Search

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.

Background: Despite the potential psychosocial risks associated with having a chronic illness, a limited number of empirical studies have examined the prevalence of mental health problems in children with HIV. Aims: To study the psychosocial profile and psychopathology in children with HIV & AIDS. Methodology: The study was carried out at PediatricAnti RetroviralTherapy centre and OP block of Niloufer Hospital, tertiary hospital at Hyderabad. Three groups of each 30 children were selected by purposive sampling namely children with HIV staying with parents, children with HIV staying in foster homes and children without HIV staying in foster homes reporting for minor health ailments.Informed consent was taken from caregivers. Sociodemographic data and details pertaining to HIV were obtained from each followed by administration of CPMSscale. Results were compiled and subjected to statistical evaluation. Results: Socio demographic factors such as lower level of paternal education, lower maternal education, death of father and death of mother were significantly associated with HIV infected children. Compared to Non HIV children, HIV children had higher total CPMS score and higher scores in CPMS factors of anxiety, low intelligence with behavior problems, special symptoms, physical illness with emotional problems and high scores of conduct disorder. Conclusion: HIV infected children suffer from both internalizing and externalizing behavioural problems.Key words: Socio-demographic factors, psychopathology, HIV children, behavioural problems.

Introduction: Retention in care and reengagement of lost to follow-up (LTFU) patients are priority challenges in pediatric HIV care. We aimed to assess whether a telephone-call active tracing program facilitated reengagement in care (RIC) in the Manhiça District Hospital, Mozambique.Methods: Telephone tracing of LTFU children was performed from July 2016 to March 2017. Both ART (antiretroviral treatment) and preART patients were included in this study. LTFU was defined as not attending the clinic for ≥120 days after last attended visit. Reengagement was determined 3 months after an attempt to contact.Results: A total of 144 children initially identified as LTFU entered the active tracing program and 37 were reached by means of telephone tracing. RIC was 57% (95% CI, 39-72%) among children who could be reached versus 18% (95% CI, 11-26%) of those who could not be reached (p = 0.001).Conclusion: Telephone tracing could be an effective tool for facilitating reengagement in pediatric HIV care. However, the difficulty of reaching patients is an obstacle that can undermine the program. [ABSTRACT FROM AUTHOR]

This work investigates the mutative potential of using personalized fictional stories to reveal to children and adolescents the diagnosis of organic diseases. It is set around psychology sessions of an HIV+ adolescent which were transcribed in the form of transference narratives and examined under the Ambrosio and Vaisberg Procedure for evaluation of psychotherapeutic benefits. Adopting this procedure, it was possible to verify that the use of stories favored a mutative experience of transition from a defended and dissociated position to a more integrated and less anxious position, characterized by the possibility of greater tolerance to suffering when the option of belonging to ordinary life is offered. Clinical and reflective dialogues with Winnicot psychoanalysis finalize the text, evidencing the passage of a HIV+ diagnosis from a subjective object to an object that belongs to the shared world

A high index of suspicion is needed in pediatric patients with neurological symptoms being the sole presenting manifestation, to diagnose infection with the Human Immunodeficiency Vnus (HIV). This is a write up of two such cases who were admitted to the pediatric intensive care unit with neurological manifestations. A 6 year old previously healthy child, who initially presented with intermittent drowsiness and fluctuation in blood pressine, later during hospital stay, developed progressive motor, cognitive, visual and language difficulties. Investigations revealed the child to be HIV positive and magnetic resonance imaging (MRI) findings were consistent with progressive multifocal leucoencephalopathy. A12 yr old child had stroke initially (for which extensive work up had been done) and later, after 8 months presented with the same complaints along with severe pneumonia .He succumbed to severe opportunistic infections. That he was HIV positive, had not been detected during the first admission as left sided weakness was the only presenting manifestation.

Historically, the cure rate model has been used for modeling time-to-event data within which a significant proportion of patients are assumed to be cured of illnesses, including breast cancer, non-Hodgkin lymphoma, leukemia, prostate cancer, melanoma, and head and neck cancer. Perhaps the most popular type of cure rate model is the mixture model introduced by Berkson and Gage [1]. In this model, it is assumed that a certain proportion of the patients are cured, in the sense that they do not present the event of interest during a long period of time and can found to be immune to the cause of failure under study. In this paper, we propose a general hazard model which accommodates comprehensive families of cure rate models as particular cases, including the model proposed by Berkson and Gage. The maximum-likelihood-estimation procedure is discussed. A simulation study analyzes the coverage probabilities of the asymptotic confidence intervals for the parameters. A real data set on children exposed to HIV by vertical transmission illustrates the methodology. [ABSTRACT FROM AUTHOR]

Exist association between hepatitis B virus (HVB), hepatitis C virus (HCV) and HIV. The coinfection of HBV/HIV and HCV/HIV in children is important for quick progression of the illness and increase of mortality rate. The objectives of this study was to contribute to the knowledge of the hepatitis B and C in cuban HIV children, identify the prevalence of the surface antigen of the HBV (HBsAg) and antibodies to the HCV (anti-HCV), to know the expourse to the HBV (anti-HBc), to detect the replication of the HBV and HCV, to determine the seroprotection against HBV, to relate aminotransferase value, check CD4+ values and viral load with viral markers. Between 2005-2008 all cuban HIV children were studied (n=30) with markers of HBsAg, anti-HCV, anti-HBc, anti-HBs by using UMELISA technique (CIE, Cuba), the positives cases were examined for viral replication ot HBV and HCV by polymerase chain reaction (PCR). The statistical analysis was carried out using the package NCSS 2000. Positivity to the HBsAg was not found, 10% of anti-HBc was registered anti-HCV presence in 10%, 53.3% was found protected against the HBV, an average geometric titre of 19.29 UI/L prevailing holding hipoprotective values. In the revaccinated children there was an increase in the titre to 104.58 UI/L. The results did not show statistical significance between anti-HCV infection and sex, skin color, means of transmission, alanin-aminotransferase (ASAT), CD4+ and viral load of HIV, however, an association between anti-HCV and aspartat-aminotransferase (ALAT) was found. This study contributes to the correct management of these children infected with hepatitis B and C and therefore improving their quality of life. [ABSTRACT FROM AUTHOR]

Aim: To investigate the role of IL-7 in HIV-infected children on highly active antiretroviral therapy (HAART) and its association with laboratory parameters related to disease progression.Patients and Methods: A cross-sectional study in 31 vertically HIV-infected children (median age 8.4 y) treated with HAART, and a longitudinal study in four of those same children was carried out. In both studies, viral load, CD4+ T-cell counts, thymic production of T cells by TCR rearrangement excision circles (TRECs), IL-7 plasma levels and viral phenotype were determined.Results: IL-7 levels were higher in HIV-infected children than in age-matched, uninfected controls. In addition, HIV children with CD4+ T cells between 200 and 500 T cells/mm3 had higher IL-7 levels and lower TREC values than HIV-infected children with CD4+ T cells >500 T cells/mm3. IL-7 levels were higher in children with syncytium-inducing (SI) phenotype than in those with non-syncytium-inducing (NSI) variants. During the follow-up of four HIV children, the decrease in viral load after HAART was always associated with a recovery of CD4+ T cells and TRECs, which was followed by a decrease in IL-7 returning to the levels present prior to the drop in CD4+ T cells. The four HIV-infected children had SI/X4 isolates in PBMC before HAART, and the viral phenotype switched to NSI/R5 after HAART.Conclusion: Our data suggest that IL-7 plays a key role in the maintenance of T-cell homeostasis in HIV-infected children on HAART, both through peripheral expansion and through a thymus-dependent mechanism. [ABSTRACT FROM AUTHOR]

HIV infection causes progressive impairment of humoral immunity, including defective specific antibody production. To evaluate whether vertical HIV infection interferes with the expression on CD4+ lymphocytes of developmentally regulated molecules, that play a crucial role in the generation of immunological memory (CD45 isoforms) and in attainment of antibody responses (CD40L), 22 HIV-infected children and 36 seroreverted children born to HIV+ mothers were studied. The percentage of CD40L+ PBMC after activation in vivo with phorbol myristate acetate (PMA) plus ionomycin was lower in HIV-infected children than in controls (P <0.004). This correlated with the depletion of CD4+ lymphocytes (r = 0.75; P < 0.001). D40L expression rose progressively with age (r = 0.36; P = 0.03) in seroreverted children, but not in HIV-infected children, suggesting that while in normal children in vivo antigen stimulation results in progressive attainment of CD40L expression (and thus to effective T-B cell cooperation), this process is largely defective in HIV-infected children, contributing to the genesis of humoral immune deficiency. The proportion of CD4+ cells bearing the CD45RO isoform was increased among HIV-infected infants during the first years of life. However, the percentage of CD4+ CD45RO+ peripheral blood mononuclear cells (PBMC) progressively increased with age in controls (r = 069; P = 0.03), but not in HIV-infected children, showing that while vertical transmission of HIV does not prevent CD45RO expression early in life, it is associated with a disturbance of the physiological process of antigen priming, contributing to poor immunological memory to T cell-dependent antigens. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate outcomes in dual nucleoside reverse transcriptase inhibitor (NRTI) pretreated children after genotyping (GT). Methods: We assessed CD4 and viral load (VL) in children three years after baseline GT at the time of dual NRTI failure. Baseline high grade resistance (HR) was defined as ≥4 nucleoside analogue mutations (NAMs)±Q151M or 69 insertion complex, and low grade resistance (LR) was defined as <4 NAMs. Genotypic susceptibility scores (GSS) were determined. The current selection of antiretrovirals (ARV) was based on physician judgment and ARV availability. Results: Seventy-two children were enrolled, with a mean age of 9.3 years; 61% were female. Baseline median CD4 was 18%, VL was 1.7 log10 with HR 37.5%, LR 56.9% and no mutation (NR, no resistance) 5.6%. Sixty-five (90.3%) switched ARV: 46.2% non-nucleoside reverse transcriptase inhibitor (NNRTI), 30.8% protease inhibitor (PI), and 23.1% PI+NNRTI based highly active antiretroviral therapy (HAART). The choice of regimen did not differ based on baseline HR, LR, and NR. The median duration from dual NRTI therapy to HAART was 5.4 years (interquartile range (IQR) 4.0–6.9 years) and the mean (SD) duration of current HAART regimen was 1.51 (1.78) years; both were similar between ARV groups. Five children continued dual NRTI, two interrupted therapy. The GSS score was significantly higher in the PI group (3.1) vs. PI+NNRTI (2.5) vs. NNRTI (2.6) groups. Sixty-three percent of the HR group used PI or PI+NNRTI-based HAART compared to 41% of the LR group, p =not significant. At follow-up, median CD4 changes from baseline were +5% and VL −2.2 log10 (p <0.001). VL <1.7 log10 was seen in 59.3% of HR, 58.5% of LR, and 50.0% of NR groups (no significant difference). More children on PI (75%) and PI+NNRTI (80%) based HAART had VL <50 compared to NNRTI-based HAART (50%), p =0.003. Conclusion: PI-based regimens showed a higher rate of undetectable VL compared with NNRTI-based regimens. Having GT may not affect second-line treatment choices in developing countries, most likely due to late VL failure and limited availability of PIs. [Copyright &y& Elsevier]

Summary: A handful of Henoch–Schönlein purpura (HSP) cases have been reported in HIV-infected adult patients. We report herein the case of an 11-year-old Thai girl with HIV infection, who developed severe abdominal pain and palpable purpura consistent with HSP, 3 months after planned antiretroviral treatment interruption (PTI). One month later she developed thrombocytopenia. It is possible that an HIV effect on vascular endothelium or PTI-associated immune activation contributed to HSP and thrombocytopenia. [Copyright &y& Elsevier]