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A 12-year-old Hispanic girl presented with fatigue, lightheadedness, and intermittent headaches. She was depressed and appeared pale to her mother. Her examination was unremarkable except for palpebral conjunctival pallor and was otherwise noncontributory. She had a profound hypoproliferative microcytic anemia with low iron level, low transferrin saturation, and a normal ferritin level. The patient experienced improvement in clinical symptoms following transfusion of packed red blood cells and oral iron therapy. At follow-up 2 months later, she presented with similar symptoms and persistent microcytic anemia with low iron levels. Her ferritin level was increased along with markedly elevated C-reactive protein and erythrocyte sedimentation rate. An oral iron challenge demonstrated lack of absorption, and hepcidin level was also significantly elevated. Thorough gastrointestinal and rheumatologic evaluations were performed to search for a source of inflammation. Key components of the patient's social history supplemented by serology, radiographic, and pathologic findings ultimately cinched an unexpected diagnosis.

BackgroundThis study measured serial plasma human immunodeficiency virus (HIV)-1-specific antibody (Ab) levels in children who initiated antiretroviral therapy (ART) prior to 2 years of age, and evaluated their relationship to peripheral blood HIV-1 RNA and DNA levels.MethodsWe studied 46 HIV-1-infected children, stratified by age at ART initiation (3 mo-2 years, late therapy [LT]) and by virologic response (R) or non-response (NR), before and up to 4 years following ART. We studied 20 HIV-1-uninfected children born to HIV-1-infected mothers (seroreverters [SR]) as controls. Plasma immunoglobulin G (IgG) Ab levels directed against HIV-1 envelope (gp160, gp41), gag (capsid, p24; matrix, p17), reverse transcriptase (p66/51), and integrase (p31) were serially measured using quantitative enzyme-linked immunosorbent assays. HIV-1 Ab rates of decline were estimated over the first 15 months of the study.ResultsThe HIV-1 Ab rates of decline in the ET-R group were similar to those in the SR group for all Ab specificities, except for p17 (P = .01). Ab decline rates in the LT-R group and the NR group were significantly slower than in the SR group for all tested Ab specificities. After 1 year of age, Ab levels to p31 and p17 were significantly associated with HIV-1 RNA levels (P < .001); Ab levels to gp160 (P < .001) and gp41 (P < .001) were significantly associated with cell-associated HIV-1 DNA levels.ConclusionsQuantitative HIV-1-specific Ab levels may be useful for screening children on ART for viral suppression or for residual, cell-associated HIV-1 DNA levels.Clinical trials registrationNCT00000872.

The article discusses three cases of infants with severe combined immunodeficiency (SCID) who were administered the RV5 Rotateq rotavirus vaccine and thereafter developed vaccine-acquired rotavirus disease. These case studies raise concerns regarding the safety of the rotavirus vaccines in such patients and highlight the need to prevent such occurrences in future.

An examination of early disease progression and survival in a population-based cohort with perinatal HIV infection in relation to year of birth and use of antiretroviral therapy (ART) is presented. The results led to the conclusion that the population-based cohort demonstrated decreased early HIV progression and improved survival at age 3 years, associated with more advanced theory.

ABBREVIATIONS. PCV, pneumococcal conjugate vaccine; HIV, human immunodeficiency virus; HAART, highly active antiretroviral treatment; PACTG 292, Pediatric AIDS Clinical Trials Group Study 292; CDC, Centers for Disease Control and Prevention; [...], Objective. Heptavalent pneumococcal conjugate vaccine (PCV) has been shown to be safe and effective in healthy infants and children. However, little is known about its use in children who have human immunodeficiency virus (HIV) infection and are known to be at increased risk of developing pneumococcal infections. This study was conducted to evaluate the safety and immunogenicity of heptavalent PCV in infants with HIV infection. Methods. The Pediatric AIDS Clinical Trials Group Study 292 Team randomized infants with HIV infection 2:1 to receive heptavalent PCV or placebo in a double-blinded manner. Infants were vaccinated with 3 doses at 2-month intervals, starting at ages 56 to 180 days. A booster dose was given at 15 months of age. Immunogenicity was evaluated after the third dose of vaccine, before and after the booster dose, and at 24 months of age. Results. Thirty infants with HIV infection received PCV, and 15 received placebo. No differences in baseline characteristics were found across arms. Five severe acute reactions were experienced by 4 subjects: 3 in the PCV arm and 1 in the placebo arm; all occurred among subjects with symptomatic disease at study entry. No differences were found in the 2 arms with respect to the number or timing of new diagnoses through 24 months of age, including diagnoses of otitis media. However, when symptomatic subjects were examined separately, the first new diagnosis occurred more rapidly among PCV recipients. Three deaths, all judged to be unrelated to study vaccine, occurred during follow-up: 2 in the PCV arm and 1 in the placebo arm. The primary immunogenicity measures were based on composites of 4-fold changes in serotype-specific immunoglobulin G titers from preimmunization levels. We found a highly significant difference between the vaccine and placebo arms, with the PCV arm showing higher rates of response. Asymptomatic and symptomatic subjects who received PCV had similar immunologic responses for all serotypes. Conclusions. This study demonstrates that heptavalent PCV was well tolerated and not associated with vaccine-associated adverse reactions. Most important, this vaccine was immunogenic in the infant with HIV infection. However, additional studies of this vaccine (or others) must pay special attention to patients with symptomatic HIV disease, as they seem to be at higher risk for adverse events to any antigen.

Research has been conducted on emotional distress in HIV-infected children. Results demonstrate that higher child IQ and family expressiveness increase the probability of earlier diagnostic disclosure to these children, but this diagnostic disclosure may not necessarily minimize emotional distress.

Assesses the clinical, immunologic and virologic effects and the pharmacokinetics of human immunodeficiency virus (HIV) human hyperimmune immunoglobulin (HIVIG) in HIV-infected children aged 2-11 years. Efficacy of the use of antibody in the treatment of viral infection; HIVIG p24 antibody concentrations at baseline and average peak and trough levels.

A 14-day old infant with stomatitis due to Candida albicans presented with frequent emesis and was found to have esophagitis by barium esophagram. She responded promptly to oral Mycostatin suspension: her emesis subsided and the stomatitis resolved. Repeat esophagram on the seventh day of therapy showed complete resolution of the esophageal mucosat abnormalities. Although Candida stomatitis is common in infants, the incidence and appropriate therapy of Candida esophagitis as a complication in otherwise normal infants are unknown. This patient responded well to frequent therapy with an oral, nonabsorhahle antifungal agent. [ABSTRACT FROM AUTHOR]

Background: Despite the high prevalence of altered iron metabolism in children with human immunodeficiency virus (HIV) disease, these alterations have not been well studied., Procedures: Twenty-six children with HIV disease underwent laboratory evaluation to determine the presence of anemia, and to classify the anemia as iron-deficiency anemia or anemia of chronic disease., Results: Half of the children had an alteration in iron metabolism: 6 were iron deficient, 4 had hyperferritinemia, and 3 demonstrated hyperferritinemia with iron deficiency., Conclusions: These data indicate that alterations in iron metabolism are common even in the HAART era and warrant further study to identify individuals at risk for these alterations.