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

XIV International AIDS Conference

Abstracts ThPeB7250-ThPeB7253 399

Objectives: To describe the current AR therapies used in a tertiary HIV pediatric
unit, and determine the most recent virological outcome achieved
Patients and methods: A cross-sectional study was done from data of HIV-1 infected children followed in a large pediatric hospital. The last available CD4 and
VL was considered. Only children with less than 300 cp/ml at that point were
deemed to have an undetectable VL (regardless of the previous determinations).
Clinical examinations and laboratory data are obtained every 3 months
Results: As of Jan. 02, 66 HIV-1 infected children are being followed. All but
one acquired the infection through vertical transmission. The median age was
111 months (18-216). Among them, 21 were followed from birth. 20 children
are on C category. Current median CD4 cell count is 842 (270-3137) and 26%
(12-39%). 9 children (14%) are not being given HAART (one child has no therapy, eight 2 NRTI) and 57 are receiving HAART (3 with 2 NRTI+EFV; 12 with
1NRTI+1NNRTI+1PI; 25 with 2 NRTI and 1 PI, and 16 with more than 3 drugs).
23 children are receiving the first regimen of HAART, 22 the second one, and 12
have already been switched more than twice. Overall 36 patients have a current
undetectable plasma VL (56%), 11 has between 300 and 1000 cp/ml, 9 between
1000 and 10.000 cp/ml, 7 between 10.000 and 100000 cp/ml and 2 more than
100.000 cp/ml
Conclusions: In our study, most, but not all, children are on HAART Nowadays,
with current AR therapy, more than 50% of HIV-infected children may obtain a
good immunologic profile and achieve a plasma viral load below 300 cp/ml.
Presenting author: Jose T Ramos, Immunodeficiencies Unit. Departamento de
Pediatria, Hospital 12 de Octubre, Avenida de Cordoba km 5,4, Madrid 28041,
Spain, Tel.: [phone], Fax: [phone], E-mail: [email protected].
es
ThPeB7250 Perinatal exposure to Antiretroviral Therapy:
A study of 118 cases
P. Coll, A. Nenna, J. Lattner, T Sepulveda, A. Serjan, F. Buraschi, P. Cahn.
Hospital Fernandez, Angel Peluffo 3932, C1202ABB, Buenos Aires, Argentina
Background: Antiretroviral drugs are increasingly used in pregnant women. After the universal adoption of three-part ZDV prophylaxis for perinatal prophylaxis,
double nucleoside and triple combinations are prescribed for the benefit of pregnant women's health. We perform an ongoing safety evaluation in a pediatric
cohort exposed to ARV during pregnancy.
Methods: In this prospective,ongoing observational cohort study,HIV pregnant women received combined ARV therapy (ZDV+Iamivudine or didanosine; ZDV+lamivudine+ nevirapine or Ritonavir, Nelfinavir or Indinavir; stavudine+lamivudine+nevirapine or one PI. IV ZDV infusion during delivery and oral
ZDV to newborns (NB) received ZDV orally for 6 weeks was prescribed. NB were
tested for HIV by PCR technique on PBMC at least twice within the first 6 months
of life. Safety labs, clinical control, growth, madurative development and Bay Ley
test were monitored at regular intervals.
Results: From 1/97 to 12/01, 118 children were followed. Median follow up: 36
weeks (r:4wks-48mo), for a total of 1210 patient/months. Median gestational age
of NB at delivery was 38 wks(24-40).One case had perinatal asphyxia; 1 seizures
at birth; sepsis was diagnosed in two cases (1 associated with congenital CMV).
Congenital malformations were not observed. One case presented premature
rupture of membranes >4 hours. Five patients showed anemia at birth; persistent neutropenia in 1 patient, moderate elevation in LFT's occurred in two. From
1/2000 Bay Ley test was performed. As of January 20,2002, 40 patients completed the evaluations,at 6 and 12months,with normal results in all cases. All 78
children who completed two PCR test remain negative (16 have only 1 PCR negative, with the second test pending).
Conclusions: Mild anemia was seen in less than 5% of the exposed NB.
Newborn exposure to different antiretroviral combinations showed no impact on
obstetric outcomes, congenital malformations nor on normal motor and mental
development.
Presenting author: Pedro Cahn, Angel Peluffo 3932, C120O2ABB, iBuenos Aires,
Argentina, Tel.: [phone], Fax: [phone], E-mail: pcahn @huesped.org.ar
ThPeB7251 Differences in growth & illness between breast-fed
& formula fed infants born to HIV +ve mothers in
Kampala
R. Serunkuuma1, A. Kaddumukasa1, A. Kiwanuka1, V. Nganga2. 1The Aids
Support Orgonanisation (TASO), TASO Mulago, Upper Mulago Hospital, B.O.Box
11485, Kampala, Uganda; 2Antenatal Clinic, Mulagd Hospital, Kampala, Uganda
Objectives: To determine the difference in: (i) growth between the differences in
infants born to HIV +ve women at Mulago Hospital; (ii) infection rates between
these 2 groups; and (iii) transmission rates between these 2 groups.
Methods: Prospective analytical observational study of all infants born to HIV +ve
women booking at the antenatal clinic at Mulago Hospital.

Results: Over 200 mother- infant pairs were enrolled into the study. The data
of 150 infants over the age of 12 months were analysed. 60% of mothers chose
to breast-feed their infants exclusively. There were no differences between the
weight and positions on the incidence of infection in the formula fed group.
Presently 28.5% of the breast fed infants have been diagnosed as being HIV
+ve (PCR or P 24 Ag) and 18% of the formula fed group are HIV +ve
Conclusion: It appears that infants born to HIV +ve women who are not breast
fed grow just as well as their breast-fed counterparts and are not susceptible to
any more intercurrent infections in an urbanising environment. There also appears to be a reduction in transmission in children who are not breast-fed.
Presenting author: Richard Serunkuuma, TASO Mulago, Upper Mulago Hospital, B.O.Box 11485, Kampala, Uganda, Tel.: [phone], Fax: +256 41
530412, E-mail: [email protected]
ThPeB7252 Induced sputum - a useful diagnostic method for
recovery of pathogens in HIV-infected infants and
children hospitalised for community acquired
pneumonia
H.J. Zar, D. Hanslo, G. Hussey. School of Child and Adolescent Health, Red
Cross Children's Hospital, University of Cape Town, Child health unit, 46 sawkins
road, Rondebosch, cape town, 7700, South Africa
Background: Induced sputum (IS) has been used to obtain lower respiratory
tract secretions for pathogens in older children and adults but has rarely been
performed in infants or young children. The aim of the study was to investigate
the usefulness of IS as a diagnostic method in HIV-infected and uninfected children with community acquired pneumonia (CAP).
Methods: Children hospitalised for CAP were prospectively enrolled over a year.
IS was obtained by nebulisation with hypertonic(5%) saline, physiotherapy and
suctioning. Sputum was submitted for bacterial and mycobacterial culture and P
carinii detection. Gastric lavages (GL) were done for M. tuberculosis culture; a
nasopharyngeal aspirate (NPA) was obtained for bacterial culture and P carinii
detection.
Results: IS was obtained in 210 children (median age 7(3-18) months); 138(66%)
were HIV-infected. 148(70%) were receiving supplemental oxygen. P carinii was
identified in IS in 12(5.7%) children; all corresponding NPAs were negative. M. tuberculosis was cultured from sputum in 18(8.6%); GL performed in 142 children
were positive in only 9 (6%). A single child had a positive GL with negative IS while
7 children cultured M. tuberculosis from sputum but not from GL. Differences in
bacteriology in 200 paired specimens (n,%) of NPAs and IS were:
Bacteria NPAs Induced sputum p
S aureus 49(24) 25(12) 0.002
H influenzae 38 (19) 21 (10) 0.017
M catarrhalis 38 (19) 8 (4) <0.001
S pneumoniae 26(13) 5 (2) <0.001
K pneumoniae 13(6) 22(11) 0.112
P aeruginosa 13 (6) 11 (5) 0.674
Seven (3%) children could not tolerate the procedure. Side effects included increased coughing (8%), epistaxis (4%) and wheezing (1%).
Conclusion: Induced sputum is a useful and safe diagnostic procedure in infants
and children with CAP.
Supported by MRC, South Africa, ASTRA respiratory fellowship, ICH fund Red
Cross Childrens Hospital
Presenting author: Heather Zar, Child health unit, 46 sawkins road, Rondebosch, cape town, 7700, South Africa, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
ThPeB7253 Vaccination against haemophilus influenzae type b
in patients infected with human immunodeficiency
virus
S.S. dos Santos1, M.H. Lopes1, V. Simonsen2, H.H. Caiaffa Filho3.
' Department of Infectious and Parasitic Diseases, Hospital das Clinicas,
University of Sao Paulo School of Medicine, R. Jose Getulio, 310 apto 21,
Aclimacao, Sao Paulo, S.P, Brazil; 2Bacteriology Laboratory Adolfo Lutz
Institute, Sao Paulo, Brazil; 3 Central Laboratory Hospital das Clinicas, University
of Sao Paulo School of Medicine, Sao Paulo, Brazil
Background: The number of individuals who live with HIV/AIDS is growing due
to the increasing incidence of this infection and to the improvement in life expectancy, making it necessary to evaluate the safety and the efficacy of immunizing this population. The purpose of this study is to verify the safety and efficacy of
H. influenzae type b conjugate vaccine in adult HIV-infected individuals. Methods:
Seventy-nine asymptomatic HIV-infected adult patients were randomly assigned
to receive or not the PRP-OMP vaccine, allocated to GROUPS A (60 pt) and B
(19 pt), respectively. Twenty HIV-seronegative control patients also received the
vaccine (GROUP C). Several blood samples were taken just before and after vaccination, with a follow-up period of 6 months. Blood samples were used to perform
blood profile with platelet count, anti-PRP antibody dosing, HIV-1 viral load and
CD4+ T-lymphocyte count.
Results: Patients from GROUP A and GROUP B presented an homogeneous

distribution regarding sex, age, HIV-infection epidemiology, time of disease evolution, classification of HIV-infection (CDC/93), initial antiretroviral therapy and
changes in antiretroviral therapy The evolution of CD4+ T-lymphocyte count
and HIV-1 viral load was not different in both vaccinated and unvaccinated HIVinfected patients. A fourfold increase in the antibody concentration against PRP
was more frequent in vaccinated HIV-infected patients (38.3%) than in those
that have received no vaccine (0%), although it was less frequent than in those