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

XIV International AIDS Conference

Abstracts WePeB5940-WePeB5943 65

WePeB5940 Lactic Acid in infants perinatally exposed to
antiretrovirals
C. Giaquinto1, S. Torresan1, O. Rampon', E.M. Rugal, F. Fregonese1,
F. Eseme Esokal, V. Balasso1, C. Manzardol, A. De Rossi2, R. DElial,
M. Sturkenboom3. 1Dipartimento di Pediatria, Padova, Italy; 2lnstitute of
Oncology, Padova, Italy; 3Department of Epidemiology and Biostatistics,
Erasmus University Medical School, Rotterdam, The Netherlands
Background: Nucleoside-analogue reverse-transcriptase inhibitors (NRTIs) reduce mother-to-child-transmission (MTCT) of HIV by about 70%. Our objective was to evaluate whether mild mitochondrial damage, as shown by elevated
plasma lactic acid (LA) level, is associated with prenatal and/or perinatal exposure
to antiretrovirals (ARV) in children of HIV infected mothers
Methods: A cohort of 60 children was followed prospectively from birth with monitoring of plasma LA levels during routine visits for an average lenght of follow
up of 265 days. All drugs administered prenatally, during labour and postnatally
were recorded. The risk of elevated LA levels (>2.5 mmol/I) was calculated and
the association with treatment was estimated through logistic regression analysis.
Results: The cohort of 60 children comprised 5 children with HIV infection. 58
children received zidovudine (ZDV) during labour. All 5 HIV-infected children
were born to mother who were not treated during pregnancy. 8 of the 55 HIVnegative children were not treated perinatally, 6 children received SQV+NRTIs,
4 IDV+NRTIs, 2 NFV+NRTIs and 8 received nevirapine plus NRTIs, 26 children
received neither a protease inhibitor nor a NNRTI and were treated only with one
or two NRTIs during gestation. 34 out of the 55 HIV-negative children (62%) developed high levels of LA after birth, the mean level was 9.85 mmol/I (STD 32
mol/1). All elevated LA levels returned to normal during follow-up and none of the
children developed severe mitochondrial damage. Use of 3TC slightly increased
the risk of elevated LA but due to the low exposure prevalence this did not reach
statistical significance.
Conclusion: In this study we observed that infants who were exposed to NRTIs
during gestation had a high risk of increased LA level during the first weeks of life
but our findings do not support a change in the current recommendations to use
ARV in pregnant women to prevent MTCT of HIV.
Presenting author: Carlo Giaquinto, Dept of Paediatrics, Via Giustiniani 3, 35128
Padova, Italy, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB5941 I Impact of combined antiretroviral therapy on
perinatal HIV transmission
A. Duran, A. Hackim, R. Zlatkes, L. Adissi, J. Toibaro, L. Lourtau, M. Losso.
Htal.Ramos Mejia, Urquiza 609, Htal.Ramos Mejia, Pabellon G 20 piso, Capital
federal, Argentina
Background: Therapy with zidovudine has been shown to reduce the risk of perinatal HIV transmission in HIV infected pregnant women population.Few data are
available in relation with both combined therapy and type of delivery
Objectives: 1. To determine the impact of combined therapy on perinatal HIV
transmission.
2. To evaluate the relationship between type of delivery and risk of transmission.
Methods: We reviewed 195 cases of our cohort of HIV+ pregnant women from
April 94 to Dec 01 searching data related to mother HIV ARV treatment, type of
delivery and newborn HIV status.
Results:. Type of delivery was vaginal in 111 (56.9%) Cesarean in 84 (43.07%),
61 electives (EC) and 23 non-electives (NEC). 166 patients in this population received any ARV therapy, 105 monotherapy with ZDV (ACTG 076 completed or
incompleted) and 61 combined therapy (25 NRTI, 19 NNRTI, 17 PI)).Mean viral load in the Combined Therapy group was 3.42 log (1.6 - 4.62) Twentynine
patients did not receive any ARV therapy.
ACTG 076 Combined No therapy n
Vaginal 75 20 16 111
EC 21 32 8 61
NEC 9 9 5 23
n 105 61 29 195
We detected 28 neonates with HIV+ status with a global transmission rate of
14.35% (28/195).
ACTG 076 Combined No therapy n
Vaginal 6 0 9 15
EC 3 0 4 7
NEC 1 0 5 6
n 10 0 18 28
We found no asociation between type of delivery and risk of transmission using

an univariate regression model with: x 2 = 2.55, p value= 0.2788. Odds Ratio por
EC and NEC in relation to vaginal delivery was: 0.76 (IC95% 0.29 - 1.9) and 2.09
(IC95% 0.71 - 6.1) respectively.
Any antiretroviral treatment in the pregnant women was associated with a reduction in the transmission rate; x2=31.05 p value < 0.0001. No cases of HIV
transmission were detected in the combined therapy group.The OR for the other
groups was 0.07 (IC95% 0.02 - 0.18)

Conclusions: Combined therapy has been show to improve the efficacy of
monotherapy with zidovudine in the prophylaxis of perinatal transmission independently of type of delivery.
Presenting author: Adriana Duran, Urquiza 609, Htal.Ramos Mejia, Pabellon G
20 piso, Capital federal, Argentina, Tel.: [phone], Fax: [phone],
E-mail: aduran @ hivramos.org.ar
WePeB5942 Partner involvement and infant feeding choices in
HIV infected women
F.M. Mwanyumba1, A. Quaghebeur2, C. Wim3, R. Melis4, C. Verhofstede5,
M. Solomon6, K. Mandaliya6, M. Temmerman7. 1Coast Provincial General
Hospital, Mombasa, Kenya and Ghent University, Belgium; 2/CRH, Ghent
University, Belgium; 3MSF, Nairobi, Kenya; 4/CRH-Kenya, Mombasa, Kenya;
5Ghent University, Ghent, Belgium; 'Coast Provincial General Hospital,
Mombasa, Kenya; 7CRH-Ghent University Ghent, Belgium
Background: The risk of HIV transmission through breastfeeding is higher if infants are given both breast and formula feeding (mixed feeding). According to
WHO recommendations, HIV positive women are encouraged either to exclusively breast or formula feed but not both.
Main objective: To determine factors which influence the choice of infant feeding
focussing on the role of the male partner.
Methodology: Women involved in a nevirapine implementation study to reduce
mother-to-child transmission in Mombasa, Kenya are advised on feeding choices
as per WHO recommendations. In this analysis, infants on mixed feeding were
compared with infants on exclusive breast-feeding on one hand, and infants on
exclusive formula feeding on the other.
Preliminary results: A total of 41 mother-infant pairs were analysed. 16 infants
were on mixed feeding, 8 were exclusively breastfed and 17 were exclusively on
formula feeding. Socio-economic variables such as age, marital status, being a
full time housewife, parity, level of education, water source, type of toilet used
and sharing of HIV results did not differ significantly between mothers whose
infants were on mixed feeding compared with mothers whose infants were on formula feeding. Otherwise, 'full-time' housewives were more likely to practice exclusive breast-feeding than women who work outside the house (54.5% VS 17.6%,
p=0.031). Mothers who shared the HIV results with the partner were significantly
more likely to practice exclusive breast-feeding compared with those who did not
share the HIV results (71.4% VS 17.6%, p=0.011).
Conclusion: Our preliminary results show that partner involvement is crucial in
postpartum MTCT. Couple counselling should be the intervention of choice with
emphasis on safe feeding practices.
Presenting author: fabian mwanyumba, coast provincial general hospital, p.o.
box 91109, mombasa, Kenya, Tel.: [phone], Fax: [phone],
E-mail: chlcpgh @ africaonline.co.ke
WePeB5943 IThe introduction of voluntary antenatal hiv testing
in Ireland
M. Horgan, A.M. Dillon, C. Sheehan. Cork University Hospital, Cork, Ireland
The Department of Health and Children in Ireland introduced a policy of voluntary
antenatal HIV testing in April 1999. The rationale was a sustained yearly increase
positive results in unlinked antenatal HIV tests since 1992 and the benefit of treatment in preventing maternal-fetal transmission. The policy was introduced and
monitored in our Health Board area since 1999.
Methods: The policy of routine testing was commenced in Hospitals A and B in
1999 and in Hospital C in 2000. Its introduction was preceded by intensive education of staff in each hospital. Dedicated midwives were appointed in each hospital
to ensure that each patient was adequately informed of the test and its implications. We prospectively collected data on the total number of tests performed in
each individual hospital and the number of patients who declined tests over 2
years. Since May 2001 reasons for refusing the test was collected.
Results: The trends in uptake of the test are outlined in the table.
1999 2000 2001
Hospital A 64% 91% 94%
Hospital B 91% 78% 68%
Hospital C test not introduced 99% 99%
The increase in uptake in Hospital A resulted from involvement of staff in the National Group looking at implementation of the program and increased experience
dealing with HIV-infected pregnant women. The decline in uptake of the test in
hospital B coincided with 2 events: a significant change in staff in the antenatal
clinic and the redeployment of the designated midwife to other duties. In Hospital
C the designated midwife is constant and provides information to all attendees.
From May 2001 we looked at reasons for declining tests with the following reasons given: considered themselves not at risk, previously done and did not want

to know.
Conclusions: Ongoing education of staff providing information on antenatal HIV
testing is important. Designated midwife providing information to all patients improves uptake. Regular review of uptake of test is essential.
Presenting author: mary horgan, cork university hospital, wilton, cork, Ireland,
Tel.: [phone], Fax: [phone], E-mail: [email protected]