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

XIV International AIDS Conference

Abstracts ThPeB7242-ThPeB7244 397

infection. A switch from NSI to SI phenotype occurs in about half of infected adults
during the course of infection and usually precedes AIDS outcome. Our aim was
to investigate the effect of HAART on the SI phenotype of HIV-1 isolates in a
pediatric cohort.
Materials and Methods: Viral isolates from 180 HIV-1 vertically infected children
with a median age of 12 months (mo) (range: 0.5-155) were obtained by cellular
cocultures. SI viral phenotype was microscopically determined by infecting MT-2
cell line with HIV-1 positive culture supernatants.
Results: 24% of the infants harbored virus with SI phenotype. Similarly to adults,
the emergence of SI HIV-1 increased progressively with time of infection, reaching 50% in children older than 120mo. After HIV-1 diagnosis, all infants received
antiretroviral (ARV) therapy including at least 2 reverse transcriptase inhibitors,
and for the evaluation, they were divided in 2 groups. Group 1 included 109 infants studied before receiving ARV (median age 6mo, 0.5-24), 16% had SI HIV-1
strains. In 10, samples were analyzed after the first study at a median time of
7mo (3-27), 8 received HAART and reverted the viral phenotype from SI to NSI
(median time of treatment before phenotype switch 6mo, 3-26). Of the remaining 2 infants, only 1 switched its virus from SI to NSI without receiving HAART.
Group 2 included 71 infants receiving ARV therapy (median age 35mo, 25-155),
37% harbored SI HIV-1. In 13, samples were analyzed at a median time of 7mo
(6-18) after the first study, 6 out of 7 receiving HAART for a median time of 7mo
(1-14) showed a shift of HIV-1 from SI to NSI, of the remaining 6 only 3 reverted
SI phenotype without receiving HAART.
Conclusions: HAART significantly affects HIV-1 phenotype favoring the reversion of SI to NSI virus, which can be relevant for the clinical and immunological
improvement of patients under this kind of treatment.
Presenting author: Julieta Kopka, Combate de Los Pozos 1881 (1245), Buenos
Aires, Argentina, Tel.: [phone], Fax: [phone], E-mail: jkopka
@garrahan.gov.ar
ThPeB7242 Follow-up of a sample of HIV-1 positive children
infected by vertical transmission in Rio de Janeiro,
Brazil: evaluation of laboratorial parameters
D.L.A. Campos-Mello', R.S.L. Lorete', A.C.M. Wiering2, M.V.S. Pone2,
J.M.S. Campos2, M.G. Morgadol. 'Lab. of AIDS & Molec. Immunol., Dept of
Immunol., Oswaldo Cruz Inst, Fiocruz, Lab. of AIDS & Molecular Immunology,
Dept. of Immunology, Oswaldo Cruz Institute, Avenida Brasil 4365 - Manguinhos,
Rio de Janeiro, Brazil; 2Fernandes Figueira Institute - FIOCRUZ, Rio de Janeiro,
Brazil
Background: Although the pathogenesis of HIV-1 infection and the antiretroviral
therapy are basically the same for all HIV-infected individuals, some important
differences in the immunological markers, viral load and treatment adherence
have been described for HIV-infected children. The HIV RNA quantification and
the CD4 T cell counts are crucial laboratorial markers for the monitoring of antiretroviral treatment in infected children and, therefore, the interpretation of these
variables should be taken into consideration to evaluate treatment efficacy
Methods: From Oct. 1997 to June 2001 we have analyzed 417 blood samples
obtained from 83 HIV-1 infected children between 1 to 12 years old, followed by
the pediatric service of the FF Institute (Fiocruz, RJ, Brazil). All samples were
evaluated for viral load (Nasba/NucliSens, Organon Teknika) and CD4+ T cell
counts (Tri-test CD3/CD4/CD8, Becton-Dickinson), in the setting of the National
Network of Viral Load nd CD4+ evaluation, supported by the Brazilian Ministry
of Health
Results: & Conclusion: Plasma samples (n=417) were divided in two groups of
1 to 5 years old (n=193) and 6 tol12 years old (n=224)] according to children
ages and analyzed in relation to antiretroviral therapy regimen and viral load. The
percentages of samples from untreated children and from those under double or
triple and more (HAART) therapies were respectively 8%, 33%, 59% and 6%,
26%, 68% for both groups. However, in spite of the drug regimen, very low frequencies of undetectable viral load were observed for both groups. Indeed, 0% of
the plasma samples from children included in the first group (1 to 5y.o.) and 4.5%
from those from the second one had undetectable viral load under HAART, with
the majority of them (respectively 68.4% and 62%) presenting viral load values
above 41og10. Moreover, in spite of the high viral load in the presence of drug
therapy, the frequency of samples with CD4 counts >25% was around 40% for
both groups
Presenting author: DLA Campos-Mello, Lab. of AIDS & Molecular Immunology,
Dept. of Immunology, Oswaldo Cruz Institute, Avenida Brasil 4365 - Manguinhos,
Rio de Janeiro, Brazil, Tel.: [phone], Fax: [phone], E-mail: camposmello@ hotmail.com

ThPeB7243 Trends in Highly Active Antiretroviral Therapy
(HAART) and plasma HIV RNA levels in children <
13 years of age, 1997-2000, U.S.A
TA. Rakusan', W. Perez', V. Hagan-Temple', V Peters2, S. Melville3,
L. Mascola4, I. Ortiz5, H. Hsu6, T. Sukalac7, K. Dominguez7, M.G. Fowler7.
SChildren's National Medical Center, George Washington University, 111
Michagan Avenue, NW Washington, DC 20010, United States; 2New York City
Department of Health, New York, NY, United States; 3Texas Department of
Health, Austin, TX, United States; 4Los Angeles County Deptartment of Health
Services, Los Angeles, CA, United States; 5Departamento de Salud, San Juan,
Puerto Rico; 6State Laboratories Institute, Boston, MA, United States; 7Centers
for Disease Control and Prevention, Atlanta, GA, United States
Background: While HAART is efficacious in reducing HIV viral load, many adults
on HAART fail to achieve complete suppression of HIV replication. We evaluated
pediatric trends in HAART use and HIV RNA plasma levels.
Methods: PSD is a longitudinal medical record review study at 6 U.S. sites that
has followed HIV- infected (HIV+) children since 1988. We analyzed data during six 6 month semesters on HIV+ children who had at least 1 HIV RNA value
recorded between 1/98 tol2/00.
Results:Review of data on 2314 eligible children indicated that the proportion of
children treated with a combination of > 3 antiretroviral drugs (HAART) increased
from 63% in 1998 to 76% of children in 2000. (p < 0.0001) Those who had at least
one RNA value of <400 c/ml in a 6-mo period increased from 24% (first semester)
to 36% (last semester). (p<0.0001)Number of Children (%) by Semester/Year
Semester 1/98 2/98 1/99 2/99 1/00 2/00
RNA < 400 c / ml 434 (24) 460 (26) 550 (30) 567 (33) 540 (35) 445 (36)
RNA > 400 c / ml 1342(76) 1288(74) 1281 (70) 1154(67) 1017(65) 793(64)
< 2 drugs 643 (37) 590 (32) 462 (30) 405 (26) 292 (24)
> 3 drugs 1105 (63) 1241 (68) 1259 (70) 1152 (74) 946 (76)
In the last semester, children on > 3 drugs prior to their viral load measurement
were 1.4 times more likely to have an RNA <400 c/ml compared to children on
1-2 drugs (p=0.0009; Cl 1.13-1.69). Children on protease inhibitor (PI)-containing
regimens were 1.3 times more likely to have an RNA<400 c/ml compared to nonPI regimens. (p=0.002; CI 1.10-1.55) Conclusion: Increasing pediatric HAART
use in the U.S. has been accompanied by a substantial increase in the proportion
of HIV+ children with undetectable plasma HIV RNA levels between 1998-2000.
Despite much progress, the majority of HIV+ children are not achieving complete
HIV suppression. This underscores the need to carefully assess factors influencing clinician choice of treatment regimens, pediatric adherence to complex
regimens and clinical factors related to sustained viral suppression.
Presenting author: Tamara Rakusan, 111 Michagan Avenue, NW, Washington,
DC 20010, United States, Tel.: [phone], Fax: [phone], E-mail:
trakusan @ cnmc.org
ThPeB7244 Neurologic development among perinatally
exposed infants to HIV infected women
L.PR Figueroa-Medrano, R. Figueroa, G.R. Arreola. Instituto Nacional de
Perinatologia, Vicente Eguia #30, Depto 12-D, CP 11850, Mexico City, Mexico
Background: There is an increasing number of children born to HIV-infected
women that are free of infection; however, few information about the physical
growth and neurologic development of these children has been reported.
Objective: To evaluate the somatic growth and neurologic development of a cohort of children born to HIV -infected mothers who were not infected by the vertical
route.
Methods: We conducted a retrospective cohort study of non-infected children
born to HIV-infected women who were treated at the National Institute of Perinatology. Each child had a physical examination, weight and height measurements.
The neurologic development was evaluated by using the Amiel-Tison test for children aged between 12 and 18 months and for children 18 months and older the
Mayo test. The Bayley Scale, as well as audiometric and language evaluations
were also made.
Results: A total of 26 children were followed for an average of 2.8 years. The
mean birth weight was 2.909 + 340g, height 48.6 + 1.8 cm and cephalic perimeter 33.6 +1.3 cm. The follow up evaluations showed 6 infants (23%) with low
weight (under percentil 3). Two children had an abnormal Amiel-Tison test with
abnormalities in the passive muscular tone. Among the 18 children with neurologic development evaluations; 7 (39%) had delay: 3 in the corporal scheme, 3
in gross coordination and one in language. All the children evaluated had normal
audiometric tests, but two had delayed language.
Conclusions: Despite of the clinical abnormalities were very common, it is difficult to attribute them to the in utero HIV -exposition and more likely are from
multifactorial origins.

Presenting author: Laura P. Figueroa-Medrano, Vicente Eguia #30, Depto 12-D,
CP 11850, Mexico City, Mexico, Tel.: [phone], E-mail: laupfim@hotmail.
com