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Sample records for hiv-infected ugandan children

  1. Zinc status in HIV infected Ugandan children aged 1-5 years: a cross sectional baseline survey

    OpenAIRE

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

    2010-01-01

    Abstract Background Low concentrations of serum zinc have been reported in HIV infected adults and are associated with disease progression and an increased risk of death. Few studies have been conducted in HIV infected children in Africa. We determined serum zinc levels and factors associated with zinc deficiency in HIV infected Ugandan children. Methods We measured the baseline zinc status of 247 children aged 1-5 years enrolled in a randomised trial for multiple micronutrient supplementatio...

  2. Zinc status in HIV infected Ugandan children aged 1-5 years: a cross sectional baseline survey

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    Ndugwa Christopher M

    2010-09-01

    Full Text Available Abstract Background Low concentrations of serum zinc have been reported in HIV infected adults and are associated with disease progression and an increased risk of death. Few studies have been conducted in HIV infected children in Africa. We determined serum zinc levels and factors associated with zinc deficiency in HIV infected Ugandan children. Methods We measured the baseline zinc status of 247 children aged 1-5 years enrolled in a randomised trial for multiple micronutrient supplementation at paediatric HIV clinics in Uganda (http://ClinicalTrials.gov NCT00122941. Zinc status was determined using inductively coupled atomic emission spectrophotometry (ICP-AES. Clinical and laboratory characteristics were compared among zinc deficient (zinc Results Of the 247 children, 134 (54.3% had low serum zinc ( Conclusion Almost two thirds of HAART naïve and a third of HAART treated HIV infected children were zinc deficient. Increased access to HAART among HIV infected children living in Uganda might reduce the prevalence of zinc deficiency.

  3. Multiple Measures Reveal Antiretroviral Adherence Successes and Challenges in HIV-Infected Ugandan Children

    Science.gov (United States)

    Haberer, Jessica E.; Kiwanuka, Julius; Nansera, Denis; Ragland, Kathleen; Mellins, Claude; Bangsberg, David R.

    2012-01-01

    Background Adherence to HIV antiretroviral therapy (ART) among children in developing settings is poorly understood. Methodology/Principal Findings 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 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; passets (AOR 0.7, 95%CI 0.6–0.9; p = 0.0007) were protective against these interruptions. Conclusions/Significance 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 the child to adhere. Further research is needed to better understand and build on these key influential factors for adherence intervention development. PMID:22590600

  4. 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

  5. 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.

  6. Association of HIV diversity and survival in HIV-infected Ugandan infants.

    Directory of Open Access Journals (Sweden)

    Maria M James

    2011-04-01

    Full Text Available The level of viral diversity in an HIV-infected individual can change during the course of HIV infection, reflecting mutagenesis during viral replication and selection of viral variants by immune and other selective pressures. Differences in the level of viral diversity in HIV-infected infants may reflect differences in viral dynamics, immune responses, or other factors that may also influence HIV disease progression. We used a novel high resolution melting (HRM assay to measure HIV diversity in Ugandan infants and examined the relationship between diversity and survival through 5 years of age.Plasma samples were obtained from 31 HIV-infected infants (HIVNET 012 trial. The HRM assay was used to measure diversity in two regions in the gag gene (Gag1 and Gag2 and one region in the pol gene (Pol.HRM scores in all three regions increased with age from 6-8 weeks to 12-18 months (for Gag1: P = 0.005; for Gag2: P = 0.006; for Pol: P = 0.016. Higher HRM scores at 6-8 weeks of age (scores above the 75(th percentile were associated with an increased risk of death by 5 years of age (for Pol: P = 0.005; for Gag1/Gag2 (mean of two scores: P = 0.003; for Gag1/Gag2/Pol (mean of three scores: P = 0.002. We did not find an association between HRM scores and other clinical and laboratory variables.Genetic diversity in HIV gag and pol measured using the HRM assay was typically low near birth and increased over time. Higher HIV diversity in these regions at 6-8 weeks of age was associated with a significantly increased risk of death by 5 years of age.

  7. 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 ...

  8. Hematological Manifestation in HIV Infected Children

    International Nuclear Information System (INIS)

    Bhowmik, A.; Banerjee, P.

    2015-01-01

    Objective: To determine the common hematological abnormalities in HIV infected children and any association of these abnormalities with HIV disease severity. Study Design: Cross-sectional study. Place and Duration of Study: Regional Pediatric ART centre, Medical College and Hospital, Kolkata, West Bengal, India, from November 2011 to November 2012. Methodology: Children up to 12 years with confirmed diagnosis of HIV infection were clinically examined and tested for complete hemogram and CD4 count. Bone marrow study was done in selected patient depending on hemogram report. Children were divided in different stages according to WHO clinical staging. Each of the hematological parameters was assessed for any association with progression of disease. Fisher's Exact Test was used for determining the association between WHO clinical staging and abnormal blood parameters. P-value < 0.05 was taken as significant. Results: Sixty nine percent of the study population was anemic; 47.37% (18/38), 66.67% (8/12), 71.43% (15/21) and 93.10% (27/29) of stage 1, 2, 3 and 4 respectively were anemic in the study population (p=0.001). Leucopenia was present in 34% (34/100) children. Neutropenia and lymphopenia was present in 19% (19/100) and 22% (22/100) children. Lymphopenia was present in 7.89% (3/38), 16.67% (2/12), 19.05% (4/21) and 44.83% (13/29) of patient with stage 1, 2, 3 and 4 respectively (p=0.020). Eosinophilia was present in 17% (17/100) and thrombocytopenia in 11% (11/100) children. 2 patients with stage 4 disease were with hypoplastic bone marrow. Conclusion: Anemia was the most common hematological abnormality in HIV infected children. Anemia and lymphopenia had a significant association with the stage of the disease. (author)

  9. 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 ...

  10. 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

    2014-01-01

    Background Malnutrition may impact the pharmacokinetics (PK) of antiretroviral medications and virologic responses in HIV-infected children. We 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. Methods Sparse dried blood spot (DBS) samples from Ugandan children were used to estimate plasma concentrations. Historical PK data from children from three resource-rich countries (RRC) were utilized to develop the PK models. Results Concentrations in 330 DBS 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 (Pmalnutrition 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 assessements, to further assess causes of virologic failure in Ugandan children. PMID:25742090

  11. Vaginal Prostate Specific Antigen (PSA) Is a Useful Biomarker of Semen Exposure Among HIV-Infected Ugandan Women.

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    Woolf-King, Sarah E; Muyindike, Winnie; Hobbs, Marcia M; Kusasira, Adrine; Fatch, Robin; Emenyonu, Nneka; Johnson, Mallory O; Hahn, Judith A

    2017-07-01

    The practical feasibility of using prostate specific antigen (PSA) as a biomarker of semen exposure was examined among HIV-infected Ugandan women. Vaginal fluids were obtained with self-collected swabs and a qualitative rapid test (ABAcard ® p30) was used to detect PSA. Trained laboratory technicians processed samples on-site and positive PSA tests were compared to self-reported unprotected vaginal sex (UVS) in the last 48 h. A total of 77 women submitted 126 samples for PSA testing at up to three study visits. Of these samples, 31 % (n = 39/126) were PSA positive, and 64 % (n = 25/39) of the positive PSA samples were accompanied by self-report of no UVS at the study visit the PSA was collected. There were no reported difficulties with specimen collection, storage, or processing. These findings provide preliminary data on high levels of misreported UVS among HIV-infected Ugandan women using practically feasible methods for PSA collection and processing.

  12. 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 ...

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

    African Journals Online (AJOL)

    Children's caregiving of HIV-infected parents accessing treatment in western Kenya: challenges and ... Log in or Register to get access to full text downloads. ... The research draws attention to the difficulties and opportunities of strengthening ...

  14. CNS penetration of ART in HIV-infected children

    NARCIS (Netherlands)

    van den Hof, Malon; Blokhuis, Charlotte; Cohen, Sophie; Scherpbier, Henriette J.; Wit, Ferdinand W. N. M.; Pistorius, M. C. M.; Kootstra, Neeltje A.; Teunissen, Charlotte E.; Mathot, Ron A. A.; Pajkrt, Dasja

    2018-01-01

    Background: Paediatric data on CNS penetration of antiretroviral drugs are scarce. Objectives: To evaluate CNS penetration of antiretroviral drugs in HIV-infected children and explore associations with neurocognitive function. Patients and methods: Antiretroviral drug levels were measured in paired

  15. 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.

  16. 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.

  17. Care of children with HIV infection and AIDS in Africa.

    Science.gov (United States)

    Marum, L H; Tindyebwa, D; Gibb, D

    1997-01-01

    HIV/AIDS is a major cause of pediatric morbidity and mortality, especially in Africa. The UN Joint Program on HIV/AIDS (UNAIDS) estimates that 85% of the 2.6 million children with HIV infection are from sub-Saharan Africa. About 650,000 children are living with HIV/AIDS and approximately 1000 infected infants are born every day in Africa. Since few of the 7 million infected African women have access to HIV testing and counseling, not to mention interventions such as AZT to reduce the risk of HIV transmission to their infants, the high incidence of HIV-infected children in Africa will likely continue for some time. The countries of east and southern Africa and several countries in west Africa have the highest HIV prevalence rates in the world. The development of cost-effective strategies to provide care and improve the quality of life of HIV-infected infants and children in Africa should be a priority area for increased research and support. The authors describe progress in understanding the natural history of HIV infection in African children, review strategies for managing HIV-infected children in resource-poor settings, and discuss issues of community response and counseling for children.

  18. The Incidence of Exudative Otitis Media in HIV Infected Children

    Directory of Open Access Journals (Sweden)

    Nuriddin U. Narzullaev, PhD

    2012-09-01

    Full Text Available Diseases of the ENT organs are among the commonly prevalent and dangerous pathologies of childhood, occurring as a complication of respiratory, bacterial diseases and HIV infection. One of the serious complications of HIV infection in children is the lesion of ENT organs. In HIV infected children, in addition to suppurative diseases occur middle ear diseases with nonsuppurative origin. A total of 79 HIV infected children aged 3-14 years with different pathologies of the nasal cavity, nasopharynx and paranasal sinuses were included into the current study. The control group included 20 healthy children of comparable age and sex. The survey was conducted in the ENT department of the Children’s Multi-Medical Center, in Bukhara region. Children with a diagnosis of suppurative otitis media and/or history of suppurative otitis media were not included into the study. All HIV infected children, along with physical examination, were performed ENT examination, finger study, X-ray examination of the paranasal sinuses, audiological research and impedancemetry.

  19. Poorer cognitive performance in perinatally HIV-infected children versus healthy socioeconomically matched controls

    NARCIS (Netherlands)

    Cohen, S.; ter Stege, J.A.; Geurtsen, G.J.; Scherpbier, H.J.; Kuijpers, T.W.; Reiss, P.; Schmand, B.; Pajkrt, D.

    2015-01-01

    Background: Despite the declining incidence of severe neurological complications such as HIV encephalopathy, human immunodeficiency virus (HIV) infection in children is still associated with a range of cognitive problems. Although most HIV-infected children in industrialized countries are immigrants

  20. Immunological Response of Hiv-Infected Children to Highly Active ...

    African Journals Online (AJOL)

    BACKGROUND: The effectiveness of highly active antiretroviral therapy (HAART) in children has not been well studied specially in developing countries where the burden of HIV is high. This study was aimed to assess the immunologic response of HIV-infected children to HAART at Pediatric ART Clinic Gondar University ...

  1. 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 ...

  2. Bone health in HIV-infected children and adolescents.

    Science.gov (United States)

    Eckard, Allison R; Mora, Stefano

    2016-05-01

    Chronic HIV infection and exposure to antiretroviral therapy compromises bone health in children and adolescents, potentially impacting their long-term quality of life. Thus, the purpose of this article is to review the most recent literature on this topic in HIV-infected children and adolescents. Recent studies continue to demonstrate bone abnormalities in HIV-infected children and adolescents, whether HIV is acquired perinatally or during adolescence. Researchers have employed new modalities, both high tech and those that can be utilized in resource-limited settings, to better assess bone health. New data suggest that this population may also be experiencing an increase incidence of fractures, and they may not acquire the same peak bone mass as their HIV-uninfected counterparts. Reassuringly, however, in-utero tenofovir exposure does not appear to have a significant impact on bone health in HIV-exposed, uninfected infants. HIV-infected children and adolescents are exposed to HIV and antiretroviral therapy for many decades starting early in life and during the most critical time for skeletal growth and bone mass accrual. Recent findings underscore the need for further research on bone in this population. Longitudinal studies are especially needed to evaluate long-term risk of osteoporosis and fracture.

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

    African Journals Online (AJOL)

    Subjects: HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya. Interventions: Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART). Main outcome measures: Diagnosis, clinical ...

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

    African Journals Online (AJOL)

    Annals of Biomedical Sciences ... Background: Most studies evaluating anaemia and associated factors in HIV infected children have been done on those that are HAART naïve. This study evaluated ... Data on age, gender, CD4 counts, CD4 percentage in those younger than 5years and tuberculosis status were obtained.

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

    African Journals Online (AJOL)

    2015-10-12

    Oct 12, 2015 ... -5Gains in child survival attributed to implementation of survival strategies had been severely eroded by increas- ing mortality for pediatric HIV infections. There is a high level of malnutrition in children in Africa, with one in every under five being malnourished6,7. Weng et al. 8studied the association ...

  6. 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

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

    Science.gov (United States)

    Puthanakit, Thanyawee; Siberry, George K

    2013-01-01

    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. PMID:23782476

  8. Dyslipidemia in HIV Infected Children Receiving Highly Active Antiretroviral Therapy.

    Science.gov (United States)

    Mandal, Anirban; Mukherjee, Aparna; Lakshmy, R; Kabra, Sushil K; Lodha, Rakesh

    2016-03-01

    To assess the prevalence of dyslipidemia and lipodystrophy in Indian children receiving non-nucleoside reverse transcriptase inhibitor (NNRTI) based highly active antiretroviral therapy (HAART) and to determine the associated risk factors for the same. The present cross-sectional study was conducted at a Pediatric Clinic of a tertiary care teaching center in India, from May 2011 through December 2012. HIV infected children aged 5-15 y were enrolled if they did not have any severe disease or hospital admission within last 3 mo or receive any medications known to affect the lipid profile. Eighty-one children were on highly active antiretroviral therapy (HAART) for at least 6 mo and 16 were receiving no antiretroviral therapy (ART). Participants' sociodemographic, nutritional, clinical, and laboratory data were recorded in addition to anthropometry and evidence of lipodystrophy. Fasting lipid profile, apolipoprotein A1 and B levels were done for all the children. Among the children on highly active antiretroviral therapy (HAART), 38.3 % had dyslipidemia and 80.2 % had lipodystrophy, while 25 % antiretroviral therapy (ART) naïve HIV infected children had dyslipidemia. No clinically significant risk factors could be identified that increased the risk of dyslipidemia or lipodystrophy in children on highly active antiretroviral therapy (HAART). There is a high prevalence of dyslipidemia and lipodystrophy in Indian children with HIV infection with an imminent need to establish facilities for testing and treatment of these children for metabolic abnormalities.

  9. Schistosoma mansoni and HIV infection in a Ugandan population with high HIV and helminth prevalence.

    Science.gov (United States)

    Sanya, Richard E; Muhangi, Lawrence; Nampijja, Margaret; Nannozi, Victoria; Nakawungu, Prossy Kabuubi; Abayo, Elson; Webb, Emily L; Elliott, Alison M

    2015-09-01

    Recent reports suggest that Schistosoma infection may increase the risk of acquiring human immunodeficiency virus (HIV). We used data from a large cross-sectional study to investigate whether Schistosoma mansoni infection is associated with increased HIV prevalence. We conducted a household survey of residents in island fishing communities in Mukono district, Uganda, between October 2012 and July 2013. HIV status was assessed using rapid test kits. Kato-Katz (KK) stool tests and urine-circulating cathodic antigen (CCA) were used to test for Schistosoma infection. Multivariable logistic regression, allowing for the survey design, was used to investigate the association between S. mansoni infection and HIV infection. Data from 1412 participants aged 13 years and older were analysed (mean age 30.3 years, 45% female). The prevalence of HIV was 17.3%. Using the stool Kato-Katz technique on a single sample, S. mansoni infection was detected in 57.2% (719/1257) of participants; urine CCA was positive in 73.8% (478/650) of those tested. S. mansoni infection was not associated with HIV infection. [KK (aOR = 1.04; 95% CI: 0.74-1.47, P = 0.81), CCA (aOR = 1.53; 95% CI: 0.78-3.00, P = 0.19)]. The median S. mansoni egg count per gram was lower in the HIV-positive participants (P = 0.005). These results add to the evidence that S. mansoni has little effect on HIV transmission, but may influence egg excretion. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  10. 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

  11. 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

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

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    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.

  13. 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.

  14. Tuberculosis in HIV-infected Tanzanian children below 14 years.

    Science.gov (United States)

    Njau, J C; Aboud, S

    2010-09-01

    Tuberculosis (TB)-human immunodeficiency virus (HIV) co-infection is an important public health problem. Diagnosis of TB in children usually follows discovery of an adult case, and relies on clinical presentation, sputum examination and chest radiograph. However, clinical features are non-specific, chest radiographs are difficult to interpret, and routine laboratory tests are not helpful. The aim of the current study was to determine the prevalence of TB in HIV-infected children below 14 years attending a tertiary hospital. A cross-sectional study was conducted in HIV-infected children below 14 years of age at Muhimbili National Hospital, in Dar es Salaam, Tanzania, between July 2008 and January 2009. Information on socio-demographic and anthropometric characteristics was collected using a structured questionnaire. Following assessment of clinical presentation, physical examination, tuberculin skin test, and chest radiograph were performed for each child. Two consecutive sputum specimens and blopd sample were collected for microscopy and culture, and CD4 T-lymphocyte percentage test, respectively. Chi-square test was used to compare differences in proportions. Odds ratio (OR) and their 95% confidence interval (CI) are presented as the risk estimator. Of 182 HIV-infected children enrolled in the study, 104 (57.1%) were males. Overall, thirty-seven (20.3%) children had TB. The prevalence of TB was highest in males (78.4%) compared to females (p = 0.003). There was a higher proportion of TB (45.9%) in the age group below 24 months compared to other age groups (p = 0.001). Male gender, history of positive TB contact and severe immunosuppression were found to be significant risk factors for TB while use of antiretroviral therapy was found to be associated with decreased risk for TB. One-fifth of children had TB/HIV co-infection. Presence of four or more clinical manifestations and a low CD4+ T-lymphocyte percentage can be used to predict active TB in HIV-infected

  15. Neurometabolite Alterations Associated With Cognitive Performance in Perinatally HIV-Infected Children

    NARCIS (Netherlands)

    van Dalen, Yvonne W.; Blokhuis, Charlotte; Cohen, Sophie; ter Stege, Jacqueline A.; Teunissen, Charlotte E.; Kuhle, Jens; Kootstra, Neeltje A.; Scherpbier, Henriette J.; Kuijpers, Taco W.; Reiss, Peter; Majoie, Charles B. L. M.; Caan, Matthan W. A.; Pajkrt, Dasja

    2016-01-01

    Despite treatment with combination antiretroviral therapy (cART), cognitive impairment is still observed in perinatally HIV-infected children. We aimed to evaluate potential underlying cerebral injury by comparing neurometabolite levels between perinatally HIV-infected children and healthy controls.

  16. Poorer cognitive performance in perinatally HIV-infected children versus healthy socioeconomically matched controls

    NARCIS (Netherlands)

    Cohen, Sophie; ter Stege, Jacqueline A.; Geurtsen, Gert J.; Scherpbier, Henriette J.; Kuijpers, Taco W.; Reiss, Peter; Schmand, Ben; Pajkrt, Dasja

    2015-01-01

    Despite the declining incidence of severe neurological complications such as HIV encephalopathy, human immunodeficiency virus (HIV) infection in children is still associated with a range of cognitive problems. Although most HIV-infected children in industrialized countries are immigrants with a

  17. Neurological disorders in HIV-infected children in India.

    Science.gov (United States)

    Gupta, S; Shah, D M; Shah, I

    2009-09-01

    There are few studies of HIV-related neurological disorders from centres in low-income countries where facilities are available for detailed investigation. Records of all patients attending the paediatric HIV outpatient department at B. J. Wadia Hospital for Children, Mumbai between April 2000 and March 2008 were reviewed. Of 668 HIV-infected patients, 48 (7.2%) had neurological manifestations and are included in this study. Twenty-six (54.2%) children had HIV encephalopathy. Other causes of neurological manifestations include febrile convulsion in five (10.4%), bacterial meningitis in three (6.3%), epilepsy in two (4.2%), tuberculous meningitis and progressive multi-focal encephalopathy in two (4.2%) each and toxoplasmosis, vasculitis, acute demyelinating encephalomyelitis, anti-phospholipid antibody syndrome, Down's syndrome, birth asphyxia, herpes simplex encephalopathy and mitochondrial encephalopathy in one (2.1%) each. Mean (SD) age at presentation was 4.36 (3.38) years with a range of 2 months to 15 years. The common subtle neurological manifestations were abnormal deep tendon reflexes and extensor plantar reflexes. The common symptomatic manifestations were delayed milestones in 21 children (43.8%) and seizures in 19 (39.6%). Seizures were more common in males (54%) than in females (25%) (p=0.038). In children neurological deficits were more common in older children. Of the 13 children who received HAART, nine (60.23%) improved. Early diagnosis of neurological disorders in HIV-infected children is important for appropriate investigation and management, especially the introduction of HAART.

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

    African Journals Online (AJOL)

    One HIV-infected child died of varicella pneumonia. Other common nosocomial infections encountered in HIV-infected and HIV-uninfected children respectively were upper respiratory tract infections (pharyngitis, tonsillitis or rhinitis) affecting 21 and four, otitis media in five and one, oral candidiasis in seven and zero, urinary ...

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

    African Journals Online (AJOL)

    The interaction between tuberculosis and HIV-infected infection is well known and is responsible for the increase in the incidence of tuberculosis ... This retrospective case-control study evaluated the occurrence of nosocomial infections in (HIV)-infected children and age- and time of ... complicated disease, or whose social.

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

    African Journals Online (AJOL)

    admin

    Factors affecting the survival of HIV-infected children after. ART initiation ... balance between treating the disease and maintaining quality of life must be weighed carefully. An evaluation .... children were forced to work in early life, especially in.

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

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    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.

  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

    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 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. Results 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 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. Trial Registration Clinicaltrials.gov NCT00993031 PMID:22879899

  3. 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 ...

  4. 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.

  5. OSELTAMIVIR APPLICATION AMONG HIV-INFECTED CHILDREN, SUFFERING FROM THE FLU

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    Yu.A. Fomin

    2007-01-01

    Full Text Available The article provides the Oseltamivir application experience in flu treatment among HIV-infected children. The researchers showed that Oseltamivir is an effective medication for the given category of patients, reducing duration of the catarrhal syndrome and intoxication signs. The undesirable phenomena related to the medication intake proved to be transient and called for no cancellation of its use.Key words: children, hiv infection, flu, Oseltamivir.

  6. Moving forward with treatment options for HIV-infected children.

    Science.gov (United States)

    Beghin, Jean-Christophe; Yombi, Jean Cyr; Ruelle, Jean; Van der Linden, Dimitri

    2018-01-01

    Current international guidelines recommend to treat all HIV-1 infected patients regardless of CD4 cell count. Despite the remarkable worldwide progress for universal access to antiretroviral during the last decade, the pediatric population remains fragile due to lack of randomized studies, inappropriate antiretroviral formulations, adherence difficulties, drug toxicity and development of resistance. Areas covered: This review summarizes the latest recommendations and advances for the treatment of HIV-infected children and highlights the potential complications of a lifelong antiretroviral treatment initiated early in life. Expert opinion: International guidelines recommend to start combination antiretroviral therapy (cART) as fast as possible in all children diagnosed with HIV-1. The principal goal is to improve survival and reduce mortality as well as rapidly decrease HIV reservoirs. This remains a challenge in resource-limited settings were diagnostic tools and treatment access may be limited. Different new strategies are in the pipeline such as immunotherapy in combination with very early cART initiation to seek remission or functional cure. For the time being and awaiting for long term remission or cure, there is a need for further pharmacokinetics studies, more pediatric formulations with improved palatability and implementation of randomized trials for the newer antiretroviral drugs.

  7. Central nervous system manifestations of HIV infection in children

    International Nuclear Information System (INIS)

    George, Reena; Andronikou, Savvas; Plessis, Jaco du; Plessis, Anne-Marie du; Maydell, Arthur; Toorn, Ronald van

    2009-01-01

    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.)

  8. 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.)

  9. Efficacy and Safety of Lopinavir/ritonavir- versus Efavirenz-based Antiretroviral Therapy in HIV-Infected Pregnant Ugandan Women

    Science.gov (United States)

    COHAN, Deborah; NATUREEBA, Paul; KOSS, Catherine A.; PLENTY, Albert; LUWEDDE, Flavia; MWESIGWA, Julia; ADES, Veronica; CHARLEBOIS, Edwin D.; GANDHI, Monica; CLARK, Tamara D.; NZARUBARA, Bridget; ACHAN, Jane; RUEL, Theodore; KAMYA, Moses R.; HAVLIR, Diane V.

    2015-01-01

    Objective Combination antiretroviral therapy (ART) is now the global standard for HIV-infected pregnant and breastfeeding women at all CD4 cell counts. We compared the efficacy and safety of an efavirenz versus lopinavir/ritonavir regimen for HIV-infected pregnant women initiating ART in rural Uganda. Design Randomized clinical trial. Methods We performed a planned secondary analysis comparing viral load suppression (HIV-1 RNA ≤400 copies/ml), safety, and HIV transmission to infants in a trial designed to test the hypothesis that lopinavir/ritonavir- versus efavirenz-based ART would reduce placental malaria (PROMOTE, ClinicalTrials.gov, NCT00993031). HIV-infected, ART-naïve pregnant women at 12–28 weeks gestation and any CD4 cell count were randomized. ART was provided and participants were counseled to breastfeed for one year postpartum. Results The median age of the 389 study participants was 29 years; median CD4 cell count was 370 cells/mm3. At delivery, virologic suppression was 97.6% in the efavirenz arm and 86.0% in the lopinavir/ritonavir arm, p HIV (both in the lopinavir/ritonavir arm) and HIV-free infant survival was similar between study arms: 92.9% (lopinavir/ritonavir) versus 97.2% (efavirenz), p = 0.10. Conclusions Virologic suppression at delivery was higher with an efavirenz- versus lopinavir/ritonavir-based regimen. However, women in both arms achieved high levels of virologic suppression through one year postpartum and the risk of transmission to infants was low. PMID:25426808

  10. Efficacy and safety of lopinavir/ritonavir versus efavirenz-based antiretroviral therapy in HIV-infected pregnant Ugandan women.

    Science.gov (United States)

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

    2015-01-14

    Combination antiretroviral therapy (ART) is now the global standard for HIV-infected pregnant and breastfeeding women at all CD4⁺ cell counts. We compared the efficacy and safety of an efavirenz versus lopinavir/ritonavir regimen for HIV-infected pregnant women initiating ART in rural Uganda. Randomized clinical trial. We performed a planned secondary analysis comparing viral load suppression (HIV-1 RNA ≤400 copies/ml), safety, and HIV transmission to infants in a trial designed to test the hypothesis that lopinavir/ritonavir versus efavirenz-based ART would reduce placental malaria (PROMOTE, ClinicalTrials.gov, NCT00993031). HIV-infected, ART-naive pregnant women at 12-28 weeks gestation and any CD4⁺ cell count were randomized. ART was provided and participants were counseled to breastfeed for 1 year postpartum. The median age of the 389 study participants was 29 years; median CD4⁺ cell count was 370 cells/μl. At delivery, virologic suppression was 97.6% in the efavirenz arm and 86.0% in the lopinavir/ritonavir arm (P HIV (both in the lopinavir/ritonavir arm), and HIV-free infant survival was similar between study arms: 92.9% (lopinavir/ritonavir) versus 97.2% (efavirenz) (P = 0.10). Virologic suppression at delivery was higher with an efavirenz versus lopinavir/ritonavir-based regimen. However, women in both arms achieved high levels of virologic suppression through 1 year postpartum and the risk of transmission to infants was low.

  11. Lipodystrophy syndrome among HIV infected children on highly ...

    African Journals Online (AJOL)

    Background: It is estimated that about 2.5 million people are living with HIV infection in India. Although antiretroviral drugs have been able to reduce the mortality, these drugs have serious side effects one of which is lipodystrophy syndrome. Most of the drugs used in HAART viz, protease inhibitors, stavudine and nevirapine ...

  12. 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

  13. 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

  14. 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

    2007-10-01

    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 logistic regression. Results indicate that orphans, fostered children, and children of HIV-infected parents are significantly less likely to attend school than non-orphaned/non-fostered children of HIV-negative parents. Children of HIV-infected parents are more likely to be underweight and wasted, and less likely to receive medical care for ARI and diarrhea. Children of HIV-negative single mothers are also disadvantaged on most indicators. The findings highlight the need to expand child welfare programs to include not only orphans but also fostered children, children of single mothers, and children of HIV-infected parents, who tend to be equally, if not more, disadvantaged.

  15. Fracture risk by HIV infection status in perinatally HIV-exposed children.

    Science.gov (United States)

    Siberry, George K; Li, Hong; Jacobson, Denise

    2012-03-01

    The objective of this study was to examine the incidence of fractures in HIV-infected children and comparable HIV-exposed, uninfected (HEU) children in a multicenter, prospective cohort study (PACTG 219/219C) in the United States. The main outcome was first fracture during the risk period. Nine fractures occurred in 7 of 1326 HIV-infected and 2 of 649 HEU children, corresponding to incidence rates of 1.2 per 1000 person-years and 1.1 per 1000 person-years, respectively. The incidence rate ratio was 1.1 (95% CI 0.2, 5.5). There was no evidence of a substantially increased risk of fracture in HIV-infected compared to HEU children.

  16. 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

  17. 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…

  18. Molar incisor hypomineralization in HIV-infected children and adolescents.

    Science.gov (United States)

    Andrade, Natália Silva; Pontes, Alessandra Silva; de Sousa Paz, Hélvis Enri; de Moura, Marcoeli Silva; Moura, Lúcia de Fátima Almeida de Deus; Lima, Marina de Deus Mourade

    2017-01-01

    The objective was to determine the prevalence of molar incisor hypomineralization (MIH) among individuals between 7 and 15 years old infected or noninfected with human immunodeficiency virus (HIV). The study was conducted with 33 HIV-infected individuals (study group; SG) and 66 non-HIV-infected schoolchildren (control group; CG), paired by gender and age. Data collection was based on medical records (SG), a questionnaire for caregivers and oral examination for diagnosis of MIH (European Academy of Pediatric Dentistry criteria) and caries (DMFT index and ICDAS). Data were analyzed with Mann-Whitney, chi-square, and Fisher's exact tests and logistic regression. In SG, MIH (45.5%) and caries (87.9%) had higher prevalence. MIH was associated with use of protease inhibitors in SG (OR: 2.14; 95% CI: 1.21 to 3.77) and incubator need in CG (OR: 2.80; 95% CI: 1.71 to 9.10). HIV-infected patients had a higher prevalence of MIH and dental caries in the permanent dentition. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.

  19. Low Prevalence of Parvovirus 4 in HIV-infected Children in Denmark.

    Science.gov (United States)

    Rosenfeldt, Vibeke; Norja, Päivi; Lindberg, Ellinor; Jensen, Lise; Hedman, Lea; Väisänen, Elina; Li, Xuemeng; Hedman, Klaus; von Linstow, Marie-Louise

    2015-07-01

    Parvovirus 4 (PARV4) has been associated with HIV infection in adults. We examined plasma samples from 46 HIV-infected 0-year-old to 16-year-old children for the presence of PARV4. Four children (8.7%) had detectable PARV4 IgG and 1 had IgM. The result of PARV4 polymerase chain reaction was found to be negative in all patients. PARV4 seropositivity was associated with low CD4 count but not with HIV viral load.

  20. Who Gets Severe Gynecomastia Among HIV-infected Children in the United Kingdom and Ireland?

    Science.gov (United States)

    Kenny, Julia; Doerholt, Katja; Gibb, Di M; Judd, Ali

    2017-03-01

    There are few data on gynecomastia in HIV-infected children. Within the UK/Ireland's national cohort, 56 of 1873 (3%) HIV-infected children had gynecomastia, of which 10 (0.5%) were severe. All 10 had received antiretroviral therapy for a median of 27.5 (21, 42) months; 4 of 10 had received efavirenz, 7 of 10 and 6 of 10 had received stavudine and/or didanosine respectively. Five were nonreversible, despite changing antiretroviral therapy, and required breast reduction surgery.

  1. 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.

  2. 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.

  3. Children Living with HIV-Infected Adults: Estimates for 23 Countries in sub-Saharan Africa.

    Science.gov (United States)

    Short, Susan E; Goldberg, Rachel E

    2015-01-01

    In sub-Saharan Africa many children live in extreme poverty and experience a burden of illness and disease that is disproportionately high. The emergence of HIV and AIDS has only exacerbated long-standing challenges to improving children's health in the region, with recent cohorts experiencing pediatric AIDS and high levels of orphan status, situations which are monitored globally and receive much policy and research attention. Children's health, however, can be affected also by living with HIV-infected adults, through associated exposure to infectious diseases and the diversion of household resources away from them. While long recognized, far less research has focused on characterizing this distinct and vulnerable population of HIV-affected children. Using Demographic and Health Survey data from 23 countries collected between 2003 and 2011, we estimate the percentage of children living in a household with at least one HIV-infected adult. We assess overlaps with orphan status and investigate the relationship between children and the adults who are infected in their households. The population of children living in a household with at least one HIV-infected adult is substantial where HIV prevalence is high; in Southern Africa, the percentage exceeded 10% in all countries and reached as high as 36%. This population is largely distinct from the orphan population. Among children living in households with tested, HIV-infected adults, most live with parents, often mothers, who are infected; nonetheless, in most countries over 20% live in households with at least one infected adult who is not a parent. Until new infections contract significantly, improvements in HIV/AIDS treatment suggest that the population of children living with HIV-infected adults will remain substantial. It is vital to on-going efforts to reduce childhood morbidity and mortality to consider whether current care and outreach sufficiently address the distinct vulnerabilities of these children.

  4. Children Living with HIV-Infected Adults: Estimates for 23 Countries in sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Susan E Short

    Full Text Available In sub-Saharan Africa many children live in extreme poverty and experience a burden of illness and disease that is disproportionately high. The emergence of HIV and AIDS has only exacerbated long-standing challenges to improving children's health in the region, with recent cohorts experiencing pediatric AIDS and high levels of orphan status, situations which are monitored globally and receive much policy and research attention. Children's health, however, can be affected also by living with HIV-infected adults, through associated exposure to infectious diseases and the diversion of household resources away from them. While long recognized, far less research has focused on characterizing this distinct and vulnerable population of HIV-affected children.Using Demographic and Health Survey data from 23 countries collected between 2003 and 2011, we estimate the percentage of children living in a household with at least one HIV-infected adult. We assess overlaps with orphan status and investigate the relationship between children and the adults who are infected in their households.The population of children living in a household with at least one HIV-infected adult is substantial where HIV prevalence is high; in Southern Africa, the percentage exceeded 10% in all countries and reached as high as 36%. This population is largely distinct from the orphan population. Among children living in households with tested, HIV-infected adults, most live with parents, often mothers, who are infected; nonetheless, in most countries over 20% live in households with at least one infected adult who is not a parent.Until new infections contract significantly, improvements in HIV/AIDS treatment suggest that the population of children living with HIV-infected adults will remain substantial. It is vital to on-going efforts to reduce childhood morbidity and mortality to consider whether current care and outreach sufficiently address the distinct vulnerabilities of these

  5. HAART impact on prevalence of chronic otitis media in Brazilian HIV-infected children.

    Science.gov (United States)

    Weber, Raimar; Pinheiro Neto, Carlos Diógenes; Miziara, Ivan Dieb; Araújo Filho, Bernardo Cunha

    2006-01-01

    The advent of new antiretroviral drugs such as protease inhibitors has generated sensible changes in morbity and mortality in HIV-infected patients. To evaluate the impact of Highly Active Antiretroviral Therapy (HAART) on the prevalence of chronic otitis media in HIV-infected pediatric population. We analyzed medical charts of 471 children aged zero to 12 years and 11 months with HIV infection from an Ambulatory of ENT and AIDS. Children were divided according to the age: 0 to 5 years and 11 months and 6 to 12 years and 11 months and classified as having chronic otitis media based on history, physical examination, audiologic and tympanometric data. Prevalence of chronic otitis media, as well as CD4+ lymphocyte count were compared between groups in use of HAART and the group without HAART. Out of 459 children, 65 (14.2%) had chronic otitis media. We observed that in children aged 0 to 5 years and 11 months who were taking HAART there was significant lower prevalence of chronic otitis media (p=0.02). The use of HAART was associated to higher mean CD4+ lymphocyte count (pmedia in HIV infected children, probably due to increase in mean CD4+ lymphocyte count.

  6. Analysis of nevirapine (NVP) resistance in Ugandan infants who were HIV infected despite receiving single-Dose (SD) NVP versus SD NVP plus daily NVP up to 6 weeks of age to prevent HIV vertical transmission.

    Science.gov (United States)

    Church, Jessica D; Omer, Saad B; Guay, Laura A; Huang, Wei; Lidstrom, Jessica; Musoke, Philippa; Mmiro, Francis; Jackson, J Brooks; Eshleman, Susan H

    2008-10-01

    Single-dose nevirapine (SD NVP) at birth plus NVP prophylaxis for the infant up to 6 weeks of age is superior to SD NVP alone for prevention of vertical transmission of human immunodeficiency virus (HIV) through breastfeeding. We analyzed NVP resistance in HIV-infected Ugandan infants who received either SD NVP or extended NVP prophylaxis. We tested plasma HIV by using a genotyping assay (ViroSeq; Celera Diagnostics), a phenotypic resistance assay (PhenoSense; Monogram Biosciences), and sensitive point mutation assay (LigAmp, for K103N, Y181C, and G190A). When infants were 6 weeks old, ViroSeq detected NVP resistance in a higher proportion of infants in the extended NVP arm than in the SD NVP arm (21 of 25 [84%] vs. 12 of 24 [50%]; P = .01). Similar results were obtained with LigAmp and PhenoSense. In both study arms, infants who were HIV infected at birth frequently had NVP resistance detected. In contrast, infants in the extended NVP arm who were HIV infected after birth were more likely to have resistance detected at 6 weeks, compared with infants in the SD NVP arm. The use of extended NVP prophylaxis was also associated with detection of NVP resistance by ViroSeq at 6 months (7 of 7 [100%] infants in the extended NVP arm had resistance detected, compared with 1 of 6 [16.7%] infants in the SD NVP arm; P = .005). The use of extended NVP prophylaxis was associated with increased selection for and persistence of NVP resistance in HIV-infected Ugandan infants.

  7. Assessment of the HBV vaccine response in a group of HIV-infected children in Morocco.

    Science.gov (United States)

    Haban, Houda; Benchekroun, Soumia; Sadeq, Mina; Benjouad, Abdelaziz; Amzazi, Said; Oumzil, Hicham; Elharti, Elmir

    2017-09-29

    Since its development in the early 1980s, Hepatitis B virus (HBV) vaccine has been proven to be highly protective. However, its immunogenicity may be ineffective among HIV-infected children. In Morocco, HBV vaccine was introduced in 1999, and since then all infants, including vertically HIV-infected infants, have been following the vaccination schedule, implemented by the Moroccan ministry of health. An assessment of the immunization of these children is important to optimize efforts aimed at tackling Hepatitis B coinfection, within the country. Forty-nine HIV-infected children (HIV group) and 112 HIV uninfected children (control group) were enrolled in this study. Samples were tested by Elisa (Monolisa Anti-HBs, Biorad) to quantify the anti-HBs antibodies. The % of lymphocyte subsets i.e. CD4+ T cells, CD8+ T cells, B cells, and NK, was determined by flow cytometry, using CellQuest Pro software (Becton-Dickinson), and for HIV group, HIV viral load was measured by real time PCR assay (Abbott). All variables were statistically compared in the two groups. The median age was 51 ± 35 months for the HIV group and 50 ± 36 months (p > 0.05) for the control group. Female represented 63% and 41% (p = 0.01), among the HIV group and the control group, respectively. Among HIV-infected children, 71.4% (35/49) were under HAART therapy at the enrollment in the study. Seroprotection titer i.e. anti-HBs ≥10mUI/ml among control group was 76% (85/112), and only 29% (14/49) among the perinatally HIV-infected children (p Morocco, in order to revaccinate non-immunized children.

  8. Impaired bone mineral accrual in prepubertal HIV-infected children: a cohort study

    Directory of Open Access Journals (Sweden)

    Cecília Zanin Palchetti

    2015-11-01

    Conclusion: HIV-infected children have compromised bone mass and the presence of puberty seems to provide suitability of these parameters. Adequate intake of calcium and fat appears to be protective for proper bone mass accumulation factor, as well as monitoring nutritional status and serum magnesium concentration.

  9. Vasculopathy in HIV-infected children – a case series | Demopoulos ...

    African Journals Online (AJOL)

    We report on 6 HIV-infected South African children who presented with vasculopathy involving medium and large vessels. Four patients presented with a stroke, one with heart failure and one with gangrene. Five patients had aneurysms and one patient had an occlusion. The arteries of the circle of Willis and the aorta and ...

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

    African Journals Online (AJOL)

    Twenty-five nosocomial infections (23%) among the HIV-infected children, but only ... candidiasis in seven and zero, urinary tract infection in four and one and .... tant or multidrug-resistant TB received ... bacterial infections, 96 hours in the case.

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

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    Camila Pugliese

    2014-09-01

    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.

  12. friendly clinic on retention of HIV-infected children in care

    African Journals Online (AJOL)

    2017-08-22

    Aug 22, 2017 ... space where a child feels both physically and emotion- ally secure and at ... experience, retention in care and loss to follow up of. HIV-infected children. ... The clinic area was painted with artistic drawings in child-friendly ...

  13. Metabolic Abnormalities and Viral Replication is Associated with Biomarkers of Vascular Dysfunction in HIV-Infected Children

    Science.gov (United States)

    Miller, Tracie L.; Borkowsky, William; DiMeglio, Linda A.; Dooley, Laurie; Geffner, Mitchell E.; Hazra, Rohan; McFarland, Elizabeth J.; Mendez, Armando J.; Patel, Kunjal; Siberry, George K.; Van Dyke, Russell B.; Worrell, Carol J.; Jacobson, Denise L.

    2011-01-01

    Objectives Human immunodeficiency virus (HIV)-infected children may be at risk for premature cardiovascular disease. We compared levels of biomarkers of vascular dysfunction among HIV-infected children with and without hyperlipidemia to HIV-exposed, uninfected children (HEU) enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS), and determined factors associated with these biomarkers. Design Prospective cohort study Methods Biomarkers of inflammation (C-reactive protein (CRP), interleukin-6 (IL-6), and monocyte chemoattractant protein-1 (MCP1)); coagulant dysfunction (fibrinogen and P-selectin); endothelial dysfunction (soluble intracellular cell adhesion molecule-1 (sICAM), soluble vascular cell adhesion molecule-1 (sVCAM), and E-selectin); and metabolic dysfunction (adiponectin) were measured in 226 HIV-infected and 140 HEU children. Anthropometry, body composition, lipids, glucose, insulin, HIV disease severity, and antiretroviral therapy were recorded. Results The median ages were 12.3 y (HIV-infected) and 10.1 y (HEU). Body mass index (BMI) Z-scores, waist and hip circumference, and percent body fat were lower among HIV-infected. Total and non-HDL cholesterol and triglycerides were higher in HIV-infected children. HIV-infected children had higher MCP-1, fibrinogen, sICAM, and sVCAM levels. In multivariable analyses in the HIV-infected children alone, BMI z-score was associated with higher CRP and fibrinogen, but lower MCP-1 and sVCAM. Unfavorable lipid profiles were positively associated with IL6, MCP1, fibrinogen, and P- and E-selectin, whereas increased HIV viral load was associated with markers of inflammation (MCP1 and CRP) and endothelial dysfunction (sICAM and sVCAM). Conclusions HIV-infected children have higher levels of biomarkers of vascular dysfunction than do HEU children. Risk factors associated with higher biomarkers include unfavorable lipid levels and active HIV replication. PMID:22136114

  14. 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.

  15. 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.

  16. Oral mucosal lesions and immune status in HIV-infected Indian children.

    Science.gov (United States)

    Subramaniam, Priya; Kumar, Krishna

    2015-04-01

    Pediatric HIV is growing at an alarming rate in developing countries. Due to their compromised immune status, children infected with HIV are prone to a number of opportunistic infections. Oral manifestations are the first signs of the disease in many of them. To assess the oral mucosal status of Indian children with HIV, based on their CD4 cell counts. Two hundred and twenty one HIV infected children aged 6-18 years from various HIV centers, were divided into three groups, based on their CD4 cell counts; Group 1: ≥500, Group 2: 201-499 and Group 3: ≤200 cells. The children in each group were further considered as 'prior to antiretroviral treatment (ART)' and 'on ART'. Oral mucosal examination was done based on presumptive criteria given by Ramos-Gomez for diagnosis of oro-facial lesions commonly associated with HIV infection in children. Data obtained was subjected to statistical analysis. Angular cheilitis and pseudomembranous candidiasis were the frequently seen oral lesions. Children with CD4 cell count ≥500 had significantly fewer oral lesions each. A high percentage of HIV-infected children were affected with oral mucosal lesions. There was a significant association between immune status and frequency of oral lesions. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Immunogenicity and effectiveness of Haemophilus influenzae type b conjugate vaccine in HIV infected and uninfected African children.

    Science.gov (United States)

    Madhi, Shabir A; Kuwanda, Locadiah; Saarinen, Leena; Cutland, Clare; Mothupi, Rosalia; Käyhty, Helena; Klugman, Keith P

    2005-12-01

    The quantitative (anti-Hib capsular polysaccharide antibody concentrations; anti-HibPS) and qualitative (bactericidal activity and avidity) aspects in immune responses to Haemophilus influenzae type b polyribosyl ribitol phospshate-CRM(197) conjugate vaccine (HibCV; HibTiter) were evaluated in 66 HIV infected children not receiving anti-retroviral therapy and 127 HIV uninfected children. Surveillance was conducted for invasive Hib disease in a cohort of 39,865 (approximately 6.4% of whom were HIV infected) children from March 1998 to June 2004. HIV infected children had lower anti-HibPS geometric mean antibody concentrations 1 month post-immunisation than HIV uninfected children (Por=1.0 microg/ml (RR 0.54; 95% CI 0.43-0.69). A lower proportion of HIV infected children than HIV uninfected children (RR 0.78; 95% CI 0.66-0.93) had measurable anti-Hib serum bactericidal activity (SBA) and the HibPS antibody concentration required for 50% killing of Hib bacteria was greater among HIV infected than HIV uninfected children (P=0.001). The estimated risk of HibCV failure was 35.1-fold greater (95% CI 14.6-84.6) amongst HIV infected than HIV uninfected children.

  18. Persistent proteinuria as an indicator of renal disease in HIV-infected children

    Directory of Open Access Journals (Sweden)

    Yuni Hisbiiyah

    2017-01-01

    Full Text Available Background Persistent proteinuria (microalbuminuria has been reported to be a precursor of HIV-related renal disease. Screening allows for early management in order to prevent the progression of renal disease and decrease morbidity and mortality associated with chronic kidney disease in HIV. Several studies have been done on renal manifestation in HIV-infected children from American and African regions, but similar studies from Asia are lacking. Objective To determine the prevalence of persistent proteinuria in HIV-positive children on antiretroviral therapy (ARV in Dr. Soetomo Hospital, Surabaya. Methods A cross-sectional study on children with HIV and treated with  highly active antiretroviral therapy (HARRT was done from August 2014 to February 2015. Microalbuminuria was measured by the ratio of urine albumin to creatinine (ACR, while proteinuria was measured by dipstick. Measurements were performed 3 times in 4-8 weeks. All subjects underwent complete evaluation of blood tests, serum creatinine, blood urea nitrogen (BUN, CD4 counts, and urinalysis. Data were analyzed using Chi-square and logistic regression tests. Results Of 38 children on HARRT enrolled in this study, 2 subjects developed acute kidney injury (AKI, 4 subjects were suspected to have urinary tract infection (UTI, and 1 subject was suspected to have urinary tract stones. The prevalence of persistent microalbuminuria was 2.6%. There was no correlation between immunological status, WHO clinical stage, or duration of ARV and the incidence of persistent proteinuria (P>0.05. Conclusion The prevalence of persistent proteinuria is  lower in younger HIV-infected children at a non-advanced stage and HIV-infected children with normal immunological status who are on HAART. We provide baseline data on the renal conditions of HIV-infected children in the era of HAART, before tenovofir is  increasingly used as an antiretroviral therapy regimen in Indonesia.

  19. PRACTICE OF USING VIRAL PROTEASE INHIBITORS IN CHILDREN WITH HIV INFECTION

    Directory of Open Access Journals (Sweden)

    V.B. Denisenko

    2010-01-01

    Full Text Available Selection of the most effective and safest high-active antiretroviral therapies is a critical issue faced by modern HIV medicine. Authors studied 28 children with HIV infection aged from 3 to 7 divided into two groups administered a combination of two HIV reverse transcriptase nucleoside inhibitors with viral protease nelfinavir inhibitors (n = 13 and lopinavir/ritonavir (n = 15. The subjects in both groups demonstrated a decreased frequency of HIV-associated symptoms and opportunistic infections, positive dynamics of immunological indicators, suppression of HIV replication. When lopinavir/ritonavir was administered, there was more even better dynamics in clinical, immunological and virologic parameters, which allows this medication to be recommended as a antiretroviral therapy for children. Key words: HIV infection, lopinavir/ritonavir, nelfinavir, children. (Pediatric Pharmacology. – 2010; 7(1:62-67

  20. The "moral career" of perinatally HIV-infected children: revisiting Goffman's concept.

    Science.gov (United States)

    Cruz, Maria Letícia Santos; Bastos, Francisco Inácio; Darmont, Mariana; Dickstein, Paulo; Monteiro, Simone

    2015-01-01

    HIV-infected children usually live in vulnerable situations, experiencing discrimination and stigma commonly felt by other people living with HIV/AIDS. The present study aims to analyse primary socialisation of HIV-infected children and adolescents recruited from a public health service in Rio de Janeiro (Brazil) as a social process that shapes a new generation of stigmatised and vulnerable persons. Research was informed by an interactionist perspective, focusing on key aspects of HIV-infected children and adolescents life histories under the conceptual frame of Erving Goffman's theories regarding "moral careers". Goffman defines the making of a moral career as the process through which a person learns that she/he possesses a particular attribute, which may lead her/him to be discredited by members of the surrounding society. We have identified aspects of life histories of HIV-vertically infected children and adolescents for each aspect of "moral career" as described by Goffman, relating them to as family structure, the experience of living HIV within the family, and the position and family role of a given subject. The patterns of "moral career" proposed by Goffman in 1963 were useful in identifying components of HIV-related stigma among children and adolescents. These include gender and social disadvantages, difficulty in coping with a child with a potentially severe disease, orphanhood, abandonment, adoption and disclosure of one's HIV serostatus. Primary socialisation of HIV-infected children and adolescents is a key piece of the complex HIV/AIDS-labelling process that could be targeted by interventions aiming to decrease stigma and marginalisation. Health care workers and stakeholders should be committed to ensuring education and guaranteeing the legal rights of this specific population, including the continuous provision of quality health care, full access to school and support to full disclosure of HIV diagnosis.

  1. Malnutrition is associated with HIV infection in children less than 5 years in Bobo-Dioulasso City, Burkina Faso

    Science.gov (United States)

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

    2017-01-01

    Abstract 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 children less than 5 years of age. High prevalence of malnutrition was observed in HIV-infected children compared with HIV-uninfected children. Except for ART, nutritional assessment and

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

    International Nuclear Information System (INIS)

    Kilborn, Tracy; Zampoli, Marco

    2009-01-01

    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.)

  3. Neuroradiological findings in perinatally HIV-infected children. Neuroradiologische Befunde bei perinatal HIV-infizierten Kindern

    Energy Technology Data Exchange (ETDEWEB)

    Spreer, J [Radiologische Abt., Universitaetsklinik Koeln (Germany); Enenkel-Stoodt, S [Abt. fuer Allgemeine Paediatrie 2, Universitaetsklinik Frankfurt am Main (Germany); Funk, M [Abt. fuer Paediatrische Haematologie und Onkologie, Universitaetsklinik Frankfurt am Main (Germany); Fiedler, A [Abt. fuer Paediatrische Neurologie, Universitaetsklinik Frankfurt am Main (Germany); Simone, A de [Neuroradiologische Abt., Universitaetsklinik Frankfurt am Main (Germany); Hacker, H [Neuroradiologische Abt., Universitaetsklinik Frankfurt am Main (Germany)

    1994-08-01

    The neuroradiological studies (CT, MRI, angiography) in 21 children with perinatal HIV infection were reviewed retrospectively. No patient showed an intracranial mass lesion; after intravenous contrast medium application there was no case with disturbed blood-brain barrier. Common non-specific findings were atrophy and delayed myelination. In 7 cases atrophy was combined with multifocal nearly symmetric white matter lesions, which characteristically spared the U-fibres. Further findings included an intramedullary ring-shaped structure in the cervical cord, an AIDS-associated vasculopathy and symmetric calcifications in the basal ganglia. The spectrum of neuroradiological findings in paediatric AIDS patients differs from that in adults. Knowledge of these age-specific findings is important because the number of HIV-infected children is rising. (orig.)

  4. Characterization of Cytomegalovirus Lung Infection in Non-HIV Infected Children

    OpenAIRE

    Restrepo-Gualteros, Sonia; Jaramillo-Barberi, Lina; Gonzalez-Santos, Monica; Rodriguez-Martinez, Carlos; Perez, Geovanny; Gutierrez, Maria; Nino, Gustavo

    2014-01-01

    Cytomegalovirus (CMV) is a prevalent pathogen in the immunocompromised host and invasive pneumonia is a feared complication of the virus in this population. In this pediatric case series we characterized CMV lung infection in 15 non-HIV infected children (median age 3 years; IQR 0.2–4.9 years), using current molecular and imaging diagnostic modalities, in combination with respiratory signs and symptoms. The most prominent clinical and laboratory findings included cough (100%), hypoxemia (100%...

  5. 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.

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

    Science.gov (United States)

    Boyede, Gbemisola O; Lesi, Foluso Ea; Ezeaka, Veronica C; Umeh, Charles S

    2013-01-01

    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. 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. 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. Younger age, poor socioeconomic status, and low level of maternal education were factors apart from HIV infection that were significantly associated with low cognitive function in school-aged HIV-infected Nigerian children.

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

    African Journals Online (AJOL)

    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 .... observation that children are sensitive and can be inquisitive. ... intelligent she is and can anticipate the questions she would ask. This.

  8. Morbidity and Mortality of a Cohort of Peruvian HIV-infected Children 2003-2012.

    Science.gov (United States)

    Baker, Amira N; Bayer, Angela M; Viani, Rolando M; Kolevic, Lenka; Sim, Myung-Shin; Deville, Jaime G

    2018-06-01

    Data on pediatric HIV in Peru are limited. The National Institute of Child Health (Instituto Nacional de Salud del Niño: INSN) cares for the most HIV-infected children under the age of 18 years in the country. We describe the outcomes of children seen at INSN's HIV clinic over the 10 years when antiretroviral therapy and prevention of mother-to-child transmission (PMTCT) interventions became available in 2004. We conducted a retrospective review of INSN HIV clinic patients between 2003 and 2012. Deidentified data were collected and analyzed. A total of 280 children were included: 50.0% (140/280) were male; 80.0% (224/280) lived in metropolitan Lima. Perinatal transmission was the mode of HIV infection in 91.4% (256/280) of children. Only 17% (32/191) of mothers were known to be HIV-infected at delivery; of these mothers, 41% (13/32) were receiving antiretroviral therapy at delivery, 72% (23/32) delivered by Cesarean section and 47% (15/32) of their infants received antiretroviral prophylaxis. Median age at HIV diagnosis for all children was 35.7 months (interquartile range 14.5-76.8 months), and 67% (143/213) had advanced disease (clinical stage C). After HIV diagnosis, the most frequent hospitalization discharge diagnoses were bacterial pneumonia, chronic malnutrition, diarrhea, anemia and tuberculosis. Twenty-four patients (8.6%) died at a median age of 77.4 months. Most cases of pediatric HIV were acquired via perinatal transmission; few mothers were diagnosed before delivery; and among mothers with known HIV status, PMTCT was suboptimal even after national PMTCT policy was implemented. Most children were diagnosed with advanced disease. These findings underscore the need for improving early pediatric HIV diagnosis and treatment, as well as PMTCT strategies.

  9. 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: ...

  10. Some Laboratory Features of HIV Infected Nigerian Children Co ...

    African Journals Online (AJOL)

    Background And Aims: Few studies on HIV coinfection with hepatitis B and C have been conducted in children especially in low resource settings. These coinfections have been shown to be associated with lower CD4 counts and high alanine transaminase in adults. In children conflicting results from different geographic ...

  11. 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.

  12. Malnutrition in HIV-Infected Children Is an Indicator of Severe Disease with an Impaired Response to Antiretroviral Therapy

    Science.gov (United States)

    Healy, Michael; Singh, Ravesh; Roider, Julia; Groll, Andreas; Kindra, Chirjeev; Sibaya, Thobekile; Moonsamy, Angeline; McGregor, Callum; Phan, Michelle Q.; Palma, Alejandro; Kloverpris, Henrik; Leslie, Alasdair; Bobat, Raziya; LaRussa, Philip; Ndung'u, Thumbi; Goulder, Philip; Sobieszczyk, Magdalena E.; Archary, Mohendran

    2018-01-01

    Abstract This observational study aimed to describe immunopathogenesis and treatment outcomes in children with and without severe acute malnutrition (SAM) and HIV-infection. We studied markers of microbial translocation (16sDNA), intestinal damage (iFABP), monocyte activation (sCD14), T-cell activation (CD38, HLA-DR) and immune exhaustion (PD1) in 32 HIV-infected children with and 41 HIV-infected children without SAM prior to initiation of antiretroviral therapy (ART) and cross-sectionally compared these children to 15 HIV-uninfected children with and 19 HIV-uninfected children without SAM. We then prospectively measured these markers and correlated them to treatment outcomes in the HIV-infected children at 48 weeks following initiation of ART. Plasma levels of 16sDNA, iFABP and sCD14 were measured by quantitative real time PCR, ELISA and Luminex, respectively. T cell phenotype markers were measured 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 compared to HIV-uninfected children without SAM. In HIV-infected children microbial translocation, immune activation, and exhaustion was strongly increased but did not differ by SAM-status. SAM was associated with increased mortality rates early after ART initiation. Malnutrition, age, microbial translocation, monocyte, and CD8 T cell activation were independently associated with decreased rates of CD4% immune recovery after 48 weeks of ART. SAM is associated with increased microbial translocation, immune activation, and immune exhaustion in HIV-uninfected children and with worse prognosis and impaired immune recovery in HIV-infected children on ART. PMID:28670966

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

    African Journals Online (AJOL)

    At the start of HAART no child had cranial nerve or ... were started on HAART based on criteria derived from the. Paediatric ... A convenience sample of 40 ambulant children attending ..... Business School, provided statistical support and Dr D.

  14. Health, schooling, needs, perspectives and aspirations of HIV infected and affected children in Botswana: a cross-sectional survey.

    Science.gov (United States)

    Anabwani, Gabriel; Karugaba, Grace; Gabaitiri, Lesego

    2016-07-22

    Antiretroviral treatment means many HIV infected children are surviving with a highly stigmatised condition. There is a paucity of data to inform policies for this growing cohort. Hence we carried out a study on the health, schooling, needs, aspirations, perspectives and knowledge of HIV infected and affected children in Botswana. A cross-sectional survey using interviews and focus group discussions among HIV infected children aged 6-18 years versus HIV aged matched HIV uninfected counterparts living in the same households between August 2010 and March 2011. Supplemental clinical data was abstracted from medical records for HIV infected participants. Nine hundred eighty-four HIV infected and 258 affected children completed the survey. Females predominated in the affected group (63.6 % versus 50.3 %, P School attendance was high in both groups (98.9 % versus 97.3 %, P = 0.057). HIV infected children were mostly in primary school (grades 3-7) while affected children were mostly in upper primary or secondary grades. Sixty percent HIV infected children reported having missed school at least 1 day in the preceding month. Significantly more infected than affected children reported experiencing problems at school (78 % versus 62.3 %, P School related problems included poor grades, poor health/school attendance, stigma and inadequate scholastic materials. The wish-list for improving the school environment was similar for both groups and included extra learning support; better meals; protection from bullying/teasing; more scholastic materials, extracurricular activities, love and care; structural improvements; improved teacher attendance and teaching approaches. Significantly more HIV infected children reported feeling hungry all the time (50.6 % versus 41 %, P = 0.007) and more trouble hearing (26.8 % versus 12.5 %, P = 0.028). The mean age for HIV disclosure 10 years was high. Sexual activity (9.2 % versus 3 %, P = 0.001) and emotions of

  15. Comparative costs of inpatient care for HIV-infected and uninfected children and adults in Soweto, South Africa.

    Science.gov (United States)

    Thomas, Leena S; Manning, Arthur; Holmes, Charles B; Naidoo, Shan; van der Linde, Frans; Gray, Glenda E; Martinson, Neil A

    2007-12-01

    HIV/AIDS creates a massive burden of care for health systems. A better understanding of the impact of HIV infection on health care utilization and costs may enable better use of limited resources. We compared public sector inpatient costs of HIV-infected versus uninfected adults and children at a large hospital in Soweto, South Africa. Daily hotel costs estimated from hospital financial data and total patient visits were combined with utilization, abstracted from patients' charts, and costed using government price lists to estimate total inpatient costs. A total of 1185 eligible records were included over a 6-week period in 2005. Eight hundred twelve were from HIV-infected patients, and of these, 77 were on antiretroviral (ARV) therapy. The mean length of stay (LOS) and mean drug and intravenous fluid utilization of HIV-infected adults not on ARVs was greater than those of uninfected adults, resulting in a $200 higher total average admission cost. Patients on ARVs had longer LOS and incurred a total average admission cost of $750 more than HIV-infected adults not on ARVs. Inpatient costs were greater for this selected group of HIV-infected adults, and even higher for the small proportion of individuals receiving ARVs. Budget allocations should incorporate case mix by HIV and ARV status as a key determinant of hospital expenditure.

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

    African Journals Online (AJOL)

    referred after an inappropriate diagnostic test for age was used. In summary, 1 in every 30 (3.3%) ... According to SA guidelines, the diagnostic protocol in children above. 18 months is similar to that of the adult ..... The National Antenatal Sentinel HIV and Syphilis Prevalence Survey, South. Africa, 2010, National Department ...

  17. HIV Infection in hospitalized under-5 children with acute watery ...

    African Journals Online (AJOL)

    Prof Ezechukwu

    2011-12-31

    Dec 31, 2011 ... HIV with acute watery diarrhea as a clinical manifesta- tion.5,6,9,10 This study therefore attempts to find out the prevalence of HIV among children admitted into the. Diarrhoea Treatment and Training Unit of the University of Calabar Teaching Hospital, Calabar, Nigeria. This study will help in identifying ...

  18. Country of Birth of Children With Diagnosed HIV Infection in the United States, 2008-2014.

    Science.gov (United States)

    Nesheim, Steven R; Linley, Laurie; Gray, Kristen M; Zhang, Tianchi; Shi, Jing; Lampe, Margaret A; FitzHarris, Lauren F

    2018-01-01

    Diagnoses of HIV infection among children in the United States have been declining; however, a notable percentage of diagnoses are among those born outside the United States. The impact of foreign birth among children with diagnosed infections has not been examined in the United States. Using the Centers for Disease Control and Prevention National HIV Surveillance System, we analyzed data for children aged United States (reported from 50 states and the District of Columbia) during 2008-2014, by place of birth and selected characteristics. There were 1516 children [726 US born (47.9%) and 676 foreign born (44.6%)]. US-born children accounted for 70.0% in 2008, declining to 32.3% in 2013, and 40.9% in 2014. Foreign-born children have exceeded US-born children in number since 2011. Age at diagnosis was younger for US-born than foreign-born children (0-18 months: 72.6% vs. 9.8%; 5-12 years: 16.9% vs. 60.3%). HIV diagnoses in mothers of US-born children were made more often before pregnancy (49.7% vs. 21.4%), or during pregnancy (16.6% vs. 13.9%), and less often after birth (23.7% vs. 41%). Custodians of US-born children were more often biological parents (71.9% vs. 43.2%) and less likely to be foster or nonrelated adoptive parents (10.4% vs. 55.1%). Of 676 foreign-born children with known place of birth, 65.5% were born in sub-Saharan Africa and 14.3% in Eastern Europe. The top countries of birth were Ethiopia, Ukraine, Uganda, Haiti, and Russia. The increasing number of foreign-born children with diagnosed HIV infection in the United States requires specific considerations for care and treatment.

  19. 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

    This observational study aimed to describe immunopathogenesis and treatment outcomes in children with and without severe acute malnutrition (SAM) and HIV-infection. We studied markers of microbial translocation (16sDNA), intestinal damage (iFABP), monocyte activation (sCD14), T-cell activation (CD...... compared to HIV-uninfected children without SAM. In HIV-infected children microbial translocation, immune activation, and exhaustion was strongly increased but did not differ by SAM-status. SAM was associated with increased mortality rates early after ART initiation. Malnutrition, age, microbial...

  20. Tribal ethnicity and CYP2B6 genetics in Ugandan and Zimbabwean populations in the UK: implications for efavirenz dosing in HIV infection.

    Science.gov (United States)

    Jamshidi, Y; Moreton, M; McKeown, D A; Andrews, S; Nithiyananthan, T; Tinworth, L; Holt, D W; Sadiq, S T

    2010-12-01

    To determine differences in CYP2B6 loss of function (LoF) single nucleotide polymorphisms (SNPs) and haplotypes between Zimbabweans and Ugandans, and within Ugandan populations (Bantu and Nilotic). Genetic epidemiological study enrolling adult black African Ugandan and Zimbabwean patients attending a UK HIV-1 clinic, irrespective of antiretroviral therapy status. Genomic DNA was extracted from whole blood and the presence of CYP2B6 alleles was determined by direct sequencing of all nine exons of the CYP2B6 gene. Blood was also collected, where appropriate, for determination of efavirenz concentrations. Frequency of SNPs in all patients and LoF haplotype frequencies were calculated. The relationship between the number of LoF haplotype alleles possessed and efavirenz trough concentration (ETC) was determined. Thirty-six Zimbabweans and 74 Ugandans (58 Bantu and 16 Nilotic) were recruited. The definite haplotypes determined were *6, *18, *20 and *27 as LoF and *4 as gain of function. Among those with definite genotypes, the frequency of LoF alleles was 65% [95% confidence interval (95% CI): 51-80] of Zimbabweans versus 22% (95% CI: 12-31) of Ugandan Bantus (P = 10(-6)) and versus 39% (95% CI: 14-64) of Ugandan Nilotics (P = 0.09). Among the 19 patients with definite genotype and with available ETCs, log ETCs were associated with a greater number of LoF haplotype alleles [848 ng/mL (n = 12), 1069 ng/mL (n = 4) and 1813 ng/mL (n = 3) for 0, 1 or 2 LoF haplotypes, respectively (P = 0.016)]. Among Zimbabweans, LoF haplotypes constitute the majority of CYP2B6 alleles and are significantly higher in prevalence compared with Ugandans. Frequencies of LoF haplotypes and SNPs in Ugandan Nilotics appear to lie between those of Zimbabweans and Ugandan Bantus. These findings may have relevance to pharmacokinetics and dosing of efavirenz in African populations.

  1. Comparison of techniques to evaluate the quantification of Candida spp. in HIV-infected children.

    Science.gov (United States)

    Cerqueira, Daniella Ferraz; Portela, Maristela Barbosa; Soares, Rosangela Maria De Araujo; De Souza, Ivete Pomarico Ribeiro; Castro, Gloria Fernanda

    2009-01-01

    This study sought to compare techniques used to make a quantified evaluation of Candida spp. in children infected with HIV. Twenty-four HIV-infected children (age 3 to 13) were selected. Three sterilized swabs were used for each child: one for the dorsum of the tongue, one for the hard palate mucosa, and one for the right jugal mucosa; each swab was rubbed for 10 seconds and transferred to sterilized test tubes containing 1 mL of 0.9% saline solution. Candida spp. growth was observed in 95.8% of all samples, including 95.7% of tongue samples (Group T), 87.0% of saliva samples, 56.6% of hard palate mucosa samples (Group P), and 47.8% of right jugal mucosa samples (Group J). There was no statistical difference in Candida spp. growth between saliva samples and Group T samples, although both had higher growth compared to Groups P and J (p < 0.05; chi(2)). Regarding the sensitivity of each site for positive Candida spp. growth, Group T samples showed 69.5%, while saliva samples showed 52.2%, Group P samples showed 21.7%, and Group J samples showed 13.04%, with no significant statistical difference between Group T and saliva; however, both were more sensitive than Groups J and P (p < 0.05, chi(2)). It was concluded that whole stimulated saliva and swabbing the tongue were considered satisfactory for measuring Candida spp. in HIV-infected children.

  2. Characterization of Cytomegalovirus Lung Infection in Non-HIV Infected Children

    Directory of Open Access Journals (Sweden)

    Sonia M. Restrepo-Gualteros

    2014-05-01

    Full Text Available Cytomegalovirus (CMV is a prevalent pathogen in the immunocompromised host and invasive pneumonia is a feared complication of the virus in this population. In this pediatric case series we characterized CMV lung infection in 15 non-HIV infected children (median age 3 years; IQR 0.2–4.9 years, using current molecular and imaging diagnostic modalities, in combination with respiratory signs and symptoms. The most prominent clinical and laboratory findings included cough (100%, hypoxemia (100%, diffuse adventitious breath sounds (100% and increased respiratory effort (93%. All patients had abnormal lung images characterized by ground glass opacity/consolidation in 80% of cases. CMV was detected in the lung either by CMV PCR in bronchoalveolar lavage (82% detection rate or histology/immunohistochemistry in lung biopsy (100% detection rate. CMV caused respiratory failure in 47% of children infected and the overall mortality rate was 13.3%. Conclusion: CMV pneumonia is a potential lethal disease in non-HIV infected children that requires a high-index of suspicion. Common clinical and radiological patterns such as hypoxemia, diffuse adventitious lung sounds and ground-glass pulmonary opacities may allow early identification of CMV lung infection in the pediatric population, which may lead to prompt initiation of antiviral therapy and better clinical outcomes.

  3. 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

  4. Hepatitis B virus prevalence and vaccine response in HIV-infected children and adolescents on combination antiretroviral therapy in Kigali, Rwanda

    NARCIS (Netherlands)

    Mutwa, Philippe R.; Boer, Kimberly R.; Rusine, John B.; Muganga, Narcisse; Tuyishimire, Diane; Reiss, Peter; Lange, Joep M. A.; Geelen, Sibyl P. M.

    2013-01-01

    The aim of this study was to determine the prevalence of hepatitis B virus (HBV) infection in a cohort of HIV-infected Rwandan children and adolescents on combination antiretroviral therapy (cART), and the success rate of HBV vaccination in those children found to be HBV negative. HIV-infected

  5. The Prevalence of Disclosure of HIV Status to HIV-Infected Children in Western Kenya.

    Science.gov (United States)

    Turissini, Matthew L; Nyandiko, Winstone M; Ayaya, Samuel O; Marete, Irene; Mwangi, Ann; Chemboi, Victor; Warui, Lucy; Vreeman, Rachel C

    2013-06-01

    As antiretroviral therapy (ART) allows the world's 2.3 million human immunodeficiency virus (HIV)-infected children to grow and thrive, these children need to be informed of their HIV status. Neither the prevalence of disclosure to children nor its impact has been evaluated in most resource-limited settings. We conducted a prospective assessment of a random sample of HIV-infected children ages 6-14 years enrolled in HIV care at a large referral clinic in Eldoret, Kenya. Clinicians administered questionnaires to children and caregivers independently at routine clinic visits to assess disclosure status, ART adherence, stigma, and depression. Children's demographic and clinical characteristics were extracted from chart review. We calculated descriptive statistics and performed logistic regression to assess the association between disclosure and other characteristics. Two hundred seventy children-caregiver dyads completed questionnaires. The mean child age was 9.3 years (standard deviation 2.6); 49% were male, and 42% were orphans. 11.1% of children had been informed of their HIV status (N = 30). Of those under 10 years, 3.3% knew their status, whereas 9.2% of 10- to 12-year-olds and 39.5% of 13- to 14-year-olds knew they had HIV. Only age was significantly associated with disclosure status in both bivariate analyses (P processes should be a key facet of long-term pediatric HIV management. © 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.

  6. 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.

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

    International Nuclear Information System (INIS)

    Pitcher, R.D.; Beningfield, S.J.; Zar, H.J.

    2010-01-01

    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.

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

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    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.

  9. Renal abnormalities among HIV infected children at Muhimbili National Hospital (MNH)-Dar es Salaam, Tanzania.

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    Fredrick, Francis; Francis, Joel M; Ruggajo, Paschal J; Maro, Eden E

    2016-03-21

    Human Immunodeficiency Virus infection is a multisystem disease that contributes to significant morbidity. Renal involvement is reported to be common among patients with HIV. This study was carried out to determine renal involvement using simple bedside tests combined with ultrasonography examination. We recruited 240 children from the HIV clinic at Muhimbili National Hospital. Data were collected using structured questionnaires and included demographic, clinical information, radiological tests; renal ultrasound and laboratory tests; serum creatinine, white blood cells, CD4+ counts and percent, urine for microalbuminuria and proteinuria. Microalbuminuria and proteinuria were present in 20.4 % and 7.1 % respectively. Significantly higher prevalence of microalbuminuria (p < 0.01) and proteinuria p < 0.01) were noted with low CD4 percent (<25 %). Lower mean CD4+ count were noted among children with microalbuminuria [937.4 ± 595.3 cells/μL vs 1164.7 ± 664.3 cell/μL, (p < 0.05)] and proteinuria [675.5 ± 352.3 cells/μL vs 1152 ± 662 cells/μL (p < 0.001)]. Fourteen (5.8 %) HIV infected children had estimated glomerular filtration rate (eGFR of 30-59) consistent with severe renal impairment. Increased cortical echogenicity was noted in 69/153 (39.2 %) of participants who had ultrasound examination. Microalbuminuria, proteinuria and renal dysfunction were noted to be prevalent among HIV infected children indicating the need to consider routine screening of renal complications in these children.

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

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    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 nutritional screening and care in the pediatric HIV-care package is needed to optimize growth and prevent metabolic disorders.

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

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    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.

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

    NARCIS (Netherlands)

    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

    2015-01-01

    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

  13. HIV-infected Children in Malawi Have Decreased Performance on the 6-minute Walk Test With Preserved Cardiac Mechanics Regardless of Antiretroviral Treatment Status.

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    Sims Sanyahumbi, Amy E; Hosseinipour, Mina C; Guffey, Danielle; Hoffman, Irving; Kazembe, Peter N; McCrary, Madeline; Minard, Charles G; van der Horst, Charles; Sable, Craig A

    2017-07-01

    The aims of this study were to 1) determine if cardiac disease can be detected in HIV-infected children by strain imaging and 2) to evaluate differences in exercise performance between HIV-infected children on antiretroviral therapy (ART) and HIV-infected children not yet on ART and in HIV-uninfected children by 6-minute walk tests (6MWTs). This cross-sectional study evaluated cardiac function by echocardiogram and exercise performance by 6MWT in HIV-infected and HIV-uninfected children 4-18 years of age in Lilongwe, Malawi. Analyses compared HIV uninfected, HIV infected not yet on ART, and HIV infected on ART. Comparisons used χ test, t test, analysis of variance and multiple linear regression. No differences were found in ejection fraction, shortening fraction or strain in 73 children not yet on ART, 149 on ART and 77 HIV-uninfected controls. As viral load increased, children had worse circumferential strain. In addition, children receiving ART had better circumferential strain than those not yet on ART. Increased CD4 percentage was associated with better longitudinal strain and farther 6MWT distance. As longitudinal strain worsened, the 6MWT distance decreased. HIV-infected children not yet on ART walked a mean of 25.8 m less than HIV-uninfected children, and HIV-infected children on ART walked 25.9 m less (P = 0.015 comparing 3 groups). HIV-uninfected children performed better on the 6MWT than HIV-infected children. Lower viral load, being on ART, and higher CD4 percentage were associated with better strain measures. Better longitudinal strain was associated with a farther 6MWT distance. Overall, ejection fraction, shortening fraction and strain measures between groups were similar, so cardiac strain did not detect cardiac dysfunction in this young population.

  14. Antiretroviral treatment program retention among HIV-infected children in the Democratic Republic of Congo.

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    John Ditekemena

    Full Text Available BACKGROUND: Retaining patients with HIV infection in care is still a major challenge in sub- Saharan Africa, particularly in the Democratic Republic of Congo (DRC where the antiretroviral treatment (ART coverage is low. Monitoring retention is an important tool for evaluating the quality of care. METHODS AND FINDINGS: A review of medical records of HIV-infected children was performed in three health facilities in the DRC: the Amo-Congo Health center, the Monkole Clinic in Kinshasa, and the HEAL Africa Clinic in Goma. Medical records of 720 children were included. Kaplan Meier curves were constructed with the probability of retention at 6 months, 1 year, 2 years and 3 years. Retention rates were: 88.2% (95% CI: 85.1%-90.8% at 6 months; 85% (95% CI: 81.5%-87.6% at one year; 79.4% (95%CI: 75.5%-82.8% at two years and 74.7% (95% CI: 70.5%-78.5% at 3 years. The retention varied across study sites: 88.2%, 66.6% and 92.5% at 6 months; 84%, 59% and 90% at 12 months and 75.7%, 56.3% and 85.8% at 24 months respectively for Amo-Congo/Kasavubu, Monkole facility and HEAL Africa. After multivariable Cox regression four variables remained independently associated with attrition: study site, CD4 cell count <350 cells/µL, children younger than 2 years and children whose caregivers were member of an independent church. CONCLUSIONS: Attrition remains a challenge for pediatric HIV positive patients in ART programs in DRC. In addition, the low coverage of pediatric treatment exacerbates the situation of pediatric HIV/AIDS.

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

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    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.

  16. Point-of-Care Virologic Testing to Improve Outcomes of HIV-Infected Children in Zambia: A Clinical Trial Protocol.

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    Chibwesha, Carla J; Ford, Catherine E; Mollan, Katie R; Stringer, Jeffrey S A

    2016-08-01

    In the absence of early infant diagnosis (EID) and immediate antiretroviral therapy (ART), some 50% of untreated HIV-infected infants die before age 2. Conventional EID requires sophisticated instruments that are typically placed in centralized or reference laboratories. In low-resource settings, centralized systems often lead to result turnaround times of several months, long delays in diagnosis, and adverse outcomes for HIV-infected children. Our clinical trial tests the effectiveness of a new point-of-care (POC) diagnostic technology to identify HIV-infected infants and start providing them life-saving ART as soon as possible. The study uses a randomized, controlled design to test whether the Alere q platform for HIV DNA polymerase chain reaction (PCR) testing improves outcomes of HIV-infected children in Zambia. We aim to enroll 2867 HIV-exposed infants aged 4-12 weeks and to follow those who are HIV infected for 12 months as they receive HIV care at 6 public health facilities in Lusaka. The trial's primary endpoint is the proportion of HIV-infected infants in each study arm who start ART and remain alive, in care, and virally suppressed 12 months after their diagnostic blood draw. Our trial will provide evidence for the incremental benefit of implementing a POC EID strategy in low-resource settings where only off-site PCR services are currently available. The results will be useful in guiding future decisions regarding investments in POC virologic testing as part of overall pediatric AIDS mitigation strategies in sub-Saharan Africa. clinicaltrials.gov NCT02682810.

  17. 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

  18. Impact of multi-micronutrient supplementation on growth and morbidity of HIV-infected South African children

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    Raaij, van J.M.A.; Villiers, de F.P.R.; Kok, F.J.

    2013-01-01

    Poor growth, micronutrient deficiencies and episodes of diarrhea and respiratory infections occur frequently in HIV-infected children. We investigated whether multi-micronutrient supplementation would improve the growth performance and reduce the number of episodes of diarrhea and/or of respiratory

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

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    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.

  20. 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

  1. 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.

  2. HIV-infected children living in Central Africa have low persistence of antibodies to vaccines used in the Expanded Program on Immunization.

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    Mathurin C Tejiokem

    Full Text Available BACKGROUND: The Expanded Program on Immunization (EPI is the most cost-effective measures to control vaccine-preventable diseases. Currently, the EPI schedule is similar for HIV-infected children; the introduction of antiretroviral therapy (ART should considerably prolong their life expectancy. METHODS AND PRINCIPAL FINDINGS: To evaluate the persistence of antibodies to the EPI vaccines in HIV-infected and HIV-exposed uninfected children who previously received these vaccines in routine clinical practice, we conducted a cross-sectional study of children, aged 18 to 36 months, born to HIV-infected mothers and living in Central Africa. We tested blood samples for antibodies to the combined diphtheria, tetanus, and whole-cell pertussis (DTwP, the measles and the oral polio (OPV vaccines. We enrolled 51 HIV-infected children of whom 33 were receiving ART, and 78 HIV-uninfected children born to HIV-infected women. A lower proportion of HIV-infected children than uninfected children had antibodies to the tested antigens with the exception of the OPV types 1 and 2. This difference was substantial for the measles vaccine (20% of the HIV-infected children and 56% of the HIV-exposed uninfected children, p<0.0001. We observed a high risk of low antibody levels for all EPI vaccines, except OPV types 1 and 2, in HIV-infected children with severe immunodeficiency (CD4(+ T cells <25%. CONCLUSIONS AND SIGNIFICANCE: Children were examined at a time when their antibody concentrations to EPI vaccines would have still not undergone significant decay. However, we showed that the antibody concentrations were lowered in HIV-infected children. Moreover, antibody concentration after a single dose of the measles vaccine was substantially lower than expected, particularly low in HIV-infected children with low CD4(+ T cell counts. This study supports the need for a second dose of the measles vaccine and for a booster dose of the DTwP and OPV vaccines to maintain the

  3. Profiles of HIV-infected anti-retroviral therapy naïve children from Mumbai, India.

    Science.gov (United States)

    Paranjpe, Supriya Mayur; Sarkate, Purva Pankaj; Ingole, Nayana Avinash; Raut, Shweta Sadanand; Mehta, Preeti Rajeev

    2016-11-01

    This study aimed to investigate the demographic profiles of human immunodifficiency virus (HIV) infected anti-retroviral therapy (ART) naïve children in our hospital and their relations to the clinical, immunological and nutritional status. A cross-sectional study was conducted in an Integrated Counselling and Testing Center (ICTC) at a tertiary care hospital in Mumbai. ART naïve HIV positive children were enrolled in the study. The demographic profiles, clinical features, immunological (CD4%/CD4 count) and nutritional status of these children were recorded. The agreement between clinical, immunological and nutritional staging was determined using Cohen's kappa test. In 192 HIV-infected ART naive children enrolled with a median age of 9 years (range 3 months-14 years), 97.4% acquired infection through vertical transmission. The most common clinical presentation was fever (39.6 %), followed by generalized lymphadenopathy (32.3%), cough (22.4%) and diarrhoea (9.9%). Tuberculosis was seen in 22.9% of the children. The agreement was fair between clinical and immunological staging, and slight between nutritional, immunological and clinical staging. Perinatal transmission is the most common mode of acquiring HIV infection in children. The Prevention of Parent to Child Transmission (PPTCT) program should be strengthened for lowering the transmission rate by providing extended ART to mothers during pregnancy and breast-feeding. Tuberculosis remains a major concern in HIV-infected children. The poor correlation between WHO clinical and immunological staging emphasizes the importance of making CD4 facilities available in HIV prevalent areas. Malnutrition cannot be used as a surrogate marker for predicting stage or severity as it is common at all stages of HIV disease.

  4. Prevalence of oral soft tissue lesions in HIV-infected minority children treated with highly active antiretroviral therapies.

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    Flanagan, M A; Barasch, A; Koenigsberg, S R; Fine, D; Houpt, M

    2000-01-01

    This project studied the prevalence of oral soft tissue disease in HIV-infected children treated with highly active antiretroviral therapy (HAART). Thirty-eight HIV-infected children participated in the study. Twenty-three of these patients were treated with HAART while 14 received exclusively reverse transcriptase inhibitors (RTI) and served as controls. The children were examined three times at approximately one-month intervals while their health history and laboratory data were abstracted from medical charts. Analyses were performed to determine differences in lesion prevalence between treatment groups as well as between lesion and no lesion groups with regard to immune differences. Thirty patients (79%) had oral lesions detected in at least one visit. There were no differences in specific lesion prevalence between HAART compared with RTI-treated children. However, a trend for more oral candidiasis in the latter group was observed. Subjects with oral soft tissue lesions had lower CD4 counts (P = 0.04) and percentage (P = 0.01) but similar viral loads when compared to patients without oral soft tissue disease. HAART does not appear to significantly affect oral soft tissue disease prevalence in HIV-infected children. Presence of lesions was associated with decreased immunity and may signal advancing disease.

  5. 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 children less than 5 years of age.High prevalence of malnutrition was observed in HIV-infected children compared with HIV-uninfected children. Except for ART, nutritional assessment and support should be

  6. Immunological Response of Hiv-Infected Children to Highly Active Antiretoviral Therapy at Gondar University Hospital, North-Western Ethiopia.

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    Kokeb, Mehretie; Degu, Getu

    2016-01-01

    The effectiveness of highly active antiretroviral therapy (HAART) in children has not been well studied specially in developing countries where the burden of HIV is high. This study was aimed to assess the immunologic response of HIV-infected children to HAART at Pediatric ART Clinic Gondar University Hospital. Institution based cross-sectional study was conducted at the Pediatric ART Clinic Gondar University Hospital from March 01-April 30, 2014. The study included 283 HIV-infected children who were on HAART for 6 months and above. Medical records of HIV-infected children were reviewed using pre-tested questionnaire. CD4 count/percent was collected every 6 months retrospectively. For all statistical significance tests, the cut-off value was pimmunological response. The study revealed that there was good Immunological response to ART, and that the maximum response was in the 1(st) 6 months of ART. Low CD4 count at initiation, undisclosed HIV status and lack of good adherence were found to cause low immunological response to HAART.

  7. Performance of Clinical Criteria for Screening of Possible Antiretroviral Related Mitochondrial Toxicity in HIV-Infected Children in Accra.

    Science.gov (United States)

    Langs-Barlow, Allison; Renner, Lorna; Katz, Karol; Northrup, Veronika; Paintsil, Elijah

    2013-01-01

    Mitochondrial damage is implicated in highly active antiretroviral therapy (HAART) toxicity. HIV infection also causes mitochondrial toxicity (MT). Differentiating between the two is critical for HIV management. Our objective was to test the utility of the Mitochondrial Disease Criteria (MDC) and the Enquête Périnatale Française (EPF) to screen for possible HAART related MT in HIV-infected children in Ghana. The EPF and MDC are compilations of clinical symptoms, or criteria, of MT: a (+) score indicates possible MT. We applied these criteria retrospectively to 403 charts of HIV-infected children. Of those studied, 331/403 received HAART. Comparing HAART exposed and HAART naïve children, the difference in EPF score, but not MDC, approached significance (P = 0.1). Young age at HIV diagnosis or at HAART initiation was associated with (+) EPF (P ≤ 0.01). Adherence to HAART trended toward an association with (+) EPF (P = 0.09). Exposure to nevirapine, abacavir, or didanosine increased risk of (+) EPF (OR = 3.55 (CI = 1.99-6.33), 4.76 (2.39-9.43), 4.93 (1.29-18.87)). Neither EPF nor MDC identified a significant difference between HAART exposed or naïve children regarding possible MT. However, as indicators of HAART exposure are associated with (+) EPF, it may be a candidate for prospective study of possible HAART related MT in resource-poor settings.

  8. Performance of Clinical Criteria for Screening of Possible Antiretroviral Related Mitochondrial Toxicity in HIV-Infected Children in Accra

    Directory of Open Access Journals (Sweden)

    Allison Langs-Barlow

    2013-01-01

    Full Text Available Mitochondrial damage is implicated in highly active antiretroviral therapy (HAART toxicity. HIV infection also causes mitochondrial toxicity (MT. Differentiating between the two is critical for HIV management. Our objective was to test the utility of the Mitochondrial Disease Criteria (MDC and the Enquête Périnatale Française (EPF to screen for possible HAART related MT in HIV-infected children in Ghana. The EPF and MDC are compilations of clinical symptoms, or criteria, of MT: a (+ score indicates possible MT. We applied these criteria retrospectively to 403 charts of HIV-infected children. Of those studied, 331/403 received HAART. Comparing HAART exposed and HAART naïve children, the difference in EPF score, but not MDC, approached significance (. Young age at HIV diagnosis or at HAART initiation was associated with (+ EPF (. Adherence to HAART trended toward an association with (+ EPF (. Exposure to nevirapine, abacavir, or didanosine increased risk of (+ EPF (OR = 3.55 (CI = 1.99–6.33, 4.76 (2.39–9.43, 4.93 (1.29–18.87. Neither EPF nor MDC identified a significant difference between HAART exposed or naïve children regarding possible MT. However, as indicators of HAART exposure are associated with (+ EPF, it may be a candidate for prospective study of possible HAART related MT in resource-poor settings.

  9. Caries risk and activity in HIV infected children and their controls

    Directory of Open Access Journals (Sweden)

    Luciana Pomarico

    Full Text Available Objective: To determine the risk factors and prevalence of caries in HIV infected children (GI and in children with no evidence ofimmunosupression (GII. Methods: One hundred and thirty-three patients of a Pediatric AIDS Ambulatorial Service in Rio de Janeiro and 85 patients of a Pediatric Dentistry Service were examined. The patients’ guardians were interviewed, and provided information about children´s oral higyene, use of medication and dietary habits. The children were examined to determine DMFT and dmft indexes. The Mann-Whitney test was performed at a level of significance of 5%. Results: The two groups (mean age: G1=6.8 years, GII=8.1 years showed no significant difference in dmft/DMFT indexes (dmft: 6.4 and 8.0; DMFT: 1.0 and 1.4 for GI and GII, but GII showed a higher number of restored teeth (p<0.05. GII showed also a higher frequency of toothbrushing (p<0.05, and in both groups, most of the children brushed their teeth withouth any adult supervision. Sucrose ingestionbetween meals was higher for GI (p<0.05. In GI 78.9% had been using combined antiretroviral therapy and the cariogenic potential of thetherapy administration classified as high was the most frequently observed (45.1%. Significant association was observed only between dmft and sucrose ingestion in GII. Conclusion: GI and GII were exposed to risk factors for a high caries prevalence. The habit of sucrose ingestion between meals was considered an important factor associated with the high prevalence of caries in deciduous dentition in children with no clinical signs of immunosupression.

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

    African Journals Online (AJOL)

    Although the use of HAART has revolutionised the management of. HIV infection ... prevent the replication of HIV and retard the development of AIDS in newly infected ..... Effect of multiple ... Nutrition, HIV, and drug abuse: The molecular basis ...

  11. Understanding motives for intravaginal practices amongst Tanzanian and Ugandan women at high risk of HIV infection: the embodiment of social and cultural norms and well-being.

    Science.gov (United States)

    Lees, Shelley; Zalwango, Flavia; Andrew, Bahati; Vandepitte, Judith; Seeley, Janet; Hayes, Richard J; Francis, Suzanna C

    2014-02-01

    Some types of intravaginal practices (IVP) may increase the risk for HIV acquisition. This is particularly worrisome for populations with dual high prevalence of HIV and IVP. Women involved in transactional sex are at increased risk for HIV infection in sub-Saharan Africa. Social, cultural and economic influences are strong drivers of IVP in this population. To explore this, we carried out a qualitative research study to investigate the drivers and motivations for using IVP within a large observational study of women at high risk of HIV in Tanzania and Uganda from September 2008 to September 2009. Of the 201 women selected, 176 women took part in a semi-structured in-depth interview. Additionally, in Tanzania, eight focus group discussions among study participants and community members were carried out to obtain information on community norms and expectations. IVP were motivated by overlapping concerns with hygiene, morality, sexual pleasure, fertility, relationship security, and economic security. These motives were driven by the need to meet cultural and social expectations of womanhood, and at the same time attend to personal well-being. Among women involved in transactional sex in East Africa, interventions aimed at modifying or eliminating IVP should attend to local cultural and social norms as well as the individual as an agent of change. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. Understanding motives for intravaginal practices amongst Tanzanian and Ugandan women at high risk of HIV infection: The embodiment of social and cultural norms and well-being☆

    Science.gov (United States)

    Lees, Shelley; Zalwango, Flavia; Andrew, Bahati; Vandepitte, Judith; Seeley, Janet; Hayes, Richard J.; Francis, Suzanna C.

    2014-01-01

    Some types of intravaginal practices (IVP) may increase the risk for HIV acquisition. This is particularly worrisome for populations with dual high prevalence of HIV and IVP. Women involved in transactional sex are at increased risk for HIV infection in sub-Saharan Africa. Social, cultural and economic influences are strong drivers of IVP in this population. To explore this, we carried out a qualitative research study to investigate the drivers and motivations for using IVP within a large observational study of women at high risk of HIV in Tanzania and Uganda from September 2008 to September 2009. Of the 201 women selected, 176 women took part in a semi-structured in-depth interview. Additionally, in Tanzania, eight focus group discussions among study participants and community members were carried out to obtain information on community norms and expectations. IVP were motivated by overlapping concerns with hygiene, morality, sexual pleasure, fertility, relationship security, and economic security. These motives were driven by the need to meet cultural and social expectations of womanhood, and at the same time attend to personal well-being. Among women involved in transactional sex in East Africa, interventions aimed at modifying or eliminating IVP should attend to local cultural and social norms as well as the individual as an agent of change. PMID:24565154

  13. Association of pol diversity with antiretroviral treatment outcomes among HIV-infected African children.

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    Iris Chen

    Full Text Available In HIV-infected children, viral diversity tends to increase with age in the absence of antiretroviral treatment (ART. We measured HIV diversity in African children (ages 6-36 months enrolled in a randomized clinical trial comparing two ART regimens (Cohort I of the P1060 trial. Children in this cohort were exposed to single dose nevirapine (sdNVP at birth.HIV diversity was measured retrospectively using a high resolution melting (HRM diversity assay. Samples were obtained from 139 children at the enrollment visit prior to ART initiation. Six regions of the HIV genome were analyzed: two in gag, one in pol, and three in env. A single numeric HRM score that reflects HIV diversity was generated for each region; composite HRM scores were also calculated (mean and median for all six regions.In multivariable median regression models using backwards selection that started with demographic and clinical variables, older age was associated with higher HRM scores (higher HIV diversity in pol (P = 0.005 and with higher mean (P = 0.014 and median (P<0.001 HRM scores. In multivariable models adjusted for age, pre-treatment HIV viral load, pre-treatment CD4%, and randomized treatment regimen, higher HRM scores in pol were associated with shorter time to virologic suppression (P = 0.016 and longer time to study endpoints (virologic failure [VF], VF/death, and VF/off study treatment; P<0.001 for all measures.In this cohort of sdNVP-exposed, ART-naïve African children, higher levels of HIV diversity in the HIV pol region prior to ART initiation were associated with better treatment outcomes.

  14. 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.

  15. 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

  16. Hepatotoxicity in HIV-infected children and adolescents on antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Ana Cecília Montes Gil

    Full Text Available CONTEXT AND OBJECTIVE: Adverse drug reactions are a significant problem in patients on antiretroviral therapy (ART. We determined liver enzyme elevation frequencies in HIV-infected children and adolescents receiving ART, and their association with risk factors. DESIGN AND SETTING: Cross-sectional study, at the Pediatrics Immunodeficiency Division, University Hospital, Universidade Estadual de Campinas. METHODS: Medical records of 152 children and adolescents (54.6% male; median age 7.48 years were analyzed, with a mean of 2.6 liver enzyme determinations per patient. Clinically, patients were classified in categories N (6, A (29, B (78 and C (39. Serum levels of aspartate aminotransferase and alanine aminotransferase were evaluated. Hepatotoxicity was scored as grade 1 (1.1-4.9 times upper limit of normality, ULN, grade 2 (5.0-9.9 times ULN, grade 3 (10.0-15.0 times ULN and grade 4 (> 15.0 times ULN. To assess hepatotoxicity risk factors, odds ratios (OR and adjusted odds ratios (aOR for age, gender, TCD4+ cell count, viral load and medication usage were calculated. RESULTS: We observed grade 1 hepatotoxicity in 19.7 % (30/152 patients. No cases of grade 2, 3 or 4 were detected. There was a significant association between hepatotoxicity and use of sulfonamides (OR, 3.61; 95% confidence interval (CI, 1.50-8.70; aOR, 3.58; 95% CI, 1.44-8.85 and antituberculous agents (OR, 9.23; 95% CI, 1.60-53.08; aOR, 9.05; 95% CI, 1.48-55.25. No toxicity was associated with ART. CONCLUSIONS: One fifth of patients experienced mild hepatotoxicity, attributed to antituberculous agents and sulfonamides. Our results suggest that ART was well tolerated.

  17. Five year neurodevelopment outcomes of perinatally HIV-infected children on early limited or deferred continuous antiretroviral therapy.

    Science.gov (United States)

    Laughton, Barbara; Cornell, Morna; Kidd, Martin; Springer, Priscilla Estelle; Dobbels, Els Françoise Marie-Thérèse; Rensburg, Anita Janse Van; Otwombe, Kennedy; Babiker, Abdel; Gibb, Diana M; Violari, Avy; Kruger, Mariana; Cotton, Mark Fredric

    2018-05-01

    Early antiretroviral therapy (ART) has improved neurodevelopmental outcomes of HIV-infected (HIV-positive) children; however, little is known about the longer term outcomes in infants commencing early ART or whether temporary ART interruption might have long-term consequences. In the children with HIV early antiretroviral treatment (CHER) trial, HIV-infected infants ≤12 weeks of age with CD4 ≥25% were randomized to deferred ART (ART-Def); immediate time-limited ART for 40 weeks (ART-40W) or 96 weeks (ART-96W). ART was restarted in the time-limited arms for immunologic/clinical progression. Our objective was to compare the neurodevelopmental profiles in all three arms of Cape Town CHER participants. A prospective, longitudinal observational study was used. The Griffiths mental development scales (GMDS), which includes six subscales and a global score, were performed at 11, 20, 30, 42 and 60 months, and the Beery-Buktenica developmental tests for visual motor integration at 60 months. HIV-exposed uninfected (HEU) and HIV-unexposed (HU) children were enrolled for comparison. Mixed model repeated measures were used to compare groups over time, using quotients derived from standardized British norms. In this study, 28 ART-Def, 35 ART-40W, 33 ART-96W CHER children, and 34 HEU and 39 HU controls were enrolled. GMDS scores over five years were similar between the five groups in all subscales except locomotor and general Griffiths (interaction p perception scores were significantly lower in HIV-infected children (mean standard scores: 75.8 ART-Def, 79.8 ART-40W, 75.9 ART-96W) versus 84.4 in HEU and 90.5 in HU (p perception where HIV-infected children scored lower. Poorer visual perception performance warrants further investigation. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

  18. Caregiver perceptions and motivation for disclosing or concealing the diagnosis of HIV infection to children receiving HIV care in Mbarara, Uganda: a qualitative study.

    Directory of Open Access Journals (Sweden)

    Julius Kiwanuka

    Full Text Available Disclosure of the diagnosis of HIV to HIV-infected children is challenging for caregivers. Despite current recommendations, data suggest that levels of disclosure of HIV status to HIV-infected children receiving care in resource-limited settings are very low. Few studies describe the disclosure process for children in these settings, particularly the motivators, antecedent goals, and immediate outcomes of disclosure to HIV-infected children. This study examined caregivers' perception of the disclosure concept prior to disclosure, their motivation towards or away from disclosure, and their short- and long-term intentions for disclosure to their HIV-infected children.In-depth interviews were conducted with primary caregivers of 40 HIV-infected children (ages 5-15 years who were receiving HIV care but did not know their HIV status.Caregivers of HIV-infected children mainly perceived disclosure as a single event rather than a process of gradual delivery of information about the child's illness. They viewed disclosure as potentially beneficial both to children and themselves, as well as an opportunity to explain the parents' role in the transmission of HIV to the children. Caregivers desired to personally conduct the disclosure; however, most reported being over-whelmed with fear of negative outcomes and revealed a lack of self-efficacy towards managing the disclosure process. Consequently, most cope by deception to avoid or delay disclosure until they perceive their own readiness to disclose.Interventions for HIV disclosure should consider that caregivers may desire to be directly responsible for disclosure to children under their care. They, however, need to be empowered with practical skills to recognize opportunities to initiate the disclosure process early, as well as supported to manage it in a phased, developmentally appropriate manner. The potential role for peer counselors in the disclosure process deserves further study.

  19. Child-rearing practices of primary caregivers of HIV-infected children: An integrative review of the literature.

    Science.gov (United States)

    Klunklin, Pimpaporn; Harrigan, Rosanne C

    2002-08-01

    The number of human immunodeficiency virus (HIV)-infected children has increased because of the HIV and acquired immunodeficiency syndrome epidemic. Yet little is known about the child-rearing practices of these children's primary caregivers. The purpose of this article is to describe what is known about the child-rearing practices of primary caregivers of HIV-infected children. The review covers a 10-year period from 1990 to 2000. Three electronic bibliographic databases (MEDLINE, CINAHL, and AIDSLINE) were explored. Key words used were HIV-positive children, caregivers, and child-rearing. A total of 50 papers were examined. Using the Matrix Method, each paper was evaluated according to five frames of reference: journal, purpose, sample, method, and findings. Content analysis was used to identity salient themes. Themes that emerged were: caregiver, child, and interactions or child-rearing practices. These findings affirm the parent-child interaction model generated by Kathryn E. Barnard and support this framework as a tool for investigating the relationships between these children and their caregivers. Copyright 2002, Elsevier Science (USA). All rights reserved.

  20. 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......). METHODS: A retrospective cohort study in children younger than five years at ART initiation between 2004 and 2009 was nested within the pWADA cohort, in Bamako-Mali and Abidjan-Côte d'Ivoire. Data on PMTCT exposure were collected through a direct review of children's medical records. The 12-month Kaplan....... Immunological failure was defined according to the 2006 World Health Organization age-related immunological thresholds for severe immunodeficiency. RESULTS: Among the 1035 eligible children, PMTCT exposure was only documented for 353 children (34.1%) and remained unknown for 682 (65.9%). Among children...

  1. 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.

    Science.gov (United States)

    Cohen, Sophie; Innes, Steve; Geelen, Sibyl P M; Wells, Jonathan C K; Smit, Colette; Wolfs, Tom F W; van Eck-Smit, Berthe L F; Kuijpers, Taco W; Reiss, Peter; Scherpbier, Henriette J; Pajkrt, Dasja; Bunders, Madeleine J

    2015-01-01

    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.

  2. EVALUATION OF THE ULTRASTRUCTURE OF THE SMALL INTESTINE OF HIV INFECTED CHILDREN BY TRANSMISSION AND SCANNING ELECTRONIC MICROSCOPY

    Directory of Open Access Journals (Sweden)

    Christiane Araujo Chaves LEITE

    2013-03-01

    Full Text Available Objectives To describe HIV children's small intestinal ultrastructural findings. Methods Descriptive, observational study of small intestine biopsies performed between August 1994 and May 1995 at São Paulo, SP, Brazil. This material pertained to 11 HIV infected children and was stored in a laboratory in paraffin blocks. Scanning and transmission electronic microscopy were used to view those intestine samples and ultrastructural findings were described by analyzing digitalized photos of this material. Ethical Committee approval was obtained. Results In most samples scanning microscopy showed various degrees of shortening and decreasing number of microvilli and also completes effacements in some areas. Derangement of the enterocytes was seen frequently and sometimes cells well defined borders limits seemed to be loosened. In some areas a mucous-fibrin like membrane with variable thickness and extension appeared to partially or totally coat the epithelial surface. Fat drops were present in the intestinal lumen in various samples and a bacterium morphologically resembling bacilli was seen in two occasions. Scanning microscopy confirmed transmission microscopy microvilli findings and also showed little “tufts” of those structures. In addition, it showed an increased number of vacuoles and multivesicular bodies inside various enterocytes, an increased presence of intraepithelial lymphocytes, mitochondrial vacuolization and basement membrane enlargement in the majority of samples analyzed. However, some samples exhibited normal aspect. Conclusions Our study showed the common occurrence of various important intestinal ultrastructural alterations with variable degrees among HIV infected children, some of them in our knowledge not described before.

  3. Impact of antiretroviral therapy on quality of life in HIV-infected Southeast Asian children in the PREDICT study.

    Science.gov (United States)

    Bunupuradah, Torsak; Kosalaraksa, Pope; Vibol, Ung; Hansudewechakul, Rawiwan; Sophonphan, Jiratchaya; Kanjanavanit, Suparat; Ngampiyaskul, Chaiwat; Wongsawat, Jurai; Luesomboon, Wicharn; Vonthanak, Saphonn; Ananworanich, Jintanat; Ruxrungtham, Kiat; Puthanakit, Thanyawee

    2013-11-01

    Quality of life (QOL) is an important antiretroviral treatment (ART) outcome. We compared QOL among 299 Thai and Cambodian children ages 1-12 years-old, CD4 15-24% randomized to early (ART at week 0, N=149) versus deferred groups (ART when at CD4 0.05) and at week 144 (all p>0.05). By multivariate analysis, the early-group had higher QOL score changes in five domains, including health perception (p=0.04), physical resilience (p=0.02), psychosocial well-being (p=0.04), social and role functioning (p<0.01), and symptoms (p=0.01) compared to the deferred group. QOL of HIV-infected children in both groups were lower than healthy control in all 7 domains at baseline (all p<0.05) and 5 of 7 domains at weeks 144 (p<0.01). In conclusion, no significant difference of QOL scores between treatment groups. Early ART commencement associated with greater increase of QOL scores over 144 weeks. QOL scores in HIV-infected children were lower than healthy controls.

  4. Clinical epidemiology of bocavirus, rhinovirus, two polyomaviruses and four coronaviruses in HIV-infected and HIV-uninfected South African children.

    Directory of Open Access Journals (Sweden)

    Marta C Nunes

    Full Text Available Advances in molecular diagnostics have implicated newly-discovered respiratory viruses in the pathogenesis of pneumonia. We aimed to determine the prevalence and clinical characteristics of human bocavirus (hBoV, human rhinovirus (hRV, polyomavirus-WU (WUPyV and -KI (KIPyV and human coronaviruses (CoV-OC43, -NL63, -HKU1 and -229E among children hospitalized with lower respiratory tract infections (LRTI.Multiplex real-time reverse-transcriptase polymerase chain reaction was undertaken on archived nasopharyngeal aspirates from HIV-infected and -uninfected children (<2 years age hospitalized for LRTI, who had been previously investigated for respiratory syncytial virus, human metapneumovirus, parainfluenza I-III, adenovirus and influenza A/B.At least one of these viruses were identified in 274 (53.0% of 517 and in 509 (54.0% of 943 LRTI-episodes in HIV-infected and -uninfected children, respectively. Human rhinovirus was the most prevalent in HIV-infected (31.7% and -uninfected children (32.0%, followed by CoV-OC43 (12.2% and hBoV (9.5% in HIV-infected; and by hBoV (13.3% and WUPyV (11.9% in HIV-uninfected children. Polyomavirus-KI (8.9% vs. 4.8%; p = 0.002 and CoV-OC43 (12.2% vs. 3.6%; p<0.001 were more prevalent in HIV-infected than -uninfected children. Combined with previously-tested viruses, respiratory viruses were identified in 60.9% of HIV-infected and 78.3% of HIV-uninfected children. The newly tested viruses were detected at high frequency in association with other respiratory viruses, including previously-investigated viruses (22.8% in HIV-infected and 28.5% in HIV-uninfected children.We established that combined with previously-investigated viruses, at least one respiratory virus was identified in the majority of HIV-infected and HIV-uninfected children hospitalized for LRTI. The high frequency of viral co-infections illustrates the complexities in attributing causality to specific viruses in the aetiology of LRTI and may indicate a

  5. 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

    NARCIS (Netherlands)

    Cohen, Sophie; Innes, Steve; Geelen, Sibyl P. M.; Wells, Jonathan C. K.; Smit, Colette; Wolfs, Tom F. W.; van Eck-Smit, Berthe L. F.; Kuijpers, Taco W.; Reiss, Peter; Scherpbier, Henriette J.; Pajkrt, Dasja; Bunders, Madeleine J.

    2015-01-01

    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

  6. 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.

  7. Psychosocial issues in children and adolescents with HIV infection evaluated with a World Health Organization age-specific descriptor system.

    Science.gov (United States)

    Giannattasio, Antonietta; Officioso, Annunziata; Continisio, Grazia Isabella; Griso, Giovanna; Storace, Cinzia; Coppini, Simonetta; Longhi, Daniela; Mango, Carmela; Guarino, Alfredo; Badolato, Raffaele; Pisacane, Alfredo

    2011-01-01

    After active antiretroviral therapy, children with HIV are clinically well, whereas psychosocial issues continue to influence their quality of life. The International Classification of Functioning, Disability and Health (ICF) of the World Health Organization evaluates health status and environmental and social factors associated with health. We investigated the efficacy of the ICF to describe the health status and needs of a cohort of children and adolescents with HIV seen at a reference center for pediatric AIDS in Europe. A quantitative analysis of structured interviews was performed. Caregivers of children and adolescents with HIV infection in follow-up at 2 reference centers for pediatric AIDS were enrolled. Four major areas included in the ICF instrument were investigated: impairments of body structures; impairments of body functions; environmental factors; and activity limitations and restrictions to social life. Forty-one families of children with HIV were enrolled. Body structures and functions were marginally impaired, whereas environmental factors and psychosocial issues had a relevant impact on quality of life. Most families considered environmental factors to be "barriers"; these were poverty, unemployment, and single-parent family structure. Activity limitations and social restrictions were also reported in a few cases. Almost all parents reported problems in disclosing their child's HIV status because of the fear of social stigma. Psychosocial issues are part of the well-being of children with HIV. The ICF is a standard tool to evaluate the clinical and psychosocial status of children and adolescents with HIV infection and to measure the impact of therapeutic interventions and strategies on psychosocial functioning.

  8. 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

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

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    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.

  10. 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

    NARCIS (Netherlands)

    Cohen, Sophie; Innes, Steve; Geelen, SPM; Wells, Jonathan C. K.; Smit, Colette; Wolfs, Tom F. W.; van Eck-Smit, Berthe L. F.; Kuijpers, Taco W.; Reiss, Peter; Scherpbier, Henriette J.; Pajkrt, Dasja; Bunders, Madeleine J.

    2015-01-01

    Objective 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

  11. Persistence of memory B-cell and T-cell responses to the quadrivalent HPV vaccine in HIV-infected children.

    Science.gov (United States)

    Weinberg, Adriana; Huang, Sharon; Moscicki, Anna-Barbara; Saah, Afred; Levin, Myron J

    2018-04-24

    To determine the magnitude and persistence of quadrivalent human papillomavirus (HPV)16 and HPV18 B-cell and T-cell memory after three or four doses of quadrivalent HPV vaccine (QHPV) in HIV-infected children. Seventy-four HIV-infected children immunized with four doses and 23 with three doses of QHPV had HPV16 and HPV18 IgG B-cell and IFNγ and IL2 T-cell ELISPOT performed at 2, 3.5 and 4-5 years after the last dose. HPV16 and HPV18 T-cell responses were similar in both treatment groups, with higher responses to HPV16 vs. HPV18. These HPV T-cell responses correlated with HIV disease characteristics at the study visits. Global T-cell function declined over time as measured by nonspecific mitogenic stimulation. B-cell memory was similar across treatment groups and HPV genotypes. There was a decline in HPV-specific B-cell memory over time that reached statistical significance for HPV16 in the four-dose group. B-cell and T-cell memory did not significantly differ after either three or four doses of QHPV in HIV-infected children. The clinical consequences of decreasing global T-cell function and HPV B-cell memory over time in HIV-infected children requires further investigation.

  12. Therapeutic DNA vaccination of vertically HIV-infected children: report of the first pediatric randomised trial (PEDVAC).

    Science.gov (United States)

    Palma, Paolo; Romiti, Maria Luisa; Montesano, Carla; Santilli, Veronica; Mora, Nadia; Aquilani, Angela; Dispinseri, Stefania; Tchidjou, Hyppolite K; Montano, Marco; Eriksson, Lars E; Baldassari, Stefania; Bernardi, Stefania; Scarlatti, Gabriella; Wahren, Britta; Rossi, Paolo

    2013-01-01

    Twenty vertically HIV-infected children, 6-16 years of age, with stable viral load control and CD4+ values above 400 cells/mm(3). Ten subjects continued their ongoing antiretroviral treatment (ART, Group A) and 10 were immunized with a HIV-DNA vaccine in addition to their previous therapy (ART and vaccine, Group B). The genetic vaccine represented HIV-1 subtypes A, B and C, encoded Env, Rev, Gag and RT and had no additional adjuvant. Immunizations took place at weeks 0, 4 and 12, with a boosting dose at week 36. Monitoring was performed until week 60 and extended to week 96. Safety data showed good tolerance of the vaccine. Adherence to ART remained high and persistent during the study and did not differ significantly between controls and vaccinees. Neither group experienced either virological failure or a decline of CD4+ counts from baseline. Higher HIV-specific cellular immune responses were noted transiently to Gag but not to other components of the vaccine. Lymphoproliferative responses to a virion antigen HIV-1 MN were higher in the vaccinees than in the controls (p = 0.047), whereas differences in reactivity to clade-specific Gag p24, RT or Env did not reach significance. Compared to baseline, the percentage of HIV-specific CD8+ lymphocytes releasing perforin in the Group B was higher after the vaccination schedule had been completed (p = 0.031). No increased CD8+ perforin levels were observed in control Group A. The present study demonstrates the feasibility, safety and moderate immunogenicity of genetic vaccination in vertically HIV-infected children, paving the way for amplified immunotherapeutic approaches in the pediatric population. clinicaltrialsregister.eu _2007-002359-18IT.

  13. Therapeutic DNA vaccination of vertically HIV-infected children: report of the first pediatric randomised trial (PEDVAC.

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    Paolo Palma

    Full Text Available SUBJECTS: Twenty vertically HIV-infected children, 6-16 years of age, with stable viral load control and CD4+ values above 400 cells/mm(3. INTERVENTION: Ten subjects continued their ongoing antiretroviral treatment (ART, Group A and 10 were immunized with a HIV-DNA vaccine in addition to their previous therapy (ART and vaccine, Group B. The genetic vaccine represented HIV-1 subtypes A, B and C, encoded Env, Rev, Gag and RT and had no additional adjuvant. Immunizations took place at weeks 0, 4 and 12, with a boosting dose at week 36. Monitoring was performed until week 60 and extended to week 96. RESULTS: Safety data showed good tolerance of the vaccine. Adherence to ART remained high and persistent during the study and did not differ significantly between controls and vaccinees. Neither group experienced either virological failure or a decline of CD4+ counts from baseline. Higher HIV-specific cellular immune responses were noted transiently to Gag but not to other components of the vaccine. Lymphoproliferative responses to a virion antigen HIV-1 MN were higher in the vaccinees than in the controls (p = 0.047, whereas differences in reactivity to clade-specific Gag p24, RT or Env did not reach significance. Compared to baseline, the percentage of HIV-specific CD8+ lymphocytes releasing perforin in the Group B was higher after the vaccination schedule had been completed (p = 0.031. No increased CD8+ perforin levels were observed in control Group A. CONCLUSIONS: The present study demonstrates the feasibility, safety and moderate immunogenicity of genetic vaccination in vertically HIV-infected children, paving the way for amplified immunotherapeutic approaches in the pediatric population. TRIAL REGISTRATION: clinicaltrialsregister.eu _2007-002359-18IT.

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

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    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.

  15. 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.

  16. Characteristics of HIV-Infected Children at Enrollment into Care and at Antiretroviral Therapy Initiation in Central Africa.

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    Adebola Adedimeji

    Full Text Available Despite the World Health Organization (WHO regularly updating guidelines to recommend earlier initiation of antiretroviral therapy (ART in children, timely enrollment into care and initiation of ART in sub-Saharan Africa in children lags behind that of adults. The impact of implementing increasingly less restrictive ART guidelines on ART initiation in Central Africa has not been described.Data are from the Central Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA pediatric cohort of 3,426 children (0-15 years entering HIV care at 15 sites in Burundi, DRC, and Rwanda. Measures include CD4 count, WHO clinical stage, age, and weight-for-age Z score (WAZ, each at enrollment into HIV care and at ART initiation. Changes in the medians or proportions of each measure by year of enrollment and year of ART initiation were assessed to capture potential impacts of changing ART guidelines.Median age at care enrollment decreased from 77.2 months in 2004-05 to 30.3 months in 2012-13. The median age at ART initiation (n = 2058 decreased from 83.0 months in 2004-05 to 66.9 months in 2012-13. The proportion of children ≤24 months of age at enrollment increased from 12.7% in 2004-05 to 46.7% in 2012-13, and from 9.6% in 2004-05 to 24.2% in 2012-13 for ART initiation. The median CD4 count at enrollment into care increased from 563 (IQR: 275, 901 in 2004-05 to 660 (IQR: 339, 1071 cells/μl in 2012-13, and the median CD4 count at ART initiation increased from 310 (IQR:167, 600 in 2004-05 to 589 (IQR: 315, 1113 cells/μl in 2012-13. From 2004-05 to 2012-13, median WAZ improved from -2 (IQR: -3.4, -1.1 to -1 (IQR: -2.5, -0.2 at enrollment in care and from -2 (IQR: -3.8, -1.6 to -1 (IQR: -2.6, -0.4 at ART initiation.Although HIV-infected children ≤24 months of age accounted for half of all children enrolling in care in our cohort during 2012-13, they represented less than a quarter of all those who were initiated on ART during the same period

  17. The Use of the Medical Dictionary for Regulatory Activities in the Identification of Mitochondrial Dysfunction in HIV-Infected Children.

    Science.gov (United States)

    Chernoff, Miriam; Ford-Chatterton, Heather; Crain, Marilyn J

    2012-10-01

    To demonstrate the utility of a medical terminology-based method for identifying cases of possible mitochondrial dysfunction (MD) in a large cohort of youths with perinatal HIV infection and to describe the scoring algorithms. Medical Dictionary for Regulatory Activities (MedDRA) ® version 6 terminology was used to query clinical criteria for mitochondrial dysfunction by two published classifications, the Enquête Périnatale Française (EPF) and the Mitochondrial Disease Classification (MDC). Data from 2,931 participants with perinatal HIV infection on PACTG 219/219C were analyzed. Data were qualified for severity and persistence, after which clinical reviews of MedDRA-coded and other study data were performed. Of 14,000 data records captured by the EPF MedDRA query, there were 3,331 singular events. Of 18,000 captured by the MDC query, there were 3,841 events. Ten clinicians blindly reviewed non MedDRA-coded supporting data for 15 separate clinical conditions. We used the Statistical Analysis System (SAS) language to code scoring algorithms. 768 participants (26%) met the EPF case definition of possible MD; 694 (24%) met the MDC case definition, and 480 (16%) met both definitions. Subjective application of codes could have affected our results. MedDRA terminology does not include indicators of severity or persistence. Version 6.0 of MedDRA did not include Standard MedDRA Queries, which would have reduced the time needed to map MedDRA terms to EPF and MDC criteria. Together with a computer-coded scoring algorithm, MedDRA terminology enabled identification of potential MD based on clinical data from almost 3000 children with substantially less effort than a case by case review. The article is accessible to readers with a background in statistical hypothesis testing. An exposure to public health issues is useful but not strictly necessary.

  18. Nasopharyngeal carriage of Streptococcus pneumoniae among HIV-infected and -uninfected children <5 years of age before introduction of pneumococcal conjugate vaccine in Mozambique.

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    Jennifer R Verani

    Full Text Available Nasopharyngeal carriage is a precursor for pneumococcal disease and can be useful for evaluating pneumococcal conjugate vaccine (PCV impact. We studied pre-PCV pneumococcal carriage among HIV-infected and -uninfected children in Mozambique. Between October 2012 and March 2013, we enrolled HIV-infected children age <5 years presenting for routine care at seven HIV clinics in 3 sites, including Maputo (urban-south, Nampula (urban-north, and Manhiça (rural-south. We also enrolled a random sample of HIV-uninfected children <5 years old from a demographic surveillance site in Manhiça. A single nasopharyngeal swab was obtained and cultured following enrichment in Todd Hewitt broth with yeast extract and rabbit serum. Pneumococcal isolates were serotyped by Quellung reaction and multiplex polymerase chain reaction. Factors associated with pneumococcal carriage were examined using logistic regression. Overall pneumococcal carriage prevalence was 80.5% (585/727, with similar prevalences among HIV-infected (81.5%, 339/416 and HIV-uninfected (79.1%, 246/311 children, and across age strata. Among HIV-infected, after adjusting for recent antibiotic use and hospitalization, there was no significant association between study site and colonization: Maputo (74.8%, 92/123, Nampula (83.7%, 82/98, Manhiça (84.6%, 165/195. Among HIV-uninfected, report of having been born to an HIV-infected mother was not associated with colonization. Among 601 pneumococcal isolates from 585 children, serotypes 19F (13.5%, 23F (13.1%, 6A (9.2%, 6B (6.2% and 19A (5.2% were most common. The proportion of serotypes included in the 10- and 13-valent vaccines was 44.9% and 61.7%, respectively, with no significant differences by HIV status or age group. Overall 36.9% (n = 268 of children were colonized with a PCV10 serotype and 49.7% (n = 361 with a PCV13 serotype. Pneumococcal carriage was common, with little variation by geographic region, age, or HIV status. PCV10 was introduced in

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

    Science.gov (United States)

    Luyten, Anke; D'haeseleer, Evelien; Budolfsen, Dorte; Hodges, Andrew; Galiwango, George; Vermeersch, Hubert; Van Lierde, Kristiane

    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 gender-matched control group. The experimental group consisted of the parents or guardians of 44 Ugandan patients (21 males, 23 females) with complete unilateral or bilateral CLP (mean age: 3;1 years). The control group included the foster mothers of 44 orphan children matched by age and gender (mean age: 3;7 years). A survey based on the Cleft Evaluation Profile was used to assess the perceived satisfaction for individual features related to cleft care. Overall high levels of satisfaction were observed in the experimental group for all features (range: 56-100%). No significant differences could be established regarding age, gender, age of lip and palatal closure, cleft type or maternal vs. paternal judgments. In participants who were dissatisfied with the appearance of the lip, the time period between the cleft closure and the survey was significantly larger compared with satisfied participants. Furthermore, significantly lower levels of satisfaction were observed in the cleft group for speech and the appearance of the teeth and the nose compared with the control group. Satisfaction with speech and facial appearance in Ugandan children with cleft lip and/or palate is important since normal esthetics and speech predominantly determine the children's social acceptance in the Ugandan society. As a result of reading this manuscript, the reader will be able to explain the attitudes of parents toward the surgical repair of their children's cleft lip and palate. As a result of reading this manuscript, the reader will be able to identify differences in parental attitudes toward synchronous lip and palate repair. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Treatment Failure in HIV-Infected Children on Second-line Protease Inhibitor-Based Antiretroviral Therapy.

    Science.gov (United States)

    Suaysod, Rapeepan; Ngo-Giang-Huong, Nicole; Salvadori, Nicolas; Cressey, Tim R; Kanjanavanit, Suparat; Techakunakorn, Pornchai; Krikajornkitti, Sawitree; Srirojana, Sakulrat; Laomanit, Laddawan; Chalermpantmetagul, Suwalai; Lallemant, Marc; Le Cœur, Sophie; McIntosh, Kenneth; Traisathit, Patrinee; Jourdain, Gonzague

    2015-07-01

    Human immunodeficiency virus (HIV)-infected children failing second-line antiretroviral therapy (ART) have no access to third-line antiretroviral drugs in many resource-limited settings. It is important to identify risk factors for second-line regimen failure. HIV-infected children initiating protease inhibitor (PI)-containing second-line ART within the Program for HIV Prevention and Treatment observational cohort study in Thailand between 2002 and 2010 were included. Treatment failure was defined as confirmed HIV type 1 RNA load >400 copies/mL after at least 6 months on second-line regimen or death. Adherence was assessed by drug plasma levels and patient self-report. Cox proportional hazards regression analyses were used to identify risk factors for failure. A total of 111 children started a PI-based second-line regimen, including 59 girls (53%). Median first-line ART duration was 1.9 years (interquartile range [IQR], 1.4-3.3 years), and median age at second-line initiation was 10.7 years (IQR, 6.3-13.4 years). Fifty-four children (49%) experienced virologic failure, and 2 (2%) died. The risk of treatment failure 24 months after second-line initiation was 41%. In multivariate analyses, failure was independently associated with exposure to first-line ART for >2 years (adjusted hazard ratio [aHR], 1.8; P = .03), age >13 years (aHR, 2.9; P < .001), body mass index-for-age z score < -2 standard deviations at second-line initiation (aHR, 2.8; P = .03), and undetectable drug levels within 6 months following second-line initiation (aHR, 4.5; P < .001). Children with longer exposure to first-line ART, entry to adolescence, underweight, and/or undetectable drug levels were at higher risk of failing second-line ART and thus should be closely monitored. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  1. 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.

  2. [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.

  3. Pregnancy and HIV infection

    OpenAIRE

    Mete Sucu; Cihan Cetin; Mehmet Ozsurmeli; Ghanim Khatib; Ceren Cetin; Cuneyt Evruke

    2016-01-01

    The management of Human Immunodeficiency Virus (HIV) infection is progressing rapidly. In developed countries, the perinatal transmission rates have decreased from 20-30% to 1-2% with the use of antiretroviral therapy and cesarean section. Interventions for the prevention of prenatal transmission has made the prenatal care of pregnant patients with HIV infection more complex. Rapid development of standard care and continuing increase in the distribution of HIV infection has required clinician...

  4. 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.

  5. Carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in HIV-infected children in Zimbabwe.

    Science.gov (United States)

    Wilmore, S M S; Kranzer, K; Williams, A; Makamure, B; Nhidza, A F; Mayini, J; Bandason, T; Metcalfe, J; Nicol, M P; Balakrishnan, I; Ellington, M J; Woodford, N; Hopkins, S; McHugh, T D; Ferrand, R A

    2017-05-01

    Antimicrobial resistance is an emerging global health issue. Data on the epidemiology of multidrug-resistant organisms are scarce for Africa, especially in HIV-infected individuals who often have frequent contact with healthcare. We investigated the prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriage in stool among HIV-infected children attending an HIV outpatient department in Harare, Zimbabwe. We recruited children who were stable on antiretroviral therapy (ART) attending a HIV clinic from August 2014 to June 2015. Information was collected on antibiotic use and hospitalization. Stool was tested for ESBL-E through combination disc diffusion. API20E identification and antimicrobial susceptibility was performed on the positive samples followed by whole genome sequencing. Stool was collected from 175/202 (86.6 %) children. Median age was 11 [inter-quartile range (IQR) 9-12] years. Median time on ART was 4.6 years (IQR 2.4-6.4). ESBL-Es were found in 24/175 samples (13.7 %); 50 % of all ESBL-Es were resistant to amoxicillin-clavulanate, 100 % to co-trimoxazole, 45.8 % to chloramphenicol, 91.6 % to ceftriaxone, 20.8 % to gentamicin and 62.5 % to ciprofloxacin. ESBL-Es variously encoded CTX-M, OXA, TEM and SHV enzymes. The odds of ESBL-E carriage were 8.5 times (95 % CI 2.2-32.3) higher in those on ART for less than one year (versus longer) and 8.5 times (95 % CI 1.1-32.3) higher in those recently hospitalized for a chest infection. We found a 13.7 % prevalence of ESBL-E carriage in a population where ESBL-E carriage has not been described previously. Antimicrobial resistance (AMR) in Africa merits further study, particularly given the high HIV prevalence and limited diagnostic and therapeutic options available.

  6. Impact of the Kenya post-election crisis on clinic attendance and medication adherence for HIV-infected children in western Kenya

    Directory of Open Access Journals (Sweden)

    Sang Edwin

    2009-04-01

    Full Text Available Abstract Background Kenya experienced a political and humanitarian crisis following presidential elections on 27 December 2007. Over 1,200 people were killed and 300,000 displaced, with disproportionate violence in western Kenya. We sought to describe the immediate impact of this conflict on return to clinic and medication adherence for HIV-infected children cared for within the USAID-Academic Model Providing Access to Healthcare (AMPATH in western Kenya. Methods We conducted a mixed methods analysis that included a retrospective cohort analysis, as well as key informant interviews with pediatric healthcare providers. Eligible patients were HIV-infected children, less than 14 years of age, seen in the AMPATH HIV clinic system between 26 October 2007 and 25 December 2007. We extracted demographic and clinical data, generating descriptive statistics for pre- and post-conflict antiretroviral therapy (ART adherence and post-election return to clinic for this cohort. ART adherence was derived from caregiver-report of taking all ART doses in past 7 days. We used multivariable logistic regression to assess factors associated with not returning to clinic. Interview dialogue from was analyzed using constant comparison, progressive coding and triangulation. Results Between 26 October 2007 and 25 December 2007, 2,585 HIV-infected children (including 1,642 on ART were seen. During 26 December 2007 to 15 April 2008, 93% (N = 2,398 returned to care. At their first visit after the election, 95% of children on ART (N = 1,408 reported perfect ART adherence, a significant drop from 98% pre-election (p Conclusion During a period of humanitarian crisis, the vulnerable, HIV-infected pediatric population had disruptions in clinical care and in medication adherence, putting children at risk for viral resistance and increased morbidity. However, unique program strengths may have minimized these disruptions.

  7. 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.

  8. Therapeutic patient education and disclosure of status of HIV infected children in Yaounde, Cameroon Achievements and competence.

    Science.gov (United States)

    Njom Nlend, A E; Lyeb, A S; Moyo, S; Nsangou, D

    2016-08-01

    Psychosocial support and therapeutic patient education are recommended practices that are poorly reported. Our objective was to describe the main achievements after a patient therapeutic education program conducted for pre-adolescents and adolescents with HIV infection. This qualitative study of 37 children with a mean age of 11 years assessed the outcome of an educational program of 8 sessions that ended by the disclosure of their HIV status. Semistructured interviews that took place 8 weeks after the last session and lasted 20 minutes evaluated the following areas: knowledge of the disease, its treatment, its prevention, and their skills in managing their treatment and the secret. The level of knowledge was acceptable except about HIV transmission, and specifically, how they had acquired the disease. In all, 33/37 (89%) of the children were able to cite or write the name of their disease; 29/37 (78%) had acquired knowledge of their treatment (name of the drugs, objective, and daily treatment times); they were able to manage treatment intake away from home; and secrecy was the standard for all. However, many were unable to explain how they had acquired the virus. Therapeutic patient education for HIV status disclosure enables adolescents to acquire knowledge about their disease and the ability to manage it. The poor results observed for knowledge of transmission needs to be improved after disclosure in support groups.

  9. HIV-Infected Children Have Elevated Levels of PD-1+ Memory CD4 T Cells With Low Proliferative Capacity and High Inflammatory Cytokine Effector Functions.

    Science.gov (United States)

    Foldi, Julia; Kozhaya, Lina; McCarty, Bret; Mwamzuka, Mussa; Marshed, Fatma; Ilmet, Tiina; Kilberg, Max; Kravietz, Adam; Ahmed, Aabid; Borkowsky, William; Unutmaz, Derya; Khaitan, Alka

    2017-09-15

    During human immunodeficiency virus (HIV) disease, chronic immune activation leads to T-cell exhaustion. PD-1 identifies "exhausted" CD8 T cells with impaired HIV-specific effector functions, but its role on CD4 T cells and in HIV-infected children is poorly understood. In a Kenyan cohort of vertically HIV-infected children, we measured PD-1+ CD4 T-cell frequencies and phenotype by flow cytometry and their correlation with HIV disease progression and immune activation. Second, in vitro CD4 T-cell proliferative and cytokine responses to HIV-specific and -nonspecific stimuli were assessed with and without PD-1 blockade. HIV-infected children have increased frequencies of PD-1+ memory CD4 T cells that fail to normalize with antiretroviral treatment. These cells are comprised of central and effector memory subsets and correlate with HIV disease progression, measured by viral load, CD4 percentage, CD4:CD8 T-cell ratio, and immune activation. Last, PD-1+ CD4 T cells predict impaired proliferative potential yet preferentially secrete the Th1 and Th17 cytokines interferon-γ and interleukin 17A, and are unresponsive to in vitro PD-1 blockade. This study highlights differences in PD-1+ CD4 T-cell memory phenotype and response to blockade between HIV-infected children and adults, with implications for potential immune checkpoint therapies. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  10. Randomized controlled trial of caregiver training for HIV-infected child neurodevelopment and caregiver well being.

    Science.gov (United States)

    Bass, Judith K; Opoka, Robert; Familiar, Itziar; Nakasujja, Noeline; Sikorskii, Alla; Awadu, Jorem; Givon, Deborah; Shohet, Cilly; Murray, Sarah M; Augustinavicius, Jura; Mendelson, Tamar; Boivin, Michael

    2017-08-24

    HIV infection places children at neurodevelopmental risk; for young children in poverty, risk is compounded by compromised caregiving quality. The mediational intervention for sensitizing caregivers (MISC) program trained caregivers on fostering daily interactions with young children. We hypothesized that MISC could enhance neurodevelopment of rural Ugandan HIV-infected children and improve mental health outcomes of their caregivers, which might mediate improved caregiving quality. A randomized trial of HIV-infected young children (ages 2-5 years) and their female caregivers; cluster randomization was to MISC or a nutrition curriculum. A total of 18 geographic clusters in rural Uganda. Children and caregivers were evaluated at baseline, 6 months, 1 year, and 1-year post-training. Mullen Scales of Early Learning, the Color-Object Association Test for memory, the Early Childhood Vigilance Test of attention, and the Behavior Rating Inventory of Executive Function for the children. Caregivers completed measures of depression and anxiety symptoms and daily functioning. MISC had a significant impact on postintervention receptive language (adjusted mean difference = 3.13, 95% confidence interval 0.08, 6.18) that persisted at 1-year follow-up. MISC caregivers reported significantly less functional impairment postprogram (adjusted mean difference = -0.15, 95% confidence interval -0.28, -0.01). Other outcomes were NS. Both intervention conditions resulted in improvements in the study children over time. MISC showed additional impacts on child language and caregiver well-being. Future directions that include assessing the extent enhanced language development resulting from improved caregiving may better prepare impoverished children for school.

  11. Larger Subcortical Gray Matter Structures and Smaller Corpora Callosa at Age 5 Years in HIV Infected Children on Early ART

    Directory of Open Access Journals (Sweden)

    Steven R. Randall

    2017-11-01

    Full Text Available Sub-Saharan Africa is home to 90% of HIV infected (HIV+ children. Since the advent of antiretroviral therapy (ART, HIV/AIDS has transitioned to a chronic condition where central nervous system (CNS damage may be ongoing. Although, most guidelines recommend early ART to reduce CNS viral reservoirs, the brain may be more vulnerable to potential neurotoxic effects of ART during the rapid development phase in the first years of life. Here we investigate differences in subcortical volumes between 5-year-old HIV+ children who received early ART (before age 18 months and uninfected children using manual tracing of Magnetic Resonance Images. Participants included 61 Xhosa children (43 HIV+/18 uninfected, mean age = 5.4 ± 0.3 years, 25 male from the children with HIV early antiretroviral (CHER trial; 27 children initiated ART before 12 weeks of age (ART-Before12Wks and 16 after 12 weeks (ART-After12Wks. Structural images were acquired on a 3T Allegra MRI in Cape Town and manually traced using MultiTracer. Volumetric group differences (HIV+ vs. uninfected; ART-Before12Wks vs. ART-After12Wks were examined for the caudate, nucleus accumbens (NA, putamen (Pu, globus pallidus (GP, and corpus callosum (CC, as well as associations within infected children of structure volumes with age at ART initiation and CD4/CD8 as a proxy for immune health. HIV+ children had significantly larger NA and Pu volumes bilaterally and left GP volumes than controls, whilst CC was smaller. Bilateral Pu was larger in both treatment groups compared to controls, while left GP and bilateral NA were enlarged only in ART-After12Wks children. CC was smaller in both treatment groups compared to controls, and smaller in ART-After12Wks compared to ART-Before12Wks. Within infected children, delayed ART initiation was associated with larger Pu volumes, effects that remained significant when controlling for sex and duration of treatment interruption (left β = 0.447, p = 0.005; right β = 0

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

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    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.

  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. Human rotavirus group a serotypes causing gastroenteritis in children less than 5 years and HIV-infected adults in Viwandani slum, Nairobi.

    Science.gov (United States)

    Raini, S K; Nyangao, J; Kombich, J; Sang, C; Gikonyo, J; Ongus, J R; Odari, E O

    2015-01-01

    Rotavirus remains a leading cause of acute gastroenteritis in children worldwide with an estimated 2000 deaths each day in developing countries. Due to HIV/AIDS scourge in Kenya, it is possible that rotavirus-related gastroenteritis has been aggravated in adults. The Global Alliance for Immunizations has ranked rotavirus infection a priority for vaccine, and, to ensure its success, there is a need to document the local strain(s) circulating in different regions. A cross-sectional study was conducted to document human rotavirus group A serotypes in children below 5 years and HIV-infected adults in Viwandani slum in Nairobi, Kenya. A total of 260 (128 from children and 132 from HIV infected adults) fecal specimen samples were analyzed from August 2012 to July 2013. Screening for rotavirus was done by antigen based enzyme immune-sorbent assay (ELISA), Polyacrylamide gel electrophoresis (PAGE) was used to detect rotavirus electropherotypes and finally genotyping was done by RT-PCR using genotype-specific primer sets targeting VP4 and VP7 genes. Rotavirus was detected in 23% and 8% of children and adult, respectively. Prevalence was high in children of 48 years. Long electropherotypes accounted for 80% and 60% while short electropherotypes accounted for 20% and 40% in children and adult, respectively. The common globally distributed strains, G1 and G3, accounted for 60% detections while the unusual G9 strain accounted for 80% infection in adults. G1P[8] was the common genotypic combination in children, accounting for 40% infection, whereas G9 [P8] accounted for 60% of the infections in adults. This study shows the existence of strain diversity between rotavirus circulating in children and adults within this study group. It further shows that as currently constituted, the 2 vaccines recommended for rotavirus would cover the circulating strain in Viwandani slum. Finally, there is a need for continuous rotavirus strain surveillance in children and a further focus on HIV

  15. 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

  16. Routine viral load monitoring in HIV-infected infants and children in low- and middle-income countries: challenges and opportunities.

    Science.gov (United States)

    Arpadi, Stephen M; Shiau, Stephanie; De Gusmao, Eduarda Pimentel; Violari, Avy

    2017-11-01

    The objective of this commentary is to review considerations for implementing routine viral load (VL) monitoring programmes for HIV-infected infants and children living in low- and middle-income countries (LMIC). Since 2013, the World Health Organization (WHO) guidelines recommend VL testing as the preferred monitoring approach for all individuals treated with ART in order to assess treatment response, detect treatment failure and determine the need to switch to a second-line regimen in a timely manner. More recently, WHO guidelines from 2016 identify HIV-infected infants and children as a priority group for routine VL monitoring. There are a number of reasons why HIV-infected infants and children should be prioritized for routine VL monitoring. Data from national VL monitoring programmes as well as systematic reviews and meta-analyses from LMIC indicate rates of viral suppression are lower for infants and children compared to adults. The number of antiretroviral drugs and palatable formulations suitable for young children are limited. In addition, emotional and developmental issues particular to children can make daily medication administration difficult and pose a challenge to adherence and achievement of sustained viral suppression. VL monitoring can be instrumental for identifying those in need of additional adherence support, reducing regimen switches and preserving treatment options. The needs of infants and children warrant consideration in all aspects of VL monitoring services. If capacity for paediatric venipuncture is not assured, platforms that accept dried blood spot specimens are necessary in order for infants and children to have equitable access. Healthcare systems also need to prepare to manage the substantial number of infants and children identified with elevated VL, including adherence interventions that are appropriate for children. Establishing robust systems to evaluate processes and outcomes of routine VL monitoring services and to support

  17. Genetically determined ancestry is more informative than self-reported race in HIV-infected and -exposed children

    Science.gov (United States)

    Spector, Stephen A.; Brummel, Sean S.; Nievergelt, Caroline M.; Maihofer, Adam X.; Singh, Kumud K.; Purswani, Murli U.; Williams, Paige L.; Hazra, Rohan; Van Dyke, Russell; Seage, George R.

    2016-01-01

    Abstract The Pediatric HIV/AIDS Cohort Study (PHACS), the largest ongoing longitudinal study of perinatal HIV-infected (PHIV) and HIV-exposed, uninfected (PHEU) children in the United States, comprises the Surveillance Monitoring of Antiretroviral Therapy [ART] Toxicities (SMARTT) Study in PHEU children and the Adolescent Master Protocol (AMP) that includes PHIV and PHEU children ≥7 years. Although race/ethnicity is often used to assess health outcomes, this approach remains controversial and may fail to accurately reflect the backgrounds of ancestry-diverse populations as represented in the PHACS participants. In this study, we compared genetically determined ancestry (GDA) and self-reported race/ethnicity (SRR) in the PHACS cohort. GDA was estimated using a highly discriminative panel of 41 single nucleotide polymorphisms and compared to SRR. Because SRR was similar between the PHIV and PHEU, and between the AMP and SMARTT cohorts, data for all unique 1958 participants were combined. According to SRR, 63% of study participants identified as Black/African-American, 27% White, and 34% Hispanic. Using the highest percentage of ancestry/ethnicity to identify GDA, 9.5% of subjects were placed in the incorrect superpopulation based on SRR. When ≥50% or ≥75% GDA of a given superpopulation was required, 12% and 25%, respectively, of subjects were placed in the incorrect superpopulation based on SRR, and the percent of subjects classified as multiracial increased. Of 126 participants with unidentified SRR, 71% were genetically identified as Eurasian. GDA provides a more robust assessment of race/ethnicity when compared to self-report, and study participants with unidentified SRR could be assigned GDA using genetic markers. In addition, identification of continental ancestry removes the taxonomic identification of race as a variable when identifying risk for clinical outcomes. PMID:27603370

  18. 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.

    2016-01-01

    ABSTRACT 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

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

    Science.gov (United States)

    Rohner, Eliane; Schmidlin, Kurt; Zwahlen, Marcel; Chakraborty, Rana; Clifford, Gary; Obel, Niels; Grabar, Sophie; Verbon, Annelies; Noguera-Julian, Antoni; Collins, Intira Jeannie; Rojo, Pablo; Brockmeyer, Norbert; Campbell, Maria; Chêne, Geneviève; Prozesky, Hans; Eley, Brian; Stefan, D Cristina; Davidson, Alan; Chimbetete, Cleophas; Sawry, Shobna; Davies, Mary-Ann; Kariminia, Azar; Vibol, Ung; Sohn, Annette; Egger, Matthias; Bohlius, Julia

    2016-11-01

    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. 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 origin, sex, cART start year, age, and HIV/AIDS stage at cART initiation. We included 24 991 children from eastern Africa, southern Africa, Europe and Asia; 26 developed KS after starting cART. Incidence rates per 100 000 person-years (PYs) were 86 in eastern Africa (95% confidence interval [CI], 55-133), 11 in southern Africa (95% CI, 4-35), and 81 (95% CI, 26-252) in children of sub-Saharan African (SSA) origin in Europe. The KS incidence rates were 0/100 000 PYs in children of non-SSA origin in Europe (95% CI, 0-50) and in Asia (95% CI, 0-27). KS risk was lower in girls than in boys (adjusted HR [aHR], 0.3; 95% CI, .1-.9) and increased with age (10-15 vs 0-4 years; aHR, 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. 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 reduce KS risk. © 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.

  20. 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

  1. 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

  2. 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

  3. 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.

  4. Predictors of poor CD4 and weight recovery in HIV-infected children initiating ART in South Africa.

    Directory of Open Access Journals (Sweden)

    Brian C Zanoni

    Full Text Available To identify baseline demographic and clinical risk factors associated with poor CD4 and weight response after initiation of antiretroviral therapy (ART in a cohort of human immunodeficiency virus (HIV-infected children in KwaZulu-Natal, South Africa.We performed a retrospective cohort study of 674 children initiating antiretroviral therapy at McCord and St. Mary's hospitals in KwaZulu-Natal, South Africa, from August 2003 to December 2008. We extracted data from paper charts and electronic medical records to assess risk factors associated with CD4 and weight response using logistic regression.From the initial cohort of 901 children <10 years old initiating ART between August 2003 and December 2008, we analyzed 674 children with complete baseline data. Viral suppression rates (<400 copies/ml were 84% after six months of therapy and 88% after 12 months of therapy. Seventy-three percent of children achieved CD4 recovery after six months and 89% after 12 months. Weight-for-age Z-score (WAZ improvements were seen in 58% of children after six months of ART and 64% after 12 months. After six months of ART, lower baseline hemoglobin (p = 0.037, presence of chronic diarrhea (p = 0.007, and virologic failure (p = 0.046 were all associated with poor CD4 recovery by multivariate logistic regression. After 12 months of ART, poor CD4 recovery was associated with higher baseline CD4% (p = 0.005, chronic diarrhea (p = 0.02, and virologic failure (p<0.001. Age less than 3 years at ART initiation (p = 0.0003, higher baseline CD4% (p<0.001, and higher baseline WAZ (p<0.001 were all associated with poor WAZ improvements after 6 months by multivariate logistic regression.The presence of chronic diarrhea at baseline, independent of nutritional status and viral response, predicts poor CD4 recovery. Age at initiation of ART is an important factor in early WAZ response to ART, while viral suppression strongly predicts CD4 recovery but not WAZ improvement.

  5. 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

    Science.gov (United States)

    Jesson, Julie; Koumakpaï, Sikiratou; Diagne, Ndeye R.; Amorissani-Folquet, Madeleine; Kouéta, Fla; Aka, Addi; Lawson-Evi, Koko; Dicko, Fatoumata; Kouakou, Kouadio; Pety, Touré; Renner, Lorna; Eboua, Tanoh; Coffie, Patrick A.; Desmonde, Sophie; Leroy, Valériane

    2015-01-01

    Background We described malnutrition and the effect of age at antiretroviral therapy (ART) initiation on catch-up growth over 24 months among HIV-infected children enrolled in the IeDEA West African paediatric cohort (pWADA). Methods Malnutrition was defined at ART initiation (baseline) by a Z-score malnutrition at ART initiation, ART regimen, time period and country, were compared by age at ART initiation. Cox proportional hazards regression models determined predictors of catch-up growth on ART over 24 months. Results Between 2001 and 2012, 2004 HIV-infected children Malnutrition among these children is an additional burden that has to be urgently managed. Despite a significant growth improvement after 24 months on ART, especially in children <5 years, a substantial proportion of children still never achieved catch-up growth. Nutritional care should be part of the global healthcare of HIV-infected children in sub-Saharan Africa. PMID:25955835

  6. Asymptomatic HIV infection

    Science.gov (United States)

    ... of HIV/AIDS during which there are no symptoms of HIV infection. During this phase, the immune system in someone with HIV slowly weakens, but the person has no symptoms. How long this phase lasts depends on how ...

  7. Predictors of early mortality in a cohort of HIV-infected children receiving high active antiretroviral treatment in public hospitals in Ethiopia.

    Science.gov (United States)

    Ebissa, Getachew; Deyessa, Negusse; Biadgilign, Sibhatu

    2015-01-01

    Highly active antiretroviral therapy (HAART) is the breakthrough in care and treatment of people living with HIV, leading to a reduction in mortality and an improvement in the quality of life. Without antiretroviral treatment, most HIV-infected children die before their fifth birthday. So the objective of this study is to determine the mortality and associated factors in a cohort of HIV-infected children receiving ART in Ethiopia. A multicentre facility-based retrospective cohort study was done in selected pediatric ART units in hospitals found in Addis Ababa, Ethiopia. The probability of survival was estimated using the Kaplan-Meier method, and multivariate analysis by Cox proportional hazards regression models was conducted to determine the independent predictor of survival. A total of 556 children were included in this study. Of the total children, 10.4% were died in the overall cohort. More deaths (70%) occurred in the first 6 months of ART initiation, and the remaining others were still on follow-up at different hospitals. Underweight (moderate and severe; HR: 10.10; 95% CI: 2.08, 28.00; P = 0.004; and HR: 46.69; 95% CI: 9.26, 200.45; P ART adherence (HR: 11.72; 95% CI: 1.60, 48.44; P = 0.015), and hemoglobin level less than 7 g/dl (HR: 4.08: 95% CI: 1.33, 12.56; P = 0.014) were confirmed as significant independent predictors of death after controlling for other factors. Underweight, advanced disease stage, poor adherence to ART, and anemia appear to be independent predictor of survival in HIV-infected children receiving HAART at the pediatric units of public hospitals in Ethiopia. Nutritional supplementations, early initiation of HAART, close supervision, and monitoring of patients during the first 6 months, the follow up period is recommended.

  8. The Dilemmas of Childhood HIV Infection.

    Science.gov (United States)

    Rudigier, Anne F.; And Others

    1990-01-01

    Increase in number of children infected with human immunodeficiency virus (HIV), and consequential developmental disabilities of these children are discussed. Families caring for HIV-infected children express four recurrent themes: psychological stress, grief and mourning, guilt and self-blame, and isolation and fear of discrimination. Flexible…

  9. Rethinking the risk-benefit ratio of efavirenz in HIV-infected children

    NARCIS (Netherlands)

    Wijer, L van de; Schellekens, A.F.A.; Burger, D.M.; Homberg, J.R.; Mast, Q. de; Ven, A.J.A.M. van der

    2016-01-01

    The non-nucleoside reverse transcriptase inhibitor efavirenz is part of the WHO guidelines for preferred first-line treatment of HIV-1-infected adults, pregnant and lactating women, and children. Efavirenz is well known to cause CNS toxicity. Although good data for CNS toxicity are available for

  10. 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

    nonprogressors. These children therefore express two cardinal immunological features of nonpathogenic SIV infection in sooty mangabeys-low immune activation despite high viremia and low CCR5 expression on long-lived central memory CD4 T cells-suggesting closer similarities with nonpathogenetic mechanisms evolved...

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

    African Journals Online (AJOL)

    In 56 children identified, the median age was 5 (interquartile range (IQR) 2 - 8) years with equal gender ratio. The majority (93%) had been previously treated for tuberculosis and/or pneumonia (71%). The most common CLD identified was lymphocytic interstitial pneumonitis (54%). The median nadir CD4 percentage was ...

  12. 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.

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

    Science.gov (United States)

    Kamuhabwa, Appolinary Ar; Manyanga, Vicky

    2015-01-01

    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. 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. 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. 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-trimoxazole during the course of prophylaxis. The majority of health care workers (89.7%) reported that co-trimoxazole is very effective for the prevention of opportunistic infections among children, but frequent shortage of co-trimoxazole in the health facilities was

  14. Age and CD4 count at initiation of antiretroviral therapy in HIV-infected children: effects on long-term T-cell reconstitution.

    Science.gov (United States)

    Lewis, Joanna; Walker, A Sarah; Castro, Hannah; De Rossi, Anita; Gibb, Diana M; Giaquinto, Carlo; Klein, Nigel; Callard, Robin

    2012-02-15

    Effective therapies and reduced AIDS-related morbidity and mortality have shifted the focus in pediatric human immunodeficiency virus (HIV) from minimizing short-term disease progression to maintaining optimal long-term health. We describe the effects of children's age and pre-antiretroviral therapy (ART) CD4 count on long-term CD4 T-cell reconstitution. CD4 counts in perinatally HIV-infected, therapy-naive children in the Paediatric European Network for the Treatment of AIDS 5 trial were monitored following initiation of ART for a median 5.7 years. In a substudy, naive and memory CD4 counts were recorded. Age-standardized measurements were analyzed using monophasic, asymptotic nonlinear mixed-effects models. One hundred twenty-seven children were studied. Older children had lower age-adjusted CD4 counts in the long term and at treatment initiation (P memory CD4 counts increased less, albeit on a faster timescale. It appears the immature immune system can recover well from HIV infection via the naive pool. However, this potential is progressively damaged with age and/or duration of infection. Current guidelines may therefore not optimize long-term immunological health.

  15. Oral Candida colonization and its relation with predisposing factors in HIV-infected children and their uninfected siblings in Brazil: the era of highly active antiretroviral therapy.

    Science.gov (United States)

    Cerqueira, Daniella Ferraz; Portela, Maristela Barbosa; Pomarico, Luciana; de Araújo Soares, Rosangela Maria; de Souza, Ivete Pomarico Ribeiro; Castro, Glória Fernanda

    2010-02-01

    To evaluate predisposing factors such as orofacial manifestations, immunosuppression status and antiretroviral therapy in relation to oral colonization by Candida spp. in Brazilian HIV-infected children and their uninfected siblings in the era of highly active antiretroviral therapy (HAART). Whole stimulated saliva was collected from 65 HIV-infected children (HIV+) and 40 uninfected siblings (HIV-), followed by assessment of orofacial manifestation, caries indexes and the number of cavitated dentinal carious teeth (CDT). The salivary samples were cultured and the colonies were counted. After which they were identified by sugar assimilation and fermentation (API 20C). Data was analyzed using chi-square, Mann-Whitney, Spearman tests and logistic regression. Regarding positive growth, HIV+ presented 80% (52/65) and HIV- 57.5% (23/40) (P = 0.013). Absence of antiretroviral therapy and HAART increased the probability of Candida isolation (P oral candidiasis (OC) had no influence on Candida isolation. Mixed Candida spp. cultures were observed in HIV+ (40%) and HIV- (52%): C. albicans was more frequently found in both groups, with a higher prevalence in HIV+ (P = 0.05); other non-albicans species were isolated in HIV+ and HIV-. Low prevalence of orofacial manifestations was observed in HIV+ (10.7% of OC). There was an association between means of CDT and Candida growth (P children had a significantly higher prevalence of oral Candida spp. compared to their uninfected siblings. Absence of HAART and presence of dentinal carious teeth increased significantly Candida spp. colonization in these children.

  16. 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

    . RESULTS:  We included 24 991 children from eastern Africa, southern Africa, Europe and Asia; 26 developed KS after starting cART. Incidence rates per 100 000 person-years (PYs) were 86 in eastern Africa (95% confidence interval [CI], 55-133), 11 in southern Africa (95% CI, 4-35), and 81 (95% CI, 26......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......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...

  17. 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

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

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    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

  19. Pharyngeal colonization and drug resistance profiles of Morraxella catarrrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae among HIV infected children attending ART Clinic of Felegehiwot Referral Hospital, Ethiopia.

    Directory of Open Access Journals (Sweden)

    Wondemagegn Mulu

    Full Text Available Asymptomatic pharyngeal colonization by potential bacteria is the primary reservoir for bacterial species within a population and is considered a prerequisite for development of major childhood diseases such as sinusitis, otitis media, pneumonia, bacteremia, and meningitis. However, there is dearth of data on the colonization and drug resistance pattern of the main bacterial pathogens in the pharynx of HIV infected children in Ethiopia. Therefore, this study determined the pharyngeal colonization and drug resistance profile of bacterial pathogens in HIV infected children attending ART clinic of Felegehiwot Referral Hospital (FHRH, Amhara Region, Ethiopia.A hospital based cross-sectional study was conducted from May 2016 to June 2017 at the ART clinic of FHRH. A total of 300 HIV infected children were enrolled in the study. Data on socio-demographic characteristics of the study participants were collected with face-to-face interview and patient-card review using structured questionnaire. Bacterial species were identified using standard bacteriological techniques. Drug susceptibility testing was performed using disk diffusion technique. Chi-square test was done to determine associations among variables.The median age of the participants was 11 years. Overall, 153 (51% of children were colonized by respiratory bacteria in their pharynx. Colonization rate was higher in children from mothers who had attained college and above levels of education than others (P = 0.04. It was also higher in children without the sign of malnutrition than others (P = 0.004. The colonization rate of S.aureus, M.catarrhalis, S.pneumoniae and H.influenzae were 88 (29%, 37 (12.3%, 31 (10.3% and 6 (2%, respectively. S.aureus-M.catarrhalis concurrent colonization was found in 14 (4.7% of children. Age (P = 0.03, schooling (P = 0.045 and history of running nose (P = 0.043 were significantly associated with S.aureus colonization. Living in urban setting (P = 0.042 and children

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

    African Journals Online (AJOL)

    Background: HIV infection has become a common risk factor for hospital admission and a major contributor to childhood morbidity in South Africa. There remains a paucity of data describing the cost of hospitalisation of HIV-infected children in South Africa. The aim of this study was to describe basic demographics and ...

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

    African Journals Online (AJOL)

    in infancy - clinical and laboratory markers of infection. M P Meyer, Z Latief, C Haworlh, 5 Salie,. A van Dyk. 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 HIV-infected (HIV antibody- and ...

  2. Perturbation of B Cell Gene Expression Persists in HIV-Infected Children Despite Effective Antiretroviral Therapy and Predicts H1N1 Response.

    Science.gov (United States)

    Cotugno, Nicola; De Armas, Lesley; Pallikkuth, Suresh; Rinaldi, Stefano; Issac, Biju; Cagigi, Alberto; Rossi, Paolo; Palma, Paolo; Pahwa, Savita

    2017-01-01

    Despite effective antiretroviral therapy (ART), HIV-infected individuals with apparently similar clinical and immunological characteristics can vary in responsiveness to vaccinations. However, molecular mechanisms responsible for such impairment, as well as biomarkers able to predict vaccine responsiveness in HIV-infected children, remain unknown. Following the hypothesis that a B cell qualitative impairment persists in HIV-infected children (HIV) despite effective ART and phenotypic B cell immune reconstitution, the aim of the current study was to investigate B cell gene expression of HIV compared to age-matched healthy controls (HCs) and to determine whether distinct gene expression patterns could predict the ability to respond to influenza vaccine. To do so, we analyzed prevaccination transcriptional levels of a 96-gene panel in equal numbers of sort-purified B cell subsets (SPBS) isolated from peripheral blood mononuclear cells using multiplexed RT-PCR. Immune responses to H1N1 antigen were determined by hemaglutination inhibition and memory B cell ELISpot assays following trivalent-inactivated influenza vaccination (TIV) for all study participants. Although there were no differences in terms of cell frequencies of SPBS between HIV and HC, the groups were distinguishable based upon gene expression analyses. Indeed, a 28-gene signature, characterized by higher expression of genes involved in the inflammatory response and immune activation was observed in activated memory B cells (CD27 + CD21 - ) from HIV when compared to HC despite long-term viral control (>24 months). Further analysis, taking into account H1N1 responses after TIV in HIV participants, revealed that a 25-gene signature in resting memory (RM) B cells (CD27 + CD21 + ) was able to distinguish vaccine responders from non-responders (NR). In fact, prevaccination RM B cells of responders showed a higher expression of gene sets involved in B cell adaptive immune responses ( APRIL, BTK, BLIMP1 ) and

  3. 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.

  4. Pregnancy and HIV infection

    Directory of Open Access Journals (Sweden)

    Mete Sucu

    2016-12-01

    Full Text Available The management of Human Immunodeficiency Virus (HIV infection is progressing rapidly. In developed countries, the perinatal transmission rates have decreased from 20-30% to 1-2% with the use of antiretroviral therapy and cesarean section. Interventions for the prevention of prenatal transmission has made the prenatal care of pregnant patients with HIV infection more complex. Rapid development of standard care and continuing increase in the distribution of HIV infection has required clinicians taking care of pregnants to have current information. Therefore, in our review we aimed to summarize the prenatal course, treatment and preventive methods for perinatal transmission of HIV. [Archives Medical Review Journal 2016; 25(4.000: 522-535

  5. 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

  6. Effects of antiretroviral drug recall on perception of therapy benefits and on adherence to antiretroviral treatment in HIV-infected children.

    Science.gov (United States)

    Giannattasio, Antonietta; Barbarino, Alessandro; Lo Vecchio, Andrea; Bruzzese, Eugenia; Mango, Carmela; Guarino, Alfredo

    2009-09-01

    In June 2007, the European Medicines Agency announced the recall by Roche of nelfinavir from European Union markets because of contamination of tablets with ethyl mesylate. Based on this event, we investigated the effect of switching therapy because of nelfinavir recall or for other reasons on the perception of therapy benefits and adherence to treatment in HIV-infected children and their caregivers. Thirty-eight children (mean age 12.1+/-6.7 years) were enrolled. A 35-item questionnaire was administered to the caregivers of enrolled children. Adherence was evaluated through a 4-day recall adherence instrument. Enrolled children were divided into 3 groups: patients who were shifted because of nelfinavir recall (group A, 8 patients); patients who were shifted for other reasons (group B, 12 patients); patients who were not shifted in the last 6 months (group C, 18 patients). All caregivers considered antiretroviral therapy necessary and effective for their children. However, drug shifting generated anxiety in most of them, irrespective of the reason for shifting. At baseline, 74% patients adhered to therapy. Adherence rate was related to the type of caregivers being higher in children cared for by foster parents than in children cared for by biological parents or second-degree relatives. Adherence rates did not change significantly in groups A and B after switching. Drug-switching raises concern in caregivers of HIV-infected children and induces a negative feeling irrespective of the reason for switching. However, switching, including the shift due to nelfinavir recall, did not affect adherence rates.

  7. 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.

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

    Science.gov (United States)

    Boivin, Michael J; Bangirana, Paul; Shaffer, Rebecca C; Smith, Rebecca C

    2010-01-27

    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. 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. 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. 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.

  9. 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.

  10. Psychogenic "HIV infection"

    NARCIS (Netherlands)

    Sno, H. N.; Storosum, J. G.; Wortel, C. H.

    1991-01-01

    The case of a man who falsely represented himself as being HIV positive is reported. In less than one year he was admitted twice with symptoms suggestive of HIV infection. The diagnoses malingering and factitious disorder were consecutively made. Early recognition of Factitious Disorder is essential

  11. HIV infection in Bophuthatswana

    African Journals Online (AJOL)

    ble exposure to HIV infection and associated risk fac- tors, information regarding demographic data, blood transfusion history, travelling from/to HIV endemic countries, history of imprisonment in the past 5 years, symptoms and signs of AIDS, lifestyle (number of sexu- al partners, heterosexual, homosexual, etc.) was collect-.

  12. 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 children ≥5 years. Three types of 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

  13. 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 Study1234

    Science.gov (United States)

    Jacobson, Denise L; Patel, Kunjal; Siberry, George K; Van Dyke, Russell B; DiMeglio, Linda A; Geffner, Mitchell E; Chen, Janet S; McFarland, Elizabeth J; Borkowsky, William; Silio, Margarita; Fielding, Roger A; Siminski, Suzanne; Miller, Tracie L

    2011-01-01

    Background: Associations between abnormal body fat distribution and clinical variables are poorly understood in pediatric HIV disease. Objective: 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 clinical variables. Design: In a cross-sectional analysis, children aged 7–16 y in the Pediatric HIV/AIDS Cohort Study underwent regionalized measurements of body fat via anthropometric methods and dual-energy X-ray absorptiometry. Multiple linear regression was used to evaluate body fat by HIV, with adjustment for age, Tanner stage, race, sex, and correlates of body fat in HIV-infected children. Percentage total body fat was compared with NHANES data. Results: Males accounted for 47% of the 369 HIV-infected and 51% of the 176 HEU children. Compared with HEU children, HIV-infected children were older, were more frequently non-Hispanic black, more frequently had Tanner stage ≥3, and had lower mean height (−0.32 compared with 0.29), weight (0.13 compared with 0.70), and BMI (0.33 compared with 0.63) z scores. On average, HIV-infected children had a 5% lower percentage total body fat (TotF), a 2.8% lower percentage extremity fat (EF), a 1.4% higher percentage trunk fat (TF), and a 10% higher trunk-to-extremity fat ratio (TEFR) than did the HEU children and a lower TotF compared with NHANES data. Stavudine use was associated with lower EF and higher TF and TEFR. Non-nucleotide reverse transcriptase inhibitor use was associated with higher TotF and EF and lower TEFR. Conclusion: Although BMI and total body fat were significantly lower in the HIV-infected children than in the HEU children, body fat distribution in the HIV-infected children followed a pattern associated with cardiovascular disease risk and possibly related to specific antiretroviral drugs. PMID:22049166

  14. Safety and tolerability of combination antimalarial therapies for uncomplicated falciparum malaria in Ugandan children

    Science.gov (United States)

    Maiteki-Sebuguzi, Catherine; Jagannathan, Prasanna; Yau, Vincent M; Clark, Tamara D; Njama-Meya, Denise; Nzarubara, Bridget; Talisuna, Ambrose O; Kamya, Moses R; Rosenthal, Philip J; Dorsey, Grant; Staedke, Sarah G

    2008-01-01

    Background Combination antimalarial therapy is recommended for the treatment of uncomplicated falciparum malaria in Africa; however, some concerns about the safety and tolerability of new regimens remain. This study compared the safety and tolerability of three combination antimalarial regimens in a cohort of Ugandan children. Methods A longitudinal, single-blind, randomized clinical trial of children was conducted between November 2004 and May 2007 in Kampala, Uganda. Upon diagnosis of the first episode of uncomplicated malaria, participants were randomized to treatment with amodiaquine + sulphadoxine-pyrimethamine (AQ+SP), artesunate + amodiaquine (AS+AQ), or artemether-lumefantrine (AL). Once randomized, participants received the same regimen for all subsequent episodes of uncomplicated malaria. Participants were actively monitored for adverse events for the first 14 days after each treatment, and then passively followed until their next study medication treatment, or withdrawal from study. Outcome measures included the risk of adverse events at 14 and 42 days after treatment. Results Of 601 enrolled children, 382 were diagnosed with at least one episode of uncomplicated malaria and were treated with study medications. The median age at treatment was 6.3 years (range 1.1 – 12.3 years). At 14 days of follow-up, AQ+SP treatment was associated with a higher risk of anorexia, weakness, and subjective fever than treatment with AL, and a higher risk of weakness, and subjective fever than treatment with AS+AQ. Treatment with AL was associated with a higher risk of elevated temperature. Repeated episodes of neutropaenia associated with AS+AQ were detected in one participant. Considering only children less than five years, those who received AQ+SP were at higher risk of developing moderate or severe anorexia and weakness than those treated with AL (anorexia: RR 3.82, 95% CI 1.59 – 9.17; weakness: RR 5.40, 95% CI 1.86 – 15.7), or AS+AQ (anorexia: RR 2.10, 95% CI 1

  15. Safety and tolerability of combination antimalarial therapies for uncomplicated falciparum malaria in Ugandan children

    Directory of Open Access Journals (Sweden)

    Kamya Moses R

    2008-06-01

    Full Text Available Abstract Background Combination antimalarial therapy is recommended for the treatment of uncomplicated falciparum malaria in Africa; however, some concerns about the safety and tolerability of new regimens remain. This study compared the safety and tolerability of three combination antimalarial regimens in a cohort of Ugandan children. Methods A longitudinal, single-blind, randomized clinical trial of children was conducted between November 2004 and May 2007 in Kampala, Uganda. Upon diagnosis of the first episode of uncomplicated malaria, participants were randomized to treatment with amodiaquine + sulphadoxine-pyrimethamine (AQ+SP, artesunate + amodiaquine (AS+AQ, or artemether-lumefantrine (AL. Once randomized, participants received the same regimen for all subsequent episodes of uncomplicated malaria. Participants were actively monitored for adverse events for the first 14 days after each treatment, and then passively followed until their next study medication treatment, or withdrawal from study. Outcome measures included the risk of adverse events at 14 and 42 days after treatment. Results Of 601 enrolled children, 382 were diagnosed with at least one episode of uncomplicated malaria and were treated with study medications. The median age at treatment was 6.3 years (range 1.1 – 12.3 years. At 14 days of follow-up, AQ+SP treatment was associated with a higher risk of anorexia, weakness, and subjective fever than treatment with AL, and a higher risk of weakness, and subjective fever than treatment with AS+AQ. Treatment with AL was associated with a higher risk of elevated temperature. Repeated episodes of neutropaenia associated with AS+AQ were detected in one participant. Considering only children less than five years, those who received AQ+SP were at higher risk of developing moderate or severe anorexia and weakness than those treated with AL (anorexia: RR 3.82, 95% CI 1.59 – 9.17; weakness: RR 5.40, 95% CI 1.86 – 15.7, or AS

  16. 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...

  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

    BACKGROUND: We described malnutrition and the effect of age at antiretroviral therapy (ART) initiation on catch-up growth over 24 months among HIV-infected children enrolled in the International epidemiologic Databases to Evaluate Aids West African paediatric cohort. METHODS: Malnutrition...

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

    African Journals Online (AJOL)

    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.

  19. 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

  20. 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.

  1. 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

  2. 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

  3. Clinical Management and Follow-up of Hypercholesterolemia Among Perinatally HIV-Infected Children Enrolled in the PACTG 219C Study

    Science.gov (United States)

    Jacobson, Denise L.; Williams, Paige; Tassiopoulos, Katherine; Melvin, Ann; Hazra, Rohan; Farley, John

    2011-01-01

    Background Hypercholesterolemia is common in perinatally HIV-infected (HIV+) children, but little is known about the clinical course and management in this population. Methods We studied HIV+ children in a multisite prospective cohort study (PACTG 219C) and considered follow-up for two years after development of hypercholesterolemia. We estimated the time to and factors associated with resolution of hypercholesterolemia and described changes in ARV regimen and use of lipid-lowering medications. We defined incident hypercholesterolemia as entry total cholesterol (cholesterol) hypercholesterolemia as two consecutive cholesterol hypercholesterolemia. Results Among 240 incident hypercholesterolemia cases, 81 (34%) had resolution to normal cholesterol within two years of follow-up (median follow-up = 1.9 years). The median age of cases was 10.3 years with 54% Non-Hispanic black and 53% male. Resolution to normal cholesterol was more likely in children who changed ARV regimen (adjusted Hazard Ratio (aHR) = 2.37, 95%CI 1.45, 3.88) and who were ≥ 13 years old (aHR=2.39, 95%CI 1.33, 4.27). Types of regimen changes varied greatly and 15 children began statins. Conclusions The majority of children who develop hypercholesterolemia maintain elevated levels over time, potentially placing them at risk for premature cardiovascular morbidity. PMID:21602698

  4. Subsets of memory CD4+ T cell and bactericidal antibody response to Neisseria meningitidis serogroup C after immunization of HIV-infected children and adolescents.

    Directory of Open Access Journals (Sweden)

    Lucimar G Milagres

    Full Text Available Meningococcal disease is endemic in Brazil, with periodic outbreaks and case fatality rates reach as high as 18 to 20% of cases. Conjugate vaccines against meningococci are immunogenic in healthy children. However, we have previously shown a poor bactericidal antibody response to a Men C conjugate vaccine in Brazilian HIV-infected children and adolescents after a single vaccine administration. The goal of the present work was to investigate associations between bactericidal antibody response induced by MenC vaccine and the frequency and activation profile (expression of CD38, HLA-DR and CCR5 molecules of total CD4+ memory T cell sub-populations in HIV-1-infected children and adolescents. Responders to vaccination against MenC had a predominance (about 44% of CD4+ TINTERMEDIATE subset followed by TTRANSITIONAL memory subset (23 to 26%. Importantly, CD4+ TINT frequency was positively associated with bactericidal antibody response induced by vaccination. The positive correlation persisted despite the observation that the frequency TINT CD38+HLA-DR+ was higher in responders. In contrast, CD4+ TCENTRAL MEMORY (TCM subset negatively correlated with bactericidal antibodies. In conclusion, these data indicate that less differentiated CD+ T cells, like TCM may be constantly differentiating into intermediate and later differentiated CD4+ T cell subsets. These include CD4 TINT subset which showed a positive association with bactericidal antibodies.

  5. 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

  6. Characterization of functional antibody and memory B-cell responses to pH1N1 monovalent vaccine in HIV-infected children and youth.

    Directory of Open Access Journals (Sweden)

    Donna J Curtis

    Full Text Available We investigated immune determinants of antibody responses and B-cell memory to pH1N1 vaccine in HIV-infected children.Ninety subjects 4 to <25 years of age received two double doses of pH1N1 vaccine. Serum and cells were frozen at baseline, after each vaccination, and at 28 weeks post-immunization. Hemagglutination inhibition (HAI titers, avidity indices (AI, B-cell subsets, and pH1N1 IgG and IgA antigen secreting cells (ASC were measured at baseline and after each vaccination. Neutralizing antibodies and pH1N1-specific Th1, Th2 and Tfh cytokines were measured at baseline and post-dose 1.At entry, 26 (29% subjects had pH1N1 protective HAI titers (≥1:40. pH1N1-specific HAI, neutralizing titers, AI, IgG ASC, IL-2 and IL-4 increased in response to vaccination (p<0.05, but IgA ASC, IL-5, IL-13, IL-21, IFNγ and B-cell subsets did not change. Subjects with baseline HAI ≥1:40 had significantly greater increases in IgG ASC and AI after immunization compared with those with HAI <1:40. Neutralizing titers and AI after vaccination increased with older age. High pH1N1 HAI responses were associated with increased IgG ASC, IFNγ, IL-2, microneutralizion titers, and AI. Microneutralization titers after vaccination increased with high IgG ASC and IL-2 responses. IgG ASC also increased with high IFNγ responses. CD4% and viral load did not predict the immune responses post-vaccination, but the B-cell distribution did. Notably, vaccine immunogenicity increased with high CD19+CD21+CD27+% resting memory, high CD19+CD10+CD27+% immature activated, low CD19+CD21-CD27-CD20-% tissue-like, low CD19+CD21-CD27-CD20-% transitional and low CD19+CD38+HLADR+% activated B-cell subsets.HIV-infected children on HAART mount a broad B-cell memory response to pH1N1 vaccine, which was higher for subjects with baseline HAI≥1:40 and increased with age, presumably due to prior exposure to pH1N1 or to other influenza vaccination/infection. The response to the vaccine was dependent

  7. 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

  8. Clinical Staging of HIV Infection as a Surrogate for CD4 Count in HIV ...

    African Journals Online (AJOL)

    naive HIV-infected children. METHODS: Newly diagnosed HIV-infected children, antiretroviral-naïve attending a paediatric infectious diseases unit were enrolled. The clinical manifesta-tions, age, sex, and. WHO clinical stage of each patient were ...

  9. 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

  10. Anthropometric Improvement among HIV Infected Pre-School Children Following Initiation of First Line Anti-Retroviral Therapy: Implications for Follow Up.

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    Atnafu Mekonnen Tekleab

    Full Text Available Antiretroviral therapy (ART is a lifesaving intervention for HIV infected children. There is a scarcity of data on immunological recovery and its relation with growth indicators among HIV infected young children. The current study aims to assess the pattern of anthropometric Z-score improvement following initiation of first-line ART among under-five children and the relationship between anthropometric Z-score improvement and immunologic recovery.We included under-five children who were on first-line ART at five major hospitals in Addis Ababa, Ethiopia. We measured anthropometry and collected clinical and laboratory data at follow up, and we retrieved clinical and anthropometric data at ART initiation from records. Z-scores for each of the anthropometric indices were calculated based on WHO growth standards using ENA for SMART 2011 software. Linear regression was used to assess the relationship between time on ART and anthropometric Z-score improvement; and the relationship between anthropometric Z-score improvement and immunologic recovery. Multiple linear regression was used to assess the independent predictors of anthropometric Z-score change.The median age of the participants was 4.1 (Interquartile range (IQR: 3.3-4.9 years. More than half (52.48% were female. The median duration of follow up was 1.69 (IQR: 1.08-2.63 years. There was a significant improvement in all anthropometric indices at any follow up after initiation of first-line ART (underweight; 39.5% vs16.5%, stunting; 71.3% vs 62.9% and wasting; 16.3% vs 1.0%; p-value< 0.0001. There was an inverse relationship between improvement in weight for age Z-score (WAZ and duration of ART (R2 = 0.04; F (1, 158; p = 0.013. Height for age Z-score (HAZ both at the time of ART initiation and follow up has a positive linear relationship with CD4 percentage at follow up (Coef. = 1.92; R2 = 0.05; p-value = 0.002. Duration on ART (Std. Err. = 0.206, t = -1.99, p-value = 0.049 and level of maternal

  11. 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.

  12. [HIV infection and immigration].

    Science.gov (United States)

    Monge, Susana; Pérez-Molina, José A

    2016-01-01

    Migrants represent around one third of patients newly diagnosed with HIV in Spain and they constitute a population with higher vulnerability to its negative consequences due to the socio-cultural, economical, working, administrative and legal contexts. Migrants are diagnosed later, which worsens their individual prognosis and facilitates the maintenance of the HIV epidemic. In spite of the different barriers they experience to access healthcare in general, and HIV-related services in particular, access to antiretroviral treatment has been similar to that of the autochthonous population. However, benefits of treatment have been not, with women in general and men from Sub-Saharan Africa exhibiting the worse response to treatment. We need to proactively promote earlier diagnosis of HIV infection, the adoption of preventive measures to avoid new infections, and to deliver accessible, adapted and high-quality health-care. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  13. Pre-ART retention in care and prevalence of tuberculosis among HIV-infected children at a district hospital in southern Ethiopia.

    Science.gov (United States)

    Westerlund, Emil; Jerene, Degu; Mulissa, Zewdie; Hallström, Inger; Lindtjørn, Bernt

    2014-10-04

    The Ethiopian epidemic is currently on the wane. However, the situation for infected children is in some ways lagging behind due to low treatment coverage and deficient prevention of mother-to-child transmission. Too few studies have examined HIV infected children presenting to care in low-income countries in general. Considering the presence of local variations in the nature of the epidemic a study in Ethiopia could be of special value for the continuing fight against HIV. The aim of this study is to describe the main characteristics of children with HIV presenting to care at a district hospital in a resource-limited area in southern Ethiopia. The aim was also to analyse factors affecting pre-ART loss to follow-up, time to ART-initiation and disease stage upon presentation. This was a prospective cohort study. The data analysed were collected in 2009 for the period January 2003 through December 2008 at Arba Minch Hospital and additional data on the ART-need in the region were obtained from official reports. The pre-ART loss to follow-up rate was 29.7%. Older children (10-14 years) presented in a later stage of their disease than younger children (76.9% vs. 45.0% in 0-4 year olds, chi-square test, χ2 = 8.8, P = 0.01). Older girls presented later than boys (100.0% vs. 57.1%, Fisher's exact test, P = 0.02). Children aged 0-4 years were more likely to be lost to follow-up (40.0 vs. 21.8%, chi-square test, χ2 = 5.4, P = 0.02) and had a longer time to initiate ART (Cox regression analysis, HR: 0.50, 95% CI: 0.25-0.97, P = 0.04, controlling for sex, place of residence, enrollment phase and WHO clinical stage upon presentation). Neither sex was overrepresented in the sample. Tuberculosis prevalence upon presentation and previous history of tubercolosis were 14.5% and 8% respectively. The loss to follow-up is alarmingly high and children present too late. Further research is needed to explore specific causes and possible solutions.

  14. Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salaam, Tanzania

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    Mikx Frans HM

    2006-08-01

    Full Text Available Abstract Background The aim of the study was to compare the prevalence and types of HIV-related oral lesions between children and adult Tanzanian patients on HAART with those not on HAART and to relate the occurrence of the lesions with anti-HIV drug regimen, clinical stage of HIV disease and CD4+ cell count. Methods Participants were 532 HIV infected patients, 51 children and 481 adults, 165 males and 367 females. Children were aged 2–17 years and adults 18 and 67 years. Participants were recruited consecutively at the Muhimbili National Hospital (MNH HIV clinic from October 2004 to September 2005. Investigations included; interviews, physical examinations, HIV testing and enumeration of CD4+ T cells. Results A total of 237 HIV-associated oral lesions were observed in 210 (39.5% patients. Oral candidiasis was the commonest (23.5%, followed by mucosal hyperpigmentation (4.7%. There was a significant difference in the occurrence of oral candidiasis (χ2 = 4.31; df = 1; p = 0.03 and parotid enlargement (χ2 = 36.5; df = 1; p = 0.04 between children and adults. Adult patients who were on HAART had a significantly lower risk of; oral lesions (OR = 0.32; 95% CI = 0.22 – 0.47; p = 0.005, oral candidiasis (OR = 0.28; 95% CI = 0.18 – 0.44; p = 0.003 and oral hairy leukoplakia (OR = 0.18; 95% CI = 0.04 – 0.85; p = 0.03. There was no significant reduction in occurrence of oral lesions in children on HAART (OR = 0.35; 95% CI = 0.11–1.14; p = 0.15. There was also a significant association between the presence of oral lesions and CD4+ cell count 3 (χ2 = 52.4; df = 2; p = 0.006 and with WHO clinical stage (χ2 = 121; df = 3; p = 0.008. Oral lesions were also associated with tobacco smoking (χ2 = 8.17; df = 2; p = 0.04. Conclusion Adult patients receiving HAART had a significantly lower prevalence of oral lesions, particularly oral candidiasis and oral hairy leukoplakia. There was no significant change in occurrence of oral lesions in children

  15. 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

    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...... these children, 75% reached immune recovery: 12-month rates were significantly highest in all those aged 2-5 years at ART initiation compared with those less than 2 years. Beyond 12 months on ART, immune recovery was significantly lower in children initiated more than 5 years (adjusted hazard ratio: 0.69, 95...

  16. 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

  17. Lung cancer in HIV Infection.

    Science.gov (United States)

    Mani, Deepthi; Haigentz, Missak; Aboulafia, David M

    2012-01-01

    Lung cancer is the most prevalent non-AIDS-defining malignancy in the highly active antiretroviral therapy era. Smoking plays a significant role in the development of HIV-associated lung cancer, but the cancer risk is two to four times greater in HIV-infected persons than in the general population, even after adjusting for smoking intensity and duration. Lung cancer is typically diagnosed a decade or more earlier among HIV-infected persons (mean age, 46 years) compared to those without HIV infection. Adenocarcinoma is the most common histological subtype, and the majority of patients are diagnosed with locally advanced or metastatic carcinoma. Because pulmonary infections are common among HIV-infected individuals, clinicians may not suspect lung cancer in this younger patient population. Surgery with curative intent remains the treatment of choice for early-stage disease. Although there is increasing experience in using radiation and chemotherapy for HIV-infected patients who do not have surgical options, there is a need for prospective studies because this population is frequently excluded from participating in cancer trials. Evidence-based treatments for smoking-cessation with demonstrated efficacy in the general population must be routinely incorporated into the care of HIV-positive smokers. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. 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.

  19. 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.

  20. 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

    children treated with HAART. Initial HAART included 2 nucleoside reverse-transcriptase inhibitors in combination with either a protease inhibitor (n =38) or a non-nucleoside reverse-transcriptase inhibitor (n =12). 19 (39%) patients were previously treated with mono- or dual therapy. Baseline......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 ... characteristics were median CD4 percentage 14% and HIV-RNA viral load 4.9 log(10). Within the first 12 weeks of therapy approximately 60% achieved HIV-RNA viral load children changed the components of HAART. The proportion of children with CD4...

  1. [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.

  2. Effect of Lopinavir and Nevirapine Concentrations on Viral Outcomes in Protease Inhibitor-experienced HIV-infected Children.

    Science.gov (United States)

    Moholisa, Retsilisitsoe R; Schomaker, Michael; Kuhn, Louise; Castel, Sandra; Wiesner, Lubbe; Coovadia, Ashraf; Strehlau, Renate; Patel, Faeezah; Pinillos, Francoise; Abrams, Elaine J; Maartens, Gary; McIlleron, Helen

    2016-12-01

    Adequate exposure to antiretroviral drugs is necessary to achieve and sustain viral suppression. However, the target antiretroviral concentrations associated with long-term viral suppression have not been adequately defined in children. We assessed the relationship between plasma lopinavir or nevirapine concentrations and the risk of subsequent viremia in children initially suppressed on antiretroviral therapy. After an induction phase of antiretroviral treatment, 195 children with viral suppression (viral load ≤400 copies/mL) were randomized to continue a lopinavir/ritonavir-based regimen or to switch to a nevirapine-based regimen (together with lamivudine and stavudine). Viral load and lopinavir or nevirapine concentrations were measured at clinic visits 4, 8, 12, 16, 20, 24, 36, 52, 64 and 76 weeks post randomization. Cox multiple failure event models were used to estimate the effects of drug concentrations on the hazard of viremia (viral load >50 copies/mL) RESULTS:: At randomization, the median (interquartile range) age, CD4 T-Lymphocyte percentage, weight-for-age and weight-for-height z scores were 19 (16-24) months, 29% (23-37), -0.6 (-1.3 to 0.2) and -3.2 (-4.1 to -2.1), respectively. The proportion of children with viral load 51-400 copies/mL at randomization was 43%. The hazard of subsequent viremia during follow-up was increased for lopinavir concentrations <1 versus ≥1 mg/L [adjusted hazard ratio 0.62 (95% confidence interval, 0.40-0.94)] and for children with viral loads 51-400 copies/mL at randomization. Nevirapine concentrations were not significantly associated with subsequent viremia. Plasma lopinavir concentrations predicted viral outcomes in children receiving lopinavir-based antiretroviral therapy. Our findings support a minimum target concentration of ≥1 mg/L of lopinavir to ensure sustained viral suppression.

  3. 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

  4. 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

  5. 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 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 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.

  6. 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.

  7. Classification, diagnostic criteria, and treatment recommendations for orofacial manifestations in HIV-infected pediatric patients. Collaborative Workgroup on Oral Manifestations of Pediatric HIV Infection.

    Science.gov (United States)

    Ramos-Gomez, F J; Flaitz, C; Catapano, P; Murray, P; Milnes, A R; Dorenbaum, A

    1999-01-01

    The criteria for diagnosis of HIV-related oral lesions in adults are well established, but corresponding criteria in the pediatric population are not as well defined. The Collaborative Workgroup on the Oral Manifestations of Pediatric HIV infection reached a consensus, based upon available data, as to the presumptive and definitive criteria to diagnose the oral manifestations of HIV infection in children. Presumptive criteria refer to the clinical features of the lesions, including signs and symptoms, whereas definitive criteria require specific laboratory tests. In general, it is recommended that definitive criteria be established whenever possible. Orofacial manifestations have been divided into three groups: 1) those commonly associated with pediatric HIV infection; 2) those less commonly associated with pediatric HIV infection; and 3) those strongly associated with HIV infection but rare in children. Orofacial lesions commonly associated with pediatric HIV infection include candidiasis, herpes simplex infection, linear gingival erythema, parotid enlargement, and recurrent aphthous stomatitis. In contrast, orofacial lesions strongly associated with HIV infection but rare in children include Kaposi's sarcoma, non-Hodgkin's lymphoma, and oral hairy leukoplakia. Treatment recommendations, specific for this age group, have been included for some of the more common HIV-related orofacial manifestations.

  8. Effect of cytomegalovirus co-infection on normalization of selected T-cell subsets in children with perinatally acquired HIV infection treated with combination antiretroviral therapy.

    Science.gov (United States)

    Kapetanovic, Suad; Aaron, Lisa; Montepiedra, Grace; Anthony, Patricia; Thuvamontolrat, Kasalyn; Pahwa, Savita; Burchett, Sandra; Weinberg, Adriana; Kovacs, Andrea

    2015-01-01

    We examined the effect of cytomegalovirus (CMV) co-infection and viremia on reconstitution of selected CD4+ and CD8+ T-cell subsets in perinatally HIV-infected (PHIV+) children ≥ 1-year old who participated in a partially randomized, open-label, 96-week combination antiretroviral therapy (cART)-algorithm study. Participants were categorized as CMV-naïve, CMV-positive (CMV+) viremic, and CMV+ aviremic, based on blood, urine, or throat culture, CMV IgG and DNA polymerase chain reaction measured at baseline. At weeks 0, 12, 20 and 40, T-cell subsets including naïve (CD62L+CD45RA+; CD95-CD28+), activated (CD38+HLA-DR+) and terminally differentiated (CD62L-CD45RA+; CD95+CD28-) CD4+ and CD8+ T-cells were measured by flow cytometry. Of the 107 participants included in the analysis, 14% were CMV+ viremic; 49% CMV+ aviremic; 37% CMV-naïve. In longitudinal adjusted models, compared with CMV+ status, baseline CMV-naïve status was significantly associated with faster recovery of CD8+CD62L+CD45RA+% and CD8+CD95-CD28+% and faster decrease of CD8+CD95+CD28-%, independent of HIV VL response to treatment, cART regimen and baseline CD4%. Surprisingly, CMV status did not have a significant impact on longitudinal trends in CD8+CD38+HLA-DR+%. CMV status did not have a significant impact on any CD4+ T-cell subsets. In this cohort of PHIV+ children, the normalization of naïve and terminally differentiated CD8+ T-cell subsets in response to cART was detrimentally affected by the presence of CMV co-infection. These findings may have implications for adjunctive treatment strategies targeting CMV co-infection in PHIV+ children, especially those that are now adults or reaching young adulthood and may have accelerated immunologic aging, increased opportunistic infections and aging diseases of the immune system.

  9. Effect of cytomegalovirus co-infection on normalization of selected T-cell subsets in children with perinatally acquired HIV infection treated with combination antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    Suad Kapetanovic

    Full Text Available We examined the effect of cytomegalovirus (CMV co-infection and viremia on reconstitution of selected CD4+ and CD8+ T-cell subsets in perinatally HIV-infected (PHIV+ children ≥ 1-year old who participated in a partially randomized, open-label, 96-week combination antiretroviral therapy (cART-algorithm study.Participants were categorized as CMV-naïve, CMV-positive (CMV+ viremic, and CMV+ aviremic, based on blood, urine, or throat culture, CMV IgG and DNA polymerase chain reaction measured at baseline. At weeks 0, 12, 20 and 40, T-cell subsets including naïve (CD62L+CD45RA+; CD95-CD28+, activated (CD38+HLA-DR+ and terminally differentiated (CD62L-CD45RA+; CD95+CD28- CD4+ and CD8+ T-cells were measured by flow cytometry.Of the 107 participants included in the analysis, 14% were CMV+ viremic; 49% CMV+ aviremic; 37% CMV-naïve. In longitudinal adjusted models, compared with CMV+ status, baseline CMV-naïve status was significantly associated with faster recovery of CD8+CD62L+CD45RA+% and CD8+CD95-CD28+% and faster decrease of CD8+CD95+CD28-%, independent of HIV VL response to treatment, cART regimen and baseline CD4%. Surprisingly, CMV status did not have a significant impact on longitudinal trends in CD8+CD38+HLA-DR+%. CMV status did not have a significant impact on any CD4+ T-cell subsets.In this cohort of PHIV+ children, the normalization of naïve and terminally differentiated CD8+ T-cell subsets in response to cART was detrimentally affected by the presence of CMV co-infection. These findings may have implications for adjunctive treatment strategies targeting CMV co-infection in PHIV+ children, especially those that are now adults or reaching young adulthood and may have accelerated immunologic aging, increased opportunistic infections and aging diseases of the immune system.

  10. Ethical issues and HIV infection

    African Journals Online (AJOL)

    ... will lose his job if he is found to be HIV-infected. ... already infected, has an interest in know- ing about ... and takes every action to do so. AM's ... forceful persuasion. .... patients don't do well, so we have ... set will affect the fairness and legit- ... emotional impact of the situation, will ... than ad hoc, when faced with individ-.

  11. Treatment of primary HIV infection

    NARCIS (Netherlands)

    Grijsen, M.L.

    2013-01-01

    In this thesis we studied the treatment of PHI. Early cART transiently lowered the viral setpoint and deferred the need for restart of cART during chronic HIV infection, which was most likely caused by the effects of the CD4 gain during treatment and the transient lowering of the viral setpoint.

  12. High Prevalence of Dyslipidemia and Insulin Resistance in HIV-infected Prepubertal African Children on Antiretroviral Therapy.

    Science.gov (United States)

    Innes, Steve; Abdullah, Kameelah L; Haubrich, Richard; Cotton, Mark F; Browne, Sara H

    2016-01-01

    Data describing the true extent of antiretroviral therapy (ART)-induced dyslipidemia and insulin resistance in perinatally infected children on ART in Africa are sparse. Fasting total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, insulin and glucose were performed on the first 100 of 190 pediatric ART clinic attendees. Diet assessment was performed by a trained dietician. Lipoatrophy was formally graded by consensus between 2 expert HIV pediatricians. Durations of previous ART exposures, clinical stage, pre-ART viral load, nadir and current CD4 were recorded. Dual-energy X-ray absorptiometry was performed on a subset of 42 patients selected semi-randomly. Prevalences of insulin resistance, abnormal total cholesterol, LDL, HDL and triglyceride were 10%, 13%, 12%, 13% and 9%, respectively. Overall, 40% had at least 1 lipid abnormality or insulin resistance. Adjusted mean LDL cholesterol increased by 0.24 mmol/L for each additional year of cumulative lopinavir/r exposure (P = 0.03) after correcting for age, gender, body mass index, previous stavudine exposure, age at ART initiation, dietary fat and refined carbohydrate, whereas adjusted mean LDL cholesterol was 0.9 mmol/L higher in children exposed to efavirenz within the previous 6 months (P = 0.02). Adjusting for age, gender and ethnicity, dual-energy X-ray absorptiometry revealed that greater trunk fat and lower peripheral subcutaneous fat were associated with elevated triglycerides but not with total cholesterol, LDL, HDL or homeostatic model assessment. Similarly, the presence of visually obvious lipoatrophy was associated with elevated triglycerides but not with total cholesterol, LDL, HDL, homeostatic model assessment or lactate. Prevalences of insulin resistance and dyslipidemia were high. Cumulative lopinavir is an independent risk factor for dyslipidemia, with efavirenz exposure having only transitory effect.

  13. A single CD4 test with 250 cells/mm3 threshold predicts viral suppression in HIV-infected adults failing first-line therapy by clinical criteria.

    Science.gov (United States)

    Gilks, Charles F; Walker, A Sarah; Munderi, Paula; Kityo, Cissy; Reid, Andrew; Katabira, Elly; Goodall, Ruth L; Grosskurth, Heiner; Mugyenyi, Peter; Hakim, James; Gibb, Diana M

    2013-01-01

    In low-income countries, viral load (VL) monitoring of antiretroviral therapy (ART) is rarely available in the public sector for HIV-infected adults or children. Using clinical failure alone to identify first-line ART failure and trigger regimen switch may result in unnecessary use of costly second-line therapy. Our objective was to identify CD4 threshold values to confirm clinically-determined ART failure when VL is unavailable. 3316 HIV-infected Ugandan/Zimbabwean adults were randomised to first-line ART with Clinically-Driven (CDM, CD4s measured but blinded) or routine Laboratory and Clinical Monitoring (LCM, 12-weekly CD4s) in the DART trial. CD4 at switch and ART failure criteria (new/recurrent WHO 4, single/multiple WHO 3 event; LCM: CD4tiebreaker' of ≥250 cells/mm(3) for clinically-monitored patients failing first-line could identify ∼80% with VL<400 copies/ml, who are unlikely to benefit from second-line. Targeting CD4s to single WHO stage 3 'clinical failures' would particularly avoid premature, costly switch to second-line ART.

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

    African Journals Online (AJOL)

    South African Journal of Child Health ... 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.

  15. 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 ...

  16. 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 ...

  17. 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

  18. 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

  19. Paediatric HIV infection.

    Science.gov (United States)

    Scarlatti, G

    1996-09-28

    By the year 2000 there will be six million pregnant women and five to ten million children infected with HIV-1. Intervention strategies have been planned and in some instances already started. A timely and cost-effective strategy needs to take into account that most HIV-1 infected individuals reside in developing countries. Further studies are needed on immunological and virological factors affecting HIV-1 transmission from mother to child, on differential disease progression in affected children, and on transient infection.

  20. 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.

  1. 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

  2. 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

  3. 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.

  4. [HIV infection in the Stavropol' region].

    Science.gov (United States)

    Filonenko, N G; Isaev, V P; Pelikh, N L

    2001-01-01

    The data on the dynamics of HIV infection in the Stavropol Territory beginning with 1987 are given. The situation became aggravated after 1996, and its sharp deterioration occurred in 2000 when 138 cases of HIV infection were detected and the area of this infection increased. In most cases patients became infected beyond the borders of the territory. About a half of the new cases of HIV infection registered in 2000 were detected in Ingushetia and Chechnya. The leading factor in the spread of HIV infection was the use of drugs by injection. The main trends of the prophylactic work are presented.

  5. Herpes zoster and HIV infection in Tanzania.

    Science.gov (United States)

    Naburi, A E; Leppard, B

    2000-04-01

    Two hundred consecutive patients with herpes zoster attending the skin clinic at the Kilimanjaro Christian Medical Centre (KCMC) were examined and checked for HIV infection. They ranged in age from 10 months to 86 years with the majority in their 20s and 30s. The dermatomes involved were thoracic (97), trigeminal (50), cervical (37), lumbar (19) and sacral (3). Six (3%) had more than one dermatome involved and 2 (1%) had disseminated disease. Only 2 (1%) had severe ulceration of the skin and all healed in less than 4 weeks. In children under the age of 10 years and in adults between the ages of 20 and 49 years virtually 100% were HIV positive; even in the age group 50-59 more than three-quarters were HIV positive. We conclude that the presence of herpes zoster at any site is a good indication that the patient is HIV positive except in the teens and the very elderly.

  6. Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges.

    Science.gov (United States)

    Lowenthal, Elizabeth D; Bakeera-Kitaka, Sabrina; Marukutira, Tafireyi; Chapman, Jennifer; Goldrath, Kathryn; Ferrand, Rashida A

    2014-07-01

    Worldwide, more than three million children are infected with HIV, 90% of whom live in sub-Saharan Africa. As the HIV epidemic matures and antiretroviral treatment is scaled up, children with HIV are reaching adolescence in large numbers. The growing population of adolescents with perinatally acquired HIV infection living within this region presents not only unprecedented challenges but also opportunities to learn about the pathogenesis of HIV infection. In this Review, we discuss the changing epidemiology of paediatric HIV and the particular features of HIV infection in adolescents in sub-Saharan Africa. Longstanding HIV infection acquired when the immune system is not developed results in distinctive chronic clinical complications that cause severe morbidity. As well as dealing with chronic illness, HIV-infected adolescents have to confront psychosocial issues, maintain adherence to drugs, and learn to negotiate sexual relationships, while undergoing rapid physical and psychological development. Context-specific strategies for early identification of HIV infection in children and prompt linkage to care need to be developed. Clinical HIV care should integrate age-appropriate sexual and reproductive health and psychological, educational, and social services. Health-care workers will need to be trained to recognise and manage the needs of these young people so that the increasing numbers of children surviving to adolescence can access quality care beyond specialist services at low-level health-care facilities. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Examination of the roles and capacities of duty bearers responsible for protecting the human rights to adequate food, nutritional health and wellbeing in Ugandan children's homes.

    Science.gov (United States)

    Olafsen, Monica; Rukooko, Archangel Byaruhanga; Iversen, Per Ole; Andreassen, Bård A

    2018-04-17

    The majority of Ugandan children face vulnerability and malnutrition. As a State Party to international human rights treaties, Uganda has legal obligations of guaranteeing the fundamental rights and the best interest of the nation's children. Despite being protected under international and national law, Uganda is not providing adequate child protection, including safeguarding children's food security. Numerous privately owned and unregulated children's homes face this problem. The overall aim of the study was to examine to what extent children's homes' operations are consistent with the right to adequate food, nutritional health and wellbeing of children. We performed a qualitative role- and capacity analysis of duty bearers with human rights duties towards children living in children's homes. We studied three groups of duty bearers: caretakers working in private children's homes, State actors working in government and its institutions, and non-State actors working in civil society organizations. A human rights based approach guided all aspects of the study. An analysis of the roles, performance and capacities of duty bearers was employed, with individual face-to-face structured qualitative in-depth interviews, self-administered structured questionnaires, and a structured observational study, as well as a desk review of relevant literature. The State of Uganda's efforts to respect and realize its obligations towards children living in children's homes is inadequate. There are numerous capacity gaps among the duty bearers, and the concepts of human rights and the best interest of the child are not well understood among the duty bearers. The efforts of the State of Uganda to realize its human rights obligations towards children in children's homes are lacking in important areas. Hence the State does not fulfill its minimum obligations under the International Covenant on Economic, Social and Cultural Rights to ensure all children freedom from hunger. There is a need

  8. 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....

  9. 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...

  10. Osteonecrosis in HIV-infected patients

    International Nuclear Information System (INIS)

    Lama, E. de; Narvaez, J. A.; Roca, Y.; Pellicer, J. M.

    2001-01-01

    We present two cases of avascular osteonecrosis, one involving the knees and the other the hips, in patients with human immunodeficiency virus (HIV) infection who met the criteria for acquired immunodeficiency syndrome (AIDS). We review the literature concerning this rare complication of HIV infection, focussing especially on the clinical and radiological features and its possible etiopathogenesis. (Author) 30 refs

  11. Comorbidity and ageing in HIV infection

    NARCIS (Netherlands)

    Kooij, K.W.

    2017-01-01

    In the era of modern combination antiretroviral therapy (cART) the HIV-infected population is ageing. Studies have suggested that HIV-infected individuals, even if appropriately treated with cART, may be at increased risk for several age-related conditions. In this thesis a variety of age-related

  12. Gastrointestinal immune responses in HIV infected subjects

    Directory of Open Access Journals (Sweden)

    LRR Castello-Branco

    1996-06-01

    Full Text Available The gut associated lymphoid tissue is responsible for specific responses to intestinal antigens. During HIV infection, mucosal immune deficiency may account for the gastrointestinal infections. In this review we describe the humoral and cellular mucosal immune responses in normal and HIV-infected subjects.

  13. 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.

  14. 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.

  15. Multiplex Real-Time PCR Detection of Intestinal Protozoa in HIV-Infected Children in Malawi, Enterocytozoon Bieneusi is Common and Associated with Gastrointestinal Complaints and May Delay BMI (Nutritional Status) Recovery.

    Science.gov (United States)

    Huibers, Minke H W; Moons, Peter; Maseko, Nelson; Gushu, Monfort B; Iwajomo, Oluwadamilola H; Heyderman, Robert S; van Hensbroek, Michael Boele; Brienen, Eric A; van Lieshout, Lisette; Calis, Job C J

    2018-05-14

    Intestinal protozoa are common opportunistic infections in HIV patients. Longitudinal studies on either the clinical relevance, or the effect of immune reconstitution by anti-retroviral therapy on intestinal protozoan infections are children is lacking however. This study investigates prevalence and clinical relevance of intestinal protozoa in HIV-infected Malawian children prior to and during their first year of ART. Stool samples collected at enrolment and during follow-up were tested for non-opportunistic (Giardia lamblia, Dientamoeba fragilis, Entamoeba histolytica) and opportunistic protozoa (Entroctytoon bieneusi, Encephalitozoon spp., Cryptosporidium spp and Cystoisospora belli) using multiplex real-time Polymerase Chain Reaction (PCR). Associations between infections and clinical symptoms were evaluated using univariate methods. Non-opportunistic and opportunistic protozoa were detected in 40%(14/35) and 46%(16/35) of children at baseline respectively. E. bieneusi was the most prevalent protozoa (37%, 13/35) and associated with gastrointestinal complaints(43% in positive (10/13) versus 18% (4/22) in E. bieneusi-negative children, p=0.001). Body Mass Index (BMI) recovery during 12 months of ART was more commonly delayed in E. bieneusi-positive (+0.29+SD 0.83) than E. bieneusi-negative children (+1.03+SD 1.25; p=0.05). E. bieneusi was not detected after 12 months of ART. E. bieneusi was the most prevalent opportunistic intestinal protozoa, present in over a third of study participants prior to initiation of ART. Although all children cleared E.bieneusi after 12 months of ART, E. bieneusi was associated with gastro-intestinal complaints and may delay BMI recovery. Trials to assess effect of treatment of E. bieneusi on nutritional status should be considered in HIV-infected African children.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download

  16. Sex Differences in HIV Infection.

    Science.gov (United States)

    Scully, Eileen P

    2018-04-01

    This review will outline the multilevel effects of biological sex on HIV acquisition, pathogenesis, treatment response, and prospects for cure. Potential mechanisms will be discussed along with future research directions. HIV acquisition risk is modified by sex hormones and the vaginal microbiome, with the latter acting through both inflammation and local metabolism of pre-exposure prophylaxis drugs. Female sex associates with enhanced risk for non-AIDS morbidities including cardiovascular and cerebrovascular disease, suggesting different inflammatory profiles in men and women. Data from research on HIV cure points to sex differences in viral reservoir dynamics and a direct role for sex hormones in latency maintenance. Biological sex remains an important variable in determining the risk of HIV infection and subsequent viral pathogenesis, and emerging data suggest sex differences relevant to curative interventions. Recruitment of women in HIV clinical research is a pathway to both optimize care for women and to identify novel therapeutics for use in both men and women.

  17. 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

  18. Human immunodeficiency virus (HIV) infection in tuberculosis ...

    African Journals Online (AJOL)

    Human immunodeficiency virus (HIV) infection in tuberculosis patients in Addis ... METHODS: A cross-sectional survey whereby blood sample was collected ... of co-infection appeared to have increased compared to previous studies, 6.6%, ...

  19. Vaccinations for Adults with HIV Infection

    Science.gov (United States)

    ... for example, lack of a functioning spleen, need vac- influenzae type b) cination with Hib. Talk to ... of developing severe complications because of your HIV infection. Meningococcal ACWY (Men- ACWY, MCV4) Yes! MenACWY vaccine ...

  20. BONE MARROW ABONRMALITIES IN HIV INFECTION

    OpenAIRE

    Sharad Antiram Dhurve

    2013-01-01

    Introduction Hematological abnormalities are a common complication of HIV infection. Bone marrow abnormalities occur in all stages of HIV infection. Present work was carried out to study the bone marrow abnormalities in patients with HIV/AIDS. Methods 160 patients of HIV +ve were included in the study. A complete blood count, relevant biochemical investigations, CD4 counts were done, besides a thorough history and clinical examination. HIV positive patients were classified as those having AID...

  1. 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).......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)....

  2. 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

  3. Long-term trends in mortality and AIDS-defining events after combination ART initiation among children and adolescents with perinatal HIV infection in 17 middle- and high-income countries in Europe and Thailand: A cohort study.

    Directory of Open Access Journals (Sweden)

    Ali Judd

    2018-01-01

    Full Text Available Published estimates of mortality and progression to AIDS as children with HIV approach adulthood are limited. We describe rates and risk factors for death and AIDS-defining events in children and adolescents after initiation of combination antiretroviral therapy (cART in 17 middle- and high-income countries, including some in Western and Central Europe (W&CE, Eastern Europe (Russia and Ukraine, and Thailand.Children with perinatal HIV aged 6 months of cART death and progression to AIDS were assessed. Of 3,526 children included, 32% were from the United Kingdom or Ireland, 30% from elsewhere in W&CE, 18% from Russia or Ukraine, and 20% from Thailand. At cART initiation, median age was 5.2 (IQR 1.4-9.3 years; 35% of children aged 400 c/mL predicted late death. Predictors of early and late progression to AIDS were similar. Study limitations include incomplete recording of US Centers for Disease Control (CDC disease stage B events and serious adverse events in some countries; events that were distributed over a long time period, and that we lacked power to analyse trends in patterns and causes of death over time.In our study, 3,526 children and adolescents with perinatal HIV infection initiated antiretroviral therapy (ART in countries in Europe and Thailand. We observed that over 40% of deaths occurred ≤6 months after cART initiation. Greater early mortality risk in infants, as compared to older children, and in Russia, Ukraine, or Thailand as compared to W&CE, raises concern. Current severe immune suppression, being underweight, and unsuppressed viral load were associated with a higher risk of death at >6 months after initiation of cART.

  4. Pesquisa de anticorpos contra o sarampo em crianças infectadas pelo HIV, após a imunização básica Search of antimeasles antibodies in HIV-infected children after basic immunization

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    Claudia R. Lindgren-Alves

    2001-12-01

    retrospective cohort study conducted in Belo Horizonte by the Universidade Federal de Minas Gerais, between 1995 and 1996. Twenty one children perinatally infected with HIV and 29 immunocompetent noninfected children were included in the study. Information about measles vaccination was obtained from patients' immunization charts. The presence of neutralizing antibodies against the measles was determined by the plaque reduction neutralization test and IgM was measured by ELISA. The level of significance was set at 5% in all the performed statistical analyses. RESULTS: median age was 44.5 months for HIV-infected patients and 62.0 months for noninfected children (P=0.64. Both groups received on average two doses of antimeasles vaccine. All HIV-seronegative patients presented antimeasles antibody titers greater than 50 mIU/ml, whereas 57.1% of infected children presented titers above this value (P=0.0001. The geometric mean titer of neutralizing antibodies was significantly lower in the group of HIV-infected children (433.5 mIU/ml than in noninfected children (1,668.1 mIU/ml, P=0.001. All patients in both groups were negative for antimeasles IgM. CONCLUSION: in the present study, HIV-infected children showed a lower seroprevalence of antimeasles antibody after immunization than noninfected children. These results emphasize the risk of acquisition of measles virus and the need to evaluate alternatives to the vaccination of HIV-infected children in an attempt to maximize the protection against the measles in this group of patients.

  5. 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

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    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.

  6. Common coinfections of Giardia intestinalis and Helicobacter pylori in non-symptomatic Ugandan children.

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    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

  7. Impact of adverse events of antiretroviral treatment on regimen change and mortality in Ugandan children

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    Ntambwe Malangu

    2010-06-01

    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 treatment, 8% of the patients had died. The most common causes of death were infectious diseases (28.6%, severe anaemia (21.4%, and severe dehydration (21.4%. Conclusion: The prevalence of adverse events was 8%; they were responsible for 54.5% of regimen changes and 21.4% of deaths in children treated at the study site. These findings suggest the need for incorporating

  8. Mucocutaneous manifestations of HIV infection

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    Shobhana A

    2004-03-01

    Full Text Available BACKGROUND AND AIMS: Human immunodeficiency virus (HIV is associated with various mucocutaneous features, which may be the first pointer towards the existence of HIV infection. This study was done to note the different mucocutaneous lesions present in the HIV population in eastern India. METHODS: Four hundred and ten HIV seropositive patients attending the outpatient and inpatient departments were included in the study. RESULTS: Out of 410 HIV positives, 40% had mucocutaneous involvement at presentation. The mean age of the study population was 29 years and male to female ratio was 2.5:1. The common mucocutaneous morbidities included oral candidiasis (36%, dermatophytosis and gingivitis (13% each, herpes zoster (6%, herpes simplex and scabies (5% each. A striking feature, noted in 36% males, was straightening of hairs. Genital herpes was the commonest genital ulcer disease. Lesions associated with declining immunity included oral candidiasis, oral hairy leukoplakia and herpes zoster with median CD4 counts of 98, 62 and 198/ L respectively. CONCLUSION: Early recognition of mucocutaneous manifestations and associated STDs help in better management of HIV/AIDS.

  9. Severe neurological sequelae and behaviour problems after cerebral malaria in Ugandan children

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    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

  10. 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

  11. Virological response and resistance among HIV-infected children receiving long-term antiretroviral therapy without virological monitoring in Uganda and Zimbabwe: Observational analyses within the randomised ARROW trial.

    Directory of Open Access Journals (Sweden)

    Alexander J Szubert

    2017-11-01

    Full Text Available Although WHO recommends viral load (VL monitoring for those on antiretroviral therapy (ART, availability in low-income countries remains limited. We investigated long-term VL and resistance in HIV-infected children managed without real-time VL monitoring.In the ARROW factorial trial, 1,206 children initiating ART in Uganda and Zimbabwe between 15 March 2007 and 18 November 2008, aged a median 6 years old, with median CD4% of 12%, were randomised to monitoring with or without 12-weekly CD4 counts and to receive 2 nucleoside reverse transcriptase inhibitors (2NRTI, mainly abacavir+lamivudine with a non-nucleoside reverse transcriptase inhibitor (NNRTI or 3 NRTIs as long-term ART. All children had VL assayed retrospectively after a median of 4 years on ART; those with >1,000 copies/ml were genotyped. Three hundred and sixteen children had VL and genotypes assayed longitudinally (at least every 24 weeks. Overall, 67 (6% switched to second-line ART and 54 (4% died. In children randomised to WHO-recommended 2NRTI+NNRTI long-term ART, 308/378 (81% monitored with CD4 counts versus 297/375 (79% without had VL <1,000 copies/ml at 4 years (difference = +2.3% [95% CI -3.4% to +8.0%]; P = 0.43, with no evidence of differences in intermediate/high-level resistance to 11 drugs. Among children with longitudinal VLs, only 5% of child-time post-week 24 was spent with persistent low-level viraemia (80-5,000 copies/ml and 10% with VL rebound ≥5,000 copies/ml. No child resuppressed <80 copies/ml after confirmed VL rebound ≥5,000 copies/ml. A median of 1.0 (IQR 0.0,1.5 additional NRTI mutation accumulated over 2 years' rebound. Nineteen out of 48 (40% VLs 1,000-5,000 copies/ml were immediately followed by resuppression <1,000 copies/ml, but only 17/155 (11% VLs ≥5,000 copies/ml resuppressed (P < 0.0001. Main study limitations are that analyses were exploratory and treatment initiation used 2006 criteria, without pre-ART genotypes.In this study, children

  12. HIV INFECTION, ANTIRETROVIRAL THERAPY AND CARDIOVASCULAR RISK

    Directory of Open Access Journals (Sweden)

    Katleen de Gaetano Donati

    2010-11-01

    Full Text Available In the last 15 years, highly active antiretroviral therapy (HAART has determined a dramatic reduction of both morbidity and mortality in human immunodeficiency virus (HIV-infected subjects, transforming this infection in a chronic and manageable disease. Patients surviving with HIV in the developed world, in larger number men,  are becoming aged. As it would be expected for a population of comparable age, many HIV-infected individuals report a family history of cardiovascular disease, a small proportion have already experienced a cardiovascular event and an increasing proportion has diabetes mellitus. Smoking rate is very high while an increasing proportion of HIV-infected individuals have dyslipidaemia. Studies suggest that these traditional risk factors could play an important  role in the development of cardiovascular disease in these patients as they do in the general population. Thus, whilst the predicted 10-year cardiovascular disease risk remains relatively low at present, it will likely increase in relation to the progressive aging of  this patient population. Thus, the long-term follow-up of HIV infected patients has to include co-morbidity management such as cardiovascular disease prevention and treatment. Two intriguing aspects related to the cardiovascular risk in patients with HIV infection are the matter of current investigation: 1 while these subjects share many cardiovascular risk factors with the general population, HIV infection itself increases cardiovascular risk; 2 some HAART regimens too influence atherosclerotic profile, partly due to lipid changes. Although the mechanisms involved in the development of cardiovascular complications in HIV-infected patients remain to be fully elucidated, treatment guidelines recommending interventions to prevent cardiovascular disease in these individuals are already available; however, their application is still limited.

  13. Quantifying Heterogeneous Malaria Exposure and Clinical Protection in a Cohort of Ugandan Children

    Science.gov (United States)

    Rodriguez-Barraquer, Isabel; Arinaitwe, Emmanuel; Jagannathan, Prasanna; Boyle, Michelle J.; Tappero, Jordan; Muhindo, Mary; Kamya, Moses R.; Dorsey, Grant; Drakeley, Chris; Ssewanyana, Isaac; Smith, David L.; Greenhouse, Bryan

    2016-01-01

    Background. Plasmodium falciparum malaria remains a leading cause of childhood morbidity and mortality. There are important gaps in our understanding of the factors driving the development of antimalaria immunity as a function of age and exposure. Methods. We used data from a cohort of 93 children participating in a clinical trial in Tororo, Uganda, an area of very high exposure to P. falciparum. We jointly quantified individual heterogeneity in the risk of infection and the development of immunity against infection and clinical disease. Results. Results showed significant heterogeneity in the hazard of infection and independent effects of age and cumulative number of infections on the risk of infection and disease. The risk of developing clinical malaria upon infection decreased on average by 6% (95% confidence interval [CI], 0%–12%) for each additional year of age and by 2% (95% CI, 1%–3%) for each additional prior infection. Children randomly assigned to receive dihydroartemisinin-piperaquine for treatment appeared to develop immunity more slowly than those receiving artemether-lumefantrine. Conclusions. Heterogeneity in P. falciparum exposure and immunity can be independently evaluated using detailed longitudinal studies. Improved understanding of the factors driving immunity will provide key information to anticipate the impact of malaria-control interventions and to understand the mechanisms of clinical immunity. PMID:27481862

  14. 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

  15. HIV INFECTED CHILDREN’S AND YOUNG RIGHT TO HEALTH IN ROMANIA

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    Daniela CALTEA

    2014-12-01

    Full Text Available The study was based on finding the characteristics of the process of acknowledging the right to the best health status of HIV infected children and adolescence in Romania from their perspective. The aim I was following with this study was the identification and analysis of the risks the HIV infected youth are exposed to when claiming specialised medical treatment. In this respect I focused on the degree of acknowledgement to their right of health received. I obtained my data after conducting life story interviews with youth from the counties of Iasi and Constanta and the city of Bucharest. In this article I will focus on general aspects concerning HIV infection and AIDS in Romania (statistics, the legislation concerning the right to health of Romanian children and adolescence, the identification and analysis of the barriers met in the acknowledgement to this right and measures to be taken for the eradication of these barriers.

  16. 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.

  17. 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...

  18. Psychopathological and Behaviour Dimensions in HIV Infection

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    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.

  19. [Travel medicine for HIV-infected patients].

    Science.gov (United States)

    Rossi, M; Furrer, H

    2001-06-01

    Many HIV-infected persons travel from temperate zones to (sub)tropical destinations. HIV-specific immigration issues, medical resources abroad and problems regarding travelling with multiple medications have to be anticipated. When prescribing immunizations and specific chemoprophylaxis, the stage of immunodeficiency as well as drug interactions with antiretrovirals and medicaments against opportunistic infections have to be taken into account. Live vaccines may be contraindicated. Immunocompromised HIV-infected travellers have a higher risk for serious courses of diseases by enteropathogens. Therefore a good information about food hygiene is important and a prescription of an antibiotic to take in case of severe diarrhea may be indicated. A new antiretroviral combination therapy should not be started immediately before travelling to the tropics. The possibility to continue an established HIV treatment during travel has to be evaluated cautiously. With good pre-travel advice the risk of severe health problems is low for most HIV-infected travellers.

  20. Antiretroviral Drugs Used in the Treatment of HIV Infection

    Science.gov (United States)

    ... HIV/AIDS Treatment Antiretroviral drugs used in the treatment of HIV infection Share Tweet Linkedin Pin it More sharing ... Pin it Email Print Drugs Used in the Treatment of HIV Infection All FDA-approved medicines used in the ...

  1. THE MANAGEMENT OF HIV INFECTION IN PREGNANCY

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    Clara Marcaelia Valerian

    2013-02-01

    Full Text Available The Human Immunodeficiency Virus (HIV is a RNA retrovirus which causes the clinical disease termed the acquired immunodeficiency syndrome (AIDS. Mother-to-child transmission is the main source of spreading HIV infection to the child with frequency is as high as 25-30%. This may occurred because of the intrapartum maternal blood exposure, infected genital tract secretions and during breastfeeding. The right combination of ARV treatment and elective section caesarean delivery has been proved to reduce the mother-to-child transmission of HIV infection prevalence and preventing obstetric complications significantly. Consultation and follow up with specialists is highly recommended.

  2. Revised surveillance case definition for HIV infection--United States, 2014.

    Science.gov (United States)

    2014-04-11

    Following extensive consultation and peer review, CDC and the Council of State and Territorial Epidemiologists have revised and combined the surveillance case definitions for human immunodeficiency virus (HIV) infection into a single case definition for persons of all ages (i.e., adults and adolescents aged ≥13 years and children aged case now accommodate new multitest algorithms, including criteria for differentiating between HIV-1 and HIV-2 infection and for recognizing early HIV infection. A confirmed case can be classified in one of five HIV infection stages (0, 1, 2, 3, or unknown); early infection, recognized by a negative HIV test within 6 months of HIV diagnosis, is classified as stage 0, and acquired immunodeficiency syndrome (AIDS) is classified as stage 3. Criteria for stage 3 have been simplified by eliminating the need to differentiate between definitive and presumptive diagnoses of opportunistic illnesses. Clinical (nonlaboratory) criteria for defining a case for surveillance purposes have been made more practical by eliminating the requirement for information about laboratory tests. The surveillance case definition is intended primarily for monitoring the HIV infection burden and planning for prevention and care on a population level, not as a basis for clinical decisions for individual patients. CDC and the Council of State and Territorial Epidemiologists recommend that all states and territories conduct case surveillance of HIV infection using this revised surveillance case definition.

  3. [Heterosexual transmission of HIV infection

    Science.gov (United States)

    Coulaud, J P

    1993-02-01

    The AIDS epidemic has spread rapidly in Africa among the urban impoverished where multiple sexual partners and sexually transmitted diseases are common. Over 80% of the 9 million Africans who will develop AIDS before the year 2000 will have been contaminated sexually. Poverty, multiple sexual partners in the framework of prostitution, and drug addiction are responsible for rapid spread of HIV infection in Southeast Asia, the West India, and Brazil. Drug addiction has played a major role in diffusion of HIV into the general population of Europe and the US. Prevalence rates are much higher in sexually transmitted disease centers in France and the US than among blood donors or pregnant women. Sexually transmitted diseases and heterosexual transmission have been studied in Africas since diagnostic tests became available. Several studies, the majority conducted among prostitutes in Nairobi or Kinshasa and their clients, allow establishment of a list of sexually transmitted diseases associated with increased risk of seroconversion. Genital ulcers within the past 6 months presented a relative risk of 2-4 depending on the series. Urethral or cervical gonorrhea has a lower relative risk of 1.2 in most studies. Absence of circumcision was also a risk factor. Studies were subsequently conducted in Europe on factors favoring sexual transmission. 513 heterosexual couples together for a minimum duration of 18 months and an average of 38 months were included in the Multicenter European Study conducted in 10 centers in 9 countries. The "index" subject was male in 400 cases and female in 113. At entry into the study, 73 of 400 males (18.2%) and 10 of 113 females (8.8%) had already infected their partners. Duration of union, frequency of intercourse, mode of transmission of the index subject, and oral contraceptive use had no effect on risk of transmission. Factors increasing risk of infection included the severity of immunosuppression of the index subject, whether judged by

  4. Cerebrospinal fluid kynurenine and kynurenic acid concentrations are associated with coma duration and long-term neurocognitive impairment in Ugandan children with cerebral malaria.

    Science.gov (United States)

    Holmberg, Dag; Franzén-Röhl, Elisabeth; Idro, Richard; Opoka, Robert O; Bangirana, Paul; Sellgren, Carl M; Wickström, Ronny; Färnert, Anna; Schwieler, Lilly; Engberg, Göran; John, Chandy C

    2017-07-28

    One-fourth of children with cerebral malaria (CM) retain cognitive sequelae up to 2 years after acute disease. The kynurenine pathway of the brain, forming neuroactive metabolites, e.g. the NMDA-receptor antagonist kynurenic acid (KYNA), has been implicated in long-term cognitive dysfunction in other CNS infections. In the present study, the association between the kynurenine pathway and neurologic/cognitive complications in children with CM was investigated. Cerebrospinal fluid (CSF) concentrations of KYNA and its precursor kynurenine in 69 Ugandan children admitted for CM to Mulago Hospital, Kampala, Uganda, between 2008 and 2013 were assessed. CSF kynurenine and KYNA were compared to CSF cytokine levels, acute and long-term neurologic complications, and long-term cognitive impairments. CSF kynurenine and KYNA from eight Swedish children without neurological or infectious disease admitted to Astrid Lindgren's Children's Hospital were quantified and used for comparison. Children with CM had significantly higher CSF concentration of kynurenine and KYNA than Swedish children (P coma duration in children of all ages (P = 0.003 and 0.04, respectively), and CSF kynurenine concentrations were associated with worse overall cognition (P = 0.056) and attention (P = 0.003) at 12-month follow-up in children ≥5 years old. CSF KYNA and kynurenine are elevated in children with CM, indicating an inhibition of glutamatergic and cholinergic signaling. This inhibition may lead acutely to prolonged coma and long-term to impairment of attention and cognition.

  5. Cognitive function in early HIV infection.

    Science.gov (United States)

    Prakash, Aanchal; Hou, Jue; Liu, Lei; Gao, Yi; Kettering, Casey; Ragin, Ann B

    2017-04-01

    This study aimed to examine cognitive function in acute/early HIV infection over the subsequent 2 years. Fifty-six HIV+ subjects and 21 seronegative participants of the Chicago Early HIV Infection Study were evaluated using a comprehensive neuropsychological assessment at study enrollment and at 2-year follow-up. Cognitive performance measures were compared in the groups using t tests and mixed-effect models. Patterns of relationship with clinical measures were determined between cognitive function and clinical status markers using Spearman's correlations. At the initial timepoint, the HIV group demonstrated significantly weaker performance on measures of verbal memory, visual memory, psychomotor speed, motor speed, and executive function. A similar pattern was found when cognitive function was examined at follow-up and across both timepoints. The HIV subjects had generally weaker performance on psychomotor speed, executive function, motor speed, visual memory, and verbal memory. The rate of decline in cognitive function across the 2-year follow-up period did not differ between groups. Correlations between clinical status markers and cognitive function at both timepoints showed weaker performance associated with increased disease burden. Neurocognitive difficulty in chronic HIV infection may have very early onset and reflect consequences of initial brain viral invasion and neuroinflammation during the intense, uncontrolled viremia of acute HIV infection. Further characterization of the changes occurring in initial stages of infection and the risk and protective factors for cognitive function could inform new strategies for neuroprotection.

  6. HIV infection: psychiatric findings in The Netherlands

    NARCIS (Netherlands)

    Sno, H. N.; Storosum, J. G.; Swinkels, J. A.

    1989-01-01

    A psychiatric consultation was requested in 51 in-patient cases of HIV infection. Reasons for referral included counselling, the evaluation of depressive symptoms, and the treatment of delirium. The most common DSM-III diagnoses included: delirium (n = 13), major depressive disorders (n = 12),

  7. 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.

  8. Head and heart in treated HIV infection

    NARCIS (Netherlands)

    Schouten, J.

    2017-01-01

    The introduction of combination antiretroviral therapy (cART) in 1996 changed HIV infection from an inevitably fatal condition into a chronic manageable disease. During the last decade however, concerns have been raised about the increasingly important role of non-AIDS comorbidities as causes of

  9. HIV INFECTION AND THE KIDNEY CLINICAL

    African Journals Online (AJOL)

    2008-04-04

    Apr 4, 2008 ... The causes of ARF in hospitalised HIV-infected patients may ... this group is divided into the 'classic' HIV-associated nephropathy (HIVAN) with focal ... commonly dehydration), sepsis, liver failure, heart failure, pancreatitis, non- ... Adrenal insufficiency, acute or chronic kidney disease with tubular damage, ...

  10. INFLUENZA IMMUNISATION IN HIV-INFECTED PERSONS

    African Journals Online (AJOL)

    in 1997' (surpassing the 6O'lb vaccine coverage goal for the country's Healthy People 2000 Project). ... (i) are HIV-infected persons at special risk for influenza complications and is annual immunisation .... virus type' 1 rep :cation can be increased in peripheral 0100d of sero- positive patiems aher influenrc. vacdnation.

  11. Knowledge of pregnant women on transmission of HIV infection through breast feeding.

    Science.gov (United States)

    Kasinga, F; Mogotlane, S M; van Rensburg, G H

    2008-09-01

    Although breast-feeding is nature's way of providing nutrition to the baby, in HIV positive mothers this has been identified as one of the means through which HIV infection is transmitted from the mother to the child. In Africa where children under the age of 5 are killed by preventable diseases like diarrhoea, the issue of HIV transmission through breast feeding poses an added huge problem. Research has, however shown that exclusive infant feeding, be it breast or formula, reduces the risk substantially. It is imperative that mothers be informed about safer methods of infant feeding so that HIV infection is kept to a minimum. The objective of the study was to explore and describe the knowledge that pregnant women had about mother to child transmission of HIV infection through breast-feeding. A non-experimental quantitative exploratory and descriptive research design was used to explore the knowledge women had on mother to child transmission of HIV infection through breast-feeding. From the data collected, it showed that although women were aware of the susceptibility of children to HIV infection if fed on breast and formula feeds simultaneously by HIV positive mothers, exclusive feeding was a problem as people associated the practise with a positive HIV status. Women who had not disclosed their HIV status and were HIV positive, found it difficult to comply with the requirement to exclusively feed their infants. These either continued with complementary feeds or did not collect the free formula milk supply preferring instead to buy the formula feeds privately. In this study it was recommended that information on transmission of HIV infection from mother to child through breast -feeding including the benefits of exclusive infant feeding, be it breast or formula, for the first three to six months be provided to the community so that relatives can support the mother on infant feeding method of choice.

  12. Pregnancy and infant outcomes among HIV-infected women taking long-term ART with and without tenofovir in the DART trial.

    Science.gov (United States)

    Gibb, Diana M; Kizito, Hilda; Russell, Elizabeth C; Chidziva, Ennie; Zalwango, Eva; Nalumenya, Ruth; Spyer, Moira; Tumukunde, Dinah; Nathoo, Kusum; Munderi, Paula; Kyomugisha, Hope; Hakim, James; Grosskurth, Heiner; Gilks, Charles F; Walker, A Sarah; Musoke, Phillipa

    2012-01-01

    children with no effect of in utero tenofovir (p>0.1). There was no evidence that in utero tenofovir affected growth after 2 years (p = 0.38). Attained height- and weight for age were similar to general (HIV-uninfected) Ugandan populations. Study limitations included relatively small size and lack of randomisation to maternal ART regimens. Overall 1-year 5% infant mortality was similar to the 2%-4% post-neonatal mortality observed in this region. No increase in congenital, renal, or growth abnormalities was observed with in utero tenofovir exposure. Although some infants died untested, absence of recorded HIV infection with combination ART in pregnancy is encouraging. Detailed safety of tenofovir for pre-exposure prophylaxis will need confirmation from longer term follow-up of larger numbers of exposed children. www.controlled-trials.com ISRCTN13968779

  13. Pregnancy and infant outcomes among HIV-infected women taking long-term ART with and without tenofovir in the DART trial.

    Directory of Open Access Journals (Sweden)

    Diana M Gibb

    Full Text Available Few data have described long-term outcomes for infants born to HIV-infected African women taking antiretroviral therapy (ART in pregnancy. This is particularly true for World Health Organization (WHO-recommended tenofovir-containing first-line regimens, which are increasingly used and known to cause renal and bone toxicities; concerns have been raised about potential toxicity in babies due to in utero tenofovir exposure.Pregnancy outcome and maternal/infant ART were collected in Ugandan/Zimbabwean HIV-infected women initiating ART during The Development of AntiRetroviral Therapy in Africa (DART trial, which compared routine laboratory monitoring (CD4; toxicity versus clinically driven monitoring. Women were followed 15 January 2003 to 28 September 2009. Infant feeding, clinical status, and biochemistry/haematology results were collected in a separate infant study. Effect of in utero ART exposure on infant growth was analysed using random effects models. 382 pregnancies occurred in 302/1,867 (16% women (4.4/100 woman-years [95% CI 4.0-4.9]. 226/390 (58% outcomes were live-births, 27 (7% stillbirths (≥22 wk, and 137 (35% terminations/miscarriages (0.4. Of 219 surviving infants, 182 (83% enrolled in the follow-up study; median (interquartile range [IQR] age at last visit was 25 (12-38 months. From mothers' ART, 62/9/111 infants had no/20%-89%/≥90% in utero tenofovir exposure; most were also zidovudine/lamivudine exposed. All 172 infants tested were HIV-negative (ten untested. Only 73/182(40% infants were breast-fed for median 94 (IQR 75-212 days. Overall, 14 infants died at median (IQR age 9 (3-23 months, giving 5% 12-month mortality; six of 14 were HIV-uninfected; eight untested infants died of respiratory infection (three, sepsis (two, burns (one, measles (one, unknown (one. During follow-up, no bone fractures were reported to have occurred; 12/368 creatinines and seven out of 305 phosphates were grade one (16 or two (three in 14 children

  14. 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.

  15. 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.

  16. Digital clubbing in tuberculosis – relationship to HIV infection, extent of disease and hypoalbuminemia

    Directory of Open Access Journals (Sweden)

    Smieja Marek

    2006-03-01

    Full Text Available Abstract Background Digital clubbing is a sign of chest disease known since the time of Hippocrates. Its association with tuberculosis (TB has not been well studied, particularly in Africa where TB is common. The prevalence of clubbing in patients with pulmonary TB and its association with Human Immunodeficiency Virus (HIV, severity of disease, and nutritional status was assessed. Methods A cross-sectional study was carried out among patients with smear-positive TB recruited consecutively from the medical and TB wards and outpatient clinics at a public hospital in Uganda. The presence of clubbing was assessed by clinical signs and measurement of the ratio of the distal and inter-phalangeal diameters (DPD/IPD of both index fingers. Clubbing was defined as a ratio > 1.0. Chest radiograph, serum albumin and HIV testing were done. Results Two hundred patients (82% HIV-infected participated; 34% had clubbing by clinical criteria whilst 30% had clubbing based on DPD/IPD ratio. Smear grade, extensive or cavitary disease, early versus late HIV disease, and hypoalbuminemia were not associated with clubbing. Clubbing was more common among patients with a lower Karnofsky performance scale score or with prior TB. Conclusion Clubbing occurs in up to one-third of Ugandan patients with pulmonary TB. Clubbing was not associated with stage of HIV infection, extensive disease or hypoalbuminemia.

  17. First UK case report of kidney transplantation from an HIV-infected deceased donor to two HIV-infected recipients.

    Science.gov (United States)

    Nolan, Eileen; Karydis, Nikolaos; Drage, Martin; Hilton, Rachel

    2018-04-01

    Kidney transplantation is now considered the treatment of choice for many human immunodeficiency virus (HIV)-infected patients with end-stage renal disease (ESRD). Graft survival rates using HIV-negative donors and carefully selected HIV-positive ESRD patients are similar to those observed in HIV-uninfected kidney transplant recipients. To address the relative shortfall in donated organs it has been proposed that organs from HIV-infected deceased donors might be allocated to HIV-infected patients on the transplant waiting list. Preliminary experience in South Africa reports promising short-term outcomes in a small number of HIV-infected recipients of kidney transplants from HIV-infected donors. We sought to replicate this experience in the UK by accepting kidney offers from HIV infected deceased donors for patients with HIV-infection on the kidney transplant waiting list. Here we report the UK's first cases of kidney transplantation between HIV-positive donors and recipients.

  18. Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salaam, Tanzania.

    NARCIS (Netherlands)

    Hamza, O.J.M.; Matee, M.I.N.; Simon, E.N.; Kikwilu, E.N.; Moshi, M.J.; Mugusi, F.; Mikx, F.H.M.; Verweij, P.E.; Ven, A.J.A.M. van der

    2006-01-01

    ABSTRACT: BACKGROUND: The aim of the study was to compare the prevalence and types of HIV-related oral lesions between children and adult Tanzanian patients on HAART with those not on HAART and to relate the occurrence of the lesions with anti-HIV drug regimen, clinical stage of HIV disease and CD4+

  19. The role of enacted stigma in parental HIV disclosure among HIV-infected parents in China.

    Science.gov (United States)

    Qiao, Shan; Li, Xiaoming; Zhou, Yuejiao; Shen, Zhiyong; Tang, Zhenzhu; Stanton, Bonita

    2015-01-01

    Existing studies have delineated that HIV-infected parents face numerous challenges in disclosing their HIV infection to the children ("parental HIV disclosure"), and practices of parental HIV disclosure vary with individual characteristics, family contexts, and social environment. Using cross-sectional data from 1254 HIV-infected parents who had children aged 5-16 years in southwest China, the current study examined the association of parental HIV disclosure with mental health and medication adherence among parents and explored the possible effect of enacted stigma on such association. Multivariate analysis of variance revealed that parents who had experienced disclosure to children reported higher level enacted stigma, worse mental health conditions, and poorer medication adherence. Enacted stigma partially mediated the associations between disclosure and both mental health and medication adherence after controlling basic background characteristics. Our findings highlight the importance of providing appropriate disclosure-related training and counseling service among HIV-infected parents. In a social setting where HIV-related stigma is still persistent, disclosure intervention should address and reduce stigma and discrimination in the practice of parental HIV disclosure.

  20. Risk factors for helminth, malaria, and HIV infection in pregnancy in Entebbe, Uganda.

    Directory of Open Access Journals (Sweden)

    Patrick William Woodburn

    2009-06-01

    Full Text Available Infections during pregnancy may have serious consequences for both mother and baby. Assessment of risk factors for infections informs planning of interventions and analysis of the impact of infections on health outcomes.To describe risk factors for helminths, malaria and HIV in pregnant Ugandan women before intervention in a trial of de-worming in pregnancy.The trial recruited 2,507 pregnant women between April 2003 and November 2005. Participants were interviewed and blood and stool samples obtained; location of residence at enrolment was mapped. Demographic, socioeconomic, behavioral and other risk factors were modelled using logistic regression.There was a high prevalence of helminth, malaria and HIV infection, as previously reported. All helminths and malaria parasitemia were more common in younger women, and education was protective against every infection. Place of birth and/or tribe affected all helminths in a pattern consistent with the geographical distribution of helminth infections in Uganda. Four different geohelminths (hookworm, Trichuris, Ascaris and Trichostrongylus showed a downwards trend in prevalence during the enrolment period. There was a negative association between hookworm and HIV, and between hookworm and low CD4 count among HIV-positive women. Locally, high prevalence of schistosomiasis and HIV occurred in lakeshore communities.Interventions for helminths, malaria and HIV need to target young women both in and out of school. Antenatal interventions for malaria and HIV infection must continue to be promoted. Women originating from a high risk area for a helminth infection remain at high risk after migration to a lower-risk area, and vice versa, but overall, geohelminths seem to be becoming less common in this population. High risk populations, such as fishing communities, require directed effort against schistosomiasis and HIV infection.

  1. 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; Sipsma, Heather; Makin, Jennifer; Triplett, Kelli; Ebersöhn, Liesel; Sikkema, Kathleen; Briggs-Gowan, Margaret; Visser, Maretha; Ferreira, Ronél; Forsyth, Brian W. C.

    2013-01-01

    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–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. PMID:23892768

  2. 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...

  3. [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.

  4. Prospective Characterization of the Risk Factors for Transmission and Symptoms of Primary Human Herpesvirus Infections Among Ugandan Infants.

    Science.gov (United States)

    Gantt, Soren; Orem, Jackson; Krantz, Elizabeth M; Morrow, Rhoda Ashley; Selke, Stacy; Huang, Meei-Li; Schiffer, Joshua T; Jerome, Keith R; Nakaganda, Annet; Wald, Anna; Casper, Corey; Corey, Lawrence

    2016-07-01

    Human herpesvirus (HHV) infections are common during infancy. Primary infections are frequently asymptomatic and best studied prospectively by using direct viral detection. Oropharyngeal swab specimens were collected weekly from Ugandan newborn infants, their mothers, and other children in the household. Blood specimens were collected every 4 months. Samples were tested for herpes simplex virus (HSV) types 1 and 2, Epstein-Barr virus (EBV), cytomegalovirus (CMV), HHV-6A, HHV-6B, and HHV-8, using quantitative polymerase chain reaction. Thirty-two infants, 32 mothers, and 49 other household children were followed for a median of 57 weeks. Seventeen mothers had human immunodeficiency virus type 1 (HIV) infection; no infants acquired HIV-1. The 12-month incidence of postnatal infection was 76% for HHV-6B, 59% for CMV, 47% for EBV, 8% for HSV-1, and 0% for HHV-8. The quantity of oropharyngeal shedding by contacts was associated with HHV-6A or HHV-6B transmission. Maternal HIV-1 infection was associated with EBV transmission, while breastfeeding and younger child contacts were associated with CMV transmission. Except for HSV-1, primary HHV infections were subclinical. By capturing exposures and acquisition events, we found that the incidence and risk factors of infection vary by HHV type. HSV-1 infection, unlike other HHV infections, caused acute clinical illness in these infants. © 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.

  5. Relationship between expressed HIV/AIDS-related stigma and HIV-beliefs/knowledge and behaviour in families of HIV infected children in Kenya.

    Science.gov (United States)

    Hamra, Mary; Ross, Michael W; Orrs, Mark; D'Agostino, Angelo

    2006-04-01

    To quantify expressed stigma in clients of the Kangemi program for HIV+ children, and to characterize the association between stigma and other population characteristics. By means of a household survey we created a stigma index and indices for other social and knowledge domains that influence HIV-related healthcare. We used chi2, anova, and correlation to identify associations between domains. The mean (+/-SD) expressed stigma on a six points scale (6 = least stigma) was 3.65 +/- 1.64. Composite scores on knowledge about AIDS were skewed toward more knowledge; and analysis of individual knowledge items indicates that most respondents reject erroneous traditional beliefs and myths about the causes and transmission routes of AIDS. Respondents who were younger, had never married, and had less education expressed greater stigma. Differences in stigma were associated with poor knowledge about AIDS and negative attitudes toward testing, but not with gender or tribal affiliation. Condom use at last intercourse, unrelated to stigma, was only 40% (n = 218). While this population has good knowledge about AIDS and appraises risks realistically, it fails to reduce these risks. Associations between stigma and other domains can inform interventions that improve HIV care and mitigate spread of HIV.

  6. Regimen durability in HIV-infected children and adolescents initiating first-line ART in a large public sector HIV cohort in South Africa.

    Science.gov (United States)

    Bonawitz, Rachael; Brennan, Alana T; Long, Lawrence; Heeren, Timothy; Maskew, Mhairi; Sanne, Ian; Fox, Matthew P

    2018-04-15

    In April 2010 tenofovir and abacavir replaced stavudine in public-sector first-line antiretroviral therapy (ART) for children under 20 years old in South Africa. The association of both abacavir and tenofovir with fewer side-effects and toxicities compared to stavudine could translate to increased durability of tenofovir or abacavir-based regimens. We evaluated changes over time in regimen durability for pediatric patients 3 to 19 years of age at 8 public sector clinics in Johannesburg, South Africa. Cohort analysis of treatment naïve, non-pregnant pediatric patients from 3 to 19 years old initiated on ART between April 2004-December 2013. First-line ART regimens before April 2010 consisted of stavudine or zidovudine with lamivudine and either efavirenz or nevirapine. Tenofovir and/or abacavir was substituted for stavudine after April 2010 in first-line ART. We evaluated the frequency and type of single-drug substitutions, treatment interruptions, and switches to second-line therapy. Fine and Gray competing risk regression models were used to evaluate the association of antiretroviral drug type with single-drug substitutions, treatment interruptions, and second-line switches in the first 24-months on treatment. 398 (15.3%) single-drug substitutions, 187 (7.2%) treatment interruptions and 86 (3.3%) switches to second-line therapy occurred among 2602 pediatric patients over 24-months on ART. Overall, the rate of single-drug substitutions started to increase in 2009, peaked in 2011 at 25%, then declined to 10% in 2013, well after the integration of tenofovir into pediatric regimens; no patients over the age of 3 were initiated on abacavir for first-line therapy. Competing risk regression models showed patients on zidovudine or stavudine had upwards of a 5-fold increase in single-drug substitution vs. patients initiated on tenofovir in the first 24-months on ART. Older adolescents also had a 2-3-fold increase in treatment interruptions and switches to second

  7. High mortality in HIV-infected children diagnosed in hospital underscores need for faster diagnostic turnaround time in prevention of mother-to-child transmission of HIV (PMTCT) programs.

    Science.gov (United States)

    Wagner, Anjuli; Slyker, Jennifer; Langat, Agnes; Inwani, Irene; Adhiambo, Judith; Benki-Nugent, Sarah; Tapia, Ken; Njuguna, Irene; Wamalwa, Dalton; John-Stewart, Grace

    2015-02-15

    Despite expanded programs for prevention of mother-to-child HIV transmission (PMTCT), HIV-infected infants may not be diagnosed until they are ill. Comparing HIV prevalence and outcomes in infants diagnosed in PMTCT programs to those in hospital settings may improve pediatric HIV diagnosis strategies. HIV-exposed infants turnaround time for tests were compared between PMTCT programs and hospital sites. Among the enrolled cohort, baseline characteristics, survival, and timing of antiretroviral therapy (ART) initiation were compared between infants diagnosed in PMTCT programs versus hospital. Among 1,923 HIV-exposed infants, HIV prevalence was higher among infants tested in hospital than PMTCT early infant diagnosis (EID) sites (41% vs. 11%, p 3 times as likely to die (HR = 3.1, 95% CI = 1.3-7.6). Among HIV-exposed infants, hospital-based testing was more likely to detect an HIV-infected infant than PMTCT testing. Because young symptomatic infants diagnosed with HIV during hospitalization have very high mortality, every effort should be made to diagnose HIV infections before symptom onset. Systems to expedite turnaround time at PMTCT EID sites and to routinize inpatient pediatric HIV testing are necessary to improve pediatric HIV outcomes.

  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. Endocrine alterations in HIV-infected patients

    Directory of Open Access Journals (Sweden)

    Sujit Kumar Tripathy

    2015-01-01

    Full Text Available Aims and objectives: To study the frequency of thyroid, adrenal and gonadal dysfunction in newly diagnosed HIV-infected patients and to correlate them at different levels of CD4 cell counts. Materials and Methods: Forty-three HIV-positive cases were included in the study group. Cases were divided into three groups on the basis of CD4 cell count. Serum free T3, free T4, TSH, Cortisol, FSH, LH, testosterone and estradiol were estimated by the radioimmunoassay method. Hormone levels between cases were compared and their correlation with CD4 count was analyzed. Results: Prevalence of gonadal dysfunction (88.3% was the most common endocrine dysfunction followed by thyroid (60.4% and adrenal dysfunction (27.9%. Secondary hypogonadism (68.4% was more common than primary (31.6%. Low T3 syndrome, that is, isolated low free T3, was the most common (25.6% thyroid dysfunction followed by secondary hypothyroidism (16.2% and subclinical hypothyroidism (11.6%. Adrenal excess (16.3% was more common than adrenal insufficiency (11.6%. The difference in hormonal dysfunction between male and female was statistically insignificant (P > 0.05. 27.9% of patients had multiple hormone deficiency. There was negligible or no correlation between CD4 count and serum hormone level. Conclusion: In our study, endocrine dysfunction was quite common among HIV-infected patients but there was no correlation between hormone levels and CD4 count. Endocrine dysfunctions and role of hormone replacement therapy in HIV-infected patient needs to be substantiated by large longitudinal study, so that it will help to reduce morbidity, improve quality of life.

  10. Prevalence of HIV infection in pregnant women in Mumbai, India: Experience from 1993-2004 and 2008.

    Science.gov (United States)

    Shah, Ira; Lala, Mamatha; Damania, Kaizad

    2017-01-01

    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. 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. 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%. Prevalence of HIV in pregnant women in Mumbai is decreasing.

  11. 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.

  12. Prevalence of HIV infection in pregnant women in Mumbai, India: Experience from 1993-2004 and 2008

    Science.gov (United States)

    Shah, Ira; Lala, Mamatha; Damania, Kaizad

    2017-01-01

    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. PMID:29302524

  13. 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...

  14. HIV Infection: Advances Toward a Cure.

    Science.gov (United States)

    Douek, Daniel C

    2018-04-01

    Achieving cure of HIV infection requires eliminating all replication-competent virus from the reservoir of latently infected cells or completely inhibiting infected cells from emerging from latency. Strategies include very early use of antiretroviral therapy; hematopoietic stem cell transplantation; "shock-and-kill" approaches; immune therapy with immune checkpoint inhibitors; gene therapy, including use of CC chemokine receptor 5-modified CD4+ T cells; and broadly neutralizing antibody therapy. Success is likely to require a combination of approaches. This article summarizes a presentation by Daniel C. Douek, MD, PhD, at the IAS-USA continuing education program held in Berkeley, California, in May 2017.

  15. Global oral inequalities in HIV infection.

    Science.gov (United States)

    Challacombe, S J

    2016-04-01

    Analysis of the prevalence and incidence of HIV infection globally reveal striking variances with regard to continent, country, region and gender. Of the global total of 33 million people infected with HIV, approximately 65% are in sub-Saharan African countries and 15% in South and South-East Asia with the remaining 20% spread over the rest of the world. As a percentage of the population, the Caribbean at 1.1% is second only to sub-Saharan Africa (5.5%). The majority of the world's HIV is in women. Deaths from HIV are twenty-fold greater in Africa than in Europe or the USA. Individual countries in sub-Saharan Africa show huge variances in the HIV+ prevalence with most West African countries having a rate of less than 2% whilst southern African countries including Swaziland and Botswana have rates of around 25%. Environment, education and social habits all contribute to the HIV infection rates. Similar variations between countries are seen in SE Asia with Cambodia and Papua New Guinea having rates three times greater than Pakistan. One of the most striking examples of inequality is in life years added to HIV populations as a result of antiretroviral therapy. UN AIDS figures over 1996-2008 suggest an average of 2.88 added years in the USA and Europe, but only 0.1 in sub-Saharan Africa, a thirty-fold difference largely due to accessibility to ART. ART leads to a reduction in oral lesions but it is estimated that some 10 million HIV+ subjects do not have access to oral care. Thus, inequalities exist both for HIV infection and for the associated oral lesions, mainly related to ART access. HIV infection and oral mucosal lesions both appear to be related to general social determinants of health. Oral HCW must be part of mainstream healthcare teams to address these inequalities. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. A single CD4 test with 250 cells/mm3 threshold predicts viral suppression in HIV-infected adults failing first-line therapy by clinical criteria.

    Directory of Open Access Journals (Sweden)

    Charles F Gilks

    Full Text Available In low-income countries, viral load (VL monitoring of antiretroviral therapy (ART is rarely available in the public sector for HIV-infected adults or children. Using clinical failure alone to identify first-line ART failure and trigger regimen switch may result in unnecessary use of costly second-line therapy. Our objective was to identify CD4 threshold values to confirm clinically-determined ART failure when VL is unavailable.3316 HIV-infected Ugandan/Zimbabwean adults were randomised to first-line ART with Clinically-Driven (CDM, CD4s measured but blinded or routine Laboratory and Clinical Monitoring (LCM, 12-weekly CD4s in the DART trial. CD4 at switch and ART failure criteria (new/recurrent WHO 4, single/multiple WHO 3 event; LCM: CD4<100 cells/mm(3 were reviewed in 361 LCM, 314 CDM participants who switched over median 5 years follow-up. Retrospective VLs were available in 368 (55% participants.Overall, 265/361 (73% LCM participants failed with CD4<100 cells/mm(3; only 7 (2% switched with CD4≥250 cells/mm(3, four switches triggered by WHO events. Without CD4 monitoring, 207/314 (66% CDM participants failed with WHO 4 events, and 77(25%/30(10% with single/multiple WHO 3 events. Failure/switching with single WHO 3 events was more likely with CD4≥250 cells/mm(3 (28/77; 36% (p = 0.0002. CD4 monitoring reduced switching with viral suppression: 23/187 (12% LCM versus 49/181 (27% CDM had VL<400 copies/ml at failure/switch (p<0.0001. Amongst CDM participants with CD4<250 cells/mm(3 only 11/133 (8% had VL<400 copies/ml, compared with 38/48 (79% with CD4≥250 cells/mm(3 (p<0.0001.Multiple, but not single, WHO 3 events predicted first-line ART failure. A CD4 threshold 'tiebreaker' of ≥250 cells/mm(3 for clinically-monitored patients failing first-line could identify ∼80% with VL<400 copies/ml, who are unlikely to benefit from second-line. Targeting CD4s to single WHO stage 3 'clinical failures' would particularly avoid premature, costly

  17. Perception of risk of HIV infection in marital and cohabiting ...

    African Journals Online (AJOL)

    Nearly 46% of women and 28% of men perceived themselves at medium or high risk of HIV infection. The qualitative and quantitative data show that perception of risk of HIV infection was influenced both by a person's own sexual behaviour and a partner's sexual behaviour. Men were significantly more likely to perceive ...

  18. The prevalence of HIV infection among cannabis-abused psychiatric ...

    African Journals Online (AJOL)

    The prevalence of HIV infection among cannabis-abused psychiatric patients: the case of federal psychiatric hospital, Calabar. ... called “Prevalence of HIV infection and Cannabis-Abused Questionnaire” (P.H.I.C.Q.), while data obtained were subjected to statistical analysis using contingency chi-square (X2) technique.

  19. 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 ...

  20. Changes in Serum Proteins and Creatinine levels in HIV Infected ...

    African Journals Online (AJOL)

    This study examined the level of total serum proteins and globulins in HIV infected Nigerians. 64 patients with HIV infection and 10 apparently healthy subjects were recruited from 3 hospitals in Lagos Metropolis. They were examined for the presence of TB and malaria. Serum total protein, albumin and creatinine levels ...

  1. Mania as complication of HIV infection: case reports | Sulyman ...

    African Journals Online (AJOL)

    These case reports highlight the fact that organic mood disorder, manic episode, in HIV infection AIDS might not be uncommon in this part of the world. Patients present with irritable mood rather than euphoria and they respond rapidly to psychotropic medications. Key words: Manic episode, HIV infection; Acquired immune ...

  2. The spectrum of renal diseases in HIV infected adults presenting ...

    African Journals Online (AJOL)

    The natural history of the renal diseases associated with HIV infection has been radically changed by antiretroviral therapy. There are other diseases, ... Patients had advanced HIV infection with mean CD4 count of197 cells/mm3. Majority of patients ( 64.5%) were not yet been initiated cART. 16% of the study patients were ...

  3. Supporting the sexual and reproductive rights of HIV-infected ...

    African Journals Online (AJOL)

    primary care clinics in the Western Cape found that 57% reported negative attitudes to continued sexual activity by HIV-infected individuals, and 87% negative attitudes to childbearing.5. Related to this, the provision of contraception within services that provide antiretroviral therapy (ART) to HIV-infected women and men has ...

  4. a study of nevirapine toxicity in hiv infected pregnant women

    African Journals Online (AJOL)

    Esem

    HIV infected women commenced on nevirapine-based regimen in the current pregnancy with CD4 counts up to. 3. 350 cells/mm at the University Teaching Hospital,. Lusaka, Zambia. Design: Longitudinal observational study with 2 arms. Group 1 (low CD4 count arm): HIV infected pregnant. 3 women with CD4 counts less ...

  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. 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....

  7. Epidemiology of HIV infection in Northern Pakistan

    International Nuclear Information System (INIS)

    Tariq, W.U.Z.; Malik, I.A.; Hassan, Z.U.; Hannan, A.; Ahmad, M.

    1993-01-01

    At the Armed Forces Institute of Pathology, Rawalpindi, facilities for HIV screening are available since 1987. So far, 54, 170 individuals have been tested. These included 48235 blood donors, 3369 persons proceeding abroad, 561 patients of venereal diseases, 350 Lymphoma cases, 21 deportees from the UAE, 460 clinically suspected cases of AIDS, 735 persons who were worried about HIV infection and 439 family members of HIV positive cases. A total of 30 cases were positive for anti-HIV on a strict protocol, which included screening tests followed by confirmatory tests including Western blot for HIV antibodies. The mode of HIV transmission was ascertained after a detailed history of all seropostive cases. It was found that in 24 cases the virus was acquired through sexual contact with high risk persons, which was homosexual in 3, heterosexual in 17, and bisexual in 4 cases. In 4 cases, the infection was acquired through blood transfusion, one child was infected through breast feeding, whereas only in one case the exact mode of HIV transmission was unclear. Out of 30 HIV positive cases, only three cases acquired the disease within Pakistan, 20 had acquired HIV infection during their stay in the Gulf states, while few cases had it from other countries (Saudi Arabia 1, Greece 1, France 2, S E Asia 3). (author)

  8. [Impact of HIV infection in hospital environment].

    Science.gov (United States)

    Martínez Avilés, P; López Benito, I; Berbegal Serra, J

    1998-12-01

    Retrospective study to review the admissions at the Hospital Marina Alta due to infection for HIV or its complications and look for risk factors. Clinical charts of patients admitted at the hospital from 1989 to 1996 were analyzed. From 11,932 admissions, 199 (1.7%) were due to patients with infection from HIV, resulting in the 2.4% of the total stay. The medium stays were higher (8.6 +/- 7.4 vs 6 +/- 4.5) more re-admissions (42.7% vs 25.5%) and higher mortality (11% vs 7.8%). The parasitic infestations of the nervous central system and cardiovascular were the most numerous number of admissions and also the longer stays. Throughout the years we saw a increase in the patients at the outpatient clinic with HIV infection and a paradogic decrease in the inpatient admissions, and also a decrease in the media stay and total stays. There is a decrease in the admissions at the inpatient level in contrast with a increment of the prevalence in the outpatients with HIV infection. The improved treatments, the experience of the physicians, the use of the Day Hospital and the use of the service of Home Care Hospitalization allows to keep more patients with less admissions and more outpatient visits.

  9. HIV antibodies for treatment of HIV infection.

    Science.gov (United States)

    Margolis, David M; Koup, Richard A; Ferrari, Guido

    2017-01-01

    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. Furthermore, 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. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  10. Morphological aspects of liver CT in patients with HIV infections

    International Nuclear Information System (INIS)

    Schedel, H.; Wicht, L.; Roegler, G.; Langer, R.; Felix, R.

    1994-01-01

    CT examinations of the liver in HIV-infected patients show more frequent pathological findings. The extended spectrum of differential diagnosis and atypical manifestations of disorders in immunodeficient patients needs to be considered in the interpretation of CT scans. Difficulties in the differential diagnosis of focal hepatic lesions in HIV-infected patients are demonstrated in the following. Besides the relatively common findings in HIV-infection such as hepato- or hepatosplenomegalia, lymphoma, and inflammatory changes of the bowel an infection with Cryptococcus neoformans, hepatitis, and local steatosis of the liver are discussed as the rare causes for suspect computertomographic findings in the live of HIV-infected patients. The examinations were obtained consecutively in 76 HIV-infected patients during abdominal CT staging. (orig.) [de

  11. HIV-infected presumptive tuberculosis patients without tuberculosis: How many are eligible for antiretroviral therapy in Karnataka, India?

    Directory of Open Access Journals (Sweden)

    Ajay M.V. Kumar

    2017-03-01

    Full Text Available For certain subgroups within people living with the human immunodeficiency virus (HIV [active tuberculosis (TB, pregnant women, children <5 years old, and serodiscordant couples], the World Health Organization recommends antiretroviral therapy (ART irrespective of CD4 count. Another subgroup which has received increased attention is “HIV-infected presumptive TB patients without TB”. In this study, we assess the proportion of HIV-infected presumptive TB patients eligible for ART in Karnataka State (population 60 million, India. This was a cross-sectional analysis of data of HIV-infected presumptive TB patients diagnosed in May 2015 abstracted from national TB and HIV program records. Of 42,585 presumptive TB patients, 28,964 (68% were tested for HIV and 2262 (8% were HIV positive. Of the latter, 377 (17% had active TB. Of 1885 “presumptive TB patients without active TB”, 1100 (58% were already receiving ART. Of the remaining 785 who were not receiving ART, 617 (79% were assessed for ART eligibility and of those, 548 (89% were eligible for ART. About 90% of “HIV-infected presumptive TB patients without TB” were eligible for ART. This evidence supports a public health approach of starting all “HIV-infected presumptive TB patients without TB” on ART irrespective of CD4 count in line with global thinking about ‘test and treat’.

  12. 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.

  13. Pregnancy incidence and outcomes in women with perinatal HIV infection.

    Science.gov (United States)

    Byrne, Laura; Sconza, Rebecca; Foster, Caroline; Tookey, Pat A; Cortina-Borja, Mario; Thorne, Claire

    2017-07-31

    To estimate the incidence of first pregnancy in women living with perinatally acquired HIV (PHIV) in the United Kingdom and to compare pregnancy management and outcomes with age-matched women with behaviourally acquired HIV (BHIV). The National Study of HIV in Pregnancy and Childhood is a comprehensive, population-based surveillance study that collects demographic and clinical data on all pregnant women living with HIV, their children, and all HIV-infected children in the United Kingdom and Ireland. The incident rate ratio of first pregnancy was calculated for all women of reproductive age who had been reported to the National Study of HIV in Pregnancy and Childhood as vertically infected children. These women and their pregnancies were compared to age-matched pregnant women with BHIV. Of the 630 women with PHIV reported in the United Kingdom as children, 7% (45) went on to have at least one pregnancy, with 70 pregnancies reported. The incident rate ratio of first pregnancy was 13/1000 woman-years. The BHIV comparison group comprised 118 women (184 pregnancies). Women with PHIV were more likely to be on combined antiretroviral therapy at conception and have a lower baseline CD4 cell count (P pregnancy incidence, but those who become pregnant are at risk of detectable viral load near delivery, reflecting their often complex clinical history, adherence, and drug resistance issues.

  14. Placental malaria among HIV-infected and uninfected women receiving anti-folates in a high transmission area of Uganda

    Directory of Open Access Journals (Sweden)

    Dorsey Grant

    2009-11-01

    Full Text Available Abstract Background HIV infection increases the risk of placental malaria, which is associated with poor maternal and infant outcomes. Recommendations in Uganda are for HIV-infected pregnant women to receive daily trimethoprim-sulphamethoxazole (TS and HIV-uninfected women to receive intermittent sulphadoxine-pyrimethamine (SP. TS decreases the risk of malaria in HIV-infected adults and children but has not been evaluated among pregnant women. Methods This was a cross sectional study comparing the prevalence of placental malaria between HIV-infected women prescribed TS and HIV-uninfected women prescribed intermittent preventive therapy with sulphadoxine-pyrimethamine (IPT-SP in a high malaria transmission area in Uganda. Placental blood was evaluated for malaria using smear and PCR. Results Placentas were obtained from 150 HIV-infected women on TS and 336 HIV-uninfected women on IPT-SP. The proportion of HIV-infected and HIV-uninfected women with placental malaria was 19% vs. 26% for those positive by PCR and 6% vs. 9% for those positive by smear, respectively. Among all infants, smear+ placental malaria was most predictive of low birth weight (LBW. Primigravidae were at higher risk than multigravidae of having placental malaria among HIV-uninfected, but not HIV-infected, women. Adjusting for gravidity, age, and season at the time of delivery, HIV-infected women on TS were not at increased risk for placental malaria compared to HIV-uninfected women on IPT-SP, regardless of the definition used. Conclusion Prevalence of placental malaria was similar in HIV-infected women on TS and HIV-uninfected women on IPT-SP. Nonetheless, while nearly all of the women in this study were prescribed anti-folates, the overall risk of placental malaria and LBW was unacceptably high. The population attributable risk of placental malaria on LBW was substantial, suggesting that future interventions that further diminish the risk of placental malaria may have a

  15. Prevalence of HIV infection among former commercial plasma donors in rural eastern China.

    Science.gov (United States)

    Wu, Z; Rou, K; Detels, R

    2001-03-01

    Sporadic reports of HIV-1 infection among commercial plasma donors in China between 1994 and 1995. (1) To determine the prevalence of HIV infection among repeat plasma donors; (2) to identify factors associated with HIV infection; and (3) to describe characteristics associated with secondary transmission. Plasma/blood donors who had a history of donating plasma/blood before March 1, 1995, their spouses, and their children under 5 years were recruited for a cross-sectional study. A questionnaire and an HIV test were collected anonymously. Information collected included demographic characteristics, sexual behaviour, recreational drug use and history of medical care and blood/plasma donation. HIV antibody was identified by the Hema-Strip rapid test and confirmed by Western blot. The prevalence of HIV infection was calculated and risk factors associated with infection determined by univariate analyses followed by multivariate modelling. A total of 1517 individuals were interviewed and tested, of whom 1043 adults admitted to donating plasma. The prevalence of HIV infection among plasma donors was 12.5% and among their non-donor spouses was 2.1%. Prevalence was inversely related to educational level and was higher in married participants, but was not associated with medical care, drug abuse or multiple sexual partners. A higher frequency of plasma donation was directly associated with a higher risk of HIV infection. Multivariate analyses demonstrated that being HIV-positive was associated with being 30 to 49 years old [odds ratio (OR) = 1.9], donating both plasma and blood (OR = 2.5), and the frequency of plasma donation (OR = 14 for >10 donations per month). The study demonstrated that the prevalence of HIV infection in the commercial plasma donor population was alarmingly high. Many married individuals and those getting married in the future will transmit the virus to their spouses and future children. Plasma donors need to be alerted to the risk of being infected with

  16. Copenhagen comorbidity in HIV infection (COCOMO) study

    DEFF Research Database (Denmark)

    Ronit, Andreas; Haissman, Judith Melchior; Kirkegaard-Klitbo, Ditte Marie

    2016-01-01

    BACKGROUND: Modern combination antiretroviral therapy (cART) has improved survival for people living with HIV (PLWHIV). Non-AIDS comorbidities have replaced opportunistic infections as leading causes of mortality and morbidity, and are becoming a key health concern as this population continues....../DESIGN: The Copenhagen comorbidity in HIV-infection (COCOMO) study is an observational, longitudinal cohort study. The study was initiated in 2015 and recruitment is ongoing with the aim of including 1500 PLWHIV from the Copenhagen area. Follow-up examinations after 2 and 10 years are planned. Uninfected controls...... (PBMC), urine, and stool samples are collected in a biobank for future studies. Data will be updated through periodical linking to national databases. DISCUSSION: As life expectancy for PLWHIV improves, it is essential to study long-term impact of HIV and cART. We anticipate that findings from...

  17. Incomplete immune recovery in HIV infection

    DEFF Research Database (Denmark)

    Gaardbo, Julie C; Hartling, Hans J; Gerstoft, Jan

    2012-01-01

    -infected patients do not achieve optimal immune reconstitution despite suppression of viral replication. These patients are referred to as immunological nonresponders (INRs). INRs present with severely altered immunological functions, including malfunction and diminished production of cells within lymphopoetic...... 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....... Additional treatment to HAART that may improve immune reconstitution has been investigated, but results thus far have proved disappointing. The reason for immunological nonresponse is incompletely understood. This paper summarizes the known and unknown factors regarding the incomplete immune reconstitution...

  18. Posttest counseling and social support from health staff caring for HIV-infected pregnant women in Vietnam

    DEFF Research Database (Denmark)

    Hanh, Nguyen Thi Thúy; Rasch, Vibeke; Chi, Bùi Kim

    2010-01-01

    Women with HIV who want to have children face a range of challenges, quandaries, and hard decisions. This article examines the role of health staff in supporting HIV-infected pregnant women who desire to maintain their pregnancies. The article is derived from anthropological research conducted...

  19. Pretreatment HIV drug resistance results in virological failure and accumulation of additional resistance mutations in Ugandan children

    NARCIS (Netherlands)

    Kityo, Cissy; Boerma, Ragna S.; Sigaloff, Kim C. E.; Kaudha, Elizabeth; Calis, Job C. J.; Musiime, Victor; Balinda, Sheila; Nakanjako, Rita; Boender, T. Sonia; Mugyenyi, Peter N.; Rinke de Wit, Tobias F.

    2017-01-01

    Background: Pretreatment HIV drug resistance (PDR) can impair virological response to ART, jeopardizing effective treatment for children. Methods: Children aged <12 years initiated first-line ART in Uganda during 2010-11. Baseline and 6 monthly viral load (VL) and genotypic resistance testing if VL.

  20. Adrenal insufficiency in pakistani hiv infected patients

    International Nuclear Information System (INIS)

    Afreen, B.; Khan, K.A.; Riaz, A.

    2017-01-01

    Background: Adrenal insufficiency (AI) is the most common endocrine complication among patients with AIDS/HIV infection and there are number of causes of AI in HIV patients. Human immunodeficiency virus directly as well as indirectly destroys adrenal glands. The estimates of its prevalence and severity vary. AI is the most life threatening but readily correctable endocrine complication that occurs in persons with HIV infection. This study was carried out to determine the frequency of Adrenal Insufficiency in HIV patients and their clinical features as proper diagnosis and timely treatment have been shown to improve quality of life and long-term mortality in AIDS patients. Methods: It was a cross sectional survey conducted at HIV clinic and Jinnah Allama Iqbal Institute of Diabetes and Endocrinology, Jinnah Hospital Lahore. Sixty-four HIV positive patients, both male and female, aged above 15 years were included in the study. HIV patients who had recently taken steroids, ketoconazole or rifampicin, determined on history, were excluded from the study. The data was collected on a structured proforma and analysis was performed in SPSS-21.0. Frequency and percentages for adrenal insufficiency and its characteristics were calculated. Chi-square test was used with p<0.05 as statistically significant. Results: In this study, 9 (14.06%) HIV patients were diagnosed with adrenal insufficiency, male to female ratio was 3.5:1 and AI was found statistically significantly associated with fatigue (p<0.008) and weight loss (p<0.001). Conclusion: Adrenal insufficiency was high among the patients with HIV, it was not gender specific but it was found to be associated with fatigue and weight loss. (author)

  1. BONE MARROW ABONRMALITIES IN HIV INFECTION

    Directory of Open Access Journals (Sweden)

    Sharad Antiram Dhurve

    2013-06-01

    Full Text Available ABSTRACT Introduction; Hematological abnormalities are a common complication of HIV infection.  Bone marrow abnormalities occur in all stages of HIV infection.  Present work was carried out to study the bone marrow abnormalities in patients with HIV/AIDS.  Methods: 160 patients of HIV +ve were included in the study. A complete blood count, relevant biochemical investigations, CD4   counts were done, besides a thorough history and clinical examination. HIV positive patients were classified as those having AIDS and those without AIDS according to NACO criteria.   Bone marrow examination was performed for indication of anemia, leucopenia, pancytopenia and thrombocytopenia. Results: As per CDC criteria 59.81% patients had AIDS in 107 patients. The most common hematological abnormality was anemia, seen in 93.12% patients.  Bone marrow was normocellular in 79.06% of non-AIDS and 79.68% of AIDS, hypocellular in 13.95%.Thrombocytopenia was seen in 4 cases of ART (4.93% and 3 cases (4.68% of AIDS group. Abnormal cells like plasma cell, histocyte and toxic granule found in bone marrow. Conclusions: Myelodysplasia was more common in AIDS than in non AIDS patients. Granulocytic series is most commonly associated with evidence of dysplasia. Anemia in HIV patients can be a good clinical indicator to predict and access the underlying immune status. Thus bone marrow study is imperative to methodically observe and follow clinical and laboratory aberration in such patients in order to improve our diagnostic and therapeutic skills pertinent to HIV/AIDS.

  2. Early syphilis affects markers of HIV infection.

    Science.gov (United States)

    Kotsafti, Ourania; Paparizos, Vassilios; Kourkounti, Sofia; Chatziioannou, Argiro; Nicolaidou, Electra; Kapsimali, Violetta; Antoniou, Christina

    2016-08-01

    The objective of this study was to investigate if early syphilis infection affects markers of HIV infection; CD4 T cells and viral load (VL). A retrospective study was performed on 160 HIV-positive patients (111 receiving antiretroviral therapy [ART] and 49 without ART). Early syphilis diagnosis was made in HIV patients during their follow-up at the HIV/AIDS Unit at a Greek Dermatology and Venereology Unit. The patients' blood tests were available at the time of diagnosis, as well as before and 12 weeks after early syphilis diagnosis. CD4 T cell counts and VL levels were measured. It was found that syphilis infection had a negative impact on the CD4 T cell counts in both groups, with reduced CD4 T cell counts observed in 84.6% (99/111) and 79.5% (39/49) of patients receiving and not receiving ART, respectively. After treatment for syphilis, CD4 T cell counts returned to pre-treatment levels in most patients, especially those receiving ART. There was a slight and transient VL increase. Patients receiving ART had a 27% increase in VL, compared to 71.4% among patients not receiving ART. Although the VL increase was slight (41-14,000 copies/ml) in the group under treatment, 4-5% (5/111) patients did not return to pre-treatment levels. Moreover, viral mutations associated with treatment resistance were identified in these patients. Early syphilis accelerates and complicates the progression of HIV infection. Early diagnosis and treatment of syphilis may prevent infection-associated complications in most instances. Consequently, prevention of syphilis and other sexually transmitted infections is of great importance for patients infected with HIV. © The Author(s) 2016.

  3. Risk of skin cancer in HIV-infected patients

    DEFF Research Database (Denmark)

    Omland, Silje Haukali; Ahlström, Magnus Glinvad; Gerstoft, Jan

    2018-01-01

    BACKGROUND: The risk of skin cancer in HIV-infected patients has not been extensively studied. OBJECTIVE: To determine the risk of skin cancer in HIV-infected patients and compare it with the risk in the background population. METHODS: In a matched, nationwide population-based cohort study we...... compared the risk of skin cancer in 4280 HIV-infected patients from the Danish HIV cohort study with a background population cohort, according to the level of immunosuppression and route of transmission. Primary outcomes were time to first basal cell carcinoma (BCC), squamous cell carcinoma (SCC...

  4. Reporting of HIV-infected pregnant women: estimates from a Brazilian study.

    Science.gov (United States)

    Domingues, Rosa Maria Soares Madeira; Saraceni, Valéria; Leal, Maria do Carmo

    2018-01-01

    To estimate the coverage of the reporting of cases of HIV-infected pregnant women, to estimate the increase in the coverage of the reporting with the routine search of data in other Brazilian health information systems, and to identify missed opportunities for identification of HIV-infected pregnant women in Brazilian maternity hospitals. This is a descriptive study on the linkage of Brazilian databases with primary data from the "Nascer no Brasil" study and secondary database collection from national health information systems. The "Nascer no Brasil" is a national-based study carried out in 2011-2012 with 23,894 pregnant women, which identified HIV-infected pregnant women using prenatal and medical records. We searched for cases of HIV-infected pregnant women identified in the "Nascer no Brasil" study in the Information System of Notifiable Diseases, the Control System for Laboratory Tests of the National CD4+/CD8+ Lymphocyte Count and HIV Viral Load Network, and the Logistics Control System for Medications. We used the OpenRecLink software for the linkage of databases. We estimated the notification coverage, with the respective confidence interval, of the evaluated Brazilian health information systems. We estimated the coverage of the reporting of HIV-infected pregnant women in the Information System of Notifiable Diseases as 57.1% (95%CI 42.9-70.2), and we located 89.3% of the HIV-infected pregnant women (95%CI 81.2-94.2) in some of the Brazilian health information systems researched. The search in other national health information systems would result in an increase of 57.1% of the reported cases. We identified no missed opportunities for the diagnosis of HIV+ in pregnant women in the maternity hospitals evaluated by the "Nascer no Brasil" study. The routine search for information in other Brazilian health information systems, a procedure carried out by the Ministry of Health for cases of AIDS in adults and children, should be adopted for cases of HIV in

  5. Evaluation of the WHO clinical case definition for pediatric HIV infection in Bloemfontein, South Africa.

    Science.gov (United States)

    van Gend, Christine L; Haadsma, Maaike L; Sauer, Pieter J J; Schoeman, Cornelius J

    2003-06-01

    The WHO clinical case definition for pediatric HIV infection has been designed to be used in countries where diagnostic laboratory resources are limited. We evaluated the WHO case definition to determine whether it is a useful instrument to discriminate between HIV-positive and HIV-negative children. In addition, clinical features not included in this case definition were recorded. We recorded clinical data from 300 consecutively admitted children in a state hospital in Bloemfontein, South Africa, and tested these children for HIV infection. A total of 222 children were included in the study; 69 children (31.1 per cent) were HIV positive. The sensitivity of the WHO case definition in this study was 14.5 per cent, the specificity was 98.6 per cent. Apart from weight loss and generalized dermatitis, the signs of the WHO case definition were significantly more often seen in HIV-positive than in HIV-negative children. Of the clinical signs not included in the WHO case definition, marasmus and hepatosplenomegaly especially occurred more frequently in HIV-positive children. Based on these findings we composed a new case definition consisting of four signs: marasmus, hepatosplenomegaly, oropharyngeal candidiasis, and generalized lymphadenopathy. HIV infection is suspected in a child presenting with at least two of these four signs. The sensitivity of this case definition was 63.2 per cent, the specificity was 96.0 per cent. We conclude that in this study the WHO case definition was not a useful instrument to discriminate between HIV-positive and HIV-negative children, mainly because its sensitivity was strikingly low. The simplified case definition we propose, proved to be more sensitive than the WHO case definition (63.2 vs. 14.5 per cent), whilst its specificity remained high.

  6. Emmonsia helica Infection in HIV-Infected Man, California, USA.

    Science.gov (United States)

    Rofael, Martin; Schwartz, Ilan S; Sigler, Lynne; Kong, Li K; Nelson, Nicholas

    2018-01-01

    Emmonsia-like fungi have rarely been reported from North America. We report a fatal case of E. helica infection in a man with advanced HIV infection from California, USA, who had progressive respiratory failure and a brain abscess.

  7. Care of HIV-exposed and HIV-infected neonates

    African Journals Online (AJOL)

    However, further reduction in MTCT may be possible if newborns at high risk of acquiring HIV ... infants of breastfeeding mothers with newly diagnosed HIV infection, dual NVP/ .... birth HIV DNA PCR testing for HIV-exposed low birth weight.

  8. Factors affecting HIV-infected mothers' ability to adhere to ...

    African Journals Online (AJOL)

    The postnatal feeding practices of 222 HIV-infected mothers were compared with their prenatal intentions and ... categorical data and Student's t-test for continuous data. Factors ... give an excuse, such as ill health (including breast cancer,.

  9. Voluntary Counseling and Testing and Prevalence of HIV Infection ...

    African Journals Online (AJOL)

    Voluntary Counseling and Testing and Prevalence of HIV Infection Amongst Patients Booked for Surgical Operations. ... The effectiveness (yield) of lay counseling in HIV testing by resident doctors who have not ... AJOL African Journals Online.

  10. Correlates of HIV infection among people visiting public HIV ...

    African Journals Online (AJOL)

    Correlates of HIV infection among people visiting public HIV counseling and testing clinics in Mpumalanga, ... Background: HIV voluntary counselling and testing (VCT) reduces high-risk sexual behaviour. ... AJOL African Journals Online.

  11. Effects of methamphetamine dependence and HIV infection on cerebral morphology

    DEFF Research Database (Denmark)

    Jernigan, Terry Lynne; Gamst, Abthony C; Archibald, Sarah L.

    2005-01-01

    -dependent participants. CONCLUSIONS: These results suggest significant brain structure alterations associated with both HIV infection and methamphetamine dependence. The regional patterns of the changes associated with these factors were distinct but overlapping, and the effects on brain volumes were opposing. Although......OBJECTIVE: The authors examined the separate and combined effects of methamphetamine dependence and HIV infection on brain morphology. METHOD: Morphometric measures obtained from magnetic resonance imaging of methamphetamine-dependent and/or HIV-positive participants and their appropriate age......- and education-matched comparison groups were analyzed. Main effects of age, HIV infection, methamphetamine dependence, and the interactions of these factors were examined in analyses of cerebral gray matter structure volumes. RESULTS: Independent of the effect of age, HIV infection was associated with reduced...

  12. Effects of methamphetamine dependence and HIV infection on cerebral morphology

    DEFF Research Database (Denmark)

    Jernigan, Terry Lynne; Gamst, Abthony C; Archibald, Sarah L.

    2005-01-01

    OBJECTIVE: The authors examined the separate and combined effects of methamphetamine dependence and HIV infection on brain morphology. METHOD: Morphometric measures obtained from magnetic resonance imaging of methamphetamine-dependent and/or HIV-positive participants and their appropriate age......- and education-matched comparison groups were analyzed. Main effects of age, HIV infection, methamphetamine dependence, and the interactions of these factors were examined in analyses of cerebral gray matter structure volumes. RESULTS: Independent of the effect of age, HIV infection was associated with reduced...... volumes of cortical, limbic, and striatal structures. There was also some evidence of an interaction between age and HIV infection such that older HIV-positive participants suffered disproportionate loss. Methamphetamine dependence was surprisingly associated with basal ganglia and parietal cortex volume...

  13. Osteopaenia and Osteonecrosis in HIV Infection: Report of Two Cases

    African Journals Online (AJOL)

    HAART) in the treatment of human immunodeficiency virus (HIV) infection has significantly ... The consequence of longer survival has manifested increasing rates of co-morbid diseases and aroused interest in the interaction of HIV and aging The ...

  14. Brief communication: Low prevalence of HIV infection, and ...

    African Journals Online (AJOL)

    Brief communication: Low prevalence of HIV infection, and knowledge, ... History of sexually transmitted diseases was reported by 10.7% of the sexually active students. ... Continued health education is needed to bring behavioral changes.

  15. The Histological Appearances Of The Adult Kidney In Hiv Infection ...

    African Journals Online (AJOL)

    SITWALA COMPUTERS

    Luchengam@gmail.com. ABSTRACT. Background: Kidney disease in acquired immunodeficiency syndrome is very common. The cause of the various histological appearances include HIV infection of the kidney, immunologic responses to the.

  16. Non-Alcoholic Fatty Liver Disease in HIV Infection.

    Science.gov (United States)

    Macías, Juan; Pineda, Juan A; Real, Luis M

    2017-01-01

    Non-alcoholic fatty liver disease is one of the most frequent chronic hepatic conditions worldwide. The spectrum of non-alcoholic fatty liver disease goes from hepatic steatosis to steatohepatitis, cirrhosis, and hepatocellular carcinoma. Risk factors for non-alcoholic fatty liver disease are metabolic, mainly obesity and the accompanying consequences. Treatment and prevention of non-alcoholic fatty liver disease should target those metabolic abnormalities. The frequency of and the factors associated with hepatic steatosis in HIV infection seem to be similar to those reported in the general population, though direct comparisons are lacking. Hepatic steatosis in HIV infection may also be secondary to antiretroviral drugs or HCV-related factors in HCV-coinfected subjects. However, more recent data suggest that hepatic steatosis in HIV infection represents true non-alcoholic fatty liver disease. As such, management of non-alcoholic fatty liver disease in HIV infection should follow the same principles as in the general population.

  17. Postpartum Sterilization Choices Made by HIV-Infected Women

    Directory of Open Access Journals (Sweden)

    Gretchen S. Stuart

    2005-01-01

    Full Text Available Objective. To assess if HIV-infected women made different choices for postpartum sterilization after implementation of the Pediatric AIDS Clinical Trials Group protocol 076 (November 1, 1994 compared to before implementation.

  18. Neurological manifestations of HIV infection in Nigerians | Imam ...

    African Journals Online (AJOL)

    Log in or Register to get access to full text downloads. ... Nervous system complications commonly accompany HIV infection and are associated with significant ... In all, 89 patients (44%) were diagnosed with at least one neurological disorder.

  19. Prevalence of HIV infection among trauma patients admitted to ...

    African Journals Online (AJOL)

    Prevalence of HIV infection among trauma patients admitted to Bugando Medical Centre, ... This was a descriptive cross sectional study involving trauma patients aged 11 years and ... A total of 250 trauma patients were recruited and studied.

  20. Hiv infection in patients of sexually transmitted disease

    Directory of Open Access Journals (Sweden)

    Sayal S

    1999-01-01

    Full Text Available A total of 1027 male patients suffering from sexually transmitted diseases (STD during 1990 to 1996 were screened for HIV infection. All cases were in the age group 17 years to 48 years. One hundred and sixty-seven STD cases (16.3% were found to have HIV infection. A rising trend in incidence of HIV infection in STD patients from 1990 (2.8% to 1996 (27.8% was noticed countrary to declining trend of STDs from 213 cases in 1990 to 79 cases in 1996. The incidence of HIV infection was 30.3% in lymphogranuloma venereum, 19.5% in chancroid, 13.5% in syphilis, 17.6% in herpes genitatis, 6.7% in gonorrhoea and 11.2% in other STD cases.

  1. FEATURES OF PNEUMONIA IN HIV-INFECTED PATIENTS

    Directory of Open Access Journals (Sweden)

    M. T. Vatutin

    2016-01-01

    Full Text Available The article presents the clinical, diagnostic and treatment features of pneumocystis pneumonia in HIV-infected patients. The clinical case of diagnosis verification in a patient 58 years old with severe respiratory failure is described.

  2. A qualitative study of vulnerability to HIV infection: Places and ...

    African Journals Online (AJOL)

    unhcc

    Methods: A qualitative study employing Focus Group Discussions (FGDs) and ... cope and are subjects to the threats for HIV infection. (2-4). In the era of HIV .... Table 1: Characteristics of participants in focus group discussions. Variable.

  3. Yellow fever vaccine for patients with HIV infection.

    Science.gov (United States)

    Barte, Hilary; Horvath, Tara H; Rutherford, George W

    2014-01-23

    Yellow fever (YF) is an acute viral haemorrhagic disease prevalent in tropical Africa and Latin America. The World Health Organization (WHO) estimates that there are 200,000 cases of YF and 30,000 deaths worldwide annually. Treatment for YF is supportive, but a live attenuated virus vaccine is effective for preventing infection. WHO recommends immunisation for all individuals > 9 months living in countries or areas at risk. However, the United States Advisory Committee on Immunization Practices (ACIP) advises that YF vaccine is contraindicated in individuals with HIV. Given the large populations of HIV-infected individuals living in tropical areas where YF is endemic, YF vaccine may be an important intervention for preventing YF in immunocompromised populations. To assess the risk and benefits of YF immunisation for people infected with HIV. We used standard Cochrane methods to search electronic databases and conference proceedings with relevant search terms without limits to language. Randomised controlled trials and cohort studies of individuals with HIV infection who received YF vaccine (17DD or 17D-204). Two authors screened abstracts of references identified by electronic or bibliographic searches according to inclusion and exclusion criteria as detailed in the protocol. We identified 199 references and examined 19 in detail for study eligibility. Data were abstracted independently using a standardised abstraction form. Three cohort studies were included in the review. They examined 484 patients with HIV infection who received YF immunisation. Patients with HIV infection developed significantly lower concentrations of neutralising antibodies in the first year post immunisation compared to uninfected patients, though decay patterns were similar for recipients regardless of HIV infection. No study patient with HIV infection suffered serious adverse events as a result of YF vaccination. YF vaccination can produce protective levels of neutralising antibodies in

  4. Outbreak of HIV infection in a Scottish prison.

    OpenAIRE

    Taylor, A.; Goldberg, D.; Emslie, J.; Wrench, J.; Gruer, L.; Cameron, S.; Black, J.; Davis, B.; McGregor, J.; Follett, E.

    1995-01-01

    OBJECTIVE--To investigate the possible spread of HIV infection and its route of transmission among prison inmates. DESIGN--In response to an outbreak of acute clinical hepatitis B and two seroconversions to HIV infection, counselling and testing for HIV were offered to all inmates over a two week period in July 1993. Information was sought about drug injecting, sexual behaviour, and previous HIV testing. SETTING--HM Prison Glenochil in Scotland. SUBJECTS--Adult male prisoners. MAIN OUTCOME ME...

  5. Lipid Profile of Anti Retroviral Treatment Naive HIV Infected Patients ...

    African Journals Online (AJOL)

    hypercholesterolemia [22.4% (22/98) vs. 10.4% (11/106), P = 0.02]. Lower HDL.C was associated with CD4+ cell count < 200 cells/ƒÊL (P = 0.02). Conclusion: Lipid abnormalities are common in treatment.naive HIV.infected patients even in the absence of major host.related risk factors for dyslipidemia. HIV.infected patients ...

  6. Adherence to feeding guidelines among HIV-infected and HIV ...

    African Journals Online (AJOL)

    For infants older than six months, complementary feeding was more common among HIV-uninfected (100%) than HIV-infected mothers (41.7%; P<0.001). Among infants of all ages, none of the HIV-uninfected and 45% of HIV-infected mothers were replacement feeding (p<0.001). More than a half (59.8%) of the mothers ...

  7. Women and HIV Infection: The Makings of a Midlife Crisis

    Science.gov (United States)

    Santoro, Nanette; Fan, Maria; Maslow, BatSheva; Schoenbaum, Ellie

    2009-01-01

    With the advent of highly active antiretroviral agents, women with HIV infection can expect to live longer than ever before. This increased survival has led to concerns about the long-term implications of HIV disease and its treatment. Women with HIV infection appear to lose ovarian function earlier in life than women without HIV infection. They also have evidence of reduced bone mineral density and increased cardiovascular risk. Moreover, many of these increases in risk factors are present even prior to the menopausal transition. All of these risks, present at mid-life, augur poorly for future health and describe a substantially increased burden of disease likely to accrue to HIV infected women as they enter older age groups. Further compounding the adversity faced by the HIV infected, the demographics of women most vulnerable to this disease include adverse social and economic influences, both of which worsen their long term prognosis. For example, drug use and poverty are related to more severe menopausal symptoms and chronic stress is related to worse psychological and cardiovascular risk. An understanding of how menopause interacts with HIV infection is therefore most important to alert the clinician to perform surveillance for common health problems in postmenopausal women, and to address directly and appropriately symptomatology during the menopausal transition. PMID:19783389

  8. Evaluation of Olfactory and Gustatory Function of HIV Infected Women

    Directory of Open Access Journals (Sweden)

    Ayotunde James Fasunla

    2016-01-01

    Full Text Available Background. Compliance with medication requires good sense of smell and taste. Objective. To evaluate the olfactory and gustatory function of HIV infected women in Ibadan, Nigeria. Methods. A case control study of women comprising 83 HIV infected women and 79 HIV uninfected women. Subjective self-rating of taste and smell function was by visual analogue scale. Olfactory function was measured via olfactory threshold (OT, olfactory discrimination (OD, olfactory identification (OI, and TDI using “Sniffin’ sticks” kits and taste function (Total Taste Strips (TTS score measurement was by taste strips. Results. The mean age of the HIV infected women was 43.67 years ± 10.72 and control was 41.48 years ± 10.99. There was no significant difference in the self-reported assessment of smell (p=0.67 and taste (p=0.84 of HIV infected and uninfected women. Although the mean OT, OD, OI, TDI, and TTS scores of HIV infected and uninfected women were within the normosmic and normogeusic values, the values were significantly higher in the controls (p<0.05. Hyposmia was in 39.7% of subjects and 12.6% of controls while hypogeusia was in 15.7% of subjects and 1.3% of controls. Conclusions. Hyposmia and hypogeusia are commoner among the HIV infected women than the HIV uninfected women and the risk increases with an increased duration of highly active antiretroviral therapy.

  9. A year-long caregiver training program to improve neurocognition in preschool Ugandan HIV-exposed children.

    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

    2013-05-01

    Mediational intervention for sensitizing caregivers (MISC) is a structured program enabling caregivers to enhance their child's cognitive and emotional development through daily interactions. The principal aim was to evaluate if a year-long MISC caregiver training program produced greater improvement in child cognitive and emotional development compared with a control program. One hundred and nineteen uninfected HIV-exposed preschool children and their caregivers were randomly assigned to 1 of 2 treatment arms: biweekly MISC training alternating between home and clinic for 1 year or a health and nutrition curriculum. All children were evaluated at baseline, 6 months, and 1 year with the Mullen Early Learning Scales, Color-Object Association Test for memory, and Achenbach Child Behavior Checklist for psychiatric symptoms. Caregivers were evaluated on the same schedule with the Hopkins Symptoms Checklist-25 for depression and anxiety. The treatment arms were compared using repeated-measures analysis of covariance with child age, gender, weight, socioeconomic status, caregiving quality, caregiver anxiety, and caregiver education as covariates. The MISC children had significantly greater gains compared to controls on the Mullen Receptive and Expressive Language development, and on the Mullen composite score of cognitive ability. Color-Object Association Test total memory for MISC children was marginally better than controls. No Achenbach Child Behavior Checklist differences between the groups were noted. Caldwell Home Observation for Measurement of the Environment scores and observed mediational interaction scores from videotapes measuring caregiving quality also improved significantly more for the MISC group. The MISC enhanced cognitive performance, especially in language development. These benefits were possibly mediated by improved caregiving and positive emotional benefit to the caregiver.

  10. HIV-infected mental health patients: characteristics and comparison with HIV-infected patients from the general population and non-infected mental health patients

    NARCIS (Netherlands)

    Schade, A.; Grootheest, G.; Smit, J.H.

    2013-01-01

    Objectives: HIV-infected patients are at increased risk of developing mental health symptoms, which negatively influence the treatment of the HIV-infection. Mental health problems in HIV-infected patients may affect public health. Psychopathology, including depression and substance abuse, can

  11. Incidence of Malaria and Efficacy of Combination Antimalarial Therapies over 4 Years in an Urban Cohort of Ugandan Children

    Science.gov (United States)

    Clark, Tamara D.; Njama-Meya, Denise; Nzarubara, Bridget; Maiteki-Sebuguzi, Catherine; Greenhouse, Bryan; Staedke, Sarah G.; Kamya, Moses R.; Dorsey, Grant; Rosenthal, Philip J.

    2010-01-01

    Background Combination therapies are now recommended to treat uncomplicated malaria. We used a longitudinal design to assess the incidence of malaria and compare the efficacies of 3 combination regimens in Kampala, Uganda. Methodology/Principal Findings Children aged 1–10 years were enrolled from randomly selected households in 2004–05 and 2007, and were followed at least monthly through 2008. Insecticide-treated bednets (ITNs) were provided in 2006. Children were randomized upon their first episode, and then treated for all episodes of uncomplicated malaria with amodiaquine/sulfadoxine-pyrimethamine (AQ/SP), artesunate/amodiaquine (AS/AQ), or artemether/lumefantrine (AL). Risks of parasitological failure were determined for each episode of uncomplicated malaria and clinical parameters were followed. A total of 690 children experienced 1464 episodes of malaria. 96% of these episodes were uncomplicated malaria and treated with study drugs; 94% were due to Plasmodium falciparum. The rank order of treatment efficacy was AL > AS/AQ > AQ/SP. Failure rates increased over time for AQ/SP, but not the artemisinin-based regimens. Over the 4-year course of the study the prevalence of asymptomatic parasitemia decreased from 11.8% to 1.4%, the incidence of malaria decreased from 1.55 to 0.32 per person year, and the prevalence of anemia (hemoglobin <10 gm/dL) decreased from 5.9% to 1.0%. No episodes of severe malaria (based on WHO criteria) and no deaths were seen. Conclusions/Significance With ready access to combination therapies and distribution of ITNs, responses were excellent for artemisinin-containing regimens, severe malaria was not seen, and the incidence of malaria and prevalence of parasitemia and anemia decreased steadily over time. Trial Registration isrctn.org ISRCTN37517549 PMID:20689585

  12. Incidence of malaria and efficacy of combination antimalarial therapies over 4 years in an urban cohort of Ugandan children.

    Directory of Open Access Journals (Sweden)

    Tamara D Clark

    2010-07-01

    Full Text Available Combination therapies are now recommended to treat uncomplicated malaria. We used a longitudinal design to assess the incidence of malaria and compare the efficacies of 3 combination regimens in Kampala, Uganda.Children aged 1-10 years were enrolled from randomly selected households in 2004-05 and 2007, and were followed at least monthly through 2008. Insecticide-treated bednets (ITNs were provided in 2006. Children were randomized upon their first episode, and then treated for all episodes of uncomplicated malaria with amodiaquine/sulfadoxine-pyrimethamine (AQ/SP, artesunate/amodiaquine (AS/AQ, or artemether/lumefantrine (AL. Risks of parasitological failure were determined for each episode of uncomplicated malaria and clinical parameters were followed. A total of 690 children experienced 1464 episodes of malaria. 96% of these episodes were uncomplicated malaria and treated with study drugs; 94% were due to Plasmodium falciparum. The rank order of treatment efficacy was AL > AS/AQ > AQ/SP. Failure rates increased over time for AQ/SP, but not the artemisinin-based regimens. Over the 4-year course of the study the prevalence of asymptomatic parasitemia decreased from 11.8% to 1.4%, the incidence of malaria decreased from 1.55 to 0.32 per person year, and the prevalence of anemia (hemoglobin <10 gm/dL decreased from 5.9% to 1.0%. No episodes of severe malaria (based on WHO criteria and no deaths were seen.With ready access to combination therapies and distribution of ITNs, responses were excellent for artemisinin-containing regimens, severe malaria was not seen, and the incidence of malaria and prevalence of parasitemia and anemia decreased steadily over time.isrctn.org ISRCTN37517549.

  13. Dual antiretroviral therapy for HIV infection.

    Science.gov (United States)

    Soriano, Vicente; Fernandez-Montero, Jose Vicente; Benitez-Gutierrez, Laura; Mendoza, Carmen de; Arias, Ana; Barreiro, Pablo; Peña, José M; Labarga, Pablo

    2017-08-01

    For two decades, triple combinations of antiretrovirals have been the standard treatment for HIV infection. The challenges of such lifelong therapy include long-term side effects, high costs and reduced drug adherence. The recent advent of more potent and safer antiretrovirals has renewed the interest for simpler HIV regimens. Areas covered: We discuss the pros and cons of dual antiretroviral therapies in both drug-naïve and in treatment-experienced patients with viral suppression (switch strategy). Expert opinion: Some dual antiretroviral regimens are safe and efficacious, particularly as maintenance therapy. At this time, combinations of dolutegravir plus rilpivirine represent the best dual regimen. Longer follow-up and larger study populations are needed before supporting dolutegravir plus lamivudine. In contrast, dual therapy based on maraviroc is less effective. Although dual regimens with boosted protease inhibitors plus either lamivudine or raltegravir may be effective, they are penalized by metabolic side effects and risk for drug interactions. The newest dual regimens could save money, reduce toxicity and spare drug options for the future. For the first time in HIV therapeutics, less can be more. Dual therapy switching has set up a new paradigm in HIV treatment that uses induction-maintenance.

  14. Interferon α subtypes in HIV infection.

    Science.gov (United States)

    Sutter, Kathrin; Dickow, Julia; Dittmer, Ulf

    2018-02-13

    Type I interferons (IFN), which are immediately induced after most virus infections, are central for direct antiviral immunity and link innate and adaptive immune responses. However, several viruses have evolved strategies to evade the IFN response by preventing IFN induction or blocking IFN signaling pathways. Thus, therapeutic application of exogenous type I IFN or agonists inducing type I IFN responses are a considerable option for future immunotherapies against chronic viral infections. An important part of the type I IFN family are 12 IFNα subtypes, which all bind the same receptor, but significantly differ in their biological activities. Up to date only one IFNα subtype (IFNα2) is being used in clinical treatment against chronic virus infections, however its therapeutic success rate is rather limited, especially during Human Immunodeficiency Virus (HIV) infection. Recent studies addressed the important question if other IFNα subtypes would be more potent against retroviral infections in in vitro and in vivo experiments. Indeed, very potent IFNα subtypes were defined and their antiviral and immunomodulatory properties were characterized. In this review we summarize the recent findings on the role of individual IFNα subtypes during HIV and Simian Immunodeficiency Virus infection. This includes their induction during HIV/SIV infection, their antiretroviral activity and the regulation of immune response against HIV by different IFNα subtypes. The findings might facilitate novel strategies for HIV cure or functional cure studies. Copyright © 2018 Elsevier Ltd. All rights reserved.

  15. Strategies for the cure of HIV infection.

    Science.gov (United States)

    Rodríguez-Muñoz, Jesús; Moreno, Santiago

    2018-03-03

    The disadvantages of the long-term administration of antiretroviral therapy as well as the huge number of affected persons have placed the cure of HIV as a primary goal of Public Health. HIV may persist in the organism by at least four mechanisms: a latently infected cellular reservoir, the persistent replication of HIV in spite of ART, anatomic sanctuaries, and the immune dysfunction. Several strategies directed against these mechanisms have been developed. With all this, a complete eradication of HIV has been achieved in a patient using the transplantation of haemopoietic stem cells that were resistant to HIV-infection, and there are examples of functional cure either spontaneously (elite controllers) or after antiretroviral therapy (post-treatment controllers). However, no strategies have been successful in reducing the reservoir size, nor in achieving constant, uniform remissions. The failure of isolated strategies makes it likely that the combination of several of them may be the future solution. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  16. Redefining Aging in HIV Infection Using Phenotypes.

    Science.gov (United States)

    Stoff, David M; Goodkin, Karl; Jeste, Dilip; Marquine, Maria

    2017-10-01

    This article critically reviews the utility of "phenotypes" as behavioral descriptors in aging/HIV research that inform biological underpinnings and treatment development. We adopt a phenotypic redefinition of aging conceptualized within a broader context of HIV infection and of aging. Phenotypes are defined as dimensions of behavior, closely related to fundamental mechanisms, and, thus, may be more informative than chronological age. Primary emphasis in this review is given to comorbid aging and cognitive aging, though other phenotypes (i.e., disability, frailty, accelerated aging, successful aging) are also discussed in relation to comorbid aging and cognitive aging. The main findings that emerged from this review are as follows: (1) the phenotypes, comorbid aging and cognitive aging, are distinct from each other, yet overlapping; (2) associative relationships are the rule in HIV for comorbid and cognitive aging phenotypes; and (3) HIV behavioral interventions for both comorbid aging and cognitive aging have been limited. Three paths for research progress are identified for phenotype-defined aging/HIV research (i.e., clinical and behavioral specification, biological mechanisms, intervention targets), and some important research questions are suggested within each of these research paths.

  17. Motivation, management, and mastery: a theory of resilience in the context of HIV infection.

    Science.gov (United States)

    De Santis, Joseph P; Florom-Smith, Aubrey; Vermeesch, Amber; Barroso, Susana; DeLeon, Diego A

    2013-01-01

    Clients with HIV infection have been conceptualized as a resilient population. Although a few researchers have documented resilience among clients with HIV infection, a theory of resilience in the context of HIV infection has not been developed. The purpose of this study was to describe the process by which resilience occurs for clients in the context of HIV infection. Grounded theory methodology was used to sample and analyze data from 15 qualitative interviews with adults with HIV infection. Data were collected until saturation was reached. A theory, motivation, management, and mastery, a description of the process by which resilience occurs in the context of HIV infection, emerged from the data. Many clients living with HIV infection are resilient, despite the physical, psychological, and social challenges of this chronic illness. Nursing interventions to promote resilience among clients with HIV infection should be directed toward identification of client motivation factors and disease management strategies that may influence health outcomes of people living with HIV infection.

  18. Longitudinal study of urban malaria in a cohort of Ugandan children: description of study site, census and recruitment

    Directory of Open Access Journals (Sweden)

    Staedke Sarah G

    2006-03-01

    Full Text Available Abstract Background Studies of malaria in well-defined cohorts offer important data about the epidemiology of this complex disease, but few have been done in urban African populations. To generate a sampling frame for a longitudinal study of malaria incidence and treatment in Kampala, Uganda, a census, mapping and survey project was conducted. Methods All households in a geographically defined area were enumerated and mapped. Probability sampling was used to recruit a representative sample of children and collect baseline descriptive data for future longitudinal studies. Results 16,172 residents living in 4931 households in a densely-populated community (18,824 persons/km2 were enumerated. A total of 582 households were approached with at least one child less than 10 years of age in order to recruit 601 children living in 322 households. At enrollment, 19% were parasitaemic, 24% were anaemic, 43% used bednets, and 6% used insecticide-treated nets. Low G6PD activity (OR = 0.33, P = 0.009 and bednet use (OR = 0.64, P = 0.045 were associated with a decreased risk of parasitaemia. Increasing age (OR = 0.62 for each year, P Conclusion Detailed surveys of target populations in urban Africa can provide valuable descriptive data and provide a sampling frame for recruitment of representative cohorts for longitudinal studies. Plans to use a multi-disciplinary approach to improve the understanding of the distribution and determinants of malaria incidence and response to therapy in this population are discussed.

  19. Chest closure without drainage after open patent ductus arteriosus ligation in Ugandan children: A non blinded randomized controlled trial.

    Science.gov (United States)

    Kebba, Naomi; Mwambu, Tom; Oketcho, Michael; Izudi, Jonathan; Obuku, Ekwaro A

    2016-09-29

    There is clinical equipoise regarding post-operative management of patients with patent ductus arteriosus (PDA) without insertion of a chest drain. This study evaluated post operative outcomes of chest closure with or without a drain following Patent Ductus Arteriosus ligation among childen at Uganda Heart Instritute (UHI). This was an open label randomized controlled trial of 62 children 12 years of age and below diagnosed with patent ductus arteriosus at Mulago National Teaching and Referral Hospital, Uganda. Participants were randomized in the ratio of 1:1 with surgical ligation of patent ductus arteriosus to either thoracotomy closure with a chest tube or without a chest tube. All participants received standard care and were monitored hourly for 24 hours then until hospital discharge. The combined primary endpoint consisted of significant pleural space accumulation of fluid or air, higher oxygen need or infection of the surgical site. Analysis was conducted by multivariable logistic regression analysis at 5 % significance level. We enrolled 62 participants, 46 (74 %) of whom were females. Their median age was 12 months (IQR: 8-36). Participants in the no-drain arm significantly had less post-operative complications compared to the drain arm (Unadjusted odds ratio [uOR]: 0.21, 95 % CI: 0.06-0.73, p = 0.015). This "protective effect" remained without statistical significance in the multivariable regression model (Adjusted odds ratio [aOR]: 0.07, 95 % CI: 0.00-2.50, p = 0.144). Children aged below 6 years with patent ductus arterious can safely and effectively have thoracotomy closure without using a drain in uncomplicated surgical ligation of the PDA. Chest drain was associated with post-operative complications. The trial was registered in the Pan African Clinical Trials registry on 1st/July/2012, retrospectively registered. Identifier number PACTR201207000395469 .

  20. Factors associated with abnormal spirometry among HIV-infected individuals.

    Science.gov (United States)

    Drummond, M Bradley; Huang, Laurence; Diaz, Philip T; Kirk, Gregory D; Kleerup, Eric C; Morris, Alison; Rom, William; Weiden, Michael D; Zhao, Enxu; Thompson, Bruce; Crothers, Kristina

    2015-08-24

    HIV-infected individuals are susceptible to development of chronic lung diseases, but little is known regarding the prevalence and risk factors associated with different spirometric abnormalities in this population. We sought to determine the prevalence, risk factors and performance characteristics of risk factors for spirometric abnormalities among HIV-infected individuals. Cross-sectional cohort study. We analyzed cross-sectional US data from the NHLBI-funded Lung-HIV consortium - a multicenter observational study of heterogeneous groups of HIV-infected participants in diverse geographic sites. Logistic regression analysis was performed to determine factors statistically significantly associated with spirometry patterns. A total of 908 HIV-infected individuals were included. The median age of the cohort was 50 years, 78% were men and 68% current smokers. An abnormal spirometry pattern was present in 37% of the cohort: 27% had obstructed and 10% had restricted spirometry patterns. Overall, age, smoking status and intensity, history of Pneumocystis infection, asthma diagnosis and presence of respiratory symptoms were independently associated with an abnormal spirometry pattern. Regardless of the presence of respiratory symptoms, five HIV-infected participants would need to be screened with spirometry to diagnose two individuals with any abnormal spirometry pattern. Nearly 40% of a diverse US cohort of HIV-infected individuals had an abnormal spirometry pattern. Specific characteristics including age, smoking status, respiratory infection history and respiratory symptoms can identify those at risk for abnormal spirometry. The high prevalence of abnormal spirometry and the poor predictive capability of respiratory symptoms to identify abnormal spirometry should prompt clinicians to consider screening spirometry in HIV-infected populations.

  1. Cutaneous Manifestations in HIV Infected Libyan Patients

    Directory of Open Access Journals (Sweden)

    Aljehawi Nabil A.

    2017-09-01

    Full Text Available Cutaneous manifestations of human immunodeficiency virus (HIV disease may result from HIV infection itself, or from opportunistic disorders secondary to the declined immunocompetence due to the disease. A total of 220 HIV positive patients, treated in the Benghazi Center of Infectious Diseases and Immunology over a period of 14 years (January 2003 to November 2016, were included in a retrospective study. The patients' age ranged from 7 to 46 years. The study was conducted by reviewing the patients' records using the management information system (MIS. Statistical analysis of the data was carried out by the t-test and Chi square test. Among the studied patients, 119 (54.1% were males and 101 (45.9% were females, and most of them (78.6% were 10 – 19 years of age. The predominant mode of transmission was parenteral transmission, in 95% of patients, and positive family history was observed in 12% of patients. Among the total number of visits to dermatologists, 93% of patients had a single disease. Of the total number of skin diseases diagnosed during the visits, parasitic infestations were seen in 92 patients (21.0%, eczematous and related disorders in 78 patients (17.8%, viral infections in 71 patients (16.2%, bacterial infections in 41 patients (9.3%, and fungal infections in 35 patients (7.9%. Dermatophyte infections were the most common fungal infections recorded in 19 patients (4.3%, followed by Candida infection in 11 patients (2.5%. Warts were found in 5.9% of viral infections, followed by herpes zoster (4.1%. HIV positive patients should be examined for skin disorders, because early diagnosis and management of such problems improves the quality of life in these patients.

  2. NKT cell depletion in humans during early HIV infection.

    Science.gov (United States)

    Fernandez, Caroline S; Kelleher, Anthony D; Finlayson, Robert; Godfrey, Dale I; Kent, Stephen J

    2014-08-01

    Natural killer T (NKT) cells bridge across innate and adaptive immune responses and have an important role in chronic viral infections such as human immunodeficiency virus (HIV). NKT cells are depleted during chronic HIV infection, but the timing, drivers and implications of this NKT cell depletion are poorly understood. We studied human peripheral blood NKT cell levels, phenotype and function in 31 HIV-infected subjects not on antiretroviral treatment from a mean of 4 months to 2 years after HIV infection. We found that peripheral CD4(+) NKT cells were substantially depleted and dysfunctional by 4 months after HIV infection. The depletion of CD4(+) NKT cells was more marked than the depletion of total CD4(+) T cells. Further, the early depletion of NKT cells correlated with CD4(+) T-cell decline, but not HIV viral levels. Levels of activated CD4(+) T cells correlated with the loss of NKT cells. Our studies suggest that the early loss of NKT cells is associated with subsequent immune destruction during HIV infection.

  3. Are HIV-Infected Older Adults Aging Differently?

    Science.gov (United States)

    Karpiak, Stephen E; Havlik, Richard

    With increasing success in treating HIV, infected persons are living longer, and a new challenge has emerged - the need to understand how HIV-infected adults are aging. What are the similarities with typical aging and what are the unique aspects that may have resulted from HIV infection, interacting with characteristic life style factors and other comorbid conditions? Are specific diseases and conditions (comorbidities), typically seen as part of the aging process, occurring at accelerated rates or with higher frequency (accentuated) in HIV-infected adults? At this juncture, conclusions should be tentative. Certainly, biological processes that correlate with aging occur earlier in the older adult HIV population. Clinical manifestations of these biological processes are age-associated illnesses occurring in greater numbers (multimorbidity), but they are not accelerated. Specifically cardiovascular disease, certain cancers, and renal disease are more common with other comorbidities less certain. Management of this elevated risk for developing multimorbidity is a major concern for patients and their health care teams. The medical system must respond to the evolving needs of this aging and growing older adult population who will dominate the epidemic. Adopting a more holistic approach to their health care management is needed to achieve optimal health and well-being in the HIV-infected older adult. Geriatric care principles best embody this approach. © 2017 S. Karger AG, Basel.

  4. Rate, correlates and outcomes of repeat pregnancy in HIV-infected women.

    Science.gov (United States)

    Floridia, M; Tamburrini, E; Masuelli, G; Martinelli, P; Spinillo, A; Liuzzi, G; Vimercati, A; Alberico, S; Maccabruni, A; Pinnetti, C; Frisina, V; Dalzero, S; Ravizza, M

    2017-07-01

    The aim of the study was to assess the rate, determinants, and outcomes of repeat pregnancies in women with HIV infection. Data from a national study of pregnant women with HIV infection were used. Main outcomes were preterm delivery, low birth weight, CD4 cell count and HIV plasma viral load. The rate of repeat pregnancy among 3007 women was 16.2%. Women with a repeat pregnancy were on average younger than those with a single pregnancy (median age 30 vs. 33 years, respectively), more recently diagnosed with HIV infection (median time since diagnosis 25 vs. 51 months, respectively), and more frequently of foreign origin [odds ratio (OR) 1.36; 95% confidence interval (CI) 1.10-1.68], diagnosed with HIV infection in the current pregnancy (OR: 1.69; 95% CI: 1.35-2.11), and at their first pregnancy (OR: 1.33; 95% CI: 1.06-1.66). In women with sequential pregnancies, compared with the first pregnancy, several outcomes showed a significant improvement in the second pregnancy, with a higher rate of antiretroviral treatment at conception (39.0 vs. 65.4%, respectively), better median maternal weight at the start of pregnancy (60 vs. 61 kg, respectively), a higher rate of end-of-pregnancy undetectable HIV RNA (60.7 vs. 71.6%, respectively), a higher median birth weight (2815 vs. 2885 g, respectively), lower rates of preterm delivery (23.0 vs. 17.7%, respectively) and of low birth weight (23.4 vs. 15.4%, respectively), and a higher median CD4 cell count (+47 cells/μL), with almost no clinical progression to Centers for Disease Control and Prevention stage C (CDC-C) HIV disease (0.3%). The second pregnancy was significantly more likely to end in voluntary termination than the first pregnancy (11.4 vs. 6.1%, respectively). Younger and foreign women were more likely to have a repeat pregnancy; in women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, suggesting that women with HIV infection who desire multiple

  5. The Importance of Quality of Care: Effects of Perinatal HIV Infection and Early Institutional Rearing on Preschoolers' Attachment and Indiscriminate Friendliness

    Science.gov (United States)

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

    2010-01-01

    Background: The rearing environment of human immunodeficiency virus (HIV)-infected children is often compromised, putting these children at additional risks. Positive caregiving may ameliorate the impact of adverse circumstances and promote attachment security. The goal of the present study was to examine the attachment relationships of…

  6. Early Diagnosis of HIV Infection in Infants - One Caribbean and Six Sub-Saharan African Countries, 2011-2015.

    Science.gov (United States)

    Diallo, Karidia; Kim, Andrea A; Lecher, Shirley; Ellenberger, Dennis; Beard, R Suzanne; Dale, Helen; Hurlston, Mackenzie; Rivadeneira, Molly; Fonjungo, Peter N; Broyles, Laura N; Zhang, Guoqing; Sleeman, Katrina; Nguyen, Shon; Jadczak, Steve; Abiola, Nadine; Ewetola, Raimi; Muwonga, Jérémie; Fwamba, Franck; Mwangi, Christina; Naluguza, Mary; Kiyaga, Charles; Ssewanyana, Isaac; Varough, Deyde; Wysler, Domercant; Lowrance, David; Louis, Frantz Jean; Desinor, Olbeg; Buteau, Josiane; Kesner, Francois; Rouzier, Vanessa; Segaren, Nat; Lewis, Tessa; Sarr, Abdoulaye; Chipungu, Geoffrey; Gupta, Sundeep; Singer, Daniel; Mwenda, Reuben; Kapoteza, Hilary; Chipeta, Zawadi; Knight, Nancy; Carmona, Sergio; MacLeod, William; Sherman, Gayle; Pillay, Yogan; Ndongmo, Clement B; Mugisa, Bridget; Mwila, Annie; McAuley, James; Chipimo, Peter J; Kaonga, Wezi; Nsofwa, Dailess; Nsama, Davy; Mwamba, Fales Zulu; Moyo, Crispin; Phiri, Clement; Borget, Marie-Yolande; Ya-Kouadio, Leonard; Kouame, Abo; Adje-Toure, Christiane A; Nkengasong, John

    2016-11-25

    Pediatric human immunodeficiency virus (HIV) infection remains an important public health issue in resource-limited settings. In 2015, 1.4 million children aged 50% decline. The most common challenges for access to testing for early infant diagnosis included difficulties in specimen transport, long turnaround time between specimen collection and receipt of results, and limitations in supply chain management. Further reductions in HIV mortality in children can be achieved through continued expansion and improvement of services for early infant diagnosis in PEPFAR-supported countries, including initiatives targeted to reach HIV-exposed infants, ensure access to programs for early infant diagnosis of HIV, and facilitate prompt linkage to treatment for children diagnosed with HIV infection.

  7. Retinitis due to opportunistic infections in Iranian HIV infected patients.

    Directory of Open Access Journals (Sweden)

    Ali Abdollahi

    2013-10-01

    Full Text Available We tried to evaluate prevalence and characteristics of Iranian HIV infected patients with retinitis due to opportunistic infections. In this cross sectional study, we evaluated 106 HIV infected patients via indirect ophthalmoscopy and slit lamp examination by 90 lens to find retinitis cases. General information and results of ophthalmologic examination were analyzed. Prevalence of retinitis due to opportunistic infections was 6.6%: cytomegalovirus (CMV retinitis 1.88%, toxoplasmosis retinochoroiditis 1.88% and tuberculosis chorioretinitis 2.83%. CD4 count was higher than 50 cell/µlit in both cases with CMV retinitis. Along with increasing survival in the HIV infected patients, the prevalence of complications such as ocular manifestation due to opportunistic infections are increasing and must be more considered.

  8. The involvement of plasmacytoid cells in HIV infection and pathogenesis.

    Science.gov (United States)

    Aiello, Alessandra; Giannessi, Flavia; Percario, Zulema A; Affabris, Elisabetta

    2018-04-01

    Plasmacytoid dendritic cells (pDCs) are a unique dendritic cell subset that are specialized in type I interferon (IFN) production. pDCs are key players in the antiviral immune response and serve as bridge between innate and adaptive immunity. Although pDCs do not represent the main reservoir of the Human Immunodeficiency Virus (HIV), they are a crucial subset in HIV infection as they influence viral transmission, target cell infection and antigen presentation. pDCs act as inflammatory and immunosuppressive cells, thus contributing to HIV disease progression. This review provides a state of art analysis of the interactions between HIV and pDCs and their potential roles in HIV transmission, chronic immune activation and immunosuppression. A thorough understanding of the roles of pDCs in HIV infection will help to improve therapeutic strategies to fight HIV infection, and will further increase our knowledge on this important immune cell subset. Copyright © 2018 Elsevier Ltd. All rights reserved.

  9. Pleurisy in tuberculosis and HIV-infected patients

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    A. K. Ivanov

    2014-01-01

    Full Text Available A clinical and epidemiological study for 14 years was conducted. Among TB patients, the percentage of persons with mixed infection (TB+HIV infection increased during the observation period from 10 up to 64%. About one third of them had a pleura reaction with an accumulation of fluid between pleura’s petals. Pleuritis in patients with mixed infection were characterized by special features: pleurisy complicated another form of tuberculosis more often, in one-third of patients (29,8% pleural liquid had hemorrhagic type, Mycobacterium tuberculosis in the pleural fluid was detected six times more often. The level of activity of adenosine deaminase and neopterin in the exudate of patients with tuberculosis and HIV infection remained significantly higher than in the control group of persons. These data can be useful in the diagnostics of specific diseases in HIV-infected patients.

  10. Incidence of chemotherapy-induced neutropenia in HIV-infected and ...

    African Journals Online (AJOL)

    show an increased incidence of breast cancer among HIV-infected ... on CIN in patients with breast cancer and HIV infection are scarce, ...... Crawford J. Pegfilgrastim for the prevention of chemotherapy-induced neutropenic complications, with.

  11. Impact of the Menstrual Cycle on Immunologic Markers in HIV-Infected Taiwanese Women

    Directory of Open Access Journals (Sweden)

    Kuang-Han Chao

    2006-03-01

    Conclusions: The CD8+ T cells were increased and activated in women with HIV infection but these alterations were not affected by the menstrual cycle. Therefore, sex hormones seem not to affect the course of HIV infection.

  12. Nutritional status of HIV-infected adults on antiretroviral therapy and ...

    African Journals Online (AJOL)

    2010-05-04

    May 4, 2010 ... infections. HIV infection, nutritional status and immune function are ... dominant aspect in this relationship is the effect of HIV infection on nutritional .... as part of the medical treatment of the patient, and training and monitoring ...

  13. Perinatal HIV-infection in Sankt Petersburg and Modern Therapy Concomitant Viral Infections

    Directory of Open Access Journals (Sweden)

    V. N. Timchenko

    2016-01-01

    Full Text Available 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 — 25.4 %. Combined therapy (causal, pathogenetic, symptomatic SARS in children with B-23 and R-75, allows you to get in early (6th d. Treatment regress the main symptoms of acute respiratory diseases. Modern therapy of congenital cytomegalovirus infection (VTSMI in children with B-23 and R-75 of the first year of life with antitsitomegalovirusnogo immunoglobulin and preparation of human recombinant interferon alfa-2b in the form of rectal suppositories — VIFERON, causes persistent normalization of clinical and laboratory parameters.

  14. Tubuloreticular inclusions in skin biopsies from patients with HIV infection

    DEFF Research Database (Denmark)

    Pedersen, C; Horn, T; Junge, Jette

    1989-01-01

    Skin biopsies obtained from apparently normal skin from 15 HIV infected patients and 6 anti-HIV negative patients were examined by electron microscopy. Tubuloreticular inclusions (TRI) were detected within the cytoplasm of capillary endothelial cells in 5/5 AIDS patients and in 2/5 patients...... of the patients without TRI, interferon activity was below detection level. The occurrence of TRI was not dependent on the presence of free p24 antigen in serum. It is concluded that the occurrence of TRI in entothelial cells of skin capillaries is associated with late stages of HIV infection and this may...

  15. Intimate partner violence and HIV infection among married Indian women.

    Science.gov (United States)

    Silverman, Jay G; Decker, Michele R; Saggurti, Niranjan; Balaiah, Donta; Raj, Anita

    2008-08-13

    Despite reductions in prevalence of human immunodeficiency virus (HIV) infection among the general population of India, women account for a rising percentage of all HIV cases with husbands' risk behavior described as the major source of women's infection. Intimate partner violence (IPV) has been described as being associated with heterosexual transmission of HIV to women in India and elsewhere. To assess the relationship between experiencing IPV and the occurrence of HIV infection in a nationally representative sample of married Indian women tested for HIV. The Indian National Family Health Survey 3 was conducted across all Indian states in 2005 through 2006. The nationally representative sample included 124,385 married women; analyses conducted in 2007 and 2008 were limited to 28,139 married women who provided IPV data and HIV test results via systematic selection into respective subsamples. Prevalence estimates of lifetime IPV and HIV infection were calculated and demographic differences assessed. Intimate partner violence was conceptualized as physical violence with or without sexual violence and then was further categorized as physical violence only vs physical and sexual violence. Regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for HIV infection among Indian women based on experiences of IPV after adjusting for demographics and women's HIV risk behaviors. One-third of married Indian women (35.49%) reported experiencing physical IPV with or without sexual violence from their husbands; 7.68% reported both physical and sexual IPV, and 27.80% reported experiencing physical IPV in the absence of sexual violence. Approximately 1 in 450 women (0.22%) tested positive for HIV. In adjusted models, married Indian women experiencing both physical and sexual violence from husbands demonstrated elevated HIV infection prevalence vs those not experiencing IPV (0.73% vs 0.19%; adjusted OR, 3.92; 95% CI, 1.41-10.94; P = .01

  16. Zygomycosis Associated with HIV Infection and Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Larry Nichols

    2011-01-01

    Full Text Available Zygomycosis is an increasing threat to patients with human immunodeficiency virus (HIV infection. Zygomycosis (formerly called mucormycosis is the fungal infection with Mucor, Rhizopus, or other species that share a common morphology of large empty pauciseptate hyphae with rare random-angle branching and a collapsed “twisted ribbon” appearance. Morphology allows a specific diagnosis on frozen section or smear prior to growth and identification of the fungi in culture which makes it improtant because treatment is different than that for more common mycoses such as candidiasis and aspergillosis. We present an informative and illustrative case of zygomycosis in a patient with HIV infection and liver transplantation.

  17. Testosterone Replacement Therapy and Polycythemia in HIV-infected Patients

    Science.gov (United States)

    Vorkas, Charles Kyriakos; Vaamonde, Carlos M.; Glesby, Marshall J.

    2013-01-01

    We conducted a case-control study to assess testosterone use as a primary risk factor for polycythemia in 21 HIV-infected men. Any testosterone use within two months of first elevated hemoglobin was associated with polycythemia (matched odds ratio 6.55; 95% CI 1.83-23.4; P=0.004) and intramuscular administration demonstrated a stronger association than topical use. No adverse cardiovascular or thrombotic events were observed. HIV-infected patients taking testosterone should undergo routine hematologic monitoring with adjustment of therapy when appropriate. PMID:22008652

  18. Decreasing cardiovascular risk in HIV infection between 2005 and 2011.

    Science.gov (United States)

    De Socio, Giuseppe V; Parruti, Giustino; Ricci, Elena; Maggi, Paolo; Celesia, Benedetto M; Penco, Giovanni; Martinelli, Canio; Franzetti, Marco; Di Biagio, Antonio; Bonfanti, Paolo; Pucci, Giacomo; Schillaci, Giuseppe

    2014-02-20

    Cardiovascular risk profile was compared in 765 Italian HIV-infected outpatients enrolled in 2005 and in 765 individually age-matched and sex-matched patients enrolled in 2011. Median Framingham risk score was 8.6% in 2005 vs. 7.9% in 2011 (P = 0.04); metabolic syndrome was present in 40.3% vs. 33.4% (P = 0.006). Blood glucose, triglycerides, prevalence of smokers, and lipodystrophy were all significantly lower in 2011 (all P < 0.0001). Cardiovascular risk improved over a 6-year period in Italian HIV-infected patients.

  19. DMPD: Is HIV infection a TNF receptor signalling-driven disease? [Dynamic Macrophage Pathway CSML Database

    Lifescience Database Archive (English)

    Full Text Available 18178131 Is HIV infection a TNF receptor signalling-driven disease? Herbein G, Khan... KA. Trends Immunol. 2008 Feb;29(2):61-7. (.png) (.svg) (.html) (.csml) Show Is HIV infection a TNF receptor signalling-driven dise...ase? PubmedID 18178131 Title Is HIV infection a TNF receptor signalling-driven diseas

  20. Characteristics of HIV-infected adults in the Deep South and their utilization of mental health services: A rural vs. urban comparison.

    Science.gov (United States)

    Reif, Susan; Whetten, Kathryn; Ostermann, Jan; Raper, James L

    2006-01-01

    Insufficient utilization of mental health services has been described among HIV-infected individuals in urban areas; however, little is known about utilization of mental health services among rural-living HIV-infected individuals. This article examines use of mental health services by HIV-infected adults in the Southern U.S., where approximately two-thirds of rural HIV cases reside, and compares mental health services use between those in rural and urban areas. Data were obtained from surveys of HIV-infected individuals receiving care at tertiary Infectious Diseases clinics in the Southern U.S. (n = 474). Study findings indicated that participants living in areas with a higher proportion of rural-living individuals were less likely to report seeing a mental health provider (p mental health visits in the previous month (p = .025). Furthermore, rural living was significantly associated with being African-American, heterosexual, less educated, and having minor children in the home. Due to differences in characteristics and mental health services use by degree of rurality, efforts are needed to assess and address the specific mental health and other needs of HIV-infected individuals in rural areas.

  1. Facilitators and barriers to discussing HIV prevention with adolescents: perspectives of HIV-infected parents.

    Science.gov (United States)

    Edwards, Laura L; Reis, Janet S; Weber, Kathleen M

    2013-08-01

    We examined HIV-infected parents' conversations about HIV prevention with their uninfected children, including what facilitated or hindered communication. Parents with HIV/AIDS (n = 90) who had children aged 10 to 18 years were recruited for a mixed method study from 2009 to 2010. Interviews assessed facilitators and barriers to discussing HIV prevention. A questionnaire identified the frequency and content of conversations, parental confidence level, and perceived importance of discussing preventive topics. Eighty-one percent of parents reported "sometimes" or "often" communicating about HIV prevention. A subset of parents found these conversations difficult; 44% indicated their desire for support. Facilitators to communication included utilizing support, focusing on the benefits of talking, and having a previous relationship with one's child. Barriers to discussions included fear of negative consequences, living in denial, and lacking a parental role model who discussed safer sex. Parents varied as to how they believed their HIV status affected communication. Those who did not disclose their HIV status to their children reported less frequent communication; self-efficacy partially mediated this relationship. Findings highlighted the need for communication skills training that support HIV-infected parents in their efforts to discuss HIV-related information with adolescents.

  2. Facilitators and Barriers to Discussing HIV Prevention With Adolescents: Perspectives of HIV-Infected Parents

    Science.gov (United States)

    Reis, Janet S.; Weber, Kathleen M.

    2013-01-01

    Objectives. We examined HIV-infected parents’ conversations about HIV prevention with their uninfected children, including what facilitated or hindered communication. Methods. Parents with HIV/AIDS (n = 90) who had children aged 10 to 18 years were recruited for a mixed method study from 2009 to 2010. Interviews assessed facilitators and barriers to discussing HIV prevention. A questionnaire identified the frequency and content of conversations, parental confidence level, and perceived importance of discussing preventive topics. Results. Eighty-one percent of parents reported “sometimes” or “often” communicating about HIV prevention. A subset of parents found these conversations difficult; 44% indicated their desire for support. Facilitators to communication included utilizing support, focusing on the benefits of talking, and having a previous relationship with one’s child. Barriers to discussions included fear of negative consequences, living in denial, and lacking a parental role model who discussed safer sex. Parents varied as to how they believed their HIV status affected communication. Those who did not disclose their HIV status to their children reported less frequent communication; self-efficacy partially mediated this relationship. Conclusions. Findings highlighted the need for communication skills training that support HIV-infected parents in their efforts to discuss HIV-related information with adolescents. PMID:23763390

  3. Expectations of vertical transmission of hiv from HIV-infected mothers in a research process at Sorocaba/SP

    OpenAIRE

    Danilo de Assis Pereira; Denise Moraes Horiy; Evelise de Oliveira Proença; Acácio Sidinei Almeida Santos

    2014-01-01

    ABSTRACT Introduction: Vertical transmission of AIDS is defined as a transmission that occurs from mother to child during pregnancy, birth or breastfeeding and is today the main route of HIV infection in children under 13 in the world. Objective: in order to understand the history of life and the therapeutic itinerary of HIV positive pregnant women, it was conducted a study with a qualitative approach to social phenomenology as theoretical and methodological references. Methods: For the st...

  4. 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...... compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4-111) vs. 8 (IQR 2-38) weeks, respectively], and highest in perinatally infected participants aged 10-14 years [49 (IQR 9-267) weeks]. The cumulative proportion with TCVF 5 years after starting ART......: We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged

  5. Diagnosis of imported Ugandan typhoid fever based on local outbreak information: A case report.

    Science.gov (United States)

    Ota, Shinichiro; Maki, Yohei; Mori, Kazuma; Hamamoto, Takaaki; Kurokawa, Atsushi; Ishihara, Masashi; Yamamoto, Takayuki; Imai, Kazuo; Misawa, Kazuhisa; Yuki, Atsushi; Fujikura, Yuji; Maeda, Takuya; Kawana, Akihiko

    2016-11-01

    Re-emerging multidrug-resistant typhoid fever is becoming a worldwide threat, especially in East Africa. At the beginning of 2015, an outbreak of typhoid fever started in the capital city of Uganda, and 1940 suspected cases were reported by 5 March 2015. In this report, we describe a case of typhoid fever caused by a MDR strain with HIV infection and hemoglobin S-syndrome thalassemia in an Ugandan from Kampala City. It is essential to consider MDR strains of Salmonella enterica serovar Typhi infections, including fluoroquinolone-resistant strains, in patients from Africa and Southeast Asia. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  6. A Discrete Model for HIV Infection with Distributed Delay

    Directory of Open Access Journals (Sweden)

    Brahim EL Boukari

    2014-01-01

    Full Text Available We give a consistent discretization of a continuous model of HIV infection, with distributed time delays to express the lag between the times when the virus enters a cell and when the cell becomes infected. The global stability of the steady states of the model is determined and numerical simulations are presented to illustrate our theoretical results.

  7. Secondary syphilis in HIV infection - a diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Panvelker V

    1997-01-01

    Full Text Available A case of secondary syphilis in HIV infection is being reported. The patient presented with skin rash only. VDRL was found to be negative and HIV testing was positive. He was treated for secondary syphilis with clinical response. Blood VDRL test was subsequently reported as reactive.

  8. Frequency of Subclinical Atherosclerosis in Brazilian HIV-Infected Patients.

    Science.gov (United States)

    Salmazo, Péricles Sidnei; Bazan, Silméia Garcia Zanati; Shiraishi, Flávio Gobbis; Bazan, Rodrigo; Okoshi, Katashi; Hueb, João Carlos

    2018-04-09

    AIDS as well as atherosclerosis are important public health problems. The longer survival among HIV-infected is associated with increased number of cardiovascular events in this population, and this association is not fully understood. To identify the frequency of subclinical atherosclerosis in HIV-infected patients compared to control subjects; to analyze associations between atherosclerosis and clinical and laboratory variables, cardiovascular risk factors, and the Framingham coronary heart disease risk score (FCRS). Prospective cross-sectional case-control study assessing the presence of subclinical atherosclerosis in 264 HIV-infected patients and 279 controls. Clinical evaluation included ultrasound examination of the carotid arteries, arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx), laboratory analysis of peripheral blood, and cardiovascular risk according to FCRS criteria. The significance level adopted in the statistical analysis was p media thickness was higher in the HIV group than in controls (p media thickness, was not associated with carotid plaque frequency, and did not alter the mechanical characteristics of the arterial system (PWV and AIx). HIV-infected patients are at increased risk of atherosclerosis in association with classical cardiovascular risk factors. Treatment with protease inhibitors does not promote functional changes in the arteries, and shows no association with increased frequency of atherosclerotic plaques in carotid arteries. The FCRS may be inappropriate for this population.

  9. Interleukin-2 therapy in patients with HIV infection

    DEFF Research Database (Denmark)

    Abrams, D; Lévy, Y; Losso, M H

    2009-01-01

    Interleukin-2 in HIV-Infected Patients with Low CD4+ Counts under Active Antiretroviral Therapy (SILCAAT) study and the Evaluation of Subcutaneous Proleukin in a Randomized International Trial (ESPRIT). In each, patients infected with the human immunodeficiency virus (HIV) who had CD4+ cell counts of either...

  10. (HIV) INFECTION AMONG ANTENATAL CLINIC ATTENDEES IN St ...

    African Journals Online (AJOL)

    DJFLEX

    The prevalence of human immunodeficiency virus (HIV) infection was estimated among pregnant women attending clinic at St. ... percentage prevalence by educational status was: women with no formal education 37.5%; those with secondary education, 11.3% and ..... 81% at age 18. These young married girls lack proper.

  11. Oxidative Stress in Patients with HIV-Infection

    Directory of Open Access Journals (Sweden)

    L.V. Moroz

    2013-11-01

    Full Text Available In the study we investigated the frequency and depth of liver injury in patients with acquired immunodeficiency syndrome, depending on age, sex, duration of disease, effects of highly active antiretroviral therapy (HAART. It is found that in patients with HIV-infection with the III degree of hepatotoxicity, antioxidant defense system is more depleted under the influence of HAART.

  12. Intimate partner violence among HIV infected and uninfected ...

    African Journals Online (AJOL)

    User

    women and vulnerable groups such as HIV-infected women. .... 12.00 hr to 13.00 hr with an intention of assuring privacy and freedom of participants to open up ... Single. 29. 32.6. 60. 67.4. 89. 23.9. Married. 43. 19.3. 180. 80.7. 223. 60.0.

  13. HIV infection in India: Epidemiology, molecular epidemiology and ...

    Indian Academy of Sciences (India)

    PRAKASH KUMAR

    The first case of HIV infection as well as first case of AIDS was reported in India ... There are very few studies on host genetic factors in India in context with ... In 2006, the surveillance network was expanded to. 1,122 sentinel sites covering almost every district in the ... A series of regional workshops in the country organized.

  14. Nodular Lymphangitis in HIV-Infected Patients in Tanzania | Mapesi ...

    African Journals Online (AJOL)

    Early diagnosis, biopsy or culture of skin lesions and treatment are essential for improving outcomes. However, this is challenging in resource-limited settings. We present two HIV-infected patients with nodular lymphangitis treated with ketoconazole in the absence of itraconazole or amphotericin B with good initial response ...

  15. Phocomelia in an HIV infected baby: Case report | Udo | Nigerian ...

    African Journals Online (AJOL)

    Phocomelia in an HIV infected baby: Case report. JJ Udo, SO Ochigbo, OE Ikpeme, TE Nlemadim. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/njp.v40i4.16 · AJOL African Journals Online. HOW TO USE ...

  16. HIV infection and the kidney | Fabian | Southern African Journal of ...

    African Journals Online (AJOL)

    There is a wide clinical spectrum of renal disease in the course of HIV infection, which includes potentially reversible acute renal failure (ARF) (more recently known as acute kidney injury), electrolyte and acid-base disturbances, and intrinsic renal disease unrelated to HIV itself (e.g. co-morbid diabetes mellitus and ...

  17. Tobacco Use among ARV Treated HIV Infected Rural South Africans ...

    African Journals Online (AJOL)

    Tobacco use remains one of the major cardiovascular risk factors and its use in ... human immunodeficiency virus (HIV) infected people may lead to activation of immune ... marital status (p=0.03) and alcohol consumption (p=0.001) were significant ... interferes with viral suppression despite treatment with antiretroviral drugs.

  18. Stroke in a patient with tuberculous meningitis and HIV infection

    Directory of Open Access Journals (Sweden)

    Maria Bruna Pasticci

    2013-02-01

    Full Text Available Abstract. Tuberculous meningitis (TBM is a devastating disease. TBM occurs more commonly in HIV infected patients. The influence of HIV co-infection on clinical manifestations and outcome of TBM is not well defined. Yet, some differences have been observed and stroke has been recorded to occur more frequently. This study reports on an HIV infected Caucasian female with lung, meningeal tuberculosis and stroke due to a cortical sub-cortical ischemic lesion.TBM was documented in the absence of neurologic symptoms. At the same time, miliary lung TB caused by multi-susceptible Mycobacterium tuberculosis was diagnosed. Anti-TB therapy consisting of a combination of four drugs was administered. The patient improved and was discharged five weeks later. In conclusion, TBM and multiple underling pathologies including HIV infection, as well as other risk factors can lead to a greater risk of stroke. Moreover, drug interactions and their side effects add levels of complexity. TBM must be included in the differential diagnosis of HIV infected patients with stroke and TBM treatment needs be started as soon as possible before the onset of vasculopathy.

  19. Peripheral neuropathy in patients with HIV infection: consider dual pathology.

    Science.gov (United States)

    Miller, R F; Bunting, S; Sadiq, S T; Manji, H

    2002-12-01

    Two HIV infected patients presented with peripheral neuropathy, in one patient this was originally ascribed to HIV associated mononeuritis multiplex and in the other to stavudine. Investigations confirmed these diagnoses and in both cases genetic analysis identified a second hereditary aetiology: in the first patient hereditary neuropathy with liability to pressure palsies and in the second hereditary motor and sensory neuropathy.

  20. Thrombocytopenia during pregnancy in women with HIV infection ...

    African Journals Online (AJOL)

    Background. Thrombocytopenia (TCP) complicates 5 - 8% of pregnancies. Most cases of TCP are gestational, and the condition is usually mild and occurs in the latter part of pregnancy. Apart from pregnancy-associated medical complications such as pre-eclampsia, HIV infection is a recognised cause of TCP, and a ...

  1. Prevalence of cervical cytology abnormalities among HIV infected ...

    African Journals Online (AJOL)

    Objectives: To establish the prevalence of cervical cytology abnormalities, determine the correlation between CD4+ cell count and abnormal Pap smear, determine the correlation between WHO-HIV staging and abnormal pap smear among HIV infected women attending HIV clinic at Rwanda Military Hospital. Design: ...

  2. affordable management of hiv infection in the private sector

    African Journals Online (AJOL)

    Management (Pty) Ltd (PBM) has developed a comprehensive programme ('Aid for AIDS') to allow for reimburseme.ilt of all aspects of treatment of HIV/ AIDS. Its aim is to facilitate clinical and financial management of HIV infection and to reimburse the most ... pharmacists and hospitals deal directly with the unit, HIV- positive ...

  3. Bone mineral density abnormalities in HIV infected patients and HIV ...

    African Journals Online (AJOL)

    Bone mineral density abnormalities in HIV infected patients and HIV ... Comprehensive Care Clinic (CCC) and a HIV negative control group seen at the ... Older patients had lower levels of BMD (i.e. more negative BMD. p-value = 0.032).

  4. The Prevalence of HIV Infection among Pregnant Women at ...

    African Journals Online (AJOL)

    AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search · USING AJOL · RESOURCES ... Log in or Register to get access to full text downloads. ... The HIV infection has been a threat to mothers and their babies since many years in ... But persistent vigilance is needed to prevent the Mother to Child transmission.

  5. Prevalence of HIV infection among the patients with an avascular ...

    African Journals Online (AJOL)

    Objective: To study the prevalence of HIV infection among the risk factors associated with the avascular necrosis of the femoral head in Ouagadougou, Burkina Faso. Design: Multicenter retrospective study. Setting: Rheumatology consultations and Orthopedic-Traumatology Surgery Department Of The University Hospital ...

  6. Migration, pastoralists, HIV infection and access to care: the ...

    African Journals Online (AJOL)

    The burden of HIV infection among the nomadic Fulani of northern Nigeria is unknown. Migration — a way of life for this population — is known to increase the rate of HIV transmission and may limit individuals' access to treatment and care. Many of Africa's other traditional, pastoral societies are similarly affected. This paper ...

  7. Poverty, sexual behaviour, gender and HIV infection among young ...

    African Journals Online (AJOL)

    While we found a clear association between the number of years of sexual activity and HIV status among both men and women, we found that past participation in a concurrent sexual partnership increased the odds of HIV infection for men but not women. Women, but not men, who made the transition from school to tertiary ...

  8. Hypertension in Pregnancy among HIV-Infected Women in Sub ...

    African Journals Online (AJOL)

    Hypertension in Pregnancy among HIV-Infected Women in Sub-Saharan Africa: Prevalence and Infant Outcomes. C Kilewo, UCM Natchu, A Young, D Donnell, E Brown, JS Read, U Sharma, BH Chi, R Goldenberg, I Hoffman, TE Taha, WW Fawzi ...

  9. Prevalence of cryptococcosis among HIV-infected patients in ...

    African Journals Online (AJOL)

    Objective: To investigate the prevalence of cryptococcosis among HIV infected patients in Yaounde. Methods: In a hospital-based surveillance study of cryptococcosis, the colonization of Cerebrospinal Fluid (CSF), urine and blood sample by C. neoformans was evaluated by direct microscopic examination and culture ...

  10. Syphilis and HIV infections among pregnant women attending ...

    African Journals Online (AJOL)

    Syphilis and HIV infections among pregnant women attending antenatal clinics in Republic of Congo. ... Introduction: HIV and syphilis during pregnancy remain a public health concern especially in developing countries. Pregnant women ... Marital status and sentinel site location were a risk factor associated with. HIV and ...

  11. Interleukin Gene Polymorphisms and Susceptibility to HIV Infection

    Indian Academy of Sciences (India)

    Chrysa

    vaccines, and with almost 36.7 million HIV-infected individuals worldwide .... The allelic and genotypic distribution of the IL genes SNPs are presented in .... polymorphism using the genetic model-free bivariate approach produced, as in ... Through its immuno-inhibitory and anti-inflammatory activities and, in particular, by.

  12. Vulnerability of wives of Nepalese labor migrants to HIV infection

    DEFF Research Database (Denmark)

    Thapa, Subash; Bista, Nirmala; Hannes, Karin

    2016-01-01

    HIV risk is determined by the interaction between social and individual risk factors, but information about such factors among Nepalese women is not yet understood. Therefore, to assess the risk factors and vulnerability of the wives of Nepalese labor migrants to HIV infection, the authors...

  13. Psychiatric symptoms and disorders in HIV infected mine workers in ...

    African Journals Online (AJOL)

    Several other psychiatric symptoms and disorders, such as psychosis, secondary mania and depression, have also been associated ... contract, the workers returned home to their families in the rural areas ... 000 (23%) for HIV infection within the work force (Dr. Brian. Brink ..... Posttraumatic stress disorder (PTSD) was not.

  14. 13 Research Article ABSTRACT Liver diseases in HIV infected ...

    African Journals Online (AJOL)

    2016-11-10

    Nov 10, 2016 ... Liver diseases in HIV infected persons can occur due to hepatitis B virus (HBV) and hepatitis C virus ... immunochromatographic test in Yaoundé central hospital, from ..... Hepatitis. B and C virus co-infection in The TREAT Asia.

  15. PRE-EXPOSURE PROPHYLAXIS FOR PREVENTION OF HIV INFECTION

    Directory of Open Access Journals (Sweden)

    Ana Rita Diniz

    2015-04-01

    Full Text Available Objectives: To review existing data on Pre-Exposure Prophylaxis (PrEP for prevention of HIV infection, including the role of medical male circumcision, oral administration of antiretroviral drugs and topical microbicides. Data Sources: PubMed and www.clinicaltrials.gov. Review Methods: Comprehensive review. Results: Medical male circumcision has been shown to prevent 48-60% of new HIV-1 infections. The efficacy rate of antiretroviral drugs given per os to prevent HIV infection varies in direct association with the adherence rate (62.2% in TDF2 study with 84% adherence; 44% in iPrEx study with <50% adherence; 48% in Bangkok study with 67% adherence; 67-75% in Partners PrEP study with 82% adherence; and 6% in FEM-PrEP study with 40% adherence. As for the use of topic microbicides, the CAPRISA 004 study showed 39% reduction in HIV infection using a 1% tenofovir gel. On the other hand, PRO2000 gel showed a modest reduction of 30% which was not statistically significant. Conclusions: The studies suggest that medical male circumcision is highly cost-effective at preventing HIV infection but requires careful communication strategies to be successful. PrEP using antiretroviral drugs is also very effective but it is highly dependent on the adherence rate. As for topical microbicides, 1% tenofovir gel is currently the only promising option.

  16. Achievement of interventions on HIV infection prevention among ...

    African Journals Online (AJOL)

    In China, migrants with acquired immunodeficiency syndrome (AIDS) have become a serious problem in the field of AIDS prevention. This study aimed to evaluate the efficacy of interventions for human immunodeficiency virus (HIV) infection prevention for migrants in China and to identify factors associated with intervention ...

  17. Awareness of Human Immunodeficiency Virus (HIV) infection among ...

    African Journals Online (AJOL)

    Objective: To determine the level of awareness of Human Immunodeficiency Virus (HIV) infection among antenatal clients in Nnewi Nigeria. Subjects and Methods: A cross sectional descriptive study of six hundred consecutive antenatal clients attending the Nnamdi Azikiwe University Teaching Hospital and five private ...

  18. Management of human immunodeficiency virus (HIV) infection in ...

    African Journals Online (AJOL)

    Management of human immunodeficiency virus (HIV) infection in adults in resource-limited countries: Challenges and prospects in Nigeria. AG Habib. Abstract. No Abstract. Annals of Ibadan Postgraduate Medicine Vol. 3 (1) 2005: pp. 26-32. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL ...

  19. Risk factors for discordant immune response among HIV-infected ...

    African Journals Online (AJOL)

    Risk factors for discordant immune response among HIV-infected patients initiating antiretroviral therapy: A retrospective cohort study. ... Multivariate logistic regression models were used to estimate adjusted odds ratios (AORs) to determine associations between discordant immune response and clinical and demographic ...

  20. Prevalence of HIV infection among premarital couples in southeast ...

    African Journals Online (AJOL)

    The Catholic Church in Nigeria offers premarital HIV screening to couples, yet instances of voluntary screening are rare in southeast Nigeria. This study examines the contribution of such tests to HIV detection, and evaluates the prevalence of HIV infection in southeast Nigeria among couples who are planning to marry.

  1. Management of Infertility in HIV infected couples: A Review ...

    African Journals Online (AJOL)

    for fertility services in the HIV-positive population has thus increased and may be employed for management of infertility and protection from transmission or acquisition of HIV infection. As such, preconception counseling, sexual health and fertility screening have become routine in the management of HIV-positive couples.

  2. Innate immune recognition and activation during HIV infection

    Directory of Open Access Journals (Sweden)

    Larsen Carsten S

    2010-06-01

    Full Text Available Abstract The pathogenesis of HIV infection, and in particular the development of immunodeficiency, remains incompletely understood. Whichever intricate molecular mechanisms are at play between HIV and the host, it is evident that the organism is incapable of restricting and eradicating the invading pathogen. Both innate and adaptive immune responses are raised, but they appear to be insufficient or too late to eliminate the virus. Moreover, the picture is complicated by the fact that the very same cells and responses aimed at eliminating the virus seem to play deleterious roles by driving ongoing immune activation and progressive immunodeficiency. Whereas much knowledge exists on the role of adaptive immunity during HIV infection, it has only recently been appreciated that the innate immune response also plays an important part in HIV pathogenesis. In this review, we present current knowledge on innate immune recognition and activation during HIV infection based on studies in cell culture, non-human primates, and HIV-infected individuals, and discuss the implications for the understanding of HIV immunopathogenesis.

  3. Diagnosis and monitoring of HIV infection | Glass | South African ...

    African Journals Online (AJOL)

    The virus infects people of all ages and social classes. A diagnosis of HIV has serious physical, emotional and social implications for the patient. HIV-infected patients are susceptible to numerous opportunistic and other infections, as well as to non-infectious diseases such as tumours. They eventually require lifelong ...

  4. Sepsis in HIV-infected patients; epidemiology and host response

    NARCIS (Netherlands)

    Huson, M.A.M.

    2016-01-01

    In this thesis, we examined the impact of HIV infection on the epidemiology (Part I) of sepsis, and host response (Part II) to sepsis. We studied sepsis patients in Gabon, a setting with a high prevalence of HIV, and in Dutch intensive care units (ICUs). In Part I, we found that HIV positive

  5. SOCIAL AND PSYCHOLOGICAL FEATURES OF HIV-INFECTED INDIVIDUALS

    Directory of Open Access Journals (Sweden)

    Liliya Anatolyevna Kudrich

    2016-02-01

    Full Text Available By 2020 the prevalence of HIV in the Russian Federation may increase by 250%, unless we provide appropriate treatment to as many HIV-infected people as possible (V.I. Skvortsova, 2015. Previous research in this field shows that the psychotraumatic character of the disease lowers the psychological resource of HIV-infected individuals. In most cases, they are not psychologically prepared for the negative life events, unable to find an optimal behavioral pattern when their life stereotypes are being destroyed. In fact, being HIV-infected is an example of an acute event (V.V. Pokrovsky, 1993. The ability to overcome the life crisis and effectiveness of using adaptation and compensatory mechanisms to fight the disease depend on the level of adaptation to the fact of being infected and resistance to stress. The aim of the current study was to determine social and psychological features of HIV-infected individuals and assess their influence on the stress resistance and adaptation abilities of HIV+ patients. We observed men and women aged 21-30 who had been HIV+ for 1-5 years. Investigation methods included the following diagnostic tools: The Cattel Sixteen Personality Factor Questionnaire (Form C, The State-Trait Anxiety Inventory (conducted by Spielberger, adapted for use in Russia by Hanin, The Social Readjustment Rating Scale (The Holmes-Rahe Stress Inventory, The Social and Psychological Adaptation Questionnaire (by C. Rogers and R. Diamond, methods of mathematical statistics. As a result of the study, we have developed comparative factor profiles of individual psychological features of HIV-infected individuals that show their dependence on the social environment and form certain behavioral patterns. We have revealed significant difference in state and trait anxiety between HIV-infected and non-HIV-infected individuals. Self-blame, inadequate self-esteem and level of aspiration indicate low cognitive assessment of the condition by the patients

  6. Cancer clinical trials in persons with HIV infection.

    Science.gov (United States)

    Little, Richard F

    2017-01-01

    The era of modern HIV therapeutics is well underway. The cancer and infectious disease epidemiology of HIV disease has markedly altered as populations are availed to the benefits of antiretroviral therapy (ARV). The types of cancers occurring among those with HIV infection has broadened but the case burden in absolute numbers is very low relative to the background population. There are fewer incident cases of the AIDS-defining cancers (aggressive B-cell lymphomas, Kaposi's sarcoma, and cervical cancer). There is an increased risk for certain non-AIDS-defining cancers, but these occur somewhat sporadically relative to clinical trial enrollment. The changing epidemiology of cancer in HIV poses challenges as well as opportunities for participation of persons with HIV in cancer therapy clinical trials. There are excellent examples of cancer trials that inform cancer therapy for patients with HIV infection. Examples include those from HIV-specific trials and from trials mainly focused on the background population that included patients with HIV infection. Interpretation of clinical trials to guide therapy for those with HIV infection and cancer largely depends on data that does not include HIV-infected patients. The ability to extend clinical trial findings to populations not included in clinical trials remains problematic for a variety of populations, including those with HIV or AIDS. Careful prioritization of studies designed to bridge this gap is needed. However, there are published studies that serve as excellent examples bridging these gaps and the portfolio of cancer therapy trials underway will inform HIV and cancer better than at any time in the past.

  7. Correlates of Prevalent Disability Among HIV-Infected Elderly Patients.

    Science.gov (United States)

    Ávila-Funes, José Alberto; Belaunzarán-Zamudio, Pablo Francisco; Tamez-Rivera, Oscar; Crabtree-Ramírez, Brenda; Navarrete-Reyes, Ana Patricia; Cuellar-Rodríguez, Jennifer; Sierra-Madero, Juan; Amieva, Hélène

    2016-02-01

    The growing elderly population of HIV-infected patients is leading to a significant epidemiological transition and HIV infection has been proposed as a premature and accelerated aging model rending the individual more susceptible to premature disability. However, the determinants of disability among this emergent population are still lacking. Therefore, the aim of this study is to determine the correlates of prevalent disability in adults ≥50 years with HIV infection. A cross-sectional study of 184 HIV-infected adults receiving ambulatory care in an HIV clinic of a tertiary care, university-affiliated hospital in Mexico City was conducted. Disability for instrumental (IADL) and basic activities of daily living (ADL) was established. Sociodemographic factors, clinical variables, current CD4(+) cell count, and HIV viral load (VL) were tested as potential determinants of disability. Multivariate logistic regression analyses were used to identify the correlates of both types of disability. The mean age was 59.3 years. All participants were receiving highly active antiretroviral therapy. Of participants 17.9% had disability for IADL and 26.1% for ADL. Multivariate logistic regression analyses indicated that being older; having a lower CD4(+) cell count, and having a detectable HIV VL were independently associated with both types of disability. In addition, educational level was also independently associated with ADL disability. Age, educational level, low CD4(+) cell count, and detectable HIV VL were independently associated with disability. Whether effective and timely antiretroviral therapy will reduce the risk of disability in HIV-infected elderly patients needs to be evaluated.

  8. Genital Herpes Simplex Virus Type 2 Shedding Among Adults With and Without HIV Infection in Uganda.

    Science.gov (United States)

    Phipps, Warren; Nakku-Joloba, Edith; Krantz, Elizabeth M; Selke, Stacy; Huang, Meei-Li; Kambugu, Fred; Orem, Jackson; Casper, Corey; Corey, Lawrence; Wald, Anna

    2016-02-01

    Despite the high prevalence of herpes simplex virus type 2 (HSV-2) in sub-Saharan Africa, the natural history of infection among Africans is not well characterized. We evaluated the frequency of genital HSV shedding in HIV-seropositive and HIV-seronegative men and women in Uganda. Ninety-three HSV-2-seropositive Ugandan adults collected anogenital swab specimens for HSV DNA quantification by polymerase chain reaction 3 times daily for 6 weeks. HSV-2 was detected from 2484 of 11 283 swab specimens collected (22%), with a median quantity of 4.3 log10 HSV copies/mL (range, 2.2-8.9 log10 HSV copies/mL). Genital lesions were reported on 749 of 3875 days (19%), and subclinical HSV shedding was detected from 1480 of 9113 swab specimens (16%) collected on days without lesions. Men had higher rates of total HSV shedding (relative risk [RR], 2.0 [95% confidence interval {CI}, 1.3-2.9]; P genital lesions (RR, 2.1 [95% CI, 1.2-3.4]; P = .005), compared with women. No differences in shedding rates or lesion frequency were observed based on HIV serostatus. HSV-2 shedding frequency and quantity are high among HSV-2-seropositive adults in sub-Saharan Africa, including persons with and those without HIV infection. Shedding rates were particularly high among men, which may contribute to the high prevalence of HSV-2 and early acquisition among African women. © 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.

  9. Antiretroviral drug susceptibility among drug-naive adults with recent HIV infection in Rakai, Uganda.

    Science.gov (United States)

    Eshleman, Susan H; Laeyendecker, Oliver; Parkin, Neil; Huang, Wei; Chappey, Colombe; Paquet, Agnes C; Serwadda, David; Reynolds, Steven J; Kiwanuka, Noah; Quinn, Thomas C; Gray, Ronald; Wawer, Maria

    2009-04-27

    HIV infection.

  10. Population pharmacokinetics and maximum a posteriori probability Bayesian estimator of abacavir: application of individualized therapy in HIV-infected infants and toddlers.

    NARCIS (Netherlands)

    Zhao, W.; Cella, M.; Pasqua, O. Della; Burger, D.M.; Jacqz-Aigrain, E.

    2012-01-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Abacavir is used to treat HIV infection in both adults and children. The recommended paediatric dose is 8 mg kg(-1) twice daily up to a maximum of 300 mg twice daily. Weight was identified as the central covariate influencing pharmacokinetics of abacavir in

  11. Understanding HIV infection for the design of a therapeutic vaccine. Part I: Epidemiology and pathogenesis of HIV infection

    NARCIS (Netherlands)

    Goede, A.L. de; Vulto, A.G.; Osterhaus, A.D.; Gruters, R.A.

    2015-01-01

    HIV infection leads to a gradual loss CD4+ T lymphocytes comprising immune competence and progression to AIDS. Effective treatment with combined antiretroviral drugs (cART) decreases viral load below detectable levels but is not able to eliminate the virus from the body. The success of cART is

  12. In vitro separation and expansion of CD4 lymphocytes from HIV-infected individuals without activation of HIV infection

    DEFF Research Database (Denmark)

    Nielsen, S D; Nielsen, Jens Ole; Hansen, J E

    1997-01-01

    In order to offer a gene therapy-based treatment against AIDS, it is likely to be necessary to harvest and culture CD4 cells from HIV-positive patients without activating the HIV infection. We have used a magnetic cell sorting (MACS) system to enrich CD4 cells. Using positive selection, CD4 cells...

  13. Response to planned treatment interruptions in HIV infection varies across childhood

    DEFF Research Database (Denmark)

    NN, NN; Valerius, Niels Henrik

    2010-01-01

    OBJECTIVE: To evaluate clinical, immunological and virological consequences of CD4-guided antiretroviral therapy (ART) planned treatment interruptions (PTIs) compared with continuous therapy in children with chronic HIV infection in the Paediatric European Network for Treatment of AIDS 11 trial......) or PTI (56). In PTI, ART was restarted if confirmed CD4% was less than 20% or more than 48 weeks had been spent off ART. The primary outcome was Centers for Disease Control and Prevention (CDC) stage C event, death or CD4% less than 15% (and CD4 cell count less than 200 cells/microl for children aged 7......-term follow-up in Paediatric European Network for Treatment of AIDS 11 trial are ongoing. Further research into the role of treatment interruption in children is required, particularly, as guidelines now recommend early ART for all infected infants....

  14. Parenting and child outcomes of HIV-infected African American mothers: a literature review.

    Science.gov (United States)

    Muze, Ruth H

    2013-01-01

    Parenting young children while living with HIV is an important public health concern. This article reviews maternal HIV and the impact it has on the parenting experience of African American mothers. Because living with HIV has been considered a family illness, the Family Systems Model provided a framework for this article. The model demonstrated an important link between maternal HIV and its impact on the health and wellbeing of not only the mother and her children, but her parenting and family roles as well. Research has documented an association between maternal HIV and negative parent-child outcomes among African American mothers. I examined studies on parenting and child outcomes among African American mothers living with HIV. The review assists in conceptualizing parenting with HIV as an area of increasing importance in health services delivery to HIV-infected African American mothers who are caring for young children.

  15. Características clínicas de niños infectados por VIH atendidos en un hospital universitario en Medellín, Colombia, 1997-2005 Clinical characteristics of HIV-infected children seen at a university hospital in Medellin, Colombia, 1997-2005

    Directory of Open Access Journals (Sweden)

    Alberto Bustamante Gallego

    2007-12-01

    Full Text Available Introducción: la infección por VIH en el niño ha sido diagnosticada en el mundo desde 1982 y en Colombia desde 1987; se ha convertido en un serio problema de salud pública, especialmente para la población infantil por sus implicaciones en el deterioro progresivo de la inmunidad celular y, en general, del estado de salud de los niños infectados. Se manifiesta con enfermedades infecciosas y no infecciosas, desnutrición secundaria y compromiso neurológico con deterioro del desarrollo psicomotor; todo ello puede dejar secuelas graves que afectan la calidad de vida y la ponen en riesgo. Métodos: se llevó a cabo un estudio descriptivo, retrospectivo transversal a partir de las historias clínicas de los niños con diagnóstico de infección por VIH en el Hospital Universitario San Vicente de Paúl de Medellín, Colombia, entre 1997 y 2005. Resultados: durante este período se diagnosticó la infección por VIH en 54 niños de los cuales 28 (51,9% fueron del sexo femenino; sus edades estuvieron entre 24 días y 108 meses; 29 niños (53,7% fueron casos índice. Veinticinco (46,3% procedían de Medellín; 52 (96,3% adquirieron verticalmente la infección; el estado clínico más frecuente fue el B (36; 66,7%; en cuanto al estado inmunológico hubo 17 niños (31,5% en la categoría 3 o de inmunosupresión grave; 12 niños (22,2% presentaron desnutrición grave cuando se comparó el peso con respecto a la edad y la neumonía ocurrió en 39 (72,2% como primera manifestación clínica, seguida por el compromiso de los sistemas gastrointestinal, linfático, nervioso y renal; se hallaron también problemas hematológicos, compromiso cardíaco y manifestaciones cutáneas. La fiebre por encima de 38 ºC, sola o acompañada de otros síntomas o signos, se presentó en 38 pacientes (70,4%. Introduction: HIV infection of children was first diagnosed in 1982. The first Colombian case was described in 1987. It has become a serious public health problem

  16. Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis.

    Science.gov (United States)

    Prioreschi, A; Munthali, R J; Soepnel, L; Goldstein, J A; Micklesfield, L K; Aronoff, D M; Norris, S A

    2017-03-29

    This systematic review aims to investigate the incidence and prevalence of type 2 diabetes mellitus (T2DM) in patients with HIV infection in African populations. Only studies reporting data from Africa were included. A systematic search was conducted using four databases for articles referring to HIV infection and antiretroviral therapy, and T2DM in Africa. Articles were excluded if they reported data on children, animals or type 1 diabetes exclusively. Incidence of T2DM and prevalence of T2DM. Risk ratios were generated for pooled data using random effects models. Bias was assessed using an adapted Cochrane Collaboration bias assessment tool. Of 1056 references that were screened, only 20 were selected for inclusion. Seven reported the incidence of T2DM in patients with HIV infection, eight reported the prevalence of T2DM in HIV-infected versus uninfected individuals and five reported prevalence of T2DM in HIV-treated versus untreated patients. Incidence rates ranged from 4 to 59 per 1000 person years. Meta-analysis showed no significant differences between T2DM prevalence in HIV-infected individuals versus uninfected individuals (risk ratio (RR) =1.61, 95% CI 0.62 to 4.21, p=0.33), or between HIV-treated patients versus untreated patients (RR=1.38, 95% CI 0.66 to 2.87, p=0.39), and heterogeneity was high in both meta-analyses (I 2 =87% and 52%, respectively). Meta-analysis showed no association between T2DM prevalence and HIV infection or antiretroviral therapy; however, these results are limited by the high heterogeneity of the included studies and moderate-to-high risk of bias, as well as, the small number of studies included. There is a need for well-designed prospective longitudinal studies with larger population sizes to better assess incidence and prevalence of T2DM in African patients with HIV. Furthermore, screening for T2DM using gold standard methods in this population is necessary. PROSPERO42016038689. Published by the BMJ Publishing Group Limited. For

  17. Estudo comparativo do padrão de respiração e a porcentagem de ocupação da nasofaringe pela tonsila faríngea em crianças com ou sem história de infecção pelo HIV A comparative study of the breathing pattern and amount of nasopharynx obstruction by the pharyngeal tonsil in hiv infected and non infected children

    Directory of Open Access Journals (Sweden)

    Michella Dinah Zastrow

    2007-10-01

    Full Text Available OBJETIVO: o objetivo deste estudo foi estudar a associação entre o padrão de respiração e o tamanho da tonsila faríngea em 122 crianças (60 infectadas pelo HIV e 62 sem infecção. MATERIAL E MÉTODO: As crianças foram analisadas quanto ao padrão de respiração, fluxo nasal e ocupação da tonsila faríngea em radiografias cefalométricas de perfil, através de uma análise computadorizada. RESULTADOS: O padrão de respiração de maior ocorrência nos dois grupos foi o tipo misto. A maioria das crianças apresentou tipo de respiração bucal ou mista, não havendo associação entre o tipo de respiração e presença do HIV (p=0,091. O fluxo nasal mostrou predomínio do fluxo médio nos dois grupos. As crianças sem história de infecção pelo HIV apresentaram fluxo nasal de médio a grande e a maioria das crianças infectadas pelo HIV apresentou de pouco a médio fluxo nasal de ar, havendo uma associação positiva entre o fluxo nasal e a infecção pelo HIV (pAIM: the goal of the present investigation was to study the association between breathing pattern and pharyngeal tonsil size in 122 children (60 HIV infected and 62 without such infection. MATERIAL AND METHODS: The children were analyzed as to their breathing pattern, nasal flow and pharyngeal tonsil obstruction seen in side cephalometric x-rays, by means of a computerized analysis. RESULTS: The pattern that most occurred in both groups was the mixed type. Most of the children presented oral or mixed type breathing and there was no association between the type of breathing and HIV presence (p=0.091. Nasal flow was mainly medium in both groups. Children without prior history of HIV infection had medium to large nasal flow and most of the HIV-infected children had medium nasal airflow. There was a positive association between nasal flow and HIV infection (p<0.0001. The average percentage of nasopharynx obstruction by the pharyngeal tonsil was high in both groups, and there was

  18. Determinants of Smoking and Quitting in HIV-Infected Individuals.

    Directory of Open Access Journals (Sweden)

    Susan Regan

    Full Text Available Cigarette smoking is widespread among HIV-infected patients, who confront increased risk of smoking-related co-morbidities. The effects of HIV infection and HIV-related variables on smoking and smoking cessation are incompletely understood. We investigated the correlates of smoking and quitting in an HIV-infected cohort using a validated natural language processor to determine smoking status.We developed and validated an algorithm using natural language processing (NLP to ascertain smoking status from electronic health record data. The algorithm was applied to records for a cohort of 3487 HIV-infected from a large health care system in Boston, USA, and 9446 uninfected control patients matched 3:1 on age, gender, race and clinical encounters. NLP was used to identify and classify smoking-related portions of free-text notes. These classifications were combined into patient-year smoking status and used to classify patients as ever versus never smokers and current smokers versus non-smokers. Generalized linear models were used to assess associations of HIV with 3 outcomes, ever smoking, current smoking, and current smoking in analyses limited to ever smokers (persistent smoking, while adjusting for demographics, cardiovascular risk factors, and psychiatric illness. Analyses were repeated within the HIV cohort, with the addition of CD4 cell count and HIV viral load to assess associations of these HIV-related factors with the smoking outcomes.Using the natural language processing algorithm to assign annual smoking status yielded sensitivity of 92.4, specificity of 86.2, and AUC of 0.89 (95% confidence interval [CI] 0.88-0.91. Ever and current smoking were more common in HIV-infected patients than controls (54% vs. 44% and 42% vs. 30%, respectively, both P<0.001. In multivariate models HIV was independently associated with ever smoking (adjusted rate ratio [ARR] 1.18, 95% CI 1.13-1.24, P <0.001, current smoking (ARR 1.33, 95% CI 1.25-1.40, P<0.001, and

  19. T-lymphocyte subsets in HIV-infected and high-risk HIV-uninfected adolescents - Retention of naive T lymphocytes in HIV-infected adolescents

    NARCIS (Netherlands)

    Douglas, SD; Rudy, B; Muenz, L; Starr, SE; Campbell, DE; Wilson, C; Holland, C; Crowley-Nowick, P; Vermund, SH

    Background: The capacity of the immune system of adolescents to generate and repopulate naive and memory cell populations under conditions of normal homeostasis and human immunodeficiency virus (HIV) infection is largely unknown. Objective: To assess lymphocyte subsets in HIV-infected and high-risk

  20. Potential health impacts of heavy metals on HIV-infected population in USA.

    Directory of Open Access Journals (Sweden)

    Xiaohui Xu

    Full Text Available PURPOSE: Noninfectious comorbidities such as cardiovascular diseases have become increasingly prevalent and occur earlier in life in persons with HIV infection. Despite the emerging body of literature linking environmental exposures to chronic disease outcomes in the general population, the impacts of environmental exposures have received little attention in HIV-infected population. The aim of this study is to investigate whether individuals living with HIV have elevated prevalence of heavy metals compared to non-HIV infected individuals in United States. METHODS: We used the National Health and Nutrition Examination Survey (NHANES 2003-2010 to compare exposures to heavy metals including cadmium, lead, and total mercury in HIV infected and non-HIV infected subjects. RESULTS: In this cross-sectional study, we found that HIV-infected individuals had higher concentrations of all heavy metals than the non-HIV infected group. In a multivariate linear regression model, HIV status was significantly associated with increased blood cadmium (p=0.03 after adjusting for age, sex, race, education, poverty income ratio, and smoking. However, HIV status was not statistically associated with lead or mercury levels after adjusting for the same covariates. CONCLUSIONS: Our findings suggest that HIV-infected patients might be significantly more exposed to cadmium compared to non-HIV infected individuals which could contribute to higher prevalence of chronic diseases among HIV-infected subjects. Further research is warranted to identify sources of exposure and to understand more about specific health outcomes.

  1. Hepatitis B virus treatment in HIV-infected patients.

    Science.gov (United States)

    Thio, Chloe L

    Hepatitis B virus (HBV) infection is common in HIV-infected persons and is associated with increased risk of liver-related morbidity and mortality. Agents available to treat HBV infection in coinfected patients include lamivudine, entecavir, emtricitabine, adefovir, peginterferon alfa, and the recently approved telbivudine. Treatment decisions should take into account a number of factors, including antiretroviral therapy status, HBV genotype, prior experience of lamivudine, and the need to avoid drug resistance in both HIV- and HBV-infected persons. This article summarizes a presentation on treatment and management of HBV infection in HIV-infected patients made by Chloe L. Thio, MD, at the 9th Annual Ryan White CARE Act Update in Washington, DC. The original presentation is available as a Webcast at www.iasusa.org.

  2. Statistical behavior of time dynamics evolution of HIV infection

    Science.gov (United States)

    González, Ramón E. R.; Santos, Iury A. X.; Nunes, Marcos G. P.; de Oliveira, Viviane M.; Barbosa, Anderson L. R.

    2017-09-01

    We use the tools of the random matrix theory (RMT) to investigate the statistical behavior of the evolution of human immunodeficiency virus (HIV) infection. By means of the nearest-neighbor spacing distribution we have identified four distinct regimes of the evolution of HIV infection. We verified that at the beginning of the so-called clinical latency phase the concentration of infected cells grows slowly and evolves in a correlated way. This regime is followed by another one in which the correlation is lost and that in turn leads the system to a regime in which the increase of infected cells is faster and correlated. In the final phase, the one in which acquired immunodeficiency syndrome (AIDS) is stablished, the system presents maximum correlation as demonstrated by GOE distribution.

  3. Late presentation of HIV infection: a consensus definition

    DEFF Research Database (Denmark)

    Antinori, A; Coenen, T; Costagiola, D

    2010-01-01

    clinical definition of late presentation. The objective of this article is to present a consensus definition of late presentation of HIV infection. Methods Over the past year, two initiatives have moved towards a harmonized definition. In spring 2009, they joined efforts to identify a common definition...... of what is meant by a 'late-presenting' patient. Results Two definitions were agreed upon, as follows. Late presentation: persons presenting for care with a CD4 count below 350 cells/muL or presenting with an AIDS-defining event, regardless of the CD4 cell count. Presentation with advanced HIV disease...... able to implement this definition (either on its own or alongside their own preferred definition) when reporting surveillance or research data relating to late presentation of HIV infection....

  4. [Improvement of parodontitis therapy of patients with HIV-infection].

    Science.gov (United States)

    Soboleva, L A; Oseeva, A O; Shul'diakov, A A; Bulkina, N V

    2010-01-01

    For the purpose to determine the clinic-pathogenetic efficacy of cycloferon liniment in the combined therapy of periodontitis of patients with subclinical stage of HIV-infection medical examination and treatment of 40 patients was carried out. It was established that use of liniment cycloferon in the combined treatment of patients with subclinical stage of HIV-infection allowed to accelerate process of normalization of lipid peroxidation parameters and antioxidant potential of blood, to decrease infection load (herpes symplex virus I, Candida albicans, Staphylococcus aureus) in parodontal recess and evidence of local inflammation with reduction of activity of the tumours necrosis factor and interleukin 1beta, what provided acceleration of recuperation processes, lowering the frequency of parodontitis relapses.

  5. Hidradenitis suppurativa in a HIV-infected child

    Directory of Open Access Journals (Sweden)

    G Prabhu

    2012-01-01

    Full Text Available Hidradenitis suppurativa (HS, a painful and chronic condition, commonly occurs in women and coincides with post-pubertal increase in sex hormones. A 13-year-old pre-pubertal HIV-infected male child presented to our clinic with a discharging right axillary lymph node swelling. The biopsy of the lesion showed features of HS. The patient was treated with oral antibiotics, oral steroids, and local antibiotic wash. Though the patient responded to this treatment, the clinical response was not adequate and the lesion recurred. Subsequently, the child was started on antiretroviral therapy (zidovudine, lamivudine, and nevirapine. Following these medications, the lesions healed and had not recurred till we last examined the child. Thus, this is a rare presentation of a known condition in an HIV-infected pre-pubertal male child, which did not respond to usual modalities of treatment and had to be treated with antiretroviral therapy.

  6. Traditional Chinese Herbal Medicines for Treating HIV Infections and AIDS

    Directory of Open Access Journals (Sweden)

    Wen Zou

    2012-01-01

    Full Text Available To assess the effects of TCHM on patients with HIV infection and AIDS, we reviewed eleven randomized placebo-controlled trials involving 998 patients. Due to the limited number of RCTs for included trials and the small sample size of each study, we are not able to draw firm conclusions concerning TCHM therapy in treating patients with HIV infection and AIDS. However, some high-quality clinical studies do exist. Studies of diarrhea and oral candidiasis, which are challenging symptoms of AIDS, were demonstrated to have positive effects. Study of peripheral leukocytes, which are a side effect of antiretroviral drugs, suggested that an integrated treatment approach may be of benefit. The overall methodological quality of the trials was adequate; however, randomization methods should be clearly described and fully reported in these trials according to the Consolidated Standards of Reporting Trials (CONSORT.

  7. Natural resistance to HIV infection: The Vif-APOBEC interaction.

    Science.gov (United States)

    Malim, Michael H

    2006-11-01

    Members of the APOBEC family of cellular polynucleotide cytidine deaminases (e.g., APOBEC3G) are potent inhibitors of HIV infection. Wild type viral infections are largely spared from APOBEC function through the action of the viral Vif protein. In Vif's absence, inhibitory APOBEC proteins are encapsidated by budding virus particles leading to excessive cytidine (C) to uridine (U) hypermutation of negative sense reverse transcripts in newly infected cells. This registers as guanosine (G) to adenosine (A) mutations in plus stranded cDNA. Because the functions of Vif and APOBEC proteins oppose each other, it is likely that fluctuations in the Vif/APOBEC balance can influence the natural history of HIV infection. Experimental support for this notion would further justify and stimulate drug discovery initiatives in this area.

  8. Left ventricular mass in HIV-infected patients.

    Science.gov (United States)

    Olalla, J; Pombo, M; Del Arco, A; de la Torre, J; Urdiales, D; García-Alegría, J

    2013-01-01

    The HIV infection has been associated with an increased incidence of vascular events. Left ventricular mass (LVM) is independently associated with greater overall mortality. Various studies have shown that patients with HIV infection have higher LVM than the uninfected population. We aim to describe the distribution of LVM in an extensive series of patients with HIV infection, and the factors associated with its increase. A cross-sectional study was performed in HIV-infected patients followed in our center from 1 December 2009 to 28 February 2011. A transthoracic echocardiography (TTE) was performed in all patients who gave their consent. Demographic variables, viroimmunological status, cardiovascular risk factors, vascular risk at 10 years (VR10) and history of exposure to antiretroviral drugs were collected. LVM was considered to be the quantitative dependent variable. A univariate analysis was performed, including in the multivariate analysis those variables with P<,05. A TTE was performed in 400 patients, and the LVM was calculated in 388. Mean age was 45 years, 75.5 males. Mean LVM was 39.54g/m(2.7)(95% CI: 38.35-40.73). Age, height, body mass index, VR10, hypertension, dyslipidemia, different medications within the cardiovascular area and having taken nevirapine have been used in the history of the patient were associated to greater LVM. In the multivariate analysis, use of nevirapine in the history of the patient and VR10 remained in the model. VR10 may be associated with greater LVM. The relationship with nevirapine may respond to an indication bias. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  9. Lues maligna in an HIV-infected patient

    Directory of Open Access Journals (Sweden)

    Passoni Luiz Fernando Cabral

    2005-01-01

    Full Text Available We report such a case of malignant syphilis in a 42-year-old HIV-infected man, co-infected with hepatitis B virus, who presented neurolues and the classical skin lesions of lues maligna. The serum VDRL titer, which was 1:64 at presentation, increased to 1:2,048 three months after successful therapy with penicillin, decreasing 15 months later to 1:8.

  10. Selective serotonin reuptake inhibitor suppression of HIV infectivity and replication.

    Science.gov (United States)

    Benton, Tami; Lynch, Kevin; Dubé, Benoit; Gettes, David R; Tustin, Nancy B; Ping Lai, Jian; Metzger, David S; Blume, Joshua; Douglas, Steven D; Evans, Dwight L

    2010-11-01

    To test the hypothesis that the selective serotonin reuptake inhibitor (SSRI) citalopram would down-regulate human immunodeficiency virus (HIV) infectivity and that the greatest effects would be seen in people with depression. Depression is a risk factor for morbidity and mortality in HIV/acquired immune deficiency syndrome. Serotonin (5-HT) neurotransmission has been implicated in the pathobiology of depression, and pharmacologic therapies for depression target this system. The 5-HT transporter and 5-HT receptors are widely distributed throughout the central nervous and immune systems. Depression has been associated with suppression of natural killer cells and CD8(+) lymphocytes, key regulators of HIV infection. Ex vivo models for acute and chronic HIV infection were used to study the effects of citalopram on HIV viral infection and replication in 48 depressed and nondepressed women. For both the acute and chronic infection models, HIV reverse transcriptase activity was measured in the citalopram treatment condition and the control condition. The SSRI significantly down-regulated the reverse transcriptase response in both the acute and chronic infection models. Specifically, citalopram significantly decreased the acute HIV infectivity of macrophages. Citalopram also significantly decreased HIV viral replication in the latently infected T-cell line and in the latently infected macrophage cell line. There was no difference in down-regulation by depression status. These studies suggest that an SSRI enhances natural killer/CD8 noncytolytic HIV suppression in HIV/acquired immune deficiency syndrome and decreases HIV viral infectivity of macrophages, ex vivo, suggesting the need for in vivo studies to determine a potential role for agents targeting serotonin in the host defense against HIV.

  11. [Renal transplantation in HIV-infected patients in Spain].

    Science.gov (United States)

    Mazuecos, A; Pascual, J; Gómez, E; Sola, E; Cofán, F; López, F; Puig-Hooper, C E; Baltar, J M; González-Molina, M; Oppenheimer, F; Marcén, R; Rivero, M

    2006-01-01

    HIV infection has experienced dramatic improvement in morbidity and mortality with the highly active antiretroviral therapy (HAART). This prompted a reevaluation of organ-solid transplantation as a treatment option for HIV-infected patients. Some trials in the United States have shown that one- and 2-year graft and patient survival is comparable to HIV-negative transplant population. In Europe the experience is still scarce. The aim of this study is to analyse the outcome and the clinical characteristics of HIV-infected patients who received kidney transplantation in Spain in the HAART era. Ten patients were transplanted in our country since 2001. Only one patient was black. The main cause of end-stage renal disease reported was glomerulonephritis. Six of the recipients were coinfected by hepatitis C virus. Inclusion criteria included undetectable HIV viral load and CD4 counts greater than 200/pL. Immunosuppression consisted of steroids, tacrolimus and mycophenolate mofetil, with antibody induction in 4 cases. The median and mean follow-up was 11 and 16.3+/-15.6 (3-46) months, respectively. One recipient lost his graft because of early renal venous thrombosis. The remaining patients are functioning graft with mean serum creatinina level of 1.5 +/- 0.5 mg/dl. Biopsy-proven acute rejection was diagnosed in 4 recipients and was reversed in all cases with antirejection treatment. The plasma HIV RNA levels have remained controlled and CD4 counts have been stable in excess of 200 cell/microL. None of patients have developed AIDS complications. Recipients receiving protease inhibitor-based HAART regimens required significant dosing modification to maintain appropriate tacrolimus levels. Our results show that renal transplantation can be a safe and effective treatment in select HIV-infected patients. Like other series, the acute rejection rate was higher than in non-HIV recipients. The reasons of this rejection incidence remain unknown.

  12. Avaliação da resposta humoral à vacina pneumocócica 7-valente em crianças com Aids Evaluación de la vacuna neumocócica 7-valente en la respuesta humoral de niños con SIDA Evaluation of humoral response to heptavalent pneumococcal conjugate vaccine in HIV-infected children

    Directory of Open Access Journals (Sweden)

    Isabel de Camargo Costa

    2008-10-01

    Paulo (Sureste de Brasil, en 2002-2003. La dosis de anticuerpos IgG contra los polisacáridos de la cápsula neumocócica fue realizada por medio de ensayo inmuno enzimático (ELISA. Los anticuerpos fueron dosificados inmediatamente antes y un mes después de la aplicación de la segunda dosis de la vacuna. Se utilizaron dos criterios para evaluar la respuesta a la vacuna: títulos de anticuerpos ? 1,3 ?g/mL en la serología post-inmunización y aumento ?4 veces en los títulos de la serología post-inmunización con relación a la pre-inmunización. RESULTADOS: Para el primer criterio (?1,3 ?g/mL, 26 (65% niños obtuvieron respuesta serológica con la vacuna, 12 (30% de ellas presentaron títulos de IgG post-inmunización en niveles de por lo menos 1,3 ?g/mL para todos los serotipos. Para el segundo criterio (incremento >4 veces en los títulos para cuatro serotipos o mas, se obtuvo respuesta serológica en 15 (37,5% niños. CONCLUSIONES: La respuesta frente a la vacuna fue considerada satisfactoria, con aumento estadísticamente significativo de los títulos geométricos promedios post-vacunales con relación a los pre-vacunales para todos los serotipos estudiados.OBJECTIVE: Invasive pneumococcal disease is a major cause of death in HIV-infected children. The objective of the study was to assess the quantitative antibody response to the seven pneumococcal serotypes of heptavalent pneumococcal conjugate vaccine in a group of HIV-infected children. METHODS: Study comprising 40 HIV-infected children aged between 2 and 9 years followed up in a specialized outpatient clinic in São Paulo, Brazil, between 2002 and 2003. Enzyme immunoassay (ELISA was used to measure IgG antibody titers against pneumococcus capsule. Antibodies were measured immediately before and 1 month after the second dose of the vaccine. Two response criteria were used: IgG titers >1.3 µg/mL in the post-immunization serology and an increase of at least 4-fold in post- compared to pre

  13. Implementation and new insights in molecular diagnostics for HIV infection.

    Science.gov (United States)

    Tsang, Hin-Fung; Chan, Lawrence Wing-Chi; Tong, Jennifer Chiu-Hung; Wong, Heong-Ting; Lai, Christopher Koon-Chi; Au, Thomas Chi-Chuen; Chan, Amanda Kit-Ching; Ng, Lawrence Po-Wah; Cho, William Chi-Shing; Wong, Sze-Chuen Cesar

    2018-05-01

    Acquired immunodeficiency syndrome (AIDS) is a kind of acquired disease that breaks down the immune system. Human immunodeficiency virus (HIV) is the causative agent of AIDS. By the end of 2016, there were 36.7 million people living with HIV worldwide. Early diagnosis can alert infected individuals to risk behaviors in order to control HIV transmission. Infected individuals are also benefited from proper treatment and management upon early diagnosis. Thanks to the public awareness of the disease, the annual increase of new HIV infections has been slowly declining over the past decades. The advent of molecular diagnostics has allowed early detection and better management of HIV infected patients. Areas covered: In this review, the authors summarized and discussed the current and future technologies in molecular diagnosis as well as the biomarkers developed for HIV infection. Expert Commentary: A simple and rapid detection of viral load is important for patients and doctors to monitor HIV progression and antiretroviral treatment efficiency. In the near future, it is expected that new technologies such as digital PCR and CRISPR-based technology will play more important role in HIV detection and patient management.

  14. Helicobacter pylori gastritis in HIV-infected patients: a review.

    Science.gov (United States)

    Nevin, Daniel T; Morgan, Christopher J; Graham, David Y; Genta, Robert M

    2014-10-01

    The risk factors for acquiring Helicobacter pylori and Human Immunodeficiency Virus (HIV) infections are different: H. pylori is transmitted by gastro- or fecal-oral routes and is associated with low socioeconomic conditions, while HIV is transmitted through sexual intercourse, infected body fluids, and transplacentally. If the host responses to these infections were independent, the prevalence of H. pylori should be similar in HIV-infected and non-infected patients. Yet, several studies have detected a lower prevalence of H. pylori in patients with HIV infection, whereas other studies found either no differences or greater rates of H. pylori infection in HIV-positive subjects. To review studies that addressed the issue of these two simultaneous infections and attempt to determine whether reliable conclusions can be drawn from this corpus of often contrasting evidence. Electronic literature search for relevant publications, followed by manual search of additional citations from extracted articles. The initial search yielded 44 publications; after excluding case reports, reviews, narrowly focused articles, and duplicate reports, there remained 29 articles, which are the corpus of this review. With one exception, all studies reported higher rates of H. pylori infection in HIV-negative subjects. Five studies also examined the CD4 lymphocyte counts and found an inverse correlation between the degree of immunosuppression and the prevalence of active H. pylori infection. Current evidence suggests that it is likely that H. pylori needs a functional immune system to successfully and persistently colonize the human gastric mucosa. © 2014 John Wiley & Sons Ltd.

  15. Micro RNA in Exosomes from HIV-Infected Macrophages

    Directory of Open Access Journals (Sweden)

    William W. Roth

    2015-12-01

    Full Text Available Exosomes are small membrane-bound vesicles secreted by cells that function to shuttle RNA and proteins between cells. To examine the role of exosomal micro RNA (miRNA during the early stage of HIV-1 infection we characterized miRNA in exosomes from HIV-infected macrophages, compared with exosomes from non-infected macrophages. Primary human monocytes from uninfected donors were differentiated to macrophages (MDM which were either mock-infected or infected with the macrophage-tropic HIV-1 BaL strain. Exosomes were recovered from culture media and separated from virus particles by centrifugation on iodixanol density gradients. The low molecular weight RNA fraction was prepared from purified exosomes. After pre-amplification, RNA was hybridized to microarrays containing probes for 1200 miRNA species of known and unknown function. We observed 48 miRNA species in both infected and uninfected MDM exosomes. Additionally, 38 miRNAs were present in infected-cell exosomes but not uninfected-cell exosomes. Of these, 13 miRNAs were upregulated in exosomes from HIV-infected cells, including 4 miRNA species that were increased by more than 10-fold. Though numerous miRNA species have been identified in HIV-infected cells, relatively little is known about miRNA content in exosomes from these cells. In the future, we plan to investigate whether the upregulated miRNA species we identified are increased in exosomes from HIV-1-positive patients.

  16. Educational software for simulating risk of HIV infection

    Science.gov (United States)

    Rothberg, Madeleine A.; Sandberg, Sonja; Awerbuch, Tamara E.

    1994-03-01

    The AIDS epidemic is still growing rapidly and the disease is thought to be uniformly fatal. With no vaccine or cure in sight, education during high school years is a critical component in the prevention of AIDS. We propose the use of computer software with which high school students can explore via simulation their own risk of acquiring an HIV infection given certain sexual behaviors. This particular software is intended to help students understand the three factors that determine their risk of HIV infection (number of sexual acts, probability that their partners are infected, and riskiness of the specific sexual activities they choose). Users can explicitly calculate their own chances of becoming infected based on decisions they make. Use of the program is expected to personalize the risk of HIV infection and thus increase users' concern and awareness. Behavioral change may not result from increased knowledge alone. Therefore the effectiveness of this program in changing attitudes toward risky sexual behaviors would be enhanced when the simulation is embedded in an appropriate curriculum. A description of the program and an example of its use are presented.

  17. Smart nanoparticles as targeting platforms for HIV infections

    Science.gov (United States)

    Adhikary, Rishi Rajat; More, Prachi; Banerjee, Rinti

    2015-04-01

    While Human Immunodeficiency Virus (HIV) infections are reducing in incidence with the advent of Highly Active Anti-retroviral Therapy (HAART), there remain a number of challenges including the existence of reservoirs, drug resistance and anatomical barriers to antiretroviral therapy. To overcome these, smart nanoparticles with stimuli responsive release are proposed for delivery of anti-retroviral agents. The paper highlights the strategic similarities between the design of smart antiretroviral nanocarriers and those optimized for cancer chemotherapy. This includes the development of nanoparticles capable of passive and active targeting as well as those that are responsive to various internal and external triggers. For antiretroviral therapy, the relevant triggers for stimuli responsive release of drugs include semen, enzymes, endosomal escape, temperature and magnetic field. Deriving from the experience of cancer chemotherapy, additional potential triggers are light and ultrasound which remain hitherto unexplored in HIV therapy. In addition, the roles of nanomicrobicides (nanogels) and virus mimetic nanoparticles are discussed from the point of view of prevention of HIV transmission. The challenges associated with translation of smart nanoparticles for HIV infections to realize the Millennium Development Goal of combating HIV infections are discussed.

  18. Health Selection, Migration, and HIV Infection in Malawi.

    Science.gov (United States)

    Anglewicz, Philip; VanLandingham, Mark; Manda-Taylor, Lucinda; Kohler, Hans-Peter

    2018-04-27

    Despite its importance in studies of migrant health, selectivity of migrants-also known as migration health selection-has seldom been examined in sub-Saharan Africa (SSA). This neglect is problematic because several features of the context in which migration occurs in SSA-very high levels of HIV, in particular-differ from contextual features in regions that have been studied more thoroughly. To address this important gap, we use longitudinal panel data from Malawi to examine whether migrants differ from nonmigrants in pre-migration health, assessed via SF-12 measures of mental and physical health. In addition to overall health selection, we focus on three more-specific factors that may affect the relationship between migration and health: (1) whether migration health selection differs by destination (rural-rural, rural-town, and rural-urban), (2) whether HIV infection moderates the relationship between migration and health, and (3) whether circular migrants differ in pre-migration health status. We find evidence of the healthy migrant phenomenon in Malawi, where physically healthier individuals are more likely to move. This relationship varies by migration destination, with healthier rural migrants moving to urban and other rural areas. We also find interactions between HIV-infected status and health: HIV-infected women moving to cities are physically healthier than their nonmigrant counterparts.

  19. Possible transmission of HIV Infection due to human bite

    Directory of Open Access Journals (Sweden)

    Bandivdekar Atmaram H

    2011-03-01

    Full Text Available Abstract The potential risk of HIV-1 infection following human bite although epidemiologically insignificant, but it is biologically possible. There are anecdotal reports of HIV transmission by human bites particularly if saliva is mixed with blood. The oral tissues support HIV replication and may serve as a previously unrecognized HIV reservoir. The HIV infected individuals have more viruses in blood than saliva, possibly due to the potent HIV-inhibitory properties of saliva. The case presented here is of a primary HIV infections following a human bite where in the saliva was not blood stained but it got smeared on a raw nail bed of a recipient. The blood and saliva of the source and blood of the recipient showed a detectable viral load with 91% sequence homology of C2-V3 region of HIV gp120 between the two individuals. The recipient did not receive PEP [post exposure prophylaxis] as his family physician was unaware of salivary transmission. The family physician should have taken PEP decision after proper evaluation of the severe and bleeding bite. Hence it is necessary to treat the HIV infected human bites with post exposure prophylaxis.

  20. HIV infection in the South African construction industry.

    Science.gov (United States)

    Bowen, Paul; Govender, Rajen; Edwards, Peter; Lake, Antony

    2018-06-01

    South Africa has one of the highest HIV prevalences in the world, and compared with other sectors of the national economy, the construction industry is disproportionately adversely affected. Using data collected nationally from more than 57,000 construction workers, HIV infection among South African construction workers was estimated, together with an assessment of the association between worker HIV serostatus and worker characteristics of gender, age, nature of employment, occupation, and HIV testing history. The HIV infection of construction workers was estimated to be lower than that found in a smaller 2008 sample. All worker characteristics are significantly associated with HIV serostatus. In terms of most at-risk categories: females are more at risk of HIV infection than males; workers in the 30-49 year old age group are more at risk than other age groups; workers employed on a less permanent basis are more at risk; as are workers not having recently tested for HIV. A