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

58 Abstracts WePeB5911-WePeB5915

XIV International AIDS Conference

WePeB591 I Co-infection with Toxoplasma gondii in a cohort of
HIV infected pregnant women
S.A. Nogueira1, E.S. Machado1, T.P. Costa2, TF. Abreu2, A.L. Gaspar1,
M.A. Maan1, A.L. Guedes1, J.S. Lambert3. 1HUCFF/UFRJ, Rua Jardim
Botnico 1008 casa 6- Rio de Janeiro - CEP: 22460.000, Brazil; 21PPMG/UFRJ,
Rio de Janeiro, Brazil; 3IHV/UMD, Baltimore, United States
Background: the frequency of acute and latent T. gondii infection HIV infected
pregnant women and its transmission to infants need to be determined in the
developing world.
Methods: In a Brazilian university hospital program for the prevention of MTCT,
HIV infected pregnant women (identified by two ELISA and one WB), were also
prospectively screened for toxoplasmosis by ELISA (IgM and IgG); and those
who tested negative where re-tested three months later and/or if clinical signs
of acquired toxoplasmosis were present. Infants with suspicion of congenital toxoplasmosis were examined with fundoscopy, skull XRAY and serology for toxoplasmosis. All patients received the 076 protocol plus other antiretrovirals as
needed for maternal health. TMP/SMZ prophylaxis was given to those with CD4
= < 200/mm3. HIV infection in infants was determined by two HIV RNA PCR >
one month of age. Breast-feeding was discouraged and formula provided for one
year.
Results: In a six year period (1996/2001) 227 patients, mean age: 26 y. (Sd:5.1),
mean CD4: 402.9 cell/mm3, and mean viral load: 35,820 copies/ml have toxoplasma serology results available. 167 (70%) were IgG: (+) and IgM: (-); 68 (30%)
IgG and IgM:(-) and two (0.9%)IgM and IgG:(+);one of whom seroconverted during the third trimester of pregnancy. One woman with toxoplasma encephalitis
received HAART and sulfadiazine plus pyrimethamine and did not transmit either
of these infections to her baby Overall, 5 infants from this cohort became infected
by HIV (MTCT rate: 2.6%) and no congenital toxoplasmosis was diagnosed.
Conclusion: The prevalence of toxoplasma infection among HIV infected pregnant women is similar to the general Brazilian population. The incidence of acute
infection is low during gestation and the MTCT of HIV and of toxoplasma do not
appear to be cofactors in enhancing either infection, as long as adequate treatment during pregnancy is provided.
Presenting author: Susie Nogueira, Rua Jardim Botanico 1008 casa 6 - Rio de
Janeiro - CEP: 22460.000, Brazil, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
WePeB5912I Changes over time in the use of antiretrovirals to
prevent vertical transmission of HIV
S.A. Noqueira1, E.S. Machado1, T.P. Costa2, T. Abreu2, M. Tavares1,
J.S. Lambert3. 1HUCFF/UFRJ, Rua Jardim Botanico 1008 casa 6 - Rio de
Janeiro CEP:22460.000, Brazil; 2IPPMG/UFRJ, Rio de Janeiro, Brazil;
3IHV/UMD, Baltimore, United States
Background: the use of interventions to prevent mother to child transmission
(MTCT) in a developing setting is important to be evaluated
Methods: a prospective cohort of HIV infected women was established at a tertiary hospital in Rio de Janeiro, Brazil in 1995. Initially only AZT was used, according to 076 regimen but later, depending on CD4 count (< 500cell/mm3) and/or viral load (>10.000) other ARVs were added. Women were counseled not to breastfeed and formula was provided for one year. Elective C section was performed for
obstetrical reasons or when women had AIDS or a high viral load close to labor.
HIV infection in infants was determined by two PCR RNA performed after one
month.
Results: Between January 1996 and December 2001, 315 infants (4 twins sets)
have had their HIV status established. Mean maternal age was: 26 y.(Sd:5.4);
mean gestational age at beginning of ARV: 22 weeks (Sd:10); mean CD4 count:
413 cell/mm3 (Sd:220); and mean viral load: 31,765 copies/mi (Sd:67,450); these
data remained constant over the study years. Among those infants with their HIV
status defined, monotherapy was administered to 134 (43%) mothers; dual therapy (mainly AZT+3TC) to 142 (45.6%); and triple therapy (mainly AZT/3TC and
nelfinavir) to 35 (11%). In the first two years none received triple therapy and a
progressive increasing in combined therapy occurred later. The MTCT rate with
monotherapy was 1.5% (2/134); with dual therapy:1.4% (2/144) and 0 with triple
therapy (0/35). One child was infected postnatally due to breastfeeding (unknown
to researchers) after having 2 RNA PCRs negative before 6 months of age. Elective C-section was performed in 95 patients and none of them had infected babies.
Overall MTCT rate was 1.6% (5/315).
Conclusion: In a developing country setting, using the same rationale recommended for the first world, interventions to prevent the MTCT of HIV have similar
good results and are improving over time.
Presenting author: Susie Nogueira, Rua Jardim Botanico 1008 casa 6 - Rio de
Janeiro CEP:22460.000, Brazil, Tel.: [phone], Fax: [phone],
E-mail: susie @ hucff.ufrj.br

WePeB59133 Antiretroviral Drug Resistance and Subtype
Distribution in the Vertical Transmission of HIV-1
I.E. Souza, M.L. Azevedo, R.M. Succi, D.M. Machado, R.S. Diaz. Federal
University of Sao Paulo (UNIFESP), Rua Pedro de Toledo, 781, 16 andar, Sao
Paulo, S.P, CEP: 04039-032, Brazil
Background: We studied the genotypic polymorphisms in the reverse transcrip
tase (RT) and protease (br) regions of HIV+ mothers and their infants to analyze
its correlation with vertical transmission (VT). Prevalence of HIV-1 clades was
evaluated in non-transmitting mothers (NTM) vs. transmitting mothers (TM). As
clade B in Brazil may show variation in the env V3 loop, we analyzed its influence
in VT.
Methods: Samples from 122 HIV+ mothers collected between 07/97-04/00 were
assayed by gag heteroduplex mobility assay or sequencing to determine the subtype. Of these, 36 were TM and 86 were NTM. Clade B samples were subjected
to V3 loop serotyping. Genotyping of RT and P genes was performed in 1 sample
from each 24 NTM, 7 TM and their infected infants, and 5 HIV+ orphan infants.
Results: Of the 114 mothers subtyped, 93% were B, 2.6% C, and 4.4% F. There
was no difference in clade distribution in TM vs. NTM. Serotyping of clade B mothers showed 54% GPGR, 41% GWGR, and 5% indeterminate at the tip of V3 loop:
no difference was found in TM vs. NTM. 25% of NTM vs. 58% of TM were drug
naive; 75% of NTM vs. 41% of TM used AZT. ARV resistance profile showed 54%
of NTM with at least 1 resistance mutation (RM) in the RT gene (codons 215,
219, 70, 184, 190). Only 3 RM (codons 70, 219) were detected in the 12 samples
from TM and infected infants (25%). No major mutation was found in the P region.
When the presence RM was analyzed in mothers who received ARV (AZT or AZT
+ another NTRI), rates of RM were similar between NTM (60%) and TM (55%),
p=0.45.
Conclusions: Although TM were more exposed to ARV, thus developing a
greater number of RM, we did not find correlation between HIV VT and ARV
genotypic resistance. There was no association between the HIV clades and VT.
Also, the Brazilian B serotype and the B serotype similar to the one circulating in
Europe and US were both found at similar rates in TM and NTM.
Presenting author: Inara Souza, Rua Pedro de Toledo, 781, 16 andar, Sao
Paulo, S.P., CEP: 04039-032, Brazil, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB59144 Mother-to-Child HIV transmission rates in
exclusively breastfed, mixed-fed and formula fed
infants of the Dominican Republic
N. Diaz', C. Soto1, G. Minervino1, S. Soto2, E. Cruz3, E. Perez-Then3
1National Pedro Henriquez Urena University (UNPHU), School of Medicine.,
Santo Domingo, Dominican Republic; 2Robert Reid Cabral Children Hospital,
Santo Domingo, Dominican Republic; 3National Research Center on Maternal
and Child Health (CEN/SM/), Santo Domingo, Dominican Republic
Background: Although breastfeeding among HIV+ women is associated with
substantial risk of HIV-1 transmission, the current WHO policy for developing
countries encourages exclusive breastfeeding in women who have no safe alternatives. We assessed the influence of breastfeeding patterns on HIV transmission
in exclusively breastfed (EB), mixed-fed (MF), and formula fed (FF) infants of HIV
positive mothers in the Dominican Republic (DR).
Methods: 117 children (aged 6mo -15 years) of HIV (+) mothers who attended
the Immunology Department of The Robert Reid Cabral Children Hospital from
1985 to 2001, participated. After informed consent, blood was drawn to confirm
HIV status. Sociodemographics, history of maternal risk factor, mode of delivery,
antiretroviral treatment (ARV) and breastfeeding patterns were recorded.
Results: Children in the EB (n=9) and MF (n=57) groups were 6.5 times (CI95%:
1.17, 4.0) and 5.5 (C195%:2.3,13.3) more likely, respectively, to be HIV (+) than
non-breastfed children (FF=51). Sociodemographic characteristics were similar
in the groups. The median duration of breastfeeding was 14 months. Prematurity
and lack of ARV therapy were also associated with HIV vertical transmission (p
< 0.05). Logistic regression analysis revealed that breastfeeding (p = 0.013) and
prematurity (p = 0.0314) were the most significant predictors of HIV infection.
Conclusions: This report, from the Dominican Republic, highlights the urgency
for implementing strategies to increase availability of affordable formula, and develop community interventions on formula feeding education to prevent post partumrn HIV infection in developing countries.
Presenting author: Eddy Perez-Then, National Research Center on Maternal
and Child Health (CENISMI), Abraham Lincoln #2 Esq. Independencia, Centro
de Los Heroes, Santo Domingo, Dominican Republic, Tel.: +[phone], Fax:
+[phone], E-mail: [email protected]
WePeB5915 Voluntary counselling and HIV testing in Southern
Brazil
M.Z. Goldani1, E.J. Giugliani1, H.C. Rosa1, T. Scanlon2, A. Tomkins2. 1UFGRS,
Jose Bonofacio Street 61 Flat 202, Zip code 90040-130, Porto Alegre, Brazil;
2UCL, London, United Kingdom
Background: The Brazilian Ministry of Health instituted voluntary counselling
and HIV testing programme for all pregnant women in order to reduce mother
to child HIV transmission. However no studies explored the effectiveness of this
programme. The aim of this study was to assess the pattern of HIV testing and

dentify factors associated with a lack of access to counselling in Porto Alegre,
Brazil.
Methods: This is a cross sectional hospital-based study. A total of 1658 mothers
were included. Biological, reproductive and social variables were obtained from
mothers by means of a standardised questionnaire after delivery. Access to counselling for HIV test was considered as the dependent variable. The mothers were
asked if they received information about risk of the mother-to child transmission