Abstract Book Vol. 1 [International Conference on AIDS (16th: 2006: Toronto, Canada)]

Uoda

Results: Basal values of CD4 cells and viral load mean were, respectively, 539
+192 cells/mm3 and 3.8 + 1.5 log 10. N on Group A, and 505 + 297 cells/mm3
and 4.0 + 1.1 log 10 on Group B. A decrease higher than 25% on the absolute
number of CD4 cells was detected on 81% of Group A and on 57% of Group B
(p=0.02). A viral load increase equal or higher than 1 log10, was verified on
46% of Group A patients and on 21% of Group B patients (p=0.02). There was
a worsening in CDC category clinical and/or immunological during the follow-up
on 89% of Group A patients and on 50% of Group B (p=0,0001).
Conclusions: We observed that pregnancy has favored an increase of viral load
replication, depletion of CD4 population and aggravation of the clinical evolution
of HIV infection. These data suggest that immunological changes induced by
pregnancy may have a harmful effect on the HIV infection prognosis.
MOPE0289
Continued improvement in survival and life
expectancy among HIV-infected individuals
following initiation of triple and boosted
combination antiretroviral regimens
R. Hogg, R. Harrigan, E. Wood, B. Yip, J. Montaner, A. Levy. BC Centre for
Excellence in HIV/AIDS, Vancouver, Canada
Background: To characterize temporal changes in mortality and life expectancy
among HIV+ persons initiating antiretroviral (ARV) therapy in British Columbia,
Canada from 1993 to 2004.
Methods: Our analysis was restricted to ARV naive HIV+ persons aged 18
years or older who started ARV therapy between 01/1993 and 09/2004. The
primary endpoint was all cause mortality. We were interested in four time
periods: 1993-95, 1996-98, 1999-01, and 2002-04. Cox-proportional hazard
models were used to estimate the hazard of death with associated 95% CIs.
We adjusted for a number of salient prognostic variables at baseline including
CD4 cell count (100 cell decrement), AIDS diagnosis (yes vs no), age (per
10 year increment), and gender (male vs female). Abridged life tables were
constructed to compare age-specific mortality rates and life expectancies at
exact age 20 years..
Results: A total of 2238 persons were eligible. As of 09/30/2004, a total of
683 deaths were identified, yielding a crude mortality rate of 30.5%. Rates of
mortality declined from 60.4 % in 1993-95 to 7.7% in 2002-04 (p-value for
trend < 0. 001). Product limit estimates of the cumulative mortality rate at 12
months were 16.0% (+1.6%) in 1993-95, 9.6% (+1.1%) in 1996-1998, 9.2%
(~1.3%) in 1999-2001, 6.6% (+1.2%) in 2002-2004. Subjects in 2002-2004
were less likely to die than those who started therapy in 1993-1995 with a
mortality risk ratio of 0.29 (95% CI: 0.21 - 0.41; p <0.001). Life expectancy
at exact age 20 years has increased from 12.3 years in 1993-95 to 30.8 years
in 2002-04. The probability of surviving from exact age 20 to 45 years has also
increased 11 fold from 4% in 1993-95 to 47% in 2002-04.
Conclusions: Our results demonstrate a significant decrease in mortality and
increase in life expectancy over the 12-year study period.
MOPEO290
Children born to HIV-1-infected women in Sweden
in 1982-2003. Trends in epidemiology and vertical
transmission
L. Navbr', S. Lindgren2, E. Belfrage3, K. Gyllensten4, K. Lidman4,
M. Gisslens, M. Arneborn6, A. Ehrnst', A.-B. Bohlin'. 'Karolinska Institutet,
Karolinska University Hospital Huddinge, Department for Clinical Science,
Intervention and Technology, Division of Pediatrics, Stockholm, Sweden,
2Karolinska Institutet, Karolinska University Hospital Huddinge, Department
for Clinical Science, Intervention and Technology, Division of Obstetrics
and Gynaecology, Stockholm, Sweden, 3Karolinska Institutet, Karolinska
University Hospital Solna, Department of Women and Child Health,
Stockholm, Sweden, 4Karolinska Institutet, Karolinska University Hospital
Solna, Department of Medicine, Unit for Infectious Diseases, Stockholm,
Sweden, sSahlgrenska University Hospital/East, Department of Infectious
Diseases, Gbteborg, Sweden, 'Swedish Institute for Infectious Disease
Control, Stockholm, Sweden, 'Karolinska Institutet, Karolinska University
Hospital Huddinge, Department of Laboratory Medicine, Division of Clinical
Virology, Stockholm, Sweden
Background: Great advances have been made during the last ten years in the
prevention of mother-to-child transmission (MTCT) of HIV-1 and the treatment
of pediatric HIV-1 infection, mainly in resource-rich countries. The aim of the
study was to describe the HIV-1 epidemic among child-bearing women and
their children in Sweden.
Methods: A population-based analysis of data on all known mother-child pairs
in Sweden with perinatal exposure to HIV-1 1982-2003.
Results: We identified a total of 421 mother-child pairs and in 357 of these
cases the child was followed prospectively from birth. The MTCT rate in children
prospectively followed from birth decreased from 24.7 % in 1985-93 to 5.7 %
in 1994-98 and 0.6 % in 1999-2003. The use of antiretroviral treatment of
the mother during pregnancy and/or prophylactic antiretroviral intervention

increased from 2.3 % to 91.6 % during the same period, and the elective
caesarean section rate increased from 8.0 % to 80.3 %. No MTCT of HIV1 occurred in Sweden after 1999. Fifty-one vertically HIV-1-infected children
aged 2.7-17.6 years were living in Sweden by December 31 2003, 71 % being
treated with antiretroviral agents. No HIV-1-related child death has been
reported in Sweden after 1996.
Conclusions: MTCT of HIV-1 can be almost eliminated when appropriate
resources are available. A national pregnancy screening program for HIV
1 running since 1987 with a high acceptance rate and implementation of
measures to prevent MTCT since 1994 have resulted in a significant decrease
in the number of infected children. Since knowledge of the infection status
of the mother is crucial for reduction of MTCT of HIV-1, continued antenatal
screening is important even in a low prevalence country as Sweden. With more
effective treatment strategies and increased immigration an increasing number
of HIV-1-infected children become young adults and psychosocial support and
educational activities are of increasing importance in this group.
MOPEO291
Relationship between frailty and CD4+ T cell count
in HIV-1 infection
L. Desquilbet', J.B. Margolick2, L.P. Frieda, J.P. Phair4, B.D. Jamieson5,
M. Holloway', L.P. Jacobson'. 'Johns Hopkins School of Public Health,
Epidemiology, Baltimore, Maryland, United States, 2Johns Hopkins School of
Public Health, Molecular Microbiology and Immunology, Baltimore, Maryland,
United States, 3Johns Hopkins School of Medicine, Geriatric Medicine and
Gerontology, Baltimore, Maryland, United States, 4Northwestern University,
Howard Brown Health Center and Department of Medicine, Chicago, Illinois,
United States, sDavid Geffen School of Medicine, UCLA, Medicine, Los Angeles,
California, United States, 6University of Pittsburgh, Infectious Diseases and
Microbiology, Pittsburgh, Pennsylvania, United States
Background: Immunological similarities between older HIV-negative adults
and HIV-infected individuals have been reported. In the general population,
frailty represents a late stage of the aging process. We investigated the
prevalence of a frailty-related phenotype (FRP) in HIV-infected men with
progressive immune deterioration.
Methods: Based on a published five-criterion definition of frailty in HIVnegative older adults, FRP was defined among 1,977 HIV-negative men in
the Multicenter AIDS Cohort Study (MACS) using four of these criteria. The
prevalence of the FRP thus defined was then determined at each 6-month
follow-up visit in 1,046 HIV- infected MACS participants followed between 1994
and 2005. Repeated measurement logistic regression models for the presence
of FRP included: CD4+ T cell count, age, ethnicity, educational level, and study
period categorized ("1994-1995', "1996-1999" and "2000-2005") to reflect
differing available therapies at the population level.
Results: Among HIV-infected men, the overall prevalence of FRP was 7.6%
before 1996 and 4.8% thereafter. FRP was more frequent after AIDS (15.1%)
than before (2.8%). Among AIDS-free person-visits, and after adjustment for
age, ethnicity and educational level, estimated prevalences of FRP remained
low for CD4+ T cell count > 350 cells/mm3 and exponentially increased with
decreasing CD4+ T cell counts.

12
10 -
8 -
C4 -2 -0,

FP prevalence (%)

- - 1994-1995
S 19962000-20041999
S2000-.2004

25 175 325 475 625 775

925

D4+Tcell count (/mm3)
[FRP and CD4 T cell count]
For"2000-2005" era, estimates of FRP prevalence were: 1.9% (95% confidence
interval, 1.3-2.7) for CD4=500 cells/mm3, 3.9% (2.6-5.9) for CD4=200, and
6.5% (4.1-10.1) for CD4=100. Although FRP prevalence was higher in personvisits following AIDS, its evolution according to CD4+ T cell count remained.
FRP prevalences by CD4+ T cell count were invariant to calendar era.
Conclusions: CD4+ T cell count predicted the risk of frailty among HIVinfected men, even in the HAART era and in the absence of clinical AIDS.
MOPE0292
Survival of HIV-positive injection drug users in the
era of HAART relative to gender-and-age specific
survival of HIV-negative users
K. Langohr', R. Mugaa', A. Sanvisens', J. Tor', J. Santesmases', I. Serra',
C. Rey-Joly', A. Munoz2. 1Hospital Universitari Germans Trias i Pujol, Internal
Medicine, Badalona, Spain, 2The Johns Hopkins School of Public Health,
Baltimore, United States
Background: The introduction of HAART has dramatically prolonged the AIDS
incubation periods and survival times of HIV-infected persons, but it remains
unclear whether HIV+ injection drug users (IDUs) have nowadays similar
survival as HIV- IDUs. The goal of this study was to compare survival times
of IDUs from 1987 through 2003, and to describe recent trends of survival in
the era of HAART.

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * ABSTRACT BOOK VOLUME 1