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

398 Abstracts ThPeB7245-ThPeB7249

XIV International AIDS Conference

ThPeB7245I Maternal vitamin supplements reduce morbidity of
children born to breastfeeding HIV-infected women
W.W. Fawzi', G.I. Msamanga2, D. Spiegelman1, G. Antelman', E. Villamorl,
R. Wei', K. Manji2, B. Renjifo', D. Hunter'. 'Harvard School of Public Health,
Harvard School of Public Health, Department of Nutrition, 665 Huntington
Avenue - SPH2, Boston MA 02115, United States; 2Muhimbili University College
of Health Sciences, Dar es Salaam, Tanzania
Background: In prospective studies, poor micronutrient status of HIV-infected
women is related to impaired immune function and higher incidence of pregnancy
complications.
Methods: We randomized 1078 HIV-1 infected pregnant women from Tanzania
in a double-blind, placebo-controlled trial to examine the effects of vitamin A or
multivitamins (excluding vitamin A) using a two-by-two factorial design. Supplements were given to mothers from first prenatal visit throughout pregnancy and
post-delivery.
Results: We previously reported the beneficial effects of multivitamin supplements excluding A on fetal loss, low birth weight, and prematurity. Multivitamins
had no effect on the risk of vertical transmission of HIV-1 (P=0.76), while vitamin
A increased the risk (RR=1.38; 95%CI=1.09,1.76; P=0.009). However, both vitamin A alone and multivitamins excluding A resulted in significant reductions
in the risk of total child diarrhea during the first 24 months of life (RR=0.77,
P=0.02 and RR=0.71, P=0.002, respectively). Similarly, protective effects were
noted for acute diarrhea and watery diarrhea. The protective effects appeared to
be stronger among HIV-uninfected children. Multivitamins but not vitamin A alone
resulted in a significant improvement in child CD4 cell counts over time (P=0.02).
The effect of micronutrients on child mortality will be presented.
Conclusion: Micronutrient supplementation of HIV-infected women is a low-cost
intervention with potential benefits on pregnancy outcomes and child health in
breastfeeding populations. The policy implications of these findings will be presented.
Presenting author: Wafaie Fawzi, Harvard School of Public Health, Department
of Nutrition, 665 Huntington Avenue - SPH2, Boston MA 02115, United States,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
I ThPeB7246 Decline in Perinatal HIV Transmission in New York
State (NYS), 1997-2000
G.S. Birkhead', N.A. Wade2, M.A. Zielinski', R. Glaros1, B.A. Warren1,
A. Novello3. 1NYS Dept of Health AIDS Institute, NYSDOH Aids Institute,
Albany NY 12237, United States; 2NYS Dept of Health Center for Community
Health, Albany, United States; 3NYS Dept of Health, Albany NY, United States
Background: NYS has implemented programs designed to decrease perinatal
HIV transmission. Interventions include increasing the rates of prenatal (PN) care,
administration of antiretroviral prophylaxis during the PN, intrapartum (IP) and
newborn (NB) periods and offering elective cesarean section (CS) when indicated. We describe the impact of these interventions on perinatal HIV transmission from 2/1/97 through 12/31/00.
Methods: Medical records (PN,IP,NB, pediatric at 6 months of age) of all HIVinfected mothers/infants in NYS were reviewed for compliance with regulatory
requirements and for quality of care. Algorithms were used to assess receipt of
PN care, ART use, mode of delivery and infant infection status.
Results: Perinatal HIV transmission in NYS decreased (10.6% in 1997, 8.4% in
1998, 6.9% in 1999, 3.5% in 2000). The number of HIV-infected pregnant women
receiving PN increased from 1997 to 2000: 843 (88.5%) in 1997; 931 (90.8%)
in 1998, 884 (92.0%) in 1999 and 730 (92.4%) in 2000 (p<0.05). 761 (96.3%)
mothers/infants received ART in the PN, IP or NB periods during 2000 with 831
(86.5%) in 1999, 767 (74.8%) in 1998 and 601 (63.1%) in 1997 (p<0.05). The
number of women receiving combination ART in the PN period also increased
[146 women (15.3%) in 1997, 420 (41.0%) in 1998, 544 (56.8%) in 1999 and 479
(60.7%) in 2000] (p<0.05). Receipt of three-part ART regimen (PN, IP, NB) increased from 445 (46.7%) in 1997, 554 (54.0%) in 1998, 612 (63.7%) in 1999 to
517 (65.4%) in 2000 (p<0.05). Elective CS deliveries increased from 63 (6.6%) in
1997, 109 (10.6%) in 1998, 281 (29.2%) in 1999 to 288 (36.5%) in 2000 (p<0.05).
Conclusions: In NYS, perinatal HIV transmission has decreased. This decline
in transmission is associated with more HIV-infected pregnant women/infants receiving PN care, combination ART in the PN period, ART during all three periods
(PN, IP, NB) and elective CS deliveries (when indicated).*Data for 2000 are preliminary.
Presenting author: Guthrie Birkhead, NYSDOH Aids Institute, Albany, NY,
12237, United States, Tel.: [phone], Fax: [phone], E-mail:
gsb02 @ health.stateny.us
ThPeB7247 Antiretrovirals for reducing the risk of
mother-to-child transmission of HIV - a Cochrane

systematic review of current evidence
J.A. Volmink', P Brocklehurst 2 1Global Health Council, Global Health Council,
1701 K Street, NW Suite 600, Washington, DC, 20006-1503, United States;
2National Perinatal Epidemiology Unit, Institute of Health Sciences, Oxford,
United Kingdom
Background Alternative antiretroviral drug regimens are continuously being assessed in randomized trials for their effectiveness in preventing mother-to-child

transmission (MTCT) of HIV. To assist decisionmakers a Cochrane review has
been prepared and will be updated in the light of new evidence.
Methods We searched for published and unpublished RCTs comparing any antiretroviral therapy aimed at decreasing the risk of MTCT of HIV infection compared with placebo or no treatment, or any two or more antiretroviral therapies or
regimens aimed at decreasing the risk of MTCT of HIV infection. Two reviewers
independently extracted data and assessed trial quality.
Results The risk of transmission is significantly reduced by zidovudine monotherapy versus placebo (OR 0.46, 95% CI 0.35-0.60). A 'short-short' course of zidovudine (from 35 weeks in pregnancy until the baby is 3 days old) is less effective
in preventing transmission than a 'long-long' course (28 weeks in pregnancy until
the baby is 6 weeks old), OR 2.55, 95% Cl 1.26-5.18. Nevirapine is more effective in preventing transmission than an intrapartum and post-partum regimen of
zidovudine (OR 0.51, 95% CI 0.33-0.79). When nevirapine is given to mothers
already receiving standard antiretroviral therapy, however, there appears to be no
additional advantage (OR 1.10, 95% CI 0.42-2.86). A combination of zidovudine
and lamivudine given during the antenatal and intrapartum period or during the
intrapartum and postpartum period is more effective than placebo. There is no
evidence that intrapartum zidovudine and lamivudine alone decreases the risk of
transmission compared with placebo.
Conclusions How the existing evidence is used to inform practice will depend on
the setting in which HIV infected women are cared for. Current evidence provides
strong support for the use of short course zidovudine and single-dose nevirapine
in low and middle income countries.
Presenting author: James Volmink, Global Health Council, 1701 K Street, NW
Suite 600, Washington, DC, 20006-1503, United States, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
ThPeB7248 HIV rapid testing during the peripartum period
followed by perinatal interventions in Brazil
V.G. Veloso1, M.G. Morgado', K.A. Nielsen2, Fl. Bastos', J.H. Pilotto',
E.C. Joao3 B. Grinsztejnl, BR. Santos4, R. Kreitchmann5, R. Fonseca4,
J. Pinto6, B. Busch7, M. Derrico', D. Mello', Y.J. Bryson2. 1FIOCRUZ, Av Brasil
4365, Biblioteca de Manguinhos, Rio de Janeiro, Brazil; 2UCLA School of
Medicine, Los Angeles, United States; 3Hospital dos Servidores, Rio de Janeiro,
Brazil; 4Grupo Conceicao, Porto Alegre, Brazil; 5SMS Porto Alegre, Porto
Alegre, Brazil; 6Universidade Federal de Minas Gerais, Belo Horizonte, Brazil;
7Maternidade Praca XV Rio de Janeiro, Brazil
Background: A significant number of pregnant women in Brazil are unaware
of their HIV serostatus because of lack of prenatal care, lack of testing or unavailability of results. We evaluated the feasibility of rapid HIV testing during the
peripartum period followed by interventions.
Methods: Pregnant women with unknown HIV status were offered rapid HIV testing from 04/2000 to 12/2001 at hospitals in Rio de Janeiro (RJ), Porto Alegre
(POA) and Belo Horizonte (BH). HIV seropositivity was determined by a rapid
HIV test (Determine 1/2) and confirmed by HIV EIA/ WB. Patients identified as
HIV+ prior to delivery received IV ZDV during labor. Infants received oral ZDV initiated before 48 hours of life until six weeks of age. HIV-exposed infants had HIV
DNA PCR performed at birth, 1 and 3 months of age
Results: 4901 women accepted HIV rapid testing during the peripartum period. 121 previously undiagnosed HIV-infected women were identified. The overall
seroprevalence rate was 2.5%. HIV rates varied by city, being 1.4% (48/3459) in
RJ, 7.2% (71/992) in POA, and 0.4% (2/450) in BH. 109 HIV-exposed infants had
HIV DNA PCR performed at birth. There were 4 stillbirths and one infant death.
7/109 infants were HIV-infected at birth, 4/42 in Rio, 2/66 in POA, and 1/1 in BH
(in utero transmission rate: 6.4%). All infants started ZDV within 48 hours of life,
and no mothers breastfed. Follow-up DNA PCRs are pending
Conclusions: HIV rapid testing was feasible and acceptable. Seroprevalence
rates were higher in the south of the country (7.2%) as compared to the southeastern region (1.4% and 0.4%). Stillbirths and infant death rates were high
among exposed infants (4%; 5/121). 6.4% of infants were infected at birth.
Women with no prenatal care are at high risk for HIV infection and adverse infant
outcomes. HIV screening during pregnancy and in the peripartum period coupled
with enhanced delivery of prenatal care should be a priority, particularly in the
south of Brazil.
Presenting author: Valdilea Veloso, Av. Brasil 4365, Biblioteca de Manguinhos,
Rio de Janeiro, Brazil, Tel.: [phone], Fax: [phone], E-mail: valdilea
@ aids.gov.br
ThPeB7249 Effectiveness of current antiretroviral therapy on
the virological outcome in HIV-1 infected children:
a cross sectional study
M.I. Gonzalez-Tome, J.M. Sanchez-Granados, M.R Carreho, P. Rojo,
J. Ruiz-Contreras, J.T. Ramos. Hospital 12 Octubre, Immunodeficiencies Unit.

Departamento de Pediatria, Hospital 12 de Octubre, Avenida de Cordoba km
5,4, Madrid 28041, Spain
Background: Antiretroviral (AR) regimens being used vary widely among HIV-1
infected children. In most clinical trials and observational studies of PI-containing
regimens, less than 50% have achieved an undetectable plasma viral load (VL).
Current AR therapy is better tolerated than the initial PIs, and salvage therapy
now leads to better results than in the early years of HAART