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The Keio Journal of Medicine Dec 1996Acquired Immunodeficiency Syndrome (AIDS) was first described to occur in children in 1983. With experience of increasing number of cases of AIDS, pathologic lesions in... (Review)
Review
OVERVIEW
Acquired Immunodeficiency Syndrome (AIDS) was first described to occur in children in 1983. With experience of increasing number of cases of AIDS, pathologic lesions in various organs and tissues such as lungs, brain, G.I. tract, heart, blood vessels, lymph nodes, spleen, bone marrow, etc. became evident in autopsy and biopsy specimens. These pathologic lesions were classified into four groups based on known or suspected pathogenesis: 1) Primary lesions due to Human Immunodeficiency (HIV) infection itself (lymph nodes, brain, etc) 2) associated lesions related to direct or indirect sequelae of HIV infection (Opportunistic infections, PLH/LIP complex, etc) 3) lesions of undetermined pathogenesis, (cardiomyopathy, arteriopathy, thrombocytopenia, nephropathy, etc) 4) lesions of multifactorial pathogenesis (villous atrophy of intestine, thymic lesions, etc).
UPDATE
In recent years the emphasis of pathologic study is on the reactive and neoplastic proliferative disorders. These disorders include nodal and extranodal lymphoproliferative lesions (such as myoepithelial sialadenitis, malignant lymphomas, etc), smooth muscle tumors (SMTs), Kaposi's sarcoma, Human Papilloma virus associated genital lesions and miscellaneous tumors. In a recent study, it has been shown that Epstein-Barr virus (EBV) may be related to the pathogenesis of SMTs. The most recently recognized lymphoproliferative lesions include those of mucosa associated lymphoid tissue (MALT) of salivary glands, lungs and tonsils. The MALT lymphomas in children with AIDS are responsive to therapy and tend to take an indolent clinical course. Therefore recognition of MALT lymphomas as a distinctive lesion in pediatric AIDS is of practical importance. In this view of increasing incidence of HIV and HPV infections in adolescent females seen in certain countries attention should also be focused on early detection of HPV related genital lesions so that their possible progression to intraepithelial and invasive cervical carcinoma can be prevented.
Topics: Acquired Immunodeficiency Syndrome; Arteries; Child; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Lung; Lymphoid Tissue; Lymphoproliferative Disorders; Maternal-Fetal Exchange; Neoplasms; Pregnancy; Thymus Gland
PubMed: 9023448
DOI: 10.2302/kjm.45.306 -
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 -
AIDS (London, England) Jun 2015With the scale-up of effective antiretroviral therapy in resource-limited settings, many HIV-infected children are now able to survive into adulthood. To achieve this...
With the scale-up of effective antiretroviral therapy in resource-limited settings, many HIV-infected children are now able to survive into adulthood. To achieve this potential, children must navigate normative developmental processes and challenges while living with an unusually complex, stigmatizing, potentially fatal chronic illness and meeting the demands of treatment.Yet many of these children, especially preadolescents, do not know they are HIV-infected. Despite compelling evidence supporting the merits of informing children of their HIV status, there has been little emphasis on equipping the child's caregiver with information and skills to promote disclosure, particularly, when the caregiver faces a variety of sociocultural barriers and is reluctant to do so. In this study, we present the background, process and methods for a first of its kind collaboration that is examining the efficacy of an intervention developed to facilitate the engagement of caregivers in the process of disclosure in a manner suitable to the sociocultural context and developmental age and needs of the child in Ghana. We also report preliminary data that supported the design of the intervention approach and currently available domains of the data system. Finally, we discuss challenges and implications for future research.
Topics: Adolescent; Adult; Caregivers; Child; Cooperative Behavior; Female; Ghana; HIV Infections; Humans; Male; Pediatrics; Truth Disclosure
PubMed: 26049537
DOI: 10.1097/QAD.0000000000000725 -
BMC Health Services Research Jan 2017Although domestic HIV/AIDS financing is increasing, international HIV/AIDS financing has plateaued. Providing incentives for the health system (i.e. performance-based... (Review)
Review
BACKGROUND
Although domestic HIV/AIDS financing is increasing, international HIV/AIDS financing has plateaued. Providing incentives for the health system (i.e. performance-based financing [PBF]) may help countries achieve more with available resources. We systematically reviewed effects of PBF on HIV/AIDS service delivery to inform WHO guidelines.
METHODS
PubMed, WHO Index Medicus, conference databases, and clinical trial registries were searched in April 2015 for randomised trials, comparative contemporaneous studies, or time-series studies. Studies evaluating PBF in people with HIV were included when they reported service quality, access, or cost. Meta-analyses were not possible due to limited data. This study is registered with PROSPERO, number CRD42015023207.
RESULTS
Four studies, published from 2009 to 2015 and including 173,262 people, met the eligibility criteria. All studies were from Sub-Saharan Africa. PBF did not improve individual testing coverage (relative risk [RR], 1.00, 95% confidence interval [CI] 0.89 to 1.13), improved couples testing coverage (RR 1.11, 95% CI 1.02 to 1.20), and improved pregnant women testing coverage (RR 1.29, 95% CI 1.28-1.30). PBF improved coverage of antiretrovirals in pregnant women (RR 1.55, 95% CI 1.50 to 1.59), infants (RR 1.92, 95% CI 1.84 to 2.01), and adults (RR 1.74, 1.64 to 1.85). PBF reduced attrition (RR 0.84, 95% CI 0.74 to 0.96) and treatment failure (odds ratio 0.55, 95% CI 0.32 to 0.97). Potential harms were not reported.
CONCLUSIONS
Although the limited data suggests PBF positively affected HIV service access and quality, critical health system and governance knowledge gaps remain. More research is needed to inform national policymaking.
Topics: Acquired Immunodeficiency Syndrome; Adult; Africa South of the Sahara; Anti-HIV Agents; Communicable Disease Control; Delivery of Health Care; Female; Financing, Organized; HIV Infections; Health Services Accessibility; Humans; Pregnancy; Randomized Controlled Trials as Topic; Reimbursement, Incentive; Universal Health Insurance
PubMed: 28052771
DOI: 10.1186/s12913-016-1962-9 -
Current HIV/AIDS Reports Dec 2012Food insecurity, micronutrient deficits, dyslipidemia, insulin resistance, obesity, cardiovascular disease, and bone disorders complicate the treatment of HIV infection.... (Review)
Review
Food insecurity, micronutrient deficits, dyslipidemia, insulin resistance, obesity, cardiovascular disease, and bone disorders complicate the treatment of HIV infection. Nutrition and exercise interventions can be effective in ameliorating these symptoms that are associated with HIV and antiretroviral therapy (ART). In this literature review, we examine the most recent nutrition and exercise interventions for HIV-infected patients. Macronutrient supplementation can be useful in treating malnutrition and wasting. Multivitamin (vitamin B complex, vitamin C, and vitamin E) supplements and vitamin D may improve quality of life and decrease morbidity and mortality. Nutritional counseling and exercise interventions are effective for treating obesity, fat redistribution, and metabolic abnormalities. Physical activity interventions improve body composition, strength, and fitness in HIV-infected individuals. Taken collectively, the evidence suggests that a proactive approach to nutrition and physical activity guidance and interventions can improve outcomes and help abrogate the adverse metabolic, cardiovascular, and psychological consequences of HIV and its treatments.
Topics: Acquired Immunodeficiency Syndrome; Bone Density; Chronic Disease; Dietary Supplements; Disease Progression; Dyslipidemias; Exercise; Female; HIV Seropositivity; Humans; Insulin Resistance; Male; Malnutrition; Nutritional Status; Obesity; Quality of Life; Vitamins
PubMed: 22933247
DOI: 10.1007/s11904-012-0135-7 -
BMC Pediatrics May 2019Children and adolescents with HIV/AIDS are more likely to have emotional and behavioral problems than the general population. This can result in a continuing negative...
Emotional and behavioral problems and associated factors among children and adolescents on highly active anti-retroviral therapy in public hospitals of West Gojjam zone, Amhara regional state of Ethiopia, 2018: a cross-sectional study.
BACKGROUND
Children and adolescents with HIV/AIDS are more likely to have emotional and behavioral problems than the general population. This can result in a continuing negative influence on the quality of life, school performance, immunity and co-morbidity of children and adolescents with HIV/AIDS.
OBJECTIVE
To assess the prevalence and associated factors of Emotional and Behavioral Problems among children and adolescents on Highly Active Anti-Retroviral Therapy in the public hospitals of West Gojjam Zone, Amhara regional state of Ethiopia.
METHODS
An institutional based cross sectional study was conducted by screening 411 children and adolescents for emotional and behavioral problems using Pediatric Symptomatology Check List (PSCL). Systematic random sampling technique was used to select the study participants. Data analysis was done using SPSS version 23. Bivariable and multivariable logistic regression analysis were fitted to identify factors associated with Emotional and Behavioral Problems. Odds ratio (OR) with 95% confidence interval (CI) was computed to determine the level of significance.
RESULT
Out of the total 411 participants, 43.6% were screened positive for Emotional and Behavioral Problems. Lower age (AOR = 5.33, 95%CI: 2.56-11.04), having non-kin care giver (AOR = 4.64, 95%CI: 1.20-17.90), parental loss (AOR = 2.15, 95%CI: 1.03-4.49), non self -disclosure of HIV sero status (AOR = 1.99, 95% CI: 1.16-3.41) and having distressed care giver (AOR = 1.64, 95%CI: 1.04-2.57) had statistically significant association with EBPs.
CONCLUSION
The prevalence of Emotional and Behavioral Problems is high among children and adolescents on HAART. Lower age, care giver's mental distress, non-self disclosure status, having non-kin care giver and parental loss were variables significantly associated with EBPs. This demonstrates a need for the integration of Mental Health and Psycho Social Support (MHPSS) service with HIV/AIDS care.
Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adolescent Behavior; Age Distribution; Antiretroviral Therapy, Highly Active; Child; Child Behavior; Cross-Sectional Studies; Developing Countries; Ethiopia; Female; HIV Infections; Hospitals, Public; Humans; Male; Mood Disorders; Problem Behavior; Quality of Life; Risk Assessment; Sex Distribution; Socioeconomic Factors
PubMed: 31053112
DOI: 10.1186/s12887-019-1453-3 -
American Journal of Public Health Apr 1988To assess the degree of house officers' concerns about acquiring AIDS (acquired immunodeficiency syndrome) from their patients, we surveyed 263 medical and pediatric...
To assess the degree of house officers' concerns about acquiring AIDS (acquired immunodeficiency syndrome) from their patients, we surveyed 263 medical and pediatric interns and residents in four housestaff training programs affiliated with seven New York City hospitals with large AIDS patient populations; 258 questionnaires (98 per cent) were returned. Thirty-six per cent of medical and 17 per cent of pediatric house officers reported percutaneous exposures to needles contaminated with blood of AIDS patients. Forty-eight per cent of medical and 30 per cent of pediatric house officers reported a moderate to major concern about acquiring AIDS from their patients. Greater concern about personal risk was noted in those house officers who were earlier in their residency training, who reported having treated a greater number of AIDS patients, and who were in medicine rather than pediatrics programs. Twenty-five per cent of all respondents reported that they would not continue to care for AIDS patients if given a choice. The results demonstrate a substantial degree of concern about acquiring AIDS among house officers caring for AIDS patients and suggest the need for housestaff program administrators for formally address these concerns.
Topics: Acquired Immunodeficiency Syndrome; Adult; Attitude of Health Personnel; Female; HIV Seropositivity; Humans; Internship and Residency; Male; Mandatory Programs; Moral Obligations; New York City; Occupational Diseases; Pediatrics
PubMed: 3348474
DOI: 10.2105/ajph.78.4.455 -
Journal of Immunological Methods Jul 2014This Special Issue of the Journal of Immunological Methods includes 16 manuscripts describing quality assurance activities related to virologic and immunologic...
This Special Issue of the Journal of Immunological Methods includes 16 manuscripts describing quality assurance activities related to virologic and immunologic monitoring of six global laboratory resource programs that support international HIV/AIDS clinical trial studies: Collaboration for AIDS Vaccine Discovery (CAVD); Center for HIV/AIDS Vaccine Immunology (CHAVI); External Quality Assurance Program Oversight Laboratory (EQAPOL); HIV Vaccine Trial Network (HVTN); International AIDS Vaccine Initiative (IAVI); and Immunology Quality Assessment (IQA). The reports from these programs address the many components required to develop comprehensive quality control activities and subsequent quality assurance programs for immune monitoring in global clinical trials including: all aspects of processing, storing, and quality assessment of PBMC preparations used ubiquitously in HIV clinical trials, the development and optimization of assays for CD8 HIV responses and HIV neutralization, a comprehensive global HIV virus repository, and reports on the development and execution of novel external proficiency testing programs for immunophenotyping, intracellular cytokine staining, ELISPOT and luminex based cytokine measurements. In addition, there are articles describing the implementation of Good Clinical Laboratory Practices (GCLP) in a large quality assurance laboratory, the development of statistical methods specific for external proficiency testing assessment, a discussion on the ability to set objective thresholds for measuring rare events by flow cytometry, and finally, a manuscript which addresses a framework for the structured reporting of T cell immune function based assays. It is anticipated that this series of manuscripts covering a wide range of quality assurance activities associated with the conduct of global clinical trials will provide a resource for individuals and programs involved in improving the harmonization, standardization, accuracy, and sensitivity of virologic and immunologic testing.
Topics: AIDS Vaccines; Acquired Immunodeficiency Syndrome; Clinical Trials as Topic; Consensus; Cooperative Behavior; Guideline Adherence; HIV Infections; Humans; Immunologic Tests; International Cooperation; Laboratories; Laboratory Proficiency Testing; Monitoring, Immunologic; Observer Variation; Practice Guidelines as Topic; Predictive Value of Tests; Program Development; Program Evaluation; Quality Control; Reproducibility of Results; Treatment Outcome
PubMed: 24910413
DOI: 10.1016/j.jim.2014.05.016 -
PloS One 2022HIV-focused organizations, care providers and research programs often hire Black gay, bisexual and other men who have sex with men (GBMSM) in their efforts to reach...
BACKGROUND
HIV-focused organizations, care providers and research programs often hire Black gay, bisexual and other men who have sex with men (GBMSM) in their efforts to reach highly affected communities. Due to their unique social position within and outside of organizations, Black GBMSM are ideally situated to contribute to HIV care and prevention programming targeting their own communities, but may also be at risk for stress and burnout in these settings. Despite this critical role for Black GBMSM in efforts to end the epidemic, little is known about subjective experiences of Black GBMSM who work in the HIV field.
METHODS
We conducted qualitative interviews with 19 Black GBMSM who were identified as key informants. All were working in community-based organizations, clinical or academic settings in the area of HIV prevention and treatment in Atlanta, Georgia. We used a thematic analysis approach to identify salient themes with respect to the workplace experiences of Black GBMSM as well as the role of their identities in their work in the field.
RESULTS
Participants discussed: (1) Shared experiences and growth; (2) Work-related stressors; (3) Worker burnout; and (4) Commitment to continue working in the HIV field. On the whole, Black GBMSM derived meaning from their work, and found their intersectional identities to be a strength in fulfilling job duties. At the same time, Black GBMSM described multiple stresses faced as they balanced their personal and professional connections to this work, while also dealing with their own challenges related to discrimination, socioeconomic status, and health. Participants repeatedly described sacrificing their own well-being for the greater good of their communities, highlighting contributors to burnout within and outside of the workplace.
CONCLUSIONS
Our participants derived meaning from their work in the HIV field and were affirmed by professional interactions with other Black GBMSM. At the same time, they also faced work-related and other psychosocial stressors that predisposed them to frustration and burnout. To promote workplace equity and wellness for Black GBMSM, we share recommendations for HIV-focused organizations that employ and serve men in this demographic.
Topics: Acquired Immunodeficiency Syndrome; Bisexuality; Burnout, Psychological; HIV Infections; Homosexuality, Male; Humans; Male; Qualitative Research; Sexual Behavior; Sexual and Gender Minorities
PubMed: 35947604
DOI: 10.1371/journal.pone.0264680 -
BMC Public Health Aug 2021HIV epidemic remains a major public health issue in Malawi especially among adolescent girls and young women (AGYW). Comprehensive HIV/AIDS knowledge (defined as correct...
Prevalence and correlates of comprehensive HIV/AIDS knowledge among adolescent girls and young women aged 15-24 years in Malawi: evidence from the 2015-16 Malawi demographic and health survey.
BACKGROUND
HIV epidemic remains a major public health issue in Malawi especially among adolescent girls and young women (AGYW). Comprehensive HIV/AIDS knowledge (defined as correct knowledge of two major ways of preventing the sexual transmission of HIV and rejection of three misconceptions about HIV) is a key component of preventing new HIV infections among AGYW. Therefore, the aim of this study was to identify the correlates of comprehensive HIV/AIDS knowledge among AGYW in Malawi.
METHODS
The study was based on cross-sectional data from the 2015-2016 Malawi Demographic and Health Survey. It involved 10,422 AGYW aged 15-24 years. The outcome variable was comprehensive HIV/AIDS knowledge. Data were analysed using descriptive statistics, bivariate and multivariable logistic regression model. All the analyses were performed using complex sample analysis procedure of the Statistical Package for Social Sciences to account for complex survey design.
RESULTS
Approximately 42.2% of the study participants had comprehensive HIV/AIDS knowledge. Around 28% of the participants did not know that using condoms consistently can reduce the risk of HIV and 25% of the participants believed that mosquitoes could transmit HIV. Multivariable logistic regression model demonstrated that having higher education (AOR = 2.97, 95% CI: 2.35-3.75), belonging to richest households (AOR = 1.24, 95% CI: 1.05-1.45), being from central region (AOR = 1.65, 95% CI:1.43-1.89), southern region (AOR = 1.65, 95% CI: 1.43-1.90),listening to radio at least once a week (AOR = 1.27, 95% CI: 1.15-1.40) and ever tested for HIV (AOR = 1.88, 95% CI: 1.68-2.09) were significantly correlated with comprehensive HIV/AIDS knowledge.
CONCLUSIONS
The findings indicate that comprehensive HIV/AIDS knowledge among AGYW in Malawi is low. Various social-demographic characteristics were significantly correlated with comprehensive HIV/AIDS knowledge in this study. These findings suggest that public health programmes designed to improve comprehensive HIV/AIDS knowledge in Malawi should focus on uneducated young women, those residing in northern region and from poor households. There is also a need to target AGYW who have never tested for HIV with voluntary counselling and testing services. This measure might both improve their comprehensive HIV/AIDS knowledge and awareness of their health status.
Topics: Acquired Immunodeficiency Syndrome; Adolescent; Cross-Sectional Studies; Female; HIV Infections; Humans; Malawi; Prevalence
PubMed: 34348679
DOI: 10.1186/s12889-021-11564-4