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VERTICAL TRANSMISSION OF HIV INFECTION IN TWINS Tatjana Kolupajeva, Ludmila Guseva, Valentina Sitkare, Diana Dusacka, Inga Januskevica, Natalija Repuscenko, Jelena Storozenko, Baiba Rozentale Riga East University Hospital Latvian Center of infectious Diseases Introduction According to WHO data risk of vertical transmission of HIV infection from mother to child without any intervention is 20-40 %, but in the era of ART this risk can be reduced to 2-8 %. Latvia the first case of HIV transmission was registered in 1998. On January the 1st, 2014, number of HIV infected children aged 1m. - 16y.o. was 59. Advanced HIV disease in mother associated with likelihood of transmission to infant. Data that twins born first are at higher risk of HIV infection suggest many infants remain uninfected until time of delivery. As additional factors of risk transmission are considered mode of delivery, mother’s age, smoking, intravenous drug using (IVD). Aim To analyze the cases of twins born to HIV-1 infected mothers enrolled in care in Latvian Center of Infectious disease (2007 -2013). Material and Methods We investigated 9 twin pairs, who were born in 2007-2013 (in 2007- 1, 2010-1, 2012-2, 2013-5). Through Caesarean section delivered 7 twins, vaginally – 2, sex identical were 6 pairs (boys- 2, girls – 4). For diagnoses of HIV infection in infants ELISA kits for the detection and confirmation of HIVp24 core Ag (Innotest) and rt-RT PCR kit (Cobas AmpliPrep/TaqMan HIV-1 system, Roche) for HIV RNA detection (detection limit 20 cop/ml) and quantification were used. CD4 + cell count were detected by flow cytometry. Third generation MEIA assay (ABBOTT) was used for the demonstration of anti-HIV seroreversion in uninfected infants. Results The first twin pair was presented to hospital in 2007, then 1 and 2 in 2010 and 2012 accordingly. Significant increasing of twins (5) born to HIV-1 infected mothers was observed in 2013. Prematurity (31-37 weeks) of deliveries observed in 89 % (8/9) and maternal age >30 (56 % - 5/9) were regarded as a risk factors. Mother’s viral load was from undetectable (2/9 – 22%) to 105 cop/ml (1/9 – 11% ), more often ( 6/9 - 67% ) from 102 ( min- 5.9 102) to 10 4 ( max7.7 104) , CD4+ - from 174 to 816 cells /mm3., only in 1 (11 % ) > 700, as an additional risk factor in 3( 3/9 – 33% ) < 500 cells/mm3 (174- 396). Five HIV-1 infected mothers received antiretroviral therapy (2 – from 14 weeks of pregnancy, others – from 23, 25 and 30 week), four didn’t. At time of first visit (as a rule at age 5 - 9 weeks, 1 twin – at 10 month ) all 18 infants have negative HIV-1 Ag and 16/18 (89 %) undetectable level of HIV viral load. Two first born children from different twins have detectable HIV-1 viral load - 7.2 x102(Caesarean section) and 1.2x105 cop/ml (vaginally delivery), one was born to mother who didn’t receive antiretroviral therapy, the other – to mother who began ART at week 25 of gestation. The rest infants hadn’t detectable HIV RNA and HIV antibody in age 1424 m. or till now are on follow up with no detectable HIV RNA and seroreversion trend in levels of HIV antibodies. Conclusion Number of twin deliveries from HIV-1 infected mothers increased in Latvia, like in other industrial countries. Recently vertical HIV transmission is proved in 2/18 infants from twin pairs, both first born. One mother didn’t receive antiretroviral therapy, the second did from the week 25. Most twin’s mothers have one or more vertical transmission risk factors (age, born prematurity, viral load, CD4+ count). Mother Cases Birth year Age Delivery Viral load cop/ml Children CD4+ cells/mm3 ART IVD Weight g. 1st 37 w. 1 2007 23 C. section 6.3E5 - - no data 2nd 1st 33/34 w. 2 2010 31 C. section 5.9E2 610 - 2nd 1st 2012 32 C. section 37 w. 4 2012 32 C. section 5.6E3 816 - 1st 688 14w. 1st 5 2013 34 3.9E4 396 25w. 2nd 6 2013 28 C. section 1st under detection limit 267 14w. 2013 39 C. section 2nd 1st 7.7E4 174 30w. 2013 26 2nd 1st C. section 7.3E2 519 23w. 2013 25 2nd 1st C. section 1.8E3 687 - 2460 not neg. detected 2560 not neg. detected 1700 1.2E5 1632 not detected neg. 2200 not neg. detected 2250 not neg. detected 1840 not neg. detected 2220 not neg. detected 2700 not neg. detected 2590 not neg. detected 3400 not detected neg. 2440 not detected neg. neg. no data 37 w. 9 1720 not neg. detected yes 38 w. 8 1660 not neg. detected yes 34 w. 7 1850 not neg. detected yes Spont. 37 w. 1820 not neg. detected no 2nd 31 w. neg. yes 2nd under detection limit 7.1E2 not no data detected neg. yes 32/33 w. 3 2410 Viral load HIV Ag cop/ml yes 2nd Literatura 1. Scavalli CP, Mandelbrot L, Berrebi A, Batallan A, Cravello L, Pannier E, Hamrene K, Ciraru-Vigneron N, Faye A, Warszawski J; ANRS EPF. Twin pregnancy as a risk factor for mother-to-child transmission of HIV-1: trends over 20 years. AIDS. 2007 May 11;21(8):993-1002. 2. Michael Carter Twin pregnancies involve greater risk of mother-to-child HIV transmission unless potent anti-HIV drugs used. http://www.aidsmap.com/Twin-pregnancies-involve-greater-risk-of-mother-to-child-HIV-transmission-unless-potent-anti-HIV-drugsused/page/1427215/