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BackgroundRandomized-trial data on the risks and benefits of antiretroviral therapy (ART) as compared with zidovudine and single-dose nevirapine to prevent transmission of the human immunodeficiency virus (HIV) in HIV-infected pregnant women with high CD4 counts are lacking.MethodsWe randomly assigned HIV-infected women at 14 or more weeks of gestation with CD4 counts of at least 350 cells per cubic millimeter to zidovudine and single-dose nevirapine plus a 1-to-2-week postpartum "tail" of tenofovir and emtricitabine (zidovudine alone); zidovudine, lamivudine, and lopinavir-ritonavir (zidovudine-based ART); or tenofovir, emtricitabine, and lopinavir-ritonavir (tenofovir-based ART). The primary outcomes were HIV transmission at 1 week of age in the infant and maternal and infant safety.ResultsThe median CD4 count was 530 cells per cubic millimeter among 3490 primarily black African HIV-infected women enrolled at a median of 26 weeks of gestation (interquartile range, 21 to 30). The rate of transmission was significantly lower with ART than with zidovudine alone (0.5% in the combined ART groups vs. 1.8%; difference, -1.3 percentage points; repeated confidence interval, -2.1 to -0.4). However, the rate of maternal grade 2 to 4 adverse events was significantly higher with zidovudine-based ART than with zidovudine alone (21.1% vs. 17.3%, P=0.008), and the rate of grade 2 to 4 abnormal blood chemical values was higher with tenofovir-based ART than with zidovudine alone (2.9% vs. 0.8%, P=0.03). Adverse events did not differ significantly between the ART groups (P>0.99). A birth weight of less than 2500 g was more frequent with zidovudine-based ART than with zidovudine alone (23.0% vs. 12.0%, P

OBJECTIVES: We investigated immune determinants of antibody responses and B-cell memory to pH1N1 vaccine in HIV-infected children. METHODS: Ninety subjects 4 to

The AIDS drugs efavirenz and nelfinavir appear to be beneficial in children with HIV infection. Researchers gave this treatment to 57 HIV-infected children who had previously been treated with nucleoside reverse transcriptase inhibitors. Efavirenz is a non-nucleoside reverse transcriptase inhibitor and nelfinavir is a protease inhibitor. After one year of treatment, 63% of the children had very low blood levels of the virus.

Background: Pneumococcal vaccination is recommended in people with HIV, prioritizing PCV. We compared the immunogenicity of PCV-10 and PPV-23 administered antepartum or postpartum.Methods: This double-blind study randomized 346 pregnant women with HIV on antiretrovirals to PCV-10, PPV-23, or placebo at 14-34 weeks gestational age. Women who received placebo antepartum were randomized at 24 weeks postpartum to PCV-10 or PPV-23. Antibodies against 7 serotypes common to both vaccines and 1 serotype only in PPV-23 were measured by ELISA/chemiluminescence; B- and T-cell responses to serotype 1 by FLUOROSPOT; and plasma cytokines/chemokines by chemiluminescence.Results: Antibody responses were higher after postpartum versus antepartum vaccination. PCV-10 generated lower antibody levels than PPV-23 against 4 and higher against 1 of 7 common serotypes. Additional factors associated with high postvaccination antibody concentrations were high prevaccination antibody concentrations and CD4+ cells; low CD8+ cells and plasma HIV RNA; and several plasma cytokines/chemokines. Serotype 1 B- and T-cell memory did not increase after vaccination.Conclusions: Antepartum immunization generated suboptimal antibody responses, suggesting that postpartum booster doses may be beneficial and warrant further studies. Considering that PCV-10 and PPV-23 had similar immunogenicity, but PPV-23 covered more serotypes, use of PPV-23 may be prioritized in women with HIV on antiretroviral therapy.Clinical Trails Registration: NCT02717494. [ABSTRACT FROM AUTHOR]

One-hundred and fifty-six children were randomly evaluated at an inner-city juvenile/family court. These children were removed from their parent's custody subsequent to a finding of severe child maltreatment. From our original sample of 156 children, 62 met strict criteria for Post Traumatic Stress Disorder (PTSD). Fifty-two of these 62 were successfully recruited and participated in the 2 year re-examination. Each PTSD diagnosis was conferred by the Diagnostic Interview for Children and Adolescents (DICA). From our sample of 52 PTSD children re-examined after 2 years, 17 (32.7%) retained the full PTSD diagnosis, while 67.3% did not meet criteria. Key Words - Child abuse, Child maltreatment, Post Traumatic Stress Disorder, PTSD outcome.

Objective: The purpose of this study was to examine the psychiatric comorbidity between children presenting with Post Traumatic Stress Disorder (PTSD) and traumatized children not developing this disorder. Design: One-hundred and seventeen severely maltreated children were examined for evidence of PTSD. Analyses probed for diagnostic relationships between PTSD and other formal diagnoses on The Diagnostic Interview for Children and Adolescents, Revised Version (DICA-C-R). Participants: All children presented before a juvenile/family court due to severe child maltreatment and psychological trauma. These children had been ordered removed from parental custody due to the trauma suffered by the child. For the purposes of analyses, this entire group of maltreated and traumatized children were dichotomized into a PTSD group and a non-PTSD group. Thirty-five percent (41 of 117) of the children met strict DICA criteria for PTSD. Measurements: The children were examined by means of a structured clinical interview, The Diagnostic Interview for Children and Adolescents, revised version (DICA-Child-R), along with a more general psychiatric interview. The DICA-Child-R responses provided the only determination of whether the children met formal PTSD criteria. Data gathering on the sample also included a comprehensive review of risk factors for the development of PTSD, including demographics, and type (s) of trauma suffered. Results: Findings revealed that the PTSD diagnosis was significantly correlated with: 1. Attention Deficit Hyperactivity Disorder (ADHD) 2. Other anxiety disorders 3. Brief Psychotic Disorder or Psychotic Disorder NOS 4. The presence of suicidal ideation. 5. A trend toward mood disorders. There were no differences between the two samples on measures of age, race, and family income. Conclusions: Pediatric PTSD is a severe psychiatric disorder. In this study, PTSD was statistically related to other formal psychiatric diagnoses. The investigators attended to the issues relating to true comorbidity versus inaccurate diagnosis secondary to symptom overlap between different conditions. Applying strict criteria, the results suggest that the presence of PTSD in children confers a substantial likelihood of other formal diagnoses. Moreover, the symptom of suicidal ideation was overrepresented among PTSD subjects. Given these additional conditions, more extensive evaluation and specialized, multi-modal treatment should be considered in children presenting with PTSD. Key Words - Child abuse and neglect, Child maltreatment, Post traumatic stress disorder (PTSD), The Diagnostic Interview for Children and Adolescents, Suicide.

IN RECENT YEARS, the care of children with disabilities and chronic illness in the United States has come to include increased reliance on a variety of medical technologies, such as […]

The purpose of this study was to examine the rates of posttraumatic stress disorder (PTSD) among a sample of severely maltreated children and their mothers, and to investigate the age of onset of documented maltreatment in these children. The sample consisted of 109 pairs of women and their children who were before a juvenile/family court due to maltreatment of sufficient severity to warrant removal of the child from parental custody. Children were examined using the PTSD Section of the Diagnostic Interview for Children and Adolescents, Revised 6th Version (DICA-6-R). The PTSD Module of the Structured Clinical Interview for DSM-III-R (SCID) was administered to all mothers. Clinical psychiatric interviews were also administered to all children and mothers. From the sample of 109 cases, 15.6% of the mothers met SCID criteria for a current presentation of PTSD, while 36.7% had a past history of PTSD. Of the 109 evaluated children, 35.8% met current DICA criteria for PTSD. Posttraumatic stress disorder is significantly overrepresented in the children of mothers diagnosed with PTSD (p = .001). The average age of maltreatment onset was 46.4 months among the children diagnosed as PTSD, and was 61.3 months in the group of seriously maltreated children who did not develop PTSD (p = .038). The onset of maltreatment is significantly earlier among children whose mothers meet PTSD criteria than among other maltreated children (p = .025). Intergenerational transmission of violence and developmental effects of traumatic experiences upon the young child are discussed.

Until recently, the HIV epidemic among children exerted its greatest institutional affect on hospitals, health care facilities, and social service agencies. However, as children with HIV infection live longer, schools [...]

* Objective.--The purpose of this study was to compare the relative effects of various forms of maltreatment on the development of posttraumatic stress disorder (PTSD) in children. Design.--Children were randomly selected from a population of court-involved maltreated children. The children were then assigned to a PTSD group and a non-PTSD group on the basis of their responses to a structured interview. Setting.--A juvenile/family court in a large urban area. Participants.--This study examined 101 children who were before a juvenile/family court because of severe child maltreatment. All children had been removed from parental custody as a result of the maltreatment. Interventions.--None. Measurements and Results.--Structured clinical psychiatric interviews were administered to each child and each parent, and all court records were reviewed. The major analyses assessed the extent to which the presence and duration of the most common types of severe maltreatment were associated with a diagnosis of PTSD. Thirty-nine children met criteria for PTSD. Those who were sexually maltreated and those who witnessed family violence had a much greater likelihood of developing PTSD than did those whose histories of maltreatment did not include these types of events. The duration of emotional abuse (psychological terror) also proved to be a significant factor in discriminating children diagnosed as having PTSD from other severely maltreated children. Conclusions.--These findings delineate factors implicated in the cause of PTSD. Moreover, they provide information that will enable the protective service community to screen more effectively for PTSD among maltreated children. (AJDC. 1993;147:755-760), Children who have been abused or who have witnessed abuse of family members may be at risk for posttraumatic stress disorder (PTSD). This mental disorder can cause the child to re-experience traumatic events, lose interest in activities, or become anxious and agitated. Researchers interviewed 101 severely abused children between 6 and 12 years old and determined that 39 of them could be diagnosed with PTSD. These children included 63% of the sexually abused children, 52% of the children who witnessed family violence, and 48% of the emotionally abused children. It was also found that a longer duration of abuse or exposure to violence increased the risk of developing PTSD.

The authors reviewed 190 randomly selected records from the case load of a large juvenile court. Th records involved cases in which the state took legal custody of the children following a finding of maltreatment, based on a 'clear and convincing' standard of evidence. Sixty-seven percent (127/190) involved parents who were classified as substance abusers. The results of this study revealed speci between (a) alcohol abuse and physical maltreatment and (b) cocaine abuse and sexual maltreatment. analyses, testing for the effects of polysubstance abuse, revealed that additional forms of substan significantly to the effects of alcohol in predicting physical maltreatment or cocaine in predictin, A study which examined the relationship between parental substance abuse and child maltreatment is presented. Records from a juvenile court were randomly selected and reviewed. Results showed that parents who indulged in heavy alcohol drinking performed physical abuse on their children while those who engaged in cocaine abuse involved their children in sexual maltreatment. Further studies are urged to specify the factors which lead to this behavior predisposition on the part of the parents.

Children with attention deficit-hyperactivity disorder (ADHD) are often treated with stimulant medications, with resulting improvements in the condition. Although this treatment strategy has been used for over 50 years, its use is often debated. Ideally, children should be active participants in their treatment, yet drug therapy is usually adjusted according to parents' and teachers' responses. The limited number of studies that have been performed have found that while children are knowledgeable about the purpose of therapy, they often dislike it even if it is helpful. This may lead to compliance problems, which may affect the long-term effectiveness of stimulant treatment. To better determine the factors that influence children's attitudes toward stimulant therapy, 58 children receiving such therapy and their parents were surveyed. Of the 45 responders, 89 percent felt that medication was helpful. Thirty-three percent liked taking medication, and 44 percent had neutral feelings toward it. Most children understood the reason for therapy, with up to 82 percent listing poor concentration, difficulty with school work, difficulty sitting still, and trouble getting along at home as contributing problems. At least one positive benefit of therapy was reported by 98 percent of the children, and 82 percent reported at least one adverse effect such as difficulty going to sleep, decreased appetite, and less energy. Thirteen children were aware of adverse media reports about therapy, and three were negatively affected by these reports. Children who disliked stimulant therapy were significantly likely to fell embarrassed about receiving medication and to feel as if something was wrong with them. Children who disliked therapy tended to be using a standard rather than long-acting preparation, which was taken during school hours and which provided a relatively low dose. The study suggests that sustained-release preparations may be more acceptable to children with ADHD, and that their perceptions of treatment should be considered by physicians. (Consumer Summary produced by Reliance Medical Information, Inc.)