WorldWideScience

Sample records for hiv-infected ugandan children

  1. Multiple micronutrient supplementation does not reduce diarrhoea morbidity in Ugandan HIV-infected children: a randomised controlled trial.

    Science.gov (United States)

    Ndeezi, Grace; Tylleskar, Thorkild; Ndugwa, Christopher M; Tumwine, James K

    2012-02-01

    To determine the effect of multiple micronutrient supplementation on the incidence and prevalence of diarrhoea in Ugandan HIV-infected children aged 1-5 years. We enrolled 847 HIV-infected Ugandan children in a randomised trial of a supplement containing 14 micronutrients (MMS) given at twice the recommended dietary allowance (RDA) versus a six-multivitamin (MV) supplement given in one RDA as the 'standard of care'. The participants were stratified into a highly active antiretroviral therapy (HAART) group of 85/847 (10%) and a non-HAART group of 762/847 (90%) participants. The supplements were given daily for 6 months. Episodes of diarrhoea assessed at routine visits, sick visits and those reported within 2 weeks before the routine visit were counted against weeks of observation for each participant. Diarrhoea incidence per child was calculated as the number of episodes per child year. Rate ratios were used to compare person-time rates in the two groups. The incidence of diarrhoea was 3·8 (95% CI 3·4-4·3) in the MMS and 3·5 (95% CI 3·1-4·0) in the MV group per child year. The rate ratio was 1·1 (0·9-1·3), similar in both strata, except that HAART-treated children had a lower incidence rate of diarrhoea. The prevalence of diarrhoea at 6 months was also similar in the two groups. The 14-multiple-micronutrient supplement given in two RDA doses compared with a six-multivitamin 'standard of care' supplement given in one RDA dose did not reduce the incidence or prevalence of diarrhoea in HIV-infected children aged 1-5 years.

  2. Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children.

    Directory of Open Access Journals (Sweden)

    Jessica E Haberer

    Full Text Available Adherence to HIV antiretroviral therapy (ART among children in developing settings is poorly understood.To understand the level, distribution, and correlates of ART adherence behavior, we prospectively determined monthly ART adherence through multiple measures and six-monthly HIV RNA levels among 121 Ugandan children aged 2-10 years for one year. Median adherence levels were 100% by three-day recall, 97.4% by 30-day visual analog scale, 97.3% by unannounced pill count/liquid formulation weights, and 96.3% by medication event monitors (MEMS. Interruptions in MEMS adherence of ≥ 48 hours were seen in 57.0% of children; 36.3% had detectable HIV RNA at one year. Only MEMS correlated significantly with HIV RNA levels (r = -0.25, p = 0.04. Multivariable regression found the following to be associated with <90% MEMS adherence: hospitalization of child (adjusted odds ratio [AOR] 3.0, 95% confidence interval [CI] 1.6-5.5; p = 0.001, liquid formulation use (AOR 1.4, 95%CI 1.0-2.0; p = 0.04, and caregiver's alcohol use (AOR 3.1, 95%CI 1.8-5.2; p<0.0001. Child's use of co-trimoxazole (AOR 0.5, 95%CI 0.4-0.9; p = 0.009, caregiver's use of ART (AOR 0.6, 95%CI 0.4-0.9; p = 0.03, possible caregiver depression (AOR 0.6, 95%CI 0.4-0.8; p = 0.001, and caregiver feeling ashamed of child's HIV status (AOR 0.5, 95%CI 0.3-0.6; p<0.0001 were protective against <90% MEMS adherence. Change in drug manufacturer (AOR 4.1, 95%CI 1.5-11.5; p = 0.009 and caregiver's alcohol use (AOR 5.5, 95%CI 2.8-10.7; p<0.0001 were associated with ≥ 48-hour interruptions by MEMS, while second-line ART (AOR 0.3, 95%CI 0.1-0.99; p = 0.049 and increasing assets (AOR 0.7, 95%CI 0.6-0.9; p = 0.0007 were protective against these interruptions.Adherence success depends on a well-established medication taking routine, including caregiver support and adequate education on medication changes. Caregiver-reported depression and shame may reflect fear of poor outcomes, functioning as motivation for

  3. Parasite Clearance and Artemether Pharmacokinetics Parameters Over the Course of Artemether-Lumefantrine Treatment for Malaria in Human Immunodeficiency Virus (HIV)-Infected and HIV-Uninfected Ugandan Children.

    Science.gov (United States)

    Kajubi, Richard; Huang, Liusheng; Were, Moses; Kiconco, Sylvia; Li, Fangyong; Marzan, Florence; Gingrich, David; Nyunt, Myaing M; Ssebuliba, Joshua; Mwebaza, Norah; Aweeka, Francesca T; Parikh, Sunil

    2016-10-01

    Artemisinins are primarily responsible for initial parasite clearance. Antimalarial pharmacokinetics (PK), human immunodeficiency virus (HIV) infection, and antiretroviral therapy have been shown to impact treatment outcomes, although their impact on early parasite clearance in children has not been well characterized. Parasite clearance parameters were generated from twice-daily blood smears in HIV-infected and HIV-uninfected Ugandan children treated with artemether-lumefantrine (AL). Artemether and dihydroartemisinin (DHA) area-under-the-curve from 0-8 hours (AUC0-8hr) after the 1st AL dose was compared with AUC0-8hr after the last (6th) dose in a concurrently enrolled cohort. The association between post-1st dose artemisinin AUC0-8hr and parasite clearance was assessed. Parasite clearance was longer in HIV-infected versus HIV-uninfected children (median, 3.5 vs 2.8 hours; P = .003). Artemether AUC0-8hr was 3- to 4-fold lower after the 6th dose versus the 1st dose of AL in HIV-infected children on nevirapine- or lopinavir/ritionavir-based regimens and in HIV-uninfected children (P ≤ .002, 1st vs 6th-dose comparisons). Children on efavirenz exhibited combined post-1st dose artemether/DHA exposure that was significantly lower than those on lopinavir/ritonavir and HIV-uninfected children. Multiple regression analysis supported that the effect of artemether/DHA exposure on parasite clearance was significantly moderated by HIV status. Parasite clearance rates remain rapid in Uganda and were not found to associate with PK exposure. However, significant decreases in artemisinin PK with repeated dosing in nearly all children, coupled with small, but significant increase in parasite clearance half-life in those with HIV, may have important implications for AL efficacy, particularly because reports of artemisinin resistance are increasing.

  4. The association between malnutrition and the incidence of malaria among young HIV-infected and -uninfected Ugandan children: a prospective study

    Directory of Open Access Journals (Sweden)

    Arinaitwe Emmanuel

    2012-03-01

    Full Text Available Abstract Background In sub-Saharan Africa, malnutrition and malaria remain major causes of morbidity and mortality in young children. There are conflicting data as to whether malnutrition is associated with an increased or decreased risk of malaria. In addition, data are limited on the potential interaction between HIV infection and the association between malnutrition and the risk of malaria. Methods A cohort of 100 HIV-unexposed, 203 HIV-exposed (HIV negative children born to HIV-infected mothers and 48 HIV-infected children aged 6 weeks to 1 year were recruited from an area of high malaria transmission intensity in rural Uganda and followed until the age of 2.5 years. All children were provided with insecticide-treated bed nets at enrolment and daily trimethoprim-sulphamethoxazole prophylaxis (TS was prescribed for HIV-exposed breastfeeding and HIV-infected children. Monthly routine assessments, including measurement of height and weight, were conducted at the study clinic. Nutritional outcomes including stunting (low height-for-age and underweight (low weight-for-age, classified as mild (mean z-scores between -1 and -2 during follow-up and moderate-severe (mean z-scores Results The overall incidence of malaria was 3.64 cases per person year. Mild stunting (IRR = 1.24, 95% CI 1.06-1.46, p = 0.008 and moderate-severe stunting (IRR = 1.24, 95% CI 1.03-1.48, p = 0.02 were associated with a similarly increased incidence of malaria compared to non-stunted children. Being mildly underweight (IRR = 1.09, 95% CI 0.95-1.25, p = 0.24 and moderate-severe underweight (IRR = 1.12, 95% CI 0.86-1.46, p = 0.39 were not associated with a significant difference in the incidence of malaria compared to children who were not underweight. There were no significant interactions between HIV-infected, HIV-exposed children taking TS and the associations between malnutrition and the incidence of malaria. Conclusions Stunting, indicative of chronic malnutrition, was

  5. Predictors of HIV infection: a prospective HIV screening study in a Ugandan refugee settlement.

    Science.gov (United States)

    O'Laughlin, Kelli N; Rabideau, Dustin J; Kasozi, Julius; Parker, Robert A; Bustamante, Nirma D; Faustin, Zikama M; Greenwald, Kelsy E; Walensky, Rochelle P; Bassett, Ingrid V

    2016-11-23

    The instability faced by refugees may place them at increased risk of exposure to HIV infection. Nakivale Refugee Settlement in southwestern Uganda hosts 68,000 refugees from 11 countries, many with high HIV prevalence. We implemented an HIV screening program in Nakivale and examined factors associated with new HIV diagnosis. From March 2013-November 2014, we offered free HIV screening to all clients in the Nakivale Health Center while they waited for their outpatient clinic visit. Clients included refugees and Ugandan nationals accessing services in the settlement. Prior to receiving the HIV test result, participants were surveyed to obtain demographic information including gender, marital status, travel time to reach clinic, refugee status, and history of prior HIV testing. We compared variables for HIV-infected and non-infected clients using Pearson's chi-square test, and used multivariable binomial regression models to identify predictors of HIV infection. During the HIV screening intervention period, 330 (4%) of 7766 individuals tested were identified as HIV-infected. Refugees were one quarter as likely as Ugandan nationals to be HIV-infected (aRR 0.27 [0.21, 0.34], p refugee settlement in Uganda, Ugandan nationals are at higher risk of having HIV than refugees. The high HIV prevalence among clients seeking outpatient care, including Ugandan nationals and refugees, warrants enhanced HIV screening services in Nakivale and in the surrounding region. Findings from this research may be relevant for other refugee settlements in Sub-Saharan Africa hosting populations with similar demographics, including the 9 other refugee settlements in Uganda.

  6. Predictors of HIV infection: a prospective HIV screening study in a Ugandan refugee settlement

    Directory of Open Access Journals (Sweden)

    Kelli N. O’Laughlin

    2016-11-01

    Full Text Available Abstract Background The instability faced by refugees may place them at increased risk of exposure to HIV infection. Nakivale Refugee Settlement in southwestern Uganda hosts 68,000 refugees from 11 countries, many with high HIV prevalence. We implemented an HIV screening program in Nakivale and examined factors associated with new HIV diagnosis. Methods From March 2013-November 2014, we offered free HIV screening to all clients in the Nakivale Health Center while they waited for their outpatient clinic visit. Clients included refugees and Ugandan nationals accessing services in the settlement. Prior to receiving the HIV test result, participants were surveyed to obtain demographic information including gender, marital status, travel time to reach clinic, refugee status, and history of prior HIV testing. We compared variables for HIV-infected and non-infected clients using Pearson’s chi-square test, and used multivariable binomial regression models to identify predictors of HIV infection. Results During the HIV screening intervention period, 330 (4% of 7766 individuals tested were identified as HIV-infected. Refugees were one quarter as likely as Ugandan nationals to be HIV-infected (aRR 0.27 [0.21, 0.34], p < 0.0001. Additionally, being female (aRR 1.43 [1.14, 1.80], p = 0.002 and traveling more than 1 h to the clinic (aRR 1.39 [1.11, 1.74], p = 0.003 increased the likelihood of being HIV-infected. Compared to individuals who were married or in a stable relationship, being divorced/separated/widowed increased the risk of being HIV-infected (aRR 2.41 [1.88, 3.08], p < 0.0001, while being single reduced the risk (aRR 0.60 [0.41, 0.86], p < 0.0001. Having been previously tested for HIV (aRR 0.59 [0.47, 0.74], p < 0.0001 also lowered the likelihood of being HIV-infected. Conclusions In an HIV screening program in a refugee settlement in Uganda, Ugandan nationals are at higher risk of having HIV than refugees. The high HIV

  7. Epidemiology of meningitis in an HIV-infected Ugandan cohort.

    Science.gov (United States)

    Rajasingham, Radha; Rhein, Joshua; Klammer, Kate; Musubire, Abdu; Nabeta, Henry; Akampurira, Andrew; Mossel, Eric C; Williams, Darlisha A; Boxrud, Dave J; Crabtree, Mary B; Miller, Barry R; Rolfes, Melissa A; Tengsupakul, Supatida; Andama, Alfred O; Meya, David B; Boulware, David R

    2015-02-01

    There is limited understanding of the epidemiology of meningitis among human immunodeficiency virus (HIV)-infected populations in sub-Saharan Africa. We conducted a prospective cohort study of HIV-infected adults with suspected meningitis in Uganda, to comprehensively evaluate the etiologies of meningitis. Intensive cerebrospiral fluid (CSF) testing was performed to evaluate for bacterial, viral, fungal, and mycobacterial etiologies, including neurosyphilis,16s ribosomal DNA (rDNA) polymerase chain reaction (PCR) for bacteria, Plex-ID broad viral assay, quantitative-PCR for HSV-1/2, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Toxoplasma gondii; reverse transcription-PCR (RT-PCR) for Enteroviruses and arboviruses, and Xpert MTB/RIF assay. Cryptococcal meningitis accounted for 60% (188 of 314) of all causes of meningitis. Of 117 samples sent for viral PCR, 36% were EBV positive. Among cryptococcal antigen negative patients, the yield of Xpert MTB/RIF assay was 22% (8 of 36). After exclusion of cryptococcosis and bacterial meningitis, 61% (43 of 71) with an abnormal CSF profile had no definitive diagnosis. Exploration of new TB diagnostics and diagnostic algorithms for evaluation of meningitis in resource-limited settings remains needed, and implementation of cryptococcal diagnostics is critical. © The American Society of Tropical Medicine and Hygiene.

  8. Cardiovascular manifestations of HIV infection in children

    NARCIS (Netherlands)

    Idris, Nikmah S; Grobbee, Diederick E; Burgner, David; Cheung, Michael M H; Kurniati, Nia; Sastroasmoro, Sudigdo; Uiterwaal, Cuno SPM

    2015-01-01

    BACKGROUND: HIV infection in children is now considered as a chronic condition, in which various non-infectious complications may occur, including those affecting the developing cardiovascular system. As children are expected to survive well into adulthood, understanding childhood as well as

  9. Proteinuria in HIV-infected Indian children.

    Science.gov (United States)

    Gupta, Gopila; Hemal, Alok; Saha, Abhijeet; Kapoor, Kanika; Goyal, Parul; Upadhyay, Ashish Datt

    2017-07-01

    Chronic kidney disease (CKD) is a major cause of morbidity and mortality among individuals with HIV infection. Screening for proteinuria in HIV-infected children will help in early detection and treatment, and thus prevention and progression to CKD to end-stage kidney disease (ESRD). We screened 139 HIV-infected children aged 18 months to 18 years for proteinuria by urinary dipstick and confirmed by spot urine protein-to-creatinine ratio. If proteinuria was absent by the above methods, patients were screened for microalbuminuria by urinary albumin to creatinine ratio. We found proteinuria in 11.5% and microalbuminuria in 10.6% of our study population. The prevalence of proteinuria was higher in the advanced stages; 8.05% in stage 1, 12.12% in stage 2 and 26.32% in stages 3 + 4.

  10. Hearing Loss in HIV-Infected Children in Lilongwe, Malawi.

    OpenAIRE

    Hrapcak, S; Kuper, H; Bartlett, P.; Devendra, A; Makawa, A; Kim, M; Kazembe, P.; Ahmed, S.

    2016-01-01

    Introduction With improved access to antiretroviral therapy (ART), HIV infection is becoming a chronic illness. Preliminary data suggest that HIV-infected children have a higher risk of disabilities, including hearing impairment, although data are sparse. This study aimed to estimate the prevalence and types of hearing loss in HIV-infected children in Lilongwe, Malawi. Methods This was a cross-sectional survey of 380 HIV-infected children aged 4?14 years attending ART clinic in Lilongwe betwe...

  11. Persistent Immune Activation and Carotid Atherosclerosis in HIV-Infected Ugandans Receiving Antiretroviral Therapy.

    Science.gov (United States)

    Siedner, Mark J; Kim, June-Ho; Nakku, Ruth Sentongo; Bibangambah, Prossy; Hemphill, Linda; Triant, Virginia A; Haberer, Jessica E; Martin, Jeffrey N; Mocello, A Rain; Boum, Yap; Kwon, Douglas S; Tracy, Russell P; Burdo, Tricia; Huang, Yong; Cao, Huyen; Okello, Samson; Bangsberg, David R; Hunt, Peter W

    2016-02-01

    Human immunodeficiency virus (HIV) infection and associated immune activation predict the risk of cardiovascular disease in resource-rich areas. Less is known about these relationships in sub-Saharan Africa. Beginning in 2005, we enrolled subjects in southwestern Uganda into a cohort at the time of antiretroviral therapy (ART) initiation. Multiple immune activation measures were assessed before and 6 months after ART initiation. Beginning in 2013, participants aged >40 years underwent metabolic profiling, including measurement of hemoglobin A1c and lipid levels and carotid ultrasonography. We fit regression models to identify traditional and HIV-specific correlates of common carotid intima media thickness (CCIMT). A total of 105 participants completed carotid ultrasonography, with a median completion time of 7 years following ART initiation. Age, low-density lipoprotein cholesterol level, and pre-ART HIV load were correlated with CCIMT. No association was found between CCIMT and any pre-ART biomarkers of immune activation. However, in multivariable models adjusted for cardiovascular disease risk factors, lower absolute levels of soluble CD14 and interleukin 6 and greater declines in the CD14 level and kynurenine-tryptophan ratio after 6 months of ART predicted a lower CCIMT years later (P < .01). Persistent immune activation despite ART-mediated viral suppression predicts the future atherosclerotic burden among HIV-infected Ugandans. Future work should focus on clinical correlates of these relationships, to elucidate the long-term health priorities for HIV-infected people in the region. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  12. Anaemia among HIV infected children attending care and treatment ...

    African Journals Online (AJOL)

    Introduction: Anaemia is common among HIV infected patients; causes of anaemia in these patients are multifactorial. Anemia is noted as one of important predictors of outcome in HIV infected patients. Tis study was carried out to determine the prevalence of anaemia among HIV infected children attending HIV clinic at ...

  13. Utility assessment of HIV/AIDS-related health states in HIV-infected Ugandans.

    Science.gov (United States)

    Lara, Antonieta Medina; Wakholi, Barbara Nyanzi; Kasirye, Agnes; Munderi, Paula; Watera, Christine; Lalloo, David G; Haycox, Alan; Gilks, Charles F; Grosskurth, Heiner

    2008-07-01

    To assess the psychometric performance of using standard gamble (SG), time trade-off (TTO) and visual analogue scale (VAS) in the evaluation of three predetermined HIV/AIDS health states in HIV-infected Ugandans, for use in cost-effectiveness analyses. We recruited participants with CD4 cells health state using VAS; rank and evaluate HIV/AIDS predetermined health states using TTO and SG relative to an improved health state. Tools were tested for psychometrical properties. Women constituted 64% and 76% of the DART and Entebbe Cohorts. Mean age was 36.5 and 36.7 years, respectively. Participants could discriminate between predetermined HIV/AIDS health states. Deterioration in health status was associated with a reduction in rating scores (VAS), increased willingness to give up time (TTO) and acceptance of increased risk (SG) to achieve a better health state, independent of the participant's actual health state, as measured by CD4 cell counts. VAS, TTO and SG have good psychometric properties, making them good candidates for use in resource-constrained settings. Further research in a wider population is necessary to generate an evidence base with which to inform resource allocation decisions.

  14. Antiretroviral drug adherence by HIV infected children attending ...

    African Journals Online (AJOL)

    It was recommended that caregivers of the HIV infected children should be educated on importance of strict adherence to prescribed doses of ARVs to the children. Future research should explore using multiple measures of adherence and reasons for non-adherence among HIV infecting children. Conclusion: The drug ...

  15. Anaemia in HIV infected Nigerian children on HAART | Sadoh ...

    African Journals Online (AJOL)

    Background: Most studies evaluating anaemia and associated factors in HIV infected children have been done on those that are HAART naïve. This study evaluated anaemia among Nigerian children on HAART. Methodology: This cross-sectional study estimated Packed Cell Volume (PCV) in 155 HIV infected children ...

  16. Incorrectly diagnosing children as HIV-infected: Experiences from a ...

    African Journals Online (AJOL)

    Urgency in ART initiation in HIV-infected children is life-saving, especially in infants. However, HIV tests may produce false-positive results leading to misdiagnosis of children as HIV-infected, which has serious consequences. Meticulous checking of HIVpositive status is of utmost importance before committing any child to ...

  17. Risk factors for anaemia among HIV infected children attending care ...

    African Journals Online (AJOL)

    There is paucity of data describing the risk factors for anaemia among HIV infected children in Tanzania. This cross sectional study was carried out to determine the contributing factors for anaemia among HIV-infected children attending Muhimbili National Hospital in Dar es Salaam. Both univariate and multivariate logistic ...

  18. ORIGINAL ARTICLES Atopy in HIV-infected children in Pretoria

    African Journals Online (AJOL)

    Tat protein may also act as a chemo-attractant for FcεR1+ cells and also upregulate chemokine receptor 3 (CCR3) expression.12. We aimed to study the association between atopy (sensitivity to environmental factors, i.e. allergy and clinical disease states) and HIV infection in children and the role of HIV infection on.

  19. Immunity to Diphtheria and Tetanus in HIV-Infected Children

    Directory of Open Access Journals (Sweden)

    A.P. Volokha

    2016-10-01

    Full Text Available Backgrоund. HIV infected patients are at risk for vaccine-preventable infections such as tetanus and diphtheria. It is important to know about the protection of HIV-infected children from these infections, as there is a risk even after complete immunization. The protective immunity after vaccination against diphtheria and tetanus is measured by the antibodies level against these pathogens. The aim of this study was to evaluate the persistence of immunity to tetanus and diphtheria toxoid in HIV-infected children. Materials and methods. The protective immunity against diphtheria and tetanus was studied in children with HIV infection in the Kyiv City AIDS Center. Immunization rate was evaluated in 142 HIV-infected children. Serum samples were obtained in 59 HIV-infected children (study group vaccinated against diphtheria and tetanus toxoid during routine check-ups. The results of anti-tetanus and anti-diphtheria antibodies were compared with the data of 17 children without HIV (the control group. The mean age of HIV-infected patients was 9.2 years old (range from 1.6 to 15.5 years old. Most children (38/59, 64.4 % had mild clinical manifestations of HIV infection (I and II clinical stage of the disease. 89.8 % (53/59 of children of the group received antiretroviral therapy. The level of CD4+ T-lymphocytes within age norms was in 88.2 % of children receiving ART. Results. The research revealed lower vaccination coverage of HIV-infected children against diphtheria and tetanus (63.3 % than in the general population. Only 19.7 % (28/142 of HIV-infected children were fully vaccinated according to the National schedule against these bacterial infections. A large proportion of children with HIV infection (79.3 % vaccinated against these pathogens does not have protective levels of antibodies against diphtheria. The protective level of antibodies against tetanus was absent in 28.8 % of vaccinated HIV-positive children. Mean level of tetanus

  20. Control beliefs and health locus of control in Ugandan, German and migrated sub-Saharan African HIV infected individuals.

    Science.gov (United States)

    Milz, Ruth U; Husstedt, Ingo-W; Reichelt, Doris; Evers, Stefan

    2016-04-01

    Little is known about the influence of control beliefs on antiretroviral drug adherence in patients who migrated from sub-Saharan Africa to Europe. The aim of this study was to explore the differences in health locus of control and control beliefs between HIV infected patients from sub-Saharan Africa with and without a lifetime experience of migration. A sample of 62 HIV infected consecutive patients referred to the HIV clinics at the University Hospital of Münster (Germany) and at the Rubaga Hospital Kampala (Uganda) were enrolled into this study. We compared three groups of patients: sub-Saharan African migrants, German patients, and local Ugandan patients. We used the German health and illness related control beliefs questionnaire (KKG), the Competence and control beliefs questionnaire (FKK), and the Powe Fatalism Inventory-HIV/AIDS-Version (PFI-HIV/AIDS-Version) and translated these scales into English and Luganda. In addition, the patients' sociodemographic, acculturation, clinical, and immunological data were registered. Significant results were shown in HIV related external locus of control between migrated sub-Saharan African and local Ugandan patients compared to German patients. General control beliefs showed no significant differences. In the PFI-HIV-Version, there was a significant difference between migrated sub-Saharan African and Ugandan patients compared to German patients. Our data suggest that the experience of migration does not influence the locus of control. Compared to German HIV patients, African patients in general showed a significantly higher external health locus of control which might have implications for drug adherence. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Hookworm infection is associated with decreased CD4+ T cell counts in HIV-infected adult Ugandans.

    Directory of Open Access Journals (Sweden)

    Bozena M Morawski

    2017-05-01

    Full Text Available Most studies evaluating epidemiologic relationships between helminths and HIV have been conducted in the pre-ART era, and evidence of the impact of helminth infections on HIV disease progression remains conflicting. Less is known about helminth infection and clinical outcomes in HIV-infected adults receiving antiretroviral therapy (ART. We sampled HIV-infected adults for eight gastrointestinal parasites and correlated parasitic infection with demographic predictors, and clinical and immunologic outcomes. Contrasting with previous studies, we measured parasitic infection with a quantitative, highly sensitive and specific polymerase chain reaction (PCR method. This cohort study enrolled HIV-infected Ugandans from August-September 2013 in Mbale, Uganda and collected stool and blood samples at enrollment. Real-time PCR quantified stool: Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, Cryptosporidium spp., Entamoeba histolytica, and Giardia intestinalis infection. Generalized linear models assessed relationships between parasitic infection and clinical or demographic data. 35% of participants (71/202 tested positive for ≥1 helminth, mainly N. americanus (55/199, 28%, and 4.5% (9/202 were infected with ≥2 stool parasites. Participants with hookworm infection had lower average CD4+ cell counts (-94 cells/mcL, 95%CI: -141, -48 cells/mcL; p<0.001 after adjustment for sex, CD4+ nadir at clinic entry, and time on ART. The high prevalence of parasitic infection and correlation with decreased CD4+ concentrations highlight the need to re-examine the effects of invasive helminth co-infection in rural, HIV-infected populations in the era of widely available ART. Elucidating the relationship between hookworm infection and immune recovery could provide opportunities for health optimization, e.g. integrated deworming, in these vulnerable populations.

  2. Hearing impairment and deafness among HIV infected children and ...

    African Journals Online (AJOL)

    Hearing impairment and deafness among HIV infected children and adolescents in Harare, Zimbabwe. C Chidziva, J Matsekete, T Bandason, S Shamu, T Dzongodza, N Matinhira, HA Mujuru, C Kunzekwenyika, M Wellington, R Luthy, C Prescott, RA Ferrand ...

  3. The effect of malnutrition on the pharmacokinetics and virologic outcomes of lopinavir, efavirenz and nevirapine in food insecure HIV-infected children in Tororo, Uganda.

    Science.gov (United States)

    Bartelink, Imke H; Savic, Rada M; Dorsey, Grant; Ruel, Theodore; Gingrich, David; Scherpbier, Henriette J; Capparelli, Edmund; Jullien, Vincent; Young, Sera L; Achan, Jane; Plenty, Albert; Charlebois, Edwin; Kamya, Moses; Havlir, Diane; Aweeka, Francesca

    2015-03-01

    Malnutrition may impact the pharmacokinetics (PKs) of antiretroviral medications and virologic responses in HIV-infected children. The authors therefore evaluated the PK of nevirapine (NVP), efavirenz (EFV) and lopinavir (LPV) in associations with nutritional status in a cohort of HIV-infected Ugandan children. Sparse dried blood spot samples from Ugandan children were used to estimate plasma concentrations. Historical PK data from children from 3 resource-rich countries (RRC) were utilized to develop the PK models. Concentrations in 330 dried blood spot from 163 Ugandan children aged 0.7-7 years were analyzed in reference to plasma PK data (1189 samples) from 204 children from RRC aged 0.5-12 years. Among Ugandan children, 48% was malnourished (underweight, thin or stunted). Compared to RRC, Ugandan children exhibited reduced bioavailability of EFV and LPV; 11% (P=0.045) and 18% (P=0.008), respectively. In contrast, NVP bioavailability was 46% higher in Ugandan children (PChildren receiving LPV, EFV or NVP had comparable risk of virologic failure. Among children on NVP, low height and weight for age Z scores were associated with reduced risk of virologic failure (P=0.034, P=0.068, respectively). Ugandan children demonstrated lower EFV and LPV and higher NVP exposure compared to children in RRC, perhaps reflecting the consequence of malnutrition on bioavailability. In children receiving NVP, the relation between exposure, malnutrition and outcome turned out to be marginally significant. Further investigations are warranted using more intensive PK measurements and adequate adherence assessments, to further assess causes of virologic failure in Ugandan children.

  4. HIV Infection Is Associated with Shortened Telomere Length in Ugandans with Suspected Tuberculosis.

    Science.gov (United States)

    Auld, Elizabeth; Lin, Jue; Chang, Emily; Byanyima, Patrick; Ayakaka, Irene; Musisi, Emmanuel; Worodria, William; Davis, J Lucian; Segal, Mark; Blackburn, Elizabeth; Huang, Laurence

    HIV infection is a risk factor for opportunistic pneumonias such as tuberculosis (TB) and for age-associated health complications. Short telomeres, markers of biological aging, are also associated with an increased risk of age-associated diseases and mortality. Our goals were to use a single cohort of HIV-infected and HIV-uninfected individuals hospitalized with pneumonia to assess whether shortened telomere length was associated with HIV infection, TB diagnosis, and 2-month mortality. This was a sub-study of the IHOP Study, a prospective observational study. Participants consisted of 184 adults admitted to Mulago Hospital in Kampala, Uganda who underwent evaluation for suspected TB and were followed for 2 months. Standardized questionnaires were administered to collect demographic and clinical data. PBMCs were isolated and analyzed using quantitative PCR to determine telomere length. The association between HIV infection, demographic and clinical characteristics, and telomere length was assessed, as were the associations between telomere length, TB diagnosis and 2-month mortality. Variables with a P≤0.2 in bivariate analysis were included in multivariate models. No significant demographic or clinical differences were observed between the HIV-infected and HIV-uninfected subjects. Older age (Paging and that shorter telomeres may be involved in age-associated health complications seen in this population. The findings indicate a need to further research the impact of HIV on aging.

  5. Comparison of antibody responses to HIV infection in Ugandan women infected with HIV subtypes A and D.

    Science.gov (United States)

    Longosz, Andrew F; Morrison, Charles S; Chen, Pai-Lien; Brand, Hilmarie H; Arts, Eric; Nankya, Immaculate; Salata, Robert A; Quinn, Thomas C; Eshleman, Susan H; Laeyendecker, Oliver

    2015-04-01

    We compared the serologic response to HIV infection in Ugandan women with HIV subtype A (N=82) and D (N=32) infection using a limiting antigen avidity assay (LAg-Avidity assay); 2,614 samples were analyzed. Study participants were followed a median of 6.6 years after HIV seroconversion. Samples were classified as assay positive if they had a LAg-Avidity assay result infection were more likely to have delayed antibody maturation. During the first 2 years after seroconversion, the mean time that women had an assay-positive result (mean duration of recent infection, MDRI) was longer for women with subtype D infection than women with subtype A infection (267.9 days, 95% CI: 231.2-308.2 vs. 167.3 days, 95% CI: 151.8-185.9 days, pinfection after excluding low viral load samples and samples from women on antiretroviral therapy (ART). Women infected for >2 years were also more likely to be misclassified as recently infected in they had subtype D infection. Women with subtype D infection were also more likely to have antibody waning compared to women with subtype A infection. These findings may be related to the higher pathogenicity of subtype D HIV infection and are relevant to use of the LAg-Avidity assay for cross-sectional HIV incidence estimation in populations where subtype D infection is prevalent.

  6. The oral health of HIV-infected Brazilian children.

    Science.gov (United States)

    de Aguiar Ribeiro, Apoena; Portela, Maristela Barbosa; de Souza, Ivete Pomarico Ribeiro

    2013-09-01

    The number of HIV-infected people has increased almost continuously. Paediatric dentists should be concerned about the oral findings in HIV-infected children and their aetiologic factors, to promote adequate treatment. To present the oral health aspects of Brazilian HIV-infected children and to verify the aetiological factors. A cross-sectional study was conducted with HIV-infected children. During the medical appointments, children were submitted to visual-tactile exams of oral soft tissues and teeth. All parents answered questions in a structured interview. Data were analysed using the SPSS, release 10.0 (Chicago, IL, USA). Of the 57 children examined, 39 (69.6%) presented one or more oral soft tissue manifestations. More than a half suffered from gingivitis and only 12.5% had no visible dental biofilm. A high prevalence of dental surfaces with active carious lesions was observed; mean DMFS-m and dmfs-m scores were 5.41 ± 5.61 and 16.77 ± 19.52, respectively. Caries activity and gingivitis were correlated with the presence of mature dental biofilm. Prevalence of soft tissue lesions, dental caries and gingivitis in HIV-infected children was high and correlated to lack of satisfactory oral hygiene habits, suggesting the need of therapeutic programmes that allow these children to recover their oral health. © 2012 John Wiley & Sons Ltd, BSPD and IAPD 359.

  7. The Experience of Children with Hemophilia and HIV Infection.

    Science.gov (United States)

    Hall, Christopher S.

    1994-01-01

    Children with hemophilia and Human Immunodeficiency Virus (HIV) infection are not a transmission risk to other children, and they can help enact best practices for school attendance by other such children. The article examines the National Hemophilia Foundation's work to promote appropriate inclusion of students with hemophilia and HIV in all…

  8. HIV Infection Is Associated with Shortened Telomere Length in Ugandans with Suspected Tuberculosis.

    Directory of Open Access Journals (Sweden)

    Elizabeth Auld

    Full Text Available HIV infection is a risk factor for opportunistic pneumonias such as tuberculosis (TB and for age-associated health complications. Short telomeres, markers of biological aging, are also associated with an increased risk of age-associated diseases and mortality. Our goals were to use a single cohort of HIV-infected and HIV-uninfected individuals hospitalized with pneumonia to assess whether shortened telomere length was associated with HIV infection, TB diagnosis, and 2-month mortality.This was a sub-study of the IHOP Study, a prospective observational study. Participants consisted of 184 adults admitted to Mulago Hospital in Kampala, Uganda who underwent evaluation for suspected TB and were followed for 2 months. Standardized questionnaires were administered to collect demographic and clinical data. PBMCs were isolated and analyzed using quantitative PCR to determine telomere length. The association between HIV infection, demographic and clinical characteristics, and telomere length was assessed, as were the associations between telomere length, TB diagnosis and 2-month mortality. Variables with a P≤0.2 in bivariate analysis were included in multivariate models.No significant demographic or clinical differences were observed between the HIV-infected and HIV-uninfected subjects. Older age (P<0.0001, male gender (P = 0.04, total pack-years smoked (P<0.001, alcohol consumption in the past year (P = 0.12, and asthma (P = 0.08 were all associated (P≤0.2 with shorter telomere length in bivariate analysis. In multivariate analysis adjusting for these five variables, HIV-positive participants had significantly shorter telomeres than HIV-negative participants (β = -0.0621, 95% CI -0.113 to -0.011, P = 0.02. Shortened telomeres were not associated with TB or short-term mortality.The association between HIV infection and shorter telomeres suggests that HIV may play a role in cellular senescence and biological aging and that shorter telomeres may be

  9. Children's caregiving of HIV-infected parents accessing treatment in ...

    African Journals Online (AJOL)

    It discusses the responsibilities and challenges that children face when becoming the primary caregiver to an HIV-infected parent enrolled in an antiretroviral therapy (ART) programme, and the coping strategies these children adopt to deal with hardship. The research draws attention to the difficulties and opportunities of ...

  10. Age at disclosure of HIV infection amongst children attending the ...

    African Journals Online (AJOL)

    Background: with easier access to life saving antiretroviral drugs, children with HIV/AIDS now have better life expectancy and informing them of their status has become of exceeding importance. Objectives: this study set to assess the age at which HIV infected children attending the Paediatric HIV care and treatment clinic of ...

  11. Steady state bioequivalence of generic and innovator formulations of stavudine, lamivudine, and nevirapine in HIV-infected Ugandan adults.

    Directory of Open Access Journals (Sweden)

    Jayne Byakika-Tusiime

    Full Text Available Generic antiretroviral therapy is the mainstay of HIV treatment in resource-limited settings, yet there is little evidence confirming the bioequivalence of generic and brand name formulations. We compared the steady-state pharmacokinetics of lamivudine, stavudine and nevirapine in HIV-infected subjects who were receiving a generic formulation (Triomune or the corresponding brand formulations (Epivir, Zerit, and Viramune.An open-label, randomized, crossover study was carried out in 18 HIV-infected Ugandan subjects stabilized on Triomune-40. Subjects received lamivudine (150 mg, stavudine (40 mg, and nevirapine (200 mg in either the generic or brand formulation twice a day for 30 days, before switching to the other formulation. At the end of each treatment period, blood samples were collected over 12 h for pharmacokinetic analysis. The main outcome measures were the mean AUC(0-12h and C(max. Bioequivalence was defined as a geometric mean ratio between the generic and brand name within the 90% confidence interval of 0.8-1.25. The geometric mean ratios and the 90% confidence intervals were: stavudine C(max, 1.3 (0.99-1.71 and AUC(0-12h, 1.1 (0.87-1.38; lamivudine C(max, 0.8 (0.63-0.98 and AUC(0-12h, 0.8 (0.65-0.99; and nevirapine C(max, 1.1 (0.95-1.23 and AUC(0-12h, 1.1 (0.95-1.31. The generic formulation was not statistically bioequivalent to the brand formulations during steady state, although exposures were comparable. A mixed random effects model identified about 50% intersubject variability in the pharmacokinetic parameters.These findings provide support for the use of Triomune in resource-limited settings, although identification of the sources of intersubject variability in these populations is critical.

  12. Severe mental illness at ART initiation is associated with worse retention in care among HIV-infected Ugandan adults.

    Science.gov (United States)

    Nachega, Jean B; Mutamba, Brian; Basangwa, David; Nguyen, Hoang; Dowdy, David W; Mills, Edward J; Katabira, Elly; Nakimuli-Mpungu, Ethel

    2013-01-01

    The impact of severe mental illness (SMI) on retention in HIV care remains uncertain. We aimed to measure the association between SMI at antiretroviral therapy (ART) initiation and subsequent retention in care in HIV-infected Ugandan adults. We conducted cohort study of 773 patients who initiated ART between January 2005 and July 2009 at the Butabika HIV clinic in Kampala, Uganda. SMI was defined as any clinically diagnosed organic brain syndrome, affective disorder or psychotic disorder. We used Kaplan-Meier and Cox proportional hazards analysis to evaluate the association between SMI and retention in care. The prevalence of SMI at ART initiation was 23%. Patients with SMI at baseline were similar to those without SMI in terms of age (median [IQR]: 35 [28-40] vs. 35 [30-40], P = 0.03), sex (36% vs. 35% female, P = 0.86) and baseline CD4+ T-cell count (112 [54-175] vs. 120 [48-187] cells/mm3, P = 0.86). At 12 months after ART initiation, Kaplan-Meier estimates of continuous retention in care were 65% (95% confidence interval, CI: 31-39%) among patients without SMI, vs. 47% (95% CI: 39-55%) among those with SMI (P 0.05). In multivariable analysis, the only baseline variable independently associated with breakage of continuous care was SMI (HR = 1.58, 95% CI: 1.06─2.33). Severe mental illness at ART initiation is associated with worse retention in HIV care in this urban Ugandan referral hospital. As ART is scaled up across sub-Saharan Africa, greater attention must be paid to the burden of mental illness and its impact on retention in care. © 2012 Blackwell Publishing Ltd.

  13. Oral and dental lesions in HIV infected Nigerian children | Oyedeji ...

    African Journals Online (AJOL)

    ... study designed to identify the oral lesions in consecutive HIV infected children and their distribution at a Paediatric Anti-retroviral clinic. Information on oral disease and clinical features of the subjects were obtained by history and clinical examination and laboratory investigations by the paediatricians and dental surgeon.

  14. Adherence to antiretroviral therapy among HIV-infected children ...

    African Journals Online (AJOL)

    Adherence to antiretroviral therapy among HIV-infected children receiving care at Kilimanjaro Christian Medical Centre (KCMC), Northern Tanzania: A cross- sectional analytical study. Amos Haki Nsheha, Dorothy Elizabeth Dow, Gabriel Erick Kapanda, Bernardus Carolus Hamel, Levina January Msuya ...

  15. Anthropometric measurements of HIV-infected children aged one to ...

    African Journals Online (AJOL)

    2015-10-12

    Oct 12, 2015 ... Abstract: Objectives: To deter- mine the association between HIV infection and anthropometric measures (weight, height, mid- upper arm circumference and head circumference) of children aged one to five years. Method: A cross sectional de- scriptive study using structured questionnaire and measurement ...

  16. Sero-prevalence of HIV infection in children attending some ...

    African Journals Online (AJOL)

    This six-month study reports on the seroprevalence of HIV infection among children less than 15 years of age but above 18 months attending Murtala Muhammad Specialist Hospitals (MMSH), Infectious Diseases Hospital (IDH) and Hasiya Bayero Pediatric Hospital (HBPH) Kano. The voluntary counseling and testing (VCT) ...

  17. Lipodystrophy syndrome in HIV-infected children on HAART | Innes ...

    African Journals Online (AJOL)

    Lipodystrophy syndrome (LD) is common in HIV-infected children, particularly those taking didanosine, stavudine or zidovudine. Lipo-atrophy in particular causes major stigmatisation and interferes with adherence. In addition, LD may have significant long-term health consequences, particularly cardiovascular. Since the ...

  18. Morbidity and mortality in HIV - infected children admitted at Moi ...

    African Journals Online (AJOL)

    Objective: To describe the characteristics and causes of hospitalisation and mortality for HIV infected children admitted to Moi Teaching and Referral hospital in western Kenya. Design: a retrospective study of prospectively collected data. Setting: The paediatric wards of Moi Teaching and Referral Hospital (MTRH).

  19. Neurological and neurocognitive function of HIV-infected children ...

    African Journals Online (AJOL)

    and in older children cryptococcal meningitis.10-14 HIV-infected patients are at risk for thromboembolic strokes caused by disturbances in blood coagulation via antiphospholipid antibodies or reduced protein S concentration, and ischaemic strokes due to infections, coagulopathies or HIV-associated vasculopathy.15 ...

  20. Characteristics of HIV-infected children seen in Western Kenya ...

    African Journals Online (AJOL)

    Main outcome measures: Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive statistical analyses and chi square tests were performed. Results: Four thousand and seventeen HIV-infected children seen between June 2002 and April 2008. Median age at enrollment ...

  1. Erythropoiesis in HIV-infected and uninfected Malawian children with severe anemia

    NARCIS (Netherlands)

    Calis, Job C. J.; Phiri, Kamija S.; Vet, Raymond J. W. M.; de Haan, Rob J.; Munthali, Francis; Kraaijenhagen, Robert J.; Hulshof, Paul J. M.; Molyneux, Malcolm E.; Brabin, Bernard J.; Boele van Hensbroek, Michaël; Bates, Imelda

    2010-01-01

    Anemia is common in HIV infection, but the pathophysiology is poorly understood. Bone marrow analysis in 329 severely anemic (hemoglobin <5 g/dl) Malawian children with (n = 40) and without (n = 289) HIV infection showed that HIV-infected children had fewer CD34(+) hematopoietic progenitors (median

  2. Bone health in children and adolescents with perinatal HIV infection

    Directory of Open Access Journals (Sweden)

    George K Siberry

    2013-06-01

    Full Text Available The long-term impact on bone health of lifelong HIV infection and prolonged ART in growing and developing children is not yet known. Measures of bone health in youth must be interpreted in the context of expected developmental and physiologic changes in bone mass, size, density and strength that occur from fetal through adult life. Low bone mineral density (BMD appears to be common in perinatally HIV-infected youth, especially outside of high-income settings, but data are limited and interpretation complicated by the need for better pediatric norms. The potential negative effects of tenofovir on BMD and bone mass accrual are of particular concern as this drug may be used more widely in younger children. Emphasizing good nutrition, calcium and vitamin D sufficiency, weight-bearing exercise and avoidance of alcohol and smoking are effective and available approaches to maintain and improve bone health in all settings. More data are needed to inform therapies and monitoring for HIV-infected youth with proven bone fragility. While very limited data suggest lack of marked increase in fracture risk for youth with perinatal HIV infection, the looming concern for these children is that they may fail to attain their expected peak bone mass in early adulthood which could increase their risk for fractures and osteoporosis later in adulthood.

  3. NATURAL HISTORY OF HIV-INFECTION IN CHILDREN WITH THE ROUTE OF INFECTION

    Directory of Open Access Journals (Sweden)

    V. B. Denisenko

    2014-01-01

    Full Text Available Natural history of HIV infection in 91 vertically HIV infected patients and in 101 parenterally HIV infected children were investigated. High relative incidence rates regardless of the route of HIV transmission have demonstrated HIV-related symptoms — generalized lymphadenopathy, hepatomegaly, splenomegaly, underweight, anemia, prolonged unmotivated fever, and opportunistic infections — bacterial infections, candidiasis, herpes simplex, cytomegalovirus infection. Vertically HIV infected children had higher relative incidence rates of HIV-related symptoms, opportunistic infections and generalized forms of opportunistic infections.

  4. The Oral Bacterial Communities of Children with Well-Controlled HIV Infection and without HIV Infection.

    Directory of Open Access Journals (Sweden)

    Brittany E Goldberg

    Full Text Available The oral microbial community (microbiota plays a critical role in human health and disease. Alterations in the oral microbiota may be associated with disorders such as gingivitis, periodontitis, childhood caries, alveolar osteitis, oral candidiasis and endodontic infections. In the immunosuppressed population, the spectrum of potential oral disease is even broader, encompassing candidiasis, necrotizing gingivitis, parotid gland enlargement, Kaposi's sarcoma, oral warts and other diseases. Here, we used 454 pyrosequencing of bacterial 16S rRNA genes to examine the oral microbiome of saliva, mucosal and tooth samples from HIV-positive and negative children. Patient demographics and clinical characteristics were collected from a cross-section of patients undergoing routine dental care. Multiple specimens from different sampling sites in the mouth were collected for each patient. The goal of the study was to observe the potential diversity of the oral microbiota among individual patients, sample locations, HIV status and various dental characteristics. We found that there were significant differences in the microbiome among the enrolled patients, and between sampling locations. The analysis was complicated by uneven enrollment in the patient cohorts, with only five HIV-negative patients enrolled in the study and by the rapid improvement in the health of HIV-infected children between the time the study was conceived and completed. The generally good oral health of the HIV-negative patients limited the number of dental plaque samples that could be collected. We did not identify significant differences between well-controlled HIV-positive patients and HIV-negative controls, suggesting that well-controlled HIV-positive patients essentially harbor similar oral flora compared to patients without HIV. Nor were significant differences in the oral microbiota identified between different teeth or with different dental characteristics. Additional studies are

  5. Hearing Loss in HIV-Infected Children in Lilongwe, Malawi

    Science.gov (United States)

    Hrapcak, Susan; Kuper, Hannah; Bartlett, Peter; Devendra, Akash; Makawa, Atupele; Kim, Maria; Kazembe, Peter; Ahmed, Saeed

    2016-01-01

    Introduction With improved access to antiretroviral therapy (ART), HIV infection is becoming a chronic illness. Preliminary data suggest that HIV-infected children have a higher risk of disabilities, including hearing impairment, although data are sparse. This study aimed to estimate the prevalence and types of hearing loss in HIV-infected children in Lilongwe, Malawi. Methods This was a cross-sectional survey of 380 HIV-infected children aged 4–14 years attending ART clinic in Lilongwe between December 2013-March 2014. Data was collected through pediatric quality of life and sociodemographic questionnaires, electronic medical record review, and detailed audiologic testing. Hearing loss was defined as >20 decibels hearing level (dBHL) in either ear. Predictors of hearing loss were explored by regression analysis generating age- and sex-adjusted odds ratios. Children with significant hearing loss were fitted with hearing aids. Results Of 380 patients, 24% had hearing loss: 82% conductive, 14% sensorineural, and 4% mixed. Twenty-one patients (23% of those with hearing loss) were referred for hearing aid fitting. There was a higher prevalence of hearing loss in children with history of frequent ear infections (OR 7.4, 4.2–13.0) and ear drainage (OR 6.4, 3.6–11.6). Hearing loss was linked to history of WHO Stage 3 (OR 2.4, 1.2–4.5) or Stage 4 (OR 6.4, 2.7–15.2) and history of malnutrition (OR 2.1, 1.3–3.5), but not to duration of ART or CD4. Only 40% of caregivers accurately perceived their child’s hearing loss. Children with hearing impairment were less likely to attend school and had poorer emotional (p = 0.02) and school functioning (p = 0.04). Conclusions There is an urgent need for improved screening tools, identification and treatment of hearing problems in HIV-infected children, as hearing loss was common in this group and affected school functioning and quality of life. Clear strategies were identified for prevention and treatment, since most

  6. Hearing Loss in HIV-Infected Children in Lilongwe, Malawi.

    Directory of Open Access Journals (Sweden)

    Susan Hrapcak

    Full Text Available With improved access to antiretroviral therapy (ART, HIV infection is becoming a chronic illness. Preliminary data suggest that HIV-infected children have a higher risk of disabilities, including hearing impairment, although data are sparse. This study aimed to estimate the prevalence and types of hearing loss in HIV-infected children in Lilongwe, Malawi.This was a cross-sectional survey of 380 HIV-infected children aged 4-14 years attending ART clinic in Lilongwe between December 2013-March 2014. Data was collected through pediatric quality of life and sociodemographic questionnaires, electronic medical record review, and detailed audiologic testing. Hearing loss was defined as >20 decibels hearing level (dBHL in either ear. Predictors of hearing loss were explored by regression analysis generating age- and sex-adjusted odds ratios. Children with significant hearing loss were fitted with hearing aids.Of 380 patients, 24% had hearing loss: 82% conductive, 14% sensorineural, and 4% mixed. Twenty-one patients (23% of those with hearing loss were referred for hearing aid fitting. There was a higher prevalence of hearing loss in children with history of frequent ear infections (OR 7.4, 4.2-13.0 and ear drainage (OR 6.4, 3.6-11.6. Hearing loss was linked to history of WHO Stage 3 (OR 2.4, 1.2-4.5 or Stage 4 (OR 6.4, 2.7-15.2 and history of malnutrition (OR 2.1, 1.3-3.5, but not to duration of ART or CD4. Only 40% of caregivers accurately perceived their child's hearing loss. Children with hearing impairment were less likely to attend school and had poorer emotional (p = 0.02 and school functioning (p = 0.04.There is an urgent need for improved screening tools, identification and treatment of hearing problems in HIV-infected children, as hearing loss was common in this group and affected school functioning and quality of life. Clear strategies were identified for prevention and treatment, since most hearing loss was conductive in nature, likely due to

  7. Hearing Loss in HIV-Infected Children in Lilongwe, Malawi.

    Science.gov (United States)

    Hrapcak, Susan; Kuper, Hannah; Bartlett, Peter; Devendra, Akash; Makawa, Atupele; Kim, Maria; Kazembe, Peter; Ahmed, Saeed

    2016-01-01

    With improved access to antiretroviral therapy (ART), HIV infection is becoming a chronic illness. Preliminary data suggest that HIV-infected children have a higher risk of disabilities, including hearing impairment, although data are sparse. This study aimed to estimate the prevalence and types of hearing loss in HIV-infected children in Lilongwe, Malawi. This was a cross-sectional survey of 380 HIV-infected children aged 4-14 years attending ART clinic in Lilongwe between December 2013-March 2014. Data was collected through pediatric quality of life and sociodemographic questionnaires, electronic medical record review, and detailed audiologic testing. Hearing loss was defined as >20 decibels hearing level (dBHL) in either ear. Predictors of hearing loss were explored by regression analysis generating age- and sex-adjusted odds ratios. Children with significant hearing loss were fitted with hearing aids. Of 380 patients, 24% had hearing loss: 82% conductive, 14% sensorineural, and 4% mixed. Twenty-one patients (23% of those with hearing loss) were referred for hearing aid fitting. There was a higher prevalence of hearing loss in children with history of frequent ear infections (OR 7.4, 4.2-13.0) and ear drainage (OR 6.4, 3.6-11.6). Hearing loss was linked to history of WHO Stage 3 (OR 2.4, 1.2-4.5) or Stage 4 (OR 6.4, 2.7-15.2) and history of malnutrition (OR 2.1, 1.3-3.5), but not to duration of ART or CD4. Only 40% of caregivers accurately perceived their child's hearing loss. Children with hearing impairment were less likely to attend school and had poorer emotional (p = 0.02) and school functioning (p = 0.04). There is an urgent need for improved screening tools, identification and treatment of hearing problems in HIV-infected children, as hearing loss was common in this group and affected school functioning and quality of life. Clear strategies were identified for prevention and treatment, since most hearing loss was conductive in nature, likely due to

  8. Health & nutritional status of HIV infected children in Hyderabad, India.

    Science.gov (United States)

    Swetha, G Krishna; Hemalatha, R; Prasad, U V; Murali, Vasudev; Damayanti, K; Bhaskar, V

    2015-01-01

    Information on nutritional status of HIV infected children from India is lacking and is required before taking up nutritional supplementation trials. Thus, the aim of the present study was to assess the growth and morbidity status of HIV infected children over a period of one year in a city in southern India. This was an observational study carried out between July 2009 and February 2011, at two orphanages in Hyderabad, India. Seventy seven HIV-positive children aged between 1 and half and 15 years, both on and not on antiretroviral therapy (ART) were included. Nutritional status was assessed longitudinally for one year by weight gain, linear growth and body composition. Serum samples were analyzed for haemoglobin, micronutrients, CD4 and CD8 counts. Dietary intakes were assessed by institutional diet survey and morbidity data were recorded every day for 12 months. Mean energy intakes were less than recommended dietary allowance (RDA) in all age groups. Iron and folate intakes were less than 50 per cent of RDA; 46 (59.7%) children were stunted, 36 (46.8%) were underweight and 15 (19.5%) had low BMI for age. Anaemia was observed in 35 (45.5%) children. Micronutrient deficiencies such as vitamin D (40/77; 51.9%), vitamin A (11/77; 14.3%), folate (37/77; 48.1%), iron (38/77; 49.3%) were widely prevalent. HIV viral load was higher in children not on ART and those with morbidity. Respiratory (36.6%) and dermatological illnesses (18.8%) were the commonest presentations. Acute, chronic malnutrition and micronutrient deficiencies were common in HIV infected children, especially in those not on ART and having morbidity. With severe malnutrition being an alarming consequence of HIV, prophylactic nutritive care should be considered for integration into HIV care strategies besides initiation of ART to improve the nutritional status and quality of life of these children.

  9. Health & nutritional status of HIV infected children in Hyderabad, India

    Directory of Open Access Journals (Sweden)

    G Krishna Swetha

    2015-01-01

    Full Text Available Background & objectives: Information on nutritional status of HIV infected children from India is lacking and is required before taking up nutritional supplementation trials. Thus, the aim of the present study was to assess the growth and morbidity status of HIV infected children over a period of one year in a city in southern India. m0 ethods: This was an observational study carried out between July 2009 and February 2011, at two orphanages in Hyderabad, India. Seventy seven HIV-positive children aged between 1 and half and 15 years, both on and not on antiretroviral therapy (ART were included. Nutritional status was assessed longitudinally for one year by weight gain, linear growth and body composition. Serum samples were analyzed for haemoglobin, micronutrients, CD4 and CD8 counts. Dietary intakes were assessed by institutional diet survey and morbidity data were recorded every day for 12 months. Results: Mean energy intakes were less than recommended dietary allowance (RDA in all age groups. Iron and folate intakes were less than 50 per cent of RDA; 46 (59.7% children were stunted, 36 (46.8% were underweight and 15 (19.5% had low BMI for age. Anaemia was observed in 35 (45.5% children. Micronutrient deficiencies such as vitamin D (40/77; 51.9%, vitamin A (11/77; 14.3%, folate (37/77; 48.1%, iron (38/77; 49.3% were widely prevalent. HIV viral load was higher in children not on ART and those with morbidity. Respiratory (36.6% and dermatological illnesses (18.8% were the commonest presentations. Interpretation &conclusions: Acute, chronic malnutrition and micronutrient deficiencies were common in HIV infected children, especially in those not on ART and having morbidity. With severe malnutrition being an alarming consequence of HIV, prophylactic nutritive care should be considered for integration into HIV care strategies besides initiation of ART to improve the nutritional status and quality of life of these children.

  10. INCIDENCE AND CLINICAL FEATURES OF TUBERCULOSIS IN HIV-INFECTED CHILDREN IN THE SVERDLOVSK REGION

    Directory of Open Access Journals (Sweden)

    N. V. Eismont

    2014-01-01

    Full Text Available The paper analyzes the structure of HIV-infected children who was ill with tuberculosis in the Sverdlovsk Region in 2004-2012. The incidence of tuberculosis in children aged 0 to 14 years in the Sverdlovsk Region showed a 79.4% increase in the above period due to the introduction of Russian innovative technologies for the diagnosis of this disease in children. At the same time there was a rise in both the number of HIV-infected children aged 0 to 14 years and the proportion of same-age children with late-stage HIV infection. Simultaneously, the incidence of tuberculosis in the non-HIV-infected children aged 0 to 14 years was 55.2-193.2 times lower than that in the HIV-infected children. In 2004-2014, the Sverdlovsk Region notified fewer new cases of tuberculosis among the children without HIV infection than among those with its late stages. Non-HIV-infected children of both sexes were also ill with tuberculosis less frequently than HIV-infected boys and girls. HIV-infected children 1-3 and 7-14 years of age proved to be most vulnerable to tuberculosis. Among those who fell ill with tuberculosis, there was a preponderance of patients with late-stage HIV infection; moreover, the majority (79.6% received highly active antiretroviral therapy. 63.3% of the cases were in contact with a tuberculosis patient, only every five patients had chemoprophylaxis for this disease. High-quality vaccination against tuberculosis prevented complications and bacterial excretion in children with comorbidity. Out of the clinical forms of tuberculosis in children with HIV infection, there was a predominance of primary tuberculous complex and intrathoracic lymph node tuberculosis. The latter was less common in children without HIV infection than in those with this disease; the same was true of bacterial excretion in respiratory tuberculosis.

  11. HIV INFECTION AND HIV-ASSOCIATED TUBERCULOSIS IN CHILDREN IN UKRAINE

    Directory of Open Access Journals (Sweden)

    O. I. Belogortseva

    2012-01-01

    Full Text Available The article presents data on the epidemiology of HIV infection and co-infection with HIV/TB in children in Ukraine. Along with the increasing number of HIV-infected women of reproductive age and their children, it is mentioned the growth of tuberculosis among HIV-infected children. The problems of adequate monitoring and management of these patients, in particular with regard to the prevention of tuberculosis among them are described. There are made conclusions about the need to improve the delivery system of TB care for children born by HIV-infected mothers.

  12. [Incidence of cancer in Chilean HIV-infected children].

    Science.gov (United States)

    Vlllarroel, Julia; Álvarez, Ana M; Chávez, Ana; Cofré, José; Galaz, M Isabel; Ledesma, Patricio; Peña, Anamaría; Vizueta, Eloisa; Wu, Elba

    2015-12-01

    Pediatric HIV (+) patients have a 100 times greater risk of cancer than HIV (-) children. To describe in Chilean HIV (+) children, cancer types, its appearance in relation to the stages of HIV disease and mortality. A protocol was created to know some characteristics of these patients from the point of view of their HIV infection and cancer pathology. Of 360 HIV (+) children confirmed by the Institute of Public Health to May 2014, 9 patients with neoplastic disease (2.5%) were diagnosed. All the children were on ART, had more than three years of evolution of HIV infection and were in moderate to severe clinical/immunological stages. Lymphoma was the most common cancer. Five children, has received therapy according to Programa Infantil Nacional de Drogas Antineoplásicas (PINDA). There was no interaction between cancer treatment and antiretroviral therapy. Mortality was 13.8 x 1000 (5 cases). The incidence and type of neoplasia is consistent with the international literature, with less survival than HIV (+) children without tumors. The occurrence of cancer was observed in children with moderate to severe clinical and immunological compromise.

  13. (BCG) infection in HIV-infected children

    African Journals Online (AJOL)

    booked for regular follow-up, from which his caretakers defaulted. ... Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital and. University of .... growing concerns over the morbidity and mortality of BCG immunisation in ...

  14. Duration of hospitalization and appetite of HIV-infected South-African children

    NARCIS (Netherlands)

    Mda, S.; Raaij, van J.M.A.; MacIntyre, U.E.; Villiers, de F.R.M.; Kok, F.J.

    2011-01-01

    Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diarrhoea and pneumonia in HIV-infected children are thought to be more severe than in HIV-uninfected children. The objective of this study was to compare duration of hospitalization, appetite and

  15. Nosocomial infections in HIV-infected and HIV-uninfected children ...

    African Journals Online (AJOL)

    Five HIV-infected children (11%) died and four of the deaths were known to be due to nosocomial infection; only one HIV-uninfected child died from severe miliary TB. Conclusion Nosocomial infections occurring in HIV-infected children are a serious cause of morbidity and mortality in children hospitalised for the treatment ...

  16. Multiple micronutrient supplementation improves vitamin B12 and folate concentrations of HIV infected children in Uganda: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bolann Bjørn J

    2011-05-01

    Full Text Available Abstract Background The effect of multiple micronutrient supplementation on vitamin B12 and folate has hither to not been reported in African HIV infected children. This paper describes vitamin B12 and folate status of Ugandan HIV infected children aged 1-5 years and reports the effect of multiple micronutrient supplementation on serum vitamin B12 and folate concentrations. Methods Of 847 children who participated in a multiple micronutrient supplementation trial, 214 were assessed for vitamin B12 and folate concentrations pre and post supplementation. One hundred and four children were randomised to two times the recommended dietary allowance (RDA of a 14 multiple micronutrient supplement (MMS and 114 to a 'standard of care' supplement of 6 multivitamins (MV. Serum vitamin B12 was measured by an electrochemiluminescence immunoassay and folate by a competitive protein-binding assay using Modular E (Roche automatic analyzer. Vitamin B12 concentrations were considered low if less than 221picomoles per litre (pmol/L and folate if Results Vitamin B12 was low in 60/214 (28% and folate in 62/214 (29.0% children. In the MMS group, the median concentration (IQR of vitamin B12 at 6 months was 401.5 (264.3 - 518.8 pmol/L compared to the baseline of 285.5 (216.5 - 371.8 pmol/L, p 12 at 6 months was 288.5 (198.8 - 391.0 pmol/L compared to the baseline of 280.0 (211.5 - 386.3 pmol/L while the median (IQR folate concentrations at 6 months were 16.5 (11.7 - 22.1 nmol/L compared to 15.7 (11.9 - 22.1 nmol/L at baseline. There was a significant difference in the MMS group in both vitamin B12 and folate concentrations but no difference in the MV group. Conclusions Almost a third of the HIV infected Ugandan children aged 1-5 years had low serum concentrations of vitamin B12 and folate. Multiple micronutrient supplementation compared to the 'standard of care' supplement of 6 multivitamins improved the vitamin B12 and folate status of HIV infected children in Uganda

  17. A behavioral and cognitive profile of clinically stable HIV-infected children

    NARCIS (Netherlands)

    Nozyce, ML; Lee, SS; Wiznia, A; Nachman, S; Mofenson, LM; Smith, ME; Yogev, R; McIntosh, K; Stanley, K; Pelton, S

    OBJECTIVE. The purpose of this research was to characterize behavioral and cognitive profiles of clinically and immunologically stable antiretroviral-experienced HIV-infected children. METHODS. Two hundred seventy-four previously treated HIV-infected children aged 2 to 17 years were assessed for

  18. Cerebral injury in perinatally HIV-infected children compared to matched healthy controls

    NARCIS (Netherlands)

    Cohen, Sophie; Caan, Matthan W. A.; Mutsaerts, Henk-Jan; Scherpbier, Henriette J.; Kuijpers, Taco W.; Reiss, Peter; Majoie, Charles B. L. M.; Pajkrt, Dasja

    2016-01-01

    The current study aims to evaluate the neurologic state of perinatally HIV-infected children on combination antiretroviral therapy and to attain a better insight into the pathogenesis of their persistent neurologic and cognitive deficits. We included perinatally HIV-infected children between 8 and

  19. Maternal Nutritional Status Predicts Adverse Birth Outcomes among HIV-Infected Rural Ugandan Women Receiving Combination Antiretroviral Therapy

    OpenAIRE

    Sera Young; Katherine Murray; Julia Mwesigwa; Paul Natureeba; Beth Osterbauer; Jane Achan; Emmanuel Arinaitwe; Tamara Clark; Veronica Ades; Albert Plenty; Edwin Charlebois; Theodore Ruel; Moses Kamya; Diane Havlir; Deborah Cohan

    2012-01-01

    Objective Maternal nutritional status is an important predictor of birth outcomes, yet little is known about the nutritional status of HIV-infected pregnant women treated with combination antiretroviral therapy (cART). We therefore examined the relationship between maternal BMI at study enrollment, gestational weight gain (GWG), and hemoglobin concentration (Hb) among 166 women initiating cART in rural Uganda. Design Prospective cohort. Methods HIV-infected, ART-naïve pregnant women were enro...

  20. Short-Term Micronutrient Supplementation Reduces the Duration of Pneumonia and Diarrheal Episodes in HIV-Infected Children

    NARCIS (Netherlands)

    Mda, S.; Raaij, van J.M.A.; Villiers, de F.P.R.; MacIntyre, U.E.; Kok, F.J.

    2010-01-01

    The duration of pneumonia and of diarrhea is reported to be longer in HIV-infected than in uninfected children. We assessed the effect of a multi-micronutrient supplement on the duration of hospitalization in HIV-infected children. In a double-blind, randomized trial, HIV-infected children (4–24 mo)

  1. Exploring HIV infection and susceptibility to measles among older children and adults in Malawi: a facility-based study

    Directory of Open Access Journals (Sweden)

    Jonathan A. Polonsky

    2015-02-01

    Conclusions: We found no evidence that HIV infection contributes to the risk of measles infection among adults, but HIV-infected children (including at ages older than previously reported, were less likely to be seroprotected in this sample.

  2. Maternal nutritional status predicts adverse birth outcomes among HIV-infected rural Ugandan women receiving combination antiretroviral therapy.

    Science.gov (United States)

    Young, Sera; Murray, Katherine; Mwesigwa, Julia; Natureeba, Paul; Osterbauer, Beth; Achan, Jane; Arinaitwe, Emmanuel; Clark, Tamara; Ades, Veronica; Plenty, Albert; Charlebois, Edwin; Ruel, Theodore; Kamya, Moses; Havlir, Diane; Cohan, Deborah

    2012-01-01

    Maternal nutritional status is an important predictor of birth outcomes, yet little is known about the nutritional status of HIV-infected pregnant women treated with combination antiretroviral therapy (cART). We therefore examined the relationship between maternal BMI at study enrollment, gestational weight gain (GWG), and hemoglobin concentration (Hb) among 166 women initiating cART in rural Uganda. Prospective cohort. HIV-infected, ART-naïve pregnant women were enrolled between 12 and 28 weeks gestation and treated with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor-based combination regimen. Nutritional status was assessed monthly. Neonatal anthropometry was examined at birth. Outcomes were evaluated using multivariate analysis. Mean GWG was 0.17 kg/week, 14.6% of women experienced weight loss during pregnancy, and 44.9% were anemic. Adverse fetal outcomes included low birth weight (LBW) (19.6%), preterm delivery (17.7%), fetal death (3.9%), stunting (21.1%), small-for-gestational age (15.1%), and head-sparing growth restriction (26%). No infants were HIV-infected. Gaining HIV-infected women initiating cART during pregnancy, grossly inadequate GWG was common. Infants whose mothers gained HIV-infected women. Clinicaltrials.gov NCT00993031.

  3. Body composition and lipodystrophy in prepubertal HIV-infected children

    Directory of Open Access Journals (Sweden)

    Cecilia Zanin Palchetti

    Full Text Available OBJECTIVE: To identify lipodystrophy in prepubertal HIV-infected children using anthropometric parameters and body composition assessment. METHODS: Cross-sectional study including 40 prepubertal HIV-infected children of both genders seen at the Care Center of the Division of Pediatric Infectious Diseases - Universidade Federal de São Paulo, São Paulo city, Brazil, was carried out from August to December 2008. Age, clinical and immunological status, prophylaxis, transmission and highly active antiretroviral therapy were recorded. Body mass index z-score and height-for-age z-score were calculated to characterize the nutritional status. Circumferences were measured with flexible tape and skinfolds were assessed by an adipometry. Fat mass and lean mass were determined by dual-energy X-ray absorptiometry. Presence of clinical signs of lipodystrophy was assessed by a trained clinician. Data were analyzed using SPSS 12.0 software. RESULTS: The mean age and standard deviation were 9.8 (1.2 years, 50% were girls and 82.5% children from B and C categories. Clinical lipodystrophy and dislypidemia were present in 27.5% and 70%, respectively. The trunk to arm ratio and the limb to trunk ratio had positive association with lipodystrophy. Patients with lipodystrophy had short stature, higher triglycerides values and lower HDL-cholesterol. CONCLUSION: The ratios obtained by skinfolds and dual-energy X-ray absorptiometry measurements can be considered as indicators of preclinical lipodystrophy. The cutoff points have not been determined yet; however, continuous assessment may be useful to identify early body composition changes.

  4. Normative nasalance data in Ugandan english-speaking children.

    NARCIS (Netherlands)

    K. van Lierde; Anke Luyten; G. Galiwango; A. Hodges; T. Boudolfsen; E. D'haeseleer; H. Vermeersch

    2012-01-01

    AIMS: The aim of this study was to obtain normative nasalance values for typically developing Ugandan English-speaking children as a reference point for clinical practice and further research. METHODS: Sixty-nine typically developing Ugandan children (35 males and 34 females, 2.7-13.5 years of age)

  5. Clinical profile of hospitalized HIV-infected children in Bangladesh, a low-HIV-prevalence country.

    Science.gov (United States)

    Shahrin, Lubaba; Leung, Daniel T; Matin, Nashaba; Kawser, Chowdhury Ali; Pervez, Mohammed Moshtaq; Chisti, Mohammod Jobayer

    2014-05-01

    Bangladesh has a low HIV prevalence and data on the risk factors and clinical presentation of HIV-infected children are lacking. To describe the clinical characteristics of hospitalized HIV-infected children in Bangladesh and determine the factors associated with a low CD4 count. An anonymous, retrospective review was undertaken of the medical records of all patients admitted to the HIV unit of the iccdr,b Dhaka Hospital between February 2009 and July 2012. Demographic, clinical and laboratory data were extracted from the electronic medical record system. HIV-infected children with a low absolute CD4 count (country.

  6. Salivary lactoferrin in HIV-infected children: correlation with Candida albicans carriage, oral manifestations, HIV infection and its antifungal activity.

    Science.gov (United States)

    Alves, Thais Pinto; Simões, Ana Clara Duarte Correa; Soares, Rosangela Maria de Araújo; Moreno, Daniela Sales Alviano; Portela, Maristela Barbosa; Castro, Gloria Fernanda Barbosa de Araújo

    2014-08-01

    This study aimed to evaluate the concentration of lactoferrin in the saliva of HIV infected and healthy children and analyze the associations between lactoferrin levels, Candida sp. colonization, oral manifestations and medical data. Also, the antifungal ability of lactoferrin to inhibit the growth of Candida albicans isolated from saliva of these children was investigated in vitro. Saliva was collected from 70 HIV-infected and 50 healthy children, followed by oral manifestation assessments. The salivary lactoferrin was quantified using an ELISA Kit. The salivary samples were cultured and the Candida spp. colonies counted and then identified by sugar assimilation and fermentation. The antifungal activity of lactoferrin was analyzed in vitro with 10 isolates of C. albicans from each group. The HIV infected children (mean age 9.8 ± 2.8) had higher lactoferrin levels (median 6.13 μg/ml (3.58-7.89)) and were colonized three times more by Candida sp. than the control group (mean age 9.4 ± 2.4) (median 5.74 μg/ml (3.12-6.86)) (p=0.003). Statistical associations were found considering the salivary lactoferrin levels and Candida sp. and oral manifestations between the groups. No associations between lactoferrin concentrations and oral manifestations, immunosuppression, presence of AIDS and use of HAART were observed in the HIV group. The percentage of dead C. albicans due to lactoferrin was inversely proportional to C. albicans cell density for both groups (plactoferrin and it was associated with Candida sp. colonization but no association with medical data was found. Also, both groups showed similar lactoferrin antifungal activity. Copyright © 2014. Published by Elsevier Ltd.

  7. Maternal nutritional status predicts adverse birth outcomes among HIV-infected rural Ugandan women receiving combination antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    Sera Young

    Full Text Available Maternal nutritional status is an important predictor of birth outcomes, yet little is known about the nutritional status of HIV-infected pregnant women treated with combination antiretroviral therapy (cART. We therefore examined the relationship between maternal BMI at study enrollment, gestational weight gain (GWG, and hemoglobin concentration (Hb among 166 women initiating cART in rural Uganda.Prospective cohort.HIV-infected, ART-naïve pregnant women were enrolled between 12 and 28 weeks gestation and treated with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor-based combination regimen. Nutritional status was assessed monthly. Neonatal anthropometry was examined at birth. Outcomes were evaluated using multivariate analysis.Mean GWG was 0.17 kg/week, 14.6% of women experienced weight loss during pregnancy, and 44.9% were anemic. Adverse fetal outcomes included low birth weight (LBW (19.6%, preterm delivery (17.7%, fetal death (3.9%, stunting (21.1%, small-for-gestational age (15.1%, and head-sparing growth restriction (26%. No infants were HIV-infected. Gaining <0.1 kg/week was associated with LBW, preterm delivery, and a composite adverse obstetric/fetal outcome. Maternal weight at 7 months gestation predicted LBW. For each g/dL higher mean Hb, the odds of small-for-gestational age decreased by 52%.In our cohort of HIV-infected women initiating cART during pregnancy, grossly inadequate GWG was common. Infants whose mothers gained <0.1 kg/week were at increased risk for LBW, preterm delivery, and composite adverse birth outcomes. cART by itself may not be sufficient for decreasing the burden of adverse birth outcomes among HIV-infected women.Clinicaltrials.gov NCT00993031.

  8. Anemia and growth failure among HIV-infected children in India: a retrospective analysis

    Directory of Open Access Journals (Sweden)

    Shet Anita

    2009-06-01

    Full Text Available Abstract Background Anemia and poor nutrition have been previously described as independent risk factors for death among HIV-infected children. We sought to describe nutritional status, anemia burden and HIV disease correlates among infected children in India. Methods We analyzed retrospective data from 248 HIV-infected children aged 1–12 years attending three outpatient clinics in South India (2004–2006. Standard WHO definitions were used for anemia, HIV staging and growth parameters. Statistical analysis included chi square, t tests, univariate and multivariate logistic regression analyses. Results The overall prevalence of anemia (defined as hemoglobin Conclusion The high prevalence and strong interrelationship of anemia and poor nutrition among HIV-infected children in India, particularly those living in rural areas underscores the need for incorporating targeted nutritional interventions during national scale up of care, support and treatment among HIV-infected children.

  9. Factors influencing T cell activation and programmed death 1 expression in HIV-infected children.

    Science.gov (United States)

    Prendergast, Andrew; O'Callaghan, Maria; Menson, Esse; Hamadache, Djamel; Walters, Sam; Klein, Nigel; Goulder, Philip

    2012-05-01

    Immune activation is the best marker of HIV disease progression in both adults and children. However, the factors that drive immune activation in HIV-infected children remain incompletely understood and may differ from those in adults. Immune activation was investigated in a cohort of 93 untreated HIV-infected children, of median age 10.8 years, and 37 HIV-uninfected children. CD8(+) T cell activation, which was higher in HIV-infected than HIV-uninfected children (pdeath 1 (PD-1) expression on CD8(+) T cells, which was higher in HIV-infected children than HIV-uninfected children (pHIV-specific CD8(+) T cell response. CD3(+)CD4(+)CD25(hi)FoxP3(+) regulatory T cells (Tregs) were depleted in HIV-infected, compared to HIV-uninfected, children [median 1.0% (IQR 0.6, 1.9) vs. 2.6% (IQR 1.7, 3.2) CD3 cells; pHIV itself, and to the depletion of Tregs that occurs during HIV infection. Further understanding of the factors that drive immune activation in children is critical to developing future therapeutic strategies in this population.

  10. Increased risk of asthma and atopic dermatitis in perinatally HIV-infected children and adolescents

    Science.gov (United States)

    Siberry, George K.; Leister, Erin; Jacobson, Denise; Foster, Samuel B.; Seage, George R.; Lipshultz, Steven E.; Paul, Mary E.; Purswani, Murli; Colin, Andrew A.; Scott, Gwendolyn; Shearer, William T.

    2011-01-01

    The incidence of asthma and atopic dermatitis (AD) were evaluated in HIV-infected (n=451) compared to HIV-exposed (n=227) but uninfected (HEU) children and adolescents by abstraction from clinical charts. Asthma was more common in HIV-infected compared to HEU children by clinical diagnosis (25% vs. 20%, p = 0.101), by asthma medication use, (31% vs. 22%, p = 0.012), and by clinical diagnosis or both medication use, (34% vs. 25%, p = 0.012). HIV-infected children had a greater risk of asthma compared to HEU children (HR = 1.37, 95% CI: 1.01 to 1.86). AD was more common in HIV-infected than HEU children (20% vs. 12%, p = 0.009)) and children with AD were more likely to have asthma in both cohorts (41% vs. 29%, p = 0.010). HIV-infected children and adolescents in this study had a 30% increased incidence of asthma and AD, a finding critical for millions of HIV-infected children worldwide. PMID:22094294

  11. Measles in HIV-infected children in southern Africa | Sheikh | South ...

    African Journals Online (AJOL)

    . Given the high human immunodeficiency virus (HIV) prevalence in the region, the particular features of measles in HIV-infected individuals are of interest to clinicians, especially as regards children, as are measles immunisation strategies for ...

  12. raemia among HIV-infected under -five children in a tertiary hospital ...

    African Journals Online (AJOL)

    2016-12-06

    %) respectively. Streptococcus pneumoniae was the second commonest isolate account- ing for 3 /19(15.8%)(Table 3). Table 2: Prevalence of bacteraemia according to age groups among HIV-infected children χ2=0.17, df=2, ...

  13. Central nervous system manifestations of HIV infection in children

    Energy Technology Data Exchange (ETDEWEB)

    George, Reena; Andronikou, Savvas; Plessis, Jaco du; Plessis, Anne-Marie du; Maydell, Arthur [University of Stellenbosch, Department of Radiology, Tygerberg Academic Hospital, Cape Town (South Africa); Toorn, Ronald van [University of Stellenbosch, Department of Paediatrics and Child Health, Tygerberg Academic Hospital, Cape Town (South Africa)

    2009-06-15

    Vertically transmitted HIV infection is a major problem in the developing world due to the poor availability of antiretroviral agents to pregnant women. HIV is a neurotrophic virus and causes devastating neurological insults to the immature brain. The effects of the virus are further compounded by the opportunistic infections and neoplasms that occur as a result of the associated immune suppression. This review focuses on the imaging features of HIV infection and its complications in the central nervous system. (orig.)

  14. Is Urinary Lipoarabinomannan the Result of Renal Tuberculosis? Assessment of the Renal Histology in an Autopsy Cohort of Ugandan HIV-Infected Adults.

    Directory of Open Access Journals (Sweden)

    Janneke A Cox

    Full Text Available The detection of urinary lipoarabinomannan (LAM, a mycobacterial cell wall component, is used to diagnose tuberculosis (TB. How LAM enters the urine is not known. To investigate if urinary LAM-positivity is the result of renal TB infection we correlated the outcomes of urinary LAM-antigen testing to renal histology in an autopsy cohort of hospitalized, Ugandan, HIV-infected adults.We performed a complete autopsy, including renal sampling, in HIV-infected adults that died during hospitalization after written informed consent was obtained from the next of kin. Urine was collected postmortem through post-mortem catheterisation or by bladder puncture and tested for LAM with both a lateral flow assay (LFA and an ELISA assay. Two pathologists assessed the kidney histology. We correlated the LAM-assay results and the histology findings.Of the 13/36 (36% patients with a positive urinary LAM ELISA and/or LFA, 8/13 (62% had renal TB. The remaining 5 LAM-positive patients had disseminated TB without renal involvement. Of the 23 LAM-negative patients, 3 had disseminated TB without renal involvement. The remaining LAM-negative patients had no TB infection and died mostly of fungal and bacterial infections. LAM LFA had a sensitivity of 81% and specificity of 100% to diagnose TB at any location, and the LAM ELISA a sensitivity of 63% and a specificity of 100%. 54% (7/13 LAM LFA-positive patients were not on anti-TB treatment at the time of death.Renal TB infection explained LAM-positivity in the majority of patients. Patients with disseminated TB without renal involvement can also be diagnosed with LAM. This suggests that other mechanisms that lead to urinary LAM-positivity exist in a minority of patients.

  15. The prevalence and etiology of anemia among HIV-infected children in India.

    Science.gov (United States)

    Shet, Anita; Arumugam, Karthika; Rajagopalan, Nirmala; Dinakar, Chitra; Krishnamurthy, Shubha; Mehta, Saurabh; Shet, Arun S

    2012-03-01

    In this report, the prevalence and multifactorial etiology of anemia among Indian human immunodeficiency virus (HIV)-infected children are described. HIV-infected children aged 2-12 years were prospectively enrolled in 2007-2008. Measured parameters included serum ferritin, vitamin B(12), red-cell folate, soluble transferrin receptor, and C-reactive protein. Children received antiretroviral therapy (ART), iron and, folate supplements as per standard of care. Among 80 enrolled HIV-infected children (mean age 6.8 years), the prevalence of anemia was 52.5%. Etiology of anemia was found to be iron deficiency alone in 38.1%, anemia of inflammation alone in 38.1%, combined iron deficiency and anemia of inflammation alone in 7.1%, vitamin B(12) deficiency in 7.1%, and others in 9.5%. Median iron intake was 5.7 mg/day (recommended dietary allowance 18-26 mg/day). Compared to nonanemic children, anemic children were more likely to be underweight (weight Z-score -2.5 vs. -1.9), stunted (height Z-score -2.6 vs. -1.9), with lower CD4 counts (18% vs. 24%, p Children taking ART combined with iron supplements experienced a larger increase in Hb compared to those receiving neither ART nor iron supplements (mean Hb change 1.5 g/dl, p children with HIV infection. Micronutrient supplements combined with ART improved anemia in HIV-infected children.

  16. Education and Nutritional Status of Orphans and Children of HIV-Infected Parents in Kenya

    Science.gov (United States)

    Mishra, Vinod; Arnold, Fred; Otieno, Fredrick; Cross, Anne; Hong, Rathavuth

    2007-01-01

    We examined whether orphaned and fostered children and children of HIV-infected parents are disadvantaged in schooling, nutrition, and health care. We analyzed data on 2,756 children aged 0-4 years and 4,172 children aged 6-14 years included in the 2003 Kenya Demographic and Health Survey, with linked anonymous HIV testing, using multivariate…

  17. Living environment and schooling of children with HIV-infected parents in southwest China.

    Science.gov (United States)

    Yang, H; Wu, Z; Duan, S; Li, Z; Li, X; Shen, M; Mathur, A; Stanton, B

    2006-10-01

    A cross-sectional household survey was conducted in Longchuan County, China, to study the lives of children with HIV-infected parents. Registered HIV-infected drug users and their households were approached and information about the living environment of children school and more likely to be truant if enrolled in school. Findings in the current study suggest that many children whose parents are infected with HIV or have died from HIV are living in stressful environments with minimal support from the community. Efforts should be taken to provide support and supervision to these children.

  18. Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy

    Science.gov (United States)

    YOUNG, Sera L.; PLENTY, Albert H. J.; LUWEDDE, Flavia A.; NATAMBA, Barnabas K.; NATUREEBA, Paul; ACHAN, Jane; MWESIGWA, Julia; RUEL, Theodore D.; ADES, Veronica; OSTERBAUER, Beth; CLARK, Tamara D.; DORSEY, Grant; CHARLEBOIS, Edwin D.; KAMYA, Moses; HAVLIR, Diane V.; COHAN, Deborah L.

    2015-01-01

    Objectives Household food insecurity may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore explored if greater household food insecurity was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. Methods We assessed these outcomes among 180 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial (NCT00993031), a prospective, longitudinal cohort study in Tororo, Uganda. Results Household food insecurity was common; the prevalence of severe, moderate, and little to no household hunger was 7.3%, 40.5%, and 52.2%, respectively. Poor maternal nutritional status was common and women in households experiencing moderate to severe household hunger (MSHH) had statistically significantly lower BMIs at enrollment (21.3 vs 22.5, p<0.01) and prior to delivery (22.6 vs. 23.8, p<0.01). However, MSHH was not associated with maternal BMI or gestational weight gain in multivariate models. The prevalence (95% CI) of EBF at 6 months was 66.4% (59.0%-72.8%), and the proportion of women breastfeeding at 12 months was 80.0% (73.0%-85.3%).MSHH was not associated with EBF at 6 months or breastfeeding at 12 months. However, among those women still EBF at 4 months (81.0% of population), those experiencing MSHH were significantly more likely to cease EBF between 4 and 6 months (aHR: 2.52, 95% CI 1.03-6.19). Conclusions Interventions addressing household food insecurity, maternal malnutrition and suboptimal breastfeeding practices are urgently needed. PMID:24585398

  19. Growth, immune and viral responses in HIV infected African children receiving highly active antiretroviral therapy: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Bagenda Danstan

    2010-08-01

    Full Text Available Abstract Background Scale up of paediatric antiretroviral therapy in resource limited settings continues despite limited access to routine laboratory monitoring. We documented the weight and height responses in HIV infected Ugandan children on highly active antiretroviral therapy and determined clinical factors associated with successful treatment outcomes. Methods A prospective cohort of HIV infected children were initiated on HAART and followed for 48 weeks. Body mass index for age z scores(BAZ, weight and height-for-age z scores (WAZ & HAZ were calculated: CD4 cell % and HIV-1 RNA were measured at baseline and every 12 weeks. Treatment outcomes were classified according to; both virological and immunological success (VS/IS, virological failure and immunological success (VF/IS. virological success and immunological failure (VS/IF and both virological and immunological failure (VF/IF. Results From March 2004 until May 2006, 124 HIV infected children were initiated on HAART. The median age (IQR was 5.0 years (2.1 - 7.0 and 49% (61/124 were female. The median [95% confidence interval (CI] BAZ, WAZ and HAZ at baseline were 0.29 (-2.9, -1.2, -1.2 (-2.1, -0.5 and -2.06 (-2.9, -1.2 respectively. Baseline median CD4 cell % and log10 HIV-1 RNA were; 11.8% (7.5-18.0 and 5.6 (5.2-5.8 copies/ml. By 48 weeks, mean WAZ and HAZ in the VF/IS group, which was younger, increased from - 0.98 (SD 1.7 to + 1.22 (SD 1.2 and from -1.99 (1.7 to + 0.76 (2.4 respectively. Mean increase in WAZ and HAZ in the VS/IF group, an older group was modest, from -1.84 (1.3 to - 0.41 (1.2 and -2.25 (1.2 to -1.16 (1.3 respectively. Baseline CD4 cell % [OR 6.97 95% CI (2.6 -18.6], age [OR 4.6 95% CI (1.14 -19.1] and WHO clinical stage [OR 3.5 95%CI (1.05 -12.7] were associated with successful treatment outcome. Conclusions HIV infected Ugandan children demonstrated a robust increase in height and weight z scores during the first 48 weeks of HAART, including those who failed to

  20. The importance of nutritional care in HIV-infected children in resource-limited settings.

    Science.gov (United States)

    McHenry, Megan S; Apondi, Edith; Vreeman, Rachel C

    2014-12-01

    Renewed efforts to provide proper nutritional care are essential for appropriate pediatric HIV management. Current studies support the use of vitamin A and macronutrients that increase caloric and protein intake. With additional research on key issues such as the needed composition and timing for nutritional supplementation, we can determine the best strategies to support the growth and development of HIV-infected children in resource-limited settings. Malnutrition among children is common in the resource-limited settings where HIV infection is most prevalent. While malnutrition is associated with higher morbidity and mortality for HIV-infected children, there is only limited evidence to guide the use of nutritional support for HIV-infected children. The best studied is vitamin A, which is associated with improved mortality and clinical outcomes. Zinc and multivitamin supplementation have not consistently been associated with clinical benefits. Limited research suggests macronutrient supplementation, which typically uses enriched formulas or foods, improves key anthropometrics for HIV-infected children, but the optimal composition of nutrients for supplementation has not been determined. More research is needed to understand the most efficient and sustainable ways to ensure adequate nutrition in this vulnerable population.

  1. Assessment of antioxidants status and superoxide dismutase activity in HIV-infected children

    Directory of Open Access Journals (Sweden)

    Camila Pugliese

    Full Text Available Objective: This study aims to assess the nutritional status of selenium, copper and zinc; and also the erythrocyte superoxide dismutase activity of HIV-infected children compared to a control group. Methods: A cross-sectional study was carried out with prepubertal HIV-infected children (n = 51 and their healthy siblings (n = 32. All biochemical measurements including plasma selenium, serum copper levels, serum and erythrocyte zinc levels and erythrocyte super-oxide dismutase activity were evaluated according to dietary, clinical and biochemical parameters. Results: Compared to the control group, the HIV-infected children had lower z-score values for height-for-age (p = 0.0006, higher prevalence of stunting (11.8% (p = 0.047, lower selenium levels (p = 0.0006 and higher copper levels (p = 0.019. No difference was found concerning superoxide dismutase activity (p > 0.05. The HIV-infected group presented a higher proportion (45.1% of children with zinc intakes below the estimated average requirement (p = 0.014; however, no association with zinc biochemical parameters was found. Conclusion: HIV-infected children have an inadequate selenium and copper nutritional status, which could influence the progression to AIDS. An adequate micronutrient status could improve the clinical conditions in these patients and minimize free radical production and cellular oxidative stress.

  2. Incidence and predictors of severe anemia in Asian HIV-infected children using first-line antiretroviral therapy

    NARCIS (Netherlands)

    Bunupuradah, Torsak; Kariminia, Azar; Chan, Kwai-Cheng; Ramautarsing, Reshmie; Huy, Bui Vu; Han, Ning; Nallusamy, Revathy; Hansudewechakul, Rawiwan; Saphonn, Vonthanak; Sirisanthana, Virat; Chokephaibulkit, Kulkanya; Kurniati, Nia; Kumarasamy, Nagalingeswaran; Yusoff, Nik Khairulddin Nik; Razali, Kamarul; Fong, Siew Moy; Sohn, Annette H.; Lumbiganon, Pagakrong

    2013-01-01

    There are limited data on treatment-related anemia in Asian HIV-infected children. Data from Asian HIV-infected children aged <18 years on first-line highly active antiretroviral therapy (HAART) were used. Children who had pre-existing severe anemia at baseline were excluded. Anemia was graded using

  3. Household food insecurity, maternal nutritional status, and infant feeding practices among HIV-infected Ugandan women receiving combination antiretroviral therapy.

    Science.gov (United States)

    Young, Sera L; Plenty, Albert H J; Luwedde, Flavia A; Natamba, Barnabas K; Natureeba, Paul; Achan, Jane; Mwesigwa, Julia; Ruel, Theodore D; Ades, Veronica; Osterbauer, Beth; Clark, Tamara D; Dorsey, Grant; Charlebois, Edwin D; Kamya, Moses; Havlir, Diane V; Cohan, Deborah L

    2014-11-01

    Household food insecurity (HHFI) may be a barrier to both optimal maternal nutritional status and infant feeding practices, but few studies have tested this relationship quantitatively, and never among HIV-infected individuals. We therefore described the prevalence of HHFI and explored if it was associated with poorer maternal nutritional status, shorter duration of exclusive breastfeeding (EBF) and fewer animal-source complementary foods. We assessed these outcomes using bivariate and multivariate analyses among 178 HIV-infected pregnant and breastfeeding (BF) women receiving combination antiretroviral therapy in the PROMOTE trial (NCT00993031), a prospective, longitudinal cohort study in Tororo, Uganda. HHFI was common; the prevalence of severe, moderate, and little to no household hunger was 7.3, 39.9, and 52.8 %, respectively. Poor maternal nutritional status was common and women in households experiencing moderate to severe household hunger (MSHH) had statistically significantly lower body mass index (BMIs) at enrollment (21.3 vs. 22.5, p < 0.01) and prior to delivery (22.6 vs. 23.8, p < 0.01). BMI across time during pregnancy, but not gestational weight gain, was significantly lower for MSHH [adjusted beta (95 % CI) -0.79 (-1.56, -0.02), p = 0.04; -2.06 (-4.31, 0.19), p = 0.07], respectively. The prevalence (95 % CI) of EBF at 6 months was 67.2 % (59.7-73.5 %), and the proportion of women BF at 12 months was 80.4 % (73.3-85.7 %). MSHH was not associated with prevalence of EBF at 6 months or BF at 12 months. However, among those women still EBF at 4 months (81.4 % of population), those experiencing MSHH were significantly more likely to cease EBF between 4 and 6 months (aHR 2.38, 95 % CI 1.02-5.58). The prevalence of HHFI, maternal malnutrition, and suboptimal infant feeding practices are high and the causal relationships among these phenomena must be further explored.

  4. HIV-Infected Ugandan Women on Antiretroviral Therapy Maintain HIV-1 RNA Suppression Across Periconception, Pregnancy, and Postpartum Periods.

    Science.gov (United States)

    Matthews, Lynn T; Ribaudo, Heather B; Kaida, Angela; Bennett, Kara; Musinguzi, Nicholas; Siedner, Mark J; Kabakyenga, Jerome; Hunt, Peter W; Martin, Jeffrey N; Boum, Yap; Haberer, Jessica E; Bangsberg, David R

    2016-04-01

    HIV-infected women risk sexual and perinatal HIV transmission during conception, pregnancy, childbirth, and breastfeeding. We compared HIV-1 RNA suppression and medication adherence across periconception, pregnancy, and postpartum periods, among women on antiretroviral therapy (ART) in Uganda. We analyzed data from women in a prospective cohort study, aged 18-49 years, enrolled at ART initiation and with ≥1 pregnancy between 2005 and 2011. Participants were seen quarterly. The primary exposure of interest was pregnancy period, including periconception (3 quarters before pregnancy), pregnancy, postpartum (6 months after pregnancy outcome), or nonpregnancy related. Regression models using generalized estimating equations compared the likelihood of HIV-1 RNA ≤400 copies per milliliter, pregnancy, and 89% of postpartum visits, and was more likely during periconception (adjusted odds ratio, 2.15) compared with nonpregnant periods. Average ART adherence was 90% [interquartile range (IQR), 70%-98%], 93% (IQR, 82%-98%), 92% (IQR, 72%-98%), and 88% (IQR, 63%-97%) during nonpregnant, periconception, pregnant, and postpartum periods, respectively. Average adherence pregnancy were virologically suppressed at most visits, with an increased likelihood of suppression and high adherence during periconception follow-up. Increased frequency of 72-hour gaps suggests a need for increased adherence support during postpartum periods.

  5. Multi-micronutrient supplementation in HIV-infected South African children : effect on nutritional s tatus, diarrhoea and respiratory infections

    NARCIS (Netherlands)

    Mda, S.

    2011-01-01

      Background: The nutritional status of HIV-infected children is reported to be poor. Diarrhoea and acute respiratory infections tend to be more common and severe in HIV-infected children than in uninfected ones. Deficiencies of micronutrients may result in poor growth and

  6. Effects of Perinatal HIV Infection and Early Institutional Rearing on Physical and Cognitive Development of Children in Ukraine

    Science.gov (United States)

    Dobrova-Krol, Natasha A.; van IJzendoorn, Marinus H.; Bakermans-Kranenburg, Marian J.; Juffer, Femmie

    2010-01-01

    To study the effects of perinatal HIV-1 infection and early institutional rearing on the physical and cognitive development of children, 64 Ukrainian uninfected and HIV-infected institutionalized and family-reared children were examined (mean age = 50.9 months). Both HIV infection and institutional care were related to delays in physical and…

  7. Improved appetite after multi-micronutrient supplementation for six months in HIV-infected South African children

    NARCIS (Netherlands)

    Mda, S.; Raaij, van J.M.A.; MacIntyre, U.E.; Villiers, de F.P.R.; Kok, F.J.

    2010-01-01

    The aim of the study was to assess the effect of multi-micronutrient supplementation on the appetite of HIV-infected children. HIV-infected children (6-24 months) who had previously been hospitalized were enrolled into a double-blind randomized trial, and given daily multi-micronutrient supplements

  8. Bone mineral density increases in HIV-infected children treated with long-term combination antiretroviral therapy

    NARCIS (Netherlands)

    Bunders, Madeleine J.; Frinking, Olivier; Scherpbier, Henriette J.; van Arnhem, Lotus A.; van Eck-Smit, Berthe L.; Kuijpers, Taco W.; Zwinderman, Aeilko H.; Reiss, Peter; Pajkrt, Dasja

    2013-01-01

    The long-term treatment of human immunodeficiency virus (HIV)-infected children with combination antiretroviral therapy (cART) requires assessment of potential adverse effects, such as osteoporosis. Longitudinal data on bone mineral density (BMD) in HIV-infected children showed that cumulative

  9. The Prevalence of Motor Delay among HIV Infected Children Living in Cape Town, South Africa

    Science.gov (United States)

    Ferguson, Gillian; Jelsma, Jennifer

    2009-01-01

    Children living with HIV often display delayed motor performance owing to HIV infection of the central nervous system, the effects of opportunistic infections and, indirectly, owing to their social environments. Although these problems have been well documented, the impact of the virus on the development of South African children is less well…

  10. Serum zinc levels in HIV infected children attending the University of ...

    African Journals Online (AJOL)

    Background: Zinc deficiency is common in the Paediatric age group but the extent of this disorder is unknown in HIV infected children in Nigeria prompting this study. Objective: To determine the prevalence of zinc deficiency in HIV seropositive children, and compare this with age and sex matched controls. Methods: A case ...

  11. Prevalence of hematological abnormalities and malnutrition in HIV-infected under five children in Enugu.

    Science.gov (United States)

    Ezeonwu, B U; Ikefuna, A N; Oguonu, T; Okafor, H U

    2014-01-01

    Hematological abnormalities such as anemia, neutropenia, and thrombocytopenia occur in children infected by the human immunodeficiency virus (HIV). These abnormalities are due to myelosuppression caused by the HIV and contribute to the morbidity and mortality of HIV-infected children. Malnutrition is prominent in HIV-infected children due to associated conditions such as oropharyngeal candidiasis, diarrhea, and cytokine production which result in poor intake, nutrient loss, and increased metabolic rate, respectively. To determine the prevalence of hematological abnormalities (using the World Health Organization (WHO) case definitions) and malnutrition in HIV-infected children receiving care at the University of Nigeria Teaching Hospital, Enugu. The hematological and anthropometric indices of HIV-infected children between 18 and 59 months were assessed. Their hemoglobin level, neutrophil, and platelet counts were the hematological profiles evaluated using the WHO case definitions in HIV clinical staging. The weight-for-height z-score index was used to assess the nutritional status of subjects using the WHO reference ranges. The t-test, Chi-square, and Pearson correlation coefficient were used for statistical analysis. There were 67 HIV positive children: 34 males and 33 females, aged 18-59 months. The mean hematological levels of subjects were hemoglobin (Hb) 10.4 ± 1.2 g/dl, neutrophil count 3,031 ± 1,039 cells/mm 3 , platelets count 294 ± 78 × 109/L. Two children (3.0%) had anemia (hemoglobin malnutrition occur in HIV positive children.

  12. morbidity and mortality in hiv-infected children admitted at moi ...

    African Journals Online (AJOL)

    2011-07-07

    Jul 7, 2011 ... the degree of immuno-suppression, current or chronic infections .... Characteristics of HIV-infected children admitted in the pediatric wards at Moi Teaching and ... Diarrhea. 8. 1. Anemia. 9. 0. Table 3. Characteristics of children previously enrolled in AMPATH who died in the wards in MTRH. Characteristic.

  13. Tuberculosis in HIV-infected infants, children, and adolescents in Latin America

    Directory of Open Access Journals (Sweden)

    Margot R. Krauss

    2015-01-01

    Conclusions: Our study emphasizes the need for adequate contact tracing of adult tuberculosis cases and screening for HIV or tuberculosis in Latin American children diagnosed with either condition. Preventive strategies in tuberculosis-exposed, HIV-infected children should be optimized.

  14. Risk factors for preterm birth among HIV-infected pregnant Ugandan women randomized to lopinavir/ritonavir- or efavirenz-based antiretroviral therapy.

    Science.gov (United States)

    Koss, Catherine A; Natureeba, Paul; Plenty, Albert; Luwedde, Flavia; Mwesigwa, Julia; Ades, Veronica; Charlebois, Edwin D; Clark, Tamara D; Achan, Jane; Ruel, Theodore; Nzarubara, Bridget; Kamya, Moses R; Havlir, Diane V; Cohan, Deborah

    2014-10-01

    Protease inhibitor-based antiretroviral therapy (ART) has been associated with preterm birth in some studies. We examined risk factors for preterm birth among women randomized to lopinavir/ritonavir (LPV/r)- or efavirenz (EFV)-based ART. This was a planned secondary analysis of the PROMOTE-Pregnant Women and Infants Study, an open-label, randomized controlled trial comparing the risk of placental malaria among HIV-infected, ART-naive pregnant Ugandan women assigned to initiate LPV/r- or EFV-based ART at 12-28 weeks gestation. Gestational age was determined based on last menstrual period and ultrasound biometry. All women received bednets and trimethoprim-sulfamethoxazole. Stillbirths, spontaneous abortions, and multiple gestations were excluded from the primary analysis. Potential risk factors for preterm birth (women were included in this analysis. At enrollment, median gestational age was 21 weeks and median CD4 cell count was 368 cells per cubic millimeter. 14.7% of deliveries in the EFV arm and 16.2% in the LPV/r arm were preterm. Preterm birth was associated with gestational weight gain below 0.1 kg/week versus 0.1 kg/week or more [odds ratio (OR) = 2.49; 95% confidence interval (CI): 1.38 to 4.47; P = 0.003]. Neither ART regimen of LPV/r versus EFV (OR = 1.12; 95% CI: 0.63 to 2.00; P = 0.69) nor placental malaria (OR = 0.74; 95% CI: 0.38 to 1.44; P = 0.37) was associated with preterm birth. LPV/r was not associated with an increased risk of preterm birth compared with EFV. However, interventions are needed to address modifiable risk factors for preterm birth, such as nutritional status (ClinicalTrials.gov, NCT00993031).

  15. Multiple micronutrient supplementation improves vitamin B₁₂ and folate concentrations of HIV infected children in Uganda: a randomized controlled trial.

    Science.gov (United States)

    Ndeezi, Grace; Tumwine, James K; Ndugwa, Christopher M; Bolann, Bjørn J; Tylleskär, Thorkild

    2011-05-21

    The effect of multiple micronutrient supplementation on vitamin B₁₂ and folate has hither to not been reported in African HIV infected children. This paper describes vitamin B₁₂ and folate status of Ugandan HIV infected children aged 1-5 years and reports the effect of multiple micronutrient supplementation on serum vitamin B12 and folate concentrations. Of 847 children who participated in a multiple micronutrient supplementation trial, 214 were assessed for vitamin B₁₂ and folate concentrations pre and post supplementation. One hundred and four children were randomised to two times the recommended dietary allowance (RDA) of a 14 multiple micronutrient supplement (MMS) and 114 to a 'standard of care' supplement of 6 multivitamins (MV). Serum vitamin B12 was measured by an electrochemiluminescence immunoassay and folate by a competitive protein-binding assay using Modular E (Roche) automatic analyzer. Vitamin B₁₂ concentrations were considered low if less than 221 picomoles per litre (pmol/L) and folate if children. In the MMS group, the median concentration (IQR) of vitamin B₁₂ at 6 months was 401.5 (264.3 - 518.8) pmol/L compared to the baseline of 285.5 (216.5 - 371.8) pmol/L, p children aged 1-5 years had low serum concentrations of vitamin B₁₂ and folate. Multiple micronutrient supplementation compared to the 'standard of care' supplement of 6 multivitamins improved the vitamin B12 and folate status of HIV infected children in Uganda. http://ClinicalTrials.govNCT00122941).

  16. Nutritional Deficiencies and Food Insecurity Among HIV-infected Children in Tanzania

    Directory of Open Access Journals (Sweden)

    Chelsea E. Modlin, BA

    2014-09-01

    Full Text Available Background: Poor nutrition has been associated with impaired immunity and accelerated disease progression in HIV- infected children. The aim of this study was to quantify the levels of nutrient intake in HIV-infected children and compare these to standard recommendations. Methods: We surveyed HIV-infected Tanzanian children enrolled in a pediatric care program that provided routine nutritional counseling and vitamin supplementation. We obtained anthropometric measurements and determined 24-hour macronutrient and micronutrient intakes and food insecurity. Values were compared to recommended nutrient intakes based on age and gender. Results: We interviewed 48 pairs of children and their caregiver(s. The age of the child ranged from 2-14 years; median age 6 and 60% female. The median weight-for-height z-score for children ≤ 5 years was 0.69 and BMI-for-age z-scores for children >5 was -0.84. Macronutrient evaluation showed that 29 (60% children were deficient in dietary intake of energy; deficiency was more common in older children (p=0.004. Micronutrient evaluation shows that over half of study subjects were deficient in dietary intake of vitamin A, vitamin D, vitamin E, thiamine, riboflavin, niacin, folate, vitamin B12, and calcium. Food insecurity was reported by 20 (58% caregivers. Conclusions and Public Health Implications: The diets of many HIV-infected children at a specialized treatment center in Tanzania do not meet recommended levels of macro- and micro-nutrients. Food insecurity was a contributory factor. Enhanced dietary counseling and provision of macro- and micro-nutrient supplements will be necessary to achieve optimal nutrition for most HIV-infected children in resource-poor regions.

  17. Challenges of malnutrition care among HIV-infected children on antiretroviral treatment in Africa.

    Science.gov (United States)

    Jesson, J; Leroy, V

    2015-05-01

    More than 90% of the estimated 3.2 million children with HIV worldwide, at the end of 2013, were living in sub-Saharan Africa. The management of these children was still difficult in 2014 despite the progress in access to antiretroviral drugs. A great number of HIV-infected children are not diagnosed at 6 weeks and start antiretroviral treatment late, at an advanced stage of HIV disease complicated by other comorbidities such as malnutrition. Malnutrition is a major problem in the sub-Saharan Africa global population; it is an additional burden for HIV-infected children because they do not respond as well as non-infected children to the usual nutritional care. HIV infection and malnutrition interact, creating a vicious circle. It is important to understand the relationship between these 2 conditions and the effect of antiretroviral treatment on this circle to taking them into account for an optimal management of pediatric HIV. An improved monitoring of growth during follow-up and the introduction of a nutritional support among HIV-infected children, especially at antiretroviral treatment initiation, are important factors that could improve response to antiretroviral treatment and optimize the management of pediatric HIV in resource-limited countries. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  18. Nucleoside analogs plus ritonavir in stable antiretroviral therapy-experienced HIV-infected children - A randomized controlled trial

    NARCIS (Netherlands)

    Nachman, SA; Stanley, K; Yogev, R; Pelton, S; Wiznia, A; Lee, S; Mofenson, L; Fiscus, S; Rathore, M; Jimenez, E; Borkowsky, W; Pitt, J; Smith, ME; Wells, B; McIntosh, K

    2000-01-01

    Context Although protease inhibitors are used routinely in adults with human immunodeficiency virus (HIV) infection, the role of these drugs in the treatment of clinically stable HIV-infected children is not clear. Objective To evaluate the safety, tolerance, and virologic response produced by a

  19. Factors affecting the survival of HIV-infected children after ART ...

    African Journals Online (AJOL)

    Background: The attention given to HIV-infected children in terms of providing ART had so far taken a second rank. This was because primary concern is about adults. Objectives: This study had the objectives to estimate the survival duration and identify socio-economic, demographic and clinical predictor variables that ...

  20. sero-prevalence of hiv infection in children attending some selected ...

    African Journals Online (AJOL)

    DR. AMINU

    children to HIV infection such as poverty, sexual abuse, homelessness and unhealthy traditional practices such as traditional circumcision should be eliminated. - Sound moral teachings are needed both at schools and homes. - Delivery of accurate knowledge of HIV by supportive supervision and monitoring of providers is ...

  1. Long-term outcomes of children treated for HIV-infection

    NARCIS (Netherlands)

    Cohen, S.

    2015-01-01

    Despite the drastic decrease of mortality and morbidity since the introduction of combination antiretroviral therapy (cART) in 1996, children with a chronic HIV-infection remain vulnerable to multiple complications that may negatively impact their physical health, cognitive function and

  2. Prevalence of Hepatitis B co-infection amongst HIV infected children ...

    African Journals Online (AJOL)

    Conclusion: Though our study shows a low prevalence of Hepatitis B co infection in HIV infected children in our centre, reduction of the rate is still strongly desirable. Reduction can be achieved by strengthing the uptake of Hepatitis B vaccine as part of the routine childhood immunization programme. Pan African Medical ...

  3. Nevirapine concentrations in HIV-infected children treated with divided fixed-dose combination antiretroviral tablets in Malawi and Zambia.

    NARCIS (Netherlands)

    Ellis, J.C.; L'homme, R.F.A.; Ewings, F.M.; Mulenga, V.; Bell, F.; Chileshe, R.; Molyneux, E.; Abernethy, J.; Oosterhout, J.J. van; Chintu, C.; Walker, A.S.; Gibb, D.M.; Burger, D.M.

    2007-01-01

    OBJECTIVE: To investigate nevirapine concentrations in African HIV-infected children receiving divided Triomune tablets (stavudine+lamivudine+nevirapine). DESIGN: Cross-sectional study. METHODS: Steady-state plasma nevirapine concentrations were determined in Malawian and Zambian children aged 8

  4. Social ecological factors associated with future orientation of children affected by parental HIV infection and AIDS.

    Science.gov (United States)

    Lin, Xiuyun; Fang, Xiaoyi; Chi, Peilian; Heath, Melissa Allen; Li, Xiaoming; Chen, Wenrui

    2016-07-01

    From a social ecological perspective, this study examined the effects of stigma (societal level), trusting relationships with current caregivers (familial level), and self-esteem (individual level) on future orientation of children affected by HIV infection and AIDS. Comparing self-report data from 1221 children affected by parental HIV infection and AIDS and 404 unaffected children, affected children reported greater stigma and lower future orientation, trusting relationships, and self-esteem. Based on structural equation modeling, stigma experiences, trusting relationships, and self-esteem had direct effects on future orientation, with self-esteem and trusting relationships partially mediating the effect of stigma experiences on children's future orientation. Implications are discussed. © The Author(s) 2014.

  5. Potential impact of infant feeding recommendations on mortality and HIV-infection in children born to HIV-infected mothers in Africa: a simulation

    Directory of Open Access Journals (Sweden)

    Seksaria Vidyunmala

    2008-05-01

    Full Text Available Abstract Background Although breast-feeding accounts for 15–20% of mother-to-child transmission (MTCT of HIV, it is not prohibited in some developing countries because of the higher mortality associated with not breast-feeding. We assessed the potential impact, on HIV infection and infant mortality, of a recommendation for shorter durations of exclusive breast-feeding (EBF and poor compliance to these recommendations. Methods We developed a deterministic mathematical model using primarily parameters from published studies conducted in Uganda or Kenya and took into account non-compliance resulting in mixed-feeding practices. Outcomes included the number of children HIV-infected and/or dead (cumulative mortality at 2 years following each of 6 scenarios of infant-feeding recommendations in children born to HIV-infected women: Exclusive replacement-feeding (ERF with 100% compliance, EBF for 6 months with 100% compliance, EBF for 4 months with 100% compliance, ERF with 70% compliance, EBF for 6 months with 85% compliance, EBF for 4 months with 85% compliance Results In the base model, reducing the duration of EBF from 6 to 4 months reduced HIV infection by 11.8% while increasing mortality by 0.4%. Mixed-feeding in 15% of the infants increased HIV infection and mortality respectively by 2.1% and 0.5% when EBF for 6 months was recommended; and by 1.7% and 0.3% when EBF for 4 months was recommended. In sensitivity analysis, recommending EBF resulted in the least cumulative mortality when the a mortality in replacement-fed infants was greater than 50 per 1000 person-years, b rate of infection in exclusively breast-fed infants was less than 2 per 1000 breast-fed infants per week, c rate of progression from HIV to AIDS was less than 15 per 1000 infected infants per week, or d mortality due to HIV/AIDS was less than 200 per 1000 infants with HIV/AIDS per year. Conclusion Recommending shorter durations of breast-feeding in infants born to HIV-infected

  6. Neurodevelopmental delay among HIV-infected preschool children receiving antiretroviral therapy and healthy preschool children in Soweto, South Africa.

    Science.gov (United States)

    Lowick, Sarah; Sawry, Shobna; Meyers, Tammy

    2012-01-01

    Neurodevelopmental delay has been documented in up to 97.5% of HIV-infected children in Soweto who were not yet on antiretroviral treatment (ART). With growing numbers of children in South Africa being successfully treated with ART, the effects of ART on neurocognitive functioning in children require investigation. The objective of this study was to determine the extent of neurodevelopmental delay in stable HIV-infected preschool children (aged five to six years) receiving ART and compare it to an apparently healthy (unconfirmed HIV-status) group of preschool children. Thirty HIV-infected preschool children (virologically and immunologically stable on ART for more than one year) were conveniently sampled from 350 eligible children on ART at the Harriet Shezi Children's Clinic in Soweto, Johannesburg. The comparison group comprised 30 well-nourished preschool children attending the Lilian Ngoyi Primary Health Care Clinic in Soweto for routine immunizations. Each child was assessed using the Griffiths Mental Development Scales-Extended Revised Version (GMDS-ER), at a single point in time. The overall developmental z-scores on GMDS-ER were children in the HIV-infected group compared to 23 (76%) in the comparison group (p = 0.166). Mental handicap (overall GQ children in the HIV-infected group compared to 10% in the comparison group (p = 0.002). There was a 7.88-fold increased likelihood of severe delay in the HIV infected group. The HIV-infected group and comparison group had significantly different (p = 0.001) mean overall GQ scores of 70 (95% CI: 66.0-74.0) and 78 (95% CI: 75.6-80.5), respectively, with lower mean scores in the HIV-infected group in all individual domains. Early initiation of ART in HIV-infected infants may improve cognitive functioning among this group; however, intervention strategies which optimize early cognitive development for all children in the area need to be urgently considered.

  7. Rotavirus antigen, cytokine, and neutralising antibody profiles in sera of children with and without HIV infection in Blantyre, Malawi.

    Science.gov (United States)

    Hull, Jennifer J; Cunliffe, Nigel; Jere, Khuzwayo C; Moon, Sung-Sil; Wang, Yuhuan; Parashar, Umesh; Jiang, Baoming

    2017-03-01

    Rotavirus and HIV infection are major causes of death among children in sub-Saharan Africa. A previous study reported no association between concomitant HIV infection and rotavirus disease severity among hospitalised children in Malawi. This study examined rotavirus antigenaemia and broader immune responses among HIV-infected and uninfected children. Stored (-80°C), paired sera from acute and convalescent phases of Malawian children less than 5 years old, hospitalised for acute gastroenteritis in the primary study, collected from July 1997 to June 1999, were utilised. Among children older than 15 months, HIV infection was defined as the presence of HIV antibody in the blood, when confirmed by at least 2 established methods. For those younger than 15 months, nested polymerase chain reaction (PCR) amplification of proviral DNA was used for verification. All were followed for up to 4 weeks after hospital discharge. Rotavirus antigen levels in sera were measured with Premier™ Rotaclone® rotavirus enzyme immunoassay (EIA) kit. Acute-phase sera were examined for 17 cytokines, using Luminex fluorescent bead human cytokine immunoassay kit. Rotavirus-specific IgA and neutralising activity were determined by EIA and microneutralisation (MN) assay, respectively. Human strains and bovine-human reassortants were propagated in MA104 cells with serum-free Iscove's Modified Dulbecco's Medium (IMDM). Differences in results, from specimens with and without HIV infection, were analysed for statistical significance using the chi-square test. We detected rotavirus antigen in 30% of the HIV-infected and 21% HIV-uninfected, in the acute-phase sera. HIV-infected children developed slightly prolonged rotavirus antigenaemia compared to HIV-uninfected children. Rotavirus-specific IgA seroconversion rates and neutralising titres were similar in HIV-infected and HIV-uninfected children, thus, HIV infection had no major effect on immune responses to rotavirus infection.

  8. Perinatal HIV Infection and Exposure and Their Association With Dental Caries in Nigerian Children.

    Science.gov (United States)

    Coker, Modupe; El-Kamary, Samer S; Enwonwu, Cyril; Blattner, William; Langenberg, Patricia; Mongodin, Emmanuel; Akhigbe, Paul; Obuekwe, Ozo; Omoigberale, Austin; Charurat, Manhattan

    2018-01-01

    Although HIV infection is associated with well-known oral pathologies, there remains a dearth of comparative studies aimed at determining the association between HIV infection/exposure and early childhood caries. This is a cross-sectional study using a convenience sample of 3 groups of children receiving care at a tertiary care hospital in Nigeria. The groups include HIV infected (HI), HIV exposed but uninfected and HIV-unexposed and -uninfected children 6 through 72 months of age. Medical records were reviewed, and caregivers were interviewed for sociodemographic, maternal and birth factors as well as early feeding and dietary information. Oral examinations were performed by trained dentist examiners. Of 335 children enrolled, 33 (9.9%) presented with caries. In an adjusted analysis, compared with HIV-unexposed and -uninfected children, HI children had significantly greater odds of having caries (odds ratio = 2.58; 95% confidence interval: 1.04-6.40; P = 0.04), but there was no statistically significant difference in HIV exposed but uninfected children (odds ratio = 2.01; 95% confidence interval: 0.56-7.23; P = 0.28). Factors significantly associated with higher caries prevalence include low CD4 counts and percentage, older age, longer duration of breastfeeding and spontaneous membrane rupture during delivery. Caries was more prevalent in HI children. These findings support the need to target HI children for oral health prevention and treatment services particularly in Nigeria and other developing countries.

  9. Neurodevelopment in perinatally HIV-infected children: a concern for adolescence

    OpenAIRE

    Barbara Laughton; Morna Cornell; Michael Boivin; Annelies Van Rie

    2013-01-01

    Globally, an estimated 3.4 million children are living with HIV, yet little is known about the effects of HIV and antiretroviral treatment (ART) on the developing brain, and the neurodevelopmental and behavioural outcomes of perinatally HIV-infected (PHIV+) adolescents. We reviewed the literature on neurodevelopmental outcomes in PHIV+ children and adolescents, and summarized the current evidence on behaviour, general cognition, specific domains, hearing and language, school performance and p...

  10. Clinical correlates of tuberculosis co-infection in HIV-infected children hospitalized in Peru.

    Science.gov (United States)

    Ramírez-Cardich, María E; Kawai, Vivian; Oberhelman, Richard A; Bautista, Christian T; Castillo, María E; Gilman, Robert H

    2006-07-01

    In developing countries, tuberculosis (TB) is responsible for almost 250,000 deaths among children yearly. Active TB in children with human immunodeficiency virus (HIV) infection is difficult to diagnose and progresses rapidly to death. The aim of this preliminary study was to investigate the prevalence and clinical correlates of TB-related illness among HIV-infected children admitted to an infectious diseases ward in Peru, a country where TB is highly endemic. Forty-seven HIV-infected children admitted for a suspected infectious process in a Peruvian hospital were investigated for evidence of clinical tuberculosis by auramine stain, culture, and polymerase chain reaction (PCR) of clinical specimens. Eight children (17%) had evidence of tuberculosis, including five with positive cultures and three with positive PCR tests only. Weight loss was the only feature associated with a positive test for tuberculosis. Radiological changes were very common in both TB-positive and TB-negative groups and these changes were not useful to identify TB-positive cases. Weight loss may be used to identify high-risk HIV positive children who require more aggressive evaluation for tuberculosis. Radiological changes were common in both TB-positive and TB-negative groups.

  11. Growth in HIV-infected children on long-term antiretroviral therapy.

    Science.gov (United States)

    Feucht, Ute D; Van Bruwaene, Lore; Becker, Piet J; Kruger, Mariana

    2016-05-01

    To describe growth in HIV-infected children on long-term antiretroviral therapy (ART) and to assess social, clinical, immunological and virological factors associated with suboptimal growth. This observational cohort study included all HIV-infected children at an urban ART site in South Africa who were younger than 5 years at ART initiation and with more than 5 years of follow-up. Growth was assessed using weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores (BAZ). Children were stratified according to pre-treatment anthropometry and age. Univariate and mixed linear analysis were used to determine associations between independent variables and weight and height outcomes. The majority of the 159 children presented with advanced clinical disease (90%) and immunosuppression (89%). Before treatment underweight, stunting and wasting were common (WAZ<-2 = 50%, HAZ<-2 = 73%, BAZ<-2 = 19%). Weight and BMI improved during the initial 12 months, while height improved over the entire 5-year period. Height at study exit was significantly worse for children with growth impairment at ART initiation (P < 0.001), and infants (<1 year) demonstrated superior improvement in terms of BMI (P = 0.04). Tuberculosis was an independent risk factor for suboptimal weight (P = 0.01) and height (P = 0.02) improvement. Weight gain was also hindered by lack of electricity (P = 0.04). Immune reconstitution and virological suppression were not associated with being underweight or stunted at study endpoint. Malnutrition was a major clinical concern for this cohort of HIV-infected children. Early ART initiation, tuberculosis co-infection management and nutritional interventions are crucial to ensure optimal growth in HIV-infected children. © 2016 John Wiley & Sons Ltd.

  12. Changes in macronutrient intake among HIV-infected children between 1995 and 2004.

    Science.gov (United States)

    Sharma, Tanvi S; Kinnamon, Daniel D; Duggan, Christopher; Weinberg, Geoffrey A; Furuta, Lauren; Bechard, Lori; Nicchitta, Jeanne; Gorbach, Sherwood L; Miller, Tracie L

    2008-08-01

    Nutritional concerns in HIV-infected children have evolved, from wasting to obesity and insulin resistance. However, little is known about the diet of these children during this evolution. We analyzed dietary macronutrient intake in HIV-infected children over nearly 10 y. HIV-infected children underwent periodic longitudinal nutritional assessments between 1995 and 2004. Sex-specific initial and final means or proportions and time trends in macronutrient intakes were estimated with regression analyses. Three hundred thirty nutritional records from 49 males and 411 from 67 females were analyzed. Caloric intake exceeded the estimated energy requirement (EER) for ideal body weight in 1995 by 62% for males and 39% for females and decreased by 3% of the EER per year in males (P = 0.02) and by 2% in females (P = 0.004). In 2004, caloric intake still remained >19% above the EER in both groups. Protein intake was nearly 400% of the recommended dietary allowance (RDA) for ideal body weight in 1995 among both males and females and decreased by 13% of the RDA per year for males (P = 0.001) and by 21% per year for females (P 60% in both groups in 2004. Females consumed more energy from carbohydrates (P = 0.05) and sugar (P = 0.10) and less from monounsaturated (P = 0.04), polyunsaturated (P = 0.05), saturated (P = 0.03), and total (P = 0.10) fat in 2004 than in 1995. Excessive caloric intake and a shift in dietary composition toward carbohydrates in females suggest that continued monitoring of diet in HIV-infected children is important to avoid increased nutritional risk.

  13. Immune reconstitution inflammatory syndrome after initiating highly active antiretroviral therapy in HIV-infected children

    Energy Technology Data Exchange (ETDEWEB)

    Kilborn, Tracy [Red Cross War Memorial Children' s Hospital, Department of Paediatric Radiology, Cape Town (South Africa); Zampoli, Marco [Red Cross War Memorial Children' s Hospital, Department of Paediatric Pulmonology, Cape Town (South Africa)

    2009-06-15

    The outcome of HIV infection has improved since the widespread availability of highly active antiretroviral therapy (HAART). Some patients, however, develop a clinical and radiological deterioration following initiation of HAART due to either the unmasking of occult subclinical infection or an enhanced inflammatory response to a treated infection. This phenomenon is believed to result from the restored ability to mount an immune response and is termed immune reconstitution inflammatory syndrome (IRIS) or immune reconstitution disease. IRIS is widely reported in the literature in adult patients, most commonly associated with mycobacterial infections. There is, however, a paucity of data documenting the radiological findings of IRIS in children. Radiologists need to be aware of this entity. As a diagnosis of exclusion it is essential that the radiological findings be assessed in the context of the clinical presentation. This article reviews the common clinical and radiological manifestations of IRIS in HIV-infected children. (orig.)

  14. Serum Micronutrient Status of Haart-Naïve, HIV Infected Children in South Western Nigeria: A Case Controlled Study

    Directory of Open Access Journals (Sweden)

    H. C. Anyabolu

    2014-01-01

    Full Text Available Background. Though micronutrients are vital in the pathogenesis of human immunodeficiency virus infection, most studies have been conducted in adults. Knowledge of the status of key micronutrients in HIV infected African children will indicate if supplementation may be beneficial to these children living in this resource-poor region. Objectives. We sought to determine the micronutrient status and associated factors of HAART-naïve HIV infected children and compare them with those of the HIV negative controls. Methods. We enrolled 70 apparently stable HAART naïve HIV infected children. Seventy age and sex matched HIV negative children were equally enrolled as the controls. Their social class, anthropometry, clinical stage, CD4 counts, serum zinc, selenium, and vitamin C were determined. Results. The prevalence of zinc, selenium, and vitamin C deficiency in HIV infected subjects was 77.1%, 71.4%, and 70.0%, respectively, as compared to 44.3%, 18.6%, and 15.7% in HIV negative controls. Among the HIV infected subjects, 58.6% were deficient in the three micronutrients. Micronutrient status was related to the weight, clinical, and immunological stages but not BMI or social class. Conclusion. Deficiency of these key micronutrients is widely prevalent in HAART naïve HIV infected children irrespective of social class. This suggests that supplementation trial studies may be indicated in this population.

  15. Pulmonary tuberculosis in severely-malnourished or HIV-infected children with pneumonia: a review.

    Science.gov (United States)

    Chisti, Mohammod Jobayer; Ahmed, Tahmeed; Pietroni, Mark A C; Faruque, Abu S G; Ashraf, Hasan; Bardhan, Pradip K; Hossain, Iqbal; Das, Sumon Kumar; Salam, Mohammed Abdus

    2013-09-01

    Presentation of pulmonary tuberculosis (PTB) as acute pneumonia in severely-malnourished and HIV-positive children has received very little attention, although this is very important in the management of pneumonia in children living in communities where TB is highly endemic. Our aim was to identify confirmed TB in children with acute pneumonia and HIV infection and/or severe acute malnutrition (SAM) (weight-for-length/height or weight-for-age z score nutritional oedema). We conducted a literature search, using PubMed and Web of Science in April 2013 for the period from January 1974 through April 2013. We included only those studies that reported confirmed TB identified by acid fast bacilli (AFB) through smear microscopy, or by culture-positive specimens from children with acute pneumonia and SAM and/or HIV infection. The specimens were collected either from induced sputum (IS), or gastric lavage (GL), or broncho-alveolar lavage (BAL), or percutaneous lung aspirates (LA). Pneumonia was defined as the radiological evidence of lobar or patchy consolidation and/or clinical evidence of severe/ very severe pneumonia according to the WHO criteria of acute respiratory infection. A total of 17 studies met our search criteria but 6 were relevant for our review. Eleven studies were excluded as those did not assess the HIV status of the children or specify the nutritional status of the children with acute pneumonia and TB. We identified only 747 under-five children from the six relevant studies that determined a tubercular aetiology of acute pneumonia in children with SAM and/or positive HIV status. Three studies were reported from South Africa and one each from the Gambia, Ethiopia, and Thailand where 610, 90, 35, and 12 children were enrolled and 64 (10%), 23 (26%), 5 (14%), and 1 (8%) children were identified with active TB respectively, with a total of 93 (12%) children with active TB. Among 610 HIV-infected children in three studies from South Africa and 137 SAM children

  16. Use of the Behavior Rating Inventory of Executive Function and Child Behavior Checklist in Ugandan Children with HIV or a History of Severe Malaria.

    Science.gov (United States)

    Familiar, Itziar; Ruisenor-Escudero, Horacio; Giordani, Bruno; Bangirana, Paul; Nakasujja, Noeline; Opoka, Robert; Boivin, Michael

    2015-05-01

    To assess the structural overlap between the Behavior Rating Inventory of Executive Function (BRIEF) and Achenbach Child Behavior Checklist (CBCL) among children in Uganda. Caregiver ratings for the BRIEF and CBCL were obtained for 2 independent samples of school-aged children: 106 children (5-12 years old, 50% males) with a history of severe malaria and on 144 HIV-infected children (5-12 years old, 58% males) in Uganda. Exploratory factor analysis was used to evaluate the factor structure of the 8 subscales for the BRIEF and the 8 scales of the CBCL to determine correlation. Overall, children in the severe malaria group had higher (increased symptom) BRIEF and CBCL scores than those in the HIV-infected group. Three factors that provided a reasonable fit to the data and could be characterized as 3 specific domains were identified: (1) Metacognition, which consisted of the scales in the BRIEF Metacognition domain, (2) Behavioral Adjustment, which comprised of the scales in the BRIEF Behavioral Regulation domain and the Externalizing Symptoms scales in the CBCL, and (3) Emotional Adjustment, which mainly consisted of the Internalizing Symptoms scales in the CBCL. The BRIEF Behavior Regulation and CBCL Externalizing Symptoms scales, however, did overlap in terms of assessing similar behavior symptoms. These findings were consistent across the severe malaria and HIV-infected samples of children. The BRIEF and CBCL instruments offer distinct, yet complementary, assessments of behavior in clinical pediatric populations in the Ugandan context, supporting the use of these measures for similar research settings.

  17. Outcomes among HIV-infected children initiating HIV care and antiretroviral treatment in Ethiopia.

    Science.gov (United States)

    Melaku, Zenebe; Lulseged, Sileshi; Wang, Chunhui; Lamb, Matthew R; Gutema, Yoseph; Teasdale, Chloe A; Ahmed, Solomon; Gadisa, Tsigereda; Habtamu, Zelalem; Bedri, Abubaker; Fayorsey, Ruby; Abrams, Elaine J

    2017-04-01

    To describe pediatric ART scale-up in Ethiopia, one of the 21 global priority countries for elimination of pediatric HIV infection. A descriptive analysis of routinely collected HIV care and treatment data on HIV-infected children (<15 years) enrolled at 70 health facilities in four regions in Ethiopia, January 2006-September 2013. Characteristics at enrollment and ART initiation are described along with outcomes at 1 year after enrollment. Among children who initiated ART, cumulative incidence of death and loss to follow-up (LTF) were estimated using survival analysis. 11 695 children 0-14 years were enrolled in HIV care and 6815 (58.3%) initiated ART. At enrollment, 31.2% were WHO stage III and 6.3% stage IV. The majority (87.9%) were enrolled in secondary or tertiary facilities. At 1 year after enrollment, 17.9% of children were LTF prior to ART initiation. Among children initiating ART, cumulative incidence of death was 3.4%, 4.1% and 4.8%, and cumulative incidence of LTF was 7.7%, 11.8% and 16.6% at 6, 12 and 24 months, respectively. Children <2 years had higher risk of LTF and death than older children (P < 0.0001). Children with more advanced disease and those enrolled in rural settings were more likely to die. Children enrolled in more recent years were less likely to die but more likely to be LTF. Over the last decade large numbers of HIV-infected children have been successfully enrolled in HIV care and initiated on ART in Ethiopia. Retention prior to and after ART initiation remains a major challenge. © 2017 John Wiley & Sons Ltd.

  18. Abnormalities in body composition and nutritional status in HIV-infected children and adolescents on antiretroviral therapy.

    Science.gov (United States)

    Ramalho, L C de Barros; Gonçalves, E M; de Carvalho, W R G; Guerra-Junior, G; Centeville, M; Aoki, F H; Morcillo, A M; dos Santos Vilela, M M; da Silva, M T N

    2011-08-01

    This cross-sectional study aimed to compare growth, nutritional status and body composition outcomes between a group of 94 HIV-infected children and adolescents on antiretroviral therapy (ART) and 364 healthy controls, and to evaluate their association with clinical and lifestyle variables within the HIV-infected group. When compared with the control group, HIV patients had higher risk of stunting (odds ratio [OR] 5.33, 95% confidence interval [CI]: 2.83-10.04) and thinness (OR 4.7, 95% CI: 2.44-9.06), higher waist-to-hip ratios (medians 0.89 versus 0.82 for boys and 0.90 versus 0.77 for girls, P HIV-infected children on ART showed significant nutritional status and body composition abnormalities, consistent with the severity of vertical HIV infection and the consequences of prolonged ART.

  19. Nonprogressing HIV-infected children share fundamental immunological features of nonpathogenic SIV infection

    DEFF Research Database (Denmark)

    Muenchhoff, Maximilian; Adland, Emily; Karimanzira, Owen

    2016-01-01

    preventing HIV disease, we investigated pediatric infection, where AIDS typically develops more rapidly than in adults. Among 170 nonprogressing antiretroviral therapy-naïve children aged >5 years maintaining normal-for-Age CD4 T cell counts, immune activation levels were low despite high viremia (median, 26......Disease-free infection in HIV-infected adults is associated with human leukocyte antigen-mediated suppression of viremia, whereas in the sooty mangabey and other healthy natural hosts of simian immunodeficiency virus (SIV), viral replication continues unabated. To better understand factors......,000 copies/ml). Potent, broadly neutralizing antibody responses in most of the subjects and strong virus-specific T cell activity were present but did not drive pediatric nonprogression. However, reduced CCR5 expression and low HIV infection in long-lived central memory CD4 T cells were observed in pediatric...

  20. Normative nasalance data in Ugandan english-speaking children.

    Science.gov (United States)

    Luyten, A; D'haeseleer, E; Hodges, A; Galiwango, G; Budolfsen, T; Vermeersch, H; Van Lierde, K

    2012-01-01

    The aim of this study was to obtain normative nasalance values for typically developing Ugandan English-speaking children as a reference point for clinical practice and further research. Sixty-nine typically developing Ugandan children (35 males and 34 females, 2.7-13.5 years of age) participated in the study. Nasalance scores were obtained with the Nasometer while children repeated 4 sustained sounds, 14 repeated syllables, 15 sentences (12 oral, 3 nasal) and 2 texts ('Rainbow Passage' and 'Zoo Passage'). Data were analyzed for gender and age dependence. No significant effects of age or gender on nasalance values were obtained; hence, normative values for the overall group were reported. The average nasalance scores for Ugandan English-speaking children were 17 and 64% for the oral and nasal sentences and 33 and 14% for the oronasal and oral text, respectively. The normative values are important as a reference point to assess the impact of several surgical procedures and several surgical timing strategies on speech in Uganda. Copyright © 2012 S. Karger AG, Basel.

  1. Role of multivitamins, micronutrients and probiotics supplementation in management of HIV infected children.

    Science.gov (United States)

    Gautam, Neetu; Dayal, Rajeshwar; Agarwal, Dipti; Kumar, Rajesh; Singh, T P; Hussain, T; Singh, S P

    2014-12-01

    To assess the immuno-clinical response of micronutrients supplementation in human immunodeficiency virus (HIV) infected children (both on and without antiretroviral therapy) and to assess the role of probiotics in improvement of CD4 counts in HIV infected children not on antiretroviral therapy. This was an open labeled randomized control study, conducted in Department of Pediatrics and Antiretrovial Therapy (ART) Center, S.N. Medical College, Agra. One hundred and twenty seven HIV infected children aged ≤ 15 y were included in the study. Enrolled children were randomized to receive micronutrients for 6 mo or probiotics for 3 mo. Children who did not receive supplements served as control. Change in WHO clinical stage, immunological stage, CD4 counts and body mass index (BMI) status were taken at the end of 6 mo. In probiotic group, mean CD4 count were taken as outcome measure. A detailed history, examination and WHO clinical staging were recorded for all the patients. In micronutrient supplemented group (not on ART), significant improvement was seen in WHO clinical staging (p = 0.049) when compared to controls after 6 mo. Probiotic supplemented group showed significant increase in CD4 counts compared to control group (p = 0.0022) in children >5 y. Control group showed significant decline in CD4 count in children ≤5 y (-65.3 cells/mm(3), p=0.005) and in children >5 y (-87.9 cells/mm(3), p=0.05) after 12 wk of supplementation. Probiotics supplementation has shown significant improvement in CD4 counts. Micronutrients supplementation has shown significant delay in the progression towards advance stage of disease.

  2. Perceptions of children with HIV infection when not told for so long: implications for diagnosis disclosure.

    Science.gov (United States)

    Instone, S L

    2000-01-01

    The perceptions of school-aged children with HIV infection about their illness were evaluated in light of parental/guardians communication about the child's diagnosis to clarify guidelines for disclosure. An innovative, qualitative research design using methods of grounded theory and projective drawings involved 12 children and 13 parents/guardians from a West Coast Pediatric AIDS Clinical Trial treatment center. A specific process of interaction between parents/guardians and children, when not told for so long, emerged as the central phenomenon of the study. Parents/guardians kept the children's HIV infection secret for 2 to 8 years after diagnosis. Regardless of disclosure status, the children's drawings and conversations suggested severe emotional distress, disturbed self-image, and social isolation. Parents and guardians were unaware of their children's concerns. Although other circumstances of the children's lives contributed to their poor psychosocial adjustment, the long interval of silence about the illness also played a part in their poor adjustment. Parents/guardians did not recognize when their children needed more supportive information. Pediatric clinicians should therefore continually assess children's psychosocial adjustment to guide families through the disclosure process. The use of projective drawing techniques can facilitate this process.

  3. HIV Disclosure: Parental dilemma in informing HIV infected Children ...

    African Journals Online (AJOL)

    Design: This was a qualitative narrative study that employed in-depth interviews with parents or guardians of children perinatally infected with HIV. A total of 20 parents and guardians of children who attend the outpatient HIV clinic at the Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence (COE) ...

  4. Predictors of mortality among HIV-infected children receiving highly active antiretroviral therapy.

    Science.gov (United States)

    Njom Nlend, A E; Loussikila, A B

    2017-02-01

    The mortality rate of HIV-infected children can be reversed under highly active antiretroviral therapy (HAART). The impact of HAART on the mortality of HIV-infected children in Cameroon has not been extensively documented. We aimed to measure the mortality rate of HIV-infected children under HAART and to identify predictive factors of mortality. Retrospective cohort study of 221 children initiated on HAART from 2005 to 2009 and followed-up until 2013. Survival data was analyzed using Kaplan Meier method and Cox regression model to identify independent predictors of child mortality on HAART. Overall, 9.9% of children (n=22) died over a follow-up period of 755 child-years (mortality of 2.9 per 100 child-years); 70% of deaths occurred during the first six months of HAART. The probability of survival after four years of treatment was 88.7% (95% CI=[84.2-93.3]). During the multivariate analysis of baseline variables, we observed that the WHO clinical stages III and IV (HR: 3.55 [1.09-13.6] and HR: 7.7 [3.07-31.2]) and age≤1year at HAART initiation were independently associated with death (HR: 2.1 [1.01-5.08]). Neither orphanhood, baseline CD4 count or hemoglobin level nor low nutritional status predicted death in this cohort. The mortality of children receiving HAART was low after five years of follow-up and it was strongly associated with WHO stages III and IV and a younger age at treatment initiation. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  5. Dental Caries Status of HIV Infected Children in Nigeria | Obileye ...

    African Journals Online (AJOL)

    Background: HIV positive children may be prone to developing Dental Caries due to prolonged and frequent use of sucrose containing medications and poor feeding practices. Objetive: To determine the caries status of primary and permanent dentition in HIV positive Nigerian children using dmft/DMFT indices. Methods: ...

  6. Adherence to antiretroviral therapy among HIV-infected children ...

    African Journals Online (AJOL)

    Drug exhaustion at home (16 children), followed by 'child slept through' (7 children) and 'caregiver away' were the most common reasons for a child having missed one or more ARV doses. Independent factors for adherence were male gender (odds ratio [OR] = 2.85; 95% confidence interval [CI]: 1.17–6.92) and attendance ...

  7. HIV INFECTION AS A RISK FACTOR OF TUBERCULOSIS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    E. P. Eremenko

    2017-01-01

    Full Text Available The article presents the results of three year follow-up over 96 HIV positive children registered in the AIDS Center. During 3 year follow up the infection with tuberculous mycobacteria was diagnosed in 27.3% (n = 23 of HIV positive children from the followed up group. The leading risk factor of tuberculosis is family exposure to a tuberculosis patient – 22.6% (n = 19. Compliance to follow-up and treatment, timely prescribed preventive anti-tuberculosis chemotherapy and highly active antiretroviral therapy enhanced prevention of development of local forms of tuberculosis in the followed up group of children.

  8. Incorrectly diagnosing children as HIV-infected: Experiences from a ...

    African Journals Online (AJOL)

    Results. There were 1 526 patient files analysed, with a male-to-female ratio of 1.01:1 and median age at first visit of 20 months (range 26 days - 17.5 years). Nearly half (n=715; 47%) of the children were aged <18 months. Fifty-one children were found to be HIV-uninfected after repeated diagnostic tests. Incorrect laboratory ...

  9. Circadian cardiac autonomic function in perinatally HIV-infected preschool children

    Directory of Open Access Journals (Sweden)

    P.R. Benchimol-Barbosa

    2009-08-01

    Full Text Available The 24-h heart rate variability and QT-interval adaptation was investigated in perinatally HIV-infected preschool children classified according to immunological status in order to assess autonomic function at early stages of infection. Thirty-five perinatally HIV-infected and clinically stable children (4.8 ± 0.3 years were enrolled after approval of the study by the University Hospital Pedro Ernesto Ethics Committee and written informed parental consent was obtained. The children were classified according to peripheral CD4+ count (cells/µL as follows: group 1, N = 11 (≥1000; group 2, N = 7 (≥500 and 55%, 24-h RR interval variability (RRV indexes (NN, SDANN, SDNN index, r-MSSD and 24-h QT and Bazett-corrected QT (QTc were determined, and groups were matched for age, body surface area, and left ventricular ejection fraction, reducing biases in RRV. The peak differences (∆ between the highest and lowest RRV and QT indexes were extracted from nocturnal (1 am-6 am and daytime (1 pm-6 pm hourly assessed segments, respectively. Pearson’s correlation (r and Kruskal-Wallis ANOVA were used to compare groups. CD4+ count correlated positively with ∆NN (r = 0.45; P = 0.003. There were no significant differences in daytime NN among groups. Nighttime SDNN index (P = 0.01, nighttime r-MSSD (P = 0.003, ∆NN (P = 0.01, ∆SDNN index (P = 0.03 and ∆r-MSSD (P = 0.004 were significantly lower in group 3 than in the other groups. Expected nighttime QTc-interval lengthening was not observed in all groups. In perinatally HIV-infected preschool children with preserved left ventricular systolic function, parasympathetic-mediated autonomic dysfunction parallels immune status, impairing both RRV and circadian QTc interval adaptation.

  10. Anaesthesia for tonsillectomy in HIV-infected children with ...

    African Journals Online (AJOL)

    percentage of children presenting for this procedure are HIV positive, even if not yet confirmed by clinical HIV testing .... as well as the breathing pattern. Airway management can be planned in advance avoiding the 'can't ... Tonsillectomy in HIV hypothermia, and pain. By choosing a safe anti-anxiety drug like hydroxyzine for.

  11. Antimycobacterial immune responses in HIV-infected children ...

    African Journals Online (AJOL)

    Methods: A total of 59 children of age 9 months to 5 years initiating ART with a history of BCG vaccination from Matero Reference Clinic in Lusaka were enrolled in a prospective cohort study. Demographic and clinical data were collected using questionnaires. Blood samples were drawn before starting ART, at 3 months and ...

  12. Humoral immune responses to Pneumocystis jirovecii antigens in HIV-infected and uninfected young children with pneumocystis pneumonia.

    Directory of Open Access Journals (Sweden)

    Kpandja Djawe

    Full Text Available Humoral immune responses in human immunodeficiency virus (HIV-infected and uninfected children with Pneumocystis pneumonia (PcP are poorly understood.Consecutive children hospitalized with acute pneumonia, tachypnea, and hypoxia in South Africa were investigated for PcP, which was diagnosed by real-time polymerase chain reaction on lower respiratory tract specimens. Serum antibody responses to recombinant fragments of the carboxyl terminus of Pneumocystis jirovecii major surface glycoprotein (MsgC were analyzed.149 children were enrolled of whom 96 (64% were HIV-infected. PcP occurred in 69 (72% of HIV-infected and 14 (26% of HIV-uninfected children. HIV-infected children with PcP had significantly decreased IgG antibodies to MsgC compared to HIV-infected patients without PcP, but had similar IgM antibodies. In contrast, HIV-uninfected children with PcP showed no change in IgG antibodies to MsgC, but had significantly increased IgM antibodies compared to HIV-uninfected children without PCP. Age was an independent predictor of high IgG antibodies, whereas PcP was a predictor of low IgG antibodies and high IgM antibodies. IgG and IgM antibody levels to the most closely related MsgC fragments were predictors of survival from PcP.Young HIV-infected children with PcP have significantly impaired humoral immune responses to MsgC, whereas HIV-uninfected children with PcP can develop active humoral immune responses. The children also exhibit a complex relationship between specific host factors and antibody levels to MsgC fragments that may be related to survival from PcP.

  13. Whole gastrointestinal transit time is associated with clinical severity and nutritional status of HIV-infected children.

    Science.gov (United States)

    Densupsoontorn, Narumon; Issaragraiseel, Patchaya; Thamonsiri, Nuchnoi; Wongarn, Renu; Jirapinyo, Pipop

    2009-07-01

    Malnutrition and malabsorption are common consequences in pediatric human immunodeficiency virus (HIV) infection. The gastrointestinal tract is a major site affected by HIV Rapid gastrointestinal transit time may contribute to malabsorption. To determine whether the whole gastrointestinal transit time (WGTT) correlates with disease stages or degrees of malnutrition in HIV-infected children. Forty HIV-seropositive children, at various stages of disease, and thirty seronegative age-matched controls, aged between 1 mo and 3 yr, were enrolled in the present study. The body weight, length, or height and the WGTT were assessed Then the WGTT of children in different stages of HIV disease and in different degrees of malnutrition were compared with those of the control group. The mean ages were 15.5 and 14.3 mo in HIV-infected and control groups respectively. A greater degree of malnutrition was found in HIV-infected children with more advances HIV clinical symptoms. Compared to controls, WGTT was most rapid in severely symptomatic acquired immunodeficiency syndrome (AIDS) patients (Category C) (14.32 +/- 3.88 versus 7.22 +/- 3.17 h; p HIV-infected children was also significantly associated with a higher degree of malnutrition. Malnutrition is clearly related to the progression ofHIV disease. Accelerated WGTT is associated with HIV seropositivity, severe clinical symptoms, and higher degrees of malnutrition.

  14. Retention in Medical Care Among Insured Children with Diagnosed HIV Infection - United States, 2010-2014.

    Science.gov (United States)

    Tanner, Mary R; Bush, Tim; Nesheim, Steven R; Weidle, Paul J; Byrd, Kathy K

    2017-10-06

    In 2014, an estimated 2,477 children aged medical care. CDC analyzed insurance claims data to evaluate retention in medical care for children in the United States with a diagnosis of HIV infection. Data sources were the 2010-2014 MarketScan Multi-State Medicaid and MarketScan Commercial Claims and Encounters databases. Children aged medical care was assessed by evaluating the frequency of medical visits during the first 24 months of the study period to see if the frequency of visits met the definition of retention in care. Frequency of medical visits was then assessed during an additional 12-month follow-up period to evaluate differences in medical care consistency between children who were retained or not retained in care during the initial 24-month period. During months 0-24, 60% of the Medicaid cohort and 69% of the commercial claims cohort were retained in care, among whom 93% (Medicaid) and 85% (commercial claims) were in care during months 25-36. To identify areas for additional public health action, further evaluation of the objectives for national medical care for children with diagnosed HIV infection is indicated.

  15. Oligosaccharide composition of breast milk influences survival of uninfected children born to HIV-infected mothers in Lusaka, Zambia.

    Science.gov (United States)

    Kuhn, Louise; Kim, Hae-Young; Hsiao, Lauren; Nissan, Caroline; Kankasa, Chipepo; Mwiya, Mwiya; Thea, Donald M; Aldrovandi, Grace M; Bode, Lars

    2015-01-01

    Human milk oligosaccharides (HMOs) have multiple immunomodulatory functions that influence child health. In this study we investigated whether HMO composition influences survival to 2 y of age in HIV-infected and HIV-exposed, uninfected (HEU) children during and after breastfeeding. In the context of an early weaning trial in 958 HIV-infected women in Lusaka, Zambia, we conducted a nested case-cohort analysis of mortality to 2 y of age among 103 HIV-infected and 143 HEU children. Breast-milk samples collected at 1 mo postpartum were analyzed for HMO content. Samples were selected to include mothers of all HIV-infected children detected by 6 wk of age, of whom 63 died at milk concentrations of 2-linked fucosylated HMOs [2'-fucosyllactose and lacto-N-fucopentaose (LNFP) I] (HR: 0.33; 95% CI: 0.14, 0.74) as well as non-2-linked fucosylated HMOs (3-fucosyllactose and LNFP II/III; HR: 0.28; 95% CI: 0.13, 0.67) were significantly associated with reduced mortality during, but not after, breastfeeding after adjustment for confounders. Breastfeeding was protective against mortality only in HEU children with high concentrations of fucosylated HMOs. Among HIV-infected children, no consistent associations between HMOs and mortality were observed, but breastfeeding was protective against mortality. The oligosaccharide composition of breast milk may explain some of the benefits of breastfeeding in HEU children. HIV infection may modulate some of the consequences of HMOs on child survival. © 2015 American Society for Nutrition.

  16. Impact of sociodemographic factors on cognitive function in school-aged HIV-infected Nigerian children

    Directory of Open Access Journals (Sweden)

    Boyede GO

    2013-07-01

    Full Text Available Gbemisola O Boyede,1,2 Foluso EA Lesi,2 Veronica C Ezeaka,2 Charles S Umeh3 1Division of Developmental Paediatrics, School of Child and Adolescent Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa; 2Department of Paediatrics, 3Clinical Psychology Unit, Department of Psychiatry, Lagos University Teaching Hospital, Lagos, Nigeria Background: In this study, we sought to evaluate the influence of sociodemographic factors, ie, age, sex, socioeconomic status, maternal education, and human immunodeficiency virus (HIV status, on cognitive performance in school-aged HIV-infected Nigerian children. Methods: Sixty-nine HIV-positive children aged 6–15 years were matched with 69 HIV-negative control children for age and sex. The children were subdivided for the purpose of analysis into two cognitive developmental stages using Piaget’s staging, ie, the concrete operational stage (6–11 years and the formal operational stage (12–15 years. All participants underwent cognitive assessment using Raven’s Standard Progressive Matrices (RPM. Sociodemographic data for the study participants, ie, age, sex, socioeconomic status, and level of maternal education, were obtained using a study proforma. Logistic regression analyses were used to determine associations of HIV status and sociodemographic characteristics with RPM cognitive scores. Results: The overall mean RPM score for the HIV-positive children was 18.2 ± 9.8 (range 8.0–47.0 which was significantly lower than the score of 27.2 ± 13.8 (range 8.0–52.0 for the HIV-negative children (P < 0.001. On RPM grading, 56.5% of the HIV-positive children had cognitive performance at below average to intellectually defective range. Below average RPM scores were found to be significantly associated with younger age (6–11 years, positive HIV status, lower socioeconomic status, and low level of maternal education. Conclusion: Younger age, poor socioeconomic

  17. Brief report: relationship between HIV infection and WPPSI-R performance in preschool-age children.

    Science.gov (United States)

    Fishkin, P E; Armstrong, F D; Routh, D K; Harris, L; Thompson, W; Miloslavich, K; Levy, J D; Johnson, A; Morrow, C; Bandstra, E S; Mason, C A; Scott, G

    2000-01-01

    To determine the neurodevelopmental effects of perinatally acquired HIV infection on children of preschool age. Participants included 40 children infected with HIV between the ages of three and five and an equal number of noninfected controls individually matched according to ethnicity, age, sex, and prenatal drug exposure. Participants were administered the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), upon which an analysis of subtest distribution was conducted. Whereas both groups evidenced mean IQ and subtest scores significantly below published norms, an effect for HIV group status was not found when a factor combining Performance IQ (PIQ) and Verbal IQ (VIQ) was analyzed. However, the group infected with HIV scored significantly lower than controls on the Block Design subtest. Gross cognitive deficits are not evident among preschool children infected with HIV relative to matched controls. However, this study does provides some evidence for more focal deficits. Further investigation with older children should be conducted.

  18. The Role of Cognitive Functioning in Medication Adherence of Children and Adolescents with HIV Infection

    Science.gov (United States)

    Williams, Paige L.; Montepiedra, Grace; Nichols, Sharon; Sirois, Patricia A.; Storm, Deborah; Farley, John; Kammerer, Betsy

    2009-01-01

    Objective To evaluate the relationship between cognitive functioning and medication adherence in children and adolescents with perinatally acquired HIV infection. Methods Children and adolescents, ages 3–18 (N = 1,429), received a cognitive evaluation and adherence assessment. Multiple logistic regression models were used to identify associations between adherence and cognitive status, adjusting for potential confounding factors. Results Children's average cognitive performance was within the low-average range; 16% of children were cognitively impaired (MDI/FSIQ stressful life events and child health characteristics, such as HIV RNA detectability, were significantly associated with nonadherence. Conclusion Cognitive status plays a limited role in medication adherence. Child and caregiver psychosocial and health characteristics should inform interventions to support adherence. PMID:18647794

  19. Children who acquire HIV infection perinatally are at higher risk of early death than those acquiring infection through breastmilk: a meta-analysis

    NARCIS (Netherlands)

    Becquet, Renaud; Marston, Milly; Dabis, François; Moulton, Lawrence H.; Gray, Glenda; Coovadia, Hoosen M.; Essex, Max; Ekouevi, Didier K.; Jackson, Debra; Coutsoudis, Anna; Kilewo, Charles; Leroy, Valériane; Wiktor, Stefan Z.; Nduati, Ruth; Msellati, Philippe; Zaba, Basia; Ghys, Peter D.; Newell, Marie-Louise; Ghys, Peter; Karcher, Sophie; Moulton, Larry; Coovadia, Jerry; Wiktor, Stephan; Ekouevi, Didier; Faso, Burkina; Meda, Nicolas; Welffens-Ekra, Christiane; You, Bruno; Manigart, Olivier; Simonon, Arlette; Cartoux, Michel; Combe, Patrice; Ouangré, Amadou; Ramon, Rosa; Ky-Zerbo, Odette; Montcho, Crépin; Salamon, Roger; Rouzioux, Christine; van de Perre, Philippe; Mandelbrot, Laurent; Dequae-Merchadou, L.; Lassalle, R.; Bazie, A.; Beraud, A. M. Cassel; Dao, B.; Gautier-Charpentier, L.; Ky, F. D.; Nacro, B.; Sanou, O.; Sombié, I.; Tall, F.; Tiendrebeogo, S.; Traore, Y.; Valea, D.; Yaro, S.; Bonnard, D.; Camara, R.; Dosso, M.; Elenga, N.; Gourvellec, G.; Kottan, J. B.; Likikouet, R.; Noba, V.; Timité, M.; Viho, I.; Leroy, V.; Salamon, R.; Cartoux, M.; Dabis, F.; Meda, N.; Msellati, P.; Ramon, R.; Bazié, A.; Mandelbrot, L.; Welffens-Ekra, C.; Bonard, D.; Combe, P.; Ouangré, A.; Ouassa, T.; Sylla-Koko, F.; van de Perre, P.; Cassel-Beraud, A. M.; Manigart, O.; Montcho, C.; Rouzioux, C.; Simonon, A.; You, B.; Ky-Zerbo, O.; Richardson, Barbra A.; John, Grace; Mbori-Ngacha, Dorothy; Mwatha, Anthony; Ndinya-Achola, Jeckoniah; Bwayo, Job; Onyango, Francis E.; Kreiss, Joan; Lange, M. A.; Saba, J.; Gray, G.; McIntyre, J.; Mmiro, F.; Ndugwa, Ch; Moodley, J.; Coovadia, H. M.; Moodley, D.; Kilewo, Ch; Massawe, A.; Okong, P.; Kituuka, P.; von Briesen, H.; Goudsmit, J.; Biberfeld, G.; Mhalu, F.; Karlson, K.; Guliano, M.; Declich, S.; Clapp, S.; Haverkamp, G.; Weverling, G. J.; Cooper, D.; Grulich, A.; Bray, D.; Perriens, J.; Ngobeni, F.; Baguma, G.; Kyambadde, S.; Musoke, P.; Nakabito, C.; Bakaki, P.; Kalyesbula, I.; Lutajumwa, M.; Mmiro, S.; Kato, R.; Byenkya, R.; Kabenge, S.; Mulira, R.; Bagenda, R.; Matavu, J.; Kikonyogo, F.; Kawuki, E.; Nkoyoyo, B.; Matovu, N.; Mukasa, C.; Dukar, C.; Mubiru, M.; Bagenda, D.; Khantaway, K.; Kayanja, K.; Kateera, S.; Sam, B.; Sabrina, B.; Ravera, M.; Omobono, E.; Magoni, M.; Urassa, E.; Kalokola, F.; Phillip, F.; Giattas, M.; Temu, F.; Kallanga, K.; Mkumbukwa, A.; Lugaiya, E.; Nyoni, S.; Haule, S.; Hilbayuded, E.; Kavugha, N.; Kayombo, I.; Lyamuya, E.; Mbena, E.; Msangi, V.; Lema, C.; Matimbwa, H.; Semali, I.; Karlsson, K.; Johnson, S.; Violari, A.; Connell, L.; Nelson, G.; Moetlo, J.; Makhofola, A.; Jivkov, B.; Kunene, M.; Ngakane, G.; Tshabalala, G.; Saba, W.; Khela, P.; Radebe, N.; Naidoo, K.; Adhikari, M.; Moniwa, T.; Moholo, D.; Mtshali, I.; Ngubane, C.; Mlaba, A.; Mkhize, N.; Sibiya, C.; Shozi, L.; Ngubane, T.; Mkhize, V.; Madurai, L.; Gopaul, V.; Thaver, L.; Swart, G.; Thomas, J.; Lange, J. M. A.; Huisman, H.; Hollak, P.; Hendriks, L.; de Amorim-Nink, A.; Klunker, H.; Kurunci, L.; Simon, A.; Hansson, E. Olausson; Östborn, A.; Jurriaans, S.; de Rooy, E.; Bakker, M.; Romp, N.; Ekpini, Ehounou; Karon, John M.; Nkengasong, John; Maurice, Chantal; Severin, Sibailly T.; Roels, Thierry H.; Kouassi, Moise K.; Lackritz, Eve M.; Coulibaly, Issa-Malick; Greenberg, Alan E.; Pillay, Kubendran; Kuhn, Louise; Spooner, Elizabeth; Tsai, Wei-Yann; Sinclair, Gill; Mburu, Anne; Mngqundaniso, Nolwandle; Uebel, Kerry; Coetzee, Ingrid; Annamalai, Ken; Doorasamy, Trevor; Govender, Ugene; Willumsen, Juana; Rollins, Nigel; Moodley, Jagidesa; Moodley, Daya; Bland, Ruth; Coovadia, Hoosen; Darbyshire, Janet; Simelela, Nono; Sithole, Victoria; Govender, Cookie; Mthethwa, Londiwe; Blose, Thembi; Mkhwanazi, Nqobile; Mkwanazi, Dumo; Fakude, Zanele; Dube, Samukelisiwe; Viljoen, Johannes; Graham, Natalie; Davaviah, Siva; Iliff, Peter J.; Piwoz, Ellen G.; Tavengwa, Naume V.; Zunguzac, Clare D.; Marinda, Edmore T.; Nathoo, Kusum J.; Ward, Brian J.; Humphrey, Jean H.; Chidawanyika, Henry; Hargrove, John; Majo, Florence; Mutasa, Kuda; Ndhlovu, Mary; Ntozini, Robert; Rambanepasi, Phillipa; Mahomva, Agnes; Malaba, Lucie; Mbizvo, Michael; Zvandasara, Partson; Zijenah, Lynn; Propper, Lidia; Ruff, Andrea; Dabis, Francois; Timite-Konan, Marguerite; Bequet, Laurence; Tonwe-Gold, Besigin; Viho, Ida; Allou, Gérard; Castetbon, Katia; Dequae-Merchadou, Laurence; Sakarovitch, Charlotte; Touchard, Dominique; Amani-Bosse, Clarisse; Ayekoe, Ignace; Bedikou, Gédéon; Coulibaly, Nacoumba; Danel, Christine; Fassinou, Patricia; Horo, Apollinaire; Likikouet, Ruffin; Toure, Hassan; Inwoley, André; Rouet, Francois; Touré, Ramata; Aka-Dago, Hortense; Sihé, Alphonse; Agbo, Hélène; Brou, Hermann; Desgrées-du-Lou, Annabel; Tijou-Traoré, Annick; Zanou, Benjamin; Colvin, Mark; Chopra, Mickey; Doherty, Tanya; Levin, Jonathan; Goga, Ameena; Moodley, Pravi; Thior, Ibou; Lockman, Shahin; Smeaton, Laura M.; Shapiro, Roger L.; Wester, Carolyn; Heymann, S. Jody; Gilbert, Peter B.; Stevens, Lisa; Peter, Trevor; Kim, Soyeon; van Widenfelt, Erik; Moffat, Claire; Ndase, Patrick; Arimi, Peter; Kebaabetswe, Poloko; Mazonde, Patson; Makhema, Joseph; McIntosh, Kenneth; Novitsky, Vladimir; Lee, Tun-Hou; Marlink, Richard; Lagakos, Stephen; Anude, C.; Chanda, J.; Makori, L.; Moorad, J. B.; Modise, T. A.; Moyo, T.; Malamba, M.; Arbi, D.; Koloi, K.; Dube, L.; Mmolotsi, T.; Babitseng, S.; Mere, D.; Boyle, J.; Magetse, J.; Modikwa, V.; Tsuro, M.; Sekoto, T.; Garebatho, L.; Sesinyi, M.; Kelebalekgosi, K.; Tedla, Z.; Mayondi, G.; Sebinang, K.; Setswalo, J.; Makubate, N.; Tsalaile, L.; Tsule, B.; Thebeetsile, I.; Leteane, I.; Makgabana, O.; Mogodi, M.; Owor, A.; Hove, I.; Asmelash, A.; Kakhu, T.; Ramalepa, P.; Lubinda, J.; Ndebele, S.; Modise, F.; Bohule, C.; Motshabi, K.; Ntshimane, M.; Karlsson, Katarina; Ngarina, Matilda; Massawe, Augustine; Lyamuya, Eligius; Swai, Andrew; Lipyoga, Rosina; Mhalu, Fred; Biberfeld, Gunnel; Msemo, G.; Mohamed, B.; Method, J.; Yuda, J.; Naburi, E.; Rugaiya, E.; Makundi, N.; Temu, A.; Kalovya, D.; Olausson-Hansson, E.

    2012-01-01

    BACKGROUND: Assumptions about survival of HIV-infected children in Africa without antiretroviral therapy need to be updated to inform ongoing UNAIDS modelling of paediatric HIV epidemics among children. Improved estimates of infant survival by timing of HIV-infection (perinatally or postnatally) are

  20. Associations of low vitamin D and elevated parathyroid hormone concentrations with bone mineral density in perinatally HIV-infected children

    Science.gov (United States)

    Background: Perinatally HIV-infected (PHIV) children have, on average, lower bone mineral density (BMD) than perinatally HIV-exposed uninfected (PHEU) and healthy children. Low 25-hydroxy vitamin D [25(OH)D] and elevated parathyroid hormone (PTH) concentrations may lead to suboptimal bone accrual. ...

  1. Pharmacokinetics of nevirapine in HIV-infected children under 3 years on rifampicin-based antituberculosis treatment.

    NARCIS (Netherlands)

    Oudijk, J.M.; McIlleron, H.; Mulenga, V.; Chintu, C.; Merry, C.; Walker, A.S.; Cook, A.; Gibb, D.M.; Burger, D.M.

    2012-01-01

    OBJECTIVE:: There is an urgent need to optimize cotreatment for children with tuberculosis and HIV infection. We described nevirapine pharmacokinetics in Zambian children aged less than 3 years, cotreated with nevirapine, lamivudine and stavudine in fixed-dose combination (using WHO weight bands)

  2. Chest radiographic features of lymphocytic interstitial pneumonitis in HIV-infected children

    Energy Technology Data Exchange (ETDEWEB)

    Pitcher, R.D., E-mail: pitcher@iafrica.co [Division of Paediatric Radiology, Red Cross War Memorial Children' s Hospital, Department of Radiation Medicine, University of Cape Town (South Africa); Beningfield, S.J. [Division of Radiology, New Groote Schuur Hospital and University of Cape Town (South Africa); Zar, H.J. [Department of Paediatric Pulmonology, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, University of Cape Town (South Africa)

    2010-02-15

    Aim: To review the radiological features of biopsy-proven lymphocytic interstitial pneumonitis (LIP) in human immunodeficiency virus (HIV)-infected children and establish whether these are based on systematic radiological analysis, and to investigate whether more specific radiological diagnostic criteria can be developed. Materials and methods: A Medline search of English-language articles on the radiological features of biopsy-proven LIP in HIV-infected children was conducted for the period 1982 to 2007 inclusive. Radiological findings were compared with the Centers for Disease Control and Prevention (CDC) criteria for a presumptive diagnosis of LIP. Results: Pulmonary pathology was recorded as 'diffuse' and 'bilateral' in 125 (97.6%) of 128 reported cases of LIP. Twenty-five different terms were used to describe the pulmonary parenchyma. In 96 (75%), the terminology was consistent with CDC diagnostic criteria. Radiological evolution was documented in 43 (33.5%). Persistent focal opacification superimposed on diffuse pulmonary nodularity was demonstrated in 10 (7.8%). The method of radiological evaluation was described in six (4.6%). In no instance was the terminology defined. Conclusion: The radiological features of LIP have not been systematically analysed. However, CDC criteria remain reliable, allowing diagnosis of at least 75% of cases. The sensitivity of these criteria may be increased by including cases with persistent focal pulmonary opacification superimposed on diffuse nodularity. Longitudinal studies utilizing standardized radiographic analysis are needed to elucidate the natural history of LIP.

  3. A Controlled Study of Tuberculosis Diagnosis in HIV-Infected and Uninfected Children in Peru.

    Science.gov (United States)

    Oberhelman, Richard A; Soto-Castellares, Giselle; Gilman, Robert H; Castillo, Maria E; Kolevic, Lenka; Delpino, Trinidad; Saito, Mayuko; Salazar-Lindo, Eduardo; Negron, Eduardo; Montenegro, Sonia; Laguna-Torres, V Alberto; Maurtua-Neumann, Paola; Datta, Sumona; Evans, Carlton A

    2015-01-01

    Diagnosing tuberculosis in children is challenging because specimens are difficult to obtain and contain low tuberculosis concentrations, especially with HIV-coinfection. Few studies included well-controls so test specificities are poorly defined. We studied tuberculosis diagnosis in 525 children with and without HIV-infection. 'Cases' were children with suspected pulmonary tuberculosis (n = 209 HIV-negative; n = 81 HIV-positive) and asymptomatic 'well-control' children (n = 200 HIV-negative; n = 35 HIV-positive). Specimens (n = 2422) were gastric aspirates, nasopharyngeal aspirates and stools analyzed by a total of 9688 tests. All specimens were tested with an in-house hemi-nested IS6110 PCR that took PCR in well-controls were more frequent in HIV-infection (P≤0.01): 17% (6/35) HIV-positive well-controls versus 5.5% (11/200) HIV-negative well-controls; caused by 6.7% (7/104) versus 1.8% (11/599) of their specimens, respectively. 6.7% (116/1719) specimens from 25% (72/290) cases were PCR-positive, similar (P>0.2) for HIV-positive versus HIV-negative cases. All specimens were also tested with auramine acid-fast microscopy, microscopic-observation drug-susceptibility (MODS) liquid culture, and Lowenstein-Jensen solid culture that took ≤6 weeks and had 100% specificity (all 2112 tests on 704 specimens from 235 well-controls were negative). Microscopy-positivity was rare (0.21%, 5/2422 specimens) and all microscopy-positive specimens were culture-positive. Culture-positivity was less frequent (P≤0.01) in HIV-infection: 1.2% (1/81) HIV-positive cases versus 11% (22/209) HIV-negative cases; caused by 0.42% (2/481) versus 4.7% (58/1235) of their specimens, respectively. In HIV-positive children with suspected tuberculosis, diagnostic yield was so low that 1458 microscopy and culture tests were done per case confirmed and even in children with culture-proven tuberculosis most tests and specimens were false-negative; whereas PCR was so prone to false-positives that

  4. Evaluation of a Nutritional Support Intervention in Malnourished HIV-Infected Children in Bamako, Mali.

    Science.gov (United States)

    Jesson, Julie; Coulibaly, Aba; Sylla, Mariam; NʼDiaye, Clémentine; Dicko, Fatoumata; Masson, David; Leroy, Valériane

    2017-10-01

    We assessed a nutritional support intervention in malnourished HIV-infected children in a HIV-care program of the University Hospital Gabriel Touré, Bamako, Mali. All HIV-infected children younger than 15 years were diagnosed for malnutrition between 07 and 12, 2014. Malnutrition was defined according to the WHO growth standards with Z-scores. Two types were studied: acute malnutrition (AM) and chronic malnutrition (CM). All participants were enrolled in a 6-month prospective interventional cohort, receiving Ready-To-Use Therapeutic Food, according to type of malnutrition. The nutritional intervention was offered until child growth reached -1.5 SD threshold. Six-month probability to catch up growth (>-2 SD) was assessed for AM using Kaplan-Meier curves and Cox model. Among the 348 children screened, 198 (57%) were malnourished of whom 158 (80%) children were included: 97 (61%) for AM (35 with associated CM) and 61 (39%) with CM. Fifty-nine percent were boys, 97% were on antiretroviral therapy, median age was 9.5 years (Interquartile Range: 6.7-12.3). Among children with AM, 74% catch-up their growth at 6-month; probability to catch-up growth was greater for those without associated CM (adjusted Hazard Ratio = 1.97, CI 95%: 1.13 to 3.44). Anemia decreased significantly from 40% to 12% at the end of intervention (P intervention showed 6-month benefits for weight gain and reduced anemia among these children mainly on antiretroviral therapy for years and aged greater than 5 years at inclusion. Associated CM slows down AM recovery and needs longer support. Integration of nutritional screening and care in the pediatric HIV-care package is needed to optimize growth and prevent metabolic disorders.

  5. Current status of herpesvirus identification in the oral cavity of HIV-infected children

    Directory of Open Access Journals (Sweden)

    Raquel dos Santos Pinheiro

    2013-01-01

    Full Text Available INTRODUCTION: Some viruses of the Herpesviridae family are frequently the etiologic agents of oral lesions associated with HIV. The aim of this study was to identify the presence of herpes simplex virus types 1 and 2 (HSV-1, HSV-2, Varicella Zoster virus (VZV, Epstein-Barr virus (EBV, human cytomegalovirus (HCMV, human herpesvirus type 6, type 7 and type 8 (HHV-6, HHV-7 and HHV-8 in the oral cavity of HIV-infected children/adolescents and verify the association between viral subtypes and clinical factors. METHODS: The cells of oral mucosa were collected from 50 HIV infected children/adolescents, 3-13 years old (mean age 8.66. The majority (66% of selected were girls, and they were all outpatients at the pediatric AIDS clinic of a public hospital in Rio de Janeiro. Nested-PCR was used to identify the viral types. RESULTS: Absence of immunosuppression was observed in 66% of the children. Highly active antiretroviral therapy (HAART was used by 72.1% of selected and moderate viral load was observed in 56% of the children/adolescents. Viral types were found in 86% of the children and the subtypes were: HSV-1 (4%, HSV-2 (2%, VZV (4%, EBV (0%, HCMV (24%, HHV6 (18%, HHV-7 (68%, HHV8 (0%. CONCLUSIONS: The use of HAART has helped to reduce oral lesions, especially with herpes virus infections. The health professionals who work with these patients should be aware of such lesions because of their predictive value and the herpes virus can be found circulating in the oral cavity without causing lesions.

  6. Immunogenicity of Licensed Influenza A (H1N1) 2009 Monovalent Vaccines in HIV-Infected Children and Youth.

    Science.gov (United States)

    Pass, Robert F; Nachman, Sharon; Flynn, Patricia M; Muresan, Petronella; Fenton, Terence; Cunningham, Coleen K; Borkowsky, William; McAuley, James B; Spector, Stephen A; Petzold, Elizabeth; Levy, Wende; Siberry, George K; Handelsman, Ed; Utech, L Jill; Weinberg, Adriana

    2013-12-01

    With the emergence of pandemic influenza A (pH1N1) in 2009, children and youth infected with human immunodeficiency virus (HIV) were vulnerable because of immunologic impairment and the greater virulence of this infection in young persons. A multicenter study of the immunogenicity of 3 licensed influenza A (H1N1) monovalent vaccines (1 live attenuated and 2 inactivated) was conducted in children and youth with perinatal HIV infection, most of whom were receiving ≥3 antiretroviral drugs, had CD4% ≥15, and plasma HIV RNA levels Puerto Rico. Over 40% had baseline HAI titers ≥40. For subjects aged 6 months to vaccine. Three weeks after a single immunization with an inactivated vaccine, similar immunogenicity results were achieved in youth aged 10-24 years. With multivariable analysis, only Hispanic ethnicity and CD4% ≥15 were associated with achieving both HAI titer ≥40- and ≥4-fold rise in titer. Although licensed pH1N1 vaccines produced HAI titers that were considered to be protective in the majority of HIV-infected children and youth, the proportion with titers ≥40- and ≥4-fold rise in titer was lower than expected for children without HIV infection. Vaccine immunogenicity was lower in HIV-infected children and youth with evidence of immune suppression. © The Author 2013. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  7. Children who acquire HIV infection perinatally are at higher risk of early death than those acquiring infection through breastmilk: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Renaud Becquet

    Full Text Available Assumptions about survival of HIV-infected children in Africa without antiretroviral therapy need to be updated to inform ongoing UNAIDS modelling of paediatric HIV epidemics among children. Improved estimates of infant survival by timing of HIV-infection (perinatally or postnatally are thus needed.A pooled analysis was conducted of individual data of all available intervention cohorts and randomized trials on prevention of HIV mother-to-child transmission in Africa. Studies were right-censored at the time of infant antiretroviral initiation. Overall mortality rate per 1000 child-years of follow-up was calculated by selected maternal and infant characteristics. The Kaplan-Meier method was used to estimate survival curves by child's HIV infection status and timing of HIV infection. Individual data from 12 studies were pooled, with 12,112 children of HIV-infected women. Mortality rates per 1,000 child-years follow-up were 39.3 and 381.6 for HIV-uninfected and infected children respectively. One year after acquisition of HIV infection, an estimated 26% postnatally and 52% perinatally infected children would have died; and 4% uninfected children by age 1 year. Mortality was independently associated with maternal death (adjusted hazard ratio 2.2, 95%CI 1.6-3.0, maternal CD4<350 cells/ml (1.4, 1.1-1.7, postnatal (3.1, 2.1-4.1 or peri-partum HIV-infection (12.4, 10.1-15.3.These results update previous work and inform future UNAIDS modelling by providing survival estimates for HIV-infected untreated African children by timing of infection. We highlight the urgent need for the prevention of peri-partum and postnatal transmission and timely assessment of HIV infection in infants to initiate antiretroviral care and support for HIV-infected children.

  8. Chest radiographic abnormalities in HIV-infected African children: a longitudinal study.

    Science.gov (United States)

    Pitcher, Richard D; Lombard, Carl J; Cotton, Mark F; Beningfield, Stephen J; Workman, Lesley; Zar, Heather J

    2015-09-01

    There is limited knowledge of chest radiographic abnormalities over time in HIV-infected children in resource-limited settings. To investigate the natural history of chest radiographic abnormalities in HIV-infected African children, and the impact of antiretroviral therapy (ART). Prospective longitudinal study of the association of chest radiographic findings with clinical and immunological parameters. Chest radiographs were performed at enrolment, 6-monthly, when initiating ART and if indicated clinically. Radiographic abnormalities were classified as normal, mild or moderate severity and considered persistent if present for 6 consecutive months or longer. An ordinal multiple logistic regression model assessed the association of enrolment and time-dependent variables with temporal radiographic findings. 258 children (median (IQR) age: 28 (13-51) months; median CD4+%: 21 (15-24)) were followed for a median of 24 (18-42) months. 70 (27%) were on ART at enrolment; 130 (50%) (median age: 33 (18-56) months) commenced ART during the study. 154 (60%) had persistent severe radiographic abnormalities, with median duration 18 (6-24) months. Among children on ART, 69% of radiographic changes across all 6-month transition periods were improvements, compared with 45% in those not on ART. Radiographic severity was associated with previous radiographic severity (OR=120.80; 95% CI 68.71 to 212.38), lack of ART (OR=1.72; 95% CI 1.29 to 2.27), enrolment age ART was beneficial, reducing the risk of radiographic deterioration or increasing the likelihood of radiological improvement. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Iron supplementation in HIV-infected Malawian children with anemia: a double-blind, randomized, controlled trial

    NARCIS (Netherlands)

    Esan, Michael O.; van Hensbroek, Michael Boele; Nkhoma, Ernest; Musicha, Crispin; White, Sarah A.; ter Kuile, Feiko O.; Phiri, Kamija S.

    2013-01-01

    It is unknown whether iron supplementation in human immunodeficiency virus (HIV)-infected children living in regions with high infection pressure is safe or beneficial. A 2-arm, double-blind, randomized, controlled trial was conducted to examine the effects of iron supplementation on hemoglobin, HIV

  10. Universal antiretroviral therapy for HIV-infected children: a review of the benefits and risks to consider during implementation

    Directory of Open Access Journals (Sweden)

    Linda Barlow-Mosha

    2017-01-01

    Conclusion: Overall, our findings suggest that the benefits could outweigh the risks and support universal ART for all HIV-infected children, but recognize that national programmes will need to put measures in place to minimize the risks if they choose to implement the strategy.

  11. Risk factors for pre-treatment mortality among HIV-infected children in rural Zambia: a cohort study.

    Directory of Open Access Journals (Sweden)

    Catherine G Sutcliffe

    Full Text Available Many HIV-infected children in sub-Saharan Africa enter care at a late stage of disease. As preparation of the child and family for antiretroviral therapy (ART can take several clinic visits, some children die prior to ART initiation. This study was undertaken to determine mortality rates and clinical predictors of mortality during the period prior to ART initiation.A prospective cohort study of HIV-infected treatment-naïve children was conducted between September 2007 and September 2010 at the HIV clinic at Macha Hospital in rural Southern Province, Zambia. HIV-infected children younger than 16 years of age who were treatment-naïve at study enrollment were eligible for analysis. Mortality rates prior to ART initiation were calculated and risk factors for mortality were evaluated.351 children were included in the study, of whom 210 (59.8% were eligible for ART at study enrollment. Among children ineligible for ART at enrollment, 6 children died (mortality rate: 0.33; 95% CI:0.15, 0.74. Among children eligible at enrollment, 21 children died before initiation of ART and their mortality rate (2.73 per 100 person-years; 95% CI:1.78, 4.18 was significantly higher than among children ineligible for ART (incidence rate ratio: 8.20; 95% CI:3.20, 24.83. In both groups, mortality was highest in the first three months of follow-up. Factors associated with mortality included younger age, anemia and lower weight-for-age z-score at study enrollment.These results underscore the need to increase efforts to identify HIV-infected children at an earlier age and stage of disease progression so they can enroll in HIV care and treatment programs prior to becoming eligible for ART and these deaths can be prevented.

  12. Risk factors for pre-treatment mortality among HIV-infected children in rural Zambia: a cohort study.

    Science.gov (United States)

    Sutcliffe, Catherine G; van Dijk, Janneke H; Munsanje, Bornface; Hamangaba, Francis; Siniwymaanzi, Pamela; Thuma, Philip E; Moss, William J

    2011-01-01

    Many HIV-infected children in sub-Saharan Africa enter care at a late stage of disease. As preparation of the child and family for antiretroviral therapy (ART) can take several clinic visits, some children die prior to ART initiation. This study was undertaken to determine mortality rates and clinical predictors of mortality during the period prior to ART initiation. A prospective cohort study of HIV-infected treatment-naïve children was conducted between September 2007 and September 2010 at the HIV clinic at Macha Hospital in rural Southern Province, Zambia. HIV-infected children younger than 16 years of age who were treatment-naïve at study enrollment were eligible for analysis. Mortality rates prior to ART initiation were calculated and risk factors for mortality were evaluated. 351 children were included in the study, of whom 210 (59.8%) were eligible for ART at study enrollment. Among children ineligible for ART at enrollment, 6 children died (mortality rate: 0.33; 95% CI:0.15, 0.74). Among children eligible at enrollment, 21 children died before initiation of ART and their mortality rate (2.73 per 100 person-years; 95% CI:1.78, 4.18) was significantly higher than among children ineligible for ART (incidence rate ratio: 8.20; 95% CI:3.20, 24.83). In both groups, mortality was highest in the first three months of follow-up. Factors associated with mortality included younger age, anemia and lower weight-for-age z-score at study enrollment. These results underscore the need to increase efforts to identify HIV-infected children at an earlier age and stage of disease progression so they can enroll in HIV care and treatment programs prior to becoming eligible for ART and these deaths can be prevented. © 2011 Sutcliffe et al.

  13. Association between age at antiretroviral therapy initiation and 24-month immune response in West-African HIV-infected children

    DEFF Research Database (Denmark)

    Desmonde, Sophie; Dicko, Fatoumata; Koueta, Fla

    2014-01-01

    OBJECTIVE: We describe the association between age at antiretroviral therapy (ART) initiation and 24-month CD4 cell response in West African HIV-infected children. METHODS: All HIV-infected children from the IeDEA paediatric West African cohort, initiating ART, with at least two CD4 cell count...... measurements, including one at ART initiation (baseline) were included. CD4 cell gain on ART was estimated using a multivariable linear mixed model adjusted for baseline variables: age, CD4 cell count, sex, first-line ART regimen. Kaplan-Meier survival curves and a Cox proportional hazards regression model...... compared immune recovery for age within 24 months post-ART. RESULTS: Of the 4808 children initiated on ART, 3014 were enrolled at a median age of 5.6 years; 61.2% were immunodeficient. After 12 months, children at least 4 years at baseline had significantly lower CD4 cell gains compared with children less...

  14. Nutritional status and its response to treatment of children, with and without HIV infection, hospitalized for the management of tuberculosis.

    Science.gov (United States)

    Schaaf, H Simon; Cilliers, Karien; Willemse, Marianne; Labadarios, Demetre; Kidd, Martin; Donald, Peter R

    2012-05-01

    The association of childhood tuberculosis (TB) and malnutrition is known, but treatment response, the influence of the acute-phase response (APR) and concomitant HIV infection are not well documented. To evaluate the nutritional response and APR in HIV-infected and uninfected children hospitalised for the treatment of TB and receiving standard anti-tuberculosis chemotherapy. During a study of the pharmacokinetics of standard anti-tuberculosis agents, anthropometric parameters were measured and blood concentrations of nutrients and C-reactive protein (CRP) determined at 1 and 4 months after initiation of chemotherapy. 24 HIV-infected and 34 HIV-uninfected children were studied. On enrollment, 31.6% of HIV-infected and 2.9% of HIV-uninfected children were underweight, and 31.6% and 14.7%, respectively, were stunted. Mean values of weight, height/length, head circumference and mid-upper-arm circumference on enrollment and at 4-month assessment in HIV-infected and uninfected children did not differ. Mean triceps skinfold (TSF) (8.17 and 9.73 cm) and subscapular skinfold (SSF) thicknesses (5.75 and 7.5 cm) on enrollment differed significantly (P = 0.03 and P = 0.003); by 4 months, TSF had declined to 5.97 cm (PHIV-infected and -uninfected children on enrollment, but at 4-month assessment was raised in 63.2% and 15.2%, respectively. Other micronutrient and haematological findings probably reflect an APR, but no children had sub-normal zinc or magnesium values; most selenium and vitamin C and E values were normal. An elevated platelet count (> 420 × 10(9)/L) was significantly more common in HIV-uninfected children, and was still raised in 39% at 4 months. A majority of HIV-infected and uninfected children had an APR but it had resolved by 4 months in most HIV-uninfected children. In both groups, low and declining skinfolds and a persistently low AMA indicate a persistent disturbance of fat and protein metabolism, despite successful chemotherapy.

  15. Serum selenium status of HIV-infected children on care and ...

    African Journals Online (AJOL)

    Lower serum selenium levels among HIV-infected indivi duals have been linked to excessive utilisation of selenoproteins by the virus.[16] It is this increased utilisation of the selenoproteins in HIV-infected individuals that results in selenium depletion. A study in Ife, south-west. Nigeria, also reported a significantly higher rate.

  16. A Controlled Study of Tuberculosis Diagnosis in HIV-Infected and Uninfected Children in Peru.

    Directory of Open Access Journals (Sweden)

    Richard A Oberhelman

    Full Text Available Diagnosing tuberculosis in children is challenging because specimens are difficult to obtain and contain low tuberculosis concentrations, especially with HIV-coinfection. Few studies included well-controls so test specificities are poorly defined. We studied tuberculosis diagnosis in 525 children with and without HIV-infection.'Cases' were children with suspected pulmonary tuberculosis (n = 209 HIV-negative; n = 81 HIV-positive and asymptomatic 'well-control' children (n = 200 HIV-negative; n = 35 HIV-positive. Specimens (n = 2422 were gastric aspirates, nasopharyngeal aspirates and stools analyzed by a total of 9688 tests. All specimens were tested with an in-house hemi-nested IS6110 PCR that took 0.2 for HIV-positive versus HIV-negative cases. All specimens were also tested with auramine acid-fast microscopy, microscopic-observation drug-susceptibility (MODS liquid culture, and Lowenstein-Jensen solid culture that took ≤6 weeks and had 100% specificity (all 2112 tests on 704 specimens from 235 well-controls were negative. Microscopy-positivity was rare (0.21%, 5/2422 specimens and all microscopy-positive specimens were culture-positive. Culture-positivity was less frequent (P≤0.01 in HIV-infection: 1.2% (1/81 HIV-positive cases versus 11% (22/209 HIV-negative cases; caused by 0.42% (2/481 versus 4.7% (58/1235 of their specimens, respectively.In HIV-positive children with suspected tuberculosis, diagnostic yield was so low that 1458 microscopy and culture tests were done per case confirmed and even in children with culture-proven tuberculosis most tests and specimens were false-negative; whereas PCR was so prone to false-positives that PCR-positivity was as likely in specimens from well-controls as suspected-tuberculosis cases. This demonstrates the importance of control participants in diagnostic test evaluation and that even extensive laboratory testing only rarely contributed to the care of children with suspected TB.This study did not

  17. A Controlled Study of Tuberculosis Diagnosis in HIV-Infected and Uninfected Children in Peru

    Science.gov (United States)

    Oberhelman, Richard A.; Soto-Castellares, Giselle; Gilman, Robert H.; Castillo, Maria E.; Kolevic, Lenka; Delpino, Trinidad; Saito, Mayuko; Salazar-Lindo, Eduardo; Negron, Eduardo; Montenegro, Sonia; Laguna-Torres, V. Alberto; Maurtua-Neumann, Paola; Datta, Sumona; Evans, Carlton A.

    2015-01-01

    Background Diagnosing tuberculosis in children is challenging because specimens are difficult to obtain and contain low tuberculosis concentrations, especially with HIV-coinfection. Few studies included well-controls so test specificities are poorly defined. We studied tuberculosis diagnosis in 525 children with and without HIV-infection. Methods and Findings ‘Cases’ were children with suspected pulmonary tuberculosis (n = 209 HIV-negative; n = 81 HIV-positive) and asymptomatic ‘well-control’ children (n = 200 HIV-negative; n = 35 HIV-positive). Specimens (n = 2422) were gastric aspirates, nasopharyngeal aspirates and stools analyzed by a total of 9688 tests. All specimens were tested with an in-house hemi-nested IS6110 PCR that took 0.2) for HIV-positive versus HIV-negative cases. All specimens were also tested with auramine acid-fast microscopy, microscopic-observation drug-susceptibility (MODS) liquid culture, and Lowenstein-Jensen solid culture that took ≤6 weeks and had 100% specificity (all 2112 tests on 704 specimens from 235 well-controls were negative). Microscopy-positivity was rare (0.21%, 5/2422 specimens) and all microscopy-positive specimens were culture-positive. Culture-positivity was less frequent (P≤0.01) in HIV-infection: 1.2% (1/81) HIV-positive cases versus 11% (22/209) HIV-negative cases; caused by 0.42% (2/481) versus 4.7% (58/1235) of their specimens, respectively. Conclusions In HIV-positive children with suspected tuberculosis, diagnostic yield was so low that 1458 microscopy and culture tests were done per case confirmed and even in children with culture-proven tuberculosis most tests and specimens were false-negative; whereas PCR was so prone to false-positives that PCR-positivity was as likely in specimens from well-controls as suspected-tuberculosis cases. This demonstrates the importance of control participants in diagnostic test evaluation and that even extensive laboratory testing only rarely contributed to the care of

  18. Epidemiology of respiratory syncytial virus-associated acute lower respiratory tract infection hospitalizations among HIV-infected and HIV-uninfected South African children, 2010-2011.

    Science.gov (United States)

    Moyes, Jocelyn; Cohen, Cheryl; Pretorius, Marthi; Groome, Michelle; von Gottberg, Anne; Wolter, Nicole; Walaza, Sibongile; Haffejee, Sumayya; Chhagan, Meera; Naby, Fathima; Cohen, Adam L; Tempia, Stefano; Kahn, Kathleen; Dawood, Halima; Venter, Marietjie; Madhi, Shabir A

    2013-12-15

    There are limited data on respiratory syncytial virus (RSV) infection among children in settings with a high prevalence of human immunodeficiency virus (HIV). We studied the epidemiology of RSV-associated acute lower respiratory tract infection (ALRTI) hospitalizations among HIV-infected and HIV-uninfected children in South Africa. Children aged infection among HIV-infected and uninfected children were examined. The relative risk of hospitalization in HIV-infected and HIV-uninfected children was calculated in 1 site with population denominators. Of 4489 participants, 4293 (96%) were tested for RSV, of whom 1157 (27%) tested positive. With adjustment for age, HIV-infected children had a 3-5-fold increased risk of hospitalization with RSV-associated ALRTI (2010 relative risk, 5.6; [95% confidence interval (CI), 4.5-6.4]; 2011 relative risk, 3.1 [95% CI, 2.6-3.6]). On multivariable analysis, HIV-infected children with RSV-associated ALRTI had higher odds of death (adjusted odds ratio. 31.1; 95% CI, 5.4-179.8) and hospitalization for >5 days (adjusted odds ratio, 4.0; 95% CI, 1.5-10.6) than HIV-uninfected children. HIV-infected children have a higher risk of hospitalization with RSV-associated ALRTI and a poorer outcome than HIV-uninfected children. These children should be targeted for interventions aimed at preventing severe RSV disease.

  19. Neurodevelopment in perinatally HIV-infected children: a concern for adolescence

    Directory of Open Access Journals (Sweden)

    Barbara Laughton

    2013-06-01

    Full Text Available Globally, an estimated 3.4 million children are living with HIV, yet little is known about the effects of HIV and antiretroviral treatment (ART on the developing brain, and the neurodevelopmental and behavioural outcomes of perinatally HIV-infected (PHIV+ adolescents. We reviewed the literature on neurodevelopmental outcomes in PHIV+ children and adolescents, and summarized the current evidence on behaviour, general cognition, specific domains, hearing and language, school performance and physical disabilities due to neurological problems. Evidence suggests that PHIV+ children do not perform as well as controls on general cognitive tests, processing speed and visual–spatial tasks, and are at much higher risk for psychiatric and mental health problems. Children with AIDS-defining diagnoses are particularly at risk for poorer outcomes. A striking finding is the lack of published data specific to the adolescent age group (10–25 years, particularly from resource-constrained countries, which have the highest HIV prevalence. In addition, extreme heterogeneity in terms of timing and source of infection, and antiretroviral experience limits our ability to summarize findings of studies and generalize results to other settings. Due to the complex nature of the developing adolescent brain, environmental influences and variation in access to ART, there is an urgent need for research on the longitudinal trajectory of neurodevelopment among children and adolescents perinatally infected with HIV, especially in high burden resource-constrained settings.

  20. Stool Xpert MTB/RIF and urine lipoarabinomannan (LAM) for diagnosing tuberculosis in hospitalized HIV-infected children.

    Science.gov (United States)

    LaCourse, Sylvia M; Pavlinac, Patricia B; Cranmer, Lisa M; Njuguna, Irene N; Mugo, Cyrus; Gatimu, John; Stern, Joshua; Walson, Judd L; Maleche-Obimbo, Elizabeth; Oyugi, Julius; Wamalwa, Dalton; John-Stewart, Grace

    2017-10-12

    Tuberculosis (TB) causes substantial morbidity and mortality in HIV-infected children. Sample collection and paucibacillary nature of TB in children makes diagnosis challenging. Rapid diagnostic tools using easily obtained specimens are urgently needed. Hospitalized, HIV-infected children ≤12 years enrolled in a randomized controlled trial (NCT02063880) comparing urgent to poststabilization ART initiation in Kenya underwent TB evaluation. At enrollment, sputum or gastric aspirates (GA) were collected for TB culture and Xpert, stool for Xpert, and urine for lateral flow lipoarabinomannan (LAM ). When possible, a second sputum/GA culture was obtained. Stool Xpert and urine LAM performance were compared to reference sputum/GA culture. Among 165 HIV-infected children, median age was 24 months (IQR 13-58), median CD4% was 14.3% (IQR 8.9-22.0%), and 114 (69.5%) had severe immunosuppression. Thirteen (7.9%) children had confirmed TB (positive culture and/or Xpert). Sputum/GA Xpert, Stool Xpert, and urine LAM sensitivities were 60% (95% CI 26-88%), 63% (95% CI 25-92%), and 43% (95% CI 10-82%), respectively. Specificity was 98% (95% CI 94-100%) for sputum/GA Xpert, 99% (95% CI 95-100%) for stool Xpert, 91% (95% CI 84-95%) for urine LAM . Stool Xpert and urine LAM sensitivity increased among children with severe immunosuppression (80% [95% CI 28-100] and 60% [95% Cl 15-95%]). Stool Xpert had similar performance compared to sputum/GA Xpert to detect TB . Urine LAM had lower sensitivity and specificity, but was higher among children with severe immunosuppression. Stool Xpert and urine LAM can aid rapid detection of TB in HIV-infected children using easily accessible samples .

  1. A comparison of tuberculosis diagnostic systems in a retrospective cohort of HIV-infected children in Rio de Janeiro, Brazil.

    Science.gov (United States)

    David, Solange Gonçalves; Lovero, Kathryn L; Pombo March, Maria de Fátima B; Abreu, Thalita G; Ruffino Netto, Antonio; Kritski, Afranio L; Sant'Anna, Clemax C

    2017-06-01

    The diagnosis of pediatric tuberculosis (TB) presents many challenges, and is further complicated in HIV-infected patients. While many diagnostic systems have been proposed, there is no pediatric TB diagnosis gold standard. The outcomes of four TB diagnostic systems in HIV-infected children were compared in this study. A retrospective cohort study was conducted at a TB/HIV reference hospital in Rio de Janeiro. HIV-infected pediatric patients evaluated for TB from 1998 to 2010 were reassessed using four diagnostic systems: Kenneth Jones, 1969; Tidjani, 1986; Ben Marais, 2006; Brazilian Ministry of Health, 2010. Results were compared to standardized diagnoses made by an expert panel of physicians. Of the 121 patients in the study cohort, the expert panel diagnosed 64 as TB and 57 as not TB cases. The Tidjani system showed the highest diagnostic accuracy, with and without the inclusion of microbiological data. The Tidjani and Kenneth Jones systems produced fewer false-positives, and the Ben Marais and Ministry of Health fewer false-negatives. Across systems, there was little agreement between TB diagnoses. In HIV-infected pediatric patients, the Ben Marais and Ministry of Health systems are useful for TB diagnostic screening, whereas the Tidjani and Kenneth Jones systems are best used in a reference center setting. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. Impaired cellular immune response to tetanus toxoid but not to cytomegalovirus in effectively HAART-treated HIV-infected children.

    Science.gov (United States)

    Alsina, Laia; Noguera-Julian, Antoni; Fortuny, Clàudia

    2013-05-07

    Despite of highly active antiretroviral therapy, the response to vaccines in HIV-infected children is poor and short-lived, probably due to a defect in cellular immune responses. We compared the cellular immune response (assessed in terms of IFN-γ production) to tetanus toxoid and to cytomegalovirus in a series of 13 HIV-perinatally-infected children and adolescents with optimal immunovirological response to first line antiretroviral therapy, implemented during chronic infection. A stronger cellular response to cytomegalovirus (11 out of 13 patients) was observed, as compared to tetanus toxoid (1 out of 13; p=0.003). These results suggest that the repeated exposition to CMV, as opposed to the past exposition to TT, is able to maintain an effective antigen-specific immune response in stable HIV-infected pediatric patients and strengthen current recommendations on immunization practices in these children. Copyright © 2013. Published by Elsevier Ltd.

  3. False negative HIV antibody test in HIV infected children who receive early antiretroviral treatment in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Gerardo Alvarez-Uria

    2012-01-01

    Full Text Available With the implementation of 2010 World Health Organization guidelines, the number of infants from developing countries who will initiate antiretroviral therapy (ART will increase considerably. In this study we describe the HIV antibody tests of 14 HIV infected children who initiated ART at age less than one year in a rural setting of India. The HIV rapid test was negative in seven and indeterminate in two cases, whereas the HIV enzyme-linked immunosorbent assay (ELISA antibody test was negative in three and indeterminate in one case. In one child who had both negative HIV rapid test and ELISA initially, HIV serology turned positive after having a virological failure to ART, suggesting the possibility of utilizing HIV serology for monitoring ART effectiveness in children who experience HIV seroreversion. In conclusion, HIV seroreversion of children with early initiation of ART is common and should be considered for avoiding misdiagnosis of HIV infection

  4. Role of Candida species from HIV infected children in enamel caries lesions: an in vitro study.

    Science.gov (United States)

    Charone, Senda; Portela, Maristela Barbosa; Martins, Karol de Oliveira; Soares, Rosangela Maria; Castro, Gloria Fernanda

    2017-01-01

    This study analyzed the capacity of Candida spp. from dental biofilm of HIV infected (HIV+) children to demineralize primary molar enamel in vitro by Transversal Microhardness (TMH), Polarized Light Microscopy (PLM) and the quantity of calcium ions (Ca2+) released from the enamel. Candida spp. samples were isolated from the supragingival biofilm of HIV+ children. A hundred and forty (140) enamel blocks were randomly assigned to six groups: biofilm formed by C. albicans (Group 1); mixed biofilm formed by C. albicans and C. tropicalis (Group 2); mixed biofilm formed by C. albicans and C. parapsilosis (Group 3); mixed biofilm formed by C. albicans, C. parapsilosis and C. glabrata (Group 4); biofilm formed by C. albicans ATCC (Group 5) and medium without Candida (Group 6). Enamel blocks from each group were removed on days 3, 5, 8 and 15 after biofilm formation to evaluate the TMH and images of enamel were analyzed by PLM. The quantity of Ca2+ released, from Groups 1 and 6, was determined using an Atomic Absorption Spectrophotometer. The SPSS program was used for statistical analysis and the significance level was 5%. TMH showed a gradual reduction in enamel hardness (pCandida species from dental biofilm of HIV+ children can cause demineralization of primary enamel in vitro.

  5. Medication Adherence in Children and Adolescents with HIV Infection: Associations with Behavioral Impairment

    Science.gov (United States)

    Williams, Paige; Montepiedra, Grace; McCabe, Marie; Nichols, Sharon; Sirois, Patricia A.; Storm, Deborah; Farley, John; Kammerer, Betsy

    2011-01-01

    Abstract The impact of behavioral functioning on medication adherence in children with perinatally acquired HIV infection is not well-explored, but has important implications for intervention. This report addresses the relationship between behavioral functioning and child self-report or caregiver report of medication adherence among children and adolescents enrolled in Pediatric AIDS Clinical Trials Group Protocol 219C (conducted 2000–2007). A total of 1134 participants, aged 3–17 years, received a behavioral evaluation and adherence assessment. Complete adherence was defined as taking 100% of prescribed antiretroviral medications during three days preceding the study visit. Multivariable logistic regression models were used to evaluate associations between adherence and behavioral functioning, adjusting for potential confounders, including demographic, psychosocial, and health factors. Children demonstrated higher than expected rates of behavioral impairment (≈7% expected with T > 65) in the areas of conduct problems (14%, z = 7.0, p stressful life events and higher HIV RNA levels, were also associated with nonadherence. Knowledge of behavioral, health, and social influences affecting the child and family should guide the development of appropriate, evidence-based interventions for medication adherence. PMID:21323533

  6. Food banking for improved nutrition of HIV infected orphans and vulnerable children; emerging evidence from quality improvement teams in high food insecure regions of Kiambu, Kenya

    National Research Council Canada - National Science Library

    Akulima Muhamed; Ikamati Rudia; Mungai Margaret; Samuel Muhula; Ndirangu Meshack; Muga Richard

    2016-01-01

    .... Quality Improvement Teams were used to facilitate food-banking initiatives. The study aimed at assessing and demonstrating roles of community food-banking in improving nutrition status of HIV-infected children in food insecure regions...

  7. Malnutrition is associated with HIV infection in children less than 5 years in Bobo-Dioulasso City, Burkina Faso: A case-control study.

    Science.gov (United States)

    Poda, Ghislain Gnimbar; Hsu, Chien-Yeh; Chao, Jane C-J

    2017-05-01

    Pediatric human immunodeficiency virus (HIV) infection and malnutrition are still 2 major health issues in sub-Saharan Africa including Burkina Faso where few studies have been conducted on child malnutrition and HIV infection. This study assessed the effects of antiretroviral therapy (ART) in HIV infection and also compared the prevalence of malnutrition in terms of an inadequate diet, underweight, stunting, and wasting among HIV-infected and uninfected children less than 5 years in Bobo-Dioulasso city, Burkina Faso.This was a case-control study matching for age and sex in 164 HIV-infected and 164 HIV-uninfected children. The sociodemographic characteristics of mothers and children, household food security, drinking water source, child feeding and care practices, and child anthropometric data such as body weight, height, and mid-upper arm circumference were collected.The prevalence of food insecurity and inadequate diet was 58% and 92% of children less than 5 years of age, respectively. The prevalence of underweight, stunting, and wasting was 77% versus 35%, 65% versus 61%, and 63% versus 26% in HIV-infected and uninfected children less than 5 years of age, respectively. Out of 164 HIV-infected children, 59% were on ART initiation during data collection and the median of CD4 cell counts was 1078 cells/μL. HIV-infected children on ART had greater CD4 cell counts (P = .04) and higher weight-for-age Z (P = .01) and weight-for-height Z scores (P = .03) than those without ART. HIV infection was a risk factor for those who had inadequate dietary intake [adjusted odds ratio (AOR) = 2.17, 95% confidence interval (CI) 1.17-3.62, P = .04]. In addition, HIV-infected children were more likely of being underweight (AOR = 10.24, 95% CI 4.34-24.17, P prevalence of malnutrition was observed in HIV-infected children compared with HIV-uninfected children. Except for ART, nutritional assessment and support should be included in pediatric HIV management.

  8. Cardiac effects in perinatally HIV-infected and HIV-exposed but uninfected children and adolescents: a view from the United States of America.

    Science.gov (United States)

    Lipshultz, Steven E; Miller, Tracie L; Wilkinson, James D; Scott, Gwendolyn B; Somarriba, Gabriel; Cochran, Thomas R; Fisher, Stacy D

    2013-06-18

    Human immunodeficiency virus (HIV) infection is a primary cause of acquired heart disease, particularly of accelerated atherosclerosis, symptomatic heart failure, and pulmonary arterial hypertension. Cardiac complications often occur in late-stage HIV infections as prolonged viral infection is becoming more relevant as longevity improves. Thus, multi-agent HIV therapies that help sustain life may also increase the risk of cardiovascular events and accelerated atherosclerosis. Before highly active antiretroviral therapy (HAART), the two-to-five-year incidence of symptomatic heart failure ranged from 4 to 28% in HIV patients. Patients both before and after HAART also frequently have asymptomatic abnormalities in cardiovascular structure. Echocardiographic measurements indicate left ventricular (LV) systolic dysfunction in 18%, LV hypertrophy in 6.5%, and left atrial dilation in 40% of patients followed on HAART therapy. Diastolic dysfunction is also common in long-term survivors of HIV infection. Accelerated atherosclerosis has been found in HIV-infected young adults and children without traditional coronary risk factors. Infective endocarditis, although rare in children, has high mortality in late-stage AIDS patients with poor nutritional status and severely compromised immune systems. Although lymphomas have been found in HIV-infected children, the incidence is low and cardiac malignancy is rare. Rates of congenital cardiovascular malformations range from 5.6 to 8.9% in cohorts of HIV-uninfected and HIV-infected children with HIV-infected mothers. In non-HIV-infected infants born to HIV-infected mothers, foetal exposure to ART is associated with reduced LV dimension, LV mass, and septal wall thickness and with higher LV fractional shortening and contractility during the first two years of life. Routine, systematic, and comprehensive cardiac evaluation, including a thorough history and directed laboratory assays, is essential for the care of HIV-infected adults and

  9. Cardiac effects in perinatally HIV-infected and HIV-exposed but uninfected children and adolescents: a view from the United States of America

    Directory of Open Access Journals (Sweden)

    Steven E Lipshultz

    2013-06-01

    Full Text Available Introduction: Human immunodeficiency virus (HIV infection is a primary cause of acquired heart disease, particularly of accelerated atherosclerosis, symptomatic heart failure, and pulmonary arterial hypertension. Cardiac complications often occur in late-stage HIV infections as prolonged viral infection is becoming more relevant as longevity improves. Thus, multi-agent HIV therapies that help sustain life may also increase the risk of cardiovascular events and accelerated atherosclerosis. Discussion: Before highly active antiretroviral therapy (HAART, the two-to-five-year incidence of symptomatic heart failure ranged from 4 to 28% in HIV patients. Patients both before and after HAART also frequently have asymptomatic abnormalities in cardiovascular structure. Echocardiographic measurements indicate left ventricular (LV systolic dysfunction in 18%, LV hypertrophy in 6.5%, and left atrial dilation in 40% of patients followed on HAART therapy. Diastolic dysfunction is also common in long-term survivors of HIV infection. Accelerated atherosclerosis has been found in HIV-infected young adults and children without traditional coronary risk factors. Infective endocarditis, although rare in children, has high mortality in late-stage AIDS patients with poor nutritional status and severely compromised immune systems. Although lymphomas have been found in HIV-infected children, the incidence is low and cardiac malignancy is rare. Rates of congenital cardiovascular malformations range from 5.6 to 8.9% in cohorts of HIV-uninfected and HIV-infected children with HIV-infected mothers. In non-HIV-infected infants born to HIV-infected mothers, foetal exposure to ART is associated with reduced LV dimension, LV mass, and septal wall thickness and with higher LV fractional shortening and contractility during the first two years of life. Conclusions: Routine, systematic, and comprehensive cardiac evaluation, including a thorough history and directed laboratory

  10. A model of associative stigma on depression and anxiety among children of HIV-infected parents in China.

    Science.gov (United States)

    Mo, Phoenix K H; Lau, Joseph T F; Yu, Xiaonan; Gu, Jing

    2015-01-01

    Human immunodeficiency virus (HIV) carries a high level of stigma to the HIV-infected individuals and their family members. Children of HIV-infected parents in China are particularly affected. The present study examined the relationship between associative stigma, self-esteem, optimism, anxiety and depression among 195 children of HIV-infected parents in rural China. Findings showed that more than one-third (35.4 %) of the participants scored higher than cut-off for depression; and 23.6-67.7 % of them scored higher than cut-off for different types of anxiety disorders. Structural equation modelling revealed that associative stigma had a significant negative relationship on self-esteem and optimism, which were associated with higher levels of depression and anxiety. The indirect effects of associative stigma on depression and anxiety were significant. The overall model showed a satisfactory fit. Findings suggest that associative stigma has a significant negative impact on mental health of children affected by HIV. Interventions to reduce their associative stigma are warranted.

  11. Antiretroviral therapy outcomes in HIV-infected children after adjusting protease inhibitor dosing during tuberculosis treatment.

    Directory of Open Access Journals (Sweden)

    Cordula Frohoff

    2011-02-01

    Full Text Available Modification of ritonavir-boosted lopinavir (LPV/r-based antiretroviral therapy is required for HIV-infected children co-treated for tuberculosis (TB. We aimed to determine virologic and toxicity outcomes among TB/HIV co-treated children with the following modifications to their antiretroviral therapy (ART: (1 super-boosted LPV/r, (2 double-dose LPV/r or (3 ritonavir.A medical record review was conducted at two clinical sites in Johannesburg, South Africa. The records of children 6-24 months of age initiating LPV/r-based therapy were reviewed. Children co-treated for TB were categorized based on the modifications made to their ART regimen and were compared to children of the same age at each site not treated for TB. Included are 526 children, 294 (56% co-treated for TB. All co-treated children had more severe HIV disease, including lower CD4 percents and worse growth indicators, than comparisons. Children in the super-boosted group (n = 156 were as likely to be virally suppressed (<400 copies/ml at 6 months as comparisons (69.2% vs. 74.8%, p = 0.36. Children in the double-dose (n = 47 and ritonavir groups (n = 91 were significantly less likely to be virally suppressed at 6 months (53.1% and 49.3% than comparisons (74.8% and 82.1%; p = 0.02 and p<0.0001, respectively. At 12 months only children in the ritonavir group still had lower rates of virological suppression relative to comparisons (63.9% vs 83.3% p<0.05. Grade 1 or greater ALT elevations were more common in the super-boosted (75% than double-dose (54.6% or ritonavir (33.9% groups (p = 0.09 and p<0.0001 but grade 3/4 elevations were observed in 3 (13.6% of the super-boosted, 7 (15.9% of the double-dose and 5 (8.9% of the ritonavir group (p = 0.81 and p = 0.29.Good short-term virologic outcomes were achieved in children co-treated for TB and HIV who received super-boosted LPV/r. Treatment limiting toxicity was rare. Strategies for increased dosing of LPV

  12. Country of Birth Does Not Influence Long-term Clinical, Virologic, and Immunological Outcome of HIV-Infected Children Living in the Netherlands: A Cohort Study Comparing Children Born in the Netherlands With Children Born in Sub-Saharan Africa

    NARCIS (Netherlands)

    Cohen, Sophie; van Bilsen, Ward P. H.; Smit, Colette; Fraaij, Pieter L. A.; Warris, Adilia; Kuijpers, Taco W.; Geelen, Sibyl P. M.; Wolfs, Tom F. W.; Scherpbier, Henriette J.; van Rossum, Annemarie M. C.; Pajkrt, Dasja

    2015-01-01

    Background:Immigrant HIV-infected adults in industrialized countries show a poorer clinical and virologic outcome compared with native patients. We aimed to investigate potential differences in clinical, immunological, and virologic outcome in Dutch HIV-infected children born in the Netherlands (NL)

  13. Country of birth does not influence long-term clinical, virologic, and immunological outcome of HIV-infected children living in the Netherlands: a cohort study comparing children born in the Netherlands with children born in Sub-Saharan Africa

    NARCIS (Netherlands)

    Cohen, S.; Bilsen, W.P. van; Smit, C.; Fraaij, P.L.; Warris, A.; Kuijpers, T.W.; Geelen, S.P.; Wolfs, T.F.; Scherpbier, H.J.; Rossum, A.M. van; Pajkrt, D.

    2015-01-01

    BACKGROUND: Immigrant HIV-infected adults in industrialized countries show a poorer clinical and virologic outcome compared with native patients. We aimed to investigate potential differences in clinical, immunological, and virologic outcome in Dutch HIV-infected children born in the Netherlands

  14. Evaluation of immune responses to combined hepatitis A and B vaccine in HIV-infected children and children on immunosuppressive medication

    NARCIS (Netherlands)

    Belderok, Sanne-Meike; Sonder, Gerard J. B.; van Rossum, Marion; van Dijk-Hummelman, Annette; Hartwig, Nico; Scherpbier, Henriette; Geelen, Sibyl; Speksnijder, Arjen G. C. L.; Baaten, Gijs; van den Hoek, Anneke

    2013-01-01

    Objective: A phase IV interventional study with a combined hepatitis A and B vaccine was conducted in HIV-infected children and children receiving immunosuppressive medication for treatment of rheumatic diseases to evaluate immune responses. Methods: Both groups (1-16 years of age) received combined

  15. Rate of candidiasis among HIV-infected children in Spain in the era of highly active antiretroviral therapy (1997-2008).

    Science.gov (United States)

    Álvaro-Meca, Alejandro; Jensen, Julia; Micheloud, Dariela; Díaz, Asunción; Gurbindo, Dolores; Resino, Salvador

    2013-03-04

    Candidiasis is the most common opportunistic infection seen in human immunodeficiency virus (HIV)-infected individuals. The aim of our study was to estimate the candidiasis rate and evaluate its trend in HIV-infected children in Spain during the era of highly active antiretroviral therapy (HAART) compared to HIV-uninfected children. We carried out a retrospective study. Data were obtained from the records of the Minimum Basic Data Set from hospitals in Spain. All HIV-infected children were under 17 years of age, and a group of HIV-uninfected children with hospital admissions matching the study group by gender and age were randomly selected. The follow-up period (1997-2008) was divided into three calendar periods: a) From 1997 to 1999 for early-period HAART; b) from 2000 to 2002 for mid-period HAART; and c) from 2003 to 2008 for late-period HAART. Among children with hospital admissions, HIV-infected children had much higher values than HIV-uninfected children during each of the three calendar periods for overall candidiasis rates (150.0 versus 6.1 events per 1,000 child hospital admissions/year (p candidiasis rate (events per 1,000 HIV-infected children/year) decreased from 1997-1999 to 2000-2002 (18.8 to 10.6; p candidiasis, both non-ICM and ICM rates experienced significant decreases from 1997-1999 to 2003-2008 (15.9 to 5.7 (p candidiasis rate still remains higher than in the general population (from 1997 to 2008), candidiasis diagnoses have decreased among HIV-infected children throughout the HAART era, and it has ceased to be a major health problem among children with HIV infection.

  16. Rate of candidiasis among HIV-infected children in Spain in the era of highly active antiretroviral therapy (1997–2008)

    Science.gov (United States)

    2013-01-01

    Background Candidiasis is the most common opportunistic infection seen in human immunodeficiency virus (HIV)-infected individuals. The aim of our study was to estimate the candidiasis rate and evaluate its trend in HIV-infected children in Spain during the era of highly active antiretroviral therapy (HAART) compared to HIV-uninfected children. Methods We carried out a retrospective study. Data were obtained from the records of the Minimum Basic Data Set from hospitals in Spain. All HIV-infected children were under 17 years of age, and a group of HIV-uninfected children with hospital admissions matching the study group by gender and age were randomly selected. The follow-up period (1997–2008) was divided into three calendar periods: a) From 1997 to 1999 for early-period HAART; b) from 2000 to 2002 for mid-period HAART; and c) from 2003 to 2008 for late-period HAART. Results Among children with hospital admissions, HIV-infected children had much higher values than HIV-uninfected children during each of the three calendar periods for overall candidiasis rates (150.0 versus 6.1 events per 1,000 child hospital admissions/year (p candidiasis rate (events per 1,000 HIV-infected children/year) decreased from 1997–1999 to 2000–2002 (18.8 to 10.6; p candidiasis, both non-ICM and ICM rates experienced significant decreases from 1997–1999 to 2003–2008 (15.9 to 5.7 (p candidiasis rate still remains higher than in the general population (from 1997 to 2008), candidiasis diagnoses have decreased among HIV-infected children throughout the HAART era, and it has ceased to be a major health problem among children with HIV infection. PMID:23510319

  17. Impaired CCR7 expression on plasmacytoid dendritic cells of HIV-infected children and adolescents with immunologic and virologic failure.

    Science.gov (United States)

    Desai, Seema; Chaparro, Aida; Liu, Huanliang; Haslett, Patrick; Arheart, Kristopher; Scott, Gwendolyn; Pahwa, Rajendra; Pahwa, Savita

    2007-08-15

    Defects of plasmacytoid (p) and myeloid (m) dendritic cells (DCs) occur in HIV infection. The aim of this study was to evaluate the maturation and function of DCs in children with perinatal HIV infection who were on antiretroviral therapy. Twenty HIV-infected children (median age = 12.9 years) classified as immunologic/virologic responders and failures were evaluated in a whole-blood assay with resiquimod (RSQ), a potent agonist to Toll-like receptors 7 and 8, as the DC stimulant. In comparison to controls, pDC and mDC numbers were decreased in patients, but RSQ stimulation resulted in upregulation of CD83, CD80, and tumor necrosis factor-alpha in both DC subsets and upregulation of interferon (IFN)-alpha in pDCs. Patients with immunologic and virologic failure demonstrated a selective impairment in upregulation of lymph node homing marker CCR7 in pDCs. Plasma virus load was negatively correlated with IFNalpha and CCR7 expression, whereas CD4 percentage correlated only with CCR7 expression in pDCs. A novel defect of pDCs, impaired CCR7 upregulation, is described in association with immunologic or virologic failure. This deficiency could impair homing of pDCs to lymph nodes, leading to secondary defects of mDC maturation and poor T-cell activation.

  18. Analysis of serum and supplemented vitamin C and oxidative stress in HIV-infected children and adolescents.

    Science.gov (United States)

    Oliveira, Karoline Faria; Cunha, Daniel Ferreira; Weffort, Virginia Resende Silva

    2011-01-01

    To assess adequacy of vitamin C intake in HIV-infected children and adolescents; to evaluate serum levels of vitamin C and indicators of oxidative stress; to compare with the uninfected group; to correlate serum vitamin C with oxidative stress and associate them according to the reference values. Comparative cross-sectional study. Two groups of 27 children and adolescents each, aged between 3 to 19 years. Group 1 (G1) comprised individuals vertically infected with HIV seen at a regional outpatient clinic. Group 2 (G2) comprised invited individuals without history of HIV infection. The groups were matched for age, sex, and socioeconomic status. The following variables were analyzed: body mass index for age; micronutrient intake and consumption; and serum vitamin C, C-reactive protein (CRP), and albumin. The mean age was 12 years old. Most subjects were female (17, 63%), and there was prevalence of the economic class C (27, 50%). The most prevalent nutritional status was normal weight in 20 individuals (74.1%) in G1 and 21 (77.8%) in G2. The intake of vitamin C was significantly higher in G1 (p = 0.006; t = 2.987) according to the 24-hour dietary recall method. There were significant differences in serum vitamin C concentration between the groups, with a lower level in G1 (p = 0.000; t = -7.309). In relation to oxidative stress, values of CRP in G1 were significantly higher (p = 0.007; t = 2.958). There was no association between deficiency of vitamin, CRP, and albumin. Our findings show that HIV-infected individuals have low levels of vitamin C; however, this deficiency is not related to eating habits, since the intake of this nutrient was higher in this group than in the control group. HIV-infected individuals have specific characteristics that increase their oxidative stress, which is evidenced by increased CRP.

  19. Role of Candida species from HIV infected children in enamel caries lesions: an in vitro study

    Directory of Open Access Journals (Sweden)

    Senda CHARONE

    Full Text Available Abstract Objectives This study analyzed the capacity of Candida spp. from dental biofilm of HIV infected (HIV+ children to demineralize primary molar enamel in vitro by Transversal Microhardness (TMH, Polarized Light Microscopy (PLM and the quantity of calcium ions (Ca2+ released from the enamel. Material and Methods Candida spp. samples were isolated from the supragingival biofilm of HIV+ children. A hundred and forty (140 enamel blocks were randomly assigned to six groups: biofilm formed by C. albicans (Group 1; mixed biofilm formed by C. albicans and C. tropicalis (Group 2; mixed biofilm formed by C. albicans and C. parapsilosis (Group 3; mixed biofilm formed by C. albicans, C. parapsilosis and C. glabrata (Group 4; biofilm formed by C. albicans ATCC (Group 5 and medium without Candida (Group 6. Enamel blocks from each group were removed on days 3, 5, 8 and 15 after biofilm formation to evaluate the TMH and images of enamel were analyzed by PLM. The quantity of Ca2+ released, from Groups 1 and 6, was determined using an Atomic Absorption Spectrophotometer. The SPSS program was used for statistical analysis and the significance level was 5%. Results TMH showed a gradual reduction in enamel hardness (p<0.05 from the 1st to 15th day, but mainly five days after biofilm formation in all groups. The PLM showed superficial lesions indicating an increase in porosity. C. albicans caused the release of Ca2+ into suspension during biofilm formation. Conclusion Candida species from dental biofilm of HIV+ children can cause demineralization of primary enamel in vitro.

  20. Challenges faced by elderly guardians in sustaining the adherence to antiretroviral therapy in HIV-infected children in Zimbabwe.

    Science.gov (United States)

    Skovdal, M; Campbell, C; Madanhire, C; Nyamukapa, C; Gregson, S

    2011-08-01

    Grandparents throughout sub-Saharan Africa have shown immense courage and fortitude in providing care and support for AIDS-affected children. However, growing old comes with a number of challenges which can compromise the quality of care and support they are able to provide, particularly for children infected by HIV and enrolled on antiretroviral therapy (ART) programmes. For ART to be effective, and for infected children not to develop drug-resistance, a complex treatment regimen must be followed. Drawing on the perspectives of 25 nurses and eight grandparents of HIV-infected children in Manicaland, eastern Zimbabwe, we explore some of the challenges faced by grandparents in sustaining children's adherence to ART. These challenges, serving as barriers to paediatric ART, are poverty, immobility, deteriorating memory and poor comprehension of complex treatments. Although older HIV-infected children were found to play an active role in sustaining the adherence to their programme of treatment by contributing to income and food generating activities and reminding their guardians about check-ups and drug administration, such contribution was not available from younger children. There is therefore an urgent need to develop ART services that both take into consideration the needs of elderly guardians and acknowledge and enhance the agency of older children as active and responsible contributors to ART adherence.

  1. Postnatal anemia and iron deficiency in HIV-infected women and the health and survival of their children

    Science.gov (United States)

    Isanaka, Sheila; Spiegelman, Donna; Aboud, Said; Manji, Karim P.; Msamanga, Gernard I.; Willet, Walter C.; Duggan, Christopher; Fawzi, Wafaie W.

    2011-01-01

    Prenatal iron supplementation may improve pregnancy outcomes and decrease the risk of child mortality. However, little is known about the importance of postnatal maternal iron status for child health and survival, particularly in the context of HIV infection. We examined the association of maternal anemia and hypochromic microcytosis, an erythrocyte morphology consistent with iron deficiency, with child health and survival in the first two to five years of life. Repeated measures of maternal anemia and hypochromic microcytosis from 840 HIV-positive women enrolled in a clinical trial of vitamin supplementation were prospectively related to child mortality, HIV infection, and CD4 T-cell count. Median duration of follow-up for the endpoints of child mortality, HIV infection and CD4 cell count was 58, 17 and 23 months, respectively. Maternal anemia and hypochromic microcytosis were associated with greater risk of child mortality (HR for severe anemia=2.58, 95% CI: 1.66-4.01, P trendanemia was not significantly associated with greater risk of child HIV infection (HR for severe anemia=1.46, 95% CI: 0.91, 2.33, P trend=0.08) but predicted lower CD4 T-cell counts among HIV-uninfected children (difference in CD4 T-cell count/μL for severe anemia:-93, 95% CI: -204-17, P trend=0.02). The potential child health risks associated with maternal anemia and iron deficiency may not be limited to the prenatal period. Efforts to reduce maternal anemia and iron deficiency during pregnancy may need to be expanded to include the postpartum period. PMID:22236211

  2. Impact of house-hold food insecurity on nutritional status of HIV-infected children attending an ART centre in Tamil Nadu.

    Science.gov (United States)

    Suresh, E; Srinivasan, R; Valan, A S; Klinton, Joel S; Padmapriyadarsini, C

    2015-03-08

    We studied the level of food insecurity among households with HIV-infected children and its relationship with childhood nutritional indicators. Among the 147 children assessed, food insecurity was present in 59% of households. Majority of children with stunting belonged to-food insecure families. Stunting and Underweight were more prevalent among children >5 years of age.

  3. Immunologic and virologic failure after first-line NNRTI-based antiretroviral therapy in Thai HIV-infected children

    Directory of Open Access Journals (Sweden)

    Phasomsap Chayapa

    2011-10-01

    Full Text Available Abstract Background There are limited data of immunologic and virologic failure in Asian HIV-infected children using non-nucleoside reverse transcriptase inhibitor (NNRTI-based highly active antiretroviral therapy (HAART. We examined the incidence rate of immunologic failure (IF and virologic failure (VF and the accuracy of using IF to predict VF in Thai HIV-infected children using first-line NNRTI-based HAART. Methods Antiretroviral (ART-naïve HIV-infected children from 2 prospective cohorts treated with NNRTI-based HAART during 2001-2008 were included. CD4 counts were performed every 12 weeks and plasma HIV-RNA measured every 24 weeks. Immune recovery was defined as CD4%≥25%. IF was defined as persistent decline of ≥5% in CD4% in children with CD4%1,000 copies/ml after at least 24 weeks of HAART. Clinical and laboratory parameter changes were assessed using a paired t-test, and a time to event approach was used to assess predictors of VF. Sensitivity and specificity of IF were calculated against VF. Results 107 ART-naive HIV-infected children were included, 52% female, % CDC clinical classification N:A:B:C 4:44:30:22%. Baseline data were median (IQR age 6.2 (4.2-8.9 years, CD4% 7 (3-15, HIV-RNA 5.0 (4.9-5.5 log10copies/ml. Nevirapine (NVP and efavirenz (EFV-based HAART were started in 70% and 30%, respectively. At 96 weeks, none had progressed to a CDC clinical classification of AIDS and one had died from pneumonia. Overall, significant improvement of weight for age z-score (p = 0.014, height for age z-score, hemoglobin, and CD4 were seen (all p 10copies/ml. Thirty five (32.7% children experienced VF within 96 weeks. Of these, 24 (68.6% and 31 (88.6% children had VF in the first 24 and 48 weeks respectively. Only 1 (0.9% child experienced IF within 96 weeks and the sensitivity (95%CI of IF to VF was 4 (0.1-20.4% and specificity was 100 (93.9-100%. Conclusion Immunologic failure, as defined here, had low sensitivity compared to VF and

  4. Nosocomial infections in HIV-infected and HIV-uninfected children ...

    African Journals Online (AJOL)

    14 a. Introduction. The interaction between tuberculosis and human immunodeficiency virus. (HIV) infection is well known and is responsible for the inordinate increase in the incidence of tuberculosis (TB) in sub-Saharan Africa over the last de- cade.1 This epidemic affects both adult and childhood tuberculosis and places.

  5. Clinical, nutritional and immunological characteristics of HIV-infected children in an area of high HIV prevalence.

    Science.gov (United States)

    Pedrini, Maura; Moraleda, Cinta; Macete, Eusebio; Gondo, Kizito; Brabin, Bernard J; Menéndez, Clara

    2015-08-01

    To evaluate the clinical, nutritional and neurodevelopment status of HIV-infected children in a high HIV prevalence area. All HIV-infected children under 15 years of age attending an outpatient clinic of Mozambique between April and May 2010 were recruited. Clinical data were collected and physical examination was performed. In all, 140 children were recruited. The median age at HIV diagnosis was 2.1 years. Fifty-one percent of the children were classified in WHO clinical Stages 3 or 4. Median age of antiretroviral treatment commencement was 3.9 years. Overall, 68% were undernourished, mainly stunted. Forty-four percent failed to pass the national psychomotor developmental test. The pathways for early HIV diagnosis and start of antiretrovirals in children should be improved in Mozambique. Malnutrition, especially stunting, and developmental delay were highly prevalent. Further research focused on early diagnosis of neurocognitive disorders and on the indications of antiretroviral treatment commencement based on chronic malnutrition is required. © The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. Kaposi Sarcoma Risk in HIV-Infected Children and Adolescents on Combination Antiretroviral Therapy From Sub-Saharan Africa, Europe, and Asia

    DEFF Research Database (Denmark)

    Rohner, Eliane; Schmidlin, Kurt; Zwahlen, Marcel

    2016-01-01

    BACKGROUND:  The burden of Kaposi sarcoma (KS) in human immunodeficiency virus (HIV)-infected children and adolescents on combination antiretroviral therapy (cART) has not been compared globally. METHODS:  We analyzed cohort data from the International Epidemiologic Databases to Evaluate AIDS...... and the Collaboration of Observational HIV Epidemiological Research in Europe. We included HIV-infected children aged HIV/AIDS stage at cART initiation......HR, 3.4; 95% CI, 1.2-10.1) and advanced HIV/AIDS stage (CDC stage C vs A/B; aHR, 2.4; 95% CI, .8-7.3) at cART initiation. CONCLUSIONS:  HIV-infected children from SSA but not those from other regions, have a high risk of developing KS after cART initiation. Early cART initiation in these children might...

  7. Effect of cotrimoxazole prophylaxis on the incidence of malaria in HIV-infected children in 2012, in Abidjan, Côte d'Ivoire

    DEFF Research Database (Denmark)

    Harouna, Aïda Mounkaila; Amorissani-Folquet, Madeleine; Eboua, François Tanoh

    2015-01-01

    /or cotrimoxazole in Abidjan, Côte d'Ivoire. METHODS: All HIV-infected children signs suggesting malaria had a thick blood smear and were......BACKGROUND: Cotrimoxazole prophylaxis has an antimalarial effect which could have an additional protective effect against malaria in HIV-infected children on antiretroviral therapy (ART). We measured the incidence and associated factors of malaria in HIV-infected children on ART and...... classified as confirmed or probable malaria. We calculated incidence density rates (IR) per 100 child-years (CY). Risk factors were assessed using a Poisson regression model. RESULTS: Overall, 1117 children were included, of whom 89 % were ART-treated and 67 % received cotrimoxazole. Overall, there were 51...

  8. Acute kidney injury in HIV-infected children: comparison of patients according to the use of highly active antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Douglas de Sousa Soares

    Full Text Available Abstract Objective: To assess clinical and laboratory data, and acute kidney injury (AKI in HIV-infected children using and not using highly active antiretroviral therapy (HAART prior to admission. Methods: A retrospective study was conducted with HIV-infected pediatric patients (<16 years. Children who were using and not using HAART prior to admission were compared. Results: Sixty-three patients were included. Mean age was 5.3 ± 4.27 years; 55.6% were females. AKI was observed in 33 (52.3% children. Patients on HAART presented lower levels of potassium (3.9 ± 0.8 vs. 4.5 ± 0.7 mEq/L, p = 0.019 and bicarbonate (19.1 ± 4.9 vs. 23.5 ± 2.2 mEq/L, p = 0.013 and had a higher estimated glomerular filtration rate (102.2 ± 36.7 vs. 77.0 ± 32.8 mL/min/1.73 m2, p = 0.011 than those not on HAART. In the multivariate analysis, the use of HAART prior to the admission was a protective factor for AKI (p = 0.036; OR = 0.30; 95% CI = 0.097-0.926. Conclusion: AKI is a common complication of pediatric HIV infection. Use of HAART prior to the admission preserved glomerular filtration and was a protective factor for AKI, but increased medication side effects, such as hypokalemia and renal metabolic acidosis.

  9. Lack of association between nutritional status and change in clinical category among HIV-infected children in Brazil

    Directory of Open Access Journals (Sweden)

    Maraisa Centeville

    Full Text Available CONTEXT AND OBJECTIVE: Malnutrition is common among HIV-infected children. Our objective was to study the occurrence of malnutrition and its relationship with changes in clinical category among HIV-infected children. DESIGN AND SETTING: Longitudinal study, at the Pediatrics Department and Pediatrics Investigation Center (CIPED, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp. METHODS: We reviewed the hospital records of 127 vertically HIV-infected children. Anthropometric measurements were obtained at the beginning of follow-up, at clinical category change and five months later. These were converted to z-scores of weight/age, height/age and weight/height. Data were presented as means, standard deviations, frequency counts and percentages. The Wilcoxon and Kruskal-Wallis tests and odds ratios were used in the analysis. RESULTS: We found that 51 (40.2% were undernourished and 40 (31.5% were stunted, with higher risk of being included in clinical category C. There was an association between nutritional condition and the clinical categories of the Centers for Disease Control classification (1994, and with age at symptom onset (except for height z-score. During follow-up, 36 patients (28.4% changed their clinical category, which occurred early among the undernourished patients. The group that changed its clinical category maintained the same z-score distribution for weight, height and weight/height throughout follow-up. CONCLUSION: Aids manifestation severity was associated with nutritional status and with age at symptom onset, but change in clinical category was not followed by worsening of nutritional status.

  10. The effect of different intervention programs on treatment adherence of HIV-infected children, a retrospective study.

    Science.gov (United States)

    van der Plas, Atie; Scherpbier, Henriette; Kuijpers, Taco; Pajkrt, Dasja

    2013-01-01

    In HIV-infected children, long-term adherence to combination anti-retroviral therapy (cART) is difficult. In this retrospective study, we evaluated the effect of two different treatment adherence programs on treatment adherence (as indicated by cART failures) and the need for additional supportive care measures in a cohort of 31 HIV-infected children between 3 and 18 years of age. In a follow-up period of 6 years, we evaluated the treatment adherence at baseline (before introduction of any treatment adherence program in 2004) and compared this to cART failures during two treatment adherence programs (in respectively 2006 and 2009). The need for additional supportive care measures (the frequency of hospitalizations, daily observed treatment, use of child protection service, attendance of special schools, and placement in foster homes) was also evaluated at these three time points. The first treatment adherence program focused on increasing patient's obedience by imposing negative measures in case of treatment failure, whereas the second program aimed to increase treatment adherence by rewarding optimal medication intake. Prior to start of any treatment adherence intervention program, cART failures were observed in 29% of the pediatric patients. After introduction of the first treatment adherence program, cART failures decreased to 6%. During the second treatment adherence program, the cART failures remained equally low (10%), but the need for some specific additional supportive care measures (the frequency of hospitalizations and placement in foster homes) was importantly reduced. Treatment adherence programs are effective in increasing treatment adherence to cART in HIV-infected children. A novel reward treatment interventional program as an addition to social supportive care programs is a promising new positive enforcement program and can reduce the need for additional supportive care programs. Further prospective studies are needed to evaluate the long

  11. Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings.

    Science.gov (United States)

    Goga, Ameena Ebrahim; Singh, Yagespari; Singh, Michelle; Noveve, Nobuntu; Magasana, Vuyolwethu; Ramraj, Trisha; Abdullah, Fareed; Coovadia, Ashraf H; Bhardwaj, Sanjana; Sherman, Gayle G

    2017-01-01

    Introduction Increasing access to HIV-related care and treatment for children aged 0-18 years in resource-limited settings is an urgent global priority. In 2011-2012 the percentage increase in children accessing antiretroviral therapy was approximately half that of adults (11 vs. 21 %). We propose a model for increasing access to, and retention in, paediatric HIV care and treatment in resource-limited settings. Methods Following a rapid appraisal of recent literature seven main challenges in paediatric HIV-related care and treatment were identified: (1) lack of regular, integrated, ongoing HIV-related diagnosis; (2) weak facility-based systems for tracking and retention in care; (3) interrupted availability of dried blood spot cards (expiration/stock outs); (4) poor quality control of rapid HIV testing; (5) supply-related gaps at health facility-laboratory interface; (6) poor uptake of HIV testing, possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure and weak systems for social support, resulting in poor retention in care. Results To increase sustained access to paediatric HIV-related care and treatment, regular updating of Policies, review of inter-sectoral Plans (at facility and community levels) and evaluation of Programme implementation and impact (at national, subnational, facility and community levels) are non-negotiable critical elements. Additionally we recommend the intensified implementation of seven main interventions: (1) update or refresher messaging for health care staff and simple messaging for key staff at early childhood development centres and schools; (2) contact tracing, disclosure and retention monitoring; (3) paying particular attention to infant dried blood spot (DBS) stock control; (4) regular quality assurance of rapid HIV testing procedures; (5) workshops/meetings/dialogues between health facilities and laboratories to resolve transport-related gaps and to facilitate return of

  12. Long-Term Changes of Subcutaneous Fat Mass in HIV-Infected Children on Antiretroviral Therapy: A Retrospective Analysis of Longitudinal Data from Two Pediatric HIV-Cohorts.

    Directory of Open Access Journals (Sweden)

    Sophie Cohen

    Full Text Available Longitudinal studies objectively evaluating changes in regional fat distribution of HIV-infected children assessed by whole body dual energy X-ray absorptiometry (DEXA are scarce, whilst this long-term effect of HIV and antiretroviral therapy (cART is an important issue in infected children in need for lifelong treatment.We assessed regional fat distribution over time, measured with sequential DEXA-scans in HIV-infected children on cART in cohorts from South Africa (SA and the Netherlands (NL, and in healthy controls (SA. Limb and trunk fat Z-scores were calculated with the lambda-mu-sigma (LMS method. Multivariable linear regression models with mixed effects were used to investigate the effect of cART compounds on body fat distribution over time.In total, 218 children underwent 445 DEXA assessments with a median follow-up of 3.5 years. Fat mass in all limbs was decreased in HIV-infected children compared to controls (arm fat Z-score: coefficient -0.4813; P = 0.006, leg fat Z-score: coefficient -0.4345; P = 0.013. In the HIV-infected group, stavudine treatment was associated with lower subcutaneous fat mass (arm fat Z-score: coefficient -0.5838; P = 0.001, with an additional cumulative exposure effect (arm fat Z-score: coefficient -0.0867; P = 0.003.Our study shows that subcutaneous fat loss is still prevalent in HIV-infected children on cART, and is strongly associated with cumulative stavudine exposure. These results underline the need for early detection of subcutaneous fat loss and alternative treatment options for HIV-infected children globally.

  13. Undernutrition and anaemia among HAART-naïve HIV infected children in Ile-Ife, Nigeria: a case-controlled, hospital based study.

    Science.gov (United States)

    Anyabolu, Henry Chineme; Adejuyigbe, Ebunoluwa Aderonke; Adeodu, Oluwagbemiga Oyewole

    2014-01-01

    Case control studies that assess the burden and factors associated with undernutrition and anaemia among HAART naïve HIV infected children in Nigeria is very sparse. This will help to formulate nutritional programs among these children. Seventy HAART naive HIV infected children aged 18 months and above were as well as seventy age and sex matched HIV negative children were recruited from August 2007 to January 2009 at Paediatric Clinic of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Their bio data, WHO clinical stage, anthropometric measurements, haematocrit, serum albumin and CD4 counts were taken with other parameters according to a study proforma. The prevalence of stunting, underweight and wasting among the HIV infected subjects were 48. 6%,58. 6% and 31. 4% respectively which as significantly higher than 28. 1%, 7. 1% and 28. 1% among the HIV negative controls. 20. 1% of the HIV infected children were marasmic compared to 2. 3% of the controls. Triple anthropometric failure was found in 7. 1% of the subjects as compared to none among the controls. Anaemia is significantly more prevalent among the subjects than the controls (70. 0% vs 31. 4%; panaemia was higher in the HIV infected subjects with undernutrition. Low socioeconomic status, hypoalbuminemia and severe immunosuppression are significantly associated with higher undernutrition prevalence. Several years after availability of HAART, undernutrition and anaemia remain widely prevalent among newly presenting HAART naïve HIV infected Nigerian children. Nutritional supplementation and evaluation for anaemia still need close attention in the management of these children.

  14. Lipodystrophy among HIV-infected children and adolescents on highly active antiretroviral therapy in Uganda: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Moses R Kamya

    2012-07-01

    Full Text Available Background: With widespread use of antiretroviral therapy (ART and prolonged survival of HIV-infected children, toxicities like lipodystrophy are becoming more evident. Little is known about lipodystrophy in children in Uganda yet there is increased use of ART. The aim of this study was to determine the prevalence and factors associated with fat redistribution and metabolic abnormalities among HIV-infected children on highly active antiretroviral therapy (HAART in Uganda. Methods: A cross-sectional study of 364 HIV positive children aged between 2 and 18 years on ART were enrolled after consent and assent as appropriate. Sociodemographic, clinical and immunological data were collected and recorded in a questionnaire. Fat redistribution was assessed clinically for physical findings of lipohypertrophy and lipoatrophy. A fasting blood sample was taken for lipid profile and blood glucose analysis. Lipodystrophy was defined as presence of abnormal fat redistribution or metabolic abnormalities or both. The proportion of children with fat redistribution and metabolic abnormalities was calculated. We conducted multivariate analysis for factors associated with lipodystrophy among children with lipodystrophic features and those without. Results: The median age of the participants was eight years (range 2 to 18, with 43% of these aged ≥10 years and a male to female ratio of 1.1:1. Majority (65% had advanced HIV (WHO Stage III/IV at ART initiation with a mean duration on ART of 3.8 years (±1.2. The prevalence of fat redistribution and hyperlipidemia was 27.0% and 34.0%, respectively. None of the children had hyperglycaemia. Among the children with hyperlipidemia, 16.8% exhibited hypercholesterolemia and 83% had hypertriglyceridemia. Only 29% of children with fat redistribution had hyperlipidemia. We found significant association between fat redistribution and Tanner stages 2 to 5 OR=2.3 (95%CI 1.3 to 3.8, age≥5 years OR=3.9 (95%CI 1.5 to 9.9 and d4T

  15. Parental satisfaction in Ugandan children with cleft lip and palate following synchronous lip and palatal repair.

    NARCIS (Netherlands)

    D. Budolfsen; G. Galiwango; Anke Luyten; A. Hodges; E. D'haeseleer; K. van Lierde; H. Vermeersch

    2013-01-01

    The purpose of the present case control study was to assess parental satisfaction with speech and facial appearance in Ugandan children with complete unilateral or bilateral cleft lip and palate (CLP), who underwent a synchronous lip and palatal closure. The results are compared with an age- and

  16. Protein-energy malnutrition and intellectual abilities : a study of teen-age Ugandan children

    NARCIS (Netherlands)

    Hoorweg, J.C.

    1976-01-01

    This study is concerned with the relation between protein-energy malnutrition and the intellectual abilities of children in Uganda. The findings are based on the investigation of a group of 60 Ugandan boys and girls who became severely malnourished during the first 27 months of their life, resulting

  17. The Incidence of Respiratory Tract Infections in Vertically HIV-Infected Children in Lower Silesia in Poland and the Approach to Infection Prevention.

    Science.gov (United States)

    Kuchar, E; Dawiec, M; Kraszewska-Glomba, B; Miśkiewicz, K; Nitsch-Osuch, Aneta; Szenborn, L

    2015-01-01

    Human immunodeficiency virus (HIV) is a risk factor associated with respiratory tract infections. However little is known about the prevalence of these infections in HIV-infected children in Poland. We investigated the incidence of respiratory tract infections in 26 HIV-infected children (aged 4-18, mean 10.3 years, including 17 girls) treated in our center and compared it with the age-matched control group of 70 children. The prevalence of chronic diseases and other factors such as cigarette smoking by household members or attending educational institutions were also taken into consideration. Among the HIV-infected children, 48 respiratory infections were observed, including 4 cases of pneumonia and 44 other respiratory infections for 312 person-month observations vs. 256 infections including 13 cases of pneumonia and 243 other respiratory infections for 840 person-month observations in the control group. Thus, incidence of respiratory infections per month was lower in HIV-infected children (14%) compared with the control group (29%), i.e., 0.14 95% CI (0.10-0.18) infections per month vs. 0.29 95% CI (0.26-0.32). There was no difference in the incidence of pneumonia. The lower incidence of respiratory infections in HIV-infected children may be explained by their avoiding sick people, taking influenza vaccination on the annual basis, and possibly antiviral medication. We conclude that the influence of modifiable environmental factors that reduce the risk of respiratory tract infections is more significant than the HIV infection itself.

  18. Global, regional, and national estimates of pneumonia burden in HIV-infected children in 2010: a meta-analysis and modelling study

    Science.gov (United States)

    Theodoratou, Evropi; McAllister, David A; Reed, Craig; Adeloye, Davies O; Rudan, Igor; Muhe, Lulu M; Madhi, Shabir A; Campbell, Harry; Nair, Harish

    2014-01-01

    Summary Background Globally, pneumonia is a leading cause of mortality and morbidity in children younger than 5 years. Underlying HIV infection is an important risk factor for pneumonia morbidity and mortality in children. There are, however, no global or country level estimates of pneumonia burden in HIV-infected children. We assessed the role of HIV in pneumonia incidence and mortality and estimated the number of pneumonia cases and deaths in HIV-infected children younger than 5 years in 133 high pneumonia-burden countries in 2010. Methods We estimated the risk of hospital admission and case fatality rate caused by pneumonia in HIV-infected children compared with HIV-uninfected children from a systematic review of studies published in Medline, Embase, and Global Health between Jan 1, 1980, and Aug 31, 2013. We estimated nationwide pneumonia incidence and mortality with two different models that incorporated several risk factors for paediatric pneumonia hospital admission and mortality (including HIV infection). We then estimated the number of pneumonia episodes and deaths that occurred in HIV-infected children in 2010. Findings The odds ratio (OR) for hospital admission for all-cause pneumonia in HIV-infected children compared with HIV-uninfected children was 6·5 (95% CI 5·9–7·2). The risk of death was higher in children with pneumonia and HIV compared with those with pneumonia only (OR 5·9, 95% CI 2·7–12·7). In 2010, 1·4 million pneumonia episodes (uncertainty range [UR] 0·6 million to 3·3 million) and 88 000 pneumonia deaths (UR 47 400–153 000) occurred in HIV-infected children in low-income countries. Of these, 1·2 million pneumonia episodes (UR 0·5 million–2·7 million) and 85 400 deaths (UR 46 000–147 300) were directly attributable to HIV. 1·3 million (90%) pneumonia episodes and 82 400 (93%) pneumonia deaths in HIV-infected children aged younger than 5 years occurred in the WHO African region. Interpretation Globally, a

  19. An Analysis of the Last Clinical Encounter before Outpatient Mortality among Children with HIV Infection and Exposure in Lilongwe, Malawi.

    Directory of Open Access Journals (Sweden)

    Chris A Rees

    Full Text Available Human immunodeficiency virus (HIV contributes to nearly 20% of all deaths in children under five years of age in Malawi. Expanded coverage of antiretroviral therapy has allowed children to access treatment on an outpatient basis. Little is known about characteristics of the final outpatient encounter prior to mortality in the outpatient setting.This retrospective cohort study assessed clinical factors associated with mortality among HIV-exposed infants and HIV-infected children less than 18 years of age at the Baylor College of Medicine Abbott Fund Children's Center of Excellence in Lilongwe, Malawi. We compared clinical indicators documented from the final outpatient encounter for patients who died in the outpatient setting versus those who were alive after their penultimate clinical encounter.Of the 8,546 patients who were attended to over a 10-year period at the Baylor Center of Excellence, 851 had died (10%. Of children who died, 392 (46% were directly admitted to the hospital after their last clinical encounter and died as inpatients. Of the remaining 459 who died as outpatients after their last visit, 53.5% had a World Health Organization (WHO stage IV condition at their last visit, and 25% had a WHO stage III condition. Multivariate regression analysis demonstrated that poor nutritional status, female gender, shorter time as a patient, more clinical encounters in the prior month, if last visit was an unscheduled sick visit, and if the patient had lost weight since their prior visit independently predicted increased mortality in the outpatient setting after the final clinical encounter.Clinical indicators may assist in identifying children with HIV who have increased risk of mortality in the outpatient setting. Recognizing these indicators may aid in identifying HIV-infected children who require a higher level of care or closer follow-up.

  20. Retinal Structure and Function in Perinatally HIV-Infected and cART-Treated Children: A Matched Case-Control Study.

    Science.gov (United States)

    Demirkaya, Nazli; Cohen, Sophie; Wit, Ferdinand W N M; Abramoff, Michael D; Schlingemann, Reinier O; Kuijpers, Taco W; Reiss, Peter; Pajkrt, Dasja; Verbraak, Frank D

    2015-06-01

    Subtle structural and functional neuroretinal changes have been described in human immunodeficiency virus (HIV)-infected adults without retinitis treated with combination antiretroviral therapy (cART). However, studies on this subject in HIV-infected children are scarce. This study aimed to assess the presence of (neuro)retinal functional and structural differences between a group of perinatally HIV-infected children on cART and age-, sex-, ethnicity-, and socioeconomically matched healthy controls. All participants underwent an extensive ophthalmological examination, including functional tests as well as optical coherence tomography, to measure individual retinal layer thicknesses. Multivariable mixed linear regression models were used to assess possible associations between HIV status (and other HIV-related parameters) and ocular parameters, while accounting for the inclusion of both eyes and several known confounders. Thirty-three HIV-infected children (median age 13.7 years [interquartile range (IQR), 12.2-15.8], median CD4+ T-cell count 760 cells/mm3, 82% with an undetectable HIV viral load [VL]), and 36 controls (median age 12.1 years [IQR, 11.5-15.8]) were included. Contrast sensitivity (CS) was significantly lower in the HIV-infected group (1.74 vs. 1.76 logCS; P = 0.006). The patients had a significantly thinner foveal thickness (-11.2 μm, P = 0.012), which was associated with a higher peak HIV VL (-10.3 μm per log copy/mL, P = 0.016). In this study, we found a decrease in foveal thickness in HIV-infected children, which was associated with a higher peak VL. Longitudinal studies are warranted to confirm our findings and to determine the course and clinical consequences of these foveal changes.

  1. Reliability of absolute lymphocyte count as a marker to assess the need to initiate antiretroviral therapy in HIV-infected children

    Directory of Open Access Journals (Sweden)

    I Shah

    2012-01-01

    Full Text Available Background: CD4 counts are a standard laboratory measure of disease progression in HIV-infected children. However, CD4 counting is done by flow cytometry and may not always be possible in every centre treating HIV-infected children in resource-limited countries. Absolute Lymphocyte Count (ALC can be derived easily by performing a routine white blood cell count. The World Health Organization (WHO in 2006 had recommended ALC to identify HIV-infected children in need of ART in resource-limited settings, when CD4 cell count is not available. Aims: This study aims to assess the reliability of using ALC as a marker for starting antiretroviral therapy (ART in HIV-infected children in a tertiary hospital setting. Settings and Design: Retrospective analysis of 46 HIV-infected children who presented at a pediatric HIV clinic at a tertiary referral centre from 2002-2005. Materials and Methods: Using WHO 2006 guidelines for cutoff values of ALC and 2008 guidelines for CD4% as a comparative standard, a retrospective analysis was done on ART-naοve HIV-infected children who underwent baseline CD4% and ALC, and sensitivity and specificity of ALC was calculated. Statistical Analysis: Fischer exact two-tailed analysis was used to correlate ALC and CD4 and need for starting ART. Results: Sensitivity of ALC was 27.6% (72.4% were false negatives, specificity was 70.6%, with positive predictive value of 61.5%. On comparison across all clinical stages of disease, only 13/46 children (28.2% would have been started on ART according to ALC cutoffs versus 29/46 children (63.04% using CD4 criteria (P value=0.0015. In children with WHO clinical Stage 1 or 2 of disease, only 1/11 (9.1% children were identified by ALC as requiring ART as opposed to 6/11 (54.5% children by CD4% (P=0.0635. Conclusions: ALC is an unreliable marker to determine the need for starting ART in HIV-infected children.

  2. Asymptomatic HIV infection

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/000682.htm Asymptomatic HIV infection To use the sharing features on this page, please enable JavaScript. Asymptomatic HIV infection is a phase of HIV/AIDS during which ...

  3. Travelers' Health: HIV Infection

    Science.gov (United States)

    ... Share Compartir Chapter 3 - Histoplasmosis Chapter 3 - Influenza HIV Infection Philip J. Peters, John T. Brooks INFECTIOUS AGENT ... skin (see Chapter 8, Health Care Workers ). EPIDEMIOLOGY HIV infection occurs worldwide. As of the end of 2014, ...

  4. Severe morbidity and mortality in untreated HIV-infected children in a paediatric care programme in Abidjan, Côte d'Ivoire, 2004-2009

    Directory of Open Access Journals (Sweden)

    Alioum Ahmadou

    2011-06-01

    Full Text Available Abstract Background Clinical evolution of HIV-infected children who have not yet initiated antiretroviral treatment (ART is poorly understood in Africa. We describe severe morbidity and mortality of untreated HIV-infected children. Methods All HIV-infected children enrolled from 2004-2009 in a prospective HIV programme in two health facilities in Abidjan, Côte d'Ivoire, were eligible from their time of inclusion. Risks of severe morbidity (the first clinical event leading to death or hospitalisation and mortality were documented retrospectively and estimated using cumulative incidence functions. Associations with baseline characteristics were assessed by competing risk regression models between outcomes and antiretroviral initiation. Results 405 children were included at a median age of 4.5 years; at baseline, 66.9% were receiving cotrimoxazole prophylaxis, and 27.7% met the 2006 WHO criteria for immunodeficiency by age. The risk of developing a severe morbid event was 14% (95%CI: 10.7 - 17.8 at 18 months; this risk was lower in children previously exposed to any prevention of mother-to-child-transmission (PMTCT intervention (adjusted subdistribution hazard ratio [sHR]: 0.16, 95% CI: 0.04 - 0.71 versus those without known exposure. Cumulative mortality reached 5.5% (95%CI: 3.5 - 8.1 at 18 months. Mortality was associated with immunodeficiency (sHR: 6.02, 95% CI: 1.28-28.42. Conclusions Having benefited from early access to care minimizes the severe morbidity risk for children who acquire HIV. Despite the receipt of cotrimoxazole prophylaxis, the risk of severe morbidity and mortality remains high in untreated HIV-infected children. Such evidence adds arguments to promote earlier access to ART in HIV-infected children in Africa and improve care interventions in a context where treatment is still not available to all.

  5. DYNAMICS OF CLINICAL LABORATORY PARAMETER IN HIV-INFECTED CHILDREN UNDERGOING DIFFERENT PATTERNS OF INITIAL HIGHLY ACTIVE ANTIRETROVIRAL THERAPY: RANDOMIZED CONTROLLED TRIAL

    Directory of Open Access Journals (Sweden)

    V. B. Denisenko

    2016-01-01

    Full Text Available Background: Adverse course of HIV infection, rapid development of immunosuppression, severe opportunistic infections and malignant tumors and high mortality substantiate the importance of timely prescription of highly active antiretroviral therapy (HAART. The initial therapy pattern must remain efficient and safe in the long term.Objective: Our aim was to study effectiveness and safety of different patterns of initial HAART in HIV-infected children.Methods: The randomized controlled trial involved HIV-infected children aged 1–3 years. Clinical, immunological and virological examinations were conducted before and 12 months after HAART. The initial therapy pattern included 2 nucleoside HIV reverse transcriptase inhibitors — zidovudine and lamivudine. Children were randomized to the groups differing in the third therapy component: lopinavir/ritonavir or nevirapine.Results: 25 patients were randomized to the lopinavir/ritonavir group, 23 children — to the nevirapine group. After 12 months of treatment, HIV replication suppression (blood viral load < 50 copies/ml was achieved in 25 (100% lopinavir/ritonavir group patients and in 16 (70% nevirapine group patients (p = 0.003. HIV infection did not progress clinically regardless of the pattern. The median number of CD4+CD3+ lymphocytes in the lopinavir/ritonavir group increased from 20.5% (12; 23 to 30% (27; 34 (p < 0,001, in the nevirapine group — from 21.5% (17; 23 to 29% (27; 38 (p < 0.001. Adverse events developed in 13 (27% children. 3 and 2 children in the lopinavir/ritonavir group suffered from nausea and emesis, respectively. 1 and 1 patient in the nevirapine group suffered from allergic rash and drug-induced hepatitis, respectively.Conclusion: High effectiveness and safety of lopinavir/ritonavir allow recommending this drug as the third component of the initial HAART pattern for HIV-infected children.

  6. Pharmacokinetics of two generic fixed-dose combinations for HIV-infected children (Pedimune Baby & Pedimune Junior) are similar to the branded products in healthy adults.

    NARCIS (Netherlands)

    L'homme, R.F.A.; Dijkema, T.; Warris, A.; Ven, A.J.A.M. van der; Gibb, D.M.; Burger, D.M.

    2007-01-01

    OBJECTIVES: Cipla Pharmaceuticals have developed generic fixed-dose combinations of stavudine, lamivudine and nevirapine for HIV-infected children (Pedimune Baby and Junior). We determined the pharmacokinetic profiles of stavudine, lamivudine and nevirapine in Pedimune and compared these with the

  7. Health workers' views on quality of prevention of mother-to-child transmission and post-natal care for HIV-infected women and their children

    NARCIS (Netherlands)

    Nguyen, T.A.; Oosterhoff, P.; Yen, P.N.; Hardon, A.; Wright, P.

    2009-01-01

    Background: Prevention of mother-to-child transmission has been considered as not a simple intervention but a comprehensive set of interventions requiring capable health workers. Viet Nam's extensive health care system reaches the village level, but still HIV-infected mothers and children have

  8. Prevalence of malnutrition among HIV-infected children in Central and West-African HIV-care programmes supported by the Growing Up Programme in 2011: a cross-sectional study

    National Research Council Canada - National Science Library

    Jesson, Julie; Masson, David; Adonon, Arsène; Tran, Caroline; Habarugira, Capitoline; Zio, Réjane; Nicimpaye, Léoncie; Desmonde, Sophie; Serurakuba, Goreth; Kwayep, Rosine; Sare, Edith; Konate, Tiefing; Nimaga, Abdoulaye; Saina, Philemon; Kpade, Akossiwa; Bassuka, Andrée; Gougouyor, Gustave; Leroy, Valériane

    2015-01-01

    The burden of malnutrition among HIV-infected children is not well described in sub-Saharan Africa, even though it is an important problem to take into account to guarantee appropriate healthcare for these children...

  9. Nutritional assessment and lipid profile in HIV-infected children and adolescents treated with highly active antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Marina Hjertquist Tremeschin

    2011-06-01

    Full Text Available INTRODUCTION: HIV-infected children and adolescents treated with highly active antiretroviral therapy (HAART regimens that include a protease inhibitor (PI can show significant improvements in clinical outcomes, nutritional status and quality of life. The study aimed to report nutritional and metabolic alterations for pediatric patients continuously exposed to HAART and for healthy controls for up to 1 year. METHODS: Clinical, anthropometric, lipid profile and food intake data were collected prospectively over approximately 12-months for each patient. RESULTS: Fifty-one individuals were studied, of these, 16 were healthy. After 12 months follow-up, HIV-positive individuals remained below the healthy control group parameters. No change was observed concerning food intake. Triglyceride serum levels were higher in patients using protease inhibitor at the onset of the study [PI groups: 114 (43 - 336, and 136 (63 - 271 versus control group: 54.5 (20 - 162; p = 0.003], but after twelve months follow-up, only the group using protease inhibitor for up to two months presented higher values [140 (73 - 273 versus 67.5 (33 - 117; p = 0.004]. HDL-cholesterol was lower in HIV-positive individuals [HIV-positive groups: 36 (27 - 58 and 36 (23 - 43; control 49.5 (34 - 69; p = 0.004]. CONCLUSIONS: HIV-infected children and adolescents treated with highly active antiretroviral therapy showed compromised nutritional parameters compared to a paired healthy control group. Individuals using protease inhibitor presented worse triglyceride serum levels compared to their healthy counterparts.

  10. Factors associated with HIV infection among children born to mothers on the prevention of mother to child transmission programme at Chitungwiza Hospital, Zimbabwe, 2008.

    Science.gov (United States)

    Ngwende, Stella; Gombe, Notion T; Midzi, Stanley; Tshimanga, Mufuta; Shambira, Gerald; Chadambuka, Addmore

    2013-12-14

    Zimbabwe is one of the five countries worst affected by the HIV/AIDS pandemic with HIV infection contributing increasingly to childhood morbidity and mortality. Among the children born to HIV positive mothers participating in the PMTCT programme, 25% tested positive to HIV. We investigated factors associated with HIV infection among children born to mothers on the PMTCT programme. A 1:1 unmatched case-control study was conducted at Chitungwiza Hospital, Zimbabwe, 2008. A case was defined as a child who tested HIV positive, born to a mother who had been on PMTCT programme. A control was a HIV negative child born to a mother who had been on PMTCT programme. An interviewer-administered questionnaire was used to collect data on demographic characteristics, risk factors associated with HIV infection and immunization status. A total of 120 mothers were interviewed. Independent risk factors associated with HIV infection among children included maternal CD4 count of less than 200 during pregnancy [aOR = 7.1, 95% CI (2.6-17)], mixed feeding [aOR = 29, 95% CI (4.2-208)], being hospitalized since birth [aOR = 2.9, 95% CI (1.2-4.8)] whilst being exclusively breast fed for less than 6 months [aOR = 0.1 (95% CI 0.03-0.4)] was protective. HIV infection among children increased if the mother's CD4 count was ≤200 cells/μL and if the child was exposed to mixed feeding. Breastfeeding exclusively for less than six months was protective. We recommended exclusive breast feeding period for the first six months and stop breast feeding after 6 months if affordable, sustainable and safe.

  11. Adherence to infant-feeding choices by HIV-infected mothers at a ...

    African Journals Online (AJOL)

    HIV-infected women. HIV-infected mothers in developing countries often face complex challenges which influence their choice of infant-feeding practice.1 .... of HIV infection in women of childbearing age, globally, is accounted ..... Prevention and Treatment of HIV Infection in Pregnant Women, Mothers and Children.

  12. The impact of perinatal HIV infection on older school-aged children's and adolescents' receptive language and word recognition skills.

    Science.gov (United States)

    Brackis-Cott, Elizabeth; Kang, Ezer; Dolezal, Curtis; Abrams, Elaine J; Mellins, Claude Ann

    2009-06-01

    Perinatally HIV-infected youths are reaching adolescence in large numbers. Little is known about their cognitive functioning. This study aims to describe and compare the receptive language ability, word recognition skills, and school functioning of older school-aged children and adolescents perinatally HIV infected (HIV-positive) and perinatally HIV-exposed but uninfected (seroreverters; HIV-negative). Participants included 340 youths (206 HIV-positive, 134 HIV-negative), 9-16 years old, and their caregivers. Youths completed the Peabody Picture Vocabulary Test, Third Edition (PPVT-III) and the Reading Subtest of the Wide Range Achievement Test, Third Edition (WRAT-3). Caregivers were interviewed regarding demographic characteristics and school placement of youths. Medical information was abstracted from medical charts. Both groups of youths scored poorly on the PPVT-III and WRAT-3 with about one third of youths scoring in less than the 10th percentile. The HIV-positive youths scored lower than the seroreverters (M = 83.8 versus 87.6, t = 2.21, p = 0.028) on the PPVT-III and on the WRAT-3 (M = 88.2 versus 93.8, t = 2.69, p = 0.008). Among the HIV-positive youths, neither CD4+ cell count, HIV RNA viral load or Centers for Disease Control and Prevention (CDC) classification were significantly associated with either PPVT-III or WRAT-3 scores. However, youths who were taking antiretroviral medication had lower WRAT-3 scores than youths not taking medication (M = 95.03 versus 86.89, t = 2.38, p = 0.018). HIV status remained significantly associated with PPVT-III and WRAT-3 standard scores after adjusting for demographic variables. Many youths had been retained in school and attended special education classes. Findings highlight poor language ability among youths infected with and affected by HIV, and the importance of educational interventions that address this emerging need.

  13. The role of social support on resilience, posttraumatic growth, hopelessness, and depression among children of HIV-infected parents in mainland China.

    Science.gov (United States)

    Mo, Phoenix Kit Han; Lau, Joseph Tak Fai; Yu, Xiaonan; Gu, Jing

    2014-01-01

    Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has a profound impact not only on the infected individuals, but also on their families. Children of the HIV-infected parents are particularly affected. The present study examined the relationship between social support, resilience, posttraumatic growth (PTG), hopelessness, and depression among 195 children of HIV-infected parents in mainland China. Results showed that 35.4% of the sample scored above the cutoff of the Children's Depression Inventory. Results from structural equation modeling reported that social support had a significant positive relationship with resilience and PTG. Higher levels of resilience and PTG were associated with lower level of hopelessness which in turn, was associated with lower level of depression. The overall model achieved satisfactory fit. Interventions are needed to improve social support of the children affected by HIV so as to improve their mental health.

  14. Effect of multiple micronutrient supplementation on survival of HIV-infected children in Uganda: a randomized, controlled trial.

    Science.gov (United States)

    Ndeezi, Grace; Tylleskär, Thorkild; Ndugwa, Christopher M; Tumwine, James K

    2010-06-03

    Micronutrient deficiencies compromise the survival of HIV-infected children in low-income countries. We assessed the effect of multiple micronutrient supplementation on the mortality of HIV-infected children in Uganda. In a randomized, controlled trial, 847 children aged one to five years and attending HIV clinics in Uganda were stratified by antiretroviral therapy (ART, n = 85 versus no ART, n = 762). The children were randomized to six months of either: twice the recommended dietary allowance of 14 micronutrients as the intervention arm (vitamins A, B1, B2, niacin, B6, B12, C, D and E, folate, zinc, copper, iodine and selenium); or the standard recommended dietary allowance of six multivitamins (vitamins A, D2, B1, B2, C and niacin) as a comparative "standard-of-care" arm. Mortality was analyzed at 12 months of follow up using Kaplan Meier curves and the log rank test. Mortality at 12 months was 25 out of 426 (5.9%) children in the intervention arm and 28 out of 421 (6.7%) in the comparative arms: risk ratio 0.9 (95% CI 0.5 - 1.5). Two out of 85 (2.4%) children in the ART stratum died compared with 51 out of 762 (6.7%) in the non-ART stratum. Of those who died in the non-ART stratum, 25 of 383 (6.5%) were in the intervention arm and 26 of 379 (6.9%) in the comparative arm; risk ratio 1.0 (95% CI 0.6 - 1.6). There was no significant difference in survival at 12 months (p = 0.64, log rank test). In addition, there was no significant difference in mean weight-for-height at 12 months; 0.70 +/- 1.43 (95% CI 0.52 - 0.88) for the intervention versus 0.59 +/- 1.15 (95% CI 0.45 - 0.75) in the comparative arm. The mean CD4 cell count; 1024 +/- 592 (95% CI 942 - 1107) versus 1060 +/- 553 (95% CI 985 - 1136) was also similar between the two groups. Twice the recommended dietary allowance of 14 micronutrients compared with a standard recommended dietary allowance of six multivitamins for six months was well tolerated, but it did not significantly alter mortality, growth or CD

  15. [Association between intracellular zinc levels and nutritional status in HIV-infected and uninfected children exposed to the virus].

    Science.gov (United States)

    Gómez G, Erika María; Maldonado C, María Elena; Rojas L, Mauricio; Posada J, Gladys

    2015-01-01

    Malnutrition, growth retardation and opportunistic infections outlast the metabolic, immune and gastrointestinal disorders produced by HIV. Zinc deficiency has been associated with deteriorating nutritional status, growth failure, and risk of infection. The aim of this study is to determine the association between zinc levels in peripheral blood mononuclear cells (PBMC) and the nutritional status of HIV-infected and uninfected children exposed to the virus. An analytical, observational, cross-sectional study was conducted on 17 infected and 17 exposed children, aged 2-10 years. Anthropometric measurements, clinical and nutritional history, 24h recall, measurement of physical activity, and zinc in PBMC by flow cytometry analysis were recorded. Height according to age, energy consumption and adequacy of energy, protein and dietary zinc were significantly higher in children exposed to the virus compared to those infected with HIV (P .05). However, the median levels of zinc in monocytes of infected patients was higher (218.6) compared to the control group (217.0). No association was found between zinc intake and levels of intracellular zinc. The deterioration of nutritional status and growth retardation in children were associated with HIV, but not with the levels of intracellular zinc. The dietary intake of this nutrient was not associated with levels of zinc in monocytes or CD4 + and CD4- lymphocytes. Copyright © 2015. Publicado por Elsevier España, S.L.U.

  16. Prevalencia de trombocitopenia en niños con HIV/sida Prevalence of thrombocytopenia in HIV infected children

    Directory of Open Access Journals (Sweden)

    Graciela Barboni

    2010-10-01

    thrombocytopenia was evaluated in a cohort of HIV infected children analyzing the clinical features and the association with the immunological and virological status of the disease in a 14 year-follow-up period. Thrombocytopenia prevalence was of 8.5% (29 out 339 children evaluated. Chronic and acute thrombocytopenia was observed in 22 and 7 children respectively. The percentages of CD4+ T cells were variable and not related with the presence of thrombocytopenia. Thrombocytopenic patients showed viral load levels significantly increased; being the thrombocytopenia the initial clinical manifestation of HIV infection in 10 out 29 children. Mild chronic thrombocytopenia bleeding found in 23% of children evaluated was not correlated with the immunologic status of the disease. In contrast, the severity of acute thrombocytopenia depended on the evolution of associated clinical conditions. Constant viral activity and failure in the use of antiretroviral agents might induce the development of thrombocytopenia in HIV-infected children.

  17. Food banking for improved nutrition of HIV infected orphans and vulnerable children; emerging evidence from quality improvement teams in high food insecure regions of Kiambu, Kenya.

    Science.gov (United States)

    Akulima, Muhamed; Ikamati, Rudia; Mungai, Margaret; Samuel, Muhula; Ndirangu, Meshack; Muga, Richard

    2016-01-01

    Estimated 236,548 People Living with HIV (PLHIV) were in Central-Eastern Kenya in 2013. Kiambu County had 46,656 PLHIV with 42,400 (91%) adults and 4,200(9%) children (1-14yrs). Amref Health Africa in Kenya, supported through USAID-APHIAplus KAMILI project, initiated two food banks to respond to poor nutritional status of the HIV infected children. Quality Improvement Teams were used to facilitate food-banking initiatives. The study aimed at assessing and demonstrating roles of community food-banking in improving nutrition status of HIV-infected children in food insecure regions. A pre and post-test study lasting 12 months (Oct 2013 to September 2014) conducted in Kiambu County, Kenya covering 103 HIV infected children. Two assessments were conducted before and after the food banking initiative and results compared. Child Status Index (CSI) and the Middle Upper Arm Circumference (MUAC) tools were used in data collection at households. Paired T-test and Wilcoxon test were applied for analysing MUAC and CSI scores respectively using the SPSS. There was a significant improvement in the children's nutrition status from a rating of 'bad' in CSI Median (IQR) score 2(2-1) before food banking to a rating of 'fair' in CSI Median (IQR) score 3(4-3) after food banking intervention (p=banking (p=banking is a community-based nutritional intervention that can address factors of food access, affordability and availability. Food banking is a sustainable way to contribute to quality nutrition and reduced related deaths among HIV infected children.

  18. Nutritional and Immunological Correlates of Memory and Neurocognitive Development Among HIV-Infected Children Living in Kayunga, Uganda.

    Science.gov (United States)

    Ruiseñor-Escudero, Horacio; Familiar-Lopez, Itziar; Sikorskii, Alla; Jambulingam, Nikita; Nakasujja, Noelline; Opoka, Robert; Bass, Judith; Boivin, Michael

    2016-04-15

    To identify the nutritional and immunological correlates of memory and neurocognitive development as measured by the Mullen Scales of Early Learning (MSEL) and by the Color Object Association Test (COAT) among children in Uganda. This analysis uses baseline data collected between 2008 and 2010 from 119 HIV-infected children aged 1-6 years, participating in a randomized controlled trial of an interventional parenting program in Kayunga, Uganda. Peripheral blood draws were performed to determine immunological biomarkers. Unadjusted and adjusted linear regression models were used to relate MSEL and COAT scores to sociodemographic characteristics, weight-for-age Z scores (WAZs), antiretroviral therapy status, and immunological biomarkers. In the final analysis, 111 children were included. Lower levels of CD4 CD38 T cells (P = 0.04) were associated to higher immediate and total recall scores (P = 0.04). Higher levels of CD8 HLA-DR T cells were associated with higher total recall score (P = 0.04) of the COAT. Higher CD4 CD38 HLA-DR T cells levels were associated with higher gross motor scores of the MSEL (P = 0.02). WAZ was positively correlated to visual reception, fine motor, expressive language, and composite score of the MSEL. Overall, WAZ was a stronger predictor of neurocognitive outcomes assessed by the MSEL. CD4 CD38 T cells were more specifically associated with memory-related outcomes. Future research should include immunological markers and standardized neurocognitive tests to further understand this relationship.

  19. Multicentre analysis of second-line antiretroviral treatment in HIV-infected children: adolescents at high risk of failure.

    Science.gov (United States)

    Boerma, Ragna S; Bunupuradah, Torsak; Dow, Dorothy; Fokam, Joseph; Kariminia, Azar; Lehman, Dara; Kityo, Cissy; Musiime, Victor; Palumbo, Paul; Schoffelen, Annelot; Sophan, Sam; Zanoni, Brian; Rinke de Wit, Tobias F; Calis, Job C J; Sigaloff, Kim C E

    2017-09-15

    The number of HIV-infected children and adolescents requiring second-line antiretroviral treatment (ART) is increasing in low- and middle-income countries (LMIC). However, the effectiveness of paediatric second-line ART and potential risk factors for virologic failure are poorly characterized. We performed an aggregate analysis of second-line ART outcomes for children and assessed the need for paediatric third-line ART. We performed a multicentre analysis by systematically reviewing the literature to identify cohorts of children and adolescents receiving second-line ART in LMIC, contacting the corresponding study groups and including patient-level data on virologic and clinical outcomes. Kaplan-Meier survival estimates and Cox proportional hazard models were used to describe cumulative rates and predictors of virologic failure. Virologic failure was defined as two consecutive viral load measurements >1000 copies/ml after at least six months of second-line treatment. We included 12 cohorts representing 928 children on second-line protease inhibitor (PI)-based ART in 14 countries in Asia and sub-Saharan Africa. After 24 months, 16.4% (95% confidence interval (CI): 13.9-19.4) of children experienced virologic failure. Adolescents (10-18 years) had failure rates of 14.5 (95% CI 11.9-17.6) per 100 person-years compared to 4.5 (95% CI 3.4-5.8) for younger children (3-9 years). Risk factors for virologic failure were adolescence (adjusted hazard ratio [aHR] 3.93, p 48 months, respectively, compared to failure rates. However, adolescents showed exceptionally poor virologic outcomes in LMIC, and optimizing their HIV care requires urgent attention. In addition, 16% of children and adolescents failed PI-based treatment and will require integrase inhibitors to construct salvage regimens. These drugs are currently not available in LMIC.

  20. Impact of highly active antiretroviral therapy on nutritional and immunologic status in HIV-infected children in the low-income country of Ethiopia.

    Science.gov (United States)

    Ebissa, Getachew; Deyessa, Negusse; Biadgilign, Sibhatu

    2016-06-01

    HIV/AIDS and malnutrition combine to undermine the immunity of individuals and are inextricably interrelated. Although the effect of highly active antiretroviral therapy (HAART) on growth in HIV-infected children is well known, the influence of prior nutritional and immunologic status on the response to HAART is not well documented. The aim of the present study was to determine the effects of HAART on nutritional and immunological status in HIV-infected children in the low-income country of Ethiopia. A multicenter, retrospective cohort study was conducted on HIV-infected children receiving antiretroviral therapy at the pediatric units of public hospitals in Addis Ababa (Black Lion, Zewditu, Yekatit 12 and ALERT hospitals), Ethiopia. Nutritional status was defined as stunting (height-for-age Z score [HAZ] underweight (weight-for-age Z score [WAZ] nutritional status) in children predicts immunologic outcomes. In all, 556 HIV-infected children receiving HAART from January 2008 to December 2009 were included in this study. Over the 24-mo follow-up period, the study showed that the immunologic recovery of stunted and underweight children, regardless of their baseline nutritional status, responded equally to treatment. However, wasted children showed less immunologic recovery at the different follow-up visits. Predictors of positive shift in WHZ after 24 mo of follow-up were advanced disease stage (World Health Organization clinical stages 3 and 4) with odds ratio (OR), 0.25 (95% confidence interval [CI], 0.34-0.99; P = 0.045) and baseline severe underweight OR, 0.19 (95% CI, 0.09-0.56; P = 0.003). The independent predictors of positive shift of growth shift in WAZ over 24 mo were lower baseline age (underweight itself with OR, 0.11 (95% CI, 0.05-0.25; P = 0.0001) were predictors of positive shift (shift to normal). Despite the apparent growth response in HIV-infected children after initiation of HAART, moderate and severe underweight are both independent

  1. Immunity to Measles, Mumps, and Rubella in US Children With Perinatal HIV Infection or Perinatal HIV Exposure Without Infection

    Science.gov (United States)

    Siberry, George K.; Patel, Kunjal; Bellini, William J.; Karalius, Brad; Purswani, Murli U.; Burchett, Sandra K.; Meyer, William A.; Sowers, Sun Bae; Ellis, Angela; Van Dyke, Russell B.

    2015-01-01

    Background. Children with perinatal human immunodeficiency virus (HIV) infection (PHIV) may not be protected against measles, mumps, and rubella (MMR) because of impaired initial vaccine response or waning immunity. Our objectives were to estimate seroimmunity in PHIV-infected and perinatally HIV-exposed but uninfected (HEU) children and identify predictors of immunity in the PHIV cohort. Methods. PHIV and HEU children were enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) at ages 7–15 years from 2007 to 2009. At annual visits, demographic, laboratory, immunization, and clinical data were abstracted and serologic specimens collected. Most recent serologic specimen was used to determine measles seroprotection by plaque reduction neutralization assay and rubella seroprotection and mumps seropositivity by enzyme immunoassay. Sustained combination antiretroviral therapy (cART) was defined as taking cART for at least 3 months. Results. Among 428 PHIV and 221 HEU PHACS participants, the prevalence was significantly lower in PHIV children for measles seroprotection (57% [95% confidence interval {CI}, 52%–62%] vs 99% [95% CI, 96%–100%]), rubella seroprotection (65% [95% CI, 60%–70%] vs 98% [95% CI, 95%–100%]), and mumps seropositivity (59% [95% CI, 55%–64%] vs 97% [95% CI, 94%–99%]). On multivariable analysis, greater number of vaccine doses while receiving sustained cART and higher nadir CD4 percentage between last vaccine dose and serologic testing independently improved the cumulative prediction of measles seroprotection in PHIV. Predictors of rubella seroprotection and mumps seropositivity were similar. Conclusions. High proportions of PHIV-infected children, but not HEU children, lack serologic evidence of immunity to MMR, despite documented immunization and current cART. Effective cART before immunization is a strong predictor of current seroimmunity. PMID:26060291

  2. Candida species from oral cavity of HIV-infected children exhibit reduced virulence factors in the HAART era.

    Science.gov (United States)

    Portela, Maristela Barbosa; Lima de Amorim, Elaine; Santos, Adrielle Mangabeira; Alexandre da Rocha Curvelo, José; de Oliveira Martins, Karol; Capillé, Cauli Lima; Maria de Araújo Soares, Rosangela; Barbosa de Araújo Castro, Gloria Fernanda

    2017-01-01

    This study aimed to assess, in vitro, the biofilm viability and the phospholipase and protease production of Candida spp. from the saliva of HIV infected children and healthy controls, and to correlate the results with the use of medical data. A total of 79 isolates were analyzed: 48 Candida albicans isolates (33/15) and 20 Candida parapsilosis sensu lato complex isolates (12/8) (from HIV/control patients, respectively), and 8 Candida krusei, 1 Candida tropicalis, 1 Candida dubliniensis and 1 Candida guilliermondii from HIV patients. The XTT (2, 3-bis (2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-Carboxanilide) reduction assay analyzed the biofilm viability. Phospholipase and protease assays were performed using the egg yolk and Bovine Serum Albumin agar plate methods, respectively. All isolates were able to form biofilm with cell viability. Quantitatively, Candida isolates from both groups presented a similar ability to form biofilm (p > 0.05). The biofilm viability activity was higher in C. albicans isolates than in non-albicans Candida isolates (p Candida spp. isolates from HIV-positive children presented higher phospholipase production, in vitro they exhibited reduced virulence factors compared to isolates from healthy individuals. This finding may enlighten the role played by immunosuppression in the modulation of Candida virulence attributes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa

    DEFF Research Database (Denmark)

    Ndondoki, Camille; Dicko, Fatoumata; Ahuatchi Coffie, Patrick

    2014-01-01

    INTRODUCTION: We assessed the rate of treatment failure of HIV-infected children after 12 months on antiretroviral treatment (ART) in the Paediatric IeDEA West African Collaboration according to their perinatal exposure to antiretroviral drugs for preventing mother-to-child transmission (PMTCT...... failure was not significantly associated with PMTCT exposure (p=0.15) but was associated with immunodeficiency (aHR 1.6; 95% CI: 1.4-1.9; p=0.001), AIDS clinical events (aHR 1.4; 95% CI: 1.0-1.9; p=0.02) at ART initiation and receiving care in Mali compared to Côte d'Ivoire (aHR 1.2; 95% CI: 1.0-1.4; p=0.......04). CONCLUSIONS: Despite a low data quality, PMTCT-exposed West African children did not have a poorer 12-month response to ART than others. Immunodeficiency and AIDS events at ART initiation remain the main predictors associated with treatment failure in this operational context....

  4. Executive Summary: 2013 Update of the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

    OpenAIRE

    Siberry, George K; Abzug, Mark J.; Nachman, Sharon

    2013-01-01

    This executive report provides an overview of the 2013 update of the Department of Health and Human Services (DHHS) Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children in the United States. The full text of the guidelines is available online at www.aidsinfo.nih.gov and as a supplement to the Pediatric Infectious Disease Journal. These guidelines are intended for use by clinicians and other health-care workers providing medical care ...

  5. Loss to follow-up among children and adolescents growing up with HIV infection: age really matters.

    Science.gov (United States)

    Kranzer, Katharina; Bradley, John; Musaazi, Joseph; Nyathi, Mary; Gunguwo, Hilary; Ndebele, Wedu; Dixon, Mark; Ndhlovu, Mbongeni; Rehman, Andrea; Khan, Palwasha; Vogt, Florian; Apollo, Tsitsi; Ferrand, Rashida Abbas

    2017-07-17

    Globally, increasing numbers of HIV-infected children are reaching adolescence due to antiretroviral therapy (ART). We investigated rates of loss-to-follow-up (LTFU) from HIV care services among children as they transition from childhood through adolescence. Individuals aged 5-19 years initiated on ART in a public-sector HIV clinic in Bulawayo, Zimbabwe, between 2005 and 2009 were included in a retrospective cohort study. Participants were categorized into narrow age-bands namely: 5-9 (children), 10-14 (young adolescents) and 15-19 (older adolescents). The effect of age at ART initiation, current age (using a time-updated Lexis expansion) and transitioning from one age group to the next on LTFU was estimated using Poisson regression. Of 2273 participants, 1013, 875 and 385 initiated ART aged 5-9, 10-14 and 15-19 years, respectively. Unlike those starting ART as children, individuals starting ART as young adolescents had higher LTFU rates after moving to the older adolescent age-band (Adjusted rate ratio (ARR) 1.54; 95% CI: 0.94-2.55) and similarly, older adolescents had higher LTFU rates after transitioning to being young adults (ARR 1.79; 95% CI: 1.05-3.07). In older adolescents, the LTFU rate among those who started ART in that age-band was higher compared to the rate among those starting ART at a younger age (ARR = 1.70; 95% CI: 1.05, 2.77). This however did not hold true for other age-groups. Adolescents had higher rates of LTFU compared to other age-groups, with older adolescents at particularly high risk in all analyses. Age-updated analyses that examine movement across narrow age-bands are paramount in understanding how developmental heterogeneity in children affects HIV outcomes.

  6. Risk factors associated with increased mortality among HIV infected children initiating antiretroviral therapy (ART in South Africa.

    Directory of Open Access Journals (Sweden)

    Brian C Zanoni

    Full Text Available OBJECTIVE: To identify demographic and clinical risk factors associated with mortality after initiation of antiretroviral therapy (ART in a cohort of human immunodeficiency (HIV infected children in KwaZulu-Natal, South Africa. METHODS: We performed a retrospective cohort study of 537 children initiating antiretroviral therapy at McCord Hospital in KwaZulu-Natal, South Africa. Data were extracted from electronic medical records and risk factors associated with mortality were assessed using Cox regression analysis. RESULTS: Overall there were 47 deaths from the cohort of 537 children initiating ART with over 991 child-years of follow-up (median 22 months on ART, yielding a mortality rate of 4.7 deaths per 100 child years on ART. Univariate analysis indicated that mortality was significantly associated with lower weight-for-age Z-score (p<0.0001, chronic diarrhea (p = 0.0002, lower hemoglobin (p = 0.002, age <3 years (p = 0.003, and CD4% <10% (p = 0.005. The final multivariable Cox proportional hazards mortality model found age less than 3 years (p = 0.004, CD4 <10% (p = 0.01, chronic diarrhea (p = 0.03, weight-for-age Z-score (<0.0001 and female gender as a covariate varying with time (p = 0.03 all significantly associated with mortality. CONCLUSION: In addition to recognized risk factors such as young age and advanced immunosuppression, we found female gender to be significantly associated with mortality in this pediatric ART cohort. Future studies are needed to determine whether intrinsic biologic differences or socio-cultural factors place female children with HIV at increased risk of death following initiation of ART.

  7. Socioeconomic predictors of cognition in Ugandan children: implications for community interventions.

    Directory of Open Access Journals (Sweden)

    Paul Bangirana

    2009-11-01

    Full Text Available Several interventions to improve cognition in at risk children have been suggested. Identification of key variables predicting cognition is necessary to guide these interventions. This study was conducted to identify these variables in Ugandan children and guide such interventions.A cohort of 89 healthy children (45 females aged 5 to 12 years old were followed over 24 months and had cognitive tests measuring visual spatial processing, memory, attention and spatial learning administered at baseline, 6 months and 24 months. Nutritional status, child's educational level, maternal education, socioeconomic status and quality of the home environment were also measured at baseline. A multivariate, longitudinal model was then used to identify predictors of cognition over the 24 months.A higher child's education level was associated with better memory (p = 0.03, attention (p = 0.005 and spatial learning scores over the 24 months (p = 0.05; higher nutrition scores predicted better visual spatial processing (p = 0.002 and spatial learning scores (p = 0.008; and a higher home environment score predicted a better memory score (p = 0.03.Cognition in Ugandan children is predicted by child's education, nutritional status and the home environment. Community interventions to improve cognition may be effective if they target multiple socioeconomic variables.

  8. Cognitive, academic, and behavioral correlates of medication adherence in children and adolescents with perinatally acquired HIV infection.

    Science.gov (United States)

    Nichols, Sharon L; Montepiedra, Grace; Farley, John J; Sirois, Patricia A; Malee, Kathleen; Kammerer, Betsy; Garvie, Patricia A; Naar-King, Sylvie

    2012-05-01

    Medication adherence is critical to the success of antiretroviral therapies for children and youth with perinatally acquired HIV. Factors that influence successful transition of medication responsibility from caregivers to youth are poorly understood. The purpose of this study was to evaluate the relationship of medication adherence with demographic, cognitive, academic, and behavioral characteristics. Randomly selected youth, N = 151, aged 8 to 18 years, completed cognitive and academic measures, and they and their caregivers completed questionnaires assessing behavior and emotional well-being. An announced pill count and questionnaires completed by youth and their caregivers were used to evaluate adherence. Of 151 participants, 100 completed all adherence measures. Adherence rates varied by assessment method. Nonadherence (reading problems predicted better self- and caregiver-reported adherence. Youth-reported locus of control was associated with pill count nonadherence, and poor relationships with parents were associated with youth-reported nonadherence. Consideration of youth cognitive or academic status may be helpful in evaluating medication adherence in patients with perinatally acquired HIV infection, particularly when using self- or caregiver reports to assess adherence. Vigilance for adherence problems is indicated when youth are older, responsible for medications, report poor caregiver relationships, and/or sense a lack of control over their lives.

  9. Profile of HIV infected children: A hospital based study at Eastern Nepal

    OpenAIRE

    Prakash Poudel; Rita Pokharel; Mohit Chitlangia; Shipra Chaudhary

    2014-01-01

    Objective: To investigate the clinical, laboratory, epidemiological profiles and outcome in human immunodeficiency virus infected Nepalese children. Methods: This was a hospital based prospective study. Human immunodeficiency virusinfected children presenting to pediatric immunology clinic at BP Koirala Institute of Health Sciences were enrolled and followed up. Results: Median age at diagnosis among 39 enrolled children was 58 months. All children acquired infection vertically...

  10. Tuberculosis, before and after Antiretroviral Therapy among HIV-Infected Children in Nigeria: What Are the Risk Factors?

    Directory of Open Access Journals (Sweden)

    Emmanuel A Anígilájé

    Full Text Available In Nigeria, there is a dearth of pediatric data on the risk factors associated with tuberculosis (TB, before and after antiretroviral therapy (ART.A retrospective observational cohort study, between October 2010 and December 2013, at the Federal Medical Centre, Makurdi, Nigeria. TB was noted among children less than 15 years of age at ART enrolment (prevalent TB-PrevTB, within 6 months (early incident tuberculosis-EITB and after 6 months (late incident tuberculosis-LITB of a 12-month follow-up on ART. Potential risk factors for PrevTB and incident TB were assessed using the multivariate logistic and Cox regression models respectively.Among 368 HIV-1 infected children, PrevTB was diagnosed in 73 children (19.8%. Twenty-eight EITB cases were diagnosed among 278 children over 132 person-years (py with an EITB rate of 21.2/100 py. Twelve LITB cases were seen among 224 children over 221.9 py with a LITB rate of 5.4/100 py. A significant reduction in the incidence rates of TB was found over time (75%, p˂ 0.001. Young age of children (12-35 months, aOR; 24, 95% CI; 4.1-146.6, p ˂ 0.001; 36-59 months, aOR;21, 95%CI;4.0-114.3, p ˂ 0.001; history of TB in children (aOR; 29, 95% CI; 7.3-119.4, P˂ 0.001; severe immunosuppression (aOR;38, 95% CI;12-123.2,p ˂ 0.001; oropharyngeal candidiasis (aOR;3.3, 95% CI; 1.4-8.0, p = 0.009 and sepsis (aOR; 3.2, 95% CI;1.0-9.6, p = 0.043 increased the risk of PrevTB. Urban residency was protective against EITB (aHR; 0.1, 95% CI; 0.0-0.4, p = 0.001. Virological failure (aHR; 4.7, 95% CI; 1.3-16.5, p ˂ 0.001 and sepsis (aHR; 26, 95% CI; 5.3-131.9, p ˂ 0.001 increased the risk of LITB.In our cohort of HIV-infected children, a significant reduction in cases of incident TB was seen following a 12-month use of ART. After ART initiation, TB screening should be optimized among children of rural residency, children with sepsis, and those with poor virological response to ART.

  11. What do we know about children living with HIV-infected or AIDS-ill adults in Sub-Saharan Africa? A systematic review of the literature.

    Science.gov (United States)

    Goldberg, Rachel E; Short, Susan E

    2016-03-01

    Millions of children in Sub-Saharan Africa live with adults, often parents, who are HIV-infected or ill due to AIDS. These children experience social, emotional, and health vulnerabilities that overlap with, but are not necessarily the same as, those of orphans or other vulnerable children. Despite their distinctive vulnerabilities, research aimed at understanding the situation of these children has been limited until very recently. This review summarizes the state of knowledge based on a systematic search of PubMed and Web of Science that identified 47 empirical research articles that examined either the population prevalence of children living with HIV-infected or AIDS-sick adults, or the consequences of adult HIV infection or AIDS illness for child well-being. This review confirms that this population of children is substantial in size, and that the vulnerabilities they experience are multi-faceted, spanning physical and emotional health and schooling. Mechanisms were examined empirically in only a small number of studies, but encompass poverty, transmission of opportunistic infections, care for unwell adults, adult distress, AIDS stigma, lack of social support, maternal breastfeeding issues, and vertical HIV transmission. Some evidence is provided that infants, adolescents, children with infected or ill mothers, and children living with severely ill adults are particularly vulnerable. Future research would benefit from more attention to causal inference and further characterization of processes and circumstances related to vulnerability and resilience. It would also benefit from further study of variation in observed associations between adult HIV/AIDS and child well-being based on characteristics such as age, sex, kinship, severity of illness, TB co-infection, disclosure, and serostatus awareness. Almost one-quarter of the studies reviewed did not investigate variation based on any of these factors. More nuanced understanding of the short- and long

  12. Weight and height z-scores improve after initiating ART among HIV-infected children in rural Zambia: a cohort study.

    Science.gov (United States)

    Sutcliffe, Catherine G; van Dijk, Janneke H; Munsanje, Bornface; Hamangaba, Francis; Sinywimaanzi, Pamela; Thuma, Philip E; Moss, William J

    2011-03-01

    Deficits in growth observed in HIV-infected children in resource-poor settings can be reversed with antiretroviral treatment (ART). However, many of the studies have been conducted in urban areas with older pediatric populations. This study was undertaken to evaluate growth patterns after ART initiation in a young pediatric population in rural Zambia with a high prevalence of undernutrition. Between 2007 and 2009, 193 HIV-infected children were enrolled in a cohort study in Macha, Zambia. Children were evaluated every 3 months, at which time a questionnaire was administered, height and weight were measured, and blood specimens were collected. Weight- and height-for-age z-scores were constructed from WHO growth standards. All children receiving ART at enrollment or initiating ART during the study were included in this analysis. Linear mixed effects models were used to model trajectories of weight and height-for-age z-scores. A high proportion of study children were underweight (59%) and stunted (72%) at treatment initiation. Improvements in both weight- and height-for-age z-scores were observed, with weight-for-age z-scores increasing during the first 6 months of treatment and then stabilizing, and height-for-age z-scores increasing consistently over time. Trajectories of weight-for-age z-scores differed by underweight status at treatment initiation, with children who were underweight experiencing greater increases in z-scores in the first 6 months of treatment. Trajectories of height-for-age z-scores differed by age, with children older than 5 years of age experiencing smaller increases over time. Some of the effects of HIV on growth were reversed with ART initiation, although a high proportion of children remained underweight and stunted after two years of treatment. Partnerships between treatment and nutrition programs should be explored so that HIV-infected children can receive optimal nutritional support.

  13. Weight and height z-scores improve after initiating ART among HIV-infected children in rural Zambia: a cohort study

    Directory of Open Access Journals (Sweden)

    Sinywimaanzi Pamela

    2011-03-01

    Full Text Available Abstract Background Deficits in growth observed in HIV-infected children in resource-poor settings can be reversed with antiretroviral treatment (ART. However, many of the studies have been conducted in urban areas with older pediatric populations. This study was undertaken to evaluate growth patterns after ART initiation in a young pediatric population in rural Zambia with a high prevalence of undernutrition. Methods Between 2007 and 2009, 193 HIV-infected children were enrolled in a cohort study in Macha, Zambia. Children were evaluated every 3 months, at which time a questionnaire was administered, height and weight were measured, and blood specimens were collected. Weight- and height-for-age z-scores were constructed from WHO growth standards. All children receiving ART at enrollment or initiating ART during the study were included in this analysis. Linear mixed effects models were used to model trajectories of weight and height-for-age z-scores. Results A high proportion of study children were underweight (59% and stunted (72% at treatment initiation. Improvements in both weight- and height-for-age z-scores were observed, with weight-for-age z-scores increasing during the first 6 months of treatment and then stabilizing, and height-for-age z-scores increasing consistently over time. Trajectories of weight-for-age z-scores differed by underweight status at treatment initiation, with children who were underweight experiencing greater increases in z-scores in the first 6 months of treatment. Trajectories of height-for-age z-scores differed by age, with children older than 5 years of age experiencing smaller increases over time. Conclusions Some of the effects of HIV on growth were reversed with ART initiation, although a high proportion of children remained underweight and stunted after two years of treatment. Partnerships between treatment and nutrition programs should be explored so that HIV-infected children can receive optimal nutritional

  14. Associations of Low Vitamin D and Elevated Parathyroid Hormone Concentrations With Bone Mineral Density in Perinatally HIV-Infected Children.

    Science.gov (United States)

    Jacobson, Denise L; Stephensen, Charles B; Miller, Tracie L; Patel, Kunjal; Chen, Janet S; Van Dyke, Russell B; Mirza, Ayesha; Schuster, Gertrud U; Hazra, Rohan; Ellis, Angela; Brummel, Sean S; Geffner, Mitchell E; Silio, Margarita; Spector, Stephen A; DiMeglio, Linda A

    2017-09-01

    Perinatally HIV-infected (PHIV) children have, on average, lower bone mineral density (BMD) than perinatally HIV-exposed uninfected (PHEU) and healthy children. Low 25-hydroxy vitamin D [25(OH)D] and elevated parathyroid hormone (PTH) concentrations may lead to suboptimal bone accrual. PHIV and PHEU children in the Pediatric HIV/AIDS Cohort Study had total body (TB) and lumbar spine (LS) BMD and bone mineral content (BMC) measured by dual-energy x-ray absorptiometry; BMD z-scores (BMDz) were calculated for age and sex. Low 25(OH)D was defined as ≤20 ng/mL and high PTH as >65 pg/mL. We fit linear regression models to estimate the average adjusted differences in BMD/BMC by 25(OH)D and PTH status and log binomial models to determine adjusted prevalence ratios of low 25(OH)D and high PTH in PHIV relative to PHEU children. PHIV children (n = 412) were older (13.0 vs. 10.8 years) and more often black (76% vs. 64%) than PHEU (n = 207). Among PHIV, children with low 25(OH)D had lower TB-BMDz [SD, -0.38; 95% confidence interval (CI), -0.60 to -0.16] and TB-BMC (SD, -59.1 g; 95% CI, -108.3 to -9.8); high PTH accompanied by low 25(OH)D was associated with lower TB-BMDz. Among PHEU, children with low 25(OH)D had lower TB-BMDz (SD, -0.34; 95% CI, -0.64 to -0.03). Prevalence of low 25(OH)D was similar by HIV status (adjusted prevalence ratio, 1.00; 95% CI, 0.81 to 1.24). High PTH was 3.17 (95% CI, 1.25 to 8.06) times more likely in PHIV children. PHIV and PHEU children with low 25(OH)D may have lower BMD. Vitamin D supplementation trials during critical periods of bone accrual are needed.

  15. Effect of cotrimoxazole on causes of death, hospital admissions and antibiotic use in HIV-infected children.

    Science.gov (United States)

    Mulenga, Veronica; Ford, Deborah; Walker, A Sarah; Mwenya, Darlington; Mwansa, James; Sinyinza, Frederick; Lishimpi, Kennedy; Nunn, Andrew; Gillespie, Stephen; Zumla, Ali; Chintu, Chifumbe; Gibb, Diana M

    2007-01-02

    Cotrimoxazole prophylaxis reduces morbidity and mortality in HIV-1-infected children, but mechanisms for these benefits are unclear. CHAP was a randomized trial comparing cotrimoxazole prophylaxis with placebo in HIV-infected children in Zambia where background bacterial resistance to cotrimoxazole is high. We compared causes of mortality and hospital admissions, and antibiotic use between randomized groups. Of 534 children (median age, 4.4 years; 32% 1-2 years), 186 died and 166 had one or more hospital admissions not ending in death. Cotrimoxazole prophylaxis was associated with lower mortality, both outside hospital (P = 0.01) and following hospital admission (P = 0.005). The largest excess of hospital deaths in the placebo group was from respiratory infections [22/56 (39%) placebo versus 10/35 (29%) cotrimoxazole]. By 2 years, the cumulative probability of dying in hospital from a serious bacterial infection (predominantly pneumonia) was 7% on cotrimoxazole and 12% on placebo (P = 0.08). There was a trend towards lower admission rates for serious bacterial infections in the cotrimoxazole group (19.1 per 100 child-years at risk versus 28.5 in the placebo group, P = 0.09). Despite less total follow-up due to higher mortality, more antibiotics (particularly penicillin) were prescribed in the placebo group in year one [6083 compared to 4972 days in the cotrimoxazole group (P = 0.05)]. Cotrimoxazole prophylaxis appears to mainly reduce death and hospital admissions from respiratory infections, supported further by lower rates of antibiotic prescribing. As such infections occur at high CD4 cell counts and are common in Africa, the role of continuing cotrimoxazole prophylaxis after starting antiretroviral therapy requires investigation.

  16. Health care workers’ perspectives about disclosure to HIV-infected children; cross-sectional survey of health facilities in Gauteng and Mpumalanga provinces, South Africa

    Directory of Open Access Journals (Sweden)

    Sphiwe Madiba

    2015-04-01

    Full Text Available The perspectives and practices of health care workers (HCWs regarding disclosure to HIV-infected children have not been adequately investigated ten years after the roll-out of pediatrics antiretroviral therapy (ART. The aim of the study was to examine the opinions of HCWs about disclosure to HIV-infected children and determine their role in disclosure to children accessing ART in health centers in South Africa. This was a cross-sectional survey using a semi-structured questionnaire among HCWs in ART centers at three hospitals and 48 primary health facilities in two provinces in South Africa. Of the 206 HCWs, 140 (68.2% were nurses, 44 (21.5% were lay counsellors, and 4 (2% were doctors. The majority (n = 183, 89.3% felt that disclosure benefits children and they should be told about their HIV status. Over half (n = 93, 51.4% recommended 11–18 years as the appropriate age to disclose. Half (n = 99, 48.5% said that caregivers should take the lead to disclose, 87 (42.7% said that disclosure is a shared responsibility of caregivers and HCWs, and 18 (8.8% said HCWs should lead disclosure. HCWs perceived their role as that of preparing the caregiver for disclosure and the child to understand the disease. However, the lack of guidelines and training on disclosure counselling for children affects their ability to fully participate in disclosure to children. There is a need to adopt the World Health Organizations’ disclosure guidelines for children and adapt them to the local cultural and community contexts and train HCWs to guide, support, and assist caregivers in their disclosure to HIV-infected children.

  17. CASE STUDY A 13-Year-Old HIV-Infected Girl with Thrombocytopenia

    African Journals Online (AJOL)

    alpha and splenectomy, and for HIV infected children, ART.4 Many of these choices, such as splenectomy and cytotoxic agents, are contraindicated or considered a last resort in HIV-infected children. Studies in HIV-infected children with ITP show ...

  18. Immunologic outcomes of antiretroviral therapy among HIV-infected Nigerian children and its association with early infant feeding and nutritional status at treatment initiation.

    Science.gov (United States)

    Omoni, Adetayo O; Christian, Parul S; Sadoh, Wilson E; Okechukwu, Adaora; Olateju, Eyinade; Omoigberale, Austin; Blattner, William; Charurat, Man E

    2013-07-01

    To evaluate immunologic response to antiretroviral treatment (ART) among HIV-infected Nigerian children (nutritional status at treatment initiation. Mixed prospective and retrospective cohort study. One hundred fifty HIV-infected children were followed for 12 months from initiation of ART. CD4 count/CD4% was assessed at baseline and every 4-6 months. Nutritional status was assessed by height-for-age, weight-for-age and weight-for-height Z scores using the 2006 World Health Organization growth reference. Children were classified into 4 feeding groups--exclusively breast-fed, predominantly breast-fed, mixed fed and exclusively formula fed. Logistic regression was used to model odds of failure to reach CD4% of ≥ 25% at the 12-month follow-up. Linear random effects models were used to model the longitudinal change in CD4%. There was a significant increase in CD4% for all children from 13.8% at baseline to 28.5% after 12 months (ΔCD4% = 14.7%, 95% confidence interval: 12.1%-17.4%). There was no association of feeding pattern with immunologic outcomes. In adjusted analyses, children who were underweight (weight-for-age nutritional status and CD4% were independently associated with failure to reach CD4% ≥ 25% at 12 months among HIV-infected Nigerian children on ART. These results emphasize the importance of early screening and initiation of ART among children in resource-poor settings before malnutrition and severe immunosuppression sets in.

  19. Working Memory Profiles in HIV-Exposed, Uninfected and HIV-Infected Children: A Comparison with Neurotypical Controls

    Science.gov (United States)

    Milligan, Robyn; Cockcroft, Kate

    2017-01-01

    This study compared the working memory profiles of three groups of children, namely HIV-infected (HIV-I; n = 95), HIV-exposed, uninfected (HIV-EU; n = 86) and an HIV-unexposed, uninfected, (HIV-UU; n = 92) neurotypical control group. Working memory, an executive function, plays an important role in frontal lobe-controlled behaviors, such as motivation, planning, decision making, and social interaction, and is a strong predictor of academic success in school children. Memory impairments have been identified in HIV-I children, particularly in visuospatial processing. Verbal working memory has not been commonly investigated in this population, while it is unknown how the working memory profiles of HIV-EU children compare to their HIV-I and HIV-UU peers. Of interest was whether the working memory profiles of the HIV-EU children would be more similar to the HIV-I group or to the uninfected control group. The results revealed no significant differences in working memory performance between the HIV-I and HIV-EU groups. However, this does not mean that the etiology of the working memory deficits is the same in the two groups, as these groups showed important differences when compared to the control group. In comparison to the controls, the HIV-I group experienced difficulties with processing tasks irrespective of whether they drew on a verbal or visuospatial modality. This appears to stem from a generalized executive function deficit that also interferes with working memory. In the HIV-EU group, difficulties occurred with verbally based tasks, irrespective of whether they required storage or processing. For this group, the dual demands of complex processing and using a second language seem to result in demand exceeding capacity on verbal tasks. Both groups experienced the greatest difficulties with verbal processing tasks for these different reasons. Thus, disruption of different cognitive abilities could result in similar working memory profiles, as evidenced in this

  20. Working Memory Profiles in HIV-Exposed, Uninfected and HIV-Infected Children: A Comparison with Neurotypical Controls

    Directory of Open Access Journals (Sweden)

    Robyn Milligan

    2017-07-01

    Full Text Available This study compared the working memory profiles of three groups of children, namely HIV-infected (HIV-I; n = 95, HIV-exposed, uninfected (HIV-EU; n = 86 and an HIV-unexposed, uninfected, (HIV-UU; n = 92 neurotypical control group. Working memory, an executive function, plays an important role in frontal lobe-controlled behaviors, such as motivation, planning, decision making, and social interaction, and is a strong predictor of academic success in school children. Memory impairments have been identified in HIV-I children, particularly in visuospatial processing. Verbal working memory has not been commonly investigated in this population, while it is unknown how the working memory profiles of HIV-EU children compare to their HIV-I and HIV-UU peers. Of interest was whether the working memory profiles of the HIV-EU children would be more similar to the HIV-I group or to the uninfected control group. The results revealed no significant differences in working memory performance between the HIV-I and HIV-EU groups. However, this does not mean that the etiology of the working memory deficits is the same in the two groups, as these groups showed important differences when compared to the control group. In comparison to the controls, the HIV-I group experienced difficulties with processing tasks irrespective of whether they drew on a verbal or visuospatial modality. This appears to stem from a generalized executive function deficit that also interferes with working memory. In the HIV-EU group, difficulties occurred with verbally based tasks, irrespective of whether they required storage or processing. For this group, the dual demands of complex processing and using a second language seem to result in demand exceeding capacity on verbal tasks. Both groups experienced the greatest difficulties with verbal processing tasks for these different reasons. Thus, disruption of different cognitive abilities could result in similar working memory profiles, as

  1. Immunity Following Childhood Vaccinations in Perinatally HIV-Exposed Children with and without HIV Infection in Latin America.

    Science.gov (United States)

    Succi, Regina Cm; Krauss, Margot R; Harris, D Robert; Machado, Daisy M; de Moraes-Pinto, Maria I; Mussi-Pinhata, Marisa M; Pavia Ruz, Noris; Pierre, Russell B; Kolevic Roca, Lenka A; Joao, Esaú; Foradori, Irene; Scotta, Marcelo C; Hazra, Rohan; Siberry, George K

    2017-11-14

    Perinatally HIV-infected (PHIV) children are at risk for undervaccination and poor vaccine response at four years of age. Childhood vaccine coverage and immune response were compared between PHIV and HIV-exposed uninfected (HEU) children in Latin America and the Caribbean. PHIV and HEU children were enrolled prospectively at fifteen sites from 2002-2009. Full vaccination by age four years was defined as: three hepatitis B virus (HBV) vaccine doses; four tetanus toxoid-containing vaccine doses; three doses of Haemophilus influenzae type b (Hib) vaccine by age 12 months or ≥1 dose given after age 12 months; one measles-containing vaccine dose; one rubella-containing vaccine dose. Immunity was defined by serum antibody titer. Fisher's exact test (for categorical measures) and t-test (for continuous measures) were used for comparisons. Among 519 children seen at age four years, 191 had serum specimens available (137 PHIV, 54 HEU). Among those with specimens available, 29.3% initiated combination antiretroviral therapy (cART) <12 months of age, 30.9% initiated at ≥12 months of age, and 39.8% had not received cART by the time they were seen at four years of age.At four years of age, 59.9% were on PI-containing cART (cART/PI), and 20.4% were on no ARV. PHIV children were less likely than HEU children to be fully vaccinated for tetanus (55.5% vs. 77.8%, p=0.005) and measles and rubella (both 70.1% vs. 94.4%, p<0.001). Among those fully vaccinated, immunity was significantly lower among PHIV than HEU for all vaccines examined: 20.9% vs. 37.8% for HBV (p=0.04), 72.0% vs. 90.5% for tetanus (p=0.02), 51.4% vs. 68.8% for Hib (p=0.05), 80.2% vs. 100% for measles (p<0.001) and 72.9% vs. 98.0% for rubella (p<0.001) vaccine, respectively. Compared to HEU, PHIV children were significantly less likely to be immune to vaccine-preventable diseases when fully vaccinated. Strategies to increase immunity against vaccine-preventable diseases among PHIV require further study.

  2. Thrombocytosis in pediatric HIV infection.

    Science.gov (United States)

    Ellaurie, Maadhava

    2004-09-01

    Thrombocytopenia has been extensively reported in association with HIV infection. Twenty-four children (6%) from a cohort of 400 children with platelet counts >500,000/mm(3) were reviewed. All had symptomatic disease and 10 (42%) patients died. In 4 children the platelet count exceeded 700,000/mm(3) and in 1 patient the platelet count was 1.5 million/mm(3). There were no thrombotic complications, and no specific therapy was required for the thrombocytosis. Thus HIV-1 infection, a chronic viral infection, is another etiologic agent for thrombocytosis and is associated with severe disease.

  3. Prevalence of Lipodystrophy in HIV-infected Children in Tanzania on Highly Active Antiretroviral Therapy

    NARCIS (Netherlands)

    Kinabo, G.; Sprengers, M.; Msuya, L.J.; Shayo, A.M.; Asten, H.A.G.H. van; Dolmans, W.M.V.; Ven, A.J.A.M. van der; Warris, A.

    2013-01-01

    OBJECTIVE: : Highly active antiretroviral therapy (HAART) has been associated with lipodystrophy (LD) in adults but data are more limited for children. The purpose of this study was to determine the prevalence of and risk factors for LD in Tanzanian children receiving HAART by clinical assessment

  4. Clinical indicators of hiv infection in under-five children with ...

    African Journals Online (AJOL)

    developmental milestone loss (38%, p<0.001). Conclusions: In resource limited settings cough, wasting or developmental delay associated with chronic diarrhoea may be used as indicators for human immunodeficiency virus screening in under-five children ...

  5. The Role of Nutritional Status on Follow-up among HIV-infected Children at a Teaching Hospital Clinic in Ghana.

    Science.gov (United States)

    Congdon, M; Gjelsvik, A; Lurie, M N; Enimil, A; Antwi, S; Kwara, A

    2015-01-01

    Malnutrition and HIV infection in children interact adversely and may have a combined effect on clinical outcomes, including response to antiretroviral treatment (ART). Evidence of the role of malnutrition at the point of registration at HIV clinics is limited. This study sought to determine the role of nutritional status and other clinical factors on loss to follow-up (LTFU) among children at Komfo Anokye Teaching Hospital Pediatric HIV clinic in Kumasi, Ghana. A total of 324 HIV-positive children aged 1.5 to 10 years old who were registered at the clinic from January 1, 2007 to June 30, 2011 were included in this retrospective study. Weight-for-age z-score (WAZ) was used to classify nutritional status. Characteristics of children who were LTFU and those who remained in care were compared using bivariate analysis and logistic regression. At registration, 116 (35.8%) children were severely underweight (WAZ -2) were more likely to be LTFU (P = 0.003). Initiation of antiretroviral therapy was associated with a lower risk of LTFU. In the multivariate analysis, hospital admission (OR 4.38; 95% CI 2.30, 8.34) and initiation of ART (OR 0.33; CI 0.19, 0.56) were independently associated with LTFU. Malnutrition was common among Ghanaian HIV-infected children and appeared to be associated with a higher risk of hospitalization and LTFU. Irrespective of nutritional status, the initiation of ART was associated with better retention in care.

  6. Epilepsy in rural Ugandan children: seizure pattern, age of onset ...

    African Journals Online (AJOL)

    Cerebral palsy, evident or evolving, was most strongly associated with CPS. A positive perinatal or infantile history was noted in 12 and 6% respectively, and 50.2% of seizures began in infancy. Conclusions: The prevalence of epilepsy is similar in Gambian children. The high contribution from early-onset CPS, resembles ...

  7. Profile of HIV infected children: A hospital based study at Eastern Nepal

    Directory of Open Access Journals (Sweden)

    Prakash Poudel

    2014-06-01

    Full Text Available Objective: To investigate the clinical, laboratory, epidemiological profiles and outcome in human immunodeficiency virus infected Nepalese children. Methods: This was a hospital based prospective study. Human immunodeficiency virusinfected children presenting to pediatric immunology clinic at BP Koirala Institute of Health Sciences were enrolled and followed up. Results: Median age at diagnosis among 39 enrolled children was 58 months. All children acquired infection vertically. Unsafe sex (74.4% and intravenous drug use (25.6% were the major risk behaviors in fathers. At presentation, 20.8% children were asymptomatic, 54.0% were malnourished, 41.0% were in WHO clinical stage 1, 17.9% were in stage 4, 74.4% were anemic, 17.9% had thrombocytopenia and median CD4 count was 543. Fever, lymphadenopathy, hepatosplenomegaly, skin eruptions and oral lesions were common presenting features (16.2%, 16.2%, 13.5%, 10.8%, and 8.1% respectively out of 74 features. Tuberculosis (16.0%, chronic otitis media (12.0%, scabies (10.7%, bacterial pneumonia (9.3% and oropharyngeal candidiasis (6.7% were common opportunistic infections. Antiretroviral treatment was started in 18 (46.2% cases at median age of 67 months. Median change in CD4 count at follow up was significantly different between the groups receiving and not receiving antiretroviral treatment (+192 vs. -72; P=0.045. Conclusions: Infection in children is vertical. Undernutrition, anemia, fever, lymphadenopathy, hepatosplenomegaly, skin eruptions, and ear discharge are common presenting features. Opportunistic infections are common and tuberculosis is the most common opportunistic infection followed by chronic ear infection, scabies, candidiasis and bacterial pneumonia. Timely antiretroviral treatment improves immune response.

  8. Clinical utility of raltegravir for the treatment of HIV infection in children and adolescents

    Directory of Open Access Journals (Sweden)

    Nuttall J

    2013-08-01

    Full Text Available James Nuttall,1 Tammy Meyers,2 Brian Eley11Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital and Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; 2Department of Paediatrics, Chris Hani Baragwanath Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaAbstract: Raltegravir (RAL is the first integrase strand transfer inhibitor and has been shown to provide potent antiretroviral (ARV activity against human immunodeficiency virus type 1 (HIV-1 in both ARV treatment-naïve and treatment-experienced individuals. Following initial US Food and Drug Administration (FDA approval of RAL for treatment of HIV-1-infected adults in 2007, an ongoing pharmacokinetic, safety, and efficacy study in ARV-experienced children and adolescents led to extension of FDA approval to children and adolescents aged 2–18 years in 2011. Availability of chewable tablets for children aged 2–11 years is a significant advantage, and twice-daily dosing is recommended based on pharmacokinetic parameters. Granules for oral suspension in children 4 weeks to 2 years of age are currently under evaluation and clinical trials in neonates are imminent. Coadministration of RAL and the anti-tuberculosis drug rifampin (RIF results in reduced RAL exposure. Evaluation of a double RAL dosing strategy in children requiring cotreatment with RIF is planned. RAL is generally well tolerated and has a good overall safety profile. Further data is required for children before RAL can be recommended in first-line ARV treatment regimens. RAL is also under investigation for use in preventing mother-to-child transmission both during pregnancy and in the HIV-exposed neonate. Currently, the main therapeutic role for RAL in children is for treatment failure and multi-drug resistant cases where the inclusion of RAL in combination with optimal background therapy has demonstrated successful

  9. Effectiveness of 7-Valent Pneumococcal Conjugate Vaccine Against Invasive Pneumococcal Disease in HIV-Infected and -Uninfected Children in South Africa: A Matched Case-Control Study

    Science.gov (United States)

    Cohen, Cheryl; von Mollendorf, Claire; de Gouveia, Linda; Naidoo, Nireshni; Meiring, Susan; Quan, Vanessa; Nokeri, Vusi; Fortuin-de Smit, Melony; Malope-Kgokong, Babatyi; Moore, David; Reubenson, Gary; Moshe, Mamokgethi; Madhi, Shabir A.; Eley, Brian; Hallbauer, Ute; Kularatne, Ranmini; Conklin, Laura; O'Brien, Katherine L.; Zell, Elizabeth R.; Klugman, Keith; Whitney, Cynthia G.; von Gottberg, Anne; Moore, David; Verwey, Charl; Varughese, Sheeba; Archary, Moherndran; Naby, Fathima; Dawood, Khathija; Naidoo, Ramola; Elliott, Gene; Hallbauer, Ute; Eley, Brian; Nuttall, James; Cooke, Louise; Finlayson, Heather; Rabie, Helena; Whitelaw, Andrew; Perez, Dania; Jooste, Pieter; Naidoo, Dhamiran; Kularatne, Ranmini; Reubenson, Gary; Cohen, Cheryl; de Gouveia, Linda; du Plessis, Mignon; Govender, Nevashan; Meiring, Susan; Quan, Vanessa; von Mollendorf, Claire; Fortuin-de Smidt, Melony; Naidoo, Nireshni; Malope-Kgokong, Babatyi; Nokeri, Vusi; Ncha, Relebohile; Lindani, Sonwabo; von Gottberg, Anne; Spies, Barry; Sono, Lino; Maredi, Phasweni; Hamese, Ken; Moshe, Mamokgethi; Nchabeleng, Maphosane; Ngcobo, Ntombenhle; van den Heever, Johann; Madhi, Shabir; Conklin, Laura; Verani, Jennifer; Whitney, Cynthia; Zell, Elizabeth; Loo, Jennifer; Nelson, George; Klugman, Keith; O'Brien, Katherine

    2014-01-01

    Background. South Africa introduced 7-valent pneumococcal conjugate vaccine (PCV7) in April 2009 using a 2 + 1 schedule (6 and 14 weeks and 9 months). We estimated the effectiveness of ≥2 PCV7 doses against invasive pneumococcal disease (IPD) in human immunodeficiency virus (HIV)–infected and -uninfected children. Methods. IPD (pneumococcus identified from a normally sterile site) cases were identified through national laboratory-based surveillance. Specimens were serotyped by Quellung or polymerase chain reaction. Four controls, matched for age, HIV status, and hospital were sought for each case. Using conditional logistic regression, we calculated vaccine effectiveness (VE) as 1 minus the adjusted odds ratio for vaccination. Results. From March 2010 through November 2012, we enrolled 187 HIV-uninfected (48 [26%] vaccine serotype) and 109 HIV-infected (43 [39%] vaccine serotype) cases and 752 HIV-uninfected and 347 HIV-infected controls aged ≥16 weeks. Effectiveness of ≥2 PCV7 doses against vaccine-serotype IPD was 74% (95% confidence interval [CI], 25%–91%) among HIV-uninfected and −12% (95% CI, −449% to 77%) among HIV-infected children. Effectiveness of ≥3 doses against vaccine-serotype IPD was 90% (95% CI, 14%–99%) among HIV-uninfected and 57% (95% CI, −371% to 96%) among HIV-infected children. Among HIV-exposed but -uninfected children, effectiveness of ≥2 doses was 92% (95% CI, 47%–99%) against vaccine-serotype IPD. Effectiveness of ≥2 doses against all-serotype multidrug-resistant IPD was 96% (95% CI, 62%–100%) among HIV-uninfected children. Conclusions. A 2 + 1 PCV7 schedule was effective in preventing vaccine-serotype IPD in HIV-uninfected and HIV-exposed, uninfected children. This finding supports the World Health Organization recommendation for this schedule as an alternative to a 3-dose primary series among HIV-uninfected individuals. PMID:24917657

  10. Clinical features and lung function in HIV-infected children with ...

    African Journals Online (AJOL)

    Methods. We undertook a cross-sectional study of children with advanced HIV disease in whom CLD was suspected. We undertook clinical evaluation and lung ... In a multiple linear regression analysis, hyperinflation, increased respiratory rate and hyperpigmented skin lesions were associated with poor lung function ...

  11. Some early observations on HIV infection in children at King Edward VIII Hospital, Durban.

    Science.gov (United States)

    Bobat, R A; Coovadia, H M; Windsor, I M

    1990-11-03

    Nine black children aged between 3 months and 30 months of age, with human immunodeficiency virus type I (HIV-I) infection are described to draw the attention of health professionals in southern Africa to special clinical characteristics useful for recognising this problem, which has many shared features with common diseases of infancy and childhood in the Third World. The main presenting complaints were chronic cough and persistent diarrhoea and vomiting. These children frequently had diarrhoea (8 of 9 patients), mucocutaneous candidiasis (8), pneumonia (7), hepatosplenomegaly (9), significant lymphadenopathy (5) and wasting (5). All were infected by common bacteria, such as Gram-negative organisms, Mycobacterium tuberculosis and Campylobacter jejuni, or by opportunistic infections such as Candida or cytomegalovirus (CMV), or by both bacterial and opportunistic organisms. A raised total serum globulin level, anaemia, lymphopenia and a cerebrospinal fluid (CSF) pleocytosis were frequent findings. Incomplete data on parental HIV status suggest perinatal transmission. Three of the children were HIV-antigen positive. The diagnosis of full-blown acquired immunodeficiency syndrome (AIDS), using the stringent Centers for Disease Control criteria, is difficult in our situation because of limited diagnostic resources; however, using these criteria, and the clinical case definition for AIDS recommended by World Health Organisation, it is thought that probably 4 of these children could be considered as having AIDS.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. A feasibility study of immediate versus deferred antiretroviral therapy in children with HIV infection

    Directory of Open Access Journals (Sweden)

    Ubolyam Sasiwimol

    2008-10-01

    Full Text Available Abstract Objective To evaluate the feasibility of a large immediate versus deferred antiretroviral therapy (ART study in children. Methods We conducted an open-label pilot randomized clinical trial study in 43 Thai children with CD4 15 to 24% of starting generic AZT/3TC/NVP immediately (Arm 1 or deferring until CD4 Results Recruitment took 15 months. Twenty-six of 69 (37.7% were not eligible due mainly to low CD4%. Twenty four and 19 were randomized to arms 1 and 2 respectively. All accepted the randomized arm; however, 3 in arm 1 stopped ART and 1 in arm 2 refused to start ART. Ten/19 (53% in arm 2 started ART. At baseline, median age was 4.8 yrs, CDC A:B were 36:7, median CD4 was 19% and viral load was 4.8 log. All in arm 1 and 17/19 in arm 2 completed the study (median of 134 weeks. No one had AIDS or death. Four in immediate arm had tuberculosis. Once started on ART, deferred arm children achieved similar CD4 and viral load response as the immediate arm. Adverse events were similar between arms. The deferred arm had a 26% ART saving. Conclusion Almost 40% of children were not eligible due mainly to low CD4% but adherence to randomized treatment and retention in trial were excellent. A larger study to evaluate when to start ART is feasible.

  13. Growth Patterns of HIV Infected Indian Children in Response to ART: A Clinic Based Cohort Study.

    Science.gov (United States)

    Parchure, Ritu S; Kulkarni, Vinay V; Darak, Trupti S; Mhaskar, Rahul; Miladinovic, Branko; Emmanuel, Patricia J

    2015-06-01

    To describe catch-up growth after antiretroviral therapy (ART) initiation among children living with human immunodeficiency virus (CLHIV), attending a private clinic in India. This is a retrospective analysis of data of CLHIV attending Prayas clinic, Pune, India. Height and weight z scores (HAZ, WAZ) were calculated using WHO growth charts. Catch-up growth post-ART was assessed using a mixed method model in cases where baseline and at least one subsequent follow-up HAZ/WAZ were available. STATA 12 was used for statistical analysis. During 1998 to 2011, 466 children were enrolled (201 girls and 265 boys; median age = 7 y). A total of 302 children were ever started on ART; of which 73 and 76 children were included for analysis for catch up growth in WAZ and HAZ respectively. Median WAZ and HAZ increased from -2.14 to -1.34 (p = 0.007) and -2.42 to -1.94 (p = 0.34), respectively, 3 y post ART. Multivariable analysis using mixed model (adjusted for gender, guardianship, baseline age, baseline WAZ/HAZ, baseline and time varying WHO clinical stage) showed gains in WAZ (coef = 0.2, 95 % CI: -0.06 to 0.46) and HAZ (coef = 0.49, 95 % CI: 0.21 to 0.77) with time on ART. Lower baseline WAZ/HAZ and older age were associated with impaired catch-up growth. Children staying in institutions and with baseline advanced clinical stage showed higher gain in WAZ. The prevalence of stunting and underweight was high at ART initiation. Sustained catch-up growth was seen with ART. The study highlights the benefit of early ART in achieving normal growth in CLHIV.

  14. Reasons for hospitalization in HIV-infected children in West Africa

    DEFF Research Database (Denmark)

    Dicko, Fatoumata; Desmonde, Sophie; Koumakpai, Sikiratou

    2014-01-01

    -infected children in West Africa (IeDEA West Africa collaboration). METHODS: We performed a six-month prospective multicentre survey from April to October 2010 in five HIV-specialized paediatric hospital wards in Ouagadougou, Accra, Cotonou, Dakar and Bamako. Baseline and follow-up data during hospitalization were......%) died during hospitalization and four (3%) were transferred out. The leading causes of hospitalization were WHO stage 3 opportunistic infections (37%), non-AIDS-defining events (28%), cachexia and other WHO stage 4 events (25%). CONCLUSIONS: Overall, most causes of hospitalizations were HIV related...... but one hospitalization in three was caused by a non-AIDS-defining event, mostly in children on ART. HIV-related fatality is also high despite the scaling-up of access to ART in resource-limited settings....

  15. Differential effects of early weaning for HIV-free survival of children born to HIV-infected mothers by severity of maternal disease.

    Directory of Open Access Journals (Sweden)

    Louise Kuhn

    2009-06-01

    Full Text Available We previously reported no benefit of early weaning for HIV-free survival of children born to HIV-infected mothers in intent-to-treat analyses. Since early weaning was poorly accepted, we conducted a secondary analysis to investigate whether beneficial effects may have been hidden.958 HIV-infected women in Lusaka, Zambia, were randomized to abrupt weaning at 4 months (intervention or to continued breastfeeding (control. Children were followed to 24 months with regular HIV PCR tests and examinations to determine HIV infection or death. Detailed behavioral data were collected on when all breastfeeding ended. Most participants were recruited before antiretroviral treatment (ART became available. We compared outcomes among mother-child pairs who weaned earlier or later than intended by study design adjusting for potential confounders.Of infants alive, uninfected and still breastfeeding at 4 months in the intervention group, 16.1% who weaned as instructed acquired HIV or died by 24 months compared to 16.0% who did not comply (p = 0.98. Children of women with less severe disease during pregnancy (not eligible for ART had worse outcomes if their mothers weaned as instructed (RH = 2.60 95% CI: 1.06-6.36 compared to those who continued breastfeeding. Conversely, children of mothers with more severe disease (eligible for ART but did not receive it who weaned early had better outcomes (p-value interaction = 0.002. In the control group, weaning before 15 months was associated with 3.94-fold (95% CI: 1.65-9.39 increase in HIV infection or death among infants of mothers with less severe disease.Incomplete adherence did not mask a benefit of early weaning. On the contrary, for women with less severe disease, early weaning was harmful and continued breastfeeding resulted in better outcomes. For women with more advanced disease, ART should be given during pregnancy for maternal health and to reduce transmission, including through breastfeeding

  16. Mortality and loss to programme before antiretroviral therapy among HIV-infected children eligible for treatment in The Gambia, West Africa

    Directory of Open Access Journals (Sweden)

    Okomo Uduak

    2012-10-01

    Full Text Available Abstract Background HIV infection among children, particularly those under 24 months of age, is often rapidly progressive; as a result guidelines recommend earlier access to combination antiretroviral therapy (cART for HIV infected children. Losses to follow-up (LTFU and death in the interval between diagnosis and initiation of ART profoundly limit this strategy. This study explores correlates of LTFU and death prior to ART initiation among children. Methods The study is based on 337 HIV-infected children enrolled into care at an urban centre in The Gambia, including those alive and in care when antiretroviral therapy became available and those who enrolled later. Children were followed until they started ART, died, transferred to another facility, or were LTFU. Cox proportional hazards regression models were used to determine the hazard of death or LTFU according to the baseline characteristics of the children. Results Overall, 223 children were assessed as eligible for ART based on their clinical and/or immunological status among whom 73 (32.7% started treatment, 15 (6.7% requested transfer to another health facility, 105 (47.1% and 30 (13.5% were lost to follow-up and died respectively without starting ART. The median survival following eligibility for children who died without starting treatment was 2.8 months (IQR: 0.9 - 5.8 with over half (60% of all deaths occurring at home. ART-eligible children less than 2 years of age and those in WHO stage 3 or 4 were significantly more likely to be LTFU when compared with their respective comparison groups. The overall pre-treatment mortality rate was 25.7 per 100 child-years of follow-up (95% CI 19.9 - 36.8 and the loss to programme rate was 115.7 per 100 child-years of follow-up (95% CI 98.8 - 137. In the multivariable Cox proportional hazard model, significant independent predictors of loss to programme were being less than 2 years of age and WHO stage 3 or 4. The Adjusted Hazard Ratio

  17. Late-stage diagnosis of HIV infection in Brazilian children: evidence from two national cohort studies

    Directory of Open Access Journals (Sweden)

    Alberto Novaes Ramos Jr.

    2013-07-01

    Full Text Available This study analyzed data from two consecutive retrospective cohort samples (1983 to 1998 and 1999 to 2002 of Brazilian children with AIDS (N = 1,758 through mother-to-child-transmission. Late-stage diagnosis (CDC category C was investigated in relation to the following variables: year of birth, year of HIV diagnosis, and time periods related to changes in government treatment guidelines. Late-stage diagnosis occurred in 731 (41.6% of cases and was more prevalent in infants under 12 months of age. The rate of late-stage diagnosis decreased from 48% to 36% between the two periods studied. We also observed a reduction in the proportion of late-stage diagnoses and the time lapse between HIV diagnosis and ART initiation. A significant association was found between timely diagnosis and having been born in recent years (OR = 0.62; p = 0.009 and year of HIV diagnosis (OR = 0.72; p = 0.002/OR = 0.62; p < 0.001. Infants under the age of 12 months were more likely to be diagnosed at a late stage than older children (OR = 1.70; p = 0.004. Despite advances, there is a need to improve the effectiveness of policies and programs focused on improving early diagnosis and management of HIV/AIDS.

  18. Evaluation of immune responses to combined hepatitis A and B vaccine in HIV-infected children and children on immunosuppressive medication.

    Science.gov (United States)

    Belderok, Sanne-Meike; Sonder, Gerard J B; van Rossum, Marion; van Dijk-Hummelman, Annette; Hartwig, Nico; Scherpbier, Henriette; Geelen, Sibyl; Speksnijder, Arjen G C L; Baaten, Gijs; van den Hoek, Anneke

    2013-08-28

    A phase IV interventional study with a combined hepatitis A and B vaccine was conducted in HIV-infected children and children receiving immunosuppressive medication for treatment of rheumatic diseases to evaluate immune responses. Both groups (1-16 years of age) received combined (inactivated) HAV and (rDNA) HBV vaccine Ambirix(®) at months 0 and 6. Serum samples were taken at four time points and tested for anti-HAV and anti-HBs antibodies. Anti-HAV concentrations ≥20 mIU/mL or anti-HBs concentrations ≥10 mIU/mL were considered protective. Seropositivity percentages were calculated and geometric mean concentrations (GMCs) were compared by nonparametric Mann-Whitney U-test or Kruskal-Wallis one-way-analysis-of-variance. Of 80 HIV-infected children who completed the study, 67 were HAV-susceptible and 68 HBV-susceptible at enrolment. Of 80 children with rheumatic diseases who completed the study, 65 were HAV-susceptible and 74 HBV-susceptible at enrolment. Immune responses to HAV after first dose of vaccine in both study groups were low: 71% and 55% respectively, whereas immune responses after the second dose were 99% and 100% respectively. Immune response to HBV after first dose of vaccine in both groups was also low: 27% and 17% respectively. Immune responses after the second dose were 97% and 93%, respectively. A larger proportion of children on combination antiretroviral therapy (cART) and of children with viral load vaccine in both groups was excellent and comparable to healthy children, a substantial proportion of both groups was not protected for HAV after first dose of vaccine. This protection gap is especially important for HAV in travel health and postexposure prophylactic treatment: both groups of children should be serologically tested for anti-HAV prior to travel to ensure protection if there is no time to await second dose of vaccine. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. The relationship between visual-spatial and auditory-verbal working memory span in Senegalese and Ugandan children.

    Directory of Open Access Journals (Sweden)

    Michael J Boivin

    Full Text Available BACKGROUND: Using the Kaufman Assessment Battery for Children (K-ABC Conant et al. (1999 observed that visual and auditory working memory (WM span were independent in both younger and older children from DR Congo, but related in older American children and in Lao children. The present study evaluated whether visual and auditory WM span were independent in Ugandan and Senegalese children. METHOD: In a linear regression analysis we used visual (Spatial Memory, Hand Movements and auditory (Number Recall WM along with education and physical development (weight/height as predictors. The predicted variable in this analysis was Word Order, which is a verbal memory task that has both visual and auditory memory components. RESULTS: Both the younger (8.5 yrs Ugandan children had auditory memory span (Number Recall that was strongly predictive of Word Order performance. For both the younger and older groups of Senegalese children, only visual WM span (Spatial Memory was strongly predictive of Word Order. Number Recall was not significantly predictive of Word Order in either age group. CONCLUSIONS: It is possible that greater literacy from more schooling for the Ugandan age groups mediated their greater degree of interdependence between auditory and verbal WM. Our findings support those of Conant et al., who observed in their cross-cultural comparisons that stronger education seemed to enhance the dominance of the phonological-auditory processing loop for WM.

  20. Prevalence of anaemia in paediatric patients with HIV infection in ...

    African Journals Online (AJOL)

    Background: HIV infection affects virtually all systems of the body including the haematological system. Objective: To determine the prevalence of anaemia in HIV infected children and compare with apparently healthy HIV negative age-sex matched controls. Design: Case control hospitalbased study. Methods: A total of 60 ...

  1. Symptomatic HIV infection in infancy - clinical and laboratory ...

    African Journals Online (AJOL)

    Symptomatic HIV infection in infancy - clinical and laboratory markers of infection. M.P. Meyer, Z Latief, C Haworth, S Salie, A van Dyk. Abstract. Objective. To investigate the usefulness of immunological tests in the diagnosis of HIV infection in young symptomatic children < 15 months of age). Design. Tests were evaluated in ...

  2. Surgical management of BCG vaccine-induced regional axillary lymphadenitis in HIV-infected children.

    Science.gov (United States)

    Juzi, J T; Sidler, D; Moore, S W

    2008-05-01

    There are as yet no clear surgical guidelines for the management of BCG vaccine-induced regional axillary lymphadenopathy. The aim of this study was to evaluate the management of the condition and to suggest possible management strategies. A retrospective study was undertaken of 23 cases of suspected ipsilateral BCG adenitis following neonatal BCG inoculation (2001 - 2004). Diagnosis of a BCG infection was confirmed by culture and/or gastric washout. The age of the patient and mode of presentation, imaging findings, and results of tuberculin skin testing (Mantoux test) were documented. Because of a change in management policy the first group of patients treated by primary surgery were compared with those treated by fine-needle aspiration (FNA). The influence of HIV status on outcome was assessed. Surgical complications and outcome were analysed. Twenty-three children under 13 years of age (mean age 8.8 months, male/female ratio 1.9:1) were evaluated. Eighteen patients tested positive for HIV and 5 were HIV-negative. A positive culture for BCG bacillus was identified in 19 cases (83%) - by FNA (N=13, 68%), on pus swab (N=3, 16%), at surgery (N=1, 5%), and by gastric washing (N=2, 11%). Three HIV-negative children had granulomas on histological examination without a positive culture. Forty-five per cent of the 11 patients treated early in the study period by primary surgery (drainage/biopsy) had complications, which included a difficult anaesthetic induction and technical surgical difficulties. The postoperative incidence of wound dehiscence/infection was extremely high in this group and 18.2% developed postoperative cutaneous sinuses. Following a change in management policy, the following 12 patients, with a comparable HIV incidence, treated by initial conservative management, had a much lower incidence of post-procedural complications. This study confirms a high perioperative complication rate associated with the primary surgical treatment of BCG lymphadenitis in

  3. [Consensus document on psychiatric and psychological aspect in adults and children with HIV infection].

    Science.gov (United States)

    2016-01-01

    This consensus document is an update of psychiatric and psychological disorders guidelines in HIV-patientes, from the standpoint of care. This document has been approved by expert panel of SPNS, SEP, GESIDA and SEIP, after reviewing the results of efficacy and safety of clinical trials, cohort and pharmacokinetic studies published in biomedical journals (PubMed and Embase) or presented at conferences. The strength of recommendation and gradation of their evidence are based onthe GRADE system. HIV Patient care should include psychological and psychiatric care which is necessary for early detection thereof. Should suicidal ideation, refer the patient to a psychiatric unit. Pharmacological treatment is recommended when there is comorbidity with moderate or severe depression. You should look for the etiology of neuropsychiatric disorder before using psychoactive drugs in HIV patients. The overall management of the health of HIV adolescents should include an assessment of mental health, environmental stressors and support systems. Training in the management of the patient both own emotions is critical to getting provide optimal care. These new guidelines updated previous recommendations regarding psychiatric and psychological disorders, including the most common pathologies in adults and children. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  4. Time to and Predictors of CD4+ T-Lymphocytes Recovery in HIV-Infected Children Initiating Highly Active Antiretroviral Therapy in Ghana

    Directory of Open Access Journals (Sweden)

    Lorna Renner

    2011-01-01

    Full Text Available Background. CD4+ T-lymphocyte monitoring is not routinely available in most resource-limited settings. We investigated predictors of time to CD4+ T-lymphocyte recovery in HIV-infected children on highly active antiretroviral (HAART at Korle-Bu Teaching Hospital, Ghana. Methods. Time to CD4+ T-lymphocyte recovery was defined as achieving percent CD4+ T-lymphocytes of 25%. We used Cox proportional hazard models for identifying significant predictor variables. Results. Of the 233 children with complete CD4+ T-lymphocyte data, the mean age at HAART initiation was 5.5 (SD=3.1 years. The median recovery time was 60 weeks (95% CL: 55–65. Evidence at baseline of severe suppression in CD4+ T-lymphocyte count adjusted for age, age at HAART initiation, gender, and having parents alive were statistically significant in predicting time to CD4+ T-lymphocyte recovery. Conclusions. A targeted approach based on predictors of CD4+ T-lymphocyte recovery can be a viable and cost-effective way of monitoring HAART in HIV-infected children in resource-limited settings.

  5. HIV Infection and Cancer Risk

    Science.gov (United States)

    ... Cancer Genetics Services Directory Cancer Prevention Overview Research HIV Infection and Cancer Risk On This Page Do people ... being linked to an increased risk of cancer, HIV infection is associated with an increased risk of dying ...

  6. Executive Functioning in Children and Adolescents With Perinatal HIV Infection and Perinatal HIV Exposure.

    Science.gov (United States)

    Nichols, Sharon L; Chernoff, Miriam C; Malee, Kathleen M; Sirois, Patricia A; Woods, Steven P; Williams, Paige L; Yildirim, Cenk; Delis, Dean; Kammerer, Betsy

    2016-12-01

    Executive functions (EFs) are critical for management of life activities, but few studies have evaluated EFs in children and adolescents with perinatally acquired HIV (PHIV), who are at risk for problems in academics, behavior, and medication adherence. We compared EFs in youth with PHIV and in perinatally HIV-exposed but uninfected (PHEU) youth. Four Delis-Kaplan Executive Function System (D-KEFS) subtests were administered to 173 youth with PHIV and 85 PHEU youth, aged 9 to Executive Functioning Study. Youth with PHIV, with or without history of a Centers for Disease Control and Prevention Class C (AIDS-defining) condition (PHIV/C [n = 45] and PHIV/non-C [n = 128], respectively), were compared with each other and with PHEU youth. Among youth with PHIV, associations with measures of current and past disease severity were evaluated using adjusted linear regression models. The PHIV/C group (mean age, 15.5 years), compared with the PHIV/non-C and PHEU groups (mean ages, 14.5 and 12.9 years, respectively), were significantly slower on the Inhibition and Color Naming/Reading Combined conditions of the Color-Word Interference subtest and made more errors on Inhibition; differences between the PHIV/C and PHEU groups persisted in adjusted models. No differences in adjusted means for fluency or problem-solving were found. The PHIV/non-C and PHEU groups did not differ on any measure. Associations of specific EF measures with HIV RNA viral load, CD4-positive T-lymphocyte percentage, and age at greatest disease severity were observed. Youth with PHIV and previous AIDS-defining conditions performed more poorly on some EF measures. Relationships of EF development with the degree and timing of disease severity require further study. Implications for long-term outcomes and interventions are important avenues for follow-up. © The Author 2016. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e

  7. Detection of persistent Plasmodium spp. infections in Ugandan children after artemether-lumefantrine treatment.

    Science.gov (United States)

    Betson, Martha; Sousa-Figueiredo, José C; Atuhaire, Aaron; Arinaitwe, Moses; Adriko, Moses; Mwesigwa, Gerald; Nabonge, Juma; Kabatereine, Narcis B; Sutherland, Colin J; Stothard, J Russell

    2014-12-01

    During a longitudinal study investigating the dynamics of malaria in Ugandan lakeshore communities, a consistently high malaria prevalence was observed in young children despite regular treatment. To explore the short-term performance of artemether-lumefantrine (AL), a pilot investigation into parasite carriage after treatment(s) was conducted in Bukoba village. A total of 163 children (aged 2-7 years) with a positive blood film and rapid antigen test were treated with AL; only 8.7% of these had elevated axillary temperatures. On day 7 and then on day 17, 40 children (26.3%) and 33 (22.3%) were positive by microscopy, respectively. Real-time PCR analysis demonstrated that multi-species Plasmodium infections were common at baseline, with 41.1% of children positive for Plasmodium falciparum/Plasmodium malariae, 9.2% for P. falciparum/ Plasmodium ovale spp. and 8.0% for all three species. Moreover, on day 17, 39.9% of children infected with falciparum malaria at baseline were again positive for the same species, and 9.2% of those infected with P. malariae at baseline were positive for P. malariae. Here, chronic multi-species malaria infections persisted in children after AL treatment(s). Better point-of-care diagnostics for non-falciparum infections are needed, as well as further investigation of AL performance in asymptomatic individuals.

  8. Impact of oral health on the quality of life of 3-6-years old HIV-infected children. Quality of life in HIV+ children.

    Science.gov (United States)

    Buczynski, A K; Castro, G F; Leão, A T; Souza, I P

    2011-06-01

    The objective was to assess the impact of oral health on the quality of life of HIV-infected patients aged 3-6 years based on their caregivers' perceptions. A questionnaire for measuring the perception and the instrument Early Childhood Oral Health Impact Scale (ECOHIS) were applied to 31 caregivers whose children were being treated in a public hospital. Results The mean age of the children was 4.52 years (SD 1.22). The total ECOHIS score ranged from 0 to 26, with a mean value of 4.13 (SD 6.66). Seventeen children (54.8%) were found to have at least one impact: toothache (64.7%), herpetic gingivostomatitis (23.5%) or both (11.8%). Statistically significant difference was found between the ECOHIS score and presence of restored teeth, prior dental treatment, AIDS, and viral load. With respect to the caregivers' perception, it resulted to be adequate, as those caregivers whose children had a greater number of decayed teeth and higher biofilm index also considered the oral health to be bad (Pchildren's general health was found to be good despite the worse immunological classification (Pchildren has been negatively affected by the oral health.

  9. Genetic variants in CYP2B6 and CYP2A6 explain interindividual variation in efavirenz plasma concentrations of HIV-infected children with diverse ethnic origin.

    Science.gov (United States)

    Soeria-Atmadja, Sandra; Österberg, Emma; Gustafsson, Lars L; Dahl, Marja-Liisa; Eriksen, Jaran; Rubin, Johanna; Navér, Lars

    2017-01-01

    Approximately 2.6 million children live with HIV globally, and efavirenz (EFV) is one of the most widely used antiretroviral agents for HIV treatment in children and adults. There are concerns about the appropriateness of current EFV dosing and it has been discussed whether EFV dosing should be adapted according to genotype in children as suggested for adults. To investigate if pediatric EFV dosing should be guided by genetic variation in drug metabolizing enzymes rather than by body weight. EFV plasma concentrations measured for clinical purposes from all children less than 18 years old at Karolinska University Hospital, Stockholm, Sweden, treated with EFV were collected retrospectively. They were genotyped for eleven polymorphisms in genes coding for drug-metabolizing enzymes and P-glycoprotein, of potential importance for EFV disposition. Data on country of origin, sex, age, weight, HIV RNA, viral resistance patterns, CD4 cells, adherence to treatment, subjective health status and adverse events were collected from their medical records. Thirty-six patients and 182 (mean 5 samples/patient) EFV plasma concentration measurements from children of African, Asian and Latin American origin were included. EFV plasma concentration varied 21-fold between measurements (n = 182) (0.85-19.3 mg/L) and 9-fold measured as mean EFV plasma concentration across the subjects (1.55-13.4 mg/L). A multivariate mixed-effects restricted maximum likelihood regression model, including multiple gene polymorphisms, identified CYP2B6*6 T/T (p EFV plasma concentration in HIV-infected children in a multi-ethnic outpatient clinic. Knowledge about individual variants in key drug metabolizing enzyme genes could improve clinical safety and genotype directed dosing could achieve more predictable EFV plasma concentrations in HIV-infected children.

  10. Functional Connectivity Alterations between Networks and Associations with Infant Immune Health within Networks in HIV Infected Children on Early Treatment: A Study at 7 Years

    Directory of Open Access Journals (Sweden)

    Jadrana T. F. Toich

    2018-01-01

    Full Text Available Although HIV has been shown to impact brain connectivity in adults and youth, it is not yet known to what extent long-term early antiretroviral therapy (ART may alter these effects, especially during rapid brain development in early childhood. Using both independent component analysis (ICA and seed-based correlation analysis (SCA, we examine the effects of HIV infection in conjunction with early ART on resting state functional connectivity (FC in 7 year old children. HIV infected (HIV+ children were from the Children with HIV Early Antiretroviral Therapy (CHER trial and all initiated ART before 18 months; uninfected children were recruited from an interlinking vaccine trial. To better understand the effects of current and early immune health on the developing brain, we also investigated among HIV+ children the association of FC at 7 years with CD4 count and CD4%, both in infancy (6–8 weeks and at scan. Although we found no differences within any ICA-generated resting state networks (RSNs between HIV+ and uninfected children (27 HIV+, 18 uninfected, whole brain connectivity to seeds located at RSN connectivity peaks revealed several loci of FC differences, predominantly from seeds in midline regions (posterior cingulate cortex, paracentral lobule, cuneus, and anterior cingulate. Reduced long-range connectivity and increased short-range connectivity suggest developmental delay. Within the HIV+ children, clinical measures at age 7 years were not associated with FC values in any of the RSNs; however, poor immune health during infancy was associated with localized FC increases in the somatosensory, salience and basal ganglia networks. Together these findings suggest that HIV may affect brain development from its earliest stages and persist into childhood, despite early ART.

  11. Respiratory Virus-Associated Severe Acute Respiratory Illness and Viral Clustering in Malawian Children in a Setting With a High Prevalence of HIV Infection, Malaria, and Malnutrition.

    Science.gov (United States)

    Peterson, Ingrid; Bar-Zeev, Naor; Kennedy, Neil; Ho, Antonia; Newberry, Laura; SanJoaquin, Miguel A; Menyere, Mavis; Alaerts, Maaike; Mapurisa, Gugulethu; Chilombe, Moses; Mambule, Ivan; Lalloo, David G; Anderson, Suzanne T; Katangwe, Thembi; Cunliffe, Nigel; Nagelkerke, Nico; McMorrow, Meredith; Widdowson, Marc-Allain; French, Neil; Everett, Dean; Heyderman, Robert S

    2016-12-01

     We used data from 4 years of pediatric severe acute respiratory illness (SARI) sentinel surveillance in Blantyre, Malawi, to identify factors associated with clinical severity and coviral clustering.  From January 2011 to December 2014, 2363 children aged 3 months to 14 years presenting to the hospital with SARI were enrolled. Nasopharyngeal aspirates were tested for influenza virus and other respiratory viruses. We assessed risk factors for clinical severity and conducted clustering analysis to identify viral clusters in children with viral codetection.  Hospital-attended influenza virus-positive SARI incidence was 2.0 cases per 10 000 children annually; it was highest among children aged infected children aged 5-9 years (6.0 cases per 10 000). A total of 605 SARI cases (26.8%) had warning signs, which were positively associated with HIV infection (adjusted risk ratio [aRR], 2.4; 95% confidence interval [CI], 1.4-3.9), respiratory syncytial virus infection (aRR, 1.9; 95% CI, 1.3-3.0) and rainy season (aRR, 2.4; 95% CI, 1.6-3.8). We identified 6 coviral clusters; 1 cluster was associated with SARI with warning signs.  Influenza vaccination may benefit young children and HIV-infected children in this setting. Viral clustering may be associated with SARI severity; its assessment should be included in routine SARI surveillance. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  12. Reversion and conversion of Mycobacterium tuberculosis IFN-γ ELISpot results during anti-tuberculous treatment in HIV-infected children

    Directory of Open Access Journals (Sweden)

    Wilkinson Katalin A

    2010-05-01

    Full Text Available Abstract Background Recent interest has focused on the potential use of serial interferon gamma (IFN-γ release assay (IGRA measurements to assess the response to anti-tuberculous (TB treatment. The kinetics of IFN-γ responses to Mycobacterium tuberculosis (MTB antigens in HIV-infected children during treatment have not however been previously investigated. Methods IFN-γ responses to the MTB antigens, ESAT-6, CFP-10 and PPD were measured by an enzyme-linked immunospot assay (IFN-γ ELISpot at presentation and at one, two and six months after starting anti-tuberculous treatment in HIV-infected children with definite or probable TB. Responses at different time points were compared using a Mann-Whitney U test with paired data analysed using the Wilcoxon signed rank test. A Fisher's exact or Chi-squared test was used to compare proportions when test results were analysed as dichotomous outcomes. Results Of 102 children with suspected TB, 22 (21% had definite TB and 24 (23% probable TB. At least one follow up IFN-γ ELISpot assay result was available for 31 (67% of the 46 children. In children with definite or probable TB in whom the IFN-γ ELISpot assay result was positive at presentation, anti-tuberculous treatment was accompanied by a significant decrease in both the magnitude of the IFN-γ response to individual or combined MTB-specific antigens (ESAT-6 median 110 SFCs/106 PBMC (IQR 65-305 at presentation vs. 15 (10-115 at six months, p = 0.04; CFP-10 177 (48-508 vs. 20 (5-165, p = 0.004, ESAT-6 or CFP-10 median 250 SFCs/106 PBMC (IQR 94-508 vs. 25 (10-165, p = 0.004 and in the proportion of children with a positive IFN-γ ELISpot assay (Fisher's exact test: ESAT-6 15/0 vs 5/11, p = 0.0002, CFP-10 22/0 vs 8/17, p = 0.0001, ESAT-6 or CFP-10 22/0 vs. 9/17, p= 0.002. However almost half of the children had a positive IFN-γ ELISpot assay after six months of anti-tuberculous treatment. In addition, there was conversion of the IFN-γ ELISpot assay

  13. 18-month occurrence of severe events among early diagnosed HIV-infected children before antiretroviral therapy in Abidjan, Côte d'Ivoire: A cohort study

    Directory of Open Access Journals (Sweden)

    Dabis François

    2008-05-01

    Full Text Available Abstract Objective To assess the 18-month field effectiveness on severe events of a pediatric package combining early HIV-diagnosis and targeted cotrimoxazole prophylaxis in HIV-infected children from age six-week before the antiretroviral era, in Abidjan, Côte d'Ivoire. Methods Data from two consecutive prevention of HIV mother-to-child transmission programs were compared: the ANRS 1201/1202 Ditrame-Plus cohort (2001–2005 and the pooled data of the ANRS 049a Ditrame randomized trial and its following open-labeled cohort (1995–2000, used as a reference group. HIV-infected pregnant women ≥ 32–36 weeks of gestation were offered a short-course peri-partum antiretroviral prophylaxis (ZDV in Ditrame, and ZDV ± 3TC+single-dose (sd NVP in Ditrame-Plus. Neonatal prophylaxis was provided in Ditrame-Plus only: 7-day ZDV and sdNVP 48–72 h after birth. A 6-week pediatric HIV-RNA diagnosis was provided on-line in the Ditrame-Plus while it was only oriented on clinical symptoms in Ditrame. Six-week HIV-infected children received a daily cotrimoxazole prophylaxis in Ditrame-Plus while no prophylaxis was provided in Ditrame. The determinants of severe events (death or hospitalization > 1 day were assessed in a Cox regression model. Results Between 1995 and 2003, 98 out of the 1121 live-births were diagnosed as HIV-infected in peri-partum: 45 from Ditrame-Plus and 53 from Ditrame. The 18-month Kaplan-Meier cumulative probability of presenting a severe event was 66% in Ditrame-Plus (95% confidence interval [95%CI]: 50%–81% and 77% in Ditrame (95%CI: 65%–89%, Log Rank test: p = 0.47. After adjustment on maternal WHO clinical stage, maternal death, 6-week pediatric viral load, birth-weight, and breastfeeding exposure, the 18-month risk of severe event was lower in Ditrame-Plus than in Ditrame (adjusted Hazard Ratio (aHR: 0.55, 95%CI: 0.3–1.1, although the difference was not statistically significant; p = 0.07. Maternal death was the only variable

  14. Prevalence of malnutrition among HIV-infected children in Central and West-African HIV-care programmes supported by the Growing Up Programme in 2011: a cross-sectional study.

    Science.gov (United States)

    Jesson, Julie; Masson, David; Adonon, Arsène; Tran, Caroline; Habarugira, Capitoline; Zio, Réjane; Nicimpaye, Léoncie; Desmonde, Sophie; Serurakuba, Goreth; Kwayep, Rosine; Sare, Edith; Konate, Tiefing; Nimaga, Abdoulaye; Saina, Philemon; Kpade, Akossiwa; Bassuka, Andrée; Gougouyor, Gustave; Leroy, Valériane

    2015-05-26

    The burden of malnutrition among HIV-infected children is not well described in sub-Saharan Africa, even though it is an important problem to take into account to guarantee appropriate healthcare for these children. We assessed the prevalence of malnutrition and its associated factors among HIV-infected children in HIV care programmes in Central and West-Africa. A cross-sectional study was conducted from September to December 2011 among the active files of HIV-infected children aged 2-19 years old, enrolled in HIV-care programmes supported by the Sidaction Growing Up Programme in Benin, Burundi, Cameroon, Côte d'Ivoire, Mali, Chad and Togo. Socio-demographics characteristics, anthropometric, clinical data, and nutritional support were collected. Anthropometric indicators, expressed in Z-scores, were used to define malnutrition: Height-for-age (HAZ), Weight-for-Height (WHZ) for children malnutrition were defined: acute malnutrition (WHZ/BAZ malnutrition (HAZ malnutrition (WHZ/BAZ malnutrition. Overall, 1350 HIV-infected children were included; their median age was 10 years (interquartile range [IQR]: 7-13 years), 49 % were girls. 80 % were on antiretroviral treatment (ART), for a median time of 36 months. The prevalence of malnutrition was 42 % (95 % confidence interval [95% CI]: 40-44 %) with acute, chronic and mixed malnutrition at 9 % (95% CI: 6-12 %), 26 % (95% CI: 23-28 %), and 7 % (95% CI: 5-10 %), respectively. Among those malnourished, more than half of children didn't receive any nutritional support at the time of the survey. Acute malnutrition was associated with male gender, severe immunodeficiency, and the absence of ART; chronic malnutrition with male gender and age (malnutrition with male gender, age (malnutrition. The prevalence of malnutrition in HIV-infected children even on ART remains high in HIV care programmes. Anthropometric measurements and appropriate nutritional care of malnourished HIV-infected children remain insufficient and a

  15. Effectiveness of efavirenz-based regimens in young HIV-infected children treated for tuberculosis: a treatment option for resource-limited settings.

    Directory of Open Access Journals (Sweden)

    Janneke H van Dijk

    Full Text Available Antiretroviral treatment (ART options for young children co-infected with HIV and tuberculosis are limited in resource-poor settings due to limited data on the use of efavirenz (EFV. Using available pharmacokinetic data, an EFV dosing schedule was developed for young co-infected children and implemented as the standard of care at Macha Hospital in Southern Province, Zambia. Treatment outcomes in children younger than 3 years of age or weighing less than 10 kg receiving either EFV-based ART plus anti-tuberculous treatment or nevirapine-based (NVP ART were compared.Treatment outcomes were measured in a cohort of HIV-infected children seeking care at Macha Hospital in rural Zambia from 2007 to 2010. Information on the diagnosis and treatment of tuberculosis was abstracted from medical records.Forty-five children treated for tuberculosis initiated an EFV-based regimen and 69 children initiated a NVP-based regimen, 7 of whom also were treated for tuberculosis. Children receiving both regimens were comparable in age, but children receiving EFV started ART with a lower CD4(+ T-cell percentage and weight-for-age z-score. Children receiving EFV experienced increases in both CD4(+ T-cell percentage and weight-for-age z-score during follow-up, such that levels were comparable to children receiving NVP after two years of ART. Cumulative survival after 12 months of ART did not differ between groups (NVP:87%;EFV:80%;p = 0.25. Eleven children experienced virologic failure during follow-up.The adjusted hazard ratio of virologic failure comparing EFV to NVP was 0.25 (95% CI:0.05,1.24 and 0.13 (95% CI:0.03,0.62 using thresholds of 5000 and 400 copies/mL, respectively.Five children receiving EFV were reported to have had convulsions after ART initiation compared to only one child receiving NVP (p = 0.04.Despite poorer health at ART initiation, children treated for tuberculosis and receiving EFV-based regimens showed significant improvements comparable to children

  16. The association between cognition and academic performance in Ugandan children surviving malaria with neurological involvement.

    Science.gov (United States)

    Bangirana, Paul; Menk, Jeremiah; John, Chandy C; Boivin, Michael J; Hodges, James S

    2013-01-01

    The contribution of different cognitive abilities to academic performance in children surviving cerebral insult can guide the choice of interventions to improve cognitive and academic outcomes. This study's objective was to identify which cognitive abilities are associated with academic performance in children after malaria with neurological involvement. 62 Ugandan children with a history of malaria with neurological involvement were assessed for cognitive ability (working memory, reasoning, learning, visual spatial skills, attention) and academic performance (reading, spelling, arithmetic) three months after the illness. Linear regressions were fit for each academic score with the five cognitive outcomes entered as predictors. Adjusters in the analysis were age, sex, education, nutrition, and home environment. Exploratory factor analysis (EFA) and structural equation models (SEM) were used to determine the nature of the association between cognition and academic performance. Predictive residual sum of squares was used to determine which combination of cognitive scores was needed to predict academic performance. In regressions of a single academic score on all five cognitive outcomes and adjusters, only Working Memory was associated with Reading (coefficient estimate = 0.36, 95% confidence interval = 0.10 to 0.63, pWorking memory, visual spatial ability and learning were the best predictors of academic performance. Academic performance is strongly associated with the latent variable labelled "cognitive ability" which captures most of the variation in the individual specific cognitive outcome measures. Working memory, visual spatial skills, and learning together stood out as the best combination to predict academic performance.

  17. Body fat distribution in perinatally HIV-infected and HIV-exposed but uninfected children in the era of highly active antiretroviral therapy: outcomes from the Pediatric HIV/AIDS Cohort Study

    Science.gov (United States)

    Associations between abnormal body fat distribution and clinical variables are poorly understood in pediatric HIV disease. Our objective was to compare total body fat and its distribution in perinatally HIV-infected and HIV-exposed but uninfected (HEU) children and to evaluate associations with clin...

  18. Clinical presentation and outcome of epidemic Kaposi sarcoma in Ugandan children.

    Science.gov (United States)

    Gantt, Soren; Kakuru, Abel; Wald, Anna; Walusansa, Victoria; Corey, Lawrence; Casper, Corey; Orem, Jackson

    2010-05-01

    Kaposi sarcoma (KS) is one of the most common pediatric cancers in sub-Saharan Africa. Few data are available about the clinical presentation or response to treatment of children with epidemic (HIV-associated) KS. Medical records of all children with KS and HIV infection referred to the Uganda Cancer Institute in Kampala, Uganda from October 2004 to June 2007 were reviewed. Charts were abstracted for age, sex, location of KS lesions at presentation, biopsy results, CD4 T-cell count and percentage, and KS treatment and outcome. Seventy-three children with epidemic KS were identified, 37 males and 36 females. The median age was 10.1 years (range 2-18). KS presented with lymph node (LN) involvement in 60% of cases. The median absolute and percentage CD4 T-cells at presentation were 210 cells/microl and 7.4%, respectively. Those children with lymphadenopathic KS were younger (mean difference 3.7 years; P = 0.01) and had higher CD4 T-cell counts (mean difference 242 cells/microl; P = 0.03) than those without LN involvement. Of 32 patients for whom outcome data were available, a complete response to chemotherapy and/or antiretroviral therapy was documented in 20 (62.5%) patients. In comparison to cutaneous involvement, LN involvement of epidemic KS occurs at younger ages and at higher CD4 levels. This clinical presentation may reflect recent infection with human herpesvirus 8 followed by a rapid progression to malignancy. Favorable response to treatment was observed in the majority of cases, but prospective studies are needed to determine optimal management.

  19. Rural and urban Ugandan primary school children's alternative ideas about animals

    Science.gov (United States)

    Otaala, Justine

    This study examined rural and urban Ugandan primary children's alternative ideas about animals through the use of qualitative research methods. Thirty-six children were selected from lower, middle, and upper primary grades in two primary schools (rural and urban). Data were collected using interview-about-instance technique. Children were shown 18 color photographs of instances and non-instances of familiar animals and asked to say if the photographed objects were animals or not. They were then asked to give reasons to justify their answers. The interviews were audiotaped and transcribed. The results indicate that children tended to apply the label "animal" to large mammals, usually found at home, on the farm, in the zoo, and in the wild. Humans were not categorized as animals, particularly by children in the lower grades. Although the children in upper grades correctly identified humans as animals, they used reasons that were irrelevant to animal attributes and improperly derived from the biological concept of evolution. Many attributes children used to categorize instances of animals were scientifically unacceptable and included superficial features, such as body outline, anatomical features (body parts), external features (visual cues), presence or absence and number of appendages. Movement and eating (nutrition) were the most popular attributes children used to identify instances of animals. The main differences in children's ideas emanated from the reasons used to identify animals. Older rural children drew upon their cultural and traditional practices more often than urban children. Anthropomorphic thinking was predominant among younger children in both settings, but diminished with progression in children's grade levels. Some of the implications of this study are: (1) teachers, teacher educators and curriculum developers should consider learners' ideas in planning and developing teaching materials and interventions. (2) Teachers should relate humans to other

  20. Rinossinusites em crianças infectadas pelo HIV sob terapia anti-retroviral Rhinosinusitis in HIV-infected children undergoing antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Carlos Diógenes Pinheiro Neto

    2009-02-01

    Full Text Available A associação dos inibidores de protease (IP à terapia anti-retroviral provocou mudanças importantes na morbidade e mortalidade de pacientes infectados pelo HIV. OBJETIVOS: Avaliar o impacto desta associação na prevalência de rinossinusite (RS e na contagem sérica de linfócitos CD4 em crianças infectadas pelo HIV. CASUÍSTICA E MÉTODOS: A forma de estudo foi cross-sectional com 471 crianças infectadas pelo HIV. Em 1996, inibidores de protease foram liberados para terapia anti-retroviral. Desta forma, dois grupos de crianças foram formados: as que não fizeram uso de IP e as que fizeram uso desta droga após 1996. A prevalência de RS e a contagem sérica de linfócitos CD4 foram comparadas entre estes grupos. RESULTADOS: 14,4% das crianças infectadas pelo HIV apresentaram RS. A RS crônica foi mais prevalente que a RS aguda em ambos os grupos. Crianças menores de 6 anos tratadas com a associação de IP apresentaram maior prevalência de RS aguda. A associação de IP esteve associada à maior contagem de linfócitos CD4 séricos com menor prevalência de RS crônica. CONCLUSÕES: A terapia com IP esteve associada ao aumento na contagem de linfócitos CD4. Crianças abaixo dos 6 anos em uso de IP apresentaram menor tendência à cronificação da doença.The association of protease inhibitors (PI to antiretroviral therapy has generated sensible changes in morbidity and mortality of HIV-infected patients. AIM: Aims at evaluating the impact of this association on the prevalence of rhinosinusitis (RS and CD4+ lymphocyte count in HIV-infected children. METHODS: Retrospective cross-sectional study of the medical charts of 471 HIV-infected children. In 1996, protease inhibitors were approved for use as an association drug in antiretroviral therapy. Children were divided into two groups: one which did not receive PI and another which received PI after 1996. The prevalence of RS and CD4+ lymphocyte counts were compared between these groups

  1. Anthropometric measurements and lipid profiles to detect early lipodystrophy in antiretroviral therapy experienced HIV-infected children in the CHAPAS-3 trial.

    Science.gov (United States)

    Musiime, Victor; Cook, Adrian; Kayiwa, Joshua; Zangata, Dorothy; Nansubuga, Carol; Arach, Beatrice; Kenny, Julia; Wavamunno, Priscilla; Komunyena, Justine; Kabamba, Desiree; Asiimwe, Alice R; Mirembe, Grace; Abongomera, George; Mulenga, Veronica; Kekitiinwa, Adeodata; Kityo, Cissy; Walker, Sarah A; Klein, Nigel; Gibb, Diana M

    2014-01-01

    Few studies have investigated objective markers of lipodystrophy in African children. We compared body circumferences, skin-fold thickness (SFT) and lipids in antiretroviral therapy (ART)-naive and stavudine (d4T)-exposed children with HIV-uninfected controls. In the CHAPAS-3 trial, HIV-infected children (ART-naive or on d4T for ≥2 years without clinical lipodystrophy) were randomized to d4T, abacavir or zidovudine with lamivudine (3TC) plus a non-nucleoside reverse transcriptase inhibitor. Mid-upper-arm circumference (MUAC) and calf circumference (CC), SFT (biceps, triceps, sub-scapular and supra-iliac) and fasting lipids (total cholesterol [TC], low-density lipoprotein [LDL], high-density lipoprotein [HDL] and triglycerides [TRIG]) were measured at randomization in all HIV-infected children, and in HIV-uninfected controls. Age- and sex-adjusted z-scores of MUAC, CC, SFT and the sum of SFT (SSF) using Dutch reference data were compared across groups using linear regression. Of 496 children, 49% were male, 299 (median age 2.5 years [IQR 1.5-4.0]) were ART-naive, 109 (median age 6 years [IQR 5.5-7.0]) were ART-experienced and 88 (median age 2.2 years [IQR 1.5-3.0]) were control children. Overall, 100% and 95% of ART-experienced children had been on d4T plus 3TC and nevirapine, respectively, for a median 3.5 years (IQR 2.6-4.2). Mean (sd) weight-for-age z-scores and MUAC z-scores were -1.51 (1.29) versus -0.90 (0.88) versus -0.33 (1.15) and -1.56 (1.25) versus -1.24 (0.97) versus -0.65 (1.06) in ART-naive versus -experienced versus controls, respectively (all P<0.02). The mean (sd) of SSF was lower in the ART-experienced (-0.78 [1.28]) than in the ART-naive (-0.32 [1.09]; P<0.0001) children and controls (-0.29 [0.88]; P<0.002). ART-experienced children had higher mean fasting TC, LDL and HDL but lower TRIG compared to ART-naive children (P-values <0.0001), and higher TC and HDL but lower TRIG compared to controls (P-values <0.01). In ART-experienced children on d4T

  2. Challenges facing effective implementation of co-trimoxazole prophylaxis in children born to HIV-infected mothers in the public health facilities

    Directory of Open Access Journals (Sweden)

    Kamuhabwa AAR

    2015-10-01

    Full Text Available Appolinary AR Kamuhabwa,1 Vicky Manyanga21Unit of Pharmacology and Therapeutics, 2Department of Medicinal Chemistry, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaBackground: If children born to HIV-infected mothers are not identified early, approximately 30% of them will die within the first year of life due to opportunistic infections. In order to prevent morbidity and mortality due to opportunistic infections in children, the World Health Organization recommends the use of prophylaxis using co-trimoxazole. However, the challenges affecting effective implementation of this policy in Tanzania have not been documented.Aim: In this study, we assessed the challenges facing the provision of co-trimoxazole prophylaxis among children born to HIV-infected mothers in the public hospitals of Dar es Salaam, Tanzania.Methodology: Four hundred and ninety-eight infants' PMTCT (Prevention of Mother-to-Child Transmission of HIV register books for the past 2 years were reviewed to obtain information regarding the provision of co-trimoxazole prophylaxis. One hundred and twenty-six health care workers were interviewed to identify success stories and challenges in the provision of co-trimoxazole prophylaxis in children. In addition, 321 parents and guardians of children born to HIV-infected mothers were interviewed in the health facilities.Results: Approximately 80% of children were initiated with co-trimoxazole prophylaxis within 2 months after birth. Two hundred and ninety-one (58.4% children started using co-trimoxazole within 4 weeks after birth. Majority (n=458, 91.8% of the children were prescribed 120 mg of co-trimoxazole per day, whereas 39 (7.8% received 240 mg per day. Only a small proportion (n=1, 0.2% of children received 480 mg/day. Dose determination was based on the child's age rather than body weight. Parents and guardians reported that 42 (13.1% children had missed one or more doses of co

  3. Thymic Output and CD4 T-Cell Reconstitution in HIV-Infected Children on Early and Interrupted Antiretroviral Treatment: Evidence from the Children with HIV Early Antiretroviral Therapy Trial

    Directory of Open Access Journals (Sweden)

    Joanna Lewis

    2017-09-01

    Full Text Available ObjectivesEarly treatment of HIV-infected children and adults is important for optimal immune reconstitution. Infants’ immune systems are more plastic and dynamic than older children’s or adults’, and deserve particular attention. This study aimed to understand the response of the HIV-infected infant immune system to early antiretroviral therapy (ART and planned ART interruption and restart.MethodsData from HIV-infected children enrolled the CHER trial, starting ART aged between 6 and 12 weeks, were used to explore the effect of ART on immune reconstitution. We used linear and non-linear regression and mixed-effects models to describe children’s CD4 trajectories and to identify predictors of CD4 count during early and interrupted ART.ResultsEarly treatment arrested the decline in CD4 count but did not fully restore it to the levels observed in HIV-uninfected children. Treatment interruption at 40 or 96 weeks resulted in a rapid decline in CD4 T-cells, which on retreatment returned to levels observed before interruption. Naïve CD4 T-cell count was an important determinant of overall CD4 levels. A strong correlation was observed between thymic output and the stable CD4 count both before and after treatment interruption.ConclusionEarly identification and treatment of HIV-infected infants is important to stabilize CD4 counts at the highest levels possible. Once stabilized, children’s CD4 counts appear resilient, with good potential for recovery following treatment interruption. The naïve T-cell pool and thymic production of naive cells are key determinants of children’s CD4 levels.

  4. CYP2B6 genotype-directed dosing is required for optimal efavirenz exposure in children 3-36 months with HIV infection.

    Science.gov (United States)

    Bolton Moore, Carolyn; Capparelli, Edmund V; Samson, Pearl; Bwakura-Dangarembizi, Mutsa; Jean-Philippe, Patrick; Worrell, Carol; Heckman, Barbara; Purdue, Lynette; Spector, Stephen A; Benns, Alex; Borkowsky, William; Loftis, Amy; Hawkins, Elizabeth; Wallis, Carole; Chadwick, Ellen G

    2017-05-15

    To determine safety-specific, efficacy-specific and genotypic-specific dose requirements of efavirenz (EFV) in children aged 3 to less than 36 months with HIV infection. IMPAACT P1070 was a 24-week prospective cohort trial of EFV (as open capsules) and two nucleoside reverse transcriptase inhibitors in children with HIV infection 3 to less than 36 months without tuberculosis (Cohort 1). CYP2B6 G516T genotype was determined, and intensive pharmacokinetics was performed at week 2. EFV dose was adjusted if outside the target area under the curve (AUC) 35-180 μg*h/ml. Pharmacokinetic and CYP2B6 G516T genotype data were used to model EFV exposures based on Food and Drug Administration (FDA)-approved doses. Forty-seven participants, median age 19 months, initiated the study regimen with 24 weeks median follow-up; 38 516GG/GT and 9 516TT genotypes. Initially, median EFV AUC was higher in 516TT vs. 516GG/GT (median 490 vs. 107 μg*h/ml; P = 0.0001) with all 516TT above AUC target. Following an amendment that reduced the 516TT EFV dose by 75%, pharmacokinetic modeling predicted that 83% of participants met the AUC target (31/38 516GG/GT, 8/9 516TT). In contrast, modeling using P1070 data predicted that FDA-approved doses would produce subtherapeutic AUCs in almost one-third of participants with 516GG/GT and excessive AUCs in more than 50% with 516TT genotypes. CYP2B6 G516T genotype strongly influences EFV exposures in this age group. Genotype-directed dosing yields therapeutic EFV concentrations and appears to outperform other dosing approaches.

  5. Pharmacokinetics of two generic fixed-dose combinations for HIV-infected children (Pedimune Baby & Pedimune Junior) are similar to the branded products in healthy adults.

    Science.gov (United States)

    L'homme, Rafaëlla F A; Dijkema, Tim; Warris, Adilia; van der Ven, Andre J A M; Gibb, Diana M; Burger, David M

    2007-01-01

    Cipla Pharmaceuticals have developed generic fixed-dose combinations of stavudine, lamivudine and nevirapine for HIV-infected children (Pedimune Baby and Junior). We determined the pharmacokinetic profiles of stavudine, lamivudine and nevirapine in Pedimune and compared these with the branded products. This Phase I, comparative, single-centre, open-label, three-period, single-dose study was designed as a pilot study to exclude large differences in pharmacokinetics. Six healthy males were randomized to the following regimen sequences: ABC; ACB; BCA; BAC; CAB; CBA (A = reference, B = Pedimune Baby, C = Pedimune Junior). Single doses of medication were administered at 3 time points 4 weeks apart. An 8 h pharmacokinetic curve was recorded at day 1 of every cycle after medication intake. In addition, blood samples were taken on days 2, 3, 4, 8 and 15. Non-parametric statistical tests revealed no statistically significant differences in Cmax (0.173 branded drugs. Also, there were no significant differences in AUC(0-infinity) of stavudine, lamivudine and nevirapine between Pedimune Junior and the branded drugs (0.345 branded drug for nevirapine (P = 0.463). In contrast, the AUC(0-infinity) of stavudine (mean change: +21%; P = 0.046) and lamivudine (mean change: +14%; P = 0.028) differed significantly between Pedimune Baby and the branded drugs, but these changes were considered not clinically significant. The pharmacokinetic profiles of stavudine, lamivudine and nevirapine in Pedimune Baby and Junior are comparable to the branded products. Based on these results, it is acceptable to test the pharmacokinetics and dosing requirements of Pedimune in HIV-infected children.

  6. Safety and effectiveness of antiretroviral therapies for HIV-infected women and their infants and children: protocol for a systematic review and network meta-analysis.

    Science.gov (United States)

    Tricco, Andrea C; Antony, Jesmin; Angeliki, Veroniki A; Ashoor, Huda; Hutton, Brian; Hemmelgarn, Brenda R; Moher, David; Finkelstein, Yaron; Gough, Kevin; Straus, Sharon E

    2014-05-25

    Antiretroviral therapy reduces mother-to-child transmission of human immunodeficiency virus (HIV) during pregnancy, delivery, and breastfeeding. However, these agents have been associated with preterm birth, anemia and low birth weight. We aim to evaluate the comparative safety and effectiveness of the use of antiretroviral drugs among HIV-infected women and the effects on their infants and children through a systematic review and network meta-analysis. Studies examining the effects of six antiretroviral drug classes (nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors, fusion inhibitors, co-receptor inhibitors) administered to HIV-infected pregnant women will be included. We will include randomized clinical trials (RCTs), quasi-RCTs, non-RCTs, controlled before-after, interrupted time series, cohort, registry, and case-control studies. No limitations will be imposed on publication status (that is, unpublished studies are eligible for inclusion), duration of follow-up, study conduct period, and language of dissemination. Comprehensive literature searches will be conducted in major electronic databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. Gray literature will be identified through searching dissertation databases, trial protocol registries, and conference abstracts.Two team members will independently screen all citations, full-text articles, and abstract data; conflicts will be resolved through discussion. The risk of bias and methodological quality will be appraised using appropriate tools (for example, Cochrane Collaboration's tool for assessing risk of bias, Newcastle-Ottawa Scale, and McMaster Quality Assessment Scale of Harms). If feasible and appropriate, we will conduct random effects meta-analysis. Network meta-analysis will be considered for outcomes with the greatest number of treatment comparisons available that fulfill

  7. Health workers' views on quality of prevention of mother-to-child transmission and postnatal care for HIV-infected women and their children

    Directory of Open Access Journals (Sweden)

    Hardon Anita

    2009-05-01

    Full Text Available Abstract Background Prevention of mother-to-child transmission has been considered as not a simple intervention but a comprehensive set of interventions requiring capable health workers. Viet Nam's extensive health care system reaches the village level, but still HIV-infected mothers and children have received inadequate health care services for prevention of mother-to-child transmission. We report here the health workers' perceptions on factors that lead to their failure to give good quality prevention of mother-to-child transmission services. Methods Semistructured interviews with 53 health workers and unstructured observations in nine health facilities in Hanoi were conducted. Selection of respondents was based on their function, position and experience in the development or implementation of prevention of mother-to-child transmission policies/programmes. Results Factors that lead to health workers' failure to give good quality services for prevention of mother-to-child transmission include their own fear of HIV infection; lack of knowledge on HIV and counselling skills; or high workloads and lack of staff; unavailability of HIV testing at commune level; shortage of antiretroviral drugs; and lack of operational guidelines. A negative attitude during counselling and provision of care, treating in a separate area and avoidance of providing service at all were seen by health workers as the result of fear of being infected, as well as distrust towards almost all HIV-infected patients because of the prevailing association with antisocial behaviours. Additionally, the fragmentation of the health care system into specialized vertical pillars, including a vertical programme for HIV/AIDS, is a major obstacle to providing a continuum of care. Conclusion Many hospital staff were not being able to provide good care or were even unwilling to provide appropriate care for HIV-positive pregnant women The study suggests that the quality of prevention of

  8. Genetic variants in CYP2B6 and CYP2A6 explain interindividual variation in efavirenz plasma concentrations of HIV-infected children with diverse ethnic origin.

    Directory of Open Access Journals (Sweden)

    Sandra Soeria-Atmadja

    proportion of variability in EFV plasma concentration in HIV-infected children in a multi-ethnic outpatient clinic. Knowledge about individual variants in key drug metabolizing enzyme genes could improve clinical safety and genotype directed dosing could achieve more predictable EFV plasma concentrations in HIV-infected children.

  9. Sex differences in the effects of maternal vitamin supplements on mortality and morbidity among children born to HIV-infected women in Tanzania.

    Science.gov (United States)

    Kawai, Kosuke; Msamanga, Gernard; Manji, Karim; Villamor, Eduardo; Bosch, Ronald J; Hertzmark, Ellen; Fawzi, Wafaie W

    2010-06-01

    We examined whether there are sex differences in the effect of vitamin supplements on birth outcomes, mortality and morbidity by 2 years of age among children born to HIV-infected women in Tanzania. A randomised placebo-controlled trial was conducted among 959 mother-infant pairs. HIV-infected pregnant women were randomly assigned to receive a daily oral dose of one of four regimens: multivitamins (vitamins B-complex, C and E), vitamin A plus beta-carotene, multivitamins including vitamin A plus beta-carotene or placebo. Supplements were administered during pregnancy and continued after delivery. The beneficial effect of multivitamins on decreasing the risk of low birth weight was stronger among girls (relative risks (RR) = 0.39, 95 % CI 0.22, 0.67) than among boys (RR = 0.81, 95 % CI 0.44, 1.49; P for interaction = 0.08). Maternal multivitamin supplements resulted in 32 % reduction in mortality among girls (RR = 0.68, 95 % CI 0.47, 0.97), whereas no effect was found among boys (RR = 1.20, 95 % CI 0.80, 1.78; P for interaction = 0.04). Multivitamins had beneficial effects on the overall risks of diarrhoea that did not differ by sex. Vitamin A plus beta-carotene alone increased the risk of HIV transmission, but had no effects on mortality, and we found no sex differences in these effects. Sex differential effects of multivitamins on mortality may be due to sex-related differences in the immunological or genetic factors. More research is warranted to examine the effect of vitamins by sex and better understand biological mechanisms mediating such effects.

  10. Witnessing intimate partner violence and child maltreatment in Ugandan children: a cross-sectional survey.

    Science.gov (United States)

    Devries, Karen M; Knight, Louise; Child, Jennifer C; Kyegombe, Nambusi; Hossain, Mazeda; Lees, Shelley; Watts, Charlotte; Naker, Dipak

    2017-02-28

    Existing evidence, mainly from high-income countries, shows children who witness intimate partner violence (IPV) at home are more likely to experience other forms of violence, but very little evidence is available from lower income countries. In this paper we aim to explore whether Ugandan children who witness IPV at home are also more likely to experience other forms of maltreatment, factors associated with witnessing and experiencing violence, and whether any increased risk comes from parents, or others outside the home. A representative cross-sectional survey of primary schools. 3427 non-boarding primary school students, aged about 11-14 years. Luwero District, Uganda, 2012. Exposure to child maltreatment was measured using the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool-Child Institutional, and 2 questions measured witnessing IPV. 26% of children reported witnessing IPV, but nearly all of these children had also experienced violence themselves. Only 0.6% of boys and 1.6% of girls had witnessed partner violence and not experienced violence. Increased risk of violence was from parents and also from other perpetrators besides parents. Both girls and boys who witnessed and experienced violence had between 1.66 (95% CI 0.96 to 2.87) and 4.50 (95% CI 1.78 to 11.33) times the odds of reporting mental health difficulties, and 3.23 (95% CI 1.99 to 5.24) and 8.12 (95% CI 5.15 to 12.80) times the odds of using physical or sexual violence themselves. In this sample, witnessing IPV almost never occurred in isolation-almost all children who witnessed partner violence also experienced violence themselves. Our results imply that children in Uganda who are exposed to multiple forms of violence may benefit from intervention to mitigate mental health consequences and reduce use of violence. IPV prevention interventions should be considered to reduce child maltreatment. Large numbers of children also experience maltreatment in

  11. HIV infections in otolaryngology

    Science.gov (United States)

    Rzewnicki, Ireneusz; Olszewska, Ewa; Rogowska-Szadkowska, Dorota

    2012-01-01

    Summary HIV (human immunodeficiency virus) infection may produce no clinical symptoms for 10 years on average. However, after many years of infection most people develop symptoms that indicate progression of the disease. There are no regular characteristic symptoms or early stage, and no logical sequence of AIDS indicator disorders has been observed. People who are not aware of the infection are referred to physicians of various specializations, including otolaryngologists. It is on their knowledge about HIV infections, among other factors, that early diagnosis of the disease depends. Appropriate and quick introduction of anti-retroviral drugs may let a person with HIV live decades longer. PMID:22367140

  12. Leishmaniasis in HIV infection.

    Directory of Open Access Journals (Sweden)

    Paredes R

    2003-01-01

    Full Text Available Herein we review the particular aspects of leishmaniasis associated with HIV infection. The data in this review are mainly from papers identified from PubMed searches and from papers in reference lists of reviewed articles and from the authors′ personal archives. Epidemiological data of HIV/Leishmania co-infection is discussed, with special focus on the influence of Highly Active Antiretroviral Therapy (HAART on incidence of leishmaniasis and transmission modalities. Microbiological characteristics, pathogenesis, clinical presentation and specific treatment of the co-infection are also presented.

  13. AIDS-defining events and deaths in HIV-infected children and adolescents on antiretrovirals: a 14-year study in Thailand.

    Science.gov (United States)

    Traisathit, Patrinee; Delory, Tristan; Ngo-Giang-Huong, Nicole; Somsamai, Rosalin; Techakunakorn, Pornchai; Theansavettrakul, Sookchai; Kanjanavanit, Suparat; Mekmullica, Jutarat; Ngampiyaskul, Chaiwat; Na-Rajsima, Sathaporn; Lallemant, Marc; Cressey, Tim R; Jourdain, Gonzague; Collins, Intira Jeannie; Le Coeur, Sophie

    2017-10-14

    Data are scarce on the long-term clinical outcomes of perinatally HIV-infected children and adolescents receiving antiretroviral therapy (ART) in low/middle-income countries. We assessed the incidence of mortality before (early) and after (late) 6-month of ART and of the composite outcome of new/recurrent AIDS-defining-event or death >6 months after ART start (late AIDS/death) and their associated factors. Study population was perinatally HIV-infected children (≤18 years) initiating ART within the Program for HIV Prevention and Treatment observational cohort (NCT00433030). Factors associated with late AIDS/death were assessed using competing risk regression models accounting for loss-to-follow-up, and included baseline and time-updated variables. Among 619 children, "early" mortality incidence was 99 deaths per 1000-PYFU (95%CI; 69-142) and "late" mortality 6 per 1000-PYFU (95%CI; 4-9). Of the 553 children alive >6 months after ART initiation, median age at ART initiation was 6.4 years, CD4% 8.2% and HIV-RNA 5.1 log10 copies/mL. 38 (7%) children developed late AIDS/death after median time of 3.3 years: 24 died and 24 experienced new/recurrent AIDS-defining-events (10 subsequently died). Factors independently associated with late AIDS/death were: current age ≥13 years (adjusted sub-distribution hazard-ratio 4.9; 95%CI; 2.4-10.1), HIV-RNA always ≥400 copies/mL (12.3; 4.0-37.6), BMI-z-score always <-2 SD (13.7; 3.4-55.7), and hemoglobin <8g/dL at least once (4.6; 2.0-10.5). After the initial 6 months of ART, being an adolescent, persistent viremia, poor nutritional status and severe anemia were associated with poor clinical outcomes. This supports the need for novel interventions that target children, particularly adolescents with poor growth and uncontrolled viremia.

  14. Ethical issues and HIV infection

    African Journals Online (AJOL)

    his job if he is found to be HIV-infected. He also refuses to share the diagnosis of pneumocystis or the possibility of HIV infection with his wife. What are the doctor's responsibilities to the patient's wife and employer? Comment. The dilemma arises because of a conflict of duties which the medical practitioner experiences.

  15. [Multiple myeloma in HIV infection].

    Science.gov (United States)

    Barbanera, M; Menicagli, V

    1990-10-01

    The Authors describe a case of multiple myeloma in a patient with HIV infection: this is an exceptional observation in young people and in HIV seropositive patients. The marked proliferation of lymphocyte B polyclones, typically found in the advanced stages of HIV infection, could be a determining factor in the appearance of a malignant clone, causing the onset of multiple myeloma.

  16. Evaluation of viral load thresholds for predicting new WHO Stage 3 and 4 events in HIV-infected children receiving highly active antiretroviral therapy

    Science.gov (United States)

    Siberry, George K; Harris, D. Robert; Oliveira, Ricardo Hugo; Krauss, Margot R.; Hofer, Cristina B.; Tiraboschi, Adriana Aparecida; Marques, Heloisa; Succi, Regina C.; Abreu, Thalita; Negra, Marinella Della; Mofenson, Lynne M.; Hazra, Rohan

    2012-01-01

    Background This study evaluated a wide range of viral load (VL) thresholds to identify a cut-point that best predicts new clinical events in children on stable highly-active antiretroviral therapy (HAART). Methods Cox proportional hazards modeling was used to assess the adjusted risk of World Health Organization stage 3 or 4 clinical events (WHO events) as a function of time-varying CD4, VL, and hemoglobin values in a cohort study of Latin American children on HAART ≥ 6 months. Models were fit using different VL cut-points between 400 and 50,000 copies/mL, with model fit evaluated on the basis of the minimum Akaike Information Criterion (AIC) value, a standard model fit statistic. Results Models were based on 67 subjects with WHO events out of 550 subjects on study. The VL cutpoints of > 2600 copies/mL and > 32,000 copies/mL corresponded to the lowest AIC values and were associated with the highest hazard ratios [2.0 (p = 0.015) and 2.1 (p = 0.0058), respectively] for WHO events. Conclusions In HIV-infected Latin American children on stable HAART, two distinct VL thresholds (> 2,600 copies/mL and > 32,000 copies/mL) were identified for predicting children at significantly increased risk of HIV-related clinical illness, after accounting for CD4 level, hemoglobin level, and other significant factors. PMID:22343177

  17. Effect of Age at Antiretroviral Therapy Initiation on Catch-up Growth Within the First 24 Months Among HIV-infected Children in the IeDEA West African Pediatric Cohort

    DEFF Research Database (Denmark)

    Jesson, Julie; Koumakpaï, Sikiratou; Diagne, Ndeye R

    2015-01-01

    was defined at ART initiation (baseline) by a Z score underweight, height-for-age (HAZ) for stunting and weight-for-height/BMI-for-age (WHZ/BAZ) for wasting. Kaplan-Meier estimates for catch-up growth (Z score ≥-2...... 2001 and 2012, 2004 HIV-infected children underweight, 48% were stunted and 33% were wasted. The 24-month adjusted estimates for catch-up growth were 69% [95% confidence interval (CI): 57-80], 61% (95% CI: 47-70) and 90% (95% CI: 76...... managed. Despite a significant growth improvement after 24 months on ART, especially in children Nutritional care should be part of the global healthcare of HIV-infected children in sub-Saharan Africa....

  18. Should first-line empiric treatment strategies cover coagulase-negative staphylococcal infections in severely malnourished or HIV-infected children in Kenya?

    Directory of Open Access Journals (Sweden)

    Christina W Obiero

    Full Text Available Bloodstream infection is a common cause of morbidity in children aged <5 years in developing countries. In studies reporting bacteremia in Africa, coagulase-negative Staphylococci (CoNS are commonly isolated. However, it is currently unclear whether children who are highly susceptible to infection because of severe acute malnutrition (SAM or HIV should be treated with antimicrobials specifically to cover CoNS. We aimed to determine the clinical significance of CoNS amongst children admitted to a rural hospital in Kenya in relation to nutritional and HIV status.Systematically collected clinical and microbiological surveillance data from children aged 6-59 months admitted to Kilifi County Hospital (2007-2013 were analysed. Multivariable regression was used to test associations between CoNS isolation from blood cultures and SAM (MUAC <11.5cm or nutritional oedema (kwashiorkor, and HIV serostatus; and among children with SAM or HIV, associations between CoNS isolation and mortality, duration of hospitalization and clinical features.CoNS were isolated from blood culture in 906/13,315 (6.8% children, of whom 135/906 (14.9% had SAM and 54/906 (6.0% were HIV antibody positive. CoNS isolation was not associated with SAM (MUAC<11.5cm (aOR 1.11, 95% CI 0.88-1.40 or kwashiorkor (aOR 0.84, 95% CI 0.48-1.49, or a positive HIV antibody test (aOR 1.25, 95% CI 0.92-1.71. Among children with SAM or a positive HIV antibody test, CoNS isolation was not associated with mortality or prolonged hospitalization.In a large, systematic study, there was no evidence that antimicrobial therapy should specifically target CoNS amongst children with SAM or HIV-infection or exposure.

  19. Undernutrition and anaemia among HAART-naïve HIV infected ...

    African Journals Online (AJOL)

    Introduction: Case control studies that assess the burden and factors associated with undernutrition and anaemia among HAART naïve HIV infected children in Nigeria is very sparse. This will help to formulate nutritional programs among these children. Methods: Seventy HAART naive HIV infected children aged 18 months ...

  20. The association between cognition and academic performance in Ugandan children surviving malaria with neurological involvement.

    Directory of Open Access Journals (Sweden)

    Paul Bangirana

    Full Text Available The contribution of different cognitive abilities to academic performance in children surviving cerebral insult can guide the choice of interventions to improve cognitive and academic outcomes. This study's objective was to identify which cognitive abilities are associated with academic performance in children after malaria with neurological involvement.62 Ugandan children with a history of malaria with neurological involvement were assessed for cognitive ability (working memory, reasoning, learning, visual spatial skills, attention and academic performance (reading, spelling, arithmetic three months after the illness. Linear regressions were fit for each academic score with the five cognitive outcomes entered as predictors. Adjusters in the analysis were age, sex, education, nutrition, and home environment. Exploratory factor analysis (EFA and structural equation models (SEM were used to determine the nature of the association between cognition and academic performance. Predictive residual sum of squares was used to determine which combination of cognitive scores was needed to predict academic performance.In regressions of a single academic score on all five cognitive outcomes and adjusters, only Working Memory was associated with Reading (coefficient estimate = 0.36, 95% confidence interval = 0.10 to 0.63, p<0.01 and Spelling (0.46, 0.13 to 0.78, p<0.01, Visual Spatial Skills was associated with Arithmetic (0.15, 0.03 to 0.26, p<0.05, and Learning was associated with Reading (0.06, 0.00 to 0.11, p<0.05. One latent cognitive factor was identified using EFA. The SEM found a strong association between this latent cognitive ability and each academic performance measure (P<0.0001. Working memory, visual spatial ability and learning were the best predictors of academic performance.Academic performance is strongly associated with the latent variable labelled "cognitive ability" which captures most of the variation in the individual specific

  1. Mortality and clinical outcomes in HIV-infected children on antiretroviral therapy in Malawi, Lesotho, and Swaziland.

    Science.gov (United States)

    Kabue, Mark M; Buck, W Chris; Wanless, Sebastian R; Cox, Carrie M; McCollum, Eric D; Caviness, A Chantal; Ahmed, Saeed; Kim, Maria H; Thahane, Lineo; Devlin, Andrew; Kochelani, Duncan; Kazembe, Peter N; Calles, Nancy R; Mizwa, Michael B; Schutze, Gordon E; Kline, Mark W

    2012-09-01

    To determine mortality and immune status improvement in HIV-infected pediatric patients on antiretroviral treatment (ART) in Malawi, Lesotho, and Swaziland. We conducted a retrospective cohort study of patients aged <12 years at ART initiation at 3 sites in sub-Saharan Africa between 2004 and 2009. Twelve-month and overall mortality were estimated, and factors associated with mortality and immune status improvement were evaluated. Included in the study were 2306 patients with an average follow-up time on ART of 2.3 years (interquartile range 1.5-3.1 years). One hundred four patients (4.5%) died, 9.0% were lost to follow-up, and 1.3% discontinued ART. Of the 104 deaths, 77.9% occurred in the first year of treatment with a 12-month mortality rate of 3.5%. The overall mortality rate was 2.25 deaths/100 person-years (95% confidence interval [CI] 1.84-2.71). Increased 12-month mortality was associated with younger age; <6 months (hazard ratio [HR] = 8.11, CI 4.51-14.58), 6 to <12 months (HR = 3.43, CI 1.96-6.02), and 12 to <36 months (HR = 1.92, CI 1.16-3.19), and World Health Organization stage IV (HR = 4.35, CI 2.19-8.67). Immune status improvement at 12 months was less likely in patients with advanced disease and age <12 months. Despite challenges associated with pediatric ART in developing countries, low mortality and good treatment outcomes can be achieved. However, outcomes are worse in younger patients and those with advanced disease at the time of ART initiation, highlighting the importance of early diagnosis and treatment.

  2. Acceptability of Outpatient Ready-To-Use Food-Based Protocols in HIV-Infected Senegalese Children and Adolescents Within the MAGGSEN Cohort Study.

    Science.gov (United States)

    Cames, Cecile; Varloteaux, Marie; Have, Ndeye Ngone; Diom, Alhadji Bassine; Msellati, Philippe; Mbaye, Ngagne; Mbodj, Helene; Sy Signate, Haby; Diack, Aminata

    2016-11-22

    To assess the acceptability of ready-to-use food (RUF)-based outpatient protocols in HIV-infected children and adolescents with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). Plumpy Nut and Plumpy Sup were supplied every 2 weeks and prescribed by weight to SAM and MAM children, respectively. Forty-three children, 24 MAM and 19 SAM, were enrolled. Organoleptic appreciation, feeding modalities, and perceptions surrounding RUF were recorded at week 2. Sachets were counted to measure adherence throughout the study. Median age was 12.2 years (interquartile range: 9.3-14.8), and 91% were on antiretroviral treatment. Overall, 80%, 76%, 68%, and 68% of children initially rated RUF color, taste, smell, and mouth feeling as good. However, feelings of disgust, refusal to eat, fragmentation of intake, self-stigma, and sharing within the household were commonly reported. Eighteen MAM and 7 SAM experienced weight recovery. Recovery duration was 54 days (31-90) in MAM versus 114 days (69-151) in SAM children (P = .02). Their rate of RUF consumption compared to amount prescribed was approximately 50% from week 2 to week 10. Nine failed to gain weight or consume RUF and were discontinued for clinical management, and 9 dropped out due to distance to the clinic. Initial RUF acceptability was satisfactory. More than half the children had successful weight recovery, although adherence to RUF prescription was suboptimal. However, further research is needed to propose therapeutic foods with improved palatability, alternative and simpler intervention design, and procedures for continuous and tailored psychosocial support in this vulnerable population. NCT01771562 (Current Controlled Trials). © The Author(s) 2016.

  3. Prevalence of lipodystrophy and metabolic abnormalities in HIV-infected African children after 3 years on first-line antiretroviral therapy.

    Science.gov (United States)

    Bwakura-Dangarembizi, Mutsawashe; Musiime, Victor; Szubert, Alexander J; Prendergast, Andrew J; Gomo, Zvenyika A; Thomason, Margaret J; Musarurwa, Cuthbert; Mugyenyi, Peter; Nahirya, Patricia; Kekitiinwa, Adeodata; Gibb, Diana M; Walker, Ann S; Nathoo, Kusum

    2015-02-01

    Most pediatric lipodystrophy data come from high-income/middle-income countries, but most HIV-infected children live in sub-Saharan Africa, where lipodystrophy studies have predominantly investigated stavudine-based regimens. Three years after antiretroviral therapy (ART) initiation, body circumferences and skinfold thicknesses were measured (n = 590), and fasted lipid profile assayed (n = 325), in children from 2 ARROW trial centres in Uganda/Zimbabwe. Analyses compared randomization to long-term versus short-term versus no zidovudine from ART initiation [unadjusted; latter 2 groups receiving abacavir+lamivudine+non-nucleoside-reverse-transciptase-inhibitor (nNRTI) long-term], and nonrandomized (confounder-adjusted) receipt of nevirapine versus efavirenz. Body circumferences and skinfold thicknesses were similar regardless of zidovudine exposure (P > 0.1), except for subscapular and supra-iliac skinfolds-for-age which were greater with long-term zidovudine (0.006 0.09; 0.02 lipodystrophy, providing reassurance where national programs now recommend long-term zidovudine. Efavirenz and nevirapine were also similar; however, the higher LDL observed with efavirenz and lower HDL observed with zidovudine suggests that zidovudine+lamivudine+efavirenz should be investigated in future.

  4. High Levels of Dual-Class Drug Resistance in HIV-Infected Children Failing First-Line Antiretroviral Therapy in Southern Ethiopia.

    Science.gov (United States)

    Tadesse, Birkneh Tilahun; Kinloch, Natalie N; Baraki, Bemuluyigza; Lapointe, Hope R; Cobarrubias, Kyle D; Brockman, Mark A; Brumme, Chanson J; Foster, Byron A; Jerene, Degu; Makonnen, Eyasu; Aklillu, Eleni; Brumme, Zabrina L

    2018-02-01

    Clinical monitoring of pediatric HIV treatment remains a major challenge in settings where drug resistance genotyping is not routinely available. As a result, our understanding of drug resistance, and its impact on subsequent therapeutic regimens available in these settings, remains limited. We investigate the prevalence and correlates of HIV-1 drug resistance among 94 participants of the Ethiopia Pediatric HIV Cohort failing first-line combination antiretroviral therapy (cART) using dried blood spot-based genotyping. Overall, 81% (73/90) of successfully genotyped participants harbored resistance mutations, including 69% (62/90) who harbored resistance to both Nucleoside Reverse Transcriptase Inhibitors (NRTIs) and Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs). Strikingly, 42% of resistant participants harbored resistance to all four NRTIs recommended for second-line use in this setting, meaning that there are effectively no remaining cART options for these children. Longer cART duration and prior regimen changes were significantly associated with detection of drug resistance mutations. Replicate genotyping increased the breadth of drug resistance detected in 34% of cases, and thus is recommended for consideration when typing from blood spots. Implementation of timely drug resistance testing and access to newer antiretrovirals and drug classes are urgently needed to guide clinical decision-making and improve outcomes for HIV-infected children on first-line cART in Ethiopia.

  5. Independent and interactive effects of HIV infection, clinical stage and other comorbidities on survival of children treated for severely malnourished in rural South Africa: A retrospective multi-cohort study

    Directory of Open Access Journals (Sweden)

    M Muzigaba

    2017-04-01

    Full Text Available Background. There is still limited to no evidence on the independent and interactive effects of HIV infection, disease stage, baseline disease severity and other important comorbidities on mortality risk among young children treated for severe acute malnutrition (SAM in South Africa (SA, using the World Health Organization (WHO recommended treatment modality. Objectives. To determine baseline clinical characteristics among children with SAM and assess whether HIV infection, disease stage, critical illness at baseline and other comorbidities independently and interactively contributed to excess mortality in this sample. Methods. We followed up children aged 6 - 60 months, who were admitted with and treated for SAM at two rural hospitals in SA, and retrospectively reviewed their treatment records to abstract data on their baseline clinical characteristics and treatment outcomes. In total, 454 children were included in the study. Descriptive statistical tests were used to summarise patients’ clinical characteristics. Kaplan-Meier failure curves were created for key characteristics and compared statistically using log-rank tests. Univariate and multivariate Cox regression was used to estimate independent and interactive effects. Results. The combined case fatality rate was 24.4%. HIV infection, clinical disease stage, the presence of lower respiratory tract infection, marasmus and disease severity at baseline were all independently associated with excess mortality. The critical stage for higher risk of death was when cases were admitted at WHO stage III. The interactions of two or three of these characteristics were associated with increased risk of death when compared with having none, with HIV infection and critical illness showing the greatest risk (hazard ratio 22, p<0.001. Conclusion. The high HIV prevalence rate in the study setting and the resultant treatment outcomes support the notion that the WHO treatment guidelines should be revised to

  6. Evidence for extended age dependent maternal immunity in infected children: mother to child transmission of HIV infection and potential interventions including sulfatides of the human fetal adnexa and complementary or alternative medicines.

    Science.gov (United States)

    Bhargav, Hemant; Huilgol, Vidya; Metri, Kashinath; Sundell, I Birgitta; Tripathi, Satyam; Ramagouda, Nagaratna; Jadhav, Mahesh; Raghuram, Nagarathna; Ramarao, Nagendra Hongasandra; Koka, Prasad S

    2012-01-01

    The two neighboring southwestern states of India, Karnataka and Maharashtra, have high incidence of HIV/AIDS and are among the six most high prevalence HIV infected states. In Karnataka state, the northern districts of Bagalkot, Belgaum and Bijapur (the three Bs) and in Maharashtra state, the southern districts of Sangli, Satara, and Solapur (the three Ss) are the areas with the highest incidence of HIV/AIDS. We have evaluated the incidence of maternal to child transmission (MTCT) of HIV-1 infection in Belgaum District which is more than 500 kilometers distance by road from the campus in greater Bangalore (Karnataka State). We have obtained the prenatal CD4 counts of HIV infected pregnant mothers. We have also screened the HIV infected children in two orphanages (rehabilitation centres for HIV infected children) in Belgaum District. The clinical conditions of these infected children were assessed for their CD4 counts, anti-retroviral therapy (ART) intake status, outpatient illnesses and body composition. We have observed that there is an influence of the age factor on the CD4 counts of the HIV infected children. Further, in view of the role of our recently found involvement of sulfatide, 3-O- galactosylceramide, in inhibition of HIV-1 replication and enhancement of hematopoiesis which is otherwise inhibited due to such infection, we have discussed the possible role of sulfatides that biologically occur in the fetal adnexa (placentatrophoblasts /amnion/chorion-umbilical cord), in containing HIV infection as a potential safer alternative to the ART regimens currently approved to be clinically practiced. Lastly, we have discussed the complementary and alternative medicine (CAM) therapies such as evidence based yoga and ayurveda as add-on to ART in potential elimination of MTCT of HIV infection. Out of a total of 150 children delivered by HIV infected mothers, 13 children were found to be positive as determined by the dried blood smear (DBS) for virological testing

  7. HIV Infection and the Epidemiology of Invasive Pneumococcal Disease (IPD in South African Adults and Older Children Prior to the Introduction of a Pneumococcal Conjugate Vaccine (PCV.

    Directory of Open Access Journals (Sweden)

    Susan Meiring

    Full Text Available Streptococcus pneumoniae is the commonest cause of bacteremic pneumonia among HIV-infected persons. As more countries with high HIV prevalence are implementing infant pneumococcal conjugate vaccine (PCV programs, we aimed to describe the baseline clinical characteristics of adult invasive pneumococcal disease (IPD in the pre-PCV era in South Africa in order to interpret potential indirect effects following vaccine use.National, active, laboratory-based surveillance for IPD was conducted in South Africa from 1 January 2003 through 31 December 2008. At 25 enhanced surveillance (ES hospital sites, clinical data, including HIV serostatus, were collected from IPD patients ≥ 5 years of age. We compared the clinical characteristics of individuals with IPD in those HIV-infected and -uninfected using multivariable analysis. PCV was introduced into the routine South African Expanded Program on Immunization (EPI in 2009.In South Africa, from 2003-2008, 17 604 cases of IPD occurred amongst persons ≥ 5 years of age, with an average incidence of 7 cases per 100 000 person-years. Against a national HIV-prevalence of 18%, 89% (4190/4734 of IPD patients from ES sites were HIV-infected. IPD incidence in HIV-infected individuals is 43 times higher than in HIV-uninfected persons (52 per 100 000 vs. 1.2 per 100 000, with a peak in the HIV-infected elderly population of 237 per 100 000 persons. Most HIV-infected individuals presented with bacteremia (74%, 3 091/4 190. HIV-uninfected individuals were older; and had more chronic conditions (excluding HIV than HIV-infected persons (39% (210/544 vs. 19% (790/4190, p<0.001. During the pre-PCV immunization era in South Africa, 71% of serotypes amongst HIV-infected persons were covered by PCV13 vs. 73% amongst HIV-uninfected persons, p = 0.4, OR 0.9 (CI 0.7-1.1.Seventy to eighty-five percent of adult IPD in the pre-PCV era were vaccine serotypes and 93% of cases had recognized risk factors (including HIV-infection for

  8. Differences in body circumferences, skin-fold thicknesses and lipid profiles among HIV-infected African children on and not on stavudine

    Directory of Open Access Journals (Sweden)

    V Musiime

    2012-11-01

    Full Text Available Purpose of the study To compare body circumferences, skin-fold thickness (SFT and lipid levels (LL, as measures of lipodystrophy, among antiretroviral therapy (ART-naïve and experienced children at enrolment into the CHAPAS-3 trial. Methods HIV-infected children in Uganda and Zambia, either ART-naïve or on stavudine (d4T for ≥2 years without clinical lipodystrophy, were randomised to receive d4T, abacavir (ABC or zidovudine (ZDV with lamivudine and efavirenz (EFV or nevirapine. At enrolment, mid-upper arm (MUAC and calf (CC circumferences, SFT (biceps, triceps, sub-scapular, supra-iliac and fasting lipids (total cholesterol (TC, low density lipo-protein (LDL, high density lipoprotein (HDL, triglycerides (TRIG were measured. Age/sex adjusted z-scores of MUAC, CC, SFT and the sum of SFT (SSF used Dutch reference data. ART-naïve and ART-experienced children were compared with t-tests using Stata v11.0. Summary of results Among 444 children, 224 (51% were male and 331 (74.5% ART-naïve. Mean (sd CD4% was 19.7% (10.2 versus (vs 34.2% (7.7 in ART-naïve vs ART-experienced children. The ART-naïve were younger than the ART-experienced children (median [IQR] age 2.5 [1.5, 4.0] vs 6.0 [5.5, 7.0] years, p<0.0001. Among the ART-experienced, 4/108 (3.7% were on EFV and median (IQR d4T use was 3.5 (2.7, 4.2 years. As expected, MUAC, CC, weight-for-age (WAZ and height-for-age (HAZ z-scores were lower in the ART-naïve; the ART-experienced had lower SFT z-scores and higher TC and HDL, but lower TRIG (Table 1. Conclusions Failure-to-thrive likely contributed to lower circumference values in ART-naïve children. Among the ART-experienced, thinner SFT and higher TC values could be ART (particularly d4T-related. Normal values, currently unavailable for African children, are being collected. During trial follow-up, we will evaluate the effect of ABC, ZDV and d4T on development of lipodystrophy in naïve children and its reversibility in d4T-treated children

  9. Hepatitis C Co-Infection and CD4+ T Cell Recovery in HIV-Infected Children Receiving Anti-Retroviral Therapy.

    Science.gov (United States)

    Majekodunmi, Adedeji O; Thorne, Claire; Malyuta, Ruslan; Volokha, Alla; Callard, Robin E; Klein, Nigel J; Lewis, Joanna

    2016-12-15

    The effect of hepatitis C virus (HCV) co-infection on CD4+ T cell recovery in treated HIV-infected children is poorly understood. To compare CD4 T cell recovery in HIV/HCV co-infected children with recovery in HIV mono-infected children. We studied 355 HIV mono-infected and 46 HIV/HCV co-infected children receiving ART during a median follow up period of 4.2 years (interquartile range: 2.7-5.3yrs). Our dataset came from the Ukraine pediatric HIV Cohort and the HIV/HCV co-infection study within the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC). We fitted an asymptotic non-linear mixed-effects model of CD4+ T cell reconstitution to age-standardized CD4 counts in all 401 children and investigated factors predicting the speed and extent of recovery. We found no significant impact of HCV co-infection on either pre-ART or long-term age-adjusted CD4 counts (z-scores). However, the rate of increase in CD4 z-score was slower in HIV/HCV co-infected children when compared with their mono-infected counterparts (p<0.001). Both mono-infected and co-infected children starting ART at younger ages had higher pre-ART (p<0.001) and long-term (p<0.001) CD4 z-scores than those who started when they were older. HIV/HCV co-infected children receiving ART had slower CD4+ T cell recovery than HIV mono-infected children. HIV/HCV co-infection had no impact on pre-ART or long-term CD4 z-scores. Early treatment of HIV/HCV co-infected children with ART should be encouraged.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  10. Immunology of Pediatric HIV Infection

    Science.gov (United States)

    Tobin, Nicole H.; Aldrovandi, Grace M.

    2013-01-01

    Summary Most infants born to human immunodeficiency virus (HIV)-infected women escape HIV infection. Infants evade infection despite an immature immune system and, in the case of breastfeeding, prolonged repetitive, exposure. If infants become infected, the course of their infection and response to treatment differs dramatically depending upon the timing (in utero, intrapartum, or during breastfeeding) and potentially the route of their infection. Perinatally acquired HIV infection occurs during a critical window of immune development. HIV’s perturbation of this dynamic process may account for the striking age-dependent differences in HIV disease progression. HIV infection also profoundly disrupts the maternal immune system upon which infants rely for protection and immune instruction. Therefore, it is not surprising that infants who escape HIV infection still suffer adverse effects. In this review, we highlight the unique aspects of pediatric HIV transmission and pathogenesis with a focus on mechanisms by which HIV infection during immune ontogeny may allow discovery of key elements for protection and control from HIV. PMID:23772619

  11. Immunology of pediatric HIV infection.

    Science.gov (United States)

    Tobin, Nicole H; Aldrovandi, Grace M

    2013-07-01

    Most infants born to human immunodeficiency virus (HIV)-infected women escape HIV infection. Infants evade infection despite an immature immune system and, in the case of breastfeeding, prolonged repetitive exposure. If infants become infected, the course of their infection and response to treatment differs dramatically depending upon the timing (in utero, intrapartum, or during breastfeeding) and potentially the route of their infection. Perinatally acquired HIV infection occurs during a critical window of immune development. HIV's perturbation of this dynamic process may account for the striking age-dependent differences in HIV disease progression. HIV infection also profoundly disrupts the maternal immune system upon which infants rely for protection and immune instruction. Therefore, it is not surprising that infants who escape HIV infection still suffer adverse effects. In this review, we highlight the unique aspects of pediatric HIV transmission and pathogenesis with a focus on mechanisms by which HIV infection during immune ontogeny may allow discovery of key elements for protection and control from HIV. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Immunogenicity and safety of high-dose trivalent inactivated influenza vaccine compared to standard-dose vaccine in children and young adults with cancer or HIV infection.

    Science.gov (United States)

    Hakim, Hana; Allison, Kim J; Van de Velde, Lee-Ann; Tang, Li; Sun, Yilun; Flynn, Patricia M; McCullers, Jonathan A

    2016-06-08

    Approaches to improve the immune response of immunocompromised patients to influenza vaccination are needed. Children and young adults (3-21 years) with cancer or HIV infection were randomized to receive 2 doses of high-dose (HD) trivalent influenza vaccine (TIV) or of standard-dose (SD) TIV. Hemagglutination inhibition (HAI) antibody titers were measured against H1, H3, and B antigens after each dose and 9 months later. Seroconversion was defined as ≥4-fold rise in HAI titer comparing pre- and post-vaccine sera. Seroprotection was defined as a post-vaccine HAI titer ≥1:40. Reactogenicity events (RE) were solicited using a structured questionnaire 7 and 14 days after each dose of vaccine, and adverse events by medical record review for 21 days after each dose of vaccine. Eighty-five participants were enrolled in the study; 27 with leukemia, 17 with solid tumor (ST), and 41 with HIV. Recipients of HD TIV had significantly greater fold increase in HAI titers to B antigen in leukemia group and to H1 antigen in ST group compared to SD TIV recipients. This increase was not documented in HIV group. There were no differences in seroconversion or seroprotection between HD TIV and SD TIV in all groups. There was no difference in the percentage of solicited RE in recipients of HD TIV (54% after dose 1 and 38% after dose 2) compared to SD TIV (40% after dose 1 and 20% after dose 2, p=0.27 and 0.09 after dose 1 and 2, respectively). HD TIV was more immunogenic than SD TIV in children and young adults with leukemia or ST, but not with HIV. HD TIV was safe and well-tolerated in children and young adults with leukemia, ST, or HIV. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. HIV infection and depression.

    Science.gov (United States)

    Arseniou, Stylianos; Arvaniti, Aikaterini; Samakouri, Maria

    2014-02-01

    Major depression is highly prevalent among HIV-positive patients (HIVpp). The prevalence of depression ranges between 18% and 81%, depending on the population studied and the methodology of the study. The etiology of depression in HIVpp is likely determined by: (i) biological factors (alterations in the white matter structure, hypothalamic-pituitary-thyroid dysfunction, Tat-protein-induced depressive behavior); (ii) psychosocial factors (HIV stigma, occupational disability, body image changes, isolation and debilitation); (iii) history or comorbidity of psychiatric illness; and (iv) the perinatal period in HIVpp women. Symptomatology of depression differs between HIVpp and HIV-negative patients (HIVnp). Depression may also alter the function of lymphocytes in HIVpp and decrease natural killer cell activity, contributing to the increased mortality in these patients. Selective serotonin re-uptake inhibitors are considered the first-line treatment. Treatment of depression can improve quality of life and lead to a better prognosis of HIV infection. © 2013 The Authors. Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology.

  14. Hypertension and HIV infection.

    Science.gov (United States)

    Balt, Christine A

    2013-01-01

    As persons living with HIV infection (PLWH) live longer, primary health care and comorbidity issues have come to the forefront. The diagnosis and treatment of hypertension can affect a number of other comorbid conditions, including metabolic syndrome, lipid abnormalities, cardiovascular disease, and diabetes. Literature specific to hypertension and HIV is limited and most often presented in theory-based, rather than empirically based, articles, with hypertension-specific information presented in small sections of articles on cardiovascular disease. A systematic literature review was conducted to evaluate current research evidence to determine prevalence of hypertension in PLWH and its association with antiretroviral therapy (ART) and HIV-related and traditional risk factors. Evidence surrounding the cause and effect of HIV and ART on hypertension is conflicting and inconclusive; however, the importance of hypertension diagnosis and treatment is clear. Evidence supports use of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension Guidelines when treating PLWH. Copyright © 2013 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  15. A year-long caregiver training program improves cognition in preschool Ugandan children with human immunodeficiency virus.

    Science.gov (United States)

    Boivin, Michael J; Bangirana, Paul; Nakasujja, Noeline; Page, Connie F; Shohet, Cilly; Givon, Deborah; Bass, Judith K; Opoka, Robert O; Klein, Pnina S

    2013-11-01

    To evaluate mediational intervention for sensitizing caregivers (MISC). MISC biweekly caregiver training significantly enhanced child development compared with biweekly training on health and nutrition (active control) and to evaluate whether MISC training improved the emotional well-being of the caregivers compared with controls. Sixty of 120 rural Ugandan preschool child/caregiver dyads with HIV were assigned by randomized clusters to biweekly MISC training, alternating between home and clinic for 1 year. Control dyads received a health and nutrition curriculum. Children were evaluated at baseline, 6 months, and 1 year with the Mullen Early Learning Scales and the Color-Object Association Test for memory. Caldwell Home Observation for Measurement of the Environment and videotaped child/caregiver MISC interactions also were evaluated. Caregivers were evaluated for depression and anxiety with the Hopkins Symptoms Checklist. Between-group repeated-measures ANCOVA comparisons were made with age, sex, CD4 levels, viral load, material socioeconomic status, physical development, and highly active anti-retroviral therapy treatment status as covariates. The children given MISC had significantly greater gains compared with controls on the Mullen Visual Reception scale (visual-spatial memory) and on Color-Object Association Test memory. MISC caregivers significantly improved on Caldwell Home Observation for Measurement of the Environment scale and total frequency of MISC videotaped interactions. MISC caregivers also were less depressed. Mortality was less for children given MISC compared with controls during the training year. MISC was effective in teaching Ugandan caregivers to enhance their children's cognitive development through practical and sustainable techniques applied during daily interactions in the home. Copyright © 2013 Mosby, Inc. All rights reserved.

  16. HIV-Infected or -Exposed Children Exhibit Lower Immunogenicity to Hepatitis B Vaccine in Yaoundé, Cameroon: An Appeal for Revised Policies in Tropical Settings?

    Science.gov (United States)

    Njom Nlend, Anne Esther; Nguwoh, Philippe Salomon; Ngounouh, Christian Taheu; Tchidjou, Hyppolite Kuekou; Pieme, Constant Anatole; Otélé, Jean Mbede; Penlap, Véronique; Colizzi, Vittorio; Moyou, Roger Somo; Fokam, Joseph

    Since 2005, anti-hepatitis B virus (anti-HBV) vaccine is part of the Expanded Program on Immunization (EPI) for infants born in Cameroon, with 99% anti-HBV coverage. In a context of generalized HIV epidemiology, we assessed paediatric anti-HBV vaccine response according to HIV status, feeding option and age in a tropical context. Prospective, observational and cross-sectional study conducted among 82 children (27 [IQR: 9-47] months, min-max: 6-59), after complete anti-HBV vaccination (Zilbrix Hepta: 10μg AgHBs) at the Essos Health Centre in Yaounde, Cameroon, classified as group-A: HIV unexposed (28), group-B: HIV-exposed/uninfected (29), group-C: HIV-infected (25). Quantitative anti-HBs ELISA was interpreted as "no", "low-" or "protective-response" with <1, 1-10, or ≥10 IU/L respectively; with p-value<0.05 considered significant. Children were all HBV-unexposed (AcHBc-negative) and uninfected (HBsAg-negative). Response to anti-HBV vaccine was 80.49% (66/82), with only 45.12% (37/82) developed a protective-response (≥10IU/L). According to HIV status, 60.71% (17/28) developed a protective-response in group-A, vs. 51.72% (15/29) and 20% (5/25) in group-B and group-C respectively, Odds Ratio (OR): 2.627 [CI95% 0.933-7.500], p = 0.041. According to feeding option during first six months of life, 47.67% (21/45) developed a protective-response on exclusive breastfeeding vs. 43.24% (16/37) on mixed or formula feeding, OR: 1.148 [CI95% 0.437-3.026], p = 0.757. According to age, protective-response decreased significantly as children grow older: 58.33% (28/48) <24 months vs. 26.47% (9/34) ≥24 months, OR: 3.889 [CI95% 1.362-11.356], p = 0.004; and specifically 67.65% (23/34) ≤6 months vs. 0%, (0/5) 33-41 months, p = 0.008. Anti-HBV vaccine provides low rate of protection (<50%) among children in general, and particularly if HIV-exposed, infected and/or older children. Implementing policies for early vaccination, specific immunization algorithm for HIV

  17. Virus and host-specific differences in oral human herpesvirus shedding kinetics among Ugandan women and children.

    Science.gov (United States)

    Matrajt, Laura; Gantt, Soren; Mayer, Bryan T; Krantz, Elizabeth M; Orem, Jackson; Wald, Anna; Corey, Lawrence; Schiffer, Joshua T; Casper, Corey

    2017-10-12

    Human herpesviruses (HHV) establish lifelong latent infection and are transmitted primarily via shedding at mucosal surfaces. Each HHV causes a unique spectrum of disease depending on the infected individual's age and immunity. We collected weekly oral swabs from young children and mothers in 32 Ugandan households for a median of one year. We characterized kinetics of oral shedding during primary and chronic infection for each virus. Cytomegalovirus (CMV), Epstein-Barr virus (EBV), and HHV-6 were shed at high rates following primary infection. The rate of oral herpes simplex virus (HSV) shedding was lower overall, and children and mothers with chronic HSV infection had lower shedding rates than children with primary infection. CMV shedding rate and viral load were higher in children with primary infection compared to children with chronic infection, and even lower in mothers with chronic infection. HHV-6 shedding rate and viral load were similar between children with primary or chronic infection, but lower in mothers. EBV shedding rate and quantity decreased less dramatically in mothers versus children, with HIV-positive mothers shedding at a higher rate than HIV-negative mothers. Each HHV has a distinct pattern of oral shedding which depends partially on the age and immune status of the host.

  18. HIV infection in the elderly

    Directory of Open Access Journals (Sweden)

    Nancy Nguyen

    2008-09-01

    Full Text Available Nancy Nguyen1, Mark Holodniy21University of the Pacific School of Pharmacy and Health Sciences, Stockton, CA, USA; 2VA Palo Alto Health Care System, Palo Alto, CA, USAAbstract: In the US, an estimated 1 million people are infected with HIV, although one-third of this population are unaware of their diagnosis. While HIV infection is commonly thought to affect younger adults, there are an increasing number of patients over 50 years of age living with the condition. UNAIDS and WHO estimate that of the 40 million people living with HIV/AIDS in the world, approximately 2.8 million are 50 years and older. With the introduction of highly active antiretroviral therapy (HAART in the mid-1990s, survival following HIV diagnosis has risen dramatically and HIV infection has evolved from an acute disease process to being managed as a chronic medical condition. As treated HIV-infected patients live longer and the number of new HIV diagnoses in older patients rise, clinicians need to be aware of these trends and become familiar with the management of HIV infection in the older patient. This article is intended for the general clinician, including geriatricians, and will review epidemiologic data and HIV treatment as well as provide a discussion on medical management issues affecting the older HIV-infected patient.Keywords: HIV, epidemiology, treatment, aging, review

  19. Nutritional, immune, micronutrient and health status of HIV-infected ...

    African Journals Online (AJOL)

    Eight per cent of children had features of TB, while 19% had a lower respiratory tract infection. The median viral load of the group ... Conclusion: A high prevalence of acute and chronic malnutrition and micronutrient deficiencies occurred among HIV-infected children residing in care centres. The study highlights the need to ...

  20. The Clinical Spectrum and Financial Burden of HIV Infected ...

    African Journals Online (AJOL)

    The Clinical Spectrum and Financial Burden of HIV Infected Children in a Regional Hospital in South Africa. ... South African Family Practice ... that the cost of hospitalising HIV-positive children is significantly more than HIV-negative controls, which will increase the financial burden on already restricted health resources.

  1. Features associated with underlying HIV infection in severe acute ...

    African Journals Online (AJOL)

    Abstract. Introduction. Up to half of all children presenting to Nutrition. Rehabilitation Units (NRUs) in Malawi with severe acute malnutrition (SAM) are infected with HIV. There are many similarities in the clinical presentation of SAM and HIV. It is important to identify HIV infected children, in order to improve case management ...

  2. HIV infection, tuberculosis and workload in a general paediatric ward

    African Journals Online (AJOL)

    HIV-TB co-infection prevalence rates in hospitalised children; to determine the proportion of hospitalised HIV-infected children who required high care; to describe the proportion of deaths associated with HIV and/or TB; and to relate workload to the level of nursing cover in a general paediatric ward over a 1-year period in a ...

  3. Influence of Caregiver's Sociodemographic Background on the Oral Health Status and Care of HIV-infected Children.

    Science.gov (United States)

    de Jesus, Marina Alvine; de Aguiar Ribeiro, Apoena; Lima, Paula Moraes; Chianca, Thomaz; de Souza, Ivete Pomarico Ribeiro; de Araujo Castro, Gloria Fernanda Barbosa

    2017-01-15

    The purpose of this study was to evaluate the relationship between socio-demographic characteristics of caregivers and the oral health of their children infected with human immunodeficiency virus (HIV+) compared to a group of HIV-children and their caregivers. One hundred forty HIV+ and 140 healthy two- to five-year-old children and their caregivers who sought care at hospitals in Rio de Janeiro, Brazil, participated. Caregivers were interviewed for sociodemographic characteristics, and knowledge and attitudes regarding oral health. The decayed, missing and filled primary teeth (dmft) index was obtained for the children. Chi-square and Mann-Whitney tests were used (five percent significance level). Content analysis method was used for qualitative evaluation. Most interviewees were mothers (83.6 percent), did no work outside the home (69.3 percent), had low educational status (47.1 percent), and were born in the South/Southeast regions of Brazil (83.6 percent). The mean dmft was 3.48±3.14 for the HIV+ group and 1.02±1.00 for the healthy children. Oral care was reported as important by 54.1 percent of the caregivers. Those who didn't consider oral care important had never received information about oral health (Pimportance given to HIV+ children's oral health as well as the oral health knowledge and practices for both HIV+ and healthy children.

  4. Different profiles of immune reconstitution in children and adults with HIV-infection after highly active antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Leal Manuel

    2006-07-01

    Full Text Available Abstract Background Recent advances in characterizing the immune recovery of HIV-1-infected people have highlighted the importance of the thymus for peripheral T-cell diversity and function. The aim of this study was to investigate differences in immune reconstitution profiles after highly active antiretroviral therapy (HAART between HIV-children and adults. Methods HIV patients were grouped according to their previous clinical and immunological status: 9 HIV-Reconstituting-adults (HIV-Rec-adults and 10 HIV-Reconstituting-children (HIV-Rec-children on HAART with viral load (VL ≤400 copies/ml and CD4+ ≥500 cells/μL at least during 6 months before the study and CD4+ ≤300 cells/μL anytime before. Fifteen healthy-adults and 20 healthy-children (control subjects were used to calculate Z-score values to unify value scales between children and adults to make them comparable. Results HIV-Rec-children had higher T-cell receptor excision circles (TREC and lower interleukin (IL-7 levels than HIV-Rec-adults (p + (CD4+CD45RA hi+CD27+, naïve CD8+ (CD8+CD45RA hi+CD27+, and memory CD8+ (CD8+CD45RO+ cells/μl than HIV-Rec-adults, but similar memory CD4+ (CD4+CD45RO+ counts. HIV-Rec-children had lower naïve CD8+ Z-score values than HIV-Rec-adults (p = 0.05. Conclusion Our data suggest that HIV-Rec-children had better thymic function than HIV-Rec-adults and this fact affects the peripheral T-cell subsets. Thus, T-cell recovery after HAART in HIV-Rec-adults could be the consequence of antigen-independent peripheral T-cell expansion while in HIV-Rec-children thymic output could play a predominant role in immune reconstitution.

  5. Poor clinical outcomes for HIV infected children on antiretroviral therapy in rural Mozambique: need for program quality improvement and community engagement.

    Directory of Open Access Journals (Sweden)

    Sten H Vermund

    Full Text Available Residents of Zambézia Province, Mozambique live from rural subsistence farming and fishing. The 2009 provincial HIV prevalence for adults 15-49 years was 12.6%, higher among women (15.3% than men (8.9%. We reviewed clinical data to assess outcomes for HIV-infected children on combination antiretroviral therapy (cART in a highly resource-limited setting.We studied rates of 2-year mortality and loss to follow-up (LTFU for children 60 days following last-scheduled medication pickup. Kaplan-Meier estimates to compute mortality assumed non-informative censoring. Cumulative LTFU incidence calculations treated death as a competing risk.Of 753 children, 29.0% (95% CI: 24.5, 33.2 were confirmed dead by 2 years and 39.0% (95% CI: 34.8, 42.9 were LTFU with unknown clinical outcomes. The cohort mortality rate was 8.4% (95% CI: 6.3, 10.4 after 90 days on cART and 19.2% (95% CI: 16.0, 22.3 after 365 days. Higher hemoglobin at cART initiation was associated with being alive and on cART at 2 years (alive: 9.3 g/dL vs. dead or LTFU: 8.3-8.4 g/dL, p<0.01. Cotrimoxazole use within 90 days of ART initiation was associated with improved 2-year outcomes Treatment was initiated late (WHO stage III/IV among 48% of the children with WHO stage recorded in their records. Marked heterogeneity in outcomes by district was noted (p<0.001.We found poor clinical and programmatic outcomes among children taking cART in rural Mozambique. Expanded testing, early infant diagnosis, counseling/support services, case finding, and outreach are insufficiently implemented. Our quality improvement efforts seek to better link pregnancy and HIV services, expand coverage and timeliness of infant diagnosis and treatment, and increase follow-up and adherence.

  6. The impact of HIV infection on the clinical presentation of severe ...

    African Journals Online (AJOL)

    A study was undertaken in a central nutritional rehabilitation unit (NRU) in southern Malawi to assess the impact of HIV infection on clinical presentation and case fatality rate. The HIV seroprevalence for 250 severely malnourished children over 1 year of age was 34.4% and the overall mortality was 28%. HIV infection was ...

  7. Leukocyte telomere length in HIV-infected and HIV-exposed uninfected children: shorter telomeres with uncontrolled HIV viremia.

    Directory of Open Access Journals (Sweden)

    Hélène C F Côté

    Full Text Available OBJECTIVES: Nucleoside reverse transcriptase inhibitors (NRTIs used in HIV antiretroviral therapy can inhibit human telomerase reverse transcriptase. We therefore investigated whether in utero or childhood exposure to NRTIs affects leukocyte telomere length (LTL, a marker of cellular aging. METHODS: In this cross-sectional CARMA cohort study, we investigated factors associated with LTL in HIV-1-infected (HIV(+ children (n = 94, HIV-1-exposed uninfected (HEU children who were exposed to antiretroviral therapy (ART perinatally (n = 177, and HIV-unexposed uninfected (HIV(- control children (n = 104 aged 0-19 years. Univariate followed by multivariate linear regression models were used to examine relationships of explanatory variables with LTL for: a all subjects, b HIV(+/HEU children only, and c HIV(+ children only. RESULTS: After adjusting for age and gender, there was no difference in LTL between the 3 groups, when considering children of all ages together. In multivariate models, older age and male gender were associated with shorter LTL. For the HIV(+ group alone, having a detectable HIV viral load was also strongly associated with shorter LTL (p = 0.007. CONCLUSIONS: In this large study, group rates of LTL attrition were similar for HIV(+, HEU and HIV(- children. No associations between children's LTL and their perinatal ART exposure or HIV status were seen in linear regression models. However, the association between having a detectable HIV viral load and shorter LTL suggests that uncontrolled HIV viremia rather than duration of ART exposure may be associated with acceleration of blood telomere attrition.

  8. Nutritional Status and Other Baseline Predictors of Mortality among HIV-Infected Children Initiating Antiretroviral Therapy in Tanzania.

    Science.gov (United States)

    Mwiru, Ramadhani S; Spiegelman, Donna; Duggan, Christopher; Seage, George R; Semu, Helen; Chalamilla, Guerino; Kisenge, Rodrick; Fawzi, Wafaie W

    2015-01-01

    We assembled a prospective cohort of 3144 children less than 15 years of age initiating antiretroviral therapy (ART) in Dar es Salaam, Tanzania. The relationships of nutritional status and other baseline characteristics in relation to mortality were examined using Cox proportional hazards model. Compared with children with weight for age (WAZ) > -1, those with WAZ ≤ -2 to nutritional status may be used as an adjunct to ART. © The Author(s) 2013.

  9. Population pharmacokinetics of lopinavir and ritonavir in combination with rifampicin-based antitubercular treatment in HIV-infected children.

    Science.gov (United States)

    Zhang, Chao; McIlleron, Helen; Ren, Yuan; van der Walt, Jan-Stefan; Karlsson, Mats O; Simonsson, Ulrika S H; Denti, Paolo

    2012-01-01

    The preferred antiretroviral regimen for young children previously exposed to non-nucleoside reverse transcriptase inhibitors is lopinavir/ritonavir plus two nucleoside reverse transcriptase inhibitors. Rifampicin-based antitubercular treatment reduces lopinavir concentrations. Adding extra ritonavir to lopinavir/ritonavir overcomes the effect of rifampicin, however this approach is not feasible in many settings. We developed an integrated population model describing lopinavir and ritonavir pharmacokinetics to predict lopinavir/ritonavir (4:1) doses achieving target lopinavir exposures in children treated for tuberculosis. The model included data from 15 children given 'super-boosted' lopinavir (lopinavir/ritonavir =1:1) and 20 children given twice the standard dose of lopinavir/ritonavir every 12 h during antitubercular treatment, and from children given standard lopinavir/ritonavir doses every 12 h (39 without tuberculosis and 11 sampled again after antitubercular treatment). A one-compartment model with first-order absorption and elimination best described the pharmacokinetics of lopinavir and a one-compartment model with transit absorption compartments described ritonavir pharmacokinetics. The dynamic influence of ritonavir concentration on lopinavir oral clearance was modelled as direct inhibition with an E(max) model. Antitubercular treatment reduced the oral bioavailability of lopinavir by 77% in children receiving twice usual lopinavir/ritonavir doses and increased ritonavir clearance by 50%. Simulations predicted that respective 27, 21, 20 and 18 mg/kg 8-hourly doses of lopinavir (in lopinavir/ritonavir, 4:1) maintains lopinavir concentrations >1 mg/l in at least 95% of children weighing 3-5.9, 6-9.9, 10-13.9 and 14-19.9 kg. The model describing the interactions between lopinavir, ritonavir and rifampicin in young children predicted feasible 8-hourly doses of lopinavir/ritonavir resulting in therapeutic lopinavir concentrations during antitubercular

  10. [Microbiological diagnosis of HIV infection].

    Science.gov (United States)

    López-Bernaldo de Quirós, Juan Carlos; Delgado, Rafael; García, Federico; Eiros, José M; Ortiz de Lejarazu, Raúl

    2007-12-01

    Currently, there are around 150,000 HIV-infected patients in Spain. This number, together with the fact that this disease is now a chronic condition since the introduction of antiretroviral therapy, has generated an increasing demand on the clinical microbiology laboratories in our hospitals. This increase has occurred not only in the diagnosis and treatment of opportunistic diseases, but also in tests related to the diagnosis and therapeutic management of HIV infection. To meet this demand, the Sociedad de Enfermedades Infecciosas y Microbiología Clinica (Spanish Society of Infectious Diseases and Clinical Microbiology) has updated its standard Procedure for the microbiological diagnosis of HIV infection. The main advances related to serological diagnosis, plasma viral load, and detection of resistance to antiretroviral drugs are reviewed in this version of the Procedure.

  11. Vaccinations for Adults with HIV Infection

    Science.gov (United States)

    Vaccinations for Adults with HIV Infection The table below shows which vaccinations you should have to protect your health if you have HIV infection. Make sure you and your healthcare provider keep ...

  12. High Rates of Baseline Drug Resistance and Virologic Failure Among ART-naive HIV-infected Children in Mali.

    Science.gov (United States)

    Crowell, Claudia S; Maiga, Almoustapha I; Sylla, Mariam; Taiwo, Babafemi; Kone, Niaboula; Oron, Assaf P; Murphy, Robert L; Marcelin, Anne-Geneviève; Traore, Ban; Fofana, Djeneba B; Peytavin, Gilles; Chadwick, Ellen G

    2017-11-01

    Limited data exist on drug resistance and antiretroviral treatment (ART) outcomes in HIV-1-infected children in West Africa. We determined the prevalence of baseline resistance and correlates of virologic failure (VF) in a cohort of ART-naive HIV-1-infected children Reverse transcriptase and protease genes were sequenced at baseline (before ART) and at 6 months. Resistance was defined according to the Stanford HIV Genotypic Resistance database. VF was defined as viral load ≥1000 copies/mL after 6 months of ART. Logistic regression was used to evaluate factors associated with VF or death >1 month after enrollment. Post hoc, antiretroviral concentrations were assayed on baseline samples of participants with baseline resistance. One-hundred twenty children with a median age 2.6 years (interquartile range: 1.6-5.0) were included. Eighty-eight percent reported no prevention of mother-to-child transmission exposure. At baseline, 27 (23%), 4 (3%) and none had non-nucleoside reverse transcriptase inhibitor (NNRTI), nucleoside reverse transcriptase inhibitor or protease inhibitor resistance, respectively. Thirty-nine (33%) developed VF and 4 died >1 month post-ART initiation. In multivariable analyses, poor adherence [odds ratio (OR): 6.1, P = 0.001], baseline NNRTI resistance among children receiving NNRTI-based ART (OR: 22.9, P < 0.001) and protease inhibitor-based ART initiation among children without baseline NNRTI resistance (OR: 5.8, P = 0.018) were significantly associated with VF/death. Ten (38%) with baseline resistance had detectable levels of nevirapine or efavirenz at baseline; 7 were currently breastfeeding, but only 2 reported maternal antiretroviral use. Baseline NNRTI resistance was common in children without reported NNRTI exposure and was associated with increased risk of treatment failure. Detectable NNRTI concentrations were present despite few reports of maternal/infant antiretroviral use.

  13. Long-term effectiveness of highly active antiretroviral therapy (HAART) in perinatally HIV-infected children in Denmark

    DEFF Research Database (Denmark)

    Bracher, Linda; Valerius, Niels Henrik; Rosenfeldt, Vibeke

    2007-01-01

    The long-term impact of highly active antiretroviral therapy (HAART) on HIV-1 infected children is not well known. The Danish Paediatric HIV Cohort Study includes all patients perinatally infected...... percentage >25% increased to 60-70% over the y of treatment. For the total cohort, 245 patient-y of observation were available with only 1 death. During our observation period there were no signs of a waning impact. The challenge remains to maintain a high adherence to therapy as the children grow...

  14. The Eye as a Window to the Brain: Neuroretinal Thickness Is Associated With Microstructural White Matter Injury in HIV-Infected Children

    NARCIS (Netherlands)

    Blokhuis, Charlotte; Demirkaya, Nazli; Cohen, Sophie; Wit, Ferdinand W. N. M.; Scherpbier, Henriëtte J.; Reiss, Peter; Abramoff, Michael D.; Caan, Matthan W. A.; Majoie, Charles B. L. M.; Verbraak, Frank D.; Pajkrt, Dasja

    2016-01-01

    Despite combination antiretroviral therapy (cART), perinatal HIV-infection can cause decreased gray and white matter volume, microstructural white matter injury, and retinal structural abnormalities. As neuroretinal tissue is directly connected to the brain, these deficits may have a shared

  15. Malnutrition in HIV-Infected Children Is an Indicator of Severe Disease with an Impaired Response to Antiretroviral Therapy

    DEFF Research Database (Denmark)

    Muenchhoff, Maximilian; Healy, Michael; Singh, Ravesh

    2018-01-01

    by flow cytometry. Multiple regression analysis was performed using generalized linear models (GLMs) and the least absolute shrinkage and selection operator (LASSO) approach for variable selection. Microbial translocation, T cell activation and exhaustion were increased in HIV-uninfected children with SAM...

  16. HIV drug resistance and hepatitis co-infections in HIV-infected adults and children initiating antiretroviral therapy in Rwanda

    NARCIS (Netherlands)

    Rusine-Bahunde, J.

    2015-01-01

    Since the roll-out of antiretroviral therapy (ART), few data have been generated on outcomes and outcome predictors of ART in adults and children in Rwanda. Equally, the extent of chronic hepatitis virus infections and their impact on the ART outcomes in the country are not known. This information

  17. Loss to follow-up among children and adolescents growing up with HIV infection: age really matters

    Directory of Open Access Journals (Sweden)

    Katharina Kranzer

    2017-01-01

    Conclusions: Adolescents had higher rates of LTFU compared to other age-groups, with older adolescents at particularly high risk in all analyses. Age-updated analyses that examine movement across narrow age-bands are paramount in understanding how developmental heterogeneity in children affects HIV outcomes.

  18. Viral suppression and adherence among HIV-infected children and adolescents on antiretroviral therapy: results of a multicenter study.

    Science.gov (United States)

    Cruz, Maria L S; Cardoso, Claudete A A; Darmont, Mariana Q; Souza, Edvaldo; Andrade, Solange D; D'Al Fabbro, Marcia M; Fonseca, Rosana; Bellido, Jaime G; Monteiro, Simone S; Bastos, Francisco I

    2014-01-01

    To evaluate treatment adherence among perinatally-infected pediatric human immunodeficiency virus (HIV) patients followed in pediatric centers in Brazil. This was a cross-sectional multicenter study. Medical records were reviewed and adherence scale, assessment of caregivers' quality of life (WHOQOL-BREF), anxiety, depression, and alcohol/substances use/abuse were assessed. Outcomes included self-reported 100% adherence in the last three days and HIV viral load (VL)<50 copies/mL. Statistical analyses included contingency tables and respective statistics, and multivariable logistic regression. 260 subjects were enrolled: 78% children and 22% adolescents; 93% of caregivers for the children and 77% of adolescents reported 100% adherence; 57% of children and 49% of adolescents had VL<50 copies/mL. In the univariate analyses, HIV diagnosis for screening due to maternal infection, lower caregiver scores for anxiety, and higher scores in physical and psychological domains of WHOQOL-BREF were associated with 100% adherence. Shorter intervals between pharmacy visits were associated with VL<50 copies/mL (p ≤ 0.01). Multivariable regression demonstrated that caregivers who did not abuse alcohol/other drugs (OR=0.49; 95% CI: 0.27-0.89) and median interval between pharmacy visits<33 days (OR=0.97; 95% CI: 0.95-0.98) were independently associated with VL<50 copies/mL; whereas lower caregiver scores for anxiety (OR=2.57; 95% CI: 1.27-5.19) and children's HIV diagnosis for screening due to maternal infection (OR=2.25; 95% CI: 1.12-4.50) were found to be independently associated with 100% adherence. Pediatric HIV programs should perform routine assessment of caregivers' quality of life, and anxiety and depression symptoms. In this setting, pharmacy records are essential to help identify less-than-optimal adherence. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  19. Viral suppression and adherence among HIV-infected children and adolescents on antiretroviral therapy: results of a multicenter study

    Directory of Open Access Journals (Sweden)

    Maria L.S. Cruz

    2014-12-01

    Full Text Available OBJECTIVE: To evaluate treatment adherence among perinatally-infected pediatric human immunodeficiency virus (HIV patients followed in pediatric centers in Brazil. METHODS: This was a cross-sectional multicenter study. Medical records were reviewed and adherence scale, assessment of caregivers' quality of life (WHOQOL-BREF, anxiety, depression, and alcohol/substances use/abuse were assessed. Outcomes included self-reported 100% adherence in the last three days and HIV viral load (VL < 50 copies/mL. Statistical analyses included contingency tables and respective statistics, and multivariable logistic regression. RESULTS: 260 subjects were enrolled: 78% children and 22% adolescents; 93% of caregivers for the children and 77% of adolescents reported 100% adherence; 57% of children and 49% of adolescents had VL < 50 copies/mL. In the univariate analyses, HIV diagnosis for screening due to maternal infection, lower caregiver scores for anxiety, and higher scores in physical and psychological domains of WHOQOL-BREF were associated with 100% adherence. Shorter intervals between pharmacy visits were associated with VL < 50 copies/mL (p ≤ 0.01. Multivariable regression demonstrated that caregivers who did not abuse alcohol/other drugs (OR = 0.49; 95% CI: 0.27-0.89 and median interval between pharmacy visits < 33 days (OR = 0.97; 95% CI: 0.95-0.98 were independently associated with VL < 50 copies/mL; whereas lower caregiver scores for anxiety (OR = 2.57; 95% CI: 1.27-5.19 and children's HIV diagnosis for screening due to maternal infection (OR = 2.25; 95% CI: 1.12-4.50 were found to be independently associated with 100% adherence. CONCLUSIONS: Pediatric HIV programs should perform routine assessment of caregivers' quality of life, and anxiety and depression symptoms. In this setting, pharmacy records are essential to help identify less-than-optimal adherence.

  20. Multicentre analysis of second-line antiretroviral treatment in HIV-infected children: adolescents at high risk of failure

    Directory of Open Access Journals (Sweden)

    Ragna S. Boerma

    2017-01-01

    Conclusions: In LMIC, paediatric PI-based second-line ART was associated with relatively low virologic failure rates. However, adolescents showed exceptionally poor virologic outcomes in LMIC, and optimizing their HIV care requires urgent attention. In addition, 16% of children and adolescents failed PI-based treatment and will require integrase inhibitors to construct salvage regimens. These drugs are currently not available in LMIC.

  1. The challenges of success: adolescents with perinatal HIV infection

    Directory of Open Access Journals (Sweden)

    Lynne M Mofenson

    2013-06-01

    Full Text Available The great success in the prevention and treatment of pediatric HIV in high resource countries, and now in low resource countries, has changed the face of the HIV epidemic in children from one of near certain mortality to that of a chronic disease. However, these successes pose new challenges as perinatally HIV-infected youth survive into adulthood. Increased survival of HIV-infected children is associated with challenges in maintaining adherence to what is likely life-long therapy, and in selecting successive antiretroviral drug regimens, given the limited availability of pediatric formulations, limitations in pharmacokinetic and safety data of drugs in children, and the development of extensive drug resistance in multi-drug-experienced children. Pediatric HIV care must now focus on morbidity related to long-term HIV infection and its treatment. Survival into adulthood of perinatally HIV-infected youth in high resource countries provides important lessons about how the epidemic will change with increasing access to antiretroviral therapy for children in low resource countries. This series of papers will focus on issues related to management of perinatally infected youth and young adults.

  2. Patient, caregiver and regimen characteristics associated with adherence to highly active antiretroviral therapy among HIV-infected children and adolescents.

    Science.gov (United States)

    Martin, Staci; Elliott-DeSorbo, Deborah K; Wolters, Pamela L; Toledo-Tamula, Mary Anne; Roby, Gregg; Zeichner, Steve; Wood, Lauren V

    2007-01-01

    This study assesses the relationship between child and caregiver perceptions of medication responsibility, disease knowledge, regimen complexity and adherence to highly active antiretroviral therapy among HIV-positive children. We also examine the association of adherence to child and caregiver demographic characteristics and surrogate markers of HIV disease. For this 6-month longitudinal study, 24 HIV-positive children (mean age = 14.0 years) being treated with highly active antiretroviral therapy and their caregivers completed measures of medication responsibility and disease knowledge. Medication Event Monitoring System caps calculated adherence across months 1 through 3 (time 1) and 4 through 6 (time 2). Medication Event Monitoring System data revealed adherence rates of 81% at time 1 and 79% at time 2. Only 8% (n = 2) of child-caregiver pairs reported complete agreement regarding who held responsibility for medication-related tasks. Patients' responsibility for medication was correlated with age based on child (r = .51) and caregiver (r = .57; Ps caregivers and fewer child-caregiver discrepancies about medication responsibility predicted better adherence (adjusted R = .45). Finally, adherence was correlated with CD4 percentages at time 1 (r = .50) and viral load at time 1 (r = -.56) and time 2 (r= -.68; Ps caregiver demographic variables. Responsibilities for medication-related tasks should be clarified among family members, regimen knowledge should be emphasized and caregivers should avoid assigning treatment responsibility to a child prematurely.

  3. THE HAEMATOLOGY OF HIV INFECTION

    African Journals Online (AJOL)

    Epstein-Barr virus (EBVl-associated. However, in HIV, approximately half the patients are EBV-negative, indicating other mechanisms of lymphoma genesis.' This may be related to cytokine deregulation and infection of stromal cellslMVECs by HIV. Infected MVECs sustain lymphoma cells in culture better than uninfected ...

  4. Serological markers in HIV infection

    NARCIS (Netherlands)

    Lange, J. M.; Goudsmit, J.; de Wolf, F.; Coutinho, R. A.; van der Noordaa, J.

    1988-01-01

    HIV antigenaemia can be detected at or possibly before the onset of clinical symptoms of primary HIV infection. Approximately one week after the onset of HIV antigenaemia, a primary anti-HIV IgM response may occur. A week later, generally within 3 to 6 weeks after infection, anti-HIV IgG can be

  5. Distal renal tubular acidosis in a child with HIV infection

    Directory of Open Access Journals (Sweden)

    Preeti Shanbag

    2012-01-01

    Full Text Available Renal tubular acidosis (RTA is not uncommon in HIV-infected children with ad-vanced disease, and has been described mainly due to nephrotoxic anti-retroviral therapy and in association with prophylaxis or treatment of Pneumocystis carinii pneumonia with co-trimoxazole. We describe an 8-year-old boy, newly diagnosed to have HIV infection, who presented with distal RTA. There were no features of chronic RTA in the form of rickets or nephrocalcinosis, making an inherited form unlikely.

  6. Prevalence of tuberculosis in post-mortem studies of HIV-infected adults and children in resource-limited settings: a systematic review and meta-analysis.

    Science.gov (United States)

    Gupta, Rishi K; Lucas, Sebastian B; Fielding, Katherine L; Lawn, Stephen D

    2015-09-24

    Tuberculosis (TB) is estimated to be the leading cause of HIV-related deaths globally. However, since HIV-associated TB frequently remains unascertained, we systematically reviewed autopsy studies to determine the true burden of TB at death. We systematically searched Medline and Embase databases (to end 2013) for literature reporting on health facility-based autopsy studies of HIV-infected adults and/or children in resource-limited settings. Using forest plots and random-effects meta-analysis, we summarized the TB prevalence found at autopsy and used meta-regression to explore variables associated with autopsy TB prevalence. We included 36 eligible studies, reporting on 3237 autopsies. Autopsy TB prevalence was extremely heterogeneous (range 0-64.4%), but was markedly higher in adults [pooled prevalence 39.7%, 95% confidence interval (CI) 32.4-47.0%] compared to children (pooled prevalence 4.5%, 95% CI 1.7-7.4%). Post-mortem TB prevalence varied by world region, with pooled estimates in adults of 63.2% (95% CI 57.7-68.7%) in South Asia (n = 2 studies); 43.2% (95% CI 38.0-48.3) in sub-Saharan Africa (n = 9 studies); and 27.1% (95% CI 16.0-38.1%) in the Americas (n = 5 studies). Autopsy prevalence positively correlated with contemporary estimates of national TB prevalence. TB in adults was disseminated in 87.9% (82.2-93.7%) of cases and was considered the cause of death in 91.4% (95% CI 85.8-97.0%) of TB cases. Overall, TB was the cause of death in 37.2% (95% CI 25.7-48.7%) of adult HIV/AIDS-related deaths. TB remained undiagnosed at death in 45.8% (95% CI 32.6-59.1%) of TB cases. In resource-limited settings, TB accounts for approximately 40% of facility-based HIV/AIDS-related adult deaths. Almost half of this disease remains undiagnosed at the time of death. These findings highlight the critical need to improve the prevention, diagnosis and treatment of HIV-associated TB globally.

  7. Two-year morbidity-mortality and alternatives to prolonged breast-feeding among children born to HIV-infected mothers in Côte d'Ivoire.

    Directory of Open Access Journals (Sweden)

    Renaud Becquet

    2007-01-01

    Full Text Available BACKGROUND: Little is known about the long-term safety of infant feeding interventions aimed at reducing breast milk HIV transmission in Africa. METHODS AND FINDINGS: In 2001-2005, HIV-infected pregnant women having received in Abidjan, Côte d'Ivoire, a peripartum antiretroviral prophylaxis were presented antenatally with infant feeding interventions: either artificial feeding, or exclusive breast-feeding and then early cessation from 4 mo of age. Nutritional counseling and clinical management were provided for 2 y. Breast-milk substitutes were provided for free. The primary outcome was the occurrence of adverse health outcomes in children, defined as validated morbid events (diarrhea, acute respiratory infections, or malnutrition or severe events (hospitalization or death. Hazards ratios to compare formula-fed versus short-term breast-fed (reference children were adjusted for confounders (baseline covariates and pediatric HIV status as a time-dependant covariate. The 18-mo mortality rates were also compared to those observed in the Ditrame historical trial, which was conducted at the same sites in 1995-1998, and in which long-term breast-feeding was practiced in the absence of any specific infant feeding intervention. Of the 557 live-born children, 262 (47% were breast-fed for a median of 4 mo, whereas 295 were formula-fed. Over the 2-y follow-up period, 37% of the formula-fed and 34% of the short-term breast-fed children remained free from any adverse health outcome (adjusted hazard ratio [HR]: 1.10; 95% confidence interval [CI], 0.87-1.38; p = 0.43. The 2-y probability of presenting with a severe event was the same among formula-fed (14% and short-term breast-fed children (15% (adjusted HR, 1.19; 95% CI, 0.75-1.91; p = 0.44. An overall 18-mo probability of survival of 96% was observed among both HIV-uninfected short-term and formula-fed children, which was similar to the 95% probability observed in the long-term breast-fed ones of the

  8. Executive summary of the consensus document on psychiatric and psychological aspects in adults and children with HIV infection.

    Science.gov (United States)

    2016-01-01

    HIV Patient care should include psychological and psychiatric care, which is necessary for early detection thereof. Should suicidal ideation occur, refer the patient to a psychiatric unit. Pharmacological treatment is recommended when there is comorbidity with moderate or severe depression. You should look for the aetiology of neuropsychiatric disorder before using psychoactive drugs in HIV patients. The overall management of the health of HIV adolescents should include an assessment of mental health, environmental stressors and support systems. Training in the management of the patient both own emotions is critical to getting to provide optimal care. These new guidelines updated previous recommendations regarding psychiatric and psychological disorders, including the most common pathologies in adults and children. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  9. Translating Technical Support Into Country Action: The Role of the Interagency Task Team on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers, and Children in the Global Plan Era.

    Science.gov (United States)

    Luo, Chewe; Hirnschall, Gottfried; Rodrigues, Jessica; Romano, Sostena; Essajee, Shaffiq; Rogers, Braeden; McCarthy, Elizabeth; Mwango, Albert; Sangrujee, Nalinee; Adler, Michelle R; Houston, James C; Langa, Judite O; Urso, Marilena; Bolu, Omotayo; Tene, Gilbert; Elat Nfetam, Jean B; Kembou, Etienne; Phelps, Benjamin R

    2017-05-01

    While the Interagency Task Team on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers, and Children (IATT) partnership existed before the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), its reconfiguration was critical to coordinating provision of technical assistance that positively influenced country decision-making and program performance. This article describes how the Global Plan anchored the work of the IATT and, in turn, how the IATT's technical assistance helped to accelerate achievement of the Global Plan targets and milestones. The technical assistance that will be discussed addressed a broad range of priority actions and milestones described in the Global Plan: (1) planning for and implementing Option B+; (2) strengthening monitoring and evaluation systems; (3) translating evidence into action and advocacy; and (4) promoting community engagement. This article also reviews the ongoing challenges and opportunities of providing technical assistance in a rapidly evolving environment that calls for ever more flexible and contextualized responses. The effectiveness of technical assistance facilitated by the IATT was defined by its timeliness, evidence base, and unique global perspective that built on the competencies of its partners and promoted synergies across program areas. Reaching the final goal of eliminating vertical transmission of HIV infection and achieving an AIDS-free generation in countries with the highest HIV burden requires that the IATT partnership and technical assistance remain responsive to country-specific needs while aligning with the current programmatic reality and new global goals such as the Sustainable Development Goals and 90-90-90 targets.

  10. HIV infection, tuberculosis and workload in a general paediatric ward

    African Journals Online (AJOL)

    Aim. To describe the impact of HIV infection and tuberculosis on the workload of a general paediatric ward at Red Cross War Memorial Children's Hospital in 2007. Methods. Prospective descriptive surveillance of the patient composition of a general paediatric ward over a 1-year period. Results. Median bed occupancy was ...

  11. Independent and interactive effects of HIV infection, clinical stage ...

    African Journals Online (AJOL)

    Background. There is still limited to no evidence on the independent and interactive effects of HIV infection, disease stage, baseline disease severity and other important comorbidities on mortality risk among young children treated for severe acute malnutrition (SAM) in South Africa (SA, using the World Health Organization ...

  12. How disclosure and antiretroviral therapy help HIV-infected ...

    African Journals Online (AJOL)

    Saharan Africa cope with stigma. ... HIV-related stigma has a major impact on the health and psychosocial wellbeing of HIV-infected children and youths. While there is some debate about the extent to which improved access to antiretroviral ...

  13. The impact of HIV infection on childhood pneumonia: comparison ...

    African Journals Online (AJOL)

    infected children. While the pattern of HIV-related pneumonia in African adults is well documented and is recognised as quite different from that which occurs among HIV-infected adults in high-income regions, less is known of the situation in ...

  14. Criptosporidiosis intestinal en niños con HIV/SIDA Intestinal cryptosporidiosis in HIV infected children

    Directory of Open Access Journals (Sweden)

    Graciela Barboni

    2008-06-01

    , especially those with the acquired immunodeficiency syndrome (AIDS. C. parvum enteric infection's incidence in a pediatric HIV/AIDS cohort, during a 6 years period, was studied. Clinical and immunologic characteristics of the dual infection were also recorded. Highly active antiretroviral therapy (HAART was started or continued by all the patients during follow-up. Azithromicyn was used as antiparasitic drug. Cryptosporidiosis incidence was 13.7%; 33 out 240 children showed chronic diarrhea lasting 14 days at least, or recurrent, without dehydration and electrolytic disturbance. Peripheral blood T CD4+ percentage levels of the patients were variable and without relationship with C. parvum presence. Viral load levels in 31 out 33 patients were over cut-off at the enteric episode time. Mild or moderate eosinophilia were recorded in 23% of the patients and other intestinal parasites were present in 11 children. When the number of enteric episodes were compared with the clinical and immunological patient's status, not significant differences were recorded. HAART is the best treatment to improve immune function in HIV patients avoiding potentially fatal complications that accompany acute diarrhea during concomitant infection with C. parvum.

  15. Predictors of treatment failure and time to detection and switching in HIV-infected Ethiopian children receiving first line anti-retroviral therapy

    Directory of Open Access Journals (Sweden)

    Bacha Tigist

    2012-08-01

    Full Text Available Abstract Background The emergence of resistance to first line antiretroviral therapy (ART regimen leads to the need for more expensive and less tolerable second line drugs. Hence, it is essential to identify and address factors associated with an increased probability of first line ART regimen failure. The objective of this article is to report on the predictors of first line ART regimen failure, the detection rate of ART regime failure, and the delay in switching to second line ART drugs. Methods A retrospective cohort study was conducted from 2005 to 2011. All HIV infected children under the age of 15 who took first line ART for at least six months at the four major hospitals of Addis Ababa, Ethiopia were included. Data were collected, entered and analyzed using Epi info/ENA version 3.5.1 and SPSS version 16. The Cox proportional-hazard model was used to assess the predictors of first line ART failure. Results Data of 1186 children were analyzed. Five hundred seventy seven (48.8% were males with a mean age of 6.22 (SD = 3.10 years. Of the 167(14.1% children who had treatment failure, 70 (5.9% had only clinical failure, 79 (6.7% had only immunologic failure, and 18 (1.5% had both clinical and immunologic failure. Patients who had height for age in the third percentile or less at initiation of ART were found to have higher probability of ART treatment failure [Adjusted Hazard Ratio (AHR, 3.25 95% CI, 1.00-10.58]. Patients who were less than three years old [AHR, 1.85 95% CI, 1.24-2.76], chronic diarrhea after initiation of antiretroviral treatment [AHR, 3.44 95% CI, 1.37-8.62], ART drug substitution [AHR, 1.70 95% CI, 1.05-2.73] and base line CD4 count below 50 cells/mm3 [AHR, 2.30 95% CI, 1.28-4.14] were also found to be at higher risk of treatment failure. Of all the 167 first line ART failure cases, only 24 (14.4% were switched to second line ART with a mean delay of 24 (SD = 11.67 months. The remaining 143 (85.6% cases were diagnosed

  16. Population Pharmacokinetics and Pharmacodynamics of Praziquantel in Ugandan Children with Intestinal Schistosomiasis: Higher Dosages Are Required for Maximal Efficacy

    Directory of Open Access Journals (Sweden)

    Amaya L. Bustinduy

    2016-08-01

    Full Text Available Each year, millions of African children receive praziquantel (PZQ by mass drug administration (MDA to treat schistosomiasis at a standard single dose of 40 mg/kg of body weight, a direct extrapolation from studies of adults. A higher dose of 60 mg/kg is also acceptable for refractory cases. We conducted the first PZQ pharmacokinetic (PK and pharmacodynamic (PD study in young children comparing dosing. Sixty Ugandan children aged 3 to 8 years old with egg patent Schistosoma mansoni received PZQ at either 40 mg/kg or 60 mg/kg. PK parameters of PZQ racemate and enantiomers (R and S were quantified. PD outcomes were assessed by standard fecal egg counts and novel schistosome-specific serum (circulating anodic antigen [CAA] and urine (circulating cathodic antigen [CCA] antigen assays. Population PK and PD analyses were performed to estimate drug exposure in individual children, and the relationship between drug exposure and parasitological cure was estimated using logistic regression. Monte Carlo simulations were performed to identify better, future dosing regimens. There was marked PK variability between children, but the area under the concentration-time curve (AUC of PZQ was strongly predictive of the parasitological cure rate (CR. Although no child achieved antigenic cure, which is suggestive of an important residual adult worm burden, higher AUC was associated with greater CAA antigenic decline at 24 days. To optimize the performance of PZQ, analysis of our simulations suggest that higher doses (>60 mg/kg are needed, particularly in smaller children.

  17. Diagnostic Performance of a Multiplex PCR assay for meningitis in an HIV-infected population in Uganda

    OpenAIRE

    Rhein, Joshua; Bahr, Nathan C; Hemmert, Andrew C; Cloud, Joann L; Bellamkonda, Satya; Oswald, Cody; Lo, Eric; Nabeta, Henry; Kiggundu, Reuben; Akampurira, Andrew; Musubire, Abdu; Williams, Darlisha; Meya, David B; Boulware, David R

    2015-01-01

    Meningitis remains a worldwide problem, and rapid diagnosis is essential to optimize survival. We evaluated the utility of a multiplex PCR test in differentiating possible etiologies of meningitis. Cerebrospinal fluid (CSF) from 69 HIV-infected Ugandan adults with meningitis was collected at diagnosis (n=51) and among persons with cryptococcal meningitis during therapeutic lumbar punctures (n=68). Cryopreserved CSF specimens were analyzed with BioFire FilmArray? Meningitis/Encephalitis panel,...

  18. The Amagugu Intervention: A Conceptual Framework for Increasing HIV Disclosure and Parent-Led Communication about Health among HIV-Infected Parents with HIV-Uninfected Primary School-Aged Children.

    Science.gov (United States)

    Rochat, Tamsen J; Mitchell, Joanie; Stein, Alan; Mkwanazi, Ntombizodumo Brilliant; Bland, Ruth M

    2016-01-01

    Advances in access to HIV prevention and treatment have reduced vertical transmission of HIV, with most children born to HIV-infected parents being HIV-uninfected themselves. A major challenge that HIV-infected parents face is disclosure of their HIV status to their predominantly HIV-uninfected children. Their children enter middle childhood and early adolescence facing many challenges associated with parental illness and hospitalization, often exacerbated by stigma and a lack of access to health education and support. Increasingly, evidence suggests that primary school-aged children have the developmental capacity to grasp concepts of health and illness, including HIV, and that in the absence of parent-led communication and education about these issues, HIV-exposed children may be at increased risk of psychological and social problems. The Amagugu intervention is a six-session home-based intervention, delivered by lay counselors, which aims to increase parenting capacity to disclose their HIV status and offer health education to their primary school-aged children. The intervention includes information and activities on disclosure, health care engagement, and custody planning. An uncontrolled pre-post-evaluation study with 281 families showed that the intervention was feasible, acceptable, and effective in increasing maternal disclosure. The aim of this paper is to describe the conceptual model of the Amagugu intervention, as developed post-evaluation, showing the proposed pathways of risk that Amagugu aims to disrupt through its intervention targets, mechanisms, and activities; and to present a summary of results from the large-scale evaluation study of Amagugu to demonstrate the acceptability and feasibility of the intervention model. This relatively low-intensity home-based intervention led to: increased HIV disclosure to children, improvements in mental health for mother and child, and improved health care engagement and custody planning for the child. The

  19. The Amagugu Intervention: A conceptual framework for increasing HIV disclosure and parent-led communication about health and HIV prevention among HIV-infected parents with HIV-uninfected primary school-aged children

    Directory of Open Access Journals (Sweden)

    Tamsen Jean Rochat

    2016-08-01

    Full Text Available Advances in access to HIV prevention and treatment have reduced vertical transmission of HIV, with most children born to HIV-infected parents being HIV-uninfected themselves. A major challenge that HIV-infected parents face is disclosure of their HIV status to their predominantly HIV-uninfected children. Their children enter middle childhood and early adolescence facing many challenges associated with parental illness and hospitalisation, often exacerbated by stigma and a lack of access to health education and support. Increasingly, evidence suggests that primary school-aged children have the developmental capacity to grasp concepts of health and illness, including HIV, and that in the absence of parent-led communication and education about these issues, HIV-exposed children may be at increased risk of psychological and social problems. The Amagugu intervention is a six-session home-based intervention, delivered by lay counsellors, which aims to increase parenting capacity to disclose their HIV status and offer health education to their primary school-aged children. The intervention includes information and activities on disclosure, health care engagement and custody planning. An uncontrolled pre-post evaluation study with 281 families showed the intervention was feasible, acceptable and effective in increasing maternal disclosure. The aim of this manuscript is to describe the conceptual model of the Amagugu intervention, as developed post-evaluation, showing the proposed pathways of risk that Amagugu aims to disrupt through its intervention targets, mechanisms and activities; and to present a summary of results from the large scale evaluation study of Amagugu to demonstrate the acceptability and feasibility of the intervention model. This relatively low-intensity home-based intervention led to: increased HIV disclosure to children, improvements in mental health for mother and child, and improved health care engagement and custody planning for

  20. Survival and Health Benefits of Breastfeeding Versus Artificial Feeding in Infants of HIV-Infected Women: Developing Versus Developed World

    OpenAIRE

    Kuhn, Louise; Aldrovandi, Grace

    2010-01-01

    Infant feeding policies for HIV-infected women in developing countries differ from policies in developed countries. Here we summarize the epidemiologic data on the risks and benefits of various infant feeding practices for HIV-infected women living in different contexts. Artificial feeding can prevent a large proportion of mother-to-child HIV transmission but also is associated with increases in morbidity and mortality among both exposed-uninfected and HIV-infected children. Antiretroviral dr...

  1. The impact of HIV infection and disease stage on the rate of weight gain and duration of refeeding and treatment in severely malnourished children in rural South African hospitals

    Directory of Open Access Journals (Sweden)

    Moïse Muzigaba

    2017-07-01

    Full Text Available Background. Evidence of the effects of HIV infection and clinical stage on the duration of refeeding and treatment (DRT and the rate of weight gain (RWG in severely malnourished children remains inconclusive. Objectives. To determine whether the RWG and DRT differ by baseline clinical characteristics, and to assess the effect of HIV status and disease stage on the relationship between these two clinical outcomes. Methods. This was a retrospective record review of 346 patiens discharged between 2009 and 2013 following treatment for severe acute malnutrition (SAM at two rural hospitals in South Africa. Results. A third of the sample was HIV-positive, the RWG (measured as g/kg/day was significantly slower in HIV-positive patients compared with HIV-negative cases (mean 5.2, 95% confidence interval (CI 4.47 - 5.93 v. mean 8.51; CI 7.98 - 9.05; p<0.0001 and cases at stage IV of HIV infection had a significantly slower RWG (mean 3.97; CI 2.33 - 5.61 compared with those at stages I (mean 7.64; CI 6.21 - 9.07 (p<0.0001 and II (mean 5.87; CI 4.74 - 6.99. The mean DRT was longer in HIV-positive cases and those at advanced stages of HIV infection. HIV-positive cases were renourished and treated for almost 3.5 times longer than their HIV-negative counterparts to achieve a moderate RWG (5 - 10 g/kg/day. Conclusion. This study highlights the need to reconsider energy requirements for HIV-positive cases at different clinical stages, for more rapid nutritional recovery in under-resourced settings where prolonged hospitalisation may be a challenge.

  2. Confronting Challenges in Monitoring and Evaluation: Innovation in the Context of the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive.

    Science.gov (United States)

    Radin, Anna K; Abutu, Andrew A; Okwero, Margaret A; Adler, Michelle R; Anyaike, Chukwuma; Asiimwe, Hilda T; Behumbiize, Prosper; Efuntoye, Timothy A; King, Rachel L; Kisaakye, Linda Nabitaka; Ogundehin, Dolapo T; Phelps, Benjamin Ryan; Watts, Heather; Weissglas, Fitti

    2017-05-01

    The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), which was launched in 2011, set a series of ambitious targets, including a reduction of new HIV infections among children by 90% by 2015 (from a baseline year of 2009) and AIDS-related maternal mortality by 50% by 2015. To reach these targets, the Global Plan called for unprecedented investments in the prevention of mother-to-child transmission of HIV (PMTCT), innovative new approaches to service delivery, immense collective effort on the programmatic and policy fronts, and importantly, a renewed focus on data collection and use. We provide an overview of major achievements in monitoring and evaluation across Global Plan countries and highlight key challenges and innovative country-driven solutions using PMTCT program data. Specifically, we describe the following: (1) Uganda's development and use of a weekly reporting system for PMTCT using short message service technology that facilitates real-time monitoring and programmatic adjustments throughout the transition to a "treat all" approach for pregnant and breastfeeding women living with HIV (Option B+); (2) Uganda's work to eliminate parallel reporting systems while strengthening the national electronic district health information system; and (3) how routine PMTCT program data in Nigeria can be used to estimate HIV prevalence at the local level and address a critical gap in local descriptive epidemiologic data to better target limited resources. We also identify several ongoing challenges in data collection, analysis, and use, and we suggest potential solutions.

  3. Prevalence and effect of pre-treatment drug resistance on the virological response to antiretroviral treatment initiated in HIV-infected children - a EuroCoord-CHAIN-EPPICC joint project

    DEFF Research Database (Denmark)

    Ngo-Giang-Huong, Nicole; Wittkop, Linda; Judd, Ali

    2016-01-01

    with virological outcome in the first year of cART in children. METHODS: HIV-infected children ... algorithm to infer resistance to prescribed drugs. Time to virological failure (VF) was defined as the first of two consecutive HIV-RNA > 500 copies/mL after 6 months cART and was assessed by Cox proportional hazards models. All models were adjusted for baseline demographic, clinical, immunology...... and virology characteristics and calendar period of cART start and initial cART regimen. RESULTS: Of 476 children, 88 % were vertically infected. At cART initiation, median (interquartile range) age was 6.6 years (2.1-10.1), CD4 cell count 297 cells/mm(3) (98-639), and HIV-RNA 5.2 log10copies/mL (4...

  4. HIV infection and Cushing's disease

    Directory of Open Access Journals (Sweden)

    Lalić Tijana

    2014-01-01

    Full Text Available Introduction: People with AIDS can have a dysfunction of the hypothalamic - pituitary-adrenal axis. With regard to HIV infection, most often mentioned is iatrogenic Cushing's syndrome or Pseudo-Cushing's Syndrome. So far there are described only two cases of Cushing disease in HIV -infected persons. Case report: A 48-year-old patient, after eleven years of HIV infection and a year since the introduction of HAART, was diagnosed with Cushing's disease based on cushingoid habitus, lack of suppression of cortisol in screening, elevated ACTH and pituitary tumor. She had transfenoidal surgery and histopathologic findings corresponded to basophilic adenoma. After the operation, short time on hydrocortisone substitution, she generally felt well with regular ART. Four years later, again easily bruising, facial redness, oily skin with acne, weight gain, uneven distribution of stomach adipose tissue, sweating, oligomenorrhea and high blood pressure. There was no rest/relapse of tumor on control pituitary MRI. Initially, elevated ACTH, valid cortisol in daily profiles, later the absence of the suppression of cortisol after 4 mg (LDST and 8 mg (HDST of dexamethasone along with maintenance of higher ACTH, indicate recurrence of clinical and laboratory relapse wherefore ketoconazole was introduced. Despite increasing doses of ketoconazole, she held slightly higher morning cortisol, ACTH and with persisting Cushing's syndrome. Conclusion: The coexistence of the two entities could lead to overlapping metabolic and phenotypic characteristics and the interaction between and/or synergism.

  5. Incidence and Prevalence of Opportunistic and Other Infections and the Impact of Antiretroviral Therapy Among HIV-infected Children in Low- and Middle-income Countries: A Systematic Review and Meta-analysis

    Science.gov (United States)

    B-Lajoie, Marie-Renée; Drouin, Olivier; Bartlett, Gillian; Nguyen, Quynh; Low, Andrea; Gavriilidis, Georgios; Easterbrook, Philippa; Muhe, Lulu

    2016-01-01

    Background. We conducted a systematic review and meta-analysis to evaluate the incidence and prevalence of 14 opportunistic infections (OIs) and other infections as well as the impact of antiretroviral therapy (ART) among human immunodeficiency virus (HIV)–infected children (aged Literatura Latino Americana em Ciências da Saúde databases. Summary incident risk (IR) and prevalent risk for each OI in ART-naive and ART-exposed children were calculated, and unadjusted odds ratios calculated for impact of ART. The number of OI cases and associated costs averted were estimated using the AIDS impact model. Results. We identified 4542 citations, and 88 studies were included, comprising 55 679 HIV-infected children. Bacterial pneumonia and tuberculosis were the most common incident and prevalent infections in both ART-naive and ART-exposed children. There was a significant reduction in IR with ART for the majority of OIs. There was a smaller impact on bacterial sepsis and pneumonia, and an increase observed for varicella zoster. ART initiation based on 2010 World Health Organization guidelines criteria for ART initiation in children was estimated to potentially avert >161 000 OIs (2013 UNAIDS data) with estimated cost savings of at least US$17 million per year. Conclusions. There is a decrease in the risk of most OIs with ART use in HIV-infected children in LMICs, and estimated large potential cost savings in OIs averted with ART use, although there are greater uncertainties in pediatric data compared with that of adults. PMID:27001796

  6. Developmental milestones of vertically HIV infected and seroreverters children: follow up of 83 children Desenvolvimento psicomotor de crianças verticalmente infectadas pelo HIV e sororevertidas: seguimento de 83 crianças

    Directory of Open Access Journals (Sweden)

    Isac Bruck

    2001-09-01

    Full Text Available The aim of the study was to detect neurological abnormalities in human immunodeficiency virus (HIV infected children. This was achieved by a prospective evaluation, from November/1995 to April/2000, of 43 HIV infected children (group I and 40 HIV seroreverters children (group II through neurological exam and neurodevelopmental tests: Denver Developmental Screening Test (DDST and Clinical Adaptive Test / Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS. A control group (III, of 67 children, were evaluated by CAT/CLAMS. Hyperactivity, irritability and hypotonia were the findings on neurological examination, without statistical differences between group I and II. On CAT/CLAMS, the group I developmental quotient (DQ was significantly lower than the other groups. The same occurred in DDST, with group I presenting significantly more failures than group II. Nineteen HIV children of group I had brain computed tomographic scan, with abnormalities in three of them (basal ganglia calcification, white matter hypodensity and asymmetry of lateral ventricles. We conclude that in HIV infected children a neurodevelopment delay occur early in the disease, and it can be detected by screening tests.Objetivou-se com o presente estudo detectar anormalidades neurológicas em crianças infectadas pelo vírus da imunodeficiência humana (HIV. Avaliou-se prospectivamente, de novembro de 1995 a abril de 2000, 43 crianças infectadas pelo HIV (grupo I e 40 crianças sororevertidas (grupo II, por meio de exame neurológico, testes de screening de neurodesenvolvimento: Teste Denver de Triagem de Desenvolvimento (DDST e Teste de Adaptação Clínica / Escala Linguística e Desenvolvimento Auditivo (CAT/CLAMS. Como grupo controle (III, foram avaliadas 67 crianças pelo CAT/CLAMS. Hiperatividade, irritabilidade e hipotonia foram as alterações encontradas ao exame neurológico, não ocorrendo diferenças estatísticas entre as crianças infectadas ou sororevertidas

  7. Sex Differences in Antiretroviral Therapy Initiation in Pediatric HIV Infection.

    Directory of Open Access Journals (Sweden)

    Masahiko Mori

    Full Text Available The incidence and severity of infections in childhood is typically greater in males. The basis for these observed sex differences is not well understood, and potentially may facilitate novel approaches to reducing disease from a range of conditions. We here investigated sex differences in HIV-infected children in relation to antiretroviral therapy (ART initiation and post-treatment outcome. In a South African cohort of 2,101 HIV-infected children, we observed that absolute CD4+ count and CD4% were significantly higher in ART-naïve female, compared to age-matched male, HIV-infected children. Absolute CD4 count and CD4% were also significantly higher in HIV-uninfected female versus male neonates. We next showed that significantly more male than female children were initiated on ART (47% female; and children not meeting criteria to start ART by >5 yrs were more frequently female (59%; p<0.001. Among ART-treated children, immune reconstitution of CD4 T-cells was more rapid and more complete in female children, even after adjustment for pre-ART absolute CD4 count or CD4% (p=0.011, p=0.030, respectively. However, while ART was initiated as a result of meeting CD4 criteria less often in females (45%, ART initiation as a result of clinical disease in children whose CD4 counts were above treatment thresholds occurred more often in females (57%, p<0.001. The main sex difference in morbidity observed in children initiating ART above CD4 thresholds, above that of TB disease, was as a result of wasting and stunting observed in females with above-threshold CD4 counts (p=0.002. These findings suggest the possibility that optimal treatment of HIV-infected children might incorporate differential CD4 treatment thresholds for ART initiation according to sex.

  8. Within and between race differences in lymphocyte, CD4+, CD8+ and neutrophil levels in HIV-uninfected children with or without HIV exposure in Europe and Uganda.

    Science.gov (United States)

    Bunders, Madeleine; Lugada, Eric; Mermin, Jonathan; Downing, Robert; Were, Willy; Thorne, Claire; Newell, Marie-Louise

    2006-09-01

    Racial immuno-haematological differences have been reported in children but to date have not been well quantified. To investigate differences in haemato-immunological markers over age between children born and living in Europe and Uganda. HIV-uninfected children living in Uganda (n = 1633) with cross-sectional data. Black (n = 604) and white children (n = 1355) living in Europe, both with prospective data. The children born in Europe were HIV-uninfected but born to HIV-infected mothers and were included in the European Collaborative Study (ECS). Patterns and levels of total lymphocyte (TLC), CD4+, CD8+ counts and CD4% were visualised by smoothers (a line representing the weighted average of all measurements over age by study group). Differences between groups were quantified using age-standardised Z-scores for individual TLC, CD4+ and CD8+ counts in uni- and multivariate regression models. In infancy, TLC, CD4+ and CD8+ counts were lower in Ugandan than black European children; neutrophil counts were similar. Thereafter, only neutrophil counts were lower in Ugandan children. To assess within-race differences, we compared Z-scores of ECS children born to Ugandan mothers with those of Ugandan children. Levels of all four markers were lower in Ugandan children at all ages. In Ugandan children, CD4+ counts were 0.5985 Z-score (p < 0.001) and neutrophil counts 0.3872 Z-score (p < 0.001) lower than in European children born to Ugandan mothers. There are differences in levels of haemato-immunological markers in children with comparable genetic backgrounds, suggesting that environmental factors such as nutrition and exposure to micro-organisms might have important effects on the developing immune system.

  9. Coagulation and morbidity in treated HIV infection

    Science.gov (United States)

    Funderburg, Nicholas T.; Lederman, Michael M.

    2014-01-01

    HIV infected patients are at increased risk for venous and arterial thromboembolic events. Multiple markers related to inflammation (IL-6, TNFrI, C-reative protein) and coagulation (tissue factor expression, FVIII, thrombin, fibrinogen and D-dimer levels) are increased in HIV infection, and several are predictive of thrombotic risk and mortality in HIV disease. The mechanisms behind the risk for abnormal coagulation in HIV infection have not been fully elucidated, but may be related to a chronic immune activation and inflammatory state in both untreated and treated HIV infection. The contribution of traditional risk factors, including smoking and dyslipidemia, overly represented in HIV infected patients, must also be considered when assessing thrombotic risk in this setting. Currently, several interventional studies are aimed at reducing inflammation and cardiovascular risk in HIV disease and may provide insights into the determinants of clotting events in HIV infected patients. PMID:24759134

  10. Perinatal HIV-infection in Sankt Petersburg and Modern Therapy Concomitant Viral Infections

    OpenAIRE

    V. N. Timchenko; E. B. Yastrebova; O. V. Bulina

    2016-01-01

    The study included 338 HIV-infected children (B-23) and 350 children with perinatal contact HIV infection (R-75), consisting on the dispensary in the department of maternal and child the St. Petersburg City AIDS Center. In 32 persons (9.5%) diagnosed with secondary infections. In the structure of viral opportunistic infections (herpesvirus, SARS) amounted to 39.8%, bacterial (bronchitis, tonsillitis, pyoderma, tuberculosis) — 34.8%, fungal and parasitic (candidiasis of the oral mucosa, PCP) —...

  11. Malnutrition is common in Ugandan children with cerebral palsy, particularly those over the age of five and those who had neonatal complications.

    Science.gov (United States)

    Kakooza-Mwesige, Angelina; Tumwine, James K; Eliasson, Ann-Christin; Namusoke, Hanifa K; Forssberg, Hans

    2015-12-01

    Poor growth and malnutrition are frequently reported in children with cerebral palsy in developed countries, but there is limited information from developing countries. We investigated the nutritional status of Ugandan children with cerebral palsy and described the factors associated with poor nutrition. We examined 135 children from two to 12 years with cerebral palsy, who attended Uganda's national referral hospital. A child was considered underweight, wasted, stunted or thin if the standard deviation scores for their weight for age, weight for height, height for age and body mass index for age were ≤-2.0 using World Health Organization growth standards. Multivariable logistic regression identified the factors associated with nutritional indicators. Over half (52%) of the children were malnourished, with underweight (42%) being the most common category, followed by stunting (38%), thinness (21%) and wasting (18%). Factors that were independently associated with being malnourished were as follows: presence of cognitive impairment, with an adjusted odds ratio (aOR) of 4.5, being 5 years or older (aOR = 3.4) and feeding difficulties in the perinatal period (aOR = 3.2). Malnutrition was common in Ugandan children with cerebral palsy and more likely if they were 5 years or more or had experienced neonatal complications. ©2015 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.

  12. Using the Uganda National Panel Survey to analyze the effect of staple food consumption on undernourishment in Ugandan children

    Directory of Open Access Journals (Sweden)

    Michelle M. Amaral

    2017-07-01

    likelihoods of both stunting and wasting in Ugandan children. Other causes of stunting and wasting identified in past research are also confirmed with the Uganda data. Finally, the analysis provides clues to other possible causes of undernourishment in young children.

  13. HIV infection and aortic stiffness.

    Science.gov (United States)

    Leite, Luisa Helena Maia; Cohen, Ariel; Boccara, Franck

    People living with human immunodeficiency virus (HIV) infection and receiving antiretroviral therapy now have the same life expectancy as the general population. However, they have a higher risk of atherosclerotic cardiovascular events because of a complex and polyfactorial vasculopathy, combining the effects of antiretroviral therapy, the HIV virus itself, immune activation, chronic inflammation and metabolic disturbances. Whether people living with HIV infection experience increased vascular aging compared with the general population remains controversial. To summarize current knowledge of the association between HIV infection and aortic stiffness as a marker of vascular aging. This review included 18 clinical studies in adult populations, published between 2009 and 2016, and identified on PubMed/MEDLINE or other databases. Search terms were aortic stiffness, arterial stiffness, vascular aging, pulse wave velocity and HIV. All 18 studies were observational, and compared groups infected (HIV+) and not infected (HIV-) with HIV. Ten studies (55%) reported no significant differences in aortic stiffness between HIV+ groups and age-matched HIV- control groups. The main reported determinants of aortic stiffness were age, blood pressure, smoking, metabolic syndrome and HIV-related variables, including CD4/CD8 ratio, current T-CD4 count < 200/mm 3 and nadir T-CD4+ count < 200/mm 3 . We found discordant results regarding whether HIV+ patients had increased aortic stiffness compared with HIV- controls. However, HIV-related conditions were associated with vascular health. This association has been confirmed in recent prospective studies. There is emerging evidence that HIV itself and immune activity affect vascular health and the large arteries. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. COURSE FEATURES EPIDEMIC PROCESS HIV INFECTION IN KHARKIV REGION

    Directory of Open Access Journals (Sweden)

    Nikolaeva LG

    2016-03-01

    whole in Ukraine (growth rate – +14.0 %. Herewith of incidence of HIV-infection in the region were lower than on the whole in Ukraine (accordingly 2.4 – 23.7 and 10.6 – 47.1 per 100 000 population. Almost all of the administrative territories of Kharkiv region have been involved into the epidemic process of HIV-infection, but in districts of the region the incidence of HIV-infection, AIDS and mortality were in 1.4 – 2.7 times higher than in Kharkiv itself. The measures directed at the prevention of HIV-infection in the groups of risk were actively being taken during the supervision in the region. Due to the collaboration of the executive authorities and local government, departmental structures, medical community and public organizations directed at the suspension of HIV-infection/AIDS epidemic in the region we managed to stabilize a little an epidemical situation on HIV-infection. For the period of 1987 – 2015 in the region there was defined the increase in the number of the infected women (from 12.9 % to 41.0 % and the decrease of the number of men (from 87.1 % to 59.0 % what led to the change of the ratio of the number of women with the number of men in accordance with 1:7 (1996 and 1:1.5 (2015. There were adult patients with HIV-infection (79.5 – 84.9 % in 4 - 5 times more than children under the age of 14 (15.1 – 20.5 %. The largest proportion of HIV-infected people in the age group of 25 – 49 years (60.0 – 72.2 % and the lowest – 15 – 17 years (0.1 – 1.0 %. In different periods of the current epidemic process of HIV-infection the ratio of parenteral, sexual and vertical routes of transmission considerably changed. At the beginning of the epidemic the incidence level of HIV-infection has been significantly affected by the drugs spreading and an increase in vulnerable groups of injecting drug users. Thus, in 1996 the part of the sexual route of transmission was equal to 5.7 % cases, whereas the part of parenteral one consists of 77.1 % cases

  15. INFLUENZA IMMUNISATION IN HIV-INFECTED PERSONS

    African Journals Online (AJOL)

    Definitive, quantitative epidemiological data on the risk of influenza complications in HIV-infected persons are still not available. However, small-scale studies have shown more severe and prolonged influenza disease in. HIV-infected persons."'" Additional factors which would also need to be taken into account when ...

  16. Discrepant coagulation profile in HIV infection

    DEFF Research Database (Denmark)

    Haugaard, Anna Karen; Lund, Tamara T.; Birch, Carsten

    2013-01-01

    In HIV infection, cardiovascular disease (CVD) has emerged as a clinical problem, and elevated D-dimer has been reported. The pathophysiologic mechanisms underlying this remain unclear. We aimed to investigate whether untreated HIV-infected individuals display evidence of functional coagulopathy...

  17. Predicting risk of cancer during HIV infection

    DEFF Research Database (Denmark)

    Borges, Álvaro H; Silverberg, Michael J; Wentworth, Deborah

    2013-01-01

    To investigate the relationship between inflammatory [interleukin-6 (IL-6) and C-reactive protein (CRP)] and coagulation (D-dimer) biomarkers and cancer risk during HIV infection.......To investigate the relationship between inflammatory [interleukin-6 (IL-6) and C-reactive protein (CRP)] and coagulation (D-dimer) biomarkers and cancer risk during HIV infection....

  18. Cognition, behaviour and academic skills after cognitive rehabilitation in Ugandan children surviving severe malaria: a randomised trial

    Directory of Open Access Journals (Sweden)

    John Chandy C

    2011-08-01

    Full Text Available Abstract Background Infection with severe malaria in African children is associated with not only a high mortality but also a high risk of cognitive deficits. There is evidence that interventions done a few years after the illness are effective but nothing is known about those done immediately after the illness. We designed a study in which children who had suffered from severe malaria three months earlier were enrolled into a cognitive intervention program and assessed for the immediate benefit in cognitive, academic and behavioral outcomes. Methods This parallel group randomised study was carried out in Kampala City, Uganda between February 2008 and October 2010. Sixty-one Ugandan children aged 5 to 12 years with severe malaria were assessed for cognition (using the Kaufman Assessment Battery for Children, second edition and the Test of Variables of Attention, academic skills (Wide Range Achievement Test, third edition and psychopathologic behaviour (Child Behaviour Checklist three months after an episode of severe malaria. Twenty-eight were randomised to sixteen sessions of computerised cognitive rehabilitation training lasting eight weeks and 33 to a non-treatment group. Post-intervention assessments were done a month after conclusion of the intervention. Analysis of covariance was used to detect any differences between the two groups after post-intervention assessment, adjusting for age, sex, weight for age z score, quality of the home environment, time between admission and post-intervention testing and pre-intervention score. The primary outcome was improvement in attention scores for the intervention group. This trial is registered with Current Controlled Trials, number ISRCTN53183087. Results Significant intervention effects were observed in the intervention group for learning mean score (SE, [93.89 (4.00 vs 106.38 (4.32, P = 0.04] but for working memory the intervention group performed poorly [27.42 (0.66 vs 25.34 (0.73, P = 0.04]. No

  19. The feasibility of an automated eye-tracking-modified Fagan test of memory for human faces in younger Ugandan HIV-exposed children.

    Science.gov (United States)

    Chhaya, Ronak; Weiss, Jonathan; Seffren, Victoria; Sikorskii, Alla; Winke, Paula M; Ojuka, Julius C; Boivin, Michael J

    2017-05-22

    The Fagan Test of Infant Intelligence (FTII) uses longer gaze length for unfamiliar versus familiar human faces to gauge visual-spatial encoding, attention, and working memory in infants. Our objective was to establish the feasibility of automated eye tracking with the FTII in HIV-exposed Ugandan infants. The FTII was administered to 31 perinatally HIV-exposed noninfected (HEU) Ugandan children 6-12 months of age (11 boys; M = 0.69 years, SD = 0.14; 19 girls; M = 0.79, SD = 0.15). A series of 10 different faces were presented (familiar face exposure for 25 s followed by a gaze preference trial of 15 s with both the familiar and unfamiliar faces). Tobii X2-30 infrared camera for pupil detection provided automated eye-tracking measures of gaze location and length during presentation of Ugandan faces selected to correspond to the gender, age (adult, child), face expression, and orientation of the original FTII. Eye-tracking gaze length for unfamiliar faces was correlated with performance on the Mullen Scales of Early Learning (MSEL). Infants gazed longer at the novel picture compared to familiar across 10 novelty preference trials. Better MSEL cognitive development was correlated with proportionately longer time spent looking at the novel faces (r(30) = 0.52, p = .004); especially for the Fine Motor Cognitive Sub-scale (r(30) = 0.54, p = .002). Automated eye tracking in a human face recognition test proved feasible and corresponded to the MSEL composite cognitive development in HEU infants in a resource-constrained clinical setting. Eye tracking may be a viable means of enhancing the validity and accuracy of other neurodevelopmental measures in at-risk children in sub-Saharan Africa.

  20. Children's Conceptions of Peace in Two Ugandan Primary Schools: Insights for Peace Curriculum

    Science.gov (United States)

    Kagaari, James; Nakasiita, Kirabo; Ntare, Edward; Atuhaire, Richard; Baguwemu, Ali; Ojok, Gerald; Okumu, Auma S.; Kaahwa, Goretti; Byamugisha, Gastone; Semakula, Paul; Namusoke, Jane; Mayengo, Nathan; Dennis, Barbara; Thompson, Chalmer E.

    2017-01-01

    Oppenheimer urged communities all over the world to study how children come to understand peace, conflict, and war. Set in various countries, their review of studies, as well as more recent examinations reveal trends in how children view these phenomena, often differing by gender, age, and extent to which they were exposed to highly dangerous and…

  1. Nelfinavir: a review of its use in the management of HIV infection.

    Science.gov (United States)

    Perry, Caroline M; Frampton, James E; McCormack, Paul L; Siddiqui, M Asif A; Cvetković, Risto S

    2005-01-01

    Nelfinavir (Viracept) is an orally administered protease inhibitor. In combination with other antiretroviral drugs (usually nucleoside reverse transcriptase inhibitors [NRTIs]), nelfinavir produces substantial and sustained reductions in viral load in patients with HIV infection. Nelfinavir may be used in the treatment of adults, adolescents and children aged >or=2 years with HIV infection. It can also be used in pregnancy. Resistance to nelfinavir may develop, but the most common mutation (D30N, appearing mainly in HIV-1 subtype B) does not confer resistance to other protease inhibitors, thereby conserving these agents for later use. Although less effective than lopinavir/ritonavir, the preferred first-line treatment in US guidelines, nelfinavir is positioned as an alternative agent for the treatment of adults and adolescents with HIV infection and is an option for those unable to tolerate other protease inhibitors. Nelfinavir also has a role in the management of pregnant patients as well as paediatric patients with HIV infection.

  2. Cerebral Oximetry in Ugandan Children With Severe Anemia: Clinical Categories and Response to Transfusion.

    Science.gov (United States)

    Dhabangi, Aggrey; Ainomugisha, Brenda; Cserti-Gazdewich, Christine; Ddungu, Henry; Kyeyune, Dorothy; Musisi, Ezra; Opoka, Robert; Stowell, Christopher P; Dzik, Walter H

    2016-10-01

    Severe anemia, defined as a hemoglobin level of less than 5.0 g/dL, affects millions of children worldwide. The brain has a high basal demand for oxygen and is especially vulnerable to hypoxemia. Previous studies have documented neurocognitive impairment in children with severe anemia. Data on cerebral tissue oxygenation in children with severe anemia and their response to blood transfusion are limited. To measure hemoglobin saturation in cerebral tissue (cerebral tissue oxygen saturation [tSo2]) before, during, and after blood transfusion in a cohort of children presenting to hospital with severe anemia. This was a prospective, observational cohort study conducted from February 2013 through May 2015 and analyzed in July 2015 at a university hospital pediatric acute care facility in Kampala, Uganda, of 128 children, ages 6 to 60 months who were enrolled in a larger clinical trial, with a presenting hemoglobin level of less than 5.0 g/dL and a blood lactate level greater than 5mM. Most children had either malaria or sickle cell disease. Red blood cell (RBC) transfusion given as 10 mL/kg over 120 minutes. Clinical and laboratory characteristics of children with pretransfusion cerebral tSo2 levels less than 65%, 65% to 75%, and greater than 75%. Change in cerebral tSo2 as a result of transfusion. Of 128 children included in the study, oximetry results in 8 cases were excluded owing to motion artifacts; thus, 120 were included in this analysis. Cerebral tSo2 values prior to transfusion ranged from 34% to 87% (median, 72%; interquartile range [IQR], 65%-76%). Eighty-one children (67%) demonstrated an initial cerebral tSo2 level (≤75%) corresponding to an oxygen extraction ratio greater than 0.36. Patients with sickle cell disease (n = 17) and malaria (n = 15) contributed in nearly equal numbers to the subgroup with an initial cerebral tSo2 (children failed to achieve a tSo2 level greater than 75%. Severe anemia in children is frequently associated with low

  3. Socioeconomic predictors of cognition in Ugandan children: implications for community interventions

    National Research Council Canada - National Science Library

    Bangirana, Paul; John, Chandy C; Idro, Richard; Opoka, Robert O; Byarugaba, Justus; Jurek, Anne M; Boivin, Michael J

    2009-01-01

    .... A cohort of 89 healthy children (45 females) aged 5 to 12 years old were followed over 24 months and had cognitive tests measuring visual spatial processing, memory, attention and spatial learning administered at baseline, 6 months and 24 months...

  4. Influence of parents’ and caregivers’ characteristics on the outcomes of antiretroviral treatment in Ugandan children

    Directory of Open Access Journals (Sweden)

    Ntambwe Malangu

    2011-02-01

    Full Text Available Background: The purpose of this study was to investigate whether there was an association between characteristics of parents and caregivers, and the outcomes of antiretroviral treatment in children younger than 6 years treated at Mildmay Centre in Uganda. Methods: This study was a cross-sectional study based on the review of records. The records of children treated from January 2000 to July 2005 were included in the analysis as part of a larger study. Descriptive and inferential statistics were used in the analysis of data.Results: Of the 179 children, 57.3% were male, 53.4% were 4–5 years, and their median age was 4 years. The majority of children were cared for, in descending order, by their mothers, aunts, grandmothers, and fathers. Whilst 16.0% were orphans of both parents, 56.9% had one of their parents still alive. With regard to outcomes of antiretroviral treatment, it was found that a CD4 count of less than 15% was the most significant predictor of death, when treatment was initiated only at that late stage. When the influence of caregivers’ and parents’ characteristics on the outcomes of treatment were considered, the only factor that was associated significantly with clinical improvement was the ‘father’s unknown human immunodeficiency virus (HIV status’. The data show that when the father was alive, as well as when both parents were alive, the children had a better chance of survival.Conclusion: The nature of the relationship between caregivers and children on antiretroviral treatment, as well as the HIV and living status of their parents seem to have little positive influence on the clinical, immunological, and survival outcomes of the children on treatment. More studies are needed to investigate other characteristics and relationships that may influence the outcomes of treatment.

  5. Impact of adverse events of antiretroviral treatment on regimen change and mortality in Ugandan children

    Directory of Open Access Journals (Sweden)

    Ntambwe Malangu

    2010-03-01

    Full Text Available Background: Outcomes of antiretroviral treatment have been documented in both developed and developing countries. It has been reported consistently that the treatment is associated with many adverse events. However, little is known about their impact on the quality of life, clinical management, and survival in children aged less than 6 years in Uganda.Objectives: The purpose of this study was to determine the prevalence of the adverse events of antiretroviral treatment, their impact on mortality and the change in regimens prescribed to children treated at Mildway Centre in Uganda.Method: A retrospective chart review was performed for children younger than 6 years, treated since the Mildway Centre was opened in 1999. In order to achieve a larger sample, the records of children treated from January 2000 to July 2005 were included in the study. A pre-tested data collection form was used to collate socio-demographic and clinical data of the patients. These included the documented adverse events, causes of death, stage of infection, duration of treatment, regimen prescribed, year of enrolment into the treatment program, as well as whether or not they were still alive. Descriptive statistics were used in the analysis of data.Results: Of the 179 children, the majority were males and had a median age of 4 years. The majority (58.8% of children had suffered from severe immune depression since they met the WHO clinical stage III and IV, 73.8% had a baseline CD4T of less than 15%. Four regimens were prescribed to the children. The most common was a regimen containing zidovudine, lamivudine, and nevirapine (34.6%, followed by a regimen containing stavudine, lamivudine, and nevirapine (27.9%. Eleven children (6.1% had their regimen changed, of which six (54.5% were due to adverse events. The prevalence of adverse events was 8%; of the 14 documented adverse events, the most common were severe anaemia (3, vomiting (3, and skin rashes (3. After 12 months on

  6. Incomplete immune recovery in HIV infection

    DEFF Research Database (Denmark)

    Gaardbo, Julie C; Hartling, Hans J; Gerstoft, Jan

    2012-01-01

    Treatment of HIV-infected patients with highly active antiretroviral therapy (HAART) usually results in diminished viral replication, increasing CD4⁺ cell counts, a reversal of most immunological disturbances, and a reduction in risk of morbidity and mortality. However, approximately 20% of all HIV...... tissue, perturbed frequencies of immune regulators such as regulatory T cells and Th17 cells, and increased immune activation, immunosenescence, and apoptosis. Importantly, INRs have an increased risk of morbidity and mortality compared to HIV-infected patients with an optimal immune reconstitution...... in HIV infection, including mechanisms, relevance for clinical care, and possible solutions....

  7. Common coinfections of Giardia intestinalis and Helicobacter pylori in non-symptomatic Ugandan children.

    Directory of Open Access Journals (Sweden)

    Johan Ankarklev

    Full Text Available BACKGROUND: The protozoan parasite Giardia intestinalis and the pathogenic bacterium Helicobacter pylori are well known for their high prevalences in human hosts worldwide. The prevalence of both organisms is known to peak in densely populated, low resource settings and children are infected early in life. Different Giardia genotypes/assemblages have been associated with different symptoms and H. pylori with induction of cancer. Despite this, not much data are available from sub-Saharan Africa with regards to the prevalence of different G. intestinalis assemblages and their potential association with H. pylori infections. METHODOLOGY/PRINCIPAL FINDINGS: Fecal samples from 427 apparently healthy children, 0-12 years of age, living in urban Kampala, Uganda were analyzed for the presence of H. pylori and G. intestinalis. G. intestinalis was found in 86 (20.1% out of the children and children age 1<5 years had the highest rates of colonization. H. pylori was found in 189 (44.3% out of the 427 children and there was a 3-fold higher risk of concomitant G. intestinalis and H. pylori infections compared to non-concomitant G. intestinalis infection, OR = 2.9 (1.7-4.8. No significant association was found in the studied population with regard to the presence of Giardia and gender, type of toilet, source of drinking water or type of housing. A panel of 45 G. intestinalis positive samples was further analyzed using multi-locus genotyping (MLG on three loci, combined with assemblage-specific analyses. Giardia MLG analysis yielded a total of five assemblage AII, 25 assemblage B, and four mixed assemblage infections. The assemblage B isolates were highly genetically variable but no significant association was found between Giardia assemblage type and H. pylori infection. CONCLUSIONS/SIGNIFICANCE: This study shows that Giardia assemblage B dominates in children in Kampala, Uganda and that the presence of H. pylori is an associated risk factor for G

  8. Hepatitis C Virus Genotype 4 in Ugandan Children and Their Mothers

    Science.gov (United States)

    Ortiz-Conde, Betty A.; Bagni, Rachel K.; Bakaki, Paul M.; Wang, Cheng-Dian; Engels, Eric A.; Mbulaiteye, Sam M.; Ndugwa, Christopher M.

    2006-01-01

    In Kampala, Uganda, in 2001, hepatitis C virus antibodies were found in 27 (4%) of 603 children and in 62 (12%) of 525 of their mothers. However, only ≈10% of positive results were confirmed by reverse transcription–PCR, which suggests frequent false-positive results or viral clearance. All sequenced types were genotype 4. PMID:17073099

  9. Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi.

    Science.gov (United States)

    Lancaster, Kathryn E; Go, Vivian F; Lungu, Thandie; Mmodzi, Pearson; Hosseinipour, Mina C; Chadwick, Katy; Powers, Kimberly A; Pence, Brian W; Hoffman, Irving F; Miller, William C

    2016-04-01

    HIV diagnosis, the first step in HIV care and treatment engagement, may be inhibited by substance use among female sex workers (FSW). We assessed the relationship between alcohol and cannabis use and lack of HIV infection awareness among HIV-infected FSW in Lilongwe, Malawi. From July to September, 2014, 200 FSW aged ≥18 years were enrolled using venue-based sampling to examine substance use, HIV testing history, and serostatus ascertained by HIV rapid test. We used Poisson regression with robust variance estimates to estimate the associations of alcohol and cannabis use and lack of HIV infection awareness. Of the 138 HIV-infected FSW, 20% were unaware of their HIV infection, with 70% not testing within 6 months prior. According to the Alcohol Use Disorder Identification Tests (AUDIT), 55% of FSW unaware of their HIV infection reported hazardous, harmful, or dependent alcohol consumption. We observed a dose-response relationship between alcohol use and lack of HIV infection awareness, with alcohol dependency significantly associated with lack of HIV infection awareness (adjusted prevalence ratio: 3.0, 95% CI: 1.3, 6.8). Current cannabis use was uncommon (26%) among unaware HIV-infected FSW and weakly associated with lack of HIV infection awareness adjusted prevalence ratio: 1.1, 95% CI: 0.5, 2.5). Increased levels of alcohol use is associated with lack of HIV infection awareness among HIV-infected FSW in Malawi. Frequent, consistent HIV testing integrated with alcohol reduction strategies could improve the health and infection awareness of substance-using FSW. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Severe neurological sequelae and behaviour problems after cerebral malaria in Ugandan children

    Directory of Open Access Journals (Sweden)

    Tugumisirize Joshua

    2010-04-01

    Full Text Available Abstract Background Cerebral malaria is the most severe neurological complication of falciparum malaria and a leading cause of death and neuro-disability in sub-Saharan Africa. This study aimed to describe functional deficits and behaviour problems in children who survived cerebral malaria with severe neurological sequelae and identify patterns of brain injury. Findings Records of children attending a specialist child neurology clinic in Uganda with severe neurological sequelae following cerebral malaria between January 2007 and December 2008 were examined to describe deficits in gross motor function, speech, vision and hearing, behaviour problems or epilepsy. Deficits were classified according to the time of development and whether their distribution suggested a focal or generalized injury. Any resolution during the observation period was also documented. Thirty children with probable exposure to cerebral malaria attended the clinic. Referral information was inadequate to exclude other diagnoses in 7 children and these were excluded. In the remaining 23 patients, the commonest severe deficits were spastic motor weakness (14, loss of speech (14, hearing deficit (9, behaviour problems (11, epilepsy (12, blindness (12 and severe cognitive impairment (9. Behaviour problems included hyperactivity, impulsiveness and inattentiveness as in attention deficit hyperactivity disorder (ADHD and conduct disorders with aggressive, self injurious or destructive behaviour. Two patterns were observed; a immediate onset deficits present on discharge and b late onset deficits. Some deficits e.g. blindness, resolved within 6 months while others e.g. speech, showed little improvement over the 6-months follow-up. Conclusions In addition to previously described neurological and cognitive sequelae, severe behaviour problems may follow cerebral malaria in children. The observed differences in patterns of sequelae may be due to different pathogenic mechanisms, brain

  11. Subjective impacts of dental caries and fluorosis in rural Ugandan children.

    Science.gov (United States)

    Robinson, Peter G; Nalweyiso, Nora; Busingye, June; Whitworth, Jimmy

    2005-12-01

    Describe the oral health related quality of life among a group of children in rural Uganda and compare impacts on oral health related quality of life associated with dental caries and fluorosis. Cross-sectional clinical and questionnaire analytical study. Proportional sample of 174 12 year olds attending primary schools in a rural sub-county of Uganda. Clinical assessments using WHO basic methods and the Thylstrup and Fejerskov index of Fluorosis (TFI). Child Oral Health Related Quality of Life data collected with self-administered child perception questionnaire (CPQ11-14). Two thirds of children reported a dental impact 'often' or 'everyday'. The mean number of impacts per child at this threshold was 2.6 and the mean total CPQ11-14 score was 25.8 (sd 21.1). Mean DMFT was 0.68. No children had fillings. Forty-one children had dental fluorosis with 10 having scores greater than 2. CPQ11-14 showed acceptable criterion validity and reliability. The number of sites with gingivitis or the presence of calculus or trauma were not associated with summary measures of CPQ11-14 whereas having any dental caries or treatment experience was associated with higher total scores and more impacts. Socially noticeable fluorosis (TFI >2) was associated with more impacts but not with higher total scores. Despite low levels of oral disease these children experience appreciable impacts on oral health related quality of life. The greatest burden was associated with dental caries and to a lesser extent, fluorosis.

  12. Inflammation in HIV-Infected Patients

    DEFF Research Database (Denmark)

    Langkilde, Anne; Petersen, Janne; Klausen, Henrik Hedegaard

    2012-01-01

    To examine mechanisms underlying the increased inflammatory state of HIV-infected patients, by investigating the association of HIV-related factors, demography, lifestyle, and body composition with the inflammatory marker soluble urokinase plasminogen activator receptor (suPAR)....

  13. HIV INFECTION AND THE KIDNEY CLINICAL

    African Journals Online (AJOL)

    2008-04-04

    Apr 4, 2008 ... Numerous electrolyte and acid-base abnormalities have ... Membranous. 3. Various glomerulonephropathies: This is a heterogeneous group with ... Very few data exist on screening asymptomatic HIV- infected patients for ...

  14. Psychopathological and Behaviour Dimensions in HIV Infection

    OpenAIRE

    Margalho, R.; Velez, J.; Guzman, D.; Oliveira, J.; Saraiva da Cunha, A.; Meliço Silvestre, A.

    2008-01-01

    HIV infection has been studied by various sciences, since it articulates biological, clinical and social realities. Since the time of its appearance to the present, advances in the treatment of HIV infection have been notorious and fascinating. Antiretroviral therapy promotes an improved quality of life for patients and increases life expectancy but has had difficulties with treatment associated behaviour, i.e., adherence to treatment. The aim of this study was to evaluate the influence of ps...

  15. Complementary feeding adequacy in relation to nutritional status among early weaned breastfed children who are born to HIV-infected mothers: ANRS 1201/1202 Ditrame Plus, Abidjan, Cote d'Ivoire.

    Science.gov (United States)

    Becquet, Renaud; Leroy, Valériane; Ekouevi, Didier K; Viho, Ida; Castetbon, Katia; Fassinou, Patricia; Dabis, François; Timite-Konan, Marguerite

    2006-04-01

    In high HIV prevalence resource-constrained settings, exclusive breastfeeding with early cessation is one of the conceivable interventions aimed at the prevention of HIV through breast milk. Nevertheless, this intervention has potential adverse effects, such as the inappropriateness of complementary feeding to take over breast milk. The purpose of our study first was to describe the nature and the ages of introduction of complementary feeding among early weaned breastfed infants up to their first birthday and second was to assess the nutritional adequacy of these complementary foods by creating a child feeding index and to investigate its association with child nutritional status. A prospective cohort study in Abidjan, Côte d'Ivoire, was conducted in HIV-infected pregnant women who were willing to breastfeed and had received a perinatal antiretroviral prophylaxis. They were requested to practice exclusive breastfeeding and initiate early cessation of breastfeeding from the fourth month to reduce breast milk HIV transmission. Nature and ages of introductory complementary feeding were described in infants up to their first birthday by longitudinal compilation of 24-hour and 7-day recall histories. These recalls were done weekly until 6 weeks of age, monthly until 9 months of age, and then quarterly. We created an index to synthesize the nutritional adequacy of infant feeding practices (in terms of quality of the source of milk, dietary diversity, food, and meal frequencies) ranging from 0 to 12. The association of this feeding index with growth outcomes in children was investigated. Among the 262 breastfed children included, complete cessation of breastfeeding occurred in 77% by their first birthday, with a median duration of 4 months. Most of the complementary foods were introduced within the seventh month of life, except for infant food and infant formula that were introduced at age 4 months. The feeding index was relatively low (5 of 12) at age 6 months, mainly

  16. Malaria with neurological involvement in Ugandan children: effect on cognitive ability, academic achievement and behaviour.

    Science.gov (United States)

    Bangirana, Paul; Musisi, Seggane; Boivin, Michael J; Ehnvall, Anna; John, Chandy C; Bergemann, Tracy L; Allebeck, Peter

    2011-11-03

    Malaria is a leading cause of ill health and neuro-disability in children in sub-Saharan Africa. Impaired cognition is a common outcome of malaria with neurological involvement. There is also a possibility that academic achievement may be affected by malaria with neurological involvement given the association between cognitive ability and academic achievement. This study investigated the effect of malaria with neurological involvement on cognitive ability, behaviour and academic achievement. This prospective case-control study was carried out in Kampala City, Uganda between February 2008 and October 2010. Sixty-two children with a history of malaria with neurological involvement were followed up and given assessments for cognitive ability (working memory, reasoning, learning, visual spatial skills and attention), behaviour (internalizing and externalizing problems) and academic achievement (arithmetic, spelling and reading) three months after the illness. Sixty-one community controls recruited from the homes or neighbouring families of the cases were also given the same assessments. Tests scores of the two groups were compared using analysis of covariance with age, sex, level of education, nutritional status and quality of the home environment as covariates. This study was approved by the relevant ethical bodies and informed consent sought from the caregivers. Children in the malaria group had more behavioural problems than the community controls for internalizing problems (estimated mean difference = -3.71, 95% confidence interval (CI), = -6.34 to -1.08, p = 0.007). There was marginal evidence of lower attention scores (0.40, CI = -0.05 to 0.86, p = 0.09). However, excluding one child from the analyses who was unable to perform the tests affected the attention scores to borderline significance (0.32, CI, = 0.01 to 0.62, p = 0.05). No significant differences were observed in other cognitive abilities or in academic achievement scores. Malaria with neurological

  17. Malaria with neurological involvement in Ugandan children: effect on cognitive ability, academic achievement and behaviour

    Directory of Open Access Journals (Sweden)

    Bangirana Paul

    2011-11-01

    Full Text Available Abstract Background Malaria is a leading cause of ill health and neuro-disability in children in sub-Saharan Africa. Impaired cognition is a common outcome of malaria with neurological involvement. There is also a possibility that academic achievement may be affected by malaria with neurological involvement given the association between cognitive ability and academic achievement. This study investigated the effect of malaria with neurological involvement on cognitive ability, behaviour and academic achievement. Methods This prospective case-control study was carried out in Kampala City, Uganda between February 2008 and October 2010. Sixty-two children with a history of malaria with neurological involvement were followed up and given assessments for cognitive ability (working memory, reasoning, learning, visual spatial skills and attention, behaviour (internalizing and externalizing problems and academic achievement (arithmetic, spelling and reading three months after the illness. Sixty-one community controls recruited from the homes or neighbouring families of the cases were also given the same assessments. Tests scores of the two groups were compared using analysis of covariance with age, sex, level of education, nutritional status and quality of the home environment as covariates. This study was approved by the relevant ethical bodies and informed consent sought from the caregivers. Results Children in the malaria group had more behavioural problems than the community controls for internalizing problems (estimated mean difference = -3.71, 95% confidence interval (CI, = -6.34 to -1.08, p = 0.007. There was marginal evidence of lower attention scores (0.40, CI = -0.05 to 0.86, p = 0.09. However, excluding one child from the analyses who was unable to perform the tests affected the attention scores to borderline significance (0.32, CI, = 0.01 to 0.62, p = 0.05. No significant differences were observed in other cognitive abilities or in academic

  18. Posttraumatic Resilience in Former Ugandan Child Soldiers

    Science.gov (United States)

    Klasen, Fionna; Oettingen, Gabriele; Daniels, Judith; Post, Manuela; Hoyer, Catrin; Adam, Hubertus

    2010-01-01

    The present research examines posttraumatic resilience in extremely exposed children and adolescents based on interviews with 330 former Ugandan child soldiers (age = 11-17, female = 48.5%). Despite severe trauma exposure, 27.6% showed posttraumatic resilience as indicated by the absence of posttraumatic stress disorder, depression, and clinically…

  19. Expresión de L-selectina en linfocitos T y neutrófilos de niños infectados con HIV L-selectin expression on T lymphocytes and neutrophils in HIV infected children

    Directory of Open Access Journals (Sweden)

    Gaddi Eduardo

    2005-04-01

    -selectin expression on peripheral T cells and neutrophils was evaluated in 25 HIV infected children, who had not received antiretroviral therapy, and 25 healthy controls. The expression level of L-selectin on T cells was also evaluated in 10 out 25 patients after 6 months of antiretroviral therapy. L-selectin expression on CD3+, CD4+ and CD8+ T cells were significantly lower in HIV infected children than in the control group. The percentage of neutrophils expressing CD62L was significantly reduced in patients with severe immunologic suppression. A positive correlation between the number of CD4+ T cells and the percentage of neutrophils CD62L+ was found. L-selectin expression on both CD4+ and CD8+ T cells did not significantly vary after 6 months of treatment. Altered leukocyte functions such as migration and homing resulting from reduced expression of CD62L may be an important contributor of the progressive dysfunction of the immune system in HIV infected children.

  20. Poor housing construction associated with increased malaria incidence in a cohort of young Ugandan children.

    Science.gov (United States)

    Snyman, Katherine; Mwangwa, Florence; Bigira, Victor; Kapisi, James; Clark, Tamara D; Osterbauer, Beth; Greenhouse, Bryan; Sturrock, Hugh; Gosling, Roly; Liu, Jenny; Dorsey, Grant

    2015-06-01

    Despite the use of accepted interventions to combat malaria, such as insecticide-treated bed nets and artemisinin-based combination therapy, malaria remains a leading cause of morbidity and mortality in Uganda. We investigated associations between household factors and malaria incidence in a cohort of children living in a highly endemic region of Uganda. Living in a modern house, defined as the use of non-earth floors, non-thatched roofs, and non-mud walls, was associated with approximately half malaria incidence compared with living in a traditional home (incidence rate ratio [IRR] = 0.54, P = 0.001). Other factors found to be associated with a lower incidence of malaria included living in town versus rural setting; sleeping in a room with openings to the outside (windows, eaves, and airbricks); and having an older and more educated primary caregiver. This study adds to the growing body of evidence that improved house construction may be associated with a lower risk of malaria. © The American Society of Tropical Medicine and Hygiene.

  1. Estimation of intracellular concentration of stavudine triphosphate in HIV-infected children given a reduced dose of 0.5 milligrams per kilogram twice daily.

    Science.gov (United States)

    Sy, Sherwin K B; Innes, Steve; Derendorf, Hartmut; Cotton, Mark F; Rosenkranz, Bernd

    2014-01-01

    The antiviral efficacy of stavudine depends on the trough concentration of its intracellular metabolite, stavudine-triphosphate (d4T-TP), while the degree of stavudine's mitochondrial toxicity depends on its peak concentration. Rates of mitochondrial toxicity are high when stavudine is used at the current standard pediatric dose (1 mg/kg twice daily [BID]). Evidence from adult work suggests that half of the original standard adult dose (i.e., 20 mg BID) may be equally effective, with markedly less mitochondrial toxicity. We present a population pharmacokinetic model to predict intracellular d4T-TP concentrations in pediatric HIV-infected patients administered a dose of 0.5 mg/kg BID. Our model predicted that the reduced pediatric dose would result in a trough intracellular d4T-TP concentration above that of the reduced 20-mg adult dose and a peak concentration below that of the 20-mg adult dose. The simulated pediatric intracellular d4T-TP at 0.5 mg/kg BID resulted in median peak and trough values of approximately 23.9 fmol/10(6) cells (95% prediction interval [PI], 14.2 to 41 fmol/10(6) cells) and 14.8 fmol/10(6) cells (95% PI, 7.2 to 31 fmol/10(6) cells), respectively. The peak and trough concentrations resulting from a 20-mg BID adult dose were 28.4 fmol/10(6) cells (95% PI, 17.3 to 45.5 fmol/10(6) cells) and 13 fmol/10(6) cells (95% PI, 6.8 to 28.6 fmol/10(6) cells), respectively. Halving the current standard pediatric dose should therefore not compromise antiviral efficacy, while markedly reducing mitochondrial toxicity.

  2. Lessons learnt from promising practices in community engagement for the elimination of new HIV infections in children by 2015 and keeping their mothers alive: summary of a desk review.

    Science.gov (United States)

    Ackerman Gulaid, Laurie; Kiragu, Karusa

    2012-07-11

    Through the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping their Mothers Alive, leaders have called for broader action to strengthen the involvement of communities. The Global Plan aspires to reduce new HIV infections among children by 90 percent, and to reduce AIDS-related maternal mortality by half. This article summarizes the results of a review commissioned by UNAIDS to help inform stakeholders on promising practices in community engagement to accelerate progress towards these ambitious goals. This research involved extensive literature review and key informant interviews. Community engagement was defined to include participation, mobilization and empowerment while excluding activities that involve communities solely as service recipients. A promising practice was defined as one for which there is documented evidence of its effectiveness in achieving intended results and some indication of replicability, scale up and/or sustainability. Promising practices that increased the supply of preventing mother-to-child transmission (PMTCT) services included extending community cadres, strengthening linkages with community- and faith-based organizations and civic participation in programme monitoring. Practices to improve demand for PMTCT included community-led social and behaviour change communication, peer support and participative approaches to generate local solutions. Practices to create an enabling environment included community activism and government leadership for greater involvement of communities. Committed leadership at all levels, facility, community, district and national, is crucial to success. Genuine community engagement requires a rights-based, capacity-building approach and sustained financial and technical investment. Participative formative research is a first step in building community capacity and helps to ensure programme relevance. Building on existing structures, rather than working in parallel to

  3. Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe

    DEFF Research Database (Denmark)

    Judd, A; Lodwick, R; Noguera-Julian, A

    2017-01-01

    OBJECTIVES: The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection. METHODS:...

  4. Incidence of World Health Organization stage 3 and 4 events, tuberculosis and mortality in untreated, HIV-infected children enrolling in care before 1 year of age: an IeDEA (International Epidemiologic Databases To Evaluate AIDS) East Africa regional analysis.

    Science.gov (United States)

    Ciaranello, Andrea; Lu, Zhigang; Ayaya, Samuel; Losina, Elena; Musick, Beverly; Vreeman, Rachel; Freedberg, Kenneth A; Abrams, Elaine J; Dillabaugh, Lisa; Doherty, Katie; Ssali, John; Yiannoutsos, Constantin T; Wools-Kaloustian, Kara

    2014-06-01

    Few studies have reported CD4%- and age-stratified rates of World Health Organization Stage 3 (WHO3) events, World Health Organization Stage 4 (WHO4) events, tuberculosis (TB) and mortality in HIV-infected infants before initiation of antiretroviral therapy. HIV-infected children enrolled before 1 year of age in the International Epidemiologic Databases to Evaluate AIDS East Africa region (October 1, 2002, to November, 2008) were included. We estimated incidence rates of earliest clinical event (WHO3, WHO4 and TB), before antiretroviral therapy initiation per local guidelines, stratified by current age (30 days post event). Among 847 children (median enrollment age: 4.8 months; median pre-antiretroviral therapy follow up: 10.8 months; 603 (71%) with ≥1 CD4% recorded), event rates were comparable for those aged 30 days post event) ranged by CD4% from 4.7 to 29.1/100 PY. In treatment-naïve, HIV-infected infants, WHO3, WHO4 and TB events were common before and after 6 months of age and led to substantial increases in mortality. Early infant HIV diagnosis and treatment are critically important, regardless of CD4%.

  5. Reproductive health and family planning needs among HIV-infected women in Sub-Saharan Africa.

    Science.gov (United States)

    Sarnquist, Clea C; Rahangdale, Lisa; Maldonado, Yvonne

    2013-03-01

    Review key topics and recent literature regarding reproductive health and family planning needs for HIV-infected women in Sub-Saharan Africa. Electronic searches performed in PubMed, JSTOR, and Web of Science; identified articles reviewed for inclusion. Most HIV-infected women in Sub-Saharan Africa bear children, and access to antiretroviral therapy may increase childbearing desires and/or fertility, resulting in greater need for contraception. Most contraceptive options can be safely and effectively used by HIV-infected women. Unmet need for contraception is high in this population, with 66- 92% of women reporting not wanting another child (now or ever), but only 20-43% using contraception. During pregnancy and delivery, HIV-infected women need access to prevention of mother-to-child transmission (PMTCT) services, a skilled birth attendant, and quality post-partum care to prevent HIV infection in the infant and maximize maternal health. Providers may lack resources as well as appropriate training and support to provide such services to women with HIV. Innovations in biomedical and behavioral interventions may improve reproductive healthcare for HIV-infected women, but in Sub-Saharan Africa, models of integrating HIV and PMTCT services with family planning and reproductive health services will be important to improve reproductive outcomes. HIV-infected women in Sub-Saharan Africa have myriad needs related to reproductive health, including access to high-quality family planning information and options, high-quality pregnancy care, and trained providers. Integrated services that help prevent unintended pregnancy and optimize maternal and infant health before, during and after pregnancy will both maximize limited resources as well as provide improved reproductive outcomes.

  6. Psychopathological and Behaviour Dimensions in HIV Infection

    Directory of Open Access Journals (Sweden)

    R. Margalho

    2014-06-01

    Full Text Available HIV infection has been studied by various sciences, since it articulates biological, clinical and social realities. Since the time of its appearance to the present, advances in the treatment of HIV infection have been notorious and fascinating. Antiretroviral therapy promotes an improved quality of life for patients and increases life expectancy but has had difficulties with treatment associated behaviour, i.e., adherence to treatment. The aim of this study was to evaluate the influence of psychopathological and behavioral determinants of HIV-positive patients. We have found that behavioral risk pattern exists in both genders and predominantely sexual in nature. Men are more compliant than women regarding treatment, but exhibit high levels in the hostility dimension. Indeed, in HIV infection, there's a limited perception of control over disease, which contributes to an adaptation guided by feelings of inadequacy. We underline the vulnerability in the female gender, since women had a behavioral pattern of significant risk.

  7. The natural history of HIV infection

    DEFF Research Database (Denmark)

    Sabin, C.A.; Lundgren, J.D.

    2013-01-01

    PURPOSE OF REVIEW: To review recent published literature around three areas: long-term nonprogression/viral control; predictors of viral load set point/disease progression; and the potential impact of antiretroviral therapy (ART) in early HIV infection. RECENT FINDINGS: The natural course...... of untreated HIV infection varies widely with some HIV-positive individuals able to maintain high CD4 cell counts and/or suppressed viral load in the absence of ART. Although similar, the underlying mechanistic processes leading to long-term nonprogression and viral control are likely to differ. Concerted...... the immunological deterioration which would otherwise be seen in untreated HIV infection, recent studies do not address the longer term clinical benefits of ART at this very early stage. SUMMARY: A better understanding of the relative influences of viral, host, and environmental factors on the natural course of HIV...

  8. Antiretroviral Drugs Used in the Treatment of HIV Infection

    Science.gov (United States)

    ... Treatment Antiretroviral drugs used in the treatment of HIV infection Share Tweet Linkedin Pin it More sharing options ... Email Print Drugs Used in the Treatment of HIV Infection All FDA-approved medicines used in the treatment ...

  9. Virological response and resistances over 12 months among HIV-infected children less than two years receiving first-line lopinavir/ritonavir-based antiretroviral therapy in Cote d'Ivoire and Burkina Faso: the MONOD ANRS 12206 cohort.

    Science.gov (United States)

    Amani-Bosse, Clarisse; Dahourou, Désiré Lucien; Malateste, Karen; Amorissani-Folquet, Madeleine; Coulibaly, Malik; Dattez, Sophie; Emieme, Arlette; Barry, Mamadou; Rouzioux, Christine; N'gbeche, Sylvie; Yonaba, Caroline; Timité-Konan, Marguerite; Mea, Véronique; Ouédraogo, Sylvie; Blanche, Stéphane; Meda, Nicolas; Seguin-Devaux, Carole; Leroy, Valériane

    2017-04-25

    Lopinavir/ritonavir-based antiretroviral therapy (ART) is recommended for all HIV-infected children less than three years. However, little is known about its field implementation and effectiveness in West Africa. We assessed the 12-month response to lopinavir/ritonavir-based antiretroviral therapy in a cohort of West African children treated before the age of two years. HIV-1-infected, ART-naive except for a prevention of mother-to-child transmission (PMTCT), tuberculosis-free, and less than two years of age children with parent's consent were enrolled in a 12-month prospective therapeutic cohort with lopinavir/ritonavir ART and cotrimoxazole prophylaxis in Ouagadougou and Abidjan. Virological suppression (VS) at 12 months (viral load [VL] <500 copies/mL) and its correlates were assessed. Between May 2011 and January 2013, 156 children initiated ART at a median age of 13.9 months (interquartile range: 7.8-18.4); 63% were from Abidjan; 53% were girls; 37% were not exposed to any PMTCT intervention or maternal ART; mother was the main caregiver in 81%; 61% were classified World Health Organization Stage 3 to 4. After 12 months on ART, 11 children had died (7%), 5 were lost-to-follow-up/withdrew (3%), and VS was achieved in 109: 70% of children enrolled and 78% of those followed-up. When adjusting for country and gender, the access to tap water at home versus none (adjusted odds ratio (aOR): 2.75, 95% confidence interval (CI): 1.09-6.94), the mother as the main caregiver versus the father (aOR: 2.82, 95% CI: 1.03-7.71), and the increase of CD4 percentage greater than 10% between inclusion and 6 months versus <10% (aOR: 2.55, 95% CI: 1.05-6.18) were significantly associated with a higher rate of VS. At 12 months, 28 out of 29 children with VL ≥1000 copies/mL had a resistance genotype test: 21 (75%) had ≥1 antiretroviral (ARV) resistance (61% to lamivudine, 29% to efavirenz, and 4% to zidovudine and lopinavir/ritonavir), of which 11 (52%) existed before ART

  10. Ipsilateral Synchronous Manifestation of an HIV-Infection Associated ...

    African Journals Online (AJOL)

    Plunging ranula is a rare lesion and even more in HIV-infected patients. There has been only one case documented in a 15-year old that had the vertical form HIV-infection. We report a plunging ranula occurring simultaneously with a sublingual salivary gland sialocoele as two separate lesions in an HIV-infected female ...

  11. Supporting the sexual and reproductive rights of HIV-infected ...

    African Journals Online (AJOL)

    rights in South Africa are extended to HIV-infected individuals. In some settings health care providers may have a negative attitude towards sexual activity and childbearing by HIV-infected women.3,4 These attitudes are also reflected in popular opinions regarding the sexual and reproductive rights of HIV-infected.

  12. Longitudinal study on Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus nasopharyngeal colonization in HIV-infected and -uninfected infants vaccinated with pneumococcal conjugate vaccine.

    Science.gov (United States)

    Madhi, Shabir A; Izu, Alane; Nunes, Marta C; Violari, Avye; Cotton, Mark F; Jean-Philippe, Patrick; Klugman, Keith P; von Gottberg, Anne; van Niekerk, Nadia; Adrian, Peter V

    2015-05-28

    Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus are all potentially pathogenic, which frequently colonize the nasopharynx (NP) prior to causing disease. We studied bacterial NP-colonization in 321 HIV-infected and 243 HIV-uninfected children vaccinated with 7-valent pneumococcal conjugate vaccine (PCV7) at 6, 10 and 14 weeks of age. HIV-uninfected infants included those born to HIV-uninfected (HUU) and HIV-infected women (HEU); HIV-infected children with CD4+ lymphocyte ≥25% were randomized to initiate antiretroviral therapy immediately (ART-Immed) or when clinically indicated (ART-Def). Nasopharyngeal swabs for bacterial culture were taken prior to each PCV7 dose (Visits 1-3) and at 20, 39, 47 and 67 weeks of age (Visits 4-7). Swabs were cultured by standard methods and pneumococcal serotyping done by the Quellung method. Colonization patterns for pneumococcus, H. influenzae and S. aureus did not differ between HUU and HEU children; and were also generally similar between ART-Def and ART-Immed children. Prevalence of PCV7-serotype colonization was similar between HIV-infected and HIV-uninfected children, however, overall pneumococcal and specifically non-vaccine serotype colonization tended to be lower in HIV-infected children. HIV-infected children also had a 44% lower prevalence of S. aureus colonization at Visit-1 (p=0.010); and H. influenzae colonization was also lower among HIV-infected than HIV-uninfected children at Visit-2, Visit-3, Visit-6 and Visit-7. Vaccine-serotype colonization is similar in PCV-immunized HIV-infected and HIV-uninfected children. We, however, identified a lower prevalence of overall-pneumococcal and H. influenzae colonization in HIV-infected children post-PCV vaccination, the clinical-relevance of which warrants further study. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Factors associated with utilization of insecticide-treated nets in children seeking health care at a Ugandan hospital: perspective of child caregivers.

    Science.gov (United States)

    Nankinga, Ziadah; Muliira, Joshua Kanaabi; Kalyango, Joan; Nankabirwa, Joaniter; Kiwuwa, Steven; Njama-Meya, Denise; Karamagi, Charles

    2012-10-01

    In Uganda malaria causes more morbidity and mortality than any other disease and children below 5 years contribute the biggest percentage of malaria related mortality. Insecticide treated nets (ITNs) are currently one of the most cost effective option for reducing malaria-related morbidity and mortality, however the factors affecting their utilization in Uganda are still not well understood. This study examined the prevalence and factors associated with ITN utilization among children of age 0-12 years seeking health care from a Ugandan hospital using caregiver's reports. A cross sectional design was used to collect data using a semi-structured questionnaire from 418 participants. Binary logistic regression was employed to determine predictors of ITN utilization. Results show that the prevalence of ITN utilization among children seeking health care was 34.2%. ITN utilization was higher among children of age children aged ≥5 years [22.9, 95% CI 13.77-32.01]. Source of mosquito net (OR = 13.53, 95% CI = 6.47-28.27), formal employment by head of household (OR = 6.00, 95% CI = 1.95-18.48), sharing a bed with parent (s) (OR = 2.61, 95% CI = 1.21-5.63) and number of children below 12 years in a household (OR = 0.80, 95% CI = 0.65-0.99), were significant predictors of utilization. ITN utilization among children was below the set national target. The predictors identified by this study reveal opportunities that can be taken advantage of by malaria control programs to achieve the desired rates of utilization and subsequently malaria prevention in children.

  14. Communication between HIV-infected children and their caregivers about HIV medicines: a cross-sectional study in Jinja district, Uganda

    Directory of Open Access Journals (Sweden)

    Phoebe Kajubi

    2014-07-01

    Full Text Available Introduction: Knowledge of antiretroviral therapy (ART among children with HIV depends on open communication with them about their health and medicines. Guidelines assign responsibility for communication to children's home caregivers. Other research suggests that communication is poor and knowledge about ART is low among children on treatment in low-income countries. This study sought to describe communication about medicine for HIV in quantitative terms from the perspectives of both children and caregivers. Thereafter, it established the factors associated with this communication and with children's knowledge about their HIV medicines. Methods: We undertook a cross-sectional survey of a random sample of 394 children with HIV on treatment and their caregivers at nine health facilities in Jinja District, Uganda. We assessed reported frequency and content of communication regarding their medicines as well as knowledge of what the medicines were for. Logistic regression analysis was used to determine the factors associated with communication patterns and children's knowledge of HIV medicines. Results: Although 79.6% of the caregivers reported that they explained to the children about the medicines, only half (50.8% of the children said they knew that they were taking medicines for HIV. Older children aged 15–17 years were less likely to communicate with a caregiver about the HIV medicines in the preceding month (OR 0.5, 95% CI 0.3–0.7, p=0.002. Children aged 11–14 years (OR 6.1, 95% CI 2.8–13.7, p<0.001 and 15–17 years (OR 12.6, 95% CI 4.6–34.3, p<0.001 were more likely to know they were taking medicines for HIV compared to the younger ones. The least common reported topic of discussion between children and caregivers was “what the medicines are for” while “the time to take medicines” was by far the most mentioned by children. Conclusions: Communication about, and knowledge of, HIV medicines among children with HIV is low. Young

  15. Anthropometric measurements and lipid profiles to detect early lipodystrophy in antiretroviral therapy experienced HIV-infected children in the CHAPAS-3 trial

    NARCIS (Netherlands)

    Musiime, V.; Cook, A.; Kayiwa, J.; Zangata, D.; Nansubuga, C.; Arach, B.; Kenny, J.; Wavamunno, P.; Komunyena, J.; Kabamba, D.; Asiimwe, A.R.; Mirembe, G.; Abongomera, G.; Mulenga, V.; Kekitiinwa, A.; Kityo, C.; Walker, S.A.; Klein, N.; Gibb, D.M.; Burger, D.M.; Fillekes, Q.

    2014-01-01

    BACKGROUND: Few studies have investigated objective markers of lipodystrophy in African children. We compared body circumferences, skin-fold thickness (SFT) and lipids in antiretroviral therapy (ART)-naive and stavudine (d4T)-exposed children with HIV-uninfected controls. METHODS: In the CHAPAS-3

  16. CANDIDURIA AMONG HIV- INFECTED PATIENTS ATTENDING A ...

    African Journals Online (AJOL)

    colonization and infection or between upper or lower urinary tract infections. Objective: This study focused on determining the spectrum of Candida species implicated in candiduria among HIV-infected individuals and their susceptibility to .... found in urine of neonates and is usually associated with systemic infection in this ...

  17. Brucella Infection in HIV Infected Patients

    Directory of Open Access Journals (Sweden)

    SeyedAhmad SeyedAlinaghi

    2011-12-01

    Full Text Available The purpose of this study was to assess the possible correlation between Brucella and HIV infections. Iran is a country where HIV infection is expanding and Brucellosis is prevalent. In the present study, 184 HIV infected patients were assigned and for all of them HIV infection was confirmed by western blot test. In order to identify the prevalence rate of Brucella infection and systemic brucellosis in these subjects, sera samples were obtained and Brucella specific serological tests were performed to reveal antibody titers. Detailed history was taken and physical examination was carried out for all of patients. 11 (6% subjects had high titers but only 3 of them were symptomatic. Most of these subjects were injection drug user (IDU men and one was a rural woman. Considering both prevalence rates of Brucella infection (3% and symptomatic brucellosis (0.1% in Iran, our HIV positive patients show higher rates of Brucella infection and systemic brucellosis. Preserved cellular immunity of participants and retention of granulocytes activity may explain this poor association; whereas other explanations such as immunological state difference and non-overlapping geographical distribution of the 2 pathogens have been mentioned by various authors.

  18. cal lymphadenopathy among HIV-infected

    African Journals Online (AJOL)

    Mulago Palliative Care Unit, Kampala, Uganda. 6. Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda. Abstract. Background: Opportunistic infections and malignancies cause lymphadenopathy in HIV-infected patients. The use and accuracy of fine needle aspiration cytology in ...

  19. Human immunodeficiency virus (HIV) infection in tuberculosis ...

    African Journals Online (AJOL)

    BACKGROUND: In a country with a rapidly spreading HIV epidemic information regarding HIV and TB Co-infection are lacking. OBJECTIVES: To determine the prevalence of HIV infection in a representative sample of sputum-positive tuberculosis patients. METHODS: A cross-sectional survey whereby blood sample was ...

  20. Articular syndromes in association with HIV infection

    African Journals Online (AJOL)

    2011-08-03

    Aug 3, 2011 ... HIV-related vasculitis, protein S deficiency, antiphospholipid antibodies, antiretroviral therapy, especially protease inhibitors and hyperlipidaemia, which may also be related to antiretroviral therapy. These factors, together with alcohol abuse and severe immunosuppression associated with HIV infection, ...

  1. CANDIDURIA AMONG HIV- INFECTED PATIENTS ATTENDING A ...

    African Journals Online (AJOL)

    Background: Candiduria is a common finding. However, in immunocompromised patients like HIV-infected individuals, it has high risk of ... highly active antiretroviral therapy (HAART). Female gender was a significant risk factor for acquiring candiduria. ..... Biofilm formation by and antifungal susceptibility of Candida isolates.

  2. Kaleidoscope of autoimmune diseases in HIV infection.

    Science.gov (United States)

    Roszkiewicz, Justyna; Smolewska, Elzbieta

    2016-11-01

    Within the last 30 years, the human immunodeficiency virus (HIV) infection has changed its status from inevitably fatal to chronic disorder with limited impact on life span. However, this breakthrough was mainly the effect of introduction of the aggressive antiviral treatment, which has led to the clinically significant increase in CD4+ cell count, resulting in fewer cases of the acquired immunodeficiency syndrome (AIDS) and improved management of opportunistic infections occurring in the course of the disease. The occurrence of a particular autoimmune disease depends on degree of immunosuppression of the HIV-positive patient. In 2002, four stages of autoimmunity were proposed in patients infected by HIV, based on the absolute CD4+ cell count, feature of AIDS as well as on the presence of autoimmune diseases. Spectrum of autoimmune diseases associated with HIV infection seems to be unexpectedly wide, involving several organs, such as lungs (sarcoidosis), thyroid gland (Graves' disease), liver (autoimmune hepatitis), connective tissue (systemic lupus erythematosus, rheumatoid arthritis, polyarteritis nodosa and other types of vasculitis, antiphospholipid syndrome) or hematopoietic system (autoimmune cytopenias). This paper contains the state of art on possible coincidences between HIV infection and a differential types of autoimmune diseases, including the potential mechanisms of this phenomenon. As the clinical manifestations of autoimmunization often mimic those inscribed in the course of HIV infection, health care providers should be aware of this rare but potentially deadly association and actively seek for its symptoms in their patients.

  3. Overestimating HIV infection: The construction and accuracy of subjective probabilities of HIV infection in rural Malawi

    OpenAIRE

    Anglewicz, Philip; Kohler, Hans-Peter

    2009-01-01

    In the absence of HIV testing, how do rural Malawians assess their HIV status? In this paper, we use a unique dataset that includes respondents' HIV status as well as their subjective likelihood of HIV infection. These data show that many rural Malawians overestimate their likelihood of current HIV infection. The discrepancy between actual and perceived status raises an important question: Why are so many wrong? We begin by identifying determinants of self-assessed HIV status, and then compar...

  4. Human immune deficiency virus (HIV) infection during pregnancy at Gadarif hospital, Eastern Sudan.

    Science.gov (United States)

    Adam, Gamal K; Ahmed, Mohammed Ahmed A; Ali, AbdelAziem A

    2016-10-01

    This was a prospective study conducted on all pregnant and parturient women attending Gadarif Maternity Hospital, Sudan from January 2009 to December 2013 to investigate the maternal characteristics, pregnancy outcomes and estimate of maternal to child transmission of HIV among HIV infected women. During the study period, there were 26 HIV positive mothers among 6420 tested women yielding an incidence rate of 0.4%. The majority of these 26 infected women were of urban residence (69.2%), presented with normal CD4+ T cell count; ? 350\\cu. mm3 (96.2%), had less than secondary education (57.7%) and housewives (84.6%). The mean age (SD) was significantly varied between the sero-positive and sero-negative women, 25.9 (5.7) vs. 36.1 (5.7), p = HIV infected until the age of 96 weeks. It is thus HIV infected women in eastern Sudan were young and likely desire more children.

  5. [Gastrointestinal diseases associated with HIV infection].

    Science.gov (United States)

    Sakamoto, M; Adachi, T; Sagara, H; Yoshikawa, K

    2000-01-01

    A clinical studies were carried out on gastrointestinal diseases associated with HIV infection. During the 6 years between January 1993 and December 1998, 71 HIV infected cases visited to Yokohama Municipal Citizen's hospital, and 26 of them developed gastrointestinal complications during the course of their illness. They consisted of 24 males and 2 females, with the mean age of 44.7 years and the medial value of 42.5 years. Of the 26 patients, 21 were Japanese, and the remaining 5 were Southeast Asian. The mean CD4 count was 143/microliter and the medial value was 32/microliter at the time of development of complications. Gastrointestinal complications were esophageal candidiasis in 6 patients, cytomegalovirus (CMV) gastritis and gastric Kaposi's sarcoma in 1 patient each, amebiasis in 8 patients, infectious colitis in 11 patients, and asymptomatic pathogen carriers in 3 patients. Esophageal and gastric complications were common in patients with low count of CD4, and endoscopy was useful for diagnosis. Amebiasis developed even in patients with normal CD4 and was common in males with experience in homosexual contact. It seems that homosexual contact acquire not only HIV infection but also Entamoeba histolytica through sexual contact. Protozoan and acid-fast bacteria were detected at high rate in patients with infectious colitis and asymptomatic pathogen carriers. Besides food-born infections, imported infections were seen in foreign and Japanese patients who had traveled abroad. The gastrointestinal diseases associated with HIV infections for the most part were opportunistic infections or tumors but imported, food-born, and sexually transmitted infections were also observed. It seems necessary to take into consideration of varying background of patients in the treatment of gastrointestinal diseases associated with HIV infections.

  6. Early increases in concentrations of total, LDL, and HDL cholesterol in HIV-infected children following new exposure to antiretroviral therapy.

    Science.gov (United States)

    Sztam, Kevin A; Jiang, Hongyu; Jurgrau, Andrea; Deckelbaum, Richard J; Foca, Marc D

    2011-04-01

    Antiretroviral therapy (ART) is associated with dyslipidemia and cardiovascular disease in adults infected with HIV. For children perinatally infected with HIV, ART exposure is lifelong and early-onset dyslipidemia could have significant long-term effects. We examined cholesterol levels in children during the first year after exposure to a new ART regimen (initiation or switch). In 52 children, total cholesterol increased by 30.5 and 43 mg/dL at 6 and 12 months, respectively (P < 0.001). Low-density lipoprotein cholesterol made the largest contribution, but high-density lipoprotein cholesterol also increased within months of therapy alteration. Early identification of these children and intervention could mediate potential increased risk for future cardiovascular disease.

  7. The role of parenting in affecting the behavior and adaptive functioning of young children of HIV-infected mothers in South Africa.

    Science.gov (United States)

    Allen, Alexandra Boeving; Finestone, Michelle; Eloff, Irma; Sipsma, Heather; Makin, Jennifer; Triplett, Kelli; Ebersöhn, Liesel; Sikkema, Kathleen; Briggs-Gowan, Margaret; Visser, Maretha; Ferreira, Ronél; Forsyth, Brian W C

    2014-03-01

    Prior investigations suggest that maternal HIV/AIDS poses significant challenges to young children. This study investigates the relationships between mothers' psychological functioning, parenting, and children's behavioral outcomes and functioning in a population of women living with HIV (N = 361) with a child between the ages of 6 and 10 years in Tshwane, South Africa. Utilizing path analysis, findings revealed that maternal depression is related to increased parenting stress and parent-child dysfunction, maternal coping is related to parenting style, and maternal coping, parenting style and stress, and parent-child dysfunction are associated with children's behavior and functioning, with parenting emerging as an important mediator. These findings suggest that interventions for women living with HIV and their children should not only address maternal psychological functioning (depression and coping), but should also focus on parenting, promoting a positive approach.

  8. Predictors of Delayed Entry into Medical Care of Children Diagnosed with HIV Infection: Data from an HIV Cohort Study in India

    Directory of Open Access Journals (Sweden)

    Gerardo Alvarez-Uria

    2013-01-01

    Full Text Available Data about the attrition before entry into care of children diagnosed with HIV in low- or middle-income countries are scarce. The aim of this study is to describe the attrition before engagement in HIV medical care in 523 children who were diagnosed with HIV from 2007 to 2012 in a cohort study in India. The cumulative incidence of children who entered into care was 87.2% at one year, but most children who did not enter into care within one year were lost to followup. The mortality before entry into care was low (1.3% at one year and concentrated during the first three months after HIV diagnosis. Factors associated with delayed entry into care were being diagnosed after mother’s HIV diagnosis, belonging to scheduled castes, age 90 minutes from the HIV centre. Children whose parents were alive and were living in a rented house were at a higher risk of delayed entry into care than those who were living in an owned house. The results of this study can be used to improve the linkage between HIV testing and HIV care of children diagnosed with HIV in India.

  9. The impact of HIV infection and disease stage on the rate of weight ...

    African Journals Online (AJOL)

    Background. Evidence of the effects of HIV infection and clinical stage on the duration of refeeding and treatment (DRT) and the rate of weight gain (RWG) in severely malnourished children remains inconclusive. Objectives. To determine whether the RWG and DRT differ by baseline clinical characteristics, and to assess the ...

  10. Childbearing intentions among sexually active HIV-infected and HIV-uninfected female adolescents in South Africa.

    Science.gov (United States)

    Adler, David H; Abar, Beau; Bennie, Thola; Sadeghi, Rokhsanna; Bekker, Linda-Gail

    2017-07-01

    Women of reproductive age account for nearly half of all HIV-infected people worldwide. Childbearing intention among HIV-infected women is complicated by social and reproductive concerns related to their HIV status. We conducted a cross-sectional study of HIV-infected and HIV-uninfected sexually active South African women aged 17 to 21 in order to compare their childbearing intentions and to identify predictors of the desire to have children among women with HIV. We found the rate of childbearing intention to be similarly high among both HIV-infected and HIV-uninfected study participants (80 and 79% respectively, p=0.81). History of previous parity was found to be associated with decreased intention to have children. No difference in childbearing intention was found between HIV-infected women on anti-retroviral therapy (ART) and women not on ART. High rates of childbearing intention among HIV-infected women require integration of reproductive health services with comprehensive HIV/AIDS care in order to mitigate the risks of sexual and vertical transmission of HIV.

  11. Body mass index and waist circumference of HIV-infected youth in a Miami cohort: comparison to local and national cohorts.

    Science.gov (United States)

    Arbeitman, Lori E; O'Brien, Robert C; Somarriba, Gabriel; Messiah, Sarah E; Neri, Daniela; Scott, Gwendolyn B; Miller, Tracie L

    2014-10-01

    Human immunodeficiency virus (HIV)-infected youth are healthier because of effective antiretroviral therapies. We compared anthropometric measurements and prevalence of overweight and obesity between perinatally HIV-infected youth, a local HIV-uninfected comparison group, and 2007 to 2010 National Health and Nutrition Examination Survey (NHANES) data. In addition, we compared only African American HIV-infected youth with NHANES African Americans. Height, weight, body mass index (BMI), and waist circumference (WC) of HIV-infected youth, aged 10 to 19 years, were compared among groups. BMI percentiles were categorized as underweight (<5%), normal (5% to <85%), overweight (85% to <95%), and obese (≥ 95%). Clinical correlates were modeled as predictors of BMI and WC. A total of 134 HIV-infected (including 103 African Americans) (mean age 16.5 years), 75 HIV-uninfected (mean age 14.2 years), and 3216 NHANES (including 771 NHANES African Americans) (mean age 15.0 years) youth were included in the analysis. Height and weight z scores of HIV-infected youth were lower than those of HIV-uninfected and NHANES (P ≤ 0.056) youth. BMI, WC, and BMI category were not statistically different between groups. In the HIV-infected African American group, BMI z score was lower (0.49 vs 0.76, P = 0.04) compared with NHANES African Americans. There were no significant predictors of BMI or WC for the HIV-infected group. HIV-infected children have similar BMIs and WCs as uninfected children both locally and nationally and show similar high rates of obesity and overweight. When compared with a more racially similar African American national sample, HIV-infected children have a lower BMI, suggesting that there may be persistent anthropometric differences in HIV.

  12. Prediction of treatment failure using 2010 World Health Organization Guidelines is associated with high misclassification rates and drug resistance among HIV-infected Cambodian children.

    Science.gov (United States)

    Westley, Benjamin P; DeLong, Allison K; Tray, Chhraing S; Sophearin, Dim; Dufort, Elizabeth M; Nerrienet, Eric; Schreier, Leeann; Harwell, Joseph I; Kantor, Rami

    2012-08-01

    Antiretroviral therapy (ART) in resource-limited settings (RLSs) is monitored clinically and immunologically, according to World Health Organization (WHO) or national guidelines. Revised WHO pediatric guidelines were published in 2010, but their ability to accurately identify virological failure is unclear. We evaluated performance of WHO 2010 guidelines and compared them with WHO 2006 and Cambodia 2011 guidelines among children on ≥6 months of first-line ART at Angkor Hospital for Children between January 2005 and September 2010. We determined sensitivity, specificity, positive and negative predictive values, and accuracy using bootstrap resampling to account for multiple tests per child. Human immunodeficiency virus (HIV) resistance was compared between those correctly and incorrectly identified by each guideline. Among 457 children with 1079 viral loads (VLs), 20% had >400 copies/mL. For children with WHO stage 1/2 HIV, misclassification as failure (met CD4 failure criteria, but VL undetectable) was 64% for WHO 2006 guidelines, 33% for WHO 2010 guidelines, and 81% for Cambodia 2011 guidelines; misclassification as success (did not meet CD4 failure, but VL detectable) was 11%, 12%, and 12%, respectively. For children with WHO stage 3/4 HIV, misclassification as failure was 35% for WHO 2006 guidelines, 40% for WHO 2010 guidelines, and 43% for Cambodia 2011 guidelines; misclassification as success was 13%, 24%, and 21%, respectively. Compared with WHO 2006 guidelines, WHO 2010 guidelines significantly increased the risk of misclassification as success in stage 3/4 HIV (P < .05). The WHO 2010 guidelines failed to identify 98% of children with extensive reverse-transcriptase resistance. In our cohort, lack of virological monitoring would result in unacceptable treatment failure misclassification, leading to premature ART switch and resistance accumulation. Affordable virological monitoring suitable for use in RLSs is desperately needed.

  13. Effectiveness of Efavirenz-Based Regimens in Young HIV-Infected Children Treated for Tuberculosis: A Treatment Option for Resource-Limited Settings

    NARCIS (Netherlands)

    J.H. van Dijk (Janneke); C.G. Sutcliffe (Catherine); F. Hamangaba (Francis); C. Bositis (Christopher); D.C. Watson (Douglas); W.J. Moss (William)

    2013-01-01

    textabstractBackground: Antiretroviral treatment (ART) options for young children co-infected with HIV and tuberculosis are limited in resource-poor settings due to limited data on the use of efavirenz (EFV). Using available pharmacokinetic data, an EFV dosing schedule was developed for young

  14. Report of the Surgeon General's Workshop on Children with HIV Infection and Their Families (Philadelphia, Pennsylvania, April 6-9, 1987).

    Science.gov (United States)

    Silverman, Benjamin K., Ed.; Waddell, Anthony, Ed.

    This publication summarizes current knowledge about Acquired Immunodeficiency Syndrome (AIDS) in children and recommends future directions for research, prevention, and amelioration of the effects of pediatric AIDS. After an excerpt from Surgeon General Koop's keynote address, contents provide selections from workshop presentations concerning (1)…

  15. Strategies for nevirapine initiation in HIV-infected children taking pediatric fixed-dose combination "baby pills" in Zambia: a randomized controlled trial.

    NARCIS (Netherlands)

    Mulenga, V.; Cook, A.; Walker, A.S.; Kabamba, D.; Chijoka, C.; Ferrier, A.; Kalengo, C.; Kityo, C.; Kankasa, C.; Burger, D.M.; Thomason, M.; Chintu, C.; Gibb, D.M.

    2010-01-01

    BACKGROUND: Fixed-dose combination scored dispersible stavudine, lamivudine, and nevirapine minitablets (Triomune Baby and Junior; Cipla Ltd) are simpler and cheaper than liquid formulations and have correct dose ratios for human immunodeficiency virus-infected children. However, they cannot be used

  16. Child mortality in relation to HIV infection, nutritional status, and socio-economic background.

    Science.gov (United States)

    Villamor, Eduardo; Misegades, Lara; Fataki, Maulidi R; Mbise, Roger L; Fawzi, Wafaie W

    2005-02-01

    The aims of this study were to examine the impact of child HIV infection on mortality and to identify nutritional and sociodemographic factors that increase the risk of child mortality independent of human immunodeficiency virus (HIV) infection. We conducted a prospective study in Dar es Salaam, Tanzania, among 687 children 6-60 months of age who were admitted to hospital with pneumonia. After discharge, children were followed up every 2 weeks during the first year and every 4 months thereafter. Sociodemographic characteristics were determined at baseline, and HIV status, haemoglobin, and malaria infection were assessed from a blood sample. During the first year of follow-up, we measured height, weight, and mid-upper arm circumference (MUAC) monthly. We estimated the risk of mortality according to HIV status and socio-economic characteristics using Cox proportional hazards models. Nutritional status variables (wasting and stunting) were examined as time-varying risk factors. Mean age at enrollment was 18 months. A total of 90 children died during an average 24.7 months of follow-up. HIV infection was associated with an adjusted 4-fold higher risk of mortality [relative risk (RR) = 3.92, 95% confidence interval (CI) 2.34-6.55, P pneumonia. Preventable conditions including inadequate water supply, child undernutrition, and anaemia contribute significantly to infant and child mortality independent of HIV infection.

  17. The Role of Parenting in Affecting the Behavior and Adaptive Functioning of Young Children of HIV-Infected Mothers in South Africa

    OpenAIRE

    Allen, Alexandra Boeving; Finestone, Michelle; Eloff, Irma; Sipsma, Heather; Makin, Jennifer; Triplett, Kelli; Ebersöhn, Liesel; Sikkema, Kathleen; Briggs-Gowan, Margaret; Visser, Maretha; Ferreira, Ronél; Forsyth, Brian W. C.

    2014-01-01

    Prior investigations suggest that maternal HIV/AIDS poses significant challenges to young children. This study investigates the relationships between mothers’ psychological functioning, parenting, and children’s behavioral outcomes and functioning in a population of women living with HIV (N = 361) with a child between the ages of 6 and 10 years in Tshwane, South Africa. Utilizing path analysis, findings revealed that maternal depression is related to increased parenting stress and parent–chil...

  18. Temporal Improvements in Long-Term Outcome in Care Among HIV Infected Children Enrolled in Public ART Care: An Analysis of Outcomes From 2004-2012 in Zimbabwe.

    Science.gov (United States)

    Makadzange, A Tariro; Dougherty, Leanne; Birri, Rutendo; Kupakuwana, Gillian; van Dijk, Janneke; Bwakura Dangarembizi, Mutsa; Mothobi, Nomvuyo; Phelps, Benjamin; Ojikutu, Bisola; Ndhlovu, Chiratidzo E

    2018-01-18

    Increasing numbers of children are requiring long-term HIV care and antiretroviral treatment (ART) in public ART programs in Africa but temporal trends and long-term outcomes in care remain poorly understood. We analyzed outcomes in a longitudinal cohort of infants (enrolling in a public tertiary ART center in Zimbabwe over an eight-year period (2004-2012). The clinic enrolled 1644 infants and children; the median age at enrollment was 39 months (IQR 14-79), with a median CD4% of 17.0 (IQR 11, 24) in infants and 15.0 (9, 23% in children (p=0.0007). Among those linked to care 33.5% dropped out of care within the first 3-months of enrollment. Following implementation of revised guidelines in 2009, decentralization of care and increased access to PMTCT services, we observed an increase in infants (48.9% to 68.3%, penrolled from 2009 were younger, had lower WHO clinical stage, improved baseline CD4 counts than those who enrolled in 2004-2008. Long-term retention in care also improved with decreasing risk of loss from care at 36-months for infants enrolled from 2009 (aHR 0.57 (95%CI: 0.34-0.95), p=0.031). ART eligibility at enrollment was a significant predictor of long-term retention in care while delayed ART initiation after age 5 years resulted in failure to fully reconstitute CD4 counts to age-appropriate levels despite prolonged ART. Significant improvements have been made in engaging and retaining children in care in public ART programs in Zimbabwe. Guideline and policy changes that increase access and eligibility will likely to continue to support improvement in pediatric HIV outcomes.

  19. [Use of darunavir in HIV-infected women during pregnancy].

    Science.gov (United States)

    Afonina, L Iu; Voronin, E E

    2013-01-01

    The use of antiretroviral drugs (ARVDs) in a mother and a child can reduce the risk of vertical transmission of human immunodeficiency virus (HIV) to less than 1%; therefore, highly active antiretroviral therapy is used in all pregnant women regardless of indications for HIV-infection treatment. The major requirements for choosing an ARVD to prevent mother-to-child HIV transmission are its high safety for a pregnant woman, a fetus, and a baby and its high therapeutic efficacy. Clinical trials of darunavir (DRV) in adults and children have shown a high virologic response, good tolerance, and safety. Trials and observations have demonstrated the high efficacy and safety of a DRV when used in pregnant women. Pharmacokinetic studies in pregnant women have indicated the effective and well-tolerated concentration of a DRV when it is co-administered with low-dose ritonavir, which permits the use of a DRV for both the prevention of mother-to-child HIV transmission and the treatment of pregnant women who require antiretroviral therapy. The Russian clinical protocol "Use of ARVDs in the package of measures for the prevention of mother-to-child HIV transmission" approved by the National Scientific Society of Infectiologists in 2013 recommends DRV as an alternative drug in antiretroviral therapy regimens for pregnant women to prevent mother-to-child HIV transmission and to treat maternal HIV infection.

  20. Intestinal Damage and Inflammatory Biomarkers in Human Immunodeficiency Virus (HIV)-Exposed and HIV-Infected Zimbabwean Infants.

    Science.gov (United States)

    Prendergast, Andrew J; Chasekwa, Bernard; Rukobo, Sandra; Govha, Margaret; Mutasa, Kuda; Ntozini, Robert; Humphrey, Jean H

    2017-09-15

    Disease progression is rapid in human immunodeficiency virus (HIV)-infected infants. Whether intestinal damage and inflammation underlie mortality is unknown. We measured plasma intestinal fatty acid binding protein (I-FABP), soluble CD14 (sCD14), interleukin 6 (IL-6), and C-reactive protein (CRP) at 6 weeks and 6 months of age in 272 HIV-infected infants who either died (cases) or survived (controls), and in 194 HIV-exposed uninfected (HEU) and 197 HIV-unexposed infants. We estimated multivariable odds ratios for mortality and postnatal HIV transmission for each biomarker using logistic regression. At 6 weeks, HIV-infected infants had higher sCD14 and IL-6 but lower I-FABP than HIV-exposed and HIV-unexposed infants (P HIV-exposed than HIV-unexposed infants (P = .02). At 6 months, HIV-infected infants had highest sCD14, IL-6, and CRP concentrations (P HIV-exposed vs HIV-unexposed infants (P = .04). No biomarker was associated with mortality in HIV-infected infants, or with odds of breast-milk HIV transmission in HIV-exposed infants. HIV-infected infants have elevated inflammatory markers by 6 weeks of age, which increase over time. In contrast to adults and older children, inflammatory biomarkers were not associated with mortality. HEU infants have higher inflammation than HIV-unexposed infants until at least 6 months, which may contribute to poor health outcomes.

  1. HIV Infection and Osteoarticular Tuberculosis: Strange Bedfellows

    Directory of Open Access Journals (Sweden)

    B. Hodkinson

    2016-01-01

    Full Text Available We report the case of a 47-year-old female patient with rheumatoid arthritis and HIV infection presenting with a 3-week history of a painful swollen knee, increased serum inflammatory markers, and a low CD4 lymphocyte count. The diagnosis of TB arthritis was made by synovial fluid culture, GeneXpert/PCR, and confirmed by histopathology of a synovial biopsy. A mini literature review suggests that although HIV infection is associated with extrapulmonary TB, osteoarticular TB is a relatively unusual presentation in an HIV positive patient. The diagnostic utility of the GeneXpert test is explored. We also describe the patient’s good response to an intra-articular corticosteroid injection in combination with standard anti-TB therapy.

  2. [Problems of early detection of HIV infection, medical and psychological support of HIV-infected soldiers].

    Science.gov (United States)

    Uliukin, I M; Bolekhan, V N; Iusupov, V V; Bulan'kov, Iu I; Orlova, E S

    2015-01-01

    The article contains the analysis of materials about HIV infection and the status of work on its early detection among soldiers. Currently, the figures have a tendency to stabilization, but there is an increase in the persantage of HIV-infected persons performing military service under the contract, as well as the actualization sexual way of infection. The insufficient effectiveness of the barrier screening during the laboratory examination of recruits may contribute the increase in the incidence of HIV infection. Have been reviewed the questions medical-diagnostic and medical-psychological support of HIV-infected soldiers. Been analyzed the social consequences of delays in seeking medical help of patients in this group, the opportunities and challenges of their dispensary observation. It was noted that early detection of HIV infection and proper medical and psychological support in the dynamics of pathological process helps to reduce the number of new cases and improve their outcomes and to reduce the period of efficiency recovery of military personnel.

  3. Trends in malaria-attributable morbidity and mortality among young children admitted to Ugandan hospitals, for the period 1990-2001.

    Science.gov (United States)

    Ndyomugyenyi, R; Magnussen, P

    2004-06-01

    A retrospective study based on paediatric ward registers was conducted in the Ugandan districts of Hoima and Kabale, which are areas of stable and unstable malaria transmission, respectively. The records of Hoima hospital from 1990 to 2001 and of Kabale hospital from 1994 to 2000 were reviewed and the initial diagnoses for all young children (i.e. those aged climate more conducive to mosquito survival and to parasite development in the vector, leading to increases in the intensity of transmission. At Hoima hospital, however, the increasing numbers of admissions for anaemia or malaria between 1990 and 2001 seem more likely to be the result of increased resistance to chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) in the parasites and to changes in treatment seeking behaviour. With the recent change in the national drug policy, from the use of CQ alone as the first-line treatment of uncomplicated malaria to the use of a combination of CQ with SP, and the abolition of user charges at government health facilities, a reversal of these worrying trends might be anticipated. Although it may be not be appropriate to extrapolate the conclusions of studies based on hospital records to the communities at risk of malaria, such conclusions do allow the health services to monitor general trends in the morbidity and mortality associated with malaria and anaemia.

  4. Impact of HIV infection on cardiac deformation.

    Science.gov (United States)

    Mendes, Lígia; Silva, Daniela; Miranda, Carla; Sá, Joana; Duque, Luís; Duarte, Nelson; Brito, Paula; Bernardino, Leonel; Poças, José

    2014-09-01

    The aim of this study was to detect abnormalities in left ventricular myocardial function due to HIV (human immunodeficiency virus) infection without established cardiovascular disease. An echocardiogram was performed in 50 asymptomatic HIV-infected patients (age 41 ± 6 years, 64% male) and in 20 healthy individuals. Conventional echocardiography and pulsed tissue Doppler imaging (TDI) were performed according to the guidelines. The strain rate of the basal segments was obtained with color tissue Doppler and used to evaluate systolic strain rate (SRS), early diastolic strain rate (SRE) and late diastolic strain rate (SRA). Longitudinal, radial and circumferential strain were assessed by 2D speckle tracking. The mean duration of HIV infection was 10 ± 5 years, CD4 count was 579 ± 286 cells/mm³, 32% had detectable viral load, and 86% were under treatment. Of the HIV-infected patients, one had grade 1 diastolic dysfunction. The groups were not different except for E wave (HIV 0.72 ± 0.17 m/s vs. control 0.84 ± 0.16 m/s, p=0.01), longitudinal strain (-19.5 ± 1.9% vs. -21 ± 2%, p=0.005), SRS (-1.1 ± 0.28 s⁻¹ vs. -1.3 ± 0.28 s⁻¹, p=0.02) and SRE (1.8 ± 0.4 s⁻¹ vs. 2.2 ± 0.4 s⁻¹, p<0.001), but only SRS (p=0.03, 95% CI 0.036; 0.67) and SRE (p=0.001, 95% CI -0.599; -0.168) had independent value. In an HIV-infected population without established cardiovascular disease, myocardial deformation abnormalities can be detected with strain and strain rate, revealing markers of myocardial injury. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  5. Virological response and resistances over 12 months among HIV-infected children less than two years receiving first-line lopinavir/ritonavir-based antiretroviral therapy in Cote d’Ivoire and Burkina Faso: the MONOD ANRS 12206 cohort

    Science.gov (United States)

    Amani-Bosse, Clarisse; Dahourou, Désiré Lucien; Malateste, Karen; Amorissani-Folquet, Madeleine; Coulibaly, Malik; Dattez, Sophie; Emieme, Arlette; Barry, Mamadou; Rouzioux, Christine; N’gbeche, Sylvie; Yonaba, Caroline; Timité-Konan, Marguerite; Mea, Véronique; Ouédraogo, Sylvie; Blanche, Stéphane; Meda, Nicolas; Seguin-Devaux, Carole; Leroy, Valériane

    2017-01-01

    Abstract Introduction: Lopinavir/ritonavir-based antiretroviral therapy (ART) is recommended for all HIV-infected children less than three years. However, little is known about its field implementation and effectiveness in West Africa. We assessed the 12-month response to lopinavir/ritonavir-based antiretroviral therapy in a cohort of West African children treated before the age of two years. Methods: HIV-1-infected, ART-naive except for a prevention of mother-to-child transmission (PMTCT), tuberculosis-free, and less than two years of age children with parent’s consent were enrolled in a 12-month prospective therapeutic cohort with lopinavir/ritonavir ART and cotrimoxazole prophylaxis in Ouagadougou and Abidjan. Virological suppression (VS) at 12 months (viral load [VL] <500 copies/mL) and its correlates were assessed. Results: Between May 2011 and January 2013, 156 children initiated ART at a median age of 13.9 months (interquartile range: 7.8–18.4); 63% were from Abidjan; 53% were girls; 37% were not exposed to any PMTCT intervention or maternal ART; mother was the main caregiver in 81%; 61% were classified World Health Organization Stage 3 to 4. After 12 months on ART, 11 children had died (7%), 5 were lost-to-follow-up/withdrew (3%), and VS was achieved in 109: 70% of children enrolled and 78% of those followed-up. When adjusting for country and gender, the access to tap water at home versus none (adjusted odds ratio (aOR): 2.75, 95% confidence interval (CI): 1.09–6.94), the mother as the main caregiver versus the father (aOR: 2.82, 95% CI: 1.03–7.71), and the increase of CD4 percentage greater than 10% between inclusion and 6 months versus <10% (aOR: 2.55, 95% CI: 1.05–6.18) were significantly associated with a higher rate of VS. At 12 months, 28 out of 29 children with VL ≥1000 copies/mL had a resistance genotype test: 21 (75%) had ≥1 antiretroviral (ARV) resistance (61% to lamivudine, 29% to efavirenz, and 4% to zidovudine and lopinavir

  6. B-cell responses to HIV infection.

    Science.gov (United States)

    Moir, Susan; Fauci, Anthony S

    2017-01-01

    The induction of neutralizing antibodies directed against the human immunodeficiency virus (HIV) has received considerable attention in recent years, in part driven by renewed interest and opportunities for antibody-based strategies for prevention such as passive transfer of antibodies and the development of preventive vaccines, as well as immune-based therapeutic interventions. Advances in the ability to screen, isolate, and characterize HIV-specific antibodies have led to the identification of a new generation of potent broadly neutralizing antibodies (bNAbs). The majority of these antibodies have been isolated from B cells of chronically HIV-infected individuals with detectable viremia. In this review, we provide insight into the phenotypic and functional attributes of human B cells, with a focus on HIV-specific memory B cells and plasmablasts/cells that are responsible for sustaining humoral immune responses against HIV. We discuss the abnormalities in B cells that occur in HIV infection both in the peripheral blood and lymphoid tissues, especially in the setting of persisting viremia. Finally, we consider the opportunities and drawbacks of intensively interrogating antibodies isolated from HIV-infected individuals to guide strategies aimed at developing effective antibody-based vaccine and therapeutic interventions for HIV. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  7. [Insurance legislation aspects and peculiarities of occupational legislation in AIDS and HIV infection].

    Science.gov (United States)

    Exner-Freisfeld, H; Stille, W

    1989-11-01

    Major aspects of the German insurance legislation regarding AIDS are being discussed. I. The structure of the statutory health and social security scheme is described; problems of coverage of persons with HIV Infection/AIDS in case of accident or unemployment are discussed (medical treatment, social security, pension). II. Private health insurance schemes are scrutinised as to the conditions for persons with HIV infection/AIDS. The aspect of coverage for children in private health schemes is also taken into account, and the differences between statutory and private health insurance schemes are considered. III. Criteria for life insurance contracts are described: it depends on the amount of money insured whether or not life insurance companies demand medical examination and HIV test from the policy holder. IV. Criteria for acknowledgement of AIDS as an occupational disease are pointed out. In particular, injuries at the place of work in connection with HIV-infected material, as well as methods of prevention, are discussed. V. Finally, labour legislation is investigated as to its consequences for persons with HIV infection/AIDS; the different aspects for employer and employee are considered, and problems like employment of persons with full-blown AIDS and termination of employment are explained.

  8. Recurrent pneumococcal meningitis in a splenectomised HIV-infected patient

    Directory of Open Access Journals (Sweden)

    Quesne Gilles

    2003-11-01

    Full Text Available Abstract Background Streptococcus pneumoniae is a major cause of human disease, especially in pre-school children and elderly people, as well as in special risk groups such as asplenic, antibody deficient patients, or presenting disruption of natural barriers. The occurrence of pneumococcal disease has increased with the onset of the HIV epidemic and the emergence of drug-resistance. Case presentation We report the case of an HIV-1-infected patient who experienced three episodes of recurrent pneumococcal meningitis over a 4-year period, despite chemoprophylaxis and capsular vaccination. Conclusions Efficacy of anti-pneumococcal chemoprophylaxis and vaccination in HIV-infected patients are discussed in the light of this particular case.

  9. Lymphocyte subsets in healthy Malawians: implications for immunologic assessment of HIV infection in Africa.

    Science.gov (United States)

    Mandala, Wilson L; MacLennan, Jenny M; Gondwe, Esther N; Ward, Steven A; Molyneux, Malcolm E; MacLennan, Calman A

    2010-01-01

    CD4(+)T lymphocyte measurements are the most important indicator of mortality in HIV-infected individuals in resource-limited settings. There is currently a lack of comprehensive immunophenotyping data from African populations to guide the immunologic assessment of HIV infection. To quantify variation in absolute and relative lymphocyte subsets with age in healthy Malawians. Lymphocyte subsets in peripheral blood of 539 healthy HIV-uninfected Malawians stratified by age were enumerated by flow cytometry. B and T-lymphocyte and T-lymphocyte subset absolute concentrations peaked in early childhood then decreased to adult levels, whereas lymphocyte subset proportions demonstrated much less variation with age. Adult lymphocyte subsets were similar to those in developed countries. In contrast, high B-lymphocyte and CD8(+)T-lymphocyte levels among children under 2 years, relative to those in developed countries, resulted in low CD4(+)T-lymphocyte percentages that varied little between 0 and 5 years (35% to 39%). The CD4(+)T-lymphocyte percentages in 35% of healthy children under 1 year and 18% of children age 1 to 3 years were below the World Health Organization threshold defining immunodeficiency in HIV-infected children in resource-limited settings. Thirteen percent of healthy children under 18 months old had a CD4:CD8T-lymphocyte ratio <1.0, which is commonly associated with HIV infection. All immunologic parameters except absolute natural killer lymphocyte concentration varied significantly with age, and percentage and overall absolute CD4(+)T-lymphocyte counts were higher in females than males. Although lymphocyte subsets in Malawian adults are similar to those from developed countries, CD4(+)T-lymphocyte percentages in young children are comparatively low. These findings need to be considered when assessing the severity of HIV-related immunodeficiency in African children under 3 years. Copyright 2010 American Academy of Allergy, Asthma & Immunology. Published by

  10. Fertility intentions of HIV-infected women in the United Kingdom.

    Science.gov (United States)

    Cliffe, Susan; Townsend, Claire L; Cortina-Borja, Mario; Newell, Marie-Louise

    2011-09-01

    In the United Kingdom (UK), the number of pregnancies in HIV-infected women has increased dramatically over the last decade, but attitudes towards childbearing among infected women have not been previously described. The aim of this survey was to explore fertility intentions among HIV-infected women and to assess the effect of HIV treatment and interventions for prevention of mother-to-child transmission (PMTCT) on these intentions. HIV-infected women, aged between 16 and 49 years, attending one of seven HIV clinics in the UK between July 2003 and January 2004 were asked to complete a questionnaire. Information on demographic factors, HIV test history, pregnancy history and fertility intentions (i.e., desire for children) was collected. Eighty-six per cent of eligible women (450/521) completed the questionnaire. Three quarters of women (336/450) reported that they wanted (more) children. Forty-five per cent (201/450) reported that HIV diagnosis did not affect their fertility intentions, 11% (50/450) that it made them want children sooner, and 10% (44/450) did not know or reported other views. About one third of women (155/450) decided they no longer wanted children after their HIV diagnosis, but 41% of these (59/144) had changed their mind following advances in HIV management and treatment. Factors associated with an increase in fertility intentions after advances in HIV management and treatment were being in a partnership and having fewer than two children. In this survey of HIV-infected women, the majority wanted children and women were more likely to want children after improvements in HIV management and treatment. These findings highlight the need for specialised family planning and reproductive health services targeting this population.

  11. Caregivers' depressive symptoms and parent-report of child executive function among young children in Uganda.

    Science.gov (United States)

    Familiar, Itziar; Nakasujja, Noeline; Bass, Judith; Sikorskii, Alla; Murray, Sarah; Ruisenor-Escudero, Horacio; Bangirana, Paul; Opoka, Robert; Boivin, Michael J

    2016-02-01

    Maternal mental health (particularly depression) may influence how they report on their child's behavior. Few research studies have focused on Sub-Saharan countries where pediatric HIV concentrates and impacts child neuropsychological development and caregiver mental health. We investigated the associations between caregivers' depressive symptoms and neuropsychological outcomes in HIV-infected (n=118) and HIV-exposed (n=164) Ugandan children aged 2-5 years. We compared performance-based tests of development (Mullen Scales of Early Learning, Color Object Association Test), to a caregiver report of executive function (Behavior Rating Inventory of Executive Function, BRIEF). Caregivers were assessed with Hopkins Symptom Checklist-25 depression subscale. The associations between all BRIEF indices and caregiver's depression symptoms were differential according to child's HIV status. Caregivers with greater depressive symptoms reported their HIV-infected children as having more behavioral problems related to executive functioning. Assessment of behavior of HIV-infected children should incorporate a variety of sources of information and screening of caregiver mental health.

  12. Subacute sclerosing panencephalitis in a child with human immunodeficiency virus (HIV) infection on antiretroviral therapy

    Science.gov (United States)

    Muthusamy, Karthik; Yoganathan, Sangeetha; Thomas, Maya Mary; Alexander, Mathew; Verghese, Valsan Philip

    2015-01-01

    Subacute Sclerosing Panencephalitis (SSPE) in HIV-infected children is a scarcely reported entity with previous reports describing fulminant course. The impact of highly active antiretroviral therapy (HAART) in altering its course remains unknown. We describe a child with HIV infection, who developed measles at 5 months of age and later developed SSPE at 14 years of age, remaining stable at 7 month follow-up, while on HAART for WHO (World Health Organisation) stage IV disease. The dynamics of HIV-related immunosuppression has an impact on the clinical course of SSPE. Contrary to reported cases of fulminant progression, a classic presentation with slow progression can be expected in children on HAART. We reemphasize the recommendation of “early measles vaccination” to prevent measles infection and subsequent SSPE in these children with an increasingly good life expectancy in the era of HAART. PMID:25745323

  13. Subacute sclerosing panencephalitis in a child with human immunodeficiency virus (HIV infection on antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Karthik Muthusamy

    2015-01-01

    Full Text Available Subacute Sclerosing Panencephalitis (SSPE in HIV-infected children is a scarcely reported entity with previous reports describing fulminant course. The impact of highly active antiretroviral therapy (HAART in altering its course remains unknown. We describe a child with HIV infection, who developed measles at 5 months of age and later developed SSPE at 14 years of age, remaining stable at 7 month follow-up, while on HAART for WHO (World Health Organisation stage IV disease. The dynamics of HIV-related immunosuppression has an impact on the clinical course of SSPE. Contrary to reported cases of fulminant progression, a classic presentation with slow progression can be expected in children on HAART. We reemphasize the recommendation of “early measles vaccination” to prevent measles infection and subsequent SSPE in these children with an increasingly good life expectancy in the era of HAART.

  14. Prevalence of HIV infection in pregnant women in Mumbai, India: Experience from 1993-2004 and 2008

    Directory of Open Access Journals (Sweden)

    Ira Shah

    2017-01-01

    Full Text Available Aim: Prevalence of HIV among pregnant women in India is of great concern, especially to prevent HIV in children. Mother–to-child transmission of HIV is the most common cause of transmission of HIV in children. Prevalence of HIV infection in pregnant women in India has ranged from 0.7% to 1.2%. Thus, estimating prevalence of HIV in pregnant women would aid in developing and prioritizing prevention of parent-to-child transmission of HIV programs. Materials and Methods: All pregnant women referred to the antenatal clinic from 1993 onward were tested for HIV infection by ELISA test after pretest counseling. A woman was diagnosed to be HIV infected if she tested positive on more than two HIV ELISA tests. Prevalence of HIV infection in them was calculated and also whether there was an increasing trend was determined. Results: A total of 123,439 pregnant women were tested for HIV from 1993 to 2004, of which 1797 women were HIV infected. Overall, the prevalence rate was found to be 1.4%. Prevalence rose from 0.76% in 1993 to 2.37% in 1998. However, from 2004, the prevalence has decreased to 0.6%. Conclusion: Prevalence of HIV in pregnant women in Mumbai is decreasing.

  15. HIV Infection and Children: A Medical Overview.

    Science.gov (United States)

    Anderson, Virginia

    1998-01-01

    Updates a 10-year medical overview on HIV/AIDS written for a Child Welfare League of America publication. Covers HIV transmission, diagnosis and treatment of HIV in infants, maternal treatment and testing, and advances and challenges, including new drug therapies. Concludes with recommendations on systems of care for affected families. (EV)

  16. Legionellosis in patients with HIV infection

    DEFF Research Database (Denmark)

    Bangsborg, Jette Marie; Jensen, B N; Friis-Møller, A

    1990-01-01

    During the five-year period 1984-1988 we received 192 specimens from 180 patients infected with the human immunodeficiency virus (HIV) for investigation of Legionella infection. The majority of specimens were bronchoalveolar lavage (BAL) fluids (84%), but tracheal suctions and lung tissue from...... specimens additionally for Pneumocystis carinii and mycobacteria. Legionellosis was not found to be common among HIV-infected patients, as only six specimens (3%) from six patients were found positive by DFA, and no specimens were culture-positive for Legionella species. Dual infection with Legionella and P...

  17. Low prevalence of vitamin D deficiency in Ugandan HIV-infected patients with and without tuberculosis

    NARCIS (Netherlands)

    Conesa-Botella, A.; Goovaerts, O.; Massinga-Loembé, M.; Worodria, W.; Mazakpwe, D.; Luzinda, K.; Mayanja-Kizza, H.; Colebunders, R.; Kestens, L.; Mascart, F.; van den Bergh, R.; Locht, C.; Reiss, P.; Cobelens, F.; Ondoa, P.; Pakker, N.; Mugerwa, R.

    2012-01-01

    To examine whether hypovitaminosis D is a risk factor for the development of tuberculosis (TB) associated immune reconstitution inflammatory syndrome (IRIS). We measured serum 25-hydroxyvitamin D (25D) concentrations in four groups of patients at Mulago Hospital, Kampala, Uganda: 1) patients

  18. Presentation, management, and outcomes of sepsis in adults and children admitted to a rural Ugandan hospital: A prospective observational cohort study.

    Directory of Open Access Journals (Sweden)

    Kristina E Rudd

    Full Text Available Limited data are available on sepsis in low-resource settings, particularly outside of urban referral centers. We conducted a prospective observational single-center cohort study in May 2013 to assess the presentation, management and outcomes of adult and pediatric patients admitted with sepsis to a community hospital in rural Uganda.We consecutively screened all patients admitted to medical wards who met sepsis criteria. We evaluated eligible patients within 24 hours of presentation and 24-48 hours after admission, and followed them until hospital discharge. In addition to chart review, mental status evaluation, peripheral capillary oxygen saturation, and point-of-care venous whole blood lactate and glucose testing were performed.Of 56 eligible patients, we analyzed data on 51 (20 adults and 31 children. Median age was 8 years (IQR 2-23 years. Sepsis accounted for a quarter of all adult and pediatric medical ward admissions during the study period. HIV prevalence among adults was 30%. On enrollment, over half of patients had elevated point-of-care whole blood lactate, few were hypoglycemic or had altered mental status, and one third were hypoxic. Over 80% of patients received at least one antibiotic, all severely hypoxic patients received supplemental oxygen, and half of patients with elevated lactate received fluid resuscitation. The most common causes of sepsis were malaria and pneumonia. In-hospital mortality was 3.9%.This study highlights the importance of sepsis among adult and pediatric patients admitted to a rural Ugandan hospital and underscores the need for continued research on sepsis in low resource settings.

  19. Comparative parameters of fertility regulation as related to STD / HIV infections. An overview.

    Science.gov (United States)

    Merino, G; Bailon, R; Correu, S

    1991-01-01

    The sexually transmitted disease (STD), chancroid, is the greatest factor for HIV infections in Africa like syphilis is in the US. 3 physicians suggest that reducing the incidence of STDs may reduce the spread of HIV. Risk factors for HIV include current or history of STD in women and bisexual men, pelvic inflammatory disease, semen, copper releasing IUDs, contraceptive dermatitis, malnutrition/food allergy, environmental pollutants, genetic make up, and prostitutes. HIV infected persons should use condoms to not only protect partners but to prevent repeated contact with HIV which influences the clinical outcome. Condom use for contraception is not widely practiced in some areas, however, including Central Africa and Haiti. Condom use has increased in the US because IUDs have been removed from the market, fear of HIV infection, and discontinued use of oral contraceptives in older women. Urticarial reactions secondary to a copper IUD often occur in adolescent women, but clears when the IUD is removed. Traces of nickel in the copper wire used in IUDs often induce an allergic reaction. Allergic reactions are cofactors of HIV which can be made worse if coupled with excessive menstrual bleeding and HIV infected semen cells entering the uterus via the IUD tail. Many countries have integrated family planning services with other public health services, such as STD clinics that address AIDS. Integrated services should provide STD services and contraception and involve males and be accessible to them. Comprehensive school based clinical model should be implemented into schools and colleges. Counselors should advice HIV infected women not to have any more children. These women should get top priority to family planning services. HIV antibody testing for women should be done at any center where women may be including family planning centers and prisons.

  20. Osteopaenia and Osteonecrosis in HIV Infection: Report of Two Cases

    African Journals Online (AJOL)

    ... of human immunodeficiency virus (HIV) infection has significantly changed the course, manifestation of HIV disease and improved the life expectancy of HIV infected patients. The consequence of longer survival has manifested increasing rates of co-morbid diseases and aroused interest in the interaction of HIV and aging ...

  1. Renal disease in HIV infected patients at University of Benin ...

    African Journals Online (AJOL)

    Background: HIV related renal disease is a common occurrence in patients with HIV infection. It is the third leading cause of end stage renal disease among African-American males between the ages of 20 and 64 years in USA. Renal function impairment has been reported at all stages of HIV infection. The aim of this study ...

  2. Uropathogens isolated from HIV-infected patients from Limpopo ...

    African Journals Online (AJOL)

    Uropathogens isolated from HIV-infected patients from Limpopo Province, South Africa. BC Iweriebor, CL Obi, O Akinyemi, NJ Ramalivhana, T Hattori, AI Okoh. Abstract. The primary aim of this study was to determine the prevalence and antibiotic susceptibility profiles of uropathogens isolated from HIV-infected patients in ...

  3. Haemorheologic and fibrinolytic activity in Nigerian HIV infected ...

    African Journals Online (AJOL)

    Objective: Human immunodeficiency virus (HIV)-infected patients, especially those on antiretrovirals are at risk of cardiovascular disease (CVD). The haemorheologic and fibrinolgtic activity of treatment naïve Nigerian HIV-infected patients were investigated. Methods: Blood was collected from 50 newly diagnosed treatment ...

  4. Diverticulitis in HIV-infected patients within the United States.

    Science.gov (United States)

    Cronley, K; Wenzke, J; Hussan, H; Vasquez, A M; Hinton, A; El-Dika, S; Conwell, D L; Krishna, S G; Stanich, P P

    2016-03-01

    Diverticulitis in patients on immunosuppressant therapy has been associated with increased mortality, but there are no data for HIV-infected patients. Our aim was to compare the outcomes of hospitalizations for diverticulitis in patients with and without HIV infection. Cross-sectional study of hospitalizations in the United States accessed through the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project. Patients hospitalized for diverticulitis in 2007-2011 were included in the analysis. The primary outcomes of interest were mortality and surgical therapy rates. Patients from 2003 to 2011 were utilized to analyse trends in prevalence. There were 2375 patients with HIV infection hospitalized for diverticulitis and 1 160 391 patients without HIV infection hospitalized for diverticulitis from 2007 to 2011. The patients with HIV infection were younger and more likely to be male and nonwhite (P diverticulitis and HIV infection had a significantly increased in-hospital mortality rate [odds ratio (OR) 3.94 (95% confidence interval, CI, 1.52-10.20)] and a lower rate of surgical intervention [OR 0.74 (95% CI 0.57-0.95)]. From 2003 to 2011, there was a linear increasing trend in the prevalence of HIV infection among patients hospitalized for diverticulitis (P diverticulitis had increased mortality and received less surgical treatment in comparison to the general population. Diverticulitis in HIV-infected patients increased in prevalence over the study period. © 2016 British HIV Association.

  5. Depressive scores in newly diagnosed HIV-infected and HIV ...

    African Journals Online (AJOL)

    Background: Prevalence rates of HIV infection in KwaZulu-Natal are high, with a significant amount of those infected being women of reproductive age. A diagnosis of HIV infection has been associated with an increased risk for the development of depression. Antenatal depression is a serious health concern, having the ...

  6. ORIGINAL ARTICLE Anemia among HIV Infected Individuals Taking ...

    African Journals Online (AJOL)

    2018-01-01

    Jan 1, 2018 ... DOI: http://dx.doi.org/10.4314/ejhs.v28i1.9. 73. ORIGINAL ARTICLE. Anemia among HIV Infected Individuals ... Immunodeficiency Virus (HIV) infection and its treatment (1, 2). Depending on the study setting, ... information system computer records at baseline. (before ART initiation), after six months and 12.

  7. Gender and Oral Manifestations of HIV Infection Among Adult ...

    African Journals Online (AJOL)

    Oral manifestations were studied in 305 adult Nigerians with HIV infection. Data collected were demographic (age, sex, marital status, educational status and occupation) and clinical (mode of transmission, general manifestations and oral manifestations of HIV infection). The chi- square test was used in test for significance ...

  8. Sexual risk behavior and HIV infection among adolescents in ...

    African Journals Online (AJOL)

    Background: In adolescents sexual risk behaviours are believed to enhance the transmission of HIV infection. This study, therefore aims to examine prevalent sexual risk behaviours of adolescents in secondary schools in a town in northern Nigeria and its relation to HIV infection. Method: A total of 883 subjects drawn from ...

  9. Treating HIV Infection like a Sexually Transmitted Disease

    African Journals Online (AJOL)

    DENTAL JOURNAL. Treating HIV Infection like a Sexually. Transmitted Disease. Dr. K. J. Pallangyo,. Consultant Physician and Senior Lecturer,. Muhimbili Meciol Centre. How can the spread of HIV infection and AIDS be most effectively prevented at the primary health care level? Dr Pollongyo from Tanzania argues that ...

  10. HIV infection and psychiatric illness | Owe-Larsson | African Journal ...

    African Journals Online (AJOL)

    Results: Patients with HIV infection are at an increased risk of psychiatric illness. Major depressive disorder and subsyndromal depressive symptoms, as well as anxiety disorder and substance abuse are more prevalent among HIV infected individuals than among the general population. HIV-associated neurocognitive ...

  11. Effect of antiretroviral drugs on prolactin in HIV infected pregnant ...

    African Journals Online (AJOL)

    We investigated the effect of anti-retroviral drugs and human immune deficiency virus (HIV) infection on prolactin production and stimulation in HIV-infected pregnant women. A total of 120 subjects participated in the study. Sixty (group 1) of these subjects were HIV seropositive pregnant women who commenced treatment ...

  12. Dialysis and renal transplantation in HIV-infected patients

    DEFF Research Database (Denmark)

    Trullas, Joan Carles; Mocroft, Amanda; Cofan, Federico

    2010-01-01

    To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients.......To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients....

  13. HIV infection and the way forward for South Sudan

    African Journals Online (AJOL)

    EDITorIAL. HIV infection and the way forward for South Sudan. 75. In the last thirty-three years HIV infection has spread to all corners of the world, but the largest concentration of the epidemic is in ... is a critical aspect of HIV prevention, which in South Sudan leaves much to be desired. The prevention strategy has advanced ...

  14. Changes in Serum Proteins and Creatinine levels in HIV Infected ...

    African Journals Online (AJOL)

    This results in either raised level of total plasma/serum protein or low level of plasma/serum protein depending on which component of immune dysregulation predominates. This study examined the level of total serum proteins and globulins in HIV infected Nigerians. 64 patients with HIV infection and 10 apparently healthy ...

  15. HIV antibodies for treatment of HIV infection

    Science.gov (United States)

    Margolis, David M.; Koup, Richard A.; Ferrari, Guido

    2016-01-01

    Summary The bar is high to improve on current combination antiretroviral therapy (ART), now highly effective, safe, and simple. However antibodies that bind the HIV envelope are able to uniquely target the virus as it seeks to enter new target cells, or as it is expressed from previously infected cells. Further, the use of antibodies against HIV as a therapeutic may offer advantages. Antibodies can have long half-lives, and are being considered as partners for long-acting antiretrovirals for use in therapy or prevention of HIV infection. Early studies in animal models and in clinical trials suggest that such antibodies can have antiviral activity but, as with small molecule antiretrovirals, the issues of viral escape and resistance will have to be addressed. Most promising, however, are the unique properties of anti-HIV antibodies: the potential ability to opsonize viral particles, to direct antibody-dependent cellular cytotoxicity (ADCC) against actively infected cells, and ultimately the ability to direct the clearance of HIV-infected cells by effector cells of the immune system. These distinctive activities suggest that HIV antibodies and their derivatives may play an important role in the next frontier of HIV therapeutics, the effort to develop treatments that could lead to an HIV cure. PMID:28133794

  16. CCD Camera Detection of HIV Infection.

    Science.gov (United States)

    Day, John R

    2017-01-01

    Rapid and precise quantification of the infectivity of HIV is important for molecular virologic studies, as well as for measuring the activities of antiviral drugs and neutralizing antibodies. An indicator cell line, a CCD camera, and image-analysis software are used to quantify HIV infectivity. The cells of the P4R5 line, which express the receptors for HIV infection as well as β-galactosidase under the control of the HIV-1 long terminal repeat, are infected with HIV and then incubated 2 days later with X-gal to stain the infected cells blue. Digital images of monolayers of the infected cells are captured using a high resolution CCD video camera and a macro video zoom lens. A software program is developed to process the images and to count the blue-stained foci of infection. The described method allows for the rapid quantification of the infected cells over a wide range of viral inocula with reproducibility, accuracy and at relatively low cost.

  17. Periodontal disease associated with HIV infection.

    Science.gov (United States)

    Winkler, J R; Robertson, P B

    1992-02-01

    Patients with severe immunosuppression as a consequence of infection by human immunodeficiency virus (HIV) are at risk for a number of severe periodontal diseases. HIV-associated gingivitis and HIV-associated periodontitis (HIV-P) are seen exclusively in HIV-infected persons. In some cases HIV-P may extend into adjacent soft tissue and bone, resulting in necrotizing stomatitis of periodontal origin. In addition, acute necrotizing ulcerative gingivitis has also been reported to have an increased prevalence in HIV-infected patients. The clinical and microbiologic features of HIV-associated gingivitis and HIV-P suggest that these diseases are early and later stages of the same lesion, that results in severe gingival erythema, extensive soft tissue necrosis, and destruction of alveolar bone. Although acute necrotizing gingivitis and the initial stages of HIV-P share a number of clinical signs current evidence indicates that they are distinct pathologic processes. Treatment of these lesions requires debridement, local antimicrobial therapy, immediate follow-up care, and long-term maintenance. In addition, patients with systemic involvement or extensive and rapidly progressing lesions may require systemic antibiotics appropriate to the organisms that dominate the lesion.