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

XIV International AIDS Conference

Abstracts WePeB5958-WePeB5960 69

WePeB5957 Effects of substance abuse on vertical
transmission
P.E. Vink, J. Farley, P. Nair, S. Hines, R. Flinko. University of Maryland Baltimore,
Baltimore, MD, United States
Background The objective of the NIDA project AIDS Risk in Pregnant IDUs and
their Children was to study substance abuse as a determinant in vertical transmission.
Methods HIV+ women (n=191) obtaining prenatal care or delivering at the Univ
of Maryland were prospectively enrolled from 1987 to 1996. They were stratified into Past P (n=32), None N (n=75), & Current C (n=84) substance users
(cocaine, heroin, and methadone) thru repeated history, physical, & lab exams.
Infant HIV status was determined by >2 HIV co-cultures & serology thru >18
months. Mother viral loads (VL) were performed on repository specimens using
NASBA.
Results Vertical transmission rates were 13% for P, 16% for N, & 29% for C. P
& N were not different from each other with p=0.62. P & N were significantly different from C with p=0.02, RR=1.9, CI=1.1-3.4. VL was available on 29P, 74N,
& 70C. Mean mother VL (log10) were not different between P, N, & C. VL<400
copies (ND) were present in 9(31%)P, 12(16%)N, & 19(27%)C. AZT was offered
to all women 1994-1996 as 3P with 1ND, 15N with 5ND, & 16C with 6ND. Each
AZT ND occurred in nontransmitting mothers.

Transmission
SR % HIV+ %

Mother Mean VL
SR range HIV+ range

P 28 88 4 13 P 3.64 2.6-5.32 4.10 3.18-4.79
N 63 84 12 16 N 3.82 2.6-5.76 4.09 2.6-5.87
C 60 71 24 29 C 3.49 2.6-5.26 3.90 2.6-5.66
15 40 3.67 2.6-5.76 3.98 2.6-5.87
Conclusions There was no difference in vertical transmission between N & P
users. Pregnant women using cocaine, heroin, or methadone vertically transmit
nearly twice as often. Substance use in pregnancy is a determinant of vertical
transmission. Programs to assist C users of childbearing age to end substance
use would likely decrease vertical transmission & be cost effective. Substance
use did not effect mother VL. A trend toward lower VL was seen in nontransmitters, due to their AZT use with ND seen in 12(34%) of them. Programs to enhance
antiretroviral adherence in C users should further decrease vertical transmission.
Presenting author: peter vink, university of maryland baltimore, 314 mstf, 685
west baltimore street, baltimore, maryland, United States, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
WePeB5958 The care of infants included in the Senegalese
program of prevention of mother to child
transmission of HIV
H. Sy, A.M. Diack, N.R. Diagne, A. Diouf, L. Diaw, N.C. Toure, I. Ndir, A. Gaye,
N. Mbaye, M. Goumbala, M. Gueye, S. Ka, Y. Dieme, P. Dionne, N.M. Sail,
S. Mboup, I. Ndoye. CHU Pedriatric Hospital Albert Royer, Senegal
The care of infants included in the Senegalese program of prevention of mother
to child transmission of HIV.
Background: The pediatric care of the HIV infected infants started in 2000 inside of the Senegalese Initiative for access to ARVs triple therapy.There is 3 sites
of pediatric HIV care: Pediatric hospital Albert Royer, Hopital Principal de Dakar,
Centre de sante Roi Baudouin.
Methods: Inside ten PMTCT program, AZT is proposed to the pregnant woman
at 36 weeks, to the new born during 6 days (2mg per kilo every 6 hours)and exclusive bottle feeding is recommended for the infant.3 HIV1 PCR were done at
6 days, 1month and 3 months; an infant is infected or non infected if 2 of the 3
PCR are positive or negative. If the woman is HIV2, the diagnostic of infection will
depended on the serology at 15 months.
Results: After 18 months of PMTCT program, 51 infants were borned. 5 died
around the first week after the birth: 3 premature babies, 1 hemorragic syndrom
and 1 respiratory distress. 21 infant were borned from HIV1 mother and are negative for HIV, 2 were positive and 11 are waiting for there virological status. 2 infants
were infected: one of the woman have her serology knowed at the delivery and
doesn't have AZT but she accepts to bottle feed her new born; the other woman
went to another hospital for delivery and doesn't accept the bottle milk.12 infants
from HIV2 mother are waiting 15 month of age for their serology.
Conclusion: The PMTCT program allowed 51 newborned to have access to care.
However, these results cannot allow us to make conclusions about the level of
transmission of HIV from mother to child. More results will be necessary
Presenting author: Haby Sy, CHU Pedriatric Hospital Albert Royer, Senegal,
E-maik [email protected]
WePeB5959 Use of zidovudine postpartum to the newborn and
HIV vertical transmission
A.G.P. Dos Santos, M.V. Arnoni, E.N. Berezin, F.J. Almeida, M.A.P. Safadi. Santa
Casa de Sao Paulo Hospital, S&o Paulo - SR Brazil
Background: Identification of pregnant HIV women is quite important because as
earlier in pregnancy treatment is started, as better. We attend a very poor population in Sao Paulo, Brazil, and many pregnant women do not go though pre natal

care or are not offer to be tested during the pregnancy We describe the incidence
of HIV infection diagnostic after delivery and the role of postpartum zidovudine in
preventing HIV vertical transmission on scenario.
Methods: From March 1998 to June 2001 all women that are admitted to labor
room and their newborns were counseling and offered to be tested to HIV by Elisa
serology and, if positive, by Western-Blott. In all exposed children a viral load was
done at 3-7 th day, 1 month, 4 month and 8 month age. Diagnosis of infected or
reverted was done with any two detectable viral loads or two undetectable viral
load, one after one month and another after four months of age. Zidovudine were
introduce to the newborn as soon as we serology result was positive.
Results: We found that 40% of pregnant women that deliveried in our hospital
were never tested to HIV. The incidence of HIV in this women was 2,3%. From the
132 tests done, 3 were elisa false-positive. The other 129 newborns were sended
to clinic follow-up but only 82 were followed at least until 6 months of age. The
mean time that AZT was iniciated was 42 hours of life. No newborn was breastfeed and the majority of the labor were normal. We had aldo two perinatal death
(both positives children with intra utero transmission. Four children had positive
viral load at the first 15 days of life. The vertical transmission rate was 34%.
Conclusions: The transmission rate was very high, probably because the Zidovudine was introduced later to the child. Only the zidovudine started as late as
48-72 hours postpartum can reduce transmission. Improving the quality and cover
of pre natal care and using rapid test probably have better impact in reducing HIV
perinatal transmission.
Presenting author: Ana Gabriela Dos Santos, Av Washington Luis, 1527 apto
13 B, CEP 04662-002, Sho Paulo - SP, Brazil, Tel.: [phone], Fax: +55
11 552125 00, E-mail: [email protected]
WePeB5960 Prevention of vertical hiv transmission in the
Bahamas, 1995-1999
M.RP. Gomez1, S.E. Read2, P. McNeil1, M. Jervis1, R.M. Bain3, C. Major4.
Princess Margaret Hospital, Toronto, ON, Canada; 2The Hospital for Sick
Children/University of Toronto, Toronto, Canada; 3Department of Public Health,
Nassau, Bahamas; 4Ontario Public Health Laboratory, Toronto, Canada
Background: A program to reduce transmission of HIV from mothers to babies
using zidovudine (ZDV) was introduced in the Bahamas in 1995. The protocol followed was similar to that of ACTG 076. The purpose of this study is to describe
the uptake of the program and the outcome in prevention of transmission.
Methods: All women attending antenatal Community Health Clinics in the Bahamas were counselled and tested for HIV, with consent. ZDV was offered to
HIV+ women. Babies were followed with serial DNA PCRs (Ontario Public Health
Laboratory) to determine infection status.
Results: The prevalence of HIV in pregnant women screened in this program
between 1995 and 1999 has varied between 3.8 and 3.0 percent. ZDV use has
ranged from 20% of positive women in 1995, to 51% in 1997 and 46% in 1999.
The transmission rate to babies of ZDV treated women over the 5 year period was
9.3%. Overall, including babies of treated and untreated women, the transmission
rates were 11% in 1995, rose to 20% in 1997 and then dropped to 5% in 1998
and 1999.
Conclusions: There has been an overall reduction in mother to child transmission of HIV in the Bahamas. Problems with implementation and ongoing functioning of this program have included: 1) initially, availability of ZDV, 2) identification
of infected women in a timely fashion, 3) infrastructure to support the program, 4)
language barriers for Haitian women, and 5) adherence. The infrastructure has
recently been substantially improved and the Ministry of Health is now supplying
triple therapy for all HIV+ pregnant women.
Presenting author: stanley read, 555 university ave, toronto, ontario, canada,
Canada, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB5961I Experience on antiretroviral therapy during
pregnancy: results from a large multicenter study
I. Solls1, J.T. Ramos1, C. Fortuny2, J. Almeda3, I. Bates4, J. Beceiro5,
J.M. Bertran6, J. Casabona3,. Del Barrio7,. Ferrando1, C. Garaulet8,
L. Garcia6, M.T. Garcia Fructuoso3, AlI. Gbnzalez Espinola9, M.D. Gurbindo1~,
J.M. Hernandez Garcia1, E. Iglesias7, J.S. Jimenez1, MlI. de Jose4, D. L6pez
Gay11, P. Miralles1~, M.A. Muhoz1~, M.C. Muhoz2, E. Muhoz Gdlligo1, A. Mur12,
M.L. Navarro1~, S. o. Pea4, Pulido1, F Regidor9, M.A. Roa13,
C. Rodrigo14, B. Rubio7, R. Rubio1, J. Ruiz Contreras1, S. Salas4,
N.A. Salcedo15, E. S~nchez6, M.J. Santos15, P Segovia1o. tHospital Doce de
Octubre, Unidad de Inmunodeficiencias, Departamento de Pedriatria, Madrid,
Spain; 2Hospital Sant Joan de Ddu, Esplugues de Llobregat, Spain; 3 CEESCAT
Hospital Universitai Germans Trias i Pujol, Badalona, Spain; 4 Hospital La Paz,
Madrid, Spain; 5Hospital Prfncipe de Asturias, Alcald de Henares, Spain;
6Hospital U. Materno-Infantil Vail d'Hebrdn, Barcelona, Spain; 7Hospital de
Getafe, Getafe, Spain; 8Hospital de M6stoles, Madrid, Spain; 9Hospital
Fundacidn de Alcorcdn, Alcorcdn, Spain; '~Hospital Gregorio Marah6n, Madrid,

Spain; 1Consejeria Sanidad CAM, Madrid, Spain; 12Hospital del Mar,
Barcelona, Spain; 13Hospital de Mdstoles, Mdstoles, Spain; 14Hospital
Universitari Germans Trias i Pujol, Badalona, Spain; ' Hospital Severo Ochoa,
Legands, Spain; 16Agencia dAvaluacid de Tecnologia Mddica, DSSS,
Generalitat de Catalunya, Barcelona, Spain
Background: Epidemiology in HIV-1 infected women is changing, largely due to