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HIV/AIDS (Auckland, N.Z.) 2018Successful management of pediatric and adult human immunodeficiency virus (HIV) disease includes lifelong administration of antiretroviral therapy (ART). The need for... (Review)
Review
INTRODUCTION
Successful management of pediatric and adult human immunodeficiency virus (HIV) disease includes lifelong administration of antiretroviral therapy (ART). The need for the continuous use of antiretroviral drugs throughout the life course poses a challenge to children, adolescents, and adults living with HIV and their caregivers. Historically, treatment interruptions have been viewed as a negative therapeutic strategy. Recently, however, treatment interruptions or treatment reduction strategies have become a focus of investigations as innovative approaches to the long-term management of HIV disease. Current challenges with treatment interruptions include identifying an appropriate timeframe for length of interruptions and identifying HIV patient populations in whom the treatment interruption can be successful.
OBJECTIVE
In this review, we aimed at summarizing recent studies of planned and unplanned treatment interruptions in children and adults living with HIV.
MATERIALS AND METHODS
We searched two databases (PubMed and Cochrane Controlled Trials Register) using keywords (HIV OR AIDS OR acquired immunodeficiency syndrome OR HIV-1 OR antiretroviral) AND (treatment interruption OR planned interruption OR therapeutic interruption OR unplanned interruption), for published randomized and nonrandomized clinical trials and observational cohort studies in children and adults (from birth to 99 years of age) in global settings covering a period from 2012 to 2018. In this review, only the studies that contained pediatric and adolescent populations with baseline immunological, virological, and clinical characteristics and outcomes after treatment interruption were included.
RESULTS
A total of 174 eligible citations from the two databases were identified. We identified 10 prospective treatment interruption studies on children (five studies) and adults (five studies) during 2012-2018 with a total of 863 pediatric and 273 adult subjects. Collectively, recent studies on children and adults with HIV infection suggest that treatment interruptions with proper monitoring can be successful by instituting well-defined immunological and virological parameters or thresholds such as CD4 count, CD4%, and HIV RNA viral load that identify low-risk populations with treatment failure. In addition to standard virological and immunological outcome measurements, selected biomarkers that help detect early immune activation may also be useful in the monitoring of treatment interruption.
CONCLUSION
Treatment interruptions in adult and especially pediatric patients with well-controlled HIV disease may provide an alternative opportunity to optimize long-term HIV management by minimizing drug-associated toxicity and improving long-term adherence and quality of life.
PubMed: 29942160
DOI: 10.2147/HIV.S141965 -
Journal of Preventive Medicine and... Sep 2020HIV/AIDS remains a major public health concern globally and Health Care Workers (HCWs) are in the frontline of preventing and providing care in the health care system....
BACKGROUND
HIV/AIDS remains a major public health concern globally and Health Care Workers (HCWs) are in the frontline of preventing and providing care in the health care system. The aim of this study was to evaluate HIV/AIDS knowledge among Iranian HCWs.
METHODOLOGY
This cross-sectional study was conducted among 200 HCWs who were randomly selected from health care centers in Kermanshah city, west of Iran, 2018. HCWs filled out a self-administered questionnaire including the socio-demographic characteristics and HIV/AIDS knowledge items. Data were analyzed by SPSS version 16 using bivariate correlations, t-test, and ANOVA statistical tests.
RESULTS
The mean score of HIV/AIDS knowledge was 29.73 [95% CI: 28.79, 30.67], ranged from 0 to 40 (74.3% of total percent). There was no significant association and correlation between HIV/AIDS knowledge and sex, education level, marital status, age and job history. Up to 50% had inadequate knowledge about HIV/AIDS status and transmission in Iran.
CONCLUSIONS
HCWs HIV/AIDS knowledge was average and it seems need to be educating regarding HIV/AIDS status and transmission in Iran.
Topics: Acquired Immunodeficiency Syndrome; Adult; Cross-Sectional Studies; Female; HIV Infections; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Iran; Male; Middle Aged; Surveys and Questionnaires; Young Adult
PubMed: 33150227
DOI: 10.15167/2421-4248/jpmh2020.61.3.1474 -
AIDS and Behavior Oct 2014Adherence to antiretroviral therapy (ART) is critical for reducing HIV/AIDS morbidity and mortality. Food insecurity (FI) is emerging as an important barrier to... (Review)
Review
Adherence to antiretroviral therapy (ART) is critical for reducing HIV/AIDS morbidity and mortality. Food insecurity (FI) is emerging as an important barrier to adherence to care and treatment recommendations for people living with HIV (PLHIV), but this relationship has not been comprehensively examined. Therefore, we reviewed the literature to explore how FI may impact ART adherence, retention in medical care, and adherence to health care recommendations among PLHIV. We found data to support FI as a critical barrier to adherence to ART and to other health care recommendations among HIV-infected adults, HIV-infected pregnant women and their HIV-exposed infants, and child and adolescent populations of PLHIV. Associations between FI and ART non-adherence were seen in qualitative and quantitative studies. We identified a number of mechanisms to explain how food insecurity and ART non-adherence may be causally linked, including the exacerbation of hunger or ART side effects in the absence of adequate food and competing resource demands. Interventions that address FI may improve adherence to care and treatment recommendations for PLHIV.
Topics: Adolescent; Adult; Anti-Retroviral Agents; Female; Food Supply; HIV Infections; Humans; Hunger; Male; Medication Adherence; Pediatrics; Population Surveillance; Pregnancy
PubMed: 23842717
DOI: 10.1007/s10461-013-0547-4 -
The Pediatric Infectious Disease Journal Sep 2020Few attempts have been made to monitor progress toward HIV diagnosis and antiretroviral treatment (ART) coverage targets in children, and the impact that ART and...
BACKGROUND
Few attempts have been made to monitor progress toward HIV diagnosis and antiretroviral treatment (ART) coverage targets in children, and the impact that ART and prevention of mother-to-child transmission (PMTCT) programs have had on pediatric HIV incidence and mortality.
METHODS
A multiparameter evidence synthesis approach was adopted to integrate South African pediatric HIV data sources. A previously developed model of HIV in South Africa was calibrated to household survey HIV prevalence data, routine antibody testing data, data on numbers and ages of children on ART, vital registration data and data on HIV diagnosis at death. The impact of ART and PMTCT was estimated by comparing validated model outputs against model predictions of the trends that would have been expected in the absence of ART and PMTCT.
RESULTS
By mid-2018, the model estimated that 75.2% (95% CI: 73.9%-76.8%) of HIV-positive children were diagnosed, substantially lower than the corresponding estimates in HIV-positive adults (91.0%). ART coverage in children in 2018 (51.2%, 95% CI: 49.4%-52.7%) was also lower than that in adults (62.0%). In 2017-2018, the numbers of new cases of mother-to-child transmission and pediatric AIDS deaths were reduced by 84% and 94%, respectively, relative to what would have been expected in the absence of interventions, but reductions in mortality were driven largely by PMTCT.
CONCLUSIONS
Although levels of AIDS mortality in children have declined dramatically in South Africa, this has mostly been due to successful PMTCT programs, and progress toward the 90-90-90 targets appears relatively poor when compared with that in adults.
Topics: Acquired Immunodeficiency Syndrome; Adolescent; Child; Child, Preschool; Humans; Incidence; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Models, Theoretical; Mortality; Prevalence; South Africa
PubMed: 32433224
DOI: 10.1097/INF.0000000000002680 -
The American Journal of Tropical... Oct 2021
Topics: Acquired Immunodeficiency Syndrome; Africa South of the Sahara; COVID-19; Disability-Adjusted Life Years; Global Health; Health Resources; Humans; Malaria; Mass Drug Administration; Neglected Diseases; Organizations; Public Health; SARS-CoV-2; Tuberculosis
PubMed: 34695793
DOI: 10.4269/ajtmh.21-1026 -
AIDS Patient Care and STDs Dec 2013The past two decades have witnessed dramatic reductions in HIV-related morbidity and mortality following the introduction of combination antiretroviral therapy (cART)... (Review)
Review
The past two decades have witnessed dramatic reductions in HIV-related morbidity and mortality following the introduction of combination antiretroviral therapy (cART) for infants and children. Improved therapeutic outcomes have changed the face of the HIV epidemic and with it the needs of patients and families. Consequently, many perinatally- and behaviorally-infected adolescents are now transitioning to adult care. What follows is a brief review and commentary concerning original research, reviews, and clinical guidelines describing challenges and best practices in facilitating care transitions for HIV-infected youth to adult care. Over 25,000 HIV-infected US youth aged 13-24 years will require transition to adult care within the next decade. Transition planning must address issues of cognitive development and mental health, medication adherence, sexuality, reproductive, and gender identity, socioeconomic and health insurance status, stigma and disclosure, disrupted relationships with pediatric care providers, and communication. Clinical experience with HIV and other chronic illnesses supports a multidisciplinary, developmentally-sensitive approach to meeting the challenges inherent in care transition that begins early and is monitored with regular evaluation and revision. Specific clinical recommendations have been made by the U.S. Department of Health and Human Services and the New York State Department of Health AIDS Institute.
Topics: Adolescent; Delivery of Health Care; Female; HIV Infections; Humans; Insurance, Health; Male; Medication Adherence; Patient Care Planning; Pediatrics; Social Stigma; Transition to Adult Care; United States; Young Adult
PubMed: 24073595
DOI: 10.1089/apc.2013.0253 -
Pediatric Clinics of North America Feb 1991Lymphocytic interstitial pneumonia is at present a pathologic diagnosis. In the setting of a chronic interstitial pneumonia in a child with lymphocytosis,... (Review)
Review
Lymphocytic interstitial pneumonia is at present a pathologic diagnosis. In the setting of a chronic interstitial pneumonia in a child with lymphocytosis, hyperglobulinemia, and lymphadenopathy or parotid enlargement, the diagnosis is often clinically presumed. At present the diagnosis can be established firmly only by lung biopsy. Models of pathogenesis include nonspecific stimulation of the immune system, HIV-specific stimulation, or synergy between EBV and HIV. Treatment includes oxygen and bronchodilators as needed. The role of zidovudine and of steroids in the management of LIP remains to be determined.
Topics: Acquired Immunodeficiency Syndrome; Child; Child, Preschool; Humans; Infant; Lymphocytes; Opportunistic Infections; Pulmonary Fibrosis
PubMed: 1987520
DOI: 10.1016/s0031-3955(16)38044-0 -
Emergency Medicine Clinics of North... May 2018Visits for pediatric minor blunt head trauma continue to increase. Variability exists in clinician evaluation and management of this generally low-risk population.... (Review)
Review
Visits for pediatric minor blunt head trauma continue to increase. Variability exists in clinician evaluation and management of this generally low-risk population. Clinical decision rules identify very low-risk children who can forgo neuroimaging. Observation before imaging decreases neuroimaging rates. Outcome data can be used to risk stratify children into more discrete categories. Decision aids improves knowledge and accuracy of risk perception and facilitates identification of caregiver preferences, allowing for shared decision making. For children in whom imaging is performed and is normal or shows isolated linear skull fractures, deterioration and neurosurgical intervention are rare and hospital admission can be avoided.
Topics: Adolescent; Child; Child, Preschool; Craniocerebral Trauma; Decision Support Techniques; Glasgow Coma Scale; Humans; Pediatric Emergency Medicine; Risk Assessment; Risk Factors
PubMed: 29622323
DOI: 10.1016/j.emc.2017.12.015 -
Emerging Infectious Diseases Oct 2004Pneumocystis pneumonia (PCP) has historically been one of the leading causes of disease among persons with AIDS. The introduction of highly active antiretroviral therapy... (Review)
Review
Pneumocystis pneumonia (PCP) has historically been one of the leading causes of disease among persons with AIDS. The introduction of highly active antiretroviral therapy in industrialized nations has brought about dramatic declines in the incidence of AIDS-associated complications, including PCP. In the adult population, the incidence of PCP has significantly decreased, but it remains among the most common AIDS-defining infections. Similar declines have been documented in the pediatric population. In much of the developing world, PCP remains a significant health problem, although its incidence among adults in sub-Saharan Africa has been debated. This review discusses the epidemiology of PCP during the current era of the AIDS epidemic. Although fewer cases of PCP occur in industrialized countries, increasing drug-resistant HIV infections, possible drug-resistant PCP, and the tremendous number of AIDS cases in developing countries make this disease of continued public health importance.
Topics: AIDS-Related Opportunistic Infections; Acquired Immunodeficiency Syndrome; Adult; Africa; Antiretroviral Therapy, Highly Active; Child; Developed Countries; Developing Countries; Global Health; HIV; Humans; Incidence; Pneumocystis carinii; Pneumonia, Pneumocystis; Risk Factors
PubMed: 15504255
DOI: 10.3201/eid1010.030985 -
JAMA Pediatrics Dec 2021The US National Institutes of Health (NIH) is the largest government funding source for biomedical research globally. Burden of disease is one of the factors considered...
IMPORTANCE
The US National Institutes of Health (NIH) is the largest government funding source for biomedical research globally. Burden of disease is one of the factors considered by the NIH in making funding allocations, though it is not known how funding patterns are associated with disease burden for pediatric conditions.
OBJECTIVE
To determine the correlation between NIH funding and disease burden across pediatric conditions.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study evaluates NIH grants funding pediatric research from 2015 to 2018 in the US. Pediatric grants were classified according to disease categories studied. Disease burden for each category was determined using measures from the Institute of Health Metrics and Evaluation and hospitalization data from the 2016 Kids' Inpatient Database.
MAIN OUTCOME AND MEASURE
Correlation between NIH funding and pediatric disease burden using Spearman rank order coefficients and predicted amounts of disease-specific funding based on disease burden estimated from linear regression models.
RESULTS
This study analyzed 14 060 disease-specific pediatric grants awarded by the NIH from 2015 to 2018 in the US. Annual funding for disease categories ranged from $0 to $382 849 631. Funding for pediatric research was correlated with pediatric disability-adjusted life-years (DALYs), deaths, years lived with disability, and years of life lost (r, 0.56-0.63; P < 0.001 for all measures). There was also a correlation between funding and hospital-based metrics, including hospital days, number of hospital admissions, and hospital charges (r, 0.67-0.69; P < .001 for all measures). Eight disease categories received greater than $500 million more than predicted levels relative to DALYs, while 5 disease categories were funded more than $50 million less than predicted levels. Based on predicted levels of funding, congenital birth defects; endocrine, metabolic, blood, and immune disorders; and HIV/AIDS were the most overfunded categories relative to DALYs and hospital days. Conditions identified as most underfunded differed depending on use of DALYs or hospital days in estimating predicted funding levels.
CONCLUSIONS AND RELEVANCE
NIH funding for pediatric research was correlated with pediatric disease burden in the US with variable correlation based on the disease metric applied. There was substantial overfunding and underfunding of certain conditions. Ongoing evaluation of pediatric funding patterns using a complementary set of disease measures may help inform and prioritize pediatric research funding.
Topics: Adolescent; Cost of Illness; Cross-Sectional Studies; Female; Financial Support; Humans; Male; National Institutes of Health (U.S.); Pediatrics; Research; United States
PubMed: 34515752
DOI: 10.1001/jamapediatrics.2021.3360