estado, Rua Ant6nio Basflio, 519/702 - Tijuca, Rio de Janeiro
- RJ, Brazil
Background: Since 1996 the Infectious Diseases and Maternal-Fetal Departments of Hospital dos Servidores do Estado - Rio de Janeiro have been following
a cohort of HIV + pregnant women and their babies. Besides prenatal care, antiretrovirals (ARV), viral load, CD4 counts and infant formula were offered to all
women. Duration of antiretroviral treatment has been suggested as an important
factor in the prevention of HIV mother-to-child transmission (MTCT).
Results: From Jan. 1996 to Nov. 2001 data were collected from 321 pregnant
women. Mean age of the mothers was 27 years and mean gestational age when
entering the cohort was 24 weeks. Most women (75.3%) were assymptomatic
with a mean CD4 count of 480 cells near delivery. All 321 women received ARV
therapy during pregnancy. Forty six per cent received only prophylaxis with ZDV,
25.1 % received two NRTI, 20.9% received 2 NRTI and 1 NNRTI, 6.5% received
2 NRTI and 1 PI, and 1.5 % received other ARV associations. Eighty per cent of
the mother-infant pairs received the three components of VT prophylaxis (protocol
076). No infant was breastfed. MTCT estimated rate was 4.12%. Among studied
variables we found prematurity and vaginal delivery to be independently associated with vertical transmission. There was no association between HIV transmission and the type of ARV treatment but a strong association was found with the
duration of ARV use. The mean duration of use of ARV drugs for mothers of infected children was 6,28 weeks, with a SD of 4,99, while it was 16,63 weeks with
SD of 11,01 (p-value=0.03) for mothers of non infected children.
Conclusion: In our cohort a longer time of ARV use in pregnancy was associated
with a lower HIV MTCT rate. Efforts should be made in order to identify and offer
ARV treatment to HIV + pregnant women early in pregnancy.
Presenting author: Guilherme Calvet, Rua Antinio Basilio, 519/702 - Tijuca, Rio
de Janeiro - RJ, Brazil, Tel.: [phone], E-mail: [email protected]
ThPeB7233 Bone mineral accrual does not differ in HIV-infected
children with and with out lipodystrophy
S.M. Arpadi, M. Horlick, W. Verret, P. Cuff, J. Thornton, J. Wang, D. Kotler.

St.Luke's-Roosevelt Hospital Center/Columbia University, St.Luke's-Roosevelt
Hospital Center, 1111 Amsterdam Ave., New York, NY, 10025, United States
Background: In addition to lipodystrophy (LD), bone mineral content is decreased in HIV-infected (HIV+) children compared to healthy children. No prior
study has assessed the relationship between LD and accrual of bone mineral content using objective criteria for LD and longitudinal measurements of bone. Our