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Background To support the COVID‐19 pandemic response, many countries, including Belgium, implemented baseline genomic surveillance (BGS) programs aiming to early detect and characterize new SARS‐CoV‐2 variants. In parallel, Belgium maintained a sentinel network of six hospitals that samples patients with severe acute respiratory infections (SARI) and integrated SARS‐CoV‐2 detection within a broader range of respiratory pathogens. We evaluate the ability of the SARI surveillance to monitor general trends and early signals of viral genetic evolution of SARS‐CoV‐2 and compare it with the BGS as a reference model. Methods Nine‐hundred twenty‐five SARS‐CoV‐2 positive samples from patients fulfilling the Belgian SARI definition between January 2020 and December 2022 were sequenced using the ARTIC Network amplicon tiling approach on a MinION platform. Weekly variant of concern (VOC) proportions and types were compared to those that were circulating between 2021 and 2022, using 96,251 sequences of the BGS. Results SARI surveillance allowed timely detection of the Omicron (BA.1, BA.2, BA.4, and BA.5) and Delta (B.1.617.2) VOCs, with no to 2 weeks delay according to the start of their epidemic growth in the Belgian population. First detection of VOCs B.1.351 and P.1 took longer, but these remained minor in Belgium. Omicron BA.3 was never detected in SARI surveillance. Timeliness could not be evaluated for B.1.1.7, being already major at the start of the study period. Conclusions Genomic surveillance of SARS‐CoV‐2 using SARI sentinel surveillance has proven to accurately reflect VOCs detected in the population and provides a cost‐effective solution for long‐term genomic monitoring of circulating respiratory viruses., SCOPUS: ar.j, info:eu-repo/semantics/published

The management of adolescents living with HIV represents a particular challenge in the global response to HIV. The challenges specific to this age group include difficulties engaging and maintaining them in care, challenges with transition to adult care, and limited therapeutic options for treatment-experienced patients, all of which have been jeopardized by the COVID-19 pandemic. This paper summarizes some of the challenges in managing adolescents living with HIV, as well as some of the most recent and innovative therapeutic approaches in this population., SCOPUS: re.j, info:eu-repo/semantics/published

To describe the dynamics of neutralizing antibody (NAbs) response after yellow fever (YF) vaccine in young adults and adolescents with perinatally acquired HIV (pHIV)., SCOPUS: ar.j, info:eu-repo/semantics/published

Le Streptococcus pneumoniae est une bactérie pathogène pouvant causer chez les êtres humains une pléiade d’infections des plus communes aux plus sévères. Malgré les nombreux progrès faits au cours de ces dernières années notamment grâce à l’avènement de la vaccination, l’impact de cet agent infectieux reste très élevé de par le monde puisqu’on estime qu’il est responsable chaque année de 14,5 millions d’infections et de plus de 800.000 décès d’enfants de moins de 5ans. Le S. pneumoniae est la première cause de pneumonie (communautaire ou hospitalière), de méningite non-épidémique et d’otite moyenne aigüe et également une cause fréquente de sepsis, l’ensemble étant associé à une mortalité et morbidité significatives surtout chez les jeunes enfants et les personnes âgées. Paradoxalement, cet agent microbien est également une bactérie commensale, cohabitant au sein du nasopharynx humain avec de multiples autres espèces au sein de structures complexes. Si le portage nasopharyngé a clairement été identifié comme la première étape indispensable au développement de l’infection invasive, beaucoup de points restent encore à élucider quant aux facteurs conditionnant in-vivo la transition du portage vers la maladie et l’invasivité bactérienne, l’ensemble résultant d’interactions complexes entre la bactérie, le système immunitaire de l’hôte, les autres agents microbiens présents et l’environnement. Avec 61% des décès pédiatriques liés au pneumocoque concentrés sur seulement 10 pays d’Afrique et d’Asie, de nombreuses inégalités géographiques persistent malheureusement en termes d’impact de ce pathogène. Dans la région appelée ceinture méningée africaine, une prévalence accrue de méningites pneumococciques est observée, conjointement aux méningites à méningocoque et survenant selon le même mode saisonnier que celles-ci mais grevées d’un taux de léthalité plus élevé. Ces méningites sont majoritairement attribuables au seul sérotype 1 (Sp1), dont le tropisme pour le système nerveux, Doctorat en Sciences médicales (Médecine), info:eu-repo/semantics/nonPublished

Les affections endocriniennes du développement sont des maladies rares que soigne et étudiele pédiatre-endocrinologue. Elles nous renseignent sur de nombreux aspects du développement normalet du fonctionnement du système endocrinien.Ce travail regroupe des études cliniques qui concernent différentes glandes endocrines. Toutd’abord l’hypophyse, dont trois aspects sont abordés. Une nouvelle étiologie d’hypopituitarismecongénital syndromique associant anophtalmie et fente palatine est décrite. Le gène impliqué, RAX, estconservé chez tous les vertébrés et était connu chez l’homme pour donner une anophtalmie isolée.L’étude fait le parallélisme entre les phénotypes humain et murin, qui sont remarquablement similaires.Un autre aspect de la pathologie du développement hypophysaire est illustré par une étude del’hypopituitarisme congénital non syndromique dont le diagnostic est fait tardivement en raison descirconstances de vie défavorables des patients. La neurohypophyse est abordée par l’étude de troisfamilles avec diabète insipide central autosomique dominant associé à un retard de croissance. Lapathophysiologie de celui-ci est discutée à la lumière de données de physiologie murine sur l’anorexiepar déshydratation. Ensuite, le syndrome triple A, pléiotrope car lié à un déséquilibre Redox, est étudiésous l’angle de son atteinte rétinienne qui ouvre une fenêtre sur le caractère neurodégénératif de lamaladie. Finalement, le suivi à long terme d’une cohorte de patients avec hypothyroïdie congénitaleillustre les causes et conséquences des anomalies développementales ou fonctionnelles de la thyroïde.Le fil d’Ariane entre les différentes composantes de ce travail est d’illustrer l’importance:- de l’interprétation des observations cliniques à la lumière des connaissances de la physiologie humaineet animale.- d’une description phénotypique minutieuse pour la prise en charge optimale des patients et pour larecherche clinique., Doctorat en Sciences médicales (Médecine), info:eu-repo/semantics/nonPublished

The aim of this study was to estimate the seroprevalence of SARS-CoV-2 antibodies in a pediatric population after the first pandemic wave in Belgium. All patients requiring a blood sample between 1 July 2020 and 31 October 2020 in our institution were invited to participate. Their parents and siblings could also participate to estimate familial transmission and the congruence between serological statuses. A questionnaire was completed for each participant to identify symptoms consistent with COVID-19 in the previous months. Blood samples were tested for SARS-CoV-2-specific immunoglobulin G using ELISA. The final population included 112 children, 24 siblings of these children, and 36 adults. The seroprevalence of cases was 6.9% before 8 September, a date that corresponds to 1 week after the beginning of the second wave in Belgium and 22.5% afterwards (OR = 3.89, 95% CI (1.20; 12.58), p-value = 0.03). Twenty-five percent of children were asymptomatic, and none experienced severe disease. The symptoms associated with SARS-CoV-2-positive antibodies were diarrhoea (OR = 9.9, 95% CI [2.88; 33.87.65] p-value < 0.01), fever (OR = 3.8, 95% CI [1.44; 10.22] p-value < 0.01), rhinitis (OR = 3.9, 95% CI [1.38; 10.90] p-value = 0.01), or anosmia (OR = 31.5, 95% CI [1.45; 682.7], p-value = 0.02). A child was the first symptomatic household member in 50% of the familial clusters. Conclusion: Seroprevalence in children was comparable to that of the general population. Children could represent the source of infection in the household.What is Known:• COVID-19 infection is generally mild or asymptomatic in children and adolescents.• Belgian strategy of testing was focused on symptoms.• Adults are believed to be responsible for most of familial clusters.What is New:• Serological testing gives a more accurate view of the rate of infected children.• Based on serological results, children have been infected as frequently as adults during the first and second wave in Belgium.• Seventy-five, SCOPUS: ar.j, info:eu-repo/semantics/published

PURPOSE: Granulomatous inflammation is a common cause of subacute cervicofacial lymphadenitis in children. Nontuberculous mycobacterial (NTM) infections and cat-scratch disease (CSD) are the most frequent causes. Optimal treatment, which may include surgery, antibiotic treatment or wait-and-see approach, is debatable. The goal of this study was to compare the short- and long-term outcome of various surgical procedures. METHODS: Case series with a chart review of all children treated by surgical excision of granulomatous lymph nodes in the cervicofacial area from 2000 to 2016 at two tertiary care centers. RESULTS: Forty patients were included in this study. The median age at first symptoms was 3.7 years (13 months-14 years). Mean follow-up was 5.8 years (6 months-15.3 years). 25 patients fit with diagnosis of NTM infection, 6 with CSD while diagnosis remained uncertain in 9 patients. The primary surgical procedure consisted of total excision (n = 27), incision/drainage (n = 9) or incomplete excision (n = 4). None of the patients treated by primary complete excision needed further intervention contrary to the group of patients with incomplete surgical procedures where additional surgical management was required in 54%. At follow-up, all patients were healthy without evidence of recurrence. CONCLUSION: We advocate early surgical intervention with complete excision to reach quick resolution and reduce the need for additional surgery. The long-term outcome was favorable.

[Objective]: The aim of this study was to describe growth during puberty in young people with vertically acquired HIV. [Design]: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. [Methods]: One thousand and ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1–10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters. [Results]: At ART initiation, median age and HAZ was 6.4 [interquartile range (IQR): 2.8, 9.0] years and −1.2 (IQR: −2.3 to −0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20–0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21–1.78) years later in those starting with HAZ less than −3 compared with HAZ at least −1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than −1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least −1, there was no association with age. Girls and boys who initiated ART with HAZ at least −1 maintained a similar height to the WHO reference mean. [Conclusion]: Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least −1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age.

Rubella infection is a vaccine preventable disease. Maternal infection during pregnancy may lead to congenital infection and severe foetal malformations. Thanks to antiretroviral therapy, perinatally HIV-infected women have better prognosis and are now experiencing pregnancy. We evaluated the rate of rubella seronegativity in a cohort of HIV perinatally-infected women of childbearing age. A high rate of seronegativity was found in this group as compared to age-matched non-perinatally infected HIV-infected women (34.5% vs 6.90%, p < 0.01). MMR administration before rubella testing was identified in 75.8% of perinatally-infected women (22/29) with a mean of 2 doses (range: 1–3 doses). HIV perinatally-infected women of childbearing age should be screened repeatedly for rubella immunity., SCOPUS: ar.j, info:eu-repo/semantics/published

Les gastroentérites aiguës (GEA) représentent un lourd fardeau pour la population pédiatrique. Elles sont responsables d’une mortalité importante, particulièrement chez les enfants de moins de 5 ans dans les pays à faibles revenus, et ont un impact socio-économique non négligeable dans les pays à hauts revenus. La prévalence des différents entéropathogènes potentiellement impliqués dans les GEA varie selon les études, dépendamment de la technique diagnostique utilisée, de la population étudiée – âge des patients, co-morbidités, situation géographique et socio-économique – et du moment où l’étude a été réalisée.Campylobacter est l’un des pathogènes entériques majeurs dans les pays à hauts revenus. Les espèces Campylobacter jejuni et coli sont les plus fréquemment retrouvées par les méthodes de culture sur des milieux sélectifs utilisées en routine dans la plupart des laboratoires de microbiologie. Cependant l’utilisation d’autres méthodes, comme la technique « de filtration » ou les techniques de PCR, permet de mettre en évidence d’autres campylobacters tels que Campylobacter concisus dont le rôle dans les GEA est sujet à controverse.Dans ce contexte, l’objectif général de ce travail de thèse est l’amélioration de la prise en charge diagnostique des GEA en pédiatrie à Bruxelles. Cet objectif se détaille en deux sousobjectifs: d’abord une étude de prévalence des entéropathogènes - et potentiels entéropathogènes -, ensuite une amélioration de techniques diagnostiques. Ces éléments sont détaillés ci-dessous.La première partie de ce travail nous a permis de recruter deux groupes de patients :l’un atteint de GEA (185 cas) et l’autre asymptomatique (179 témoins), mais comparables notamment en termes d’âge, de fréquentation de la crèche ou de l’école, de vaccination contre rotavirus, et de traitement par antibiotique. Au vu des techniques diagnostiques utilisées dans notre étude, Campylobacter jejuni-coli était le principal reponsable de GEA dans notre population (14% des c, Doctorat en Sciences médicales (Médecine), info:eu-repo/semantics/nonPublished

Measles infection is a vaccine-preventable disease currently resurging in Europe. HIV-infected subjects are at higher risk of complications following measles infection. We investigated the risk factors associated with being seronegative in a cohort of HIV-infected subjects., SCOPUS: ar.j, info:eu-repo/semantics/published

Au travers d’une base de données médicales de patients drépanocytaires en Belgique, le travail aborde trois aspects qui ont fait l’objet de publications. Le premier est une description de la population drépanocytaire sur base d’une cohorte de 167 nouveau-nés avec un suivi médian en Belgique de 6,1 ans. Un second est l’apport du dépistage néonatal et de la prise en charge clinique précoce des patients. Un troisième concerne la survie des patients en fonction de l’intensification thérapeutique mise en œuvre. Enfin, des résultats non publiés rapportent les événements cliniques avant et après le passage à l’âge adulte.Les résultats ont permis de démontrer que les patients drépanocytaires suivis en Belgique présentent une forme sévère de la maladie ;le dépistage néonatal et en particulier la prise en charge précoce des malades donne un bénéfice clinique mais également de qualité de vie. L’intensification thérapeutique par hydroxyurée est efficace et entre autre sur la survie des patients. La période de transition entre l ‘équipe médicale pédiatrique et celle pour les adultes n’est pas, sur la cohorte étudiée, une période à risque au niveau de la survie des patients drépanocytaires. L’ensemble de ces résultats démontrent qu’une base de données médicales est essentielle pour permettre de faire évoluer nos connaissances et pratiques sur la maladie et de partager celles-ci.​, Through a medical database of sickle cell patients in Belgium, the work addresses three aspects that have been published. The first is a description of the sickle cell population based on a cohort of 167 newborns with a median follow-up in Belgium of 6.1 years. A second is the provision of neonatal screening and early clinical management of these patients. A third concerns the survival of patients according to the therapeutic intensification implemented. Finally, unpublished results report clinical events before and after adulthood.The results have shown that sickle cell patients followed in Belgium have a severe form of the disease; Neonatal screening and in particular the early management of patients gives a clinical benefit but also quality of life. The therapeutic intensification with hydroxyurea is effective and in particular on the survival of the patients. The transition period between the pediatric medical team and the adult team is not, for the cohort studied, a risk period for the survival of sickle cell patients. All of these results demonstrate that a medical database is essential to evolve and share our knowledge and practices about the disease., Doctorat en Sciences médicales (Médecine), info:eu-repo/semantics/nonPublished

The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV-1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short-term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long-term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first- and second-line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained., SCOPUS: ar.j, info:eu-repo/semantics/published

Background. Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods. Children aged <18 years initiating combination ART (.2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of .1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results. Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7.10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9.8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%.23%), with significant regional variations. Median time to switch was 30 (IQR, 16.58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions. One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch., 0, SCOPUS: ar.j, info:eu-repo/semantics/published

[Objective] To characterize children, adolescents and young adults infected with HIV/hepatitis C virus (HCV) vertically or before age of 18 years and living in Europe regarding mode of acquisition, HCV genotype, clinical status and treatment., [Design] Retrospective, cross-sectional study using pooled data from 11 European paediatric HIV cohorts., [Methods] Patients aged more than 18 months and less than 25 years, with HIV/HCV acquired vertically or in childhood, were included. Anonymized individual patient data were collected using a standard protocol and modified HIV Cohorts Data Exchange Protocol., [Results] Of 229 patients included, 142 (62%) had vertically acquired infection. Median age at last follow-up was 16.2 years. Most children had HCV genotype 1 (101/184, 55%) or 3 (57/184, 31%). One-fifth (46/214) had a previous AIDS diagnosis (data missing on prior AIDS diagnoses for 15). At their last clinic visit, 70% (145/208) had no/mild immunosuppression (Centers for Disease Control and Prevention stage 1), and 131 of 179 on antiretroviral therapy had undetectable HIV RNA (assay thresholds varied from <20 to <150 copies/ml). Overall, 42% (86/204) had hepatomegaly in the previous year, and 55% (116/213) had alanine aminotransferase more than 40 IU/l at their last test. Of 97 patients with transient elastography, 12 had results more than 9 kPa; this was associated with duration of HCV infection (P = 0.033), but not with CD4+ cell count, antiretroviral therapy use or sex in univariable analysis. Of 17 patients with liver biopsies, six had bridging fibrosis and one had cirrhosis. Twenty-five (11%) had been treated successfully for HCV., [Conclusion] The high proportion of patients with progressive liver disease underscores the need for close monitoring and earlier and more effective HCV treatment.

La majorité des infections par le VIH de l’enfant sont acquises par transmission de la mère à l’enfant en période périnatale. Le fait que le système immunitaire des nourrissons soit « immature » par certains aspects et le fait que le virus transmis ait déjà échappé au contrôle de l’environnement immunitaire maternel, génétiquement proche de celui de l’enfant, sont probablement responsables du risque important que l’évolution naturelle soit extrêmement rapide lorsque l’infection est acquise en tout début de vie. En l’absence d’un traitement antirétroviral, la réplication virale va en effet se maintenir à un niveau très élevé pendant les premières années de vie chez tous les enfants et jusque 25% d’entre eux vont évoluer jusqu’au stade SIDA ou le décès durant leur 1ère année de vie. L'utilisation des traitements antirétroviraux puissants actuellement disponibles permet de réduire drastiquement la réplication virale et a profondément modifié le pronostic de l’infection par le VIH. D’une infection inéluctablement fatale, elle est devenue une affection chronique peu ou pas évolutive pour autant que le traitement antirétroviral soit pris de façon ininterrompue. Dans ce travail, nous présentons les résultats d’une étude prospective qui incluait les patients chez qui un traitement antirétroviral efficace était débuté pour la première fois. Nous avons pu démontrer que le nombre de lymphocytes CD4+ naïfs était d’autant plus rapidement reconstitué après l’initiation d’un traitement antiviral que celui-ci avait été débuté jeune. Non seulement les patients restauraient leurs nombres de cellules CD4+, et leurs cellules CD4+ naïves en particulier, mais des tests plus fonctionnels des lymphocytes (réponses lymphoprolifératives aux mitogènes) montraient également une nette amélioration sous traitement antirétroviral. Malgré cela, certaines anomalies, et en particulier l’activation des lymphocytes CD8+ persistaient après un an de traitement.Dans une étude cross-sectionnelle ayant inc, Doctorat en Sciences médicales (Médecine), info:eu-repo/semantics/nonPublished

Objective: To assess the adherence to antiretroviral therapy in adolescents infected by HIV since early childhood and to determine its medical and psychosocial determinants. Methods: The study was based on patient interviews to administer 2 adherence questionnaires. The medical charts were reviewed for the record of the latest CD4 counts, viral load, and sociodemographic characteristics. Results: Thirty-two HIV-infected adolescents were enrolled in the study. Only 15 of 32 of them (47%) claimed adherence greater than 95%, whereas 26 of 32 (81%) had a viral load less than 50 copies/mL. The adolescents with an undetectable viral load had a median adherence rate significantly higher than adolescents with virological failure (100 versus 83.5%; P=. 0.01). Among the latter, 5 out of 6 patients acknowledged adherence less than 95% versus 12 of 26 patients with an undetectable viral load. Having forgotten was the main reason reported for skipping medication doses. Fear of being seen while taking the pills differentiated adolescents with adherence less than 95% from the others (79 versus 33%; P=. 0.01). Conclusion: The self-reported adherence rate evaluated by questionnaire was associated with control of the viremia. However, the significance of these rates and the thresholds used have to be interpreted taking into account the characteristics of the drugs as well as the patients' treatment history. The reasons for skipping treatment doses are related to the adolescent process and the representations that the adolescent has of his illness. © 2013 Elsevier Masson SAS., SCOPUS: ar.j, info:eu-repo/semantics/published

Background The treatment of complicated urinary tract infection in children is still a matter of debate. In our hospital, antimicrobial treatment is initiated intravenously, and the duration of this treatment is adapted according to the results of a Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy. Aim This study was conducted to evaluate retrospectively the frequency and the importance of late renal sequelae when treating intravenously for 7 days those patients with an abnormal acute DMSA. Methods A review was conducted of the medical charts of all patients consecutively admitted between 2005 and 2008 with positive urine culture and clinical and biological evidence of complicated urinary tract infection (UTI). Results There were 144 patients (59 %) with abnormal early DMSA scintigraphy and 98 (41 %) with normal scintigraphy. The median duration of intravenous treatment was 7.0 days in the children with DMSA lesions and 5.0 days in those without lesions. Obvious renal sequelae were observed on late DMSA scintigraphy in 4 (6 %) out of the 65 patients with an abnormal early DMSA who came back for control scintigraphy. Conclusion Sequelae of acute DMSA lesions observed during complicated UTI treated 7 days intravenously were infrequent. Whether the mode and duration of antimicrobial treatment might explain the low rate of sequelae remains to be demonstrated., SCOPUS: ar.j, info:eu-repo/semantics/published

The objective of this study was to investigate whether the restored immune functions of vertically human immunodeficiency virus (HIV)-infected children who were severely immunodeficient before the initiation of highly active anti-retroviral therapy (HAART) are comparable to those of untreated slow progressors. We therefore assessed T cell proliferation and cytokine [interferon (IFN)-γ, interleukin (IL)-5 and IL-13] secretions after mitogen, recall antigens and HIV-1-specific stimulation in 12 untreated slow progressors, 16 untreated progressors and 18 treated patients. Treated children were profoundly immunodeficient before the initiation of HAART and had long-lasting suppression of viral replication on treatment. We demonstrated that slow progressors are characterized not only by the preservation of HIV-1-specific lymphoproliferative responses but also by the fact that these responses are clearly T helper type 1 (Th1)-polarized. Children on HAART had proliferative responses to HIV-1 p24 antigen, purified protein derivative (PPD) and tetanus antigen similar to slow progressors and higher than those of progressors. However, in contrast to slow progressors, most treated children exhibited a release of Th2 cytokines accompanying the IFN-γ secretion in response to the HIV-1 p24 antigen. Moreover, despite higher proliferative responses to phytohaemagglutinin (PHA) than the two groups of untreated children, treated children had lower levels of IFN-γ secretion in response to PHA than slow progressors. These data show that in severely immunodeficient vertically HIV-infected children, a long-lasting HAART allows recovering lymphoproliferative responses similar to untreated slow progressors. However, alterations in IFN-γ secretion in response to the mitogen PHA persisted, and their cytokine release after HIV-specific stimulation was biased towards a Th2 response. © 2011 The Authors. Clinical and Experimental Immunology © 2011 British Society for Immunology., SCOPUS: ar.j, FLWIN, info:eu-repo/semantics/published

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The occurrence of an unusual number of group B streptococcal (GBS) infections in HIV-exposed uninfected (HEU) infants who were followed in our center prompted this study. The objective of this study was to describe and compare the incidence and clinical presentation of GBS infections in infants who were born to HIV-infected and -uninfected mothers., Comparative Study, Journal Article, SCOPUS: ar.j, info:eu-repo/semantics/published