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Fernández-McPhee C, Sainz T, Mellado MJ, Noguera-Julian A, Otero C, Fortuny C, Soler-Palacín P, Falcón MD, Ramos Amador JT, Gavilán C, González-Tomé MI, Navarro ML. Effect of Hepatitis C Virus Coinfection on the Progression of Vertically Acquired Human Immunodeficiency Virus Infection During Childhood and Adolescence. J Pediatric Infect Dis Soc 2020; 9:232-235. [PMID: 30929024 DOI: 10.1093/jpids/piz008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/25/2019] [Indexed: 11/13/2022]
Abstract
Data for a total of 57 patients vertically coinfected with human immunodeficiency virus (HIV)/hepatitis C virus (HCV) and 365 HIV-monoinfected patients were compared until their transition to adult care. No differences regarding the dynamics of CD4 and/or CD8 T-cell counts during childhood were found. The coexistence of HCV does not increase the risk of disease progression in vertically HIV-infected patients.
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Affiliation(s)
- Carolina Fernández-McPhee
- Departments of Pediatric Infectious Diseases, University Hospital Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), Madrid.,Spain Universidad Complutense de Madrid, Spain
| | - Talía Sainz
- Department of Pediatric Infectious Diseases, University Hospital La Paz and La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - María José Mellado
- Department of Pediatrics, Universidad Autonoma de Madrid, Madrid, Spain.,Department of Pediatric Infectious Diseases, Universidad Autónoma de Madrid, Spain
| | - Antoni Noguera-Julian
- Unit of infectious Diseases and Systemic Inflammatory Response and Hospital Sant Joan de Déu Research Institute, Barcelona, Spain.,Department of Pediatrics, Universidad de Barcelona, Barcelona Spain.,CIBER in Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Carmen Otero
- Department of Pediatric Infectious Diseases, University Hospital La Fe, Valencia, Spain
| | - Claudia Fortuny
- Unit of infectious Diseases and Systemic Inflammatory Response and Hospital Sant Joan de Déu Research Institute, Barcelona, Spain.,Department of Pediatrics, Universidad de Barcelona, Barcelona Spain.,CIBER in Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - María Dolores Falcón
- Pediatric Infectious Diseases, Immunology and Rheumatology Unit, University Hospital Virgen del Rocío, Sevilla, Spain.,Pediatric Infectious Diseases, Immunology and Rheumatology Unit, Instituto de Biomedicina de Sevilla (IBiS), Spain
| | - José Tomás Ramos Amador
- Department of Pediatrics, Hospital Clinico San Carlos and Hospital Clinico San Carlos Research Institute, Madrid, Spain.,Department of Pediatrics, Universidad Complutense de Madrid, Madrid, Spain
| | - César Gavilán
- Department of Pediatrics, University Hospital Sant Joan d'Alacant, Alicante, Spain
| | | | - María Luisa Navarro
- Departments of Pediatric Infectious Diseases, University Hospital Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), Madrid.,Spain Universidad Complutense de Madrid, Spain
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Domínguez-Rodríguez S, Rojas P, Fernández McPhee C, Pagán I, Navarro ML, Ramos JT, Holguín Á. Effect of HIV/HCV Co-Infection on the Protease Evolution of HIV-1B: A Pilot Study in a Pediatric Population. Sci Rep 2018; 8:2347. [PMID: 29403002 PMCID: PMC5799169 DOI: 10.1038/s41598-018-19312-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/29/2017] [Indexed: 12/28/2022] Open
Abstract
This pilot study evaluates in pediatric patients the impact of HIV/HCV coinfection in the molecular evolution of the HIV-1 subtype B protease (HIV-1BPR). For this study, HIV-1B/HCV coinfected (15) and HIV-1B monoinfected (56) patients with available HIV-1B pol sequences were enrolled. Both groups of patients had comparable gender frequencies and average age, time of infection, antiretroviral treatment (ART) exposure and time under ART. Prevalence of drug resistance mutations (DRM), genetic diversity, number of synonymous (dS) and non-synonymous (dN) mutations per site and selection pressures (dN - dS) in the HIV-1BPR were estimated and compared between mono- and coinfected patients. Both HIV-1B populations presented similar genetic diversity (0.050 ± 0.02 vs. 0.045 ± 0.01) and dS (0.074 ± 0.03 vs. 0.078 ± 0.04). In turn, in coinfected patients the HIV-1BPR had higher dN (0.045 ± 0.01 vs. 0.024 ± 0.01) and dN-dS (-0.026 ± 0.02 vs. -0.048 ± 0.04) values, and less amino acid sites under purifying selection (4.2% vs. 42.1%) than in monoinfected patients. Accordingly, in co-infection with HCV, the HIV-1BPR sites 50, 53, 82, 84 and 88 - associated with resistance to PIs - were under neutral evolution, whereas these sites were under purifying selection in monoinfected patients. This pilot study suggests that HIV-1B may evolve differently in the presence than in the absence of HCV.
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Affiliation(s)
- Sara Domínguez-Rodríguez
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBER-ESP, Madrid, 28034, Spain
| | - Patricia Rojas
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBER-ESP, Madrid, 28034, Spain
| | - Carolina Fernández McPhee
- Department of Pediatric Infectious Diseases, Hospital Universitario Gregorio Marañón-IisGM-UCM-RITIP-CoRISPe, Madrid, 28009, Spain
| | - Israel Pagán
- Centro de Biotecnología y Genómica de Plantas (UPM-INIA), Campus Montegancedo, Pozuelo de Alarcón, 28223, Madrid, Spain
| | - María Luisa Navarro
- Department of Pediatric Infectious Diseases, Hospital Universitario Gregorio Marañón-IisGM-UCM-RITIP-CoRISPe, Madrid, 28009, Spain
| | - José Tomás Ramos
- Pediatric Department, Hospital Clínico Universitario and Universidad Complutense, Madrid, 28040, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBER-ESP, Madrid, 28034, Spain.
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Noninvasive procedures to evaluate liver involvement in HIV-1 vertically infected children. J Pediatr Gastroenterol Nutr 2009; 49:599-606. [PMID: 19668009 DOI: 10.1097/mpg.0b013e3181a15b72] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES : Progressive liver injury is a concern in HIV-infected children exposed to long-term antiretroviral drugs and to the cytopathic effect of HIV. Yet liver biopsy is usually considered too invasive to be repeated in these patients. The aims of this study are to evaluate the feasibility of noninvasive hepatic investigations in HIV-1-infected children, assess the prevalence of signs of liver affection, and analyse the influence of the HIV disease severity and the exposure to antiretroviral therapy. MATERIALS AND METHODS : A cross-sectional study conducted in 26 HIV-1 vertically infected children ages 8 to 18 years old. Liver function was assessed with standard serum biochemical markers, FibroTest, ActiTest, SteatoTest, Forns index, aspartate aminotransferase to platelet ratio index, ultrasound, and Fibroscan. RESULTS : Nineteen (>60%) children had signs of liver affection on at least 1 of the test results: 13 (50%) had elevated liver enzymes, 15 (63%), 8 (33%), 5 (21%), and 5 (21%) had abnormal FibroTest, ActiTest, Forns index, and aspartate aminotransferase to platelet ratio index results, respectively. Four children (17%) had mild liver steatosis on ultrasound. Fibroscan measures were significantly higher in patients than in age-matched healthy children. Patients with elevated Fibroscan measures also had significantly higher FibroTest results. Age, HIV stage N in the Centers for Disease Control and Prevention classification and exposure duration to nucleoside reverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitor drugs were the main risk factors for hepatotoxicity. CONCLUSIONS : More than half of our population of HIV-infected children had biological and/or radiological signs of liver affection. Regular follow-up of liver function is necessary in these patients, which is now possible with noninvasive procedures.
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Dollfus C, Tabone MD, Trocme N, Vaudre G, Leverger G. Devenir à l'adolescence des enfants séropositifs au VIH après transmission mère–enfant. Med Mal Infect 2006; 36:479-80. [PMID: 17011735 DOI: 10.1016/j.medmal.2006.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 06/20/2006] [Indexed: 11/23/2022]
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Affiliation(s)
- C Dollfus
- Service d'hématologie et d'oncologie pédiatriques, hôpital d'enfants-Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75571 Paris cedex 12, France
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Ramos JT, de José MI, Polo R, Fortuny C, Mellado MJ, Muñoz-Fernández MA, Beceiro J, Bertrán JM, Calvo C, Chamorro L, Ciria L, Guillén S, González-Montero R, González-Tomé MI, Gurbindo MD, Martín-Fontelos P, Martínez-Pérez J, Moreno D, Muñoz-Almagro MC, Mur A, Navarro ML, Otero C, Rojo P, Rubio B, Saavedra J. Recomendaciones CEVIHP/SEIP/AEP/PNS respecto al tratamiento antirretroviral en niños y adolescentes infectados por el VIH. Enferm Infecc Microbiol Clin 2005; 23:279-312. [PMID: 15899180 DOI: 10.1157/13074970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To update antiretroviral recommendations in antiretroviral therapy (ART) in HIV-infected children and adolescents. METHODS Theses guidelines have been formulated by a panel of members of the Plan Nacional sobre el SIDA (PNS) and the Asociacion Espanola de Pediatria (AEP) by reviewing the current available evidence of efficacy, safety, and pharmacokinetics in pediatric studies. Three levels of evidence have been defined according to the source of data: Level A: randomized and controlled studies; Level B: Cohort and case-control studies; Level C: Descriptive studies and experts' opinion. RESULTS When to start ART should be made on an individual basis, discussed with the family, considering the risk of progression according to age, CD4 and viral load, the ART-related complications and adherence. The ART goal is to reach a maximum and durable viral suppression. This is not always possible, even with clinical and immunologic improvement. The difficulties of permanent adherence and side-effects are resulting in a more conservative trend to initiate ART, and to less toxic and simpler strategies. Currently, combinations of at least three drugs are of first choice both in acute and chronic infection. They must include 2 NA 1 1 NN or 2 NA 1 1 PI. ART is recommended in all symptomatic patients and, with few exceptions, in all infants in the first year of life. Older asymptomatic children should start ART according to CD4 count, especially CD4 percentage, that vary with age. Despite potent salvage therapies, it is common not to reach viral undetectability. Therapeutical options when ART fails are scarce due to cross-resistance. The cause of failure must be identified. Occasionally, there exists clinical and/or immunological progression, and a change of therapy with at least two new drugs still active for the patient, is warranted with the aim of increasing the CD4 count to a lower level of risk. Toxicity and adherence must be regularly monitored. Some aspects about post exposure prophylaxis and coinfection with HCV or HBV are discussed. CONCLUSIONS A higher level of evidence with regard to ART effectiveness and toxicity in pediatrics is currently available, leading to a more conservative and individualized approach. Clinical symptoms and CD4 count are the main determinants to start and change ART.
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Affiliation(s)
- José Tomás Ramos
- Unidad de Inmunodeficiencias, Departamento de Pediatría, Hospital 12 Octubre, 28041 Madrid, Spain.
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