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

XIV International AIDS Conference

Abstracts ThPeC7427-ThPeC7430 445

Women were defined as transmitters (TR) if PCR analysis of their infants tested
positive in at least two viral loci and also tested positive using the Amplicor v1.5
diagnostic kit. Otherwise, women were defined as non-transmitters (NTR). Maternal proviral DNA was measured using quantitative real-time PCR and sequencing
was done using fluorescent chemistry
Results: The overall rate of transmission among 112 HIV positive mothers was
34.8% based on analysis of matched infant blood. The mean plasma viral load for
33 TR mothers and 58 NTR mothers was 147,202/ml and 89,557/ml, respectively.
The proviral load within the blood and cervico-vaginal fluid (CVF) was also determined for 24 TR and 19 NTR mothers. A trend analysis for association with transmission indicated a weak but significant trend for plasma viral load (p = 0.0204)
and a stronger trend in the proviral blood load (p = 0.0054) and proviral CVF load
(p = 0.0054). Viral signature sequence analysis of the envelope region indicated
that TR mothers appeared to contain signatures in the C3 alpha helical region of
the genital tract virus.
Conclusions: This study suggests that proviral load may be an important correlate of perinatal transmission that can be evaluated post facto and that viral signatures appear to persist among TR and NTR mothers after parturition, as well.
The persistence of relevant transmission correlates may have some value in the
retrospective analysis of transmission determinants and also in the prospective
analysis of future risk of transmission.
Presenting author: Monty Montano, 650 Albany Street, ebrc, 6th floor, Boston
Medical Center, Boston, USA 02118, United States, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
ThPeC7427 Risk factors for HIV infection in mother-child pairs
in rural South Africa
M. Dedicoat1, T. Page2, D. Mbatha3, K. Bishop2, S. Cassol 2, C. Gilks4.
1Liverpool University, Liverpool, United Kingdom; 2Africa Centre/University of
Natal, Durban, South Africa; 3Hlabisa Hospital, Hlabisa, South Africa; 4Liverpool
School of Tropical Meiccine, Liverpool, United Kingdom
Background: South Africa has one of the highest infection rates with HIV in the
world. Our aim was to assess the prevalence of HIV infection and examine risk
factors for infection in a mother child cohort immediately prior to the introduction
of a transmission prevention programme.
Methods:Mothers and their children were recruited in 6 primary health clinics
whilst attending for vaccination. A questionnaire was completed for each mother
and child and linked anonymous HIV testing was performed. All mothers gave
informed consent. Risk factors for HIV infection in the mother and the child were
analysed by means of a multiple logistic regression model.
Results:1500 mother child pairs were recruited. HIV status was determined for
1476 (98.4%) mothers and 1448 (97%) children. 387/1476 (26.2% Cl 20.6 - 29.8)
of mothers were HIV infected. 89/387 (24.9% Cl 24.0 - 28.6) of the children were
HIV infected. Mean age of HIV positive and negative mothers was 25.5 and 26.2
(not significant). The mean age of the children was 20 months (no significant
difference between HIV positive and negative).
For the mothers univariate analysis revealed HIV infection to be associated
with younger age (p =0.022), smaller clothes size (p=0.013), unmarried status
(p <0.0001), higher education level (p=0.041) and higher number of partners
(p=.002). In the logistic regression model only unmarried status (p <.001) and
number of partners (p<0.01) remained significant. For the children born to HIV
positive mothers after controlling for the Childs age only early mixed feeding was
associated with HIV infection (p=0.021) in the model.
Conclusions:Despite biases inherent in using vaccination clinics this study gives
important baseline data on HIV prevalence and transmission in a rural area prior
to the introduction of a prevention programme. The observation that early mixed
feeding is associated with HIV infection needs to be examined in a prospective
trial.
Presenting author: martin dedicoat, po box 252, hlabisa, 3937, kwazulu / natal,
South Africa, Tel.: [phone], Fax: [phone], E-mail: martded@aol.
com
ThPeC7428 Determinants of mother to child transmission of
HIV in the inter uterine/intrapartum period and
during breastfeeding in Rakai, Uganda
H.P.B. Brahmbhatt1, G.K. Kigozi2, EW.M. Wabwire-Mangen3, M.W. Wawer4,
R.H.G. Gray1. 1Johns Hopkins School of Public Health, Baltimore, MD, United
States; 2Rakai Project, Rakai Uganda; 3Makerere University, Kampala, Uganda;
4Columbia University, New York, United States
Background: objective was to examine intrauterine/intrapartum and lactational
predictors of mother to child transmission of HIV
Methods: Data are from a prospective community-randomized trial in Rakai District, Uganda. Sociodemographic characteristics, and maternal HIV serostatus
were assessed at 10-month intervals and infant HIV status (determined by PCR)

was evaluated at 1-6 weeks postpartum and at during breastfeeding. Multivariate
logistic regression modeling was used to assess determinants of mother to child
transmission of HIV.
Results: Of the 372 children who were tested for HIV around birth, 61 were HIV
positive (16.4%) and of 94 children tested at a follow-up visit, 15 (16.0%) were
positive. In the multivariate model, risk factors for mother to child transmission of
HIV in the intrauterine/intrapartum period were: presence malaria pigment or par
asite during pregnancy (OR=1 1.81, p=0.012), increasing log10 maternal viral load
(OR=7.31, p=0.005) and children born at low birth weight (OR=12.49, p=0.008).
For children who escaped infection of HIV during birth, risk factors for transmission of HIV during breastfeeding in the multivariate model were: being born at low
birth weight (OR=12.5, p=0.008), and presence of malaria pigment/parasite in the
placenta (OR=6.52, p=0.007).
Conclusions: Reductions of maternal viral loads, antenatal care to reduce prevalence of low birth weight and provision of malaria prophylaxis during pregnancy
could reduce mother to child transmission of HIV.
Presenting author: Heena Brahmbhatt, 4001 Deepwood Road, Baltimore, Maryland, 21218, United States, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
ThPeC7429I What is wrong with this picture? Preventing
maternal HIV transmission amongst black women
and women of color in Toronto, Canada
E. Tharaol, N. Massaquoi2, M. Brown2. 1Women's Health in Womens Hands/
University of Toronto; 2 Women's Health in Women's Hands, Toronto, Canada
Background: In developed countries where services and therapies to reduce
maternal HIV transmission are available, black women continue to bear HIV infected children and have the highest rates of maternal HIV transmission in the
general population. In Ontario all pregnant women are to be provided with HIV
information, counselled and offered testing with informed consent. Yet women of
color continue to have limited knowledge about HIV, testing, treatment and implications to their unborn children, limiting their ability to make informed decisions.
This study investigates and documents; the experiences of women of color and
their services providers with HIV testing during pregnancy; their understanding of
informed consent; and reasons for testing or not testing.
Methods: Data was collected through focus groups and in-depth interviews with
29 African, Caribbean, Latin American and South Asian women and 8 prenatal
providers. Interviews were taped, transcribed and analyzed.
Results: a) Most women did not receive the necessary information or counseling
to permit informed decisions; had limited information on HIV, testing and treatment; South Asian women were least likely to be offered testing, black women
most likely b) Women tested because of doctors' insistence; for the baby's sake;
because they were told "something" could be done (but not what); or to prove that
not all African women are infected.
c) Reasons for not testing: conviction that there was not risk; being informed that
there was no risk; not informed or offered testing; fear of stigma, isolation and
implications of testing on immigration; lack of health coverage.
Conclusions: Decisions about: testing; to end or continue a pregnancy; to
access HIV treatment or not requires appropriate information, knowledge and
counseling failure of which results in continuing ignorance and stereotypes
about HIV/AIDS putting women and their unborn children at risk of contracting
HIV/AIDS.
Presenting author: Esther Tharao, Women's Health in Women's Hands Community Health Centre, 2 Carlton Street, Suite 500, Toronto, Ontario, M5B 1J3,
Canada, Tel.: [phone], Fax: [phone], E-mail: esther@whiwh.
com
ThPeC7430 Contextual barriers to prevention of mother to child
transmission (PMTCT) of HIV among HIV positive
pregnant women in Southern India
P. Gondi', S. Raghavan2, P. Balamba3, H. Yelamanchali4, A. Addala5,
M. Delima5, S. Perumalla5, B. Fullilove'. 'Columbia University, New York, NY,
United States; 2Columbia University and Harlem Hospital Center, New York,
United States; 3Osmania Hospital, Hyderabad, India; 4Maternity Hospital,
Hyderabad, India; 5Maternity Hospital, Hyderabad, India
Background: India is experiencing a rapidly increasing HIV epidemic. Vertical
transmission is a leading contributor, accounting for 2.13% of total HIV transmission rates. Yet few studies have attempted to understand the barriers to PMTCT
in India.
Methods: This study assessed the knowledge, attitudes, and practices of 49
HIV+ pregnant women attending a maternity hospital in the southern city of Hyderabad. A triangulation of research methods involving qualitative focus groups,
quantitative surveys, and observational field notes were used. Regression techniques and thematic word analysis were used to analyze the quantitative and
qualitative data, respectively.
Results: The mean age was 21 years, 100% were married, 45% had no formal
education, 36% worked outside the home, and 41% lived in a rural area. The
majority of focus group participants and 73% of the survey population were unaware of the term HIV, yet all understood their affliction as a 'fault with their blood'.
Nearly 40% of survey respondents were unaware that HIV could be transmitted
through sex, mother to child during pregnancy, and unsafe blood transfusions

and 10-27% of women believed inaccurate HIV transmission modes as factual.
Regression analysis revealed a significant association between formal education
and knowledge scores, however no associations were noted with age, rural vs
urban living and working status (R 0.32, P. 001). Only 33% knew of their origin of
HIV infection, 33% believed god was punishing them, and 48% felt they deserved
their fate. Moreover, 64% failed to know the meaning of a condom and 88% were
unaware of how to protect their unborn child from infection.