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Archives of Disease in Childhood Jan 1989
Review
Topics: Acquired Immunodeficiency Syndrome; Breast Feeding; Cross Infection; Delivery, Obstetric; Female; Humans; Infant Care; Infant, Newborn; Occupational Diseases; Personnel, Hospital; Pregnancy; Pregnancy Complications, Infectious
PubMed: 2647042
DOI: 10.1136/adc.64.1_spec_no.4 -
Revista de NeurologiaAccording to different authors, between 30% and 70% of children with AIDS clinically present some degree of neurological involvement. When including studies on... (Review)
Review
INTRODUCTION
According to different authors, between 30% and 70% of children with AIDS clinically present some degree of neurological involvement. When including studies on pathology, the number increases to 96%.
DEVELOPMENT
We present the epidemiology of pediatric neuro-AIDS in Argentina and our experience in the follow-up of 784 HIV+ children infected by vertical transmission, of whom 311 developed neuro-AIDS. Of these children, 92% presented encephalopathy. In 29% of cases infection of the central nervous system was the hallmark of the disease followed by recurrent bacterial infection in 33%. The present series accounts for 25% of pediatric cases of HIV infection in the country.
CONCLUSIONS
In our experience, the most remarkable results of antiretroviral treatment compared with natural evolution were: a) Ad integrum remission or noteworthy improvement of progressive and non-progressive encephalopathy, b) Conversion of the most severe cases of progressive encephalopathy (severe developmental delay, acquired microcephaly, spastic quadriparesis and fatal progression) into a more moderate phenotype (less developmental delay, normal head growth, spastic paraparesis and chronic evolution of the disease), and c) Reversion of acquired microcephaly observed in the first years of the epidemic, on which little has been published in the literature.
Topics: AIDS Dementia Complex; Acquired Immunodeficiency Syndrome; Anti-HIV Agents; Argentina; Brain Diseases; Child; Disease Progression; HIV Seropositivity; HIV-1; History, 20th Century; Humans; Infectious Disease Transmission, Vertical
PubMed: 16775801
DOI: No ID Found -
Nutrition (Burbank, Los Angeles County,... Jun 2010To assess serum retinol and levels of carotenoids in children and adolescents with acquired immunodeficiency syndrome (AIDS) and to correlate low serum retinol and...
OBJECTIVE
To assess serum retinol and levels of carotenoids in children and adolescents with acquired immunodeficiency syndrome (AIDS) and to correlate low serum retinol and carotenoid levels with the presence of lipodystrophy, lipid profile changes, lipid peroxidation, and insulin resistance.
METHODS
A cross-sectional, controlled observational study was carried out with 30 children and adolescents with AIDS (mean age 9.1 y) receiving antiretroviral therapy (median length of treatment 28.4 mo), including 30 uninfected healthy controls matched for age and gender. Clinical and laboratory assessments were performed to determine nutritional status, presence of lipodystrophy, serum concentrations of retinol, beta-carotene, lycopene, lipid profile (high-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triacylglycerols), lipid peroxidation (thiobarbituric acid-reactive substances), glycemia, and serum insulin (homeostasis model assessment for insulin resistance, cutoff point >3). Statistical analysis was done with chi-square test and Student's t test.
RESULTS
Lipodystrophy was observed in 53.3% of patients with AIDS, and dyslipidemia was detected in 60% and 23% of subjects with human immunodeficiency virus and control subjects, respectively (P = 0.004). A higher prevalence of retinol deficiency (60% versus 26.7%, P = 0.009) and beta-carotene deficiency (23.3% versus 3.3%, P = 0.026) was found in the group with human immunodeficiency virus than in the control group. No correlation was found for low retinol and beta-carotene levels, changes in lipid and glucose metabolism, or lipodystrophy in children and adolescents with AIDS.
CONCLUSION
Despite the high frequency of dyslipidemia, lipodystrophy, and retinol and beta-carotene deficiencies, it was not possible to demonstrate a correlation of these findings with lipid peroxidation and insulin resistance. More studies are needed to investigate the causes of retinol and beta-carotene deficiencies in this population and the clinical consequences of these findings.
Topics: Acquired Immunodeficiency Syndrome; Adolescent; Anti-Retroviral Agents; Blood Glucose; Case-Control Studies; Child; Child, Preschool; Cross-Sectional Studies; Dyslipidemias; Female; HIV; HIV-Associated Lipodystrophy Syndrome; Humans; Insulin Resistance; Lipid Metabolism; Lipid Peroxidation; Male; Oxidative Stress; Prevalence; Vitamin A; Vitamin A Deficiency; beta Carotene
PubMed: 20116215
DOI: 10.1016/j.nut.2009.06.024 -
Journal of Acquired Immune Deficiency... Dec 2014"Option B+" is a World Health Organization-recommended approach to prevent mother-to-child HIV transmission whereby all HIV-positive pregnant and lactating women... (Review)
Review
BACKGROUND
"Option B+" is a World Health Organization-recommended approach to prevent mother-to-child HIV transmission whereby all HIV-positive pregnant and lactating women initiate lifelong antiretroviral therapy (ART). This review of early Option B+ implementation experience is intended to inform Ministries of Health and others involved in implementing Option B+.
METHODS
This implementation science study analyzed data from 11 African countries supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to describe early experience implementing Option B+. Data are from 4 sources: (1) national guidelines for prevention of mother-to-child HIV transmission and Option B+ implementation plans, (2) aggregated service delivery data between January 2013 and March 2014 from EGPAF-supported sites, (3) field visits to Option B+ implementation sites, and (4) relevant EGPAF research, quality improvement, and evaluation studies.
RESULTS
Rapid adoption of Option B+ led to large increases in percentage of HIV-positive pregnant women accessing ART in antenatal care. By the end of 2013, most programs reached at least 50% of HIV-positive women in antenatal care with ART, even in countries using a phased approach to implementation. Scaling up Option B+ through integrating ART in maternal and child health settings has required expansion of the workforce, and task shifting to allow nurse-led ART initiation has created staffing pressure on lower-level cadres for counseling and community follow-up. Complex data collection needs may be impairing data quality.
DISCUSSION
Early experiences with Option B+ implementation demonstrate promise. Continued program evaluation is needed, as is specific attention to counseling and support around initiation of lifetime ART in the context of pregnancy and lactation.
Topics: Acquired Immunodeficiency Syndrome; Africa; Anti-HIV Agents; Breast Feeding; Child; Child, Preschool; Female; Foundations; HIV Infections; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Pregnancy; Pregnancy Complications, Infectious; Program Evaluation; World Health Organization
PubMed: 25436817
DOI: 10.1097/QAI.0000000000000372 -
AIDS (London, England) Mar 2023To establish the incidence, risk factors and correlation with survival of thrombocytopenia and thrombocytosis (T/T) among children with HIV infection (CWH).
OBJECTIVES
To establish the incidence, risk factors and correlation with survival of thrombocytopenia and thrombocytosis (T/T) among children with HIV infection (CWH).
DESIGN
A retrospective nested case control study of patients 0-18 years in five Baylor International Pediatric AIDS Initiative (BIPAI) centers in sub-Sahara Africa, 2004-2014.
METHODS
Clinical and laboratory variables including complete blood counts (CBC) were extracted from the BIPAI electronic medical record system. Incident cases of T/T were identified and frequency-matched on follow-up time with controls with normal platelets. We calculated the prevalence and incidence density of T/T and used conditional logistic regression to evaluate their association with selected clinical variables. We constructed Kaplan-Meier curves and a Cox proportional hazards model to evaluate the impact of T/T on survival.
RESULTS
Two thousand, one hundred and nine children were sampled. The incidence density of thrombocytopenia was 1 per 57.9 (95% confidence interval [CI] 50.3-66.8) CWH-years. Thrombocytopenia was higher in children with WHO Stage III/IV, lower in children on zidovudine, and had no association with use of lamivudine or nevirapine, CD4 + suppression, age, and nutrition status. Thrombocytopenia was independently associated with 2.2-fold higher mortality (95% CI 1.62-3.08). The incidence density of thrombocytosis was 1 per 11.4 (95% CI 10.7-12.1) CWH-years. Thrombocytosis was associated with higher CD4 + cell count, younger age, and use of lamivudine or nevirapine, and did not impact survival.
CONCLUSIONS
Platelet count is a clinically valuable biomarker of HIV clinical progression and mortality. Laboratory studies are necessary to elucidate the mechanisms of T/T.
Topics: Humans; Child; HIV Infections; Nevirapine; Lamivudine; Retrospective Studies; Prognosis; Case-Control Studies; Platelet Count; Risk Factors; Acquired Immunodeficiency Syndrome; CD4 Lymphocyte Count; Thrombocytopenia; Thrombocytosis
PubMed: 36129118
DOI: 10.1097/QAD.0000000000003387 -
The Journal of Infectious Diseases Mar 2023Little is known about inflammation/immune activation during pregnancy in people with HIV (PWH) and growth in their children who are HIV-exposed and uninfected (CHEU).
BACKGROUND
Little is known about inflammation/immune activation during pregnancy in people with HIV (PWH) and growth in their children who are HIV-exposed and uninfected (CHEU).
METHODS
Using data from the Pediatric HIV/AIDS Cohort Study and an HIV-seronegative comparison group, we assessed associations of (1) HIV status, mode of HIV acquisition (perinatally vs nonperinatally acquired), and type of antiretroviral therapy (ART) with inflammation/immune activation in pregnancy; and (2) inflammation/immune activation in pregnancy with growth of CHEU at 12 months. Interleukin 6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), soluble(s) TNF-α receptor 1 and 2 (sTNFR1, sTNFR2), sCD14, and sCD163 were measured between 13 and 27 weeks' gestation. Linear regression models were fit to estimate differences between groups for each log-transformed biomarker, adjusted for confounders.
RESULTS
Pregnant PWH (188 total, 39 perinatally acquired, 149 nonperinatally acquired) and 76 HIV-seronegative persons were included. PWH had higher IL-6, sTNFR1, sCD14, and sCD163 and lower sTNFR2 compared to HIV-seronegative persons in adjusted models. Among PWH, sCD163 was higher in those with perinatally versus nonperinatally acquired HIV and on PI-based versus INSTI-based ART. Higher maternal concentrations of IL-6, sTNFR2, and hs-CRP were associated with poorer growth at 12 months.
CONCLUSIONS
Maternal HIV status is associated with a distinct profile of inflammation/immune activation during pregnancy, which may influence child growth.
Topics: Pregnancy; Female; Humans; Child; United States; C-Reactive Protein; Interleukin-6; Cohort Studies; Lipopolysaccharide Receptors; Inflammation; Biomarkers; HIV Infections; Acquired Immunodeficiency Syndrome
PubMed: 36592383
DOI: 10.1093/infdis/jiac501 -
International Journal of Environmental... Oct 2022From the early stage of the millennium development goals campaign, HIV/AIDS, tuberculosis and malaria have received huge aid funds. With the datasets published by the...
Association between Development Assistance for Health and Disease Burden: A Longitudinal Analysis on Official Development Assistance for HIV/AIDS, Tuberculosis, and Malaria in 2005-2017.
From the early stage of the millennium development goals campaign, HIV/AIDS, tuberculosis and malaria have received huge aid funds. With the datasets published by the Institute for Health Metrics and Evaluation, Organization for Economic Cooperation and Developments, and World Health Organization from 2005 to 2017, we analyzed the association between the total DAH or DAH per capita and the disease burden. We measured the total DAH or DAH per capita as the dependent variable, with six independent variables of disease burden for Disability Adjusted Life Year (DALY), number of infected people, number of deaths, prevalence, incidence, and mortality rate. For the trend in ODA targeting, the likelihood ratio test of the fixed effects models was used to assess any existence of slope changes in linear regression across the years. The total amount of DAH and DAH per capita was found positively related with every aspect of disease burden, with the regression coefficients increasing during 2005-2017. For instance, the slope of association between the DAH per capita and the disease burden of malaria became steeper over time (likelihood ratio, χ = 26.14, < 0.001). Although the selection criteria for the recipient country have been controversial, ODA targeting has been performed based on disease burden in this research.
Topics: Humans; Global Health; Acquired Immunodeficiency Syndrome; Tuberculosis; Cost of Illness; Malaria; Developing Countries
PubMed: 36360980
DOI: 10.3390/ijerph192114091 -
Sexually Transmitted Diseases Mar 2022Of new sexually transmitted infections (STIs) in the United States, 50% occur among youth aged 15 to 24 years. Previous studies among youth with HIV (YHIV) do not...
BACKGROUND
Of new sexually transmitted infections (STIs) in the United States, 50% occur among youth aged 15 to 24 years. Previous studies among youth with HIV (YHIV) do not distinguish STI trends among individuals with perinatally (YPHIV) and nonperinatally (YNPHIV) acquired HIV.
METHODS
Among 3 Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) studies conducted between 2009 and 2015, we estimated incident diagnoses of trichomonal, bacterial, viral, and overall STIs stratified by sex assigned at birth, mode of HIV acquisition (perinatal [YPHIV] and nonperinatal [YNPHIV]), age (13-17 and 18-24 years), CD4 count (<200, 200-499, and ≥500/μL), and HIV viral load (VL) (<400 and ≥400 copies/mL).
RESULTS
Among 3131 YHIV, across the 3 studies, mean (SD) age was 20.6 (2.6) years, 888 (28%) were female, 2498 (80%) had nonperinatal HIV acquisition recorded, and 2298 (73%) were African American/Black. Mean follow-up was 0.9 (0.3) years. Compared with YPHIV, YNPHIV spent less person-time with VL <400 copies/mL (47% vs. 53%) and more time off antiretroviral therapy (49% vs. 15%), and had higher overall STI rates (males, 65.9 vs. 8.5/100 person-years [PY]; females, 54.7 vs. 17.2/100 PY). Among YPHIV, bacterial STIs were higher during person-time spent with VL ≥400 vs. <400 copies/mL (male YPHIV, 10.9 vs. 0.6/100 PY; female YPHIV, 11.2 vs. 2.9/100 PY); no difference was observed among YNPHIV, which may be due to concurrent acquisition of HIV and other STIs and limited follow-up.
CONCLUSIONS
Compared with YPHIV, YNPHIV spent less time on antiretroviral therapy and virologically suppressed; YNPHIV also had higher STI diagnosis rates. Very high STI diagnosis rates among YHIV, including among those without virologic suppression, highlight the importance of youth-focused efforts to support durable virologic suppression and identify and treat STIs.
Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Black or African American; CD4 Lymphocyte Count; Female; HIV Infections; Humans; Infant, Newborn; Male; Sexually Transmitted Diseases; United States; Young Adult
PubMed: 34711773
DOI: 10.1097/OLQ.0000000000001578 -
Trends in Microbiology Mar 2014The contribution of fungal infections to the morbidity and mortality of HIV-infected individuals is largely unrecognized. A recent meeting highlighted several priorities...
The contribution of fungal infections to the morbidity and mortality of HIV-infected individuals is largely unrecognized. A recent meeting highlighted several priorities that need to be urgently addressed, including improved epidemiological surveillance, increased availability of existing diagnostics and drugs, more training in the field of medical mycology, and better funding for research and provision of treatment, particularly in developing countries.
Topics: AIDS-Related Opportunistic Infections; Acquired Immunodeficiency Syndrome; Antifungal Agents; Humans; Mycoses
PubMed: 24581941
DOI: 10.1016/j.tim.2013.12.008 -
Journal of Microbiology, Immunology,... Dec 2019Pneumocystis jiroveci pneumonia (PJP) is a severe and lethal opportunistic infection in the immunocompromised patients. As the increasing usage of immunosuppressants,... (Comparative Study)
Comparative Study
BACKGROUND
Pneumocystis jiroveci pneumonia (PJP) is a severe and lethal opportunistic infection in the immunocompromised patients. As the increasing usage of immunosuppressants, the incidence of non-HIV related PJP has increased in recent years. Still, there is little research regarding children with PJP. The aim of this study is to understand PJP more among pediatric population.
METHODS
We reviewed the medical records of the patients with PJP in National Taiwan University Hospital from 2014 to 2017. Diagnosis was made if the patient met all of the criteria: presence of relevant pulmonary symptoms and signs, pulmonary infiltrates on images, detection of Pneumocystis jiroveci from respiratory specimens via polymerase chain reaction (PCR), and received antibiotics for PJP.
RESULTS
Twenty children and 132 adults were enrolled in this study. The most common underlying diseases among children included malignancy (40%), post-transplantation (30%), and primary immunodeficiency (20%). The major underlying diseases in adults included malignancy (36%), HIV with acquired immunodeficiency syndrome (AIDS) (31%), and autoimmune diseases (24%). There is no significant difference in the clinical manifestations, mortality, and complication between children and adults, but children tended to have less chance of using alternative antibiotics, methylprednisolone and inhaled nitric oxide (NO). The chance of concomitant cytomegalovirus disease was also significantly lower in pediatric patients.
CONCLUSION
No significant difference was found in the clinical manifestations, mortality, and complication between children and adults, but children tended to have lesser chance of using alternative antibiotics, methylprednisolone and inhaled NO. The chance of associated cytomegalovirus (CMV) disease was also significantly lower in children.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bronchoalveolar Lavage Fluid; Child; Child, Preschool; Female; Humans; Immunocompromised Host; Infant; Male; Medical Records; Middle Aged; Pneumonia, Pneumocystis; Retrospective Studies; Sputum; Taiwan; Treatment Outcome; Young Adult
PubMed: 31164278
DOI: 10.1016/j.jmii.2019.05.003