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

68 Abstracts WePeB5953-WePeB5956

XIV International AIDS Conference

wass no natural mutations associated with resistance to AZT, 3tc and nevirapine
found in the plasma HIV-1 RNA.
Conclusions: The results obtained seemed to suggest that there was no critical
viral load that could described as responsible fro breaking the blood-breast-barrier
in the women studied. There is, however, need to carry out the study with a larger
sample size before any proposals to change current recommendations on infant
feeding are made. Shedding of the virus in breastmilk may depend on many yet
unknown factors.
Presenting author: Norman Nyazema, Department of Clinical Pharmacology,
University of Zimbabwe, PO.Box A178, Avondale. HARARE, Zimbabwe, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
WePeB5953 Impact of Highly Active Anti-Retroviral Treatment
(HAART) during pregnancy and breastfeeding on
Mother-to-Child HIV Transmission (MTCT) and
mother's health in developing countries
I. de Vincenzi, R Gaillard, T Farley. World Health Organization, World Health
Organization, Department Reproductive Health and Research, 20 Avenue
Appia, CH-1211 Geneva 27, Switzerland
Background: Starting HAART during pregnancy in women with immunodeficiency in resource constrained settings has several potential advantages:
(1) to improve efficacy of current interventions to prevent MTCT based on short
course antiretroviral regimens; (2) to protect against transmission through breastfeeding, thus simplifying counselling on infant feeding in the context of HIV; (3)
provide care for and prolong life of women.
Objectives and Methods: WHO and research partners are implementing a multicentre trial in developing countries to assess the acceptability, efficacy and safety
of a triple antiretroviral combination (ZDV, 3TC, NVP) to reduce MTCT during
pregnancy and breastfeeding and maintain mothers healthy. Treatment arms will
be allocated according to CD4 counts and AIDS symptoms:
(1) CD4 counts below 200 cells/mm3 or AIDS symptoms: all women will be provided with HAART through pregnancy, delivery, the breastfeeding period and beyond, as they require antiretroviral therapy for the management of their own HIV
disease
(2) CD4 counts in the range 200 - 500 cells/mm3: randomisation to either shortcourse ZDV prophylaxis, or HAART for up to 6 months post-partum provided that
mothers continue to breastfeed
(3) CD4 counts above 500 cells/mm3: ZDV short-course prophylactic regimen
All women will receive infant feeding counselling according to WHO recommendations. Women and their infants will be followed for 2 years from delivery. It is
important to note that ZDV+3TC+NVP combination for 6 months currently costs
-200 USD, similar to infant formula. HAART will also be provided to women's
partners and children who require treatment.
Results: The study protocol will be presented, including methodological and ethical issues. Study results will be available in late 2004.
Conclusion: This protocol serves as a model for integrated prevention and care
MTCT programs.
Presenting author: Isabelle de Vincenzi, World Health Organization, Department Reproductive Health and Research, 20 Avenue Appia, CH-1211 Geneva
27, Switzerland, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB5954 Reaching out and scaling up of PMTCT
programme in the city of Mumbai, India
A. Gogate1, P. Gurnani2. 1Mumbai Districts Aids Control Society (MDACS),
Project Director, 12 Sahayog Co-op. Hsg. Society, L.J. Road, Mahim,
Mumbai-400 016,; 2UNICEF, Mumbai
Issue: The population of Mega city of Mumbai > 12 million. Mumbai has become
epicenter of HIV infection having sero-prevalence of 3.5% in general population
with sero-prevalence of HIV infection of 3.5% to 5.5% in ante-natal cases. Mumbai has birth rate of 18/1000 estimates.
Description: Mother to child transmission is one of the important issues in the
prevention of HIV/AIDS control to the next generation. There is a geographical diversity in prevalence of HIV infection across the country. The high prevalence states include Maharashtra (including Mumbai as epicenter), Tamilnadu,
Karnataka, Andhra Pradesh, Manipur & Nagaland. A feasibility study on administering Short Term AZT among HIV infected mothers was taken up at 11 centres
all over the country. Out of these 11 centres, 3 centres are located in the city of
Mumbai.
Lessons learnt: The 15 months study in these centres, show that the ANC attendees varied from 3846 to 7240. Only a percentage of the positive mothers
accepted HIV treatment, however, it did help to great extent for primary prevention (80% to 98%). Hence, it is decided to scale up the programme to reach out
to more population as a modality of primary prevention.

Recommendations: Any scaling up of the programme is not a simple task and
there is a need to facilitate close coordination & cooperation of government health
care services, NGOs and community at large so that it can be integrated. Mumbai city has 5 medical schools, 20 peripheral hospitals, 23 maternity homes, 163
dispensaries & 178 health posts. The medical colleges will be used as a nodal
centre of excellence. It is planned to reach to peripheral hospitals in this year &
to the maternity homes next year & simultaneously approach the private sector

so that in the third year this programme can reach to the private sector covering
100% of deliveries.
Presenting author: Dr. Alka Gogate, Project Director, 12 Sahayog Co-op. Hsg.
Society, L.J. Road, Mahim, Mumbai-400 016, India, Tel.: [phone], Fax:
[phone], E-mail: alkagogate @ hotmail.com
WePeB5955 Antiretroviral therapy in pregnancy: exposure
patterns over time and the prevalence of birth
defects
P.M. Garcia1, D. Covington2, D.H. Watts3, K. Beckerman4, H.E. Fox5,
A. Parker6, A. White7. 1Northwestern University, Suite 410 Prentice, 333 East
Superior Street, Chicago, Illinois 60611, United States; 2PharmaReserch,
Wilmington, United States; 3PAMAB, NICHD, Bethesda, United States;
4 University of California, San Francisco, United States; 5Johns Hopkins
University Baltimore, United States; 6Bristol-Myers Squibb Co., Princeton,
United States; 7'Glaxo Wellcome, Inc., Research Triangle Park, United States
Objective: To describe the changing patterns of antiretroviral (ARV) therapy in
pregnancy along with the prevalence of birth defects.
Methods: The Antiretroviral Pregnancy Registry (APR) is an international registry of pregnancy exposures to ARV agents voluntarily reported by health care
providers. Since 1989, prospective reports are collected on specific drugs by
trimester of first exposure and neonatal outcomes (gestational age, birth weight
and birth defects). The prevalence of birth defects is reported only for drug categories with at least 200 exposures.
Results: Prospective reports now total 1,970 live births. The most dramatic
change in ARV therapy in pregnancy is the transition from AZT monotherapy to
combination therapy (AZT monotherapy as a percentage of all regimens, 96%1989-95, 6%- 2001). The first reports of protease inhibitor exposures were noted
in 1996 (13% of all reports), increased to 52% in 1998, and then steadily declined
to 41% in 2001. Before 1999, nnRTI reports accounted for less than 10% of exposures and then steadily increased to 43% in 2001. The proportion of ARV exposures reported in the first trimester has varied little over time (33% in 1989-95, to
a high of 47% in 1997-1998). The prevalence of birth defects for 1st trimester exposure to any ARV drug (cases closed through July, 2001) is 20 defects per 819
live births (2.4, 95%CI=1.5-3.8). The prevalence is similar for any 1st trimester
PI exposure (9/402, 2.2, 95%CI=1.0-4.2) and any 1st trimester NRTI exposure
(20/798, 2.5, 95%C1=1.5-3.9).
Conclusions: Antiretroviral drug therapy in pregnancies reported to the APR
changed dramatically over time and are now characterized by combination regimens that often include PI's and/or nnRTl's. The prevalence of overall birth defects for 1st trimester exposure to any ARV drug is not increased over populationbased figures. However, the power to detect an increase in specific birth defects
is limited.
Presenting author: Patricia Garcia, Suite 410 Prentice, 333 East Superior Street,
Chicago, Illinois 60611, United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB5956 Pluridisciplinary care in a mother to child
transmission prevention program in Le Dantec
Hospital
A. Diouf, M.L. Cisse, C. Cisse, Y. Wane, L. Diaw, N.M. Sail, S. Mboup, I. Ndoye.
PNLS, CHU H6pital Aristide Le Dantec, Dakar, Senegal
Background: The prevention of mother to child transmission include the pluridisciplinary approach from the counsellers to the pediatrician crossing the gynecologist, the biologist, the infectiologic doctor, the social worker and the community.
Methods: Before the ANC, the social workers, the midwives and members of
NGO organize a focus group meeting to talk about MTCT.During the ANC, the
test is systematicly proposed to the mother to be with a pre test counselling.If
the test is positive or negative, a post test counselling is done. The woman HIV
+ have to do a biological test for CD4 level and viral load to allow to ARVs triple
therapy if necessary. The peadiatrician will also talk to the mother to be specially
about infant feeding (bottle milk is recommended) and about the diagnosis of HIV
infection in children.Social and psychological support is given to HIV+ women.
AZT is given at 34th week of pregnancy(300mg twice a day), and during labour
and delivery(300mg every 3 hours). The infant received 2 mg per kilo of AZT syrup
every 6 hours. Contraception is proposed to the woman just after the delivery.
Results: In Le Dantec, 18 months after the beginning of the program, 418 women
received the propition of test, 363 accepted (82,9% of acceptance), 330 are effectivly done (86,8%) and 38 women were HIV+. 4 women lost their pregnancy(1
VTP). Three women died with a advanced HIV infection status.8 women take
triple therapy. In 22 deliveries, 20 mothers and children received AZT and 2 Nevirapine.4 elective caesarian section are done.18 infant take replacement feeding
and 4 are breastfeeded(81,2%).
Conclusion: Pluridisciplinary care(medical, biological, social, psychological) is

very important in the prevention of MTCT and contribute in optimizing the support
of the mother to be in spite of the socio-cultural barriers, the acceptance of the
replacement feeding is very high: 81,2% in an african area and the acceptance of
HIV test in around 83% in Le Dantec hospital.
Presenting author: Alassane Diouf, CHU H6pital Aristide Le Dantec, Dakar,
Senegal, Tel.: [phone], Fax: [phone], E-mail: [email protected]