144 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0370 Immunology
Torch Infection and Serological Testing in Women with Bad Obstetric History: Probably the Doubtful Associa- tion to Diagnose and Treat
Dhruba ACHARYA1, Bikash BOGATI2
Kathmandu University School of Medical Sciences, Nepal1, Dhulikhel Hospital, Nepal2
Background: The role of TORCH infections as a cause of bad obstetric outcomes is still debatable with confl icting Results: Even though, the demonstration of seroconver- sion in the patient sera in vitro is a highly established method to predict bad obstetric outcomes. However, it is our impression that the TORCH test has not been optimally used in hospital settings in Nepal.
Methods: This descriptive case control study was undertaken (January 2012 to De- cember, 2013) to discover the association of TORCH infections in women with bad obstetric history by serological testing. A serological evaluation was carried out to determine the presence of Toxoplasma gondii, Rubella, Cytomegalovirus (CMV) and Herpes Simplex Virus (HSV) specifi c immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies, using ELISA technique.
Results: Mean age of the study and control subjects were 27.8+/-5.4 and 25.3+/- 2.8 years, respectively where majority of the study subjects were of the age between 20 to 35 years. Most of the cases were of spontaneous abortions (81%) followed by IUGR (9%). Only 0.9% of both IgG and IgM seropositivity against TORCH agents were noted among the study subjects whereas highest IgG seropositivity was detected with Rubella (76.8%) followed by HSV-I (71.8%). An infection susceptibility rate of 75.9%
to Toxoplasma gondii, 9.2% to Rubella, 41.2% to CMV, 21.4% to HSV-I and 72.1% to HSV-II was noted.
Conclusions: Two possible results might be concluded from our study. First, acute infection of TORCH agents might not be the only possible etiology of bad obstetric outcome and secondly, serological TORCH screening may not be conclusive. This study, probably the fi rst of its kind from Nepal, suggests that TORCH test is questionable for its reliability.
PS 0371 Immunology
Pediatric HIV -1 in Kenya
Njeri Rahab MBUGUA1, Elizabeth Ann BUKUSI1 Kenya Medical Research Institute, Kenya1
Background: There is limited information regarding the pattern and correlates of viral replication in vertically HIV-1–infected children and its role on their outcomes in re- source-limited settings.
Methods: HIV-1–infected infants were followed from birth to 24 months. Serial HIV- 1 RNA levels were compared in infants infected in utero (<48 hours), peripartum (48 hours–1 month), and late postnatal (after 1 month). Cofactors for viral peak [highest viral load (VL) within 6 months of infection] and set point and mortality were deter- mined.
Results: Among 85 HIV-1–infected infants, 24 were infected in utero, 41 peripartum, 13 late postnatal; 7 had no 48-hour assay. HIV-1 VL set point was signifi cantly lower in infants infected >1 month vs. =1 month (5.59 vs. 6.24 log10 copies per milliliter, P = 0.01). Maternal VL correlated with peak infant VL (P < 0.001). Univariately, infant peak and set point VL and 6-month CD4% <15% predicted mortality; and 6-month CD4%
<15% remained independently predictive in multivariate analyses (hazard ratio = 4.85, 95% confi dence interval: 1.90 to 12.36).
Conclusions: Infants infected after the age of 1 month contained virus better than in- fants infected before 1 month of age. Maternal VL predicted infant VL, which, in turn was associated with early mortality
PS 0372 Immunology
HV-1-Specifi c Cytotoxic T Lymphocytes and Breast Milk HIV-1 Transmission
Njeri Rahab MBUGUA1, Asunta Wagura WAGURA2, Elizabeth Ann BUKUSI4 Kenya Medical Research Institute, Kenya1, Kenya Network of Women Living with HIV/AIDS, Kenya2, Kenyatta National Hospital, Kenya3, Nairobi University, Kenya4
Background: Breast-feeding by infants exposed to human immunodefi ciency virus type 1 (HIV-1) provides an opportunity to assess the role played by repeated HIV-1 ex- posure in eliciting HIV-1-specifi c immunity and in defi ning whether immune responses correlate with protection from infection.
Methods: Breast-feeding infants born to HIV-1-seropositive women were assessed for HLA-selected HIV-1 peptide-specifi c cytotoxic T lymphocyte interferon (IFN)-gamma responses by means of enzyme-linked immunospot (ELISpot) assays at 1, 3, 6, 9, and 12 months of age. Responses were deemed to be positive when they reached > or = 50 HIV-1-specifi c sfu/1 x 10(6) peripheral blood mononuclear cells (PBMCs) and were at least twice those of negative controls.
Results: A total of 807 ELISpot assays were performed for 217 infants who remained uninfected with HIV-1 at approximately 12 months of age; 101 infants (47%) had at least 1 positive ELISpot result (median, 78-170 sfu/1 x 10(6) PBMCs). The prevalence and magnitude of responses increased with age (P = .01 and P = .007, respectively);
the median log(10) value for HIV-1-specifi c IFN-gamma responses increased by 1.0 sfu/1 x 10(6) PBMCs/month (P<0.001) between 1 and 12 months of age. Of 141 HIV-1-uninfected infants with 1-month ELISpot results, 10 (7%) acquired HIV-1 infec- tion (0/16 with positive vs. 10/125 [8%] with negative ELISpot results; P = .6). Higher values for log(10) HIV-1-specifi c spot-forming units at 1 month of age were associ- ated with a decreased risk of HIV-1 infection, adjusted for maternal HIV-1 RNA level (adjusted hazard ratio, 0.09 [95% confi dence interval, 0.01-0.72]).
Conclusions: Breast-feeding HIV-1-exposed uninfected infants frequently had HIV-1-specific IFN-gamma responses. Greater early HIV-1-specific IFN-gamma re- sponses were associated with decreased HIV-1 acquisition.
PS 0373 Immunology
Acute HIV Infection among Kenyan Infants
Njeri Rahab MBUGUA1, Elizabeth Ann BUKUSI1 Kenya Medical Research Institute, Kenya1
Background: Clinical signs and symptoms of acute human immunodefi ciency virus (HIV) infection in infants are not well characterized.
Methods: Clinical signs and symptoms of acute human immunodefi ciency virus (HIV) infection in infants are not well characterized.
Results: There were 125 acute infection visits (among 56 infants) and 3491 noninfec- tion visits (among 306 infants). Acute HIV infection was associated with rash (odds ratio [OR], 1.8; 95% confi dence interval [CI], 1.1-2.8), failure to thrive (OR, 1.9; 95%
CI, 1.0-3.5), and lymphadenopathy (OR, 2.5; 95% CI, 1.4-4.8). Acute HIV infection was associated with lymphadenopathy (OR, 2.6; 95% CI, 1.3-5.0) in infants <2 months of age and with pneumonia (OR, 3.2; 95% CI, 1.1-9.3) and dehydration (OR, 6.0; 95% CI, 1.9-18.5) in infants >or=2 months of age. Infant peak viral load and mortality were not associated with symptoms of acute HIV infection. However, infants with symp- toms had higher viral levels later in the course of infection than did those without symptoms (P=.05).
Conclusions: Infants may manifest symptoms early during the course of HIV infec- tion, and symptoms of acute HIV infection may correlate with poor viral control. Rash, failure to thrive, lymphadenopathy, pneumonia, and dehydration may signify acute HIV infection in infants.
