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AIDS Care 2012The number of children losing one or both parents to HIV/AIDS has continued to rise in the past decade, with most of them being school-aged children. This study reviews... (Review)
Review
The number of children losing one or both parents to HIV/AIDS has continued to rise in the past decade, with most of them being school-aged children. This study reviews global literature on the effects of HIV/AIDS (e.g., parental HIV-related illness or death) on children's schooling. Systematic review procedures generated 23 studies for examination. Existing studies show educational disadvantages among children affected by AIDS in various educational outcomes, including school enrollment and attendance, school behavior and performance, school completion, and educational attainment. A number of individual and contextual factors potentially moderate or mediate the effect of HIV/AIDS on children's education. These factors include gender of child, pattern of parental loss (maternal vs. paternal vs. dual), living arrangement (relationship with caregivers, gender of the household head), and household poverty. Current literature indicates limitations in number and scope of existing studies and in educational outcome measurements. There is a lack of studies with longitudinal design and data collection from multiple sources (e.g., students, teachers, caregivers), and a lack of studies on the relationship between psychosocial well-being of children affected by AIDS and their educational outcomes. Future studies need to employ more rigorous methodology and incorporate both individual and contextual factors for children affected by AIDS in various regions. More efforts are needed to design and implement culturally appropriate and context-specific approaches to improve the educational outcomes of children affected by AIDS.
Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adolescent Development; Adult; Child; Child Development; Education; Educational Status; Female; HIV Infections; Humans; Male; Parents; Risk Factors; Young Adult
PubMed: 22519300
DOI: 10.1080/09540121.2012.668170 -
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 -
Clinical Trials (London, England) Aug 2020We describe enrollment and accrual challenges in the "Promoting Maternal and Infant Survival Everywhere" (PROMISE) trial conducted in resource-limited countries, as well...
Enrollment and transition challenges in the International Maternal Pediatric and Adolescent AIDS Clinical Trials (IMPAACT) network's PROMISE trial for resource-limited regions.
BACKGROUND
We describe enrollment and accrual challenges in the "Promoting Maternal and Infant Survival Everywhere" (PROMISE) trial conducted in resource-limited countries, as well as the challenges in transitioning participants from the antepartum to the postpartum components of the study.
METHODS
PROMISE was a large multi-national randomized controlled trial of the safety and efficacy of interventions to reduce perinatal transmission of HIV-1 (HIV) during pregnancy and breastfeeding and of interventions to preserve maternal health after cessation of perinatal transmission risk. The PROMISE study included two protocols for HIV-infected pregnant women in resource-limited countries who intended to either breastfeed or formula-feed their infants and did not meet country criteria for antiretroviral treatment. The PROMISE breastfeeding protocol (1077BF) used a sequential randomization design with up to three randomizations (Antepartum, Postpartum, and Maternal Health). The PROMISE formula-feeding protocol (1077FF) had two randomizations (Antepartum and Maternal Health). Women presenting to the clinic during early or active labor or in the immediate postpartum period were registered as Late Presenters and screened to determine whether eligible to participate in the Postpartum randomization.
RESULTS
The study was conducted at 14 sites in seven countries and opened to enrollment in April 2011. A total of 3259 pregnant women intending to breastfeed and an additional 284 pregnant women intending to formula feed were randomized in the Antepartum component. A total of 204 Late Presenters were registered during labor or after delivery. Enrollment was high among breastfeeding women (representing 96% of the target of 3400 women) but was lower than expected among women intending to formula feed (28% of 1000 expected) and late-presenting women (8% of 2500 expected). The successful overall enrollment and final primary study analyses results were attributed to substantial preparation before the study opened, collaboration among all stakeholders, close study monitoring during implementation and the flexibility to change and streamline the protocol.
CONCLUSIONS
Experiences from the PROMISE study illustrate the challenges of enrolling in longer term studies in the setting of rapidly evolving prevention and treatment standards priorities. The lessons learned will help the community, site investigators, and study coordinators in the design and implementation of future clinical trials.
Topics: Acquired Immunodeficiency Syndrome; Adolescent; Anti-HIV Agents; Anti-Retroviral Agents; Breast Feeding; Child; Female; HIV Infections; Health Resources; Humans; Infant; Infant Formula; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Mothers; Patient Selection; Pregnancy; Pregnancy Complications, Infectious; Randomized Controlled Trials as Topic; Research Design
PubMed: 32191142
DOI: 10.1177/1740774520912428 -
Technology in Cancer Research &... 2024Studies on the prognosis and risk stratification of patients with acquired immune deficiency syndrome (AIDS) - related Burkitt lymphoma (AR-BL) are rare. We aim to...
Studies on the prognosis and risk stratification of patients with acquired immune deficiency syndrome (AIDS) - related Burkitt lymphoma (AR-BL) are rare. We aim to construct a novel model to improve the risk assessment of these patients. We retrospectively analyzed the clinical data of 34 patients over the past 10 years and the factors associated with progression-free survival (PFS) and overall survival (OS) were evaluated in univariate and multivariate Cox models. Then, the novel model consisting of screened factors was compared with the existing models. With a 37-month median follow-up, the overall 2-year PFS and OS rates were 40.50% and 36.18%, respectively. The OS of patients who received chemotherapy was better compared with those without chemotherapy (.0012). Treatment with an etoposide, prednisone, oncovin, cyclophosphamide, and hydroxydaunorubicin-based regimen was associated with longer OS and PFS compared with a cyclophosphamide, doxorubicin, vincristine, and prednisone-based regimen (OS, .0002; PFS, .0158). Chemotherapy (hazard ratio [] = 0.075; 95% confidence interval [CI], 0.009-0.614) and Eastern Cooperative Oncology Group Performance Status (ECOG PS) 2 to 4 (4.738; 95% CI, 1.178-19.061) were independent prognostic factors of OS in multivariate analysis and we established a novel prognostic risk stratification model named GZ8H model with chemotherapy and ECOG PS. GZ8H showed better stratification ability than the international prognostic index (IPI) or Burkitt lymphoma IPI (BL-IPI). Furthermore, the C-index of the nomogram used to predict OS was 0.884 in the entire cohort and the calibration curve showed excellent agreement between the predicted and actual results of OS. No human immunodeficiency virus-related factors were found to be associated with OS and PFS of AR-BL patients in our study. Overall, the clinical characteristics and outcomes in AR-BL were shown and prognostic factors for OS and PFS were identified in this study.
Topics: Humans; Burkitt Lymphoma; Retrospective Studies; Acquired Immunodeficiency Syndrome; Lymphoma, Large B-Cell, Diffuse; Prednisone; Disease-Free Survival; Prognosis; Cyclophosphamide; Vincristine; Doxorubicin; Antineoplastic Combined Chemotherapy Protocols
PubMed: 38179657
DOI: 10.1177/15330338231214236 -
Journal of Acquired Immune Deficiency... Dec 2022An increasing number of women living with perinatally acquired HIV are reaching adulthood and becoming pregnant. Achieving viral suppression is challenging in this...
BACKGROUND
An increasing number of women living with perinatally acquired HIV are reaching adulthood and becoming pregnant. Achieving viral suppression is challenging in this population frequently exposed to numerous antiretroviral regimens. This study describes the long-term outcomes of pregnant women living with perinatally acquired HIV in Spain.
METHODS
Descriptive, retrospective, multicenter study of the women living with perinatally acquired HIV who gave birth between January 2000 and December 2019 in Madrid. Epidemiological, clinical, and HIV-related data were collected from the first delivery to the end of the study period, including antiretroviral therapy, prevention strategies, and outcomes.
RESULTS
Sixty-three live births in 33 women were included. The mean number of pregnancies per women was 1.9 (range: 1-6). At first delivery, women's median age was 20 years (interquartile range: 18-23), 11 (33.3%) had been previously diagnosed with AIDS and 6 (18%) with mental health disorders. Forty percent became pregnant unsuppressed, whereas 81% achieved viral suppression at delivery. Treatment interruptions were common after delivery, as were losses to follow-up, with no positive effect of pregnancy on retention to care or the immune virological situation. Five women (15%) experienced a new AIDS event, and there were 2 deaths (6%) during follow-up. There was 1 case of mother-to-child transmission in a nonadherent woman in whom preventive measures could not be implemented.
CONCLUSIONS
Pregnancy in this unique population of women living with perinatally acquired HIV poses particular challenges. Specific strategies, including a multidisciplinary approach, are needed to minimize perinatal transmission risks and improve outcomes during the postpartum period.
Topics: Female; Pregnancy; Humans; Adult; Young Adult; Infectious Disease Transmission, Vertical; Pregnancy Outcome; Anti-HIV Agents; Pregnancy Complications, Infectious; HIV Infections; Retrospective Studies; Spain; Acquired Immunodeficiency Syndrome
PubMed: 36215978
DOI: 10.1097/QAI.0000000000003070 -
Current HIV/AIDS Reports Aug 2020Perinatal HIV-1 infection is associated with an increased risk for neurologic impairments. With limited access to clinical specimens, animal models could advance our... (Review)
Review
PURPOSE OF REVIEW
Perinatal HIV-1 infection is associated with an increased risk for neurologic impairments. With limited access to clinical specimens, animal models could advance our understanding of pediatric central nervous system (CNS) disease and viral persistence. Here, we summarize current findings on HIV-1 CNS infection from nonhuman primate (NHP) models and discuss their implications for improving pediatric clinical outcomes.
RECENT FINDINGS
SIV/SHIV can be found in the CNS of infant macaques within 48 h of challenge. Recent studies show an impermeable BBB during SIV infection, suggesting neuroinvasion in post-partum infection is likely not wholly attributed to barrier dysfunction. Histopathological findings reveal dramatic reductions in hippocampal neuronal populations and myelination in infected infant macaques, providing a link for cognitive impairments seen in pediatric cases. Evidence from humans and NHPs support the CNS as a functional latent reservoir, harbored in myeloid cells that may require unique eradication strategies. Studies in NHP models are uncovering early events, causes, and therapeutic targets of CNS disease as well as highlighting the importance of age-specific studies that capture the distinct features of pediatric HIV-1 infection.
Topics: Animals; Anti-HIV Agents; Blood-Brain Barrier; Brain; CD4-Positive T-Lymphocytes; Cerebrospinal Fluid; Child; Cognitive Dysfunction; Disease Models, Animal; Encephalitis; HIV Infections; HIV Seropositivity; HIV-1; Humans; Infectious Disease Transmission, Vertical; Macaca; Myeloid Cells; Simian Acquired Immunodeficiency Syndrome; Simian Immunodeficiency Virus
PubMed: 32388691
DOI: 10.1007/s11904-020-00503-4 -
JAMA Apr 2023
Topics: Female; Humans; Pregnancy; Acquired Immunodeficiency Syndrome; Anti-HIV Agents; Anti-Retroviral Agents; HIV Infections; Infectious Disease Transmission, Vertical; Pregnancy Complications, Infectious
PubMed: 37010862
DOI: 10.1001/jama.2023.5076 -
Clinics in Chest Medicine Dec 1996Because children acquire HIV infection differently than adults, this article begins with a discussion of the epidemiology of AIDS in children. This is followed by a... (Review)
Review
Because children acquire HIV infection differently than adults, this article begins with a discussion of the epidemiology of AIDS in children. This is followed by a discussion of factors related to progression of the disease and survival in pediatric AIDS. A discussion of the pulmonary manifestations in children is followed by a suggested approach to the HIV-infected child with respiratory symptoms.
Topics: AIDS-Related Opportunistic Infections; Acquired Immunodeficiency Syndrome; Child; Child, Preschool; HIV Infections; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Lung Diseases
PubMed: 9016379
DOI: 10.1016/s0272-5231(05)70347-6 -
Clinical Pharmacology and Therapeutics Dec 2008Adolescents infected with human immunodeficiency virus (HIV) represent a heterogeneous group of pubertal children and young adults. Antiretroviral therapy (ART) in... (Review)
Review
Adolescents infected with human immunodeficiency virus (HIV) represent a heterogeneous group of pubertal children and young adults. Antiretroviral therapy (ART) in adolescents is complex and depends on multiple factors. The continued use of higher (weight- or surface-based) pediatric doses can result in potentially toxic drug exposure, whereas early introduction of lower adult doses can lead to the development of drug resistance and virologic failure. The physiological and psychosocial changes during puberty create strong grounds for an individualized therapeutic approach in HIV-infected adolescents.
Topics: Acquired Immunodeficiency Syndrome; Adolescent; Age Factors; Anti-HIV Agents; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Global Health; HIV Infections; HIV Seropositivity; Humans; Male; Maximum Tolerated Dose; Needs Assessment; Patient Care Planning; Practice Guidelines as Topic; Prognosis; Reverse Transcriptase Inhibitors; Risk Assessment; Severity of Illness Index; Treatment Outcome; World Health Organization
PubMed: 18830226
DOI: 10.1038/clpt.2008.187 -
Science (New York, N.Y.) Mar 2012Many species of African nonhuman primates are naturally infected with simian immunodeficiency viruses (SIVs) in the wild and in captivity. In contrast to HIV-infected... (Review)
Review
Many species of African nonhuman primates are naturally infected with simian immunodeficiency viruses (SIVs) in the wild and in captivity. In contrast to HIV-infected humans, these natural SIV hosts typically do not develop AIDS, despite chronic infection with a highly replicating virus. In this Review, we discuss the most recent advances on the mechanisms of protection from disease progression in natural SIV hosts, with emphasis on how they differ from pathogenic HIV/SIV infections of humans and rhesus macaques. These mechanisms include: (i) resolution of immune activation after acute infection, (ii) restricted pattern of target cell infection, and (iii) protection from mother-to-infant transmission. We highlight the areas that should be pursued in future studies, focusing on potential applications for the treatment and prevention of HIV infection.
Topics: Adaptive Immunity; Animals; CD4-Positive T-Lymphocytes; Cercocebus atys; Chlorocebus aethiops; Disease Progression; Female; HIV Infections; Host-Pathogen Interactions; Humans; Immunity, Innate; Infectious Disease Transmission, Vertical; Simian Acquired Immunodeficiency Syndrome; Simian Immunodeficiency Virus; T-Lymphocyte Subsets
PubMed: 22403383
DOI: 10.1126/science.1217550