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

XIV International AIDS Conference

Abstracts WePeB5932-WePeB5935 63

positive women were not satisfied with their counsellor. 88% of HIV negative and
68% of positive women had at the time of interview already discussed HIV testing
with their partners. 42% of HIV negative and 39% of positive women's partners
had already been HIV-tested. The majority of HIV negative women breastfed or
mixed-fed compared with only 2% of HIV positive women. The most commonly
reported problems for HIV positive women were financial difficulties (63%), health
problems (24%). 2% said they had tried to hurt or kill themselves and 17% have
thought about hurting themselves.
Conclusion: HIV negative and positive mothers were satisfied with information
given and counselor interaction. Disclosure and partner testing was high compared to other countries. Access to economic support and health care for HIV
positive women would be a beneficial addition to the PMTCT program. Specific
training for counselors on recognizing and preventing suicide and self-harm following VCT and ongoing psychosocial support for HIV positive women should be
provided if needed.
Presenting author: Siripon Kanshana, Bureau of Health Promotion, Department of Health, Ministry of Public Health, Nonthaburi 11000, Thailand, Tel.: +66
5904121, Fax: [phone], E-mail: siripon @health.moph.go.th
WePeB5932 Vertical HIV transmission in Switzerland: results of
the Swiss mother+child HIV cohort study
C. Rudin. University Children's Hospital, Basel, Switzerland
Background: The publication of results of the PACTG-076 trial in 1994 initiated
a new era of progress in combatting the Pediatric AIDS epidemic in industrialized countries. Subsequently a continuing decrease in the.vertical transmission
rate has been achieved with introduction of additional interventions such as elective caesarean section delivery, refraining from breastfeeding and prescription of
HAART during pregnancy.
Methods: The Swiss Mother+Child HIV Cohort Study (MoCHiV) data base has
been used to evaluate the impact of these interventions on the vertical HIV transmission rate in Switzerland.
Results: Between 1986 and 2001 a total of 1'026 livebirths in HIV infected women
have been registered. The number of pregnancies has remained stable at 60 -70 per year. Maternal illicit drug use has decreased from 66% before 1990 to
< 15% in 2000 whereas heterosexually acquired maternal HIV infection has increased from 26% to > 65%. Starting in 1994 there has been a steady increase in
use of antiretrovirals, with 40% of women treated during pregnancy in 1996-1997
and nearly 80% in 1998-1999 including more than 70% receiving combined antiretroviral treatment or HAART More than 75% of the children were delivered by
elective C-section in 1999. After 1994 there has been a sharp decline in vertical
transmission rates from > 20% to < 2% with no single vertical transmission having occurred in children with exposure to combined ART and elective C-section
delivery
Conclusions: In concordance with data from other industrialized countries, the
widespread use of preventive interventions has resulted in an almost complete
elimination of vertical HIV transmission in Switzerland.
Presenting author: Christoph Rudin, University Children's Hospital, Roemergasse 8, CH-4058 Basel, Switzerland, Tel.: [phone], Fax: [phone]
60 19, E-mail: [email protected]
WePeB5933 Congenital malformations in children of
HIV1 -positive mothers naive or treated with
different regimes of antiretroviral drugs in
pregnancy
B. Buchholz1, M. Beichert2, N. Holzwarth1, S. Hien', T. Schaible1,
K.H. Niessen1. 1Universititskinderklinik, Universititskinderklinik, Klinikum
Mannheim, Theodor-Kutzer-Ufer 1-3, D-68157 Mannheim, Germany;
2Gynecology and Obstetrics Practice, Mannheim, Germany
Background: In the last years increasingly more HIV-1 infected pregnant women
are treated with 3 antiretroviral drugs(HAART) before and during pregnancy or receive two antirerovirals(ART) in pregnancy to prevent vertical HIVl-transmission.
Up to now the embryo- and fetotoxic effects of single drugs are unknown, even
less of their combinations.
Methods: We retrospectively registered congenital malformations(CM) in 100
children of HIVl-positive mothers, born from Jan. 1986 to Dec. 2001 and treated
in our pediatric hospital in the first months of life. 25 mothers were not treated,
22 received Zidovudine(ZDV) only, 41 got ART (two nucleoside analogues/NRTI)
and 12 HAART (8x 2NRTI+1 NNRTI, 2x 2NRTI+1 protease inhibitor, lx 3NRTI
and lx Mega-HAART) in pregnancy.
Results: 3 children had major malformations(MAM); 17 minor malformations(MIM). Two children are born with more than 1 CM: one with skin appendage+inguinal hernia (2 MIM) and one with a syndrome consisting of polyhydramnion, radioulnar synostosis type2, muscular hypotonia and respiratory insufficiency. The 18 MIM consist in 7 hernias (5 umbilical+2 inguinal), 5 cavernous

hemangiomas (2x single, lx double, lx triple + one child with hemangioma covering the whole upper- and forearm), 3 skin appendages(ear, chest, foot), 2 dilatations of renal pelvis and 1 cutaneous fibroma. Beside the described syndrome
MAM consist in a congenital clavicle fracture and a clubfoot. The rate of CM in
the group without prenatal treatment comes to 20%, under ZDV 22,7%, under
ART 22% and in the HAART group 16,6%. Umbilical hernia(3/25) predominate in
children of naive mothers; hemangiomas(5/75) in children of treated mothers.

Conclusions: The high rate(20%) of congenital malformations in the examined
HIV1 -exposed children does not differ significantly between the 4 groups of maternal treatment in pregnancy. The HIV1-exposed children we studied very often
have malformations of the skin(9/100) and hernias (7/100).
Presenting author: Bernd Buchholz, Universitatskinderklinik, Klinikum
Mannheim, Theodor-Kutzer-Ufer 1-3, D-68157 Mannheim, Germany, Tel.: [phone], Fax: [phone], E-mail: j.leoff@ netclub.de
WePeB5934 Successful antiretroviral prophylaxis with two
NRTI's and a two dose nevirapine regime for
newborn with a very high risk of vertical HIV-1
transmission
S. Hien1, B. Buchholz1, M. Beichert2, R. Linde3, N. Holzwarth1, T. Schaible1,
K.H. Niessen1. 1Universit6tskinderklinik, Universitatskinderklinik, Klinikum
Mannheim, Theodor-Kutzer-Ufer 1-3, D-68157 Mannheim, Germany;
2Gynecology and Obstetrics Practice, Mannheim, Germany; 3Children University
Hospital, Frankfurt, Germany
Background: In Germany a low rate of vertical HIV-1 transmission (1-2%) in
pregnant women with known HIV-1 infection has been achieved since 1995 by
combination of antiretroviral therapy for pregnant woman, caesarean section before onset of labor, antiretroviral prophylaxis of the newborn and refraining from
breastfeeding. This combined strategy was updated and risk-adapted in 1998 and
2001 by interdisciplinary consensus meetings.
Methods: In current update an increase of HIV-1 viral load of the pregnant prepartally(IVL), premature infants(PRE), born after amnionitis, rupture of membranes
> 4h(ROM), incision injury during caesarean (IIS), aspiration/ingestion of bloody
amniotic fluid(BAF) and with no pre- and/or intrapartal HIV-1 transmission prophylaxis(NPP) are defined as a group of very high risk for vertical HIV-1 transmission. It is recommended to treat these newborn with Zidovudine(4x 2mg/kg)
and Lamivudine(2x 2mg/kg) for 6 weeks and with Nevirapine (once or twice). According to data from the HIVNET012 study, a single dose of Nevirapine (200mg)
given to the mother was combined with a single dose (2mg/kg Nevirapine) given
to the newborn within 72hours of birth. If Nevirapine was not administered to the
mother prepartally the newborn received a first dose of 2mg/kg Nevirapine as
soon as possible after birth up to 48hours followed by a second dose within 72 h.
HIV-1 PCR was performed after 1,2,3 and 6 months to exclude or diagnose HIV-1
infection.
Results: Since January 2000 altogether 11 newborn (2x IVL, 2x PRE, 3x ROM,
2x IIS, lx BAF and lx NPP) were treated with this high risk prophylaxis. Up to now
already 6 children were HIV-1 PCR negative after 1,2,3 and 6 months, 2 children
have 3 negative HIV-1 PCR. Except of anaemia (3 cases) no adverse effects are
registered.
Conclusion: The triple antiretroviral therapy for HIV-1 exposed newborn with a
very high risk of vertical HIV-1 transmission is very successful and well tolerated.
Presenting author: Steffen Hien, Universitatskinderklinik, Klinikum Mannheim,
Theodor-Kutzer-Ufer 1-3, D-68157 Mannheim, Germany, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
WePeB5935 Maximizing Nevirapine (NVP) coverage to prevent
perinatal HIV transmission in high-prevalence,
resource poor settings
J.S.A. Stringer1, M. Sinkala2, R.L. Goldenberg1, E.P. Acosta', R. Kumwenda2
V. Chapman1, S.H. Vermund1. 1 University of Alabama at Birmingham, 9965
Makanta Close, PO Box: 34681, Fairview, Lusaka, United States; 2Central Board
of Health, Lusaka, Zambia
Introduction: We studied implementation strategies that maximize use of NVP
to prevent MTCT.
Methods: We compared 2 antenatal-care-based NVP strategies and one laborward-based NVP strategy in a prospective trial in Lusaka, Zambia. TARGETED
therapy offered HIV testing to women in antenatal care (ANC) and NVP to
seropositives only; MASS therapy offered NVP in ANC, without testing; L&D therapy offered NVP upon presentation in labor, without testing. With TARGETED
and MASS, NVP was self-administered upon labor onset; with L&D, ingestion
was directly observed. Coverage (the primary outcome) represents the product
of uptake (proportion of women who agreed to participate in a strategy) and adherence (proportion who actually ingest NVP.) Adherence was assessed by cord
blood NVP assay.
Results:
MASS TARGETED L&D
Offered 700 732 1219
Uptook 492 (70%) 435 (59%) 634 (52%)
HIV+ 124 (25%) 122 (28%) 184 (29%)
Lost to f/u 9 10 0

Non-adherent 45/115 (39%) 25/112 (22%) 1/184 (0.5%)
Women did not differ by arm with respect to age, parity, education, HIV prevalence, or median CD4 count (p>0.05). The MASS strategy resulted in higher
uptake than both TARGETED (70% v. 59%, p< 0.01) and L&D (70% v. 52%, p <
0.01). Non-adherence was higher in the MASS (39%) and TARGETED strategies