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

XIV International AIDS Conference

Abstracts WePeB5924-WePeB5927 61

WePeB5924 HIV screening of women presenting in early labor
to the dlivery room in Pune, India
K. Bharuchal, A. Shrotril, J. Sastry2, A. Bhore', P. Bulakah', R.C. Bollinger3,
M. Phadke4. 1BJMC, 22, Saken, Valentina housing society, Koregaon Park,
Pune, Maharashtra, India; 2JHU, Pune, India; 3Johns Hopkins University,
Baltimore, United States; 4Department of Medical Education and Research,
State of Maharashtra, Mumbai, India
Background: Most HIV screening programs for pregnant women are restricted
to prenatal clinics. However, in many countries, access to prenatal care is limited.
Little data is available about the prevalence of HIV infection in women presenting
for delivery.
Methods: From April-Dec 2001, women presenting to the delivery room(DR) of
Sassoon General Hospital(SGH) in Pune, India were evaluated for their eligibility for HIV screening, which included age >17 years, early labor and no significant physical or emotional distress. Eligible consenting women were offered HIV
screening using rapid HIV tests and conventional ELISA. HIV prevalence and
characteristics of the HIV-infected mothers were measured.
Results: 5995 pregnant women presented to the DR during the study period.
1231(20%) were eligible for HIV screening and 920(75%) of the eligible women
were offered HIV screening. 4764 women were not eligible for HIV screening in
the DR due to advanced labor(50%) and labor complications(39%). 782 women
accepted HIV screening in the DR. 19(2.4%) of the women screened were HIVinfected based upon at least 2 different positive rapid HIV tests and 20(2.6%)
were HIV positive by at least 2 ELISA tests. Most(75%) of mothers found to be
HIV-infected were referred for delivery from outside SGH and 80% had been previously HIV screened. HIV-infected women had a median age of 21 years and
55% were nulliparus. Half of the HIV-infected women presented in labor before
38 weeks gestation and all had normal vaginal deliveries.
Conclusions: In India, many HIV-infected women present for the first time for
prenatal care in labor and are thus not provided prenatal screening. In addition,
many practitioners screen and refer their HIV-infected mothers to government
hospitals for delivery. The ability to provide HIV screening in the DR provides an
opportunity to offer counseling and interventions to improve prevention of mother
to infant HIV transmission in India.
Presenting author: Kapila Bharucha, 22, Saken, Valentina housing society,
Koregaon Park, Pune, Maharashtra, India, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB5925 Outcome and study of ACTGO76 in 50 HIV +ve
pregnancies in a developing country over a period
of 4 years
L. Vadrevu, R. Vadrevu, R. Manthena. Saisudha Hospital, Saisudha Hospital,
21-1-13, Jawahar Street, Salipeta, Kakinada-533 001
Background: The present study was undertaken over a period of 50 months from
JUN 1997 to AUG 2001 in a developing country with poverty, illiteracy and ignorance about HIV-AIDS. In tune with lack of HIV awareness in the general public
there was a lot of ignorance about the disease prevalence and Mother to Child
transmission(MTCT) among the doctors also. 50 consecutive HIV +ve antenatal
women were included in this study.
Methods: Each HIV +ve antenatal woman was confirmed by Elisa / Rapid spot
test and a Western Blot test before inclusion. ZIDOVUDINE (AZT) was given in a
dose of 100 mg 5 times per day orally. The patients were included from an earliest of 26th week of gestation to the latest of 37th week. This was so because
some women were refered to our clinic at a late stage of pregnancy Intrapartum
parenteral AZT could not be given because of non-availability A lower segment
caesarian section (LSCS) was done prior to the EDD. Postnatally no breast feeding was allowed to the infant. Both the Mother and the new born were given AZT
as per the ACTGO76 protocol.
Results: Out of the 50 deliveries conducted thus 49 were LSCS and one was a
spontaneous labor. 49 babies thus born were tested negative for HIV by Elisa /
Rapid spot test and a Western Blot test and also a plasma viral load where indicated. These were generally done at 16 months age. One baby died at the age of
6 months due to Meningitis. Her Mother also died due to Cryptococcal Meningitis
and she was the one who received AZT for only 2 weeks.None of the babies has
developed any congenital anomalies. No Single mother or Baby has shown any
side effects related to maternal AZT administration.
Conclusions: Our study has established that ACTGO76 protocol delivers excellent results even in compromised settings.
There were no adverse effects or Congenital Anomalies in any of the babies.
Very late administration of AZT gives poor results.
Presenting author: Lalitha Vadrevu, Saisudha Hospital, 21-1-13, Jawahar
Street, Salipeta, Kakinada-533 001, India, Tel.: [phone], Fax: +91884
361166, E-mail: [email protected]

WePeB5926 High post-partum morbidity in replacement fed
infants born to HIV-infected women in India,
receiving short-course zidovudine
M.A. Phadkel, K.E. Bharucha2, A.N. Shrotri2, J. Sastry3, N.A. Gupte4,
R. Brookmeyer4, P.L. Joshi5, R.C. Bollinger4. 1Directorate of Medical Education
& Research, Maharashtra Ministry of Health, Mumbai, Maharashtra, India; 2BJ
Medical College & Sassoon Hospitals, Pune, India; 3Johns Hopkins University
Baltimore, India; 4Johns Hopkins University Baltimore, United States; 5National
AIDS Control Organization, Ministry of Health & Family Welfare, India, New
Delhi, India
Background: This study examined the relationship between early post-partum
morbidity of infants born to HIV-infected mothers and infant feeding practices, in
a large government hospital in Pune, India.
Methods: Between March 2000 and November 2001, infants born to consenting HIV-infected mothers who were provided short course AZT were followed for
up to 21 months and post-partum infant hospitalization rates and mortality were
measured.
Results: 77(52%) of 150 participating mothers, reported that they were exclusively replacement feeding their infants (cow, goat or buffalo milk). Only 2(1.3%)
mothers reported exclusive formula feeding. 66(42%) of the mothers reported exclusive breastfeeding and 7 (4.7%) mothers reported mixed feeding. All of the 21
infants that required hospitalization were receiving replacement feeding yielding a
rate of 0.09 hospitalizations/100 person-days (95% CI = 0.06-0.14). None of the
exclusively breast fed infants were hospitalized. Acute gastroenteritis (15.4%),
pneumonia 10.58% and septicemia 3.8% were the common hospital diagnoses.
There were 4(3.31%) infant deaths among the non-breast fed infants, resulting in
an infant mortality rate of 46.5/1000 live births. None of the exclusively breast fed
infants died during this follow-up period.

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Kaplan-Meier analysis comparing proportion of infants without hospitalization among brest-fed
(BF) and non-brest-fed (NBF) infants born to HIV-infected mothers
Conclusion: A high risk of early post-partum hospitalization was found for infants born to HIV-infected mothers that were not breast fed. In settings such as
India, where access to affordable, safe infant formula is limited, interventions that
would make exclusive breastfeeding safer for both mother and infant are needed.
Such interventions would be valuable additions to the very effective national prevention programs that currently rely on provision of short course zidovudine and
nevirapine.
Presenting author: Mrudula Phadke, Directorate of Medical Education & Research, Govt. Dental College & Hospital Building (Near C.S.T.), Mumbai 400001,
Maharashtra, India, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB5927I The impact of a programme for the prevention of
HIV vertical transmission at a public Maternity.
Rosario. Argentina
L.I. Sainz de Vicuna San Pedro, M. Leguizamon, M. Rodriguez, R. Leguizamon,
F. Burgueno, H. Navarro, G. Gomez, M. Estalayo. Martin Maternity, 9 de Julio
1758, Rosario - 2000, Argentina
Background: Argentina has got the highest rate in pediatrics HIV in Latin America. The detection of the infected pregnant is essential to avoid Vertical transmission.
Materials and Methods: Study of a retrospective cohort of pregnant women
based on statistical data, which correlates the annual childbirth with the HIV detection. It was carried out in a Maternity Hospital that attends the 35% of the public
deliveries in the city of Rosario. Most of the women belong to low socio-economic
levels. The program consisted of different aspects: universal requirement of the
serology in all the pregnancies (ELISA/Western Blot serologic testing); the centralization of the care of the infected pregnant; the strict inclusion of the 076 protocol; elective Caesarean since August 1998; training of the health staff; improve