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Seng R, Frange P, Faye A, Dollfus C, le Chenadec J, Boufassa F, Essat A, Goetghebuer T, Arezes E, Avettand-Fènoël V, Bigna JJ, Blanche S, Goujard C, Meyer L, Warszawski J, Viard JP. Immunovirological status in people with perinatal and adult-acquired HIV-1 infection: a multi-cohort analysis from France. THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100885. [PMID: 38576825 PMCID: PMC10993179 DOI: 10.1016/j.lanepe.2024.100885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 04/06/2024]
Abstract
Background No study has compared the virological and immunological status of young people with perinatally-acquired HIV infection (P-HIV) with that of people with HIV adulthood (A-HIV) having a similar duration of infection. Methods 5 French cohorts of P-HIV and A-HIV patients with a known date of HIV-infection and receiving antiretroviral treatment (ART), were used to compare the following proportions of: virological failure (VF) defined as plasma HIV RNA ≥ 50 copies/mL, CD4 cell percentages and CD4:CD8 ratios, at the time of the most recent visit since 2012. The analysis was stratified on time since infection, and multivariate models were adjusted for demographics and treatment history. Findings 310 P-HIV were compared to 1515 A-HIV (median current ages 20.9 [IQR:14.4-25.5] and 45.9 [IQR:37.9-53.5] respectively). VF at the time of the most recent evaluation was significantly higher among P-HIV (22.6%, 69/306) than A-HIV (3.3%, 50/1514); p ≤ 0.0001. The risk of VF was particularly high among the youngest children (2-5 years), adolescents (13-17 years) and young adults (18-24 years), compared to A-HIV with a similar duration of infection: adjusted Odds-Ratio (aOR) 7.0 [95% CI: 1.7; 30.0], 11.4 [4.2; 31.2] and 3.3 [1.0; 10.8] respectively. The level of CD4 cell percentages did not differ between P-HIV and A-HIV. P-HIV aged 6-12 and 13-17 were more likely than A-HIV to have a CD4:CD8 ratio ≥ 1: 84.1% vs. 58.8% (aOR = 3.5 [1.5; 8.3]), and 60.9% vs. 54.7% (aOR = 1.9 [0.9; 4.2]) respectively. Interpretation P-HIV were at a higher risk of VF than A-HIV with a similar duration of infection, even after adjusting for treatment history, whereas they were not at a higher risk of immunological impairment. Exposure to viral replication among young patients living with HIV since birth or a very early age, probably because of lower adherence, could have an impact on health, raising major concerns about the selection of resistance mutations and the risk of HIV transmission. Funding Inserm - ANRS MIE.
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Affiliation(s)
- Rémonie Seng
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Pierre Frange
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Microbiology, Necker-Enfants Malades Hospital, Paris, France
- URP 7328 FETUS, Université Paris Cité, Paris, France
| | - Albert Faye
- Assistance Publique-Hôpitaux de Paris (AP-HP), General Pediatrics and Infectious Diseases, Robert Debré Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Catherine Dollfus
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Hematology and Oncology Department, Trousseau Hospital, Paris, France
| | | | - Faroudy Boufassa
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Asma Essat
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Tessa Goetghebuer
- Pediatric Department, Saint-Pierre Hospital, Brussels, Belgium
- Université Libre de Bruxelles, Belgium
| | - Elisa Arezes
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Véronique Avettand-Fènoël
- Université d’Orléans, CHU Orléans, Laboratoire de Virologie, Orléans, France
- Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
| | - Jean-Joël Bigna
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Stéphane Blanche
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paediatric Immunology and Hematology Unit, Necker Enfants Malades Hospital, Paris, France
| | - Cécile Goujard
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine and Clinical Immunology Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Laurence Meyer
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Josiane Warszawski
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jean-Paul Viard
- Assistance Publique-Hôpitaux de Paris (AP-HP), Immunology-Infectious Diseases Unit, Hôtel-Dieu Hospital, Université Paris Cité, Paris, France
| | - COVERTE
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Microbiology, Necker-Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), General Pediatrics and Infectious Diseases, Robert Debré Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Hematology and Oncology Department, Trousseau Hospital, Paris, France
- Pediatric Department, Saint-Pierre Hospital, Brussels, Belgium
- Université d’Orléans, CHU Orléans, Laboratoire de Virologie, Orléans, France
- Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paediatric Immunology and Hematology Unit, Necker Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine and Clinical Immunology Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Immunology-Infectious Diseases Unit, Hôtel-Dieu Hospital, Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- Université Libre de Bruxelles, Belgium
- URP 7328 FETUS, Université Paris Cité, Paris, France
| | - PRIMO
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Microbiology, Necker-Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), General Pediatrics and Infectious Diseases, Robert Debré Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Hematology and Oncology Department, Trousseau Hospital, Paris, France
- Pediatric Department, Saint-Pierre Hospital, Brussels, Belgium
- Université d’Orléans, CHU Orléans, Laboratoire de Virologie, Orléans, France
- Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paediatric Immunology and Hematology Unit, Necker Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine and Clinical Immunology Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Immunology-Infectious Diseases Unit, Hôtel-Dieu Hospital, Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- Université Libre de Bruxelles, Belgium
- URP 7328 FETUS, Université Paris Cité, Paris, France
| | - SEROPRI
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Microbiology, Necker-Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), General Pediatrics and Infectious Diseases, Robert Debré Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Hematology and Oncology Department, Trousseau Hospital, Paris, France
- Pediatric Department, Saint-Pierre Hospital, Brussels, Belgium
- Université d’Orléans, CHU Orléans, Laboratoire de Virologie, Orléans, France
- Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paediatric Immunology and Hematology Unit, Necker Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine and Clinical Immunology Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Immunology-Infectious Diseases Unit, Hôtel-Dieu Hospital, Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- Université Libre de Bruxelles, Belgium
- URP 7328 FETUS, Université Paris Cité, Paris, France
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Universal Repeat Screening for Human Immunodeficiency Virus in the Third Trimester of Pregnancy: A Cost-Effectiveness Analysis. Obstet Gynecol 2023; 141:535-543. [PMID: 36800852 DOI: 10.1097/aog.0000000000005086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/01/2022] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To assess the cost effectiveness of universal repeat screening for human immunodeficiency virus (HIV) infection in the third trimester of pregnancy. METHODS A decision-analytic model was constructed to compare two strategies: screening for HIV infection in the first trimester alone compared with the addition of repeat screening in the third trimester. Probabilities, costs, and utilities were derived from the literature and varied in sensitivity analyses. The assumed incidence of HIV infection in pregnancy was 0.0145% or 14.5 per 100,000. Outcomes included costs (in 2022 U.S. dollars), maternal and neonatal quality-adjusted life-years (QALYs), and cases of neonatal HIV infection. Our theoretical cohort contained 3.8 million pregnant individuals, the approximate number of births per year in the United States. The willingness-to-pay threshold was set at $100,000/QALY. We performed univariable and multivariable sensitivity analyses to determine inputs that most influenced the model. RESULTS Universal third-trimester screening prevented 133 cases of neonatal HIV infection in this theoretical cohort. Universal third-trimester screening led to an increased cost of $17.54 million and 2,732 increased QALYs, with an incremental cost-effectiveness ratio of $6,418.56 per QALY, less than the willingness-to-pay threshold. In a univariate sensitivity analysis, third-trimester screening remained cost effective with variation of HIV incidence in pregnancy to as low as 0.0052%. CONCLUSION In a theoretical U.S.-based cohort of pregnant individuals, universal repeat screening for HIV infection in the third trimester was found to be cost effective and to reduce vertical transmission of HIV. These results merit consideration of a broader HIV-screening program in the third trimester.
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Tiruneh F, Deyas Y. How Far Does Highly Active Antiretroviral Treatment Reduce TB Incidence among Children? A Marginal Structural Modeling Analysis, Southwest Ethiopia. Ethiop J Health Sci 2021; 30:653-660. [PMID: 33911825 PMCID: PMC8047272 DOI: 10.4314/ejhs.v30i5.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Children younger than 15 years, carry almost 80% of the global burden of HIV/AIDS. HIV worsens the progression of latent TB to active TB disease. Although antiretroviral treatment has shown marked reduction in Tuberculosis incidence, TB continues to occur in Sub-Saharan countries including Ethiopia. The aim of this study was to investigate the impact of HAART on the incidence of tuberculosis among children infected with HIV in Southwest Ethiopia. Methods A retrospective cohort study was conducted between 2009 to 2014. We used chi-square test, and Mann-Whitney U test to compare non-HAART and HAART cohort. We estimated the effect of HAART on TB incidence using marginal structural model after adjusting for time-dependent confounders affected by exposure. Result A total of 844 children were followed. We observed them for a median of 51 months (IQR 31) and a total of 2942.99 child-years. The overall TB incidence rate was 7.917 per 100 child years (95% CI, 6.933–9.002). TB incidence for specific HAART and non-HAART cohort were 7.67 per 100 child-years (95% CI, 6.318–9.217) and 8.17 per 100 child-years (95% CI, 6.772–9.767) respectively. From marginal structural modeling, children on HAART were 36% (HR=0.642, 95% CI 0.442–0.931, p<0.02) less likely to develop TB compared to those who were not. Conclusion HAART reduced the hazard of TB in HIV-infected children by 36%. This is by far less than what is expected.
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Affiliation(s)
- Firew Tiruneh
- Department of Midwifery, Collage of Health Science, Mizan Tepi University, Mizan Teferi, Ethiopia
| | - Yared Deyas
- Department of Midwifery, Collage of Health Science, Mizan Tepi University, Mizan Teferi, Ethiopia
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Ayeni OA, Walaza S, Tempia S, Groome M, Kahn K, Madhi SA, Cohen AL, Moyes J, Venter M, Pretorius M, Treurnicht F, Hellferscee O, von Gottberg A, Wolter N, Cohen C. Mortality in children aged <5 years with severe acute respiratory illness in a high HIV-prevalence urban and rural areas of South Africa, 2009-2013. PLoS One 2021; 16:e0255941. [PMID: 34383824 PMCID: PMC8360538 DOI: 10.1371/journal.pone.0255941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/27/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Severe acute respiratory illness (SARI) is an important cause of mortality in young children, especially in children living with HIV infection. Disparities in SARI death in children aged <5 years exist in urban and rural areas. OBJECTIVE To compare the factors associated with in-hospital death among children aged <5 years hospitalized with SARI in an urban vs. a rural setting in South Africa from 2009-2013. METHODS Data were collected from hospitalized children with SARI in one urban and two rural sentinel surveillance hospitals. Nasopharyngeal aspirates were tested for ten respiratory viruses and blood for pneumococcal DNA using polymerase chain reaction. We used multivariable logistic regression to identify patient and clinical characteristics associated with in-hospital death. RESULTS From 2009 through 2013, 5,297 children aged <5 years with SARI-associated hospital admission were enrolled; 3,811 (72%) in the urban and 1,486 (28%) in the rural hospitals. In-hospital case-fatality proportion (CFP) was higher in the rural hospitals (6.9%) than the urban hospital (1.3%, p<0.001), and among HIV-infected than the HIV-uninfected children (9.6% vs. 1.6%, p<0.001). In the urban hospital, HIV infection (odds ratio (OR):11.4, 95% confidence interval (CI):5.4-24.1) and presence of any other underlying illness (OR: 3.0, 95% CI: 1.0-9.2) were the only factors independently associated with death. In the rural hospitals, HIV infection (OR: 4.1, 95% CI: 2.3-7.1) and age <1 year (OR: 3.7, 95% CI: 1.9-7.2) were independently associated with death, whereas duration of hospitalization ≥5 days (OR: 0.5, 95% CI: 0.3-0.8) and any respiratory virus detection (OR: 0.4, 95% CI: 0.3-0.8) were negatively associated with death. CONCLUSION We found that the case-fatality proportion was substantially higher among children admitted to rural hospitals and HIV infected children with SARI in South Africa. While efforts to prevent and treat HIV infections in children may reduce SARI deaths, further efforts to address health care inequality in rural populations are needed.
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Affiliation(s)
- Oluwatosin A. Ayeni
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
| | - Stefano Tempia
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Programme, Centers for Disease Control and Prevention-South Africa, Pretoria, South Africa
- Mass Genics, Duluth, Georgia, Unites States of America
| | - Michelle Groome
- Faculty of Health Sciences, Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
- INDEPTH Network, Accra, Ghana
| | - Shabir A. Madhi
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- Faculty of Health Sciences, Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam L. Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Programme, Centers for Disease Control and Prevention-South Africa, Pretoria, South Africa
| | - Jocelyn Moyes
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
| | - Marietjie Venter
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Marthi Pretorius
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Florette Treurnicht
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
| | - Orienka Hellferscee
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Division of Infectious Diseases, Hubert Department of Global Health, Rollins School of Public Health, School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Nicole Wolter
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
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Tiruneh F, Deyas Y. Effect of highly active antiretroviral treatment on TB incidence among HIV infected children and their clinical profile, retrospective cohort study, South West Ethiopia. Sci Rep 2020; 10:21468. [PMID: 33293656 PMCID: PMC7722879 DOI: 10.1038/s41598-020-78466-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022] Open
Abstract
Globally, 1.8 million HIV infected children live with HIV; nearly 53% of them were receiving HIV treatment. People who are infected with HIV are 18 times more likely to develop active TB. Despite antiretroviral treatment has shown marked reduction in TB incidence, TB continues to occur in Sub-Saharan countries including Ethiopia among HIV infected people. The effect of highly active antiretroviral treatment is quite successful in developed countries. However, in developing country TB/HIV co-infection remains perplexing among children on the treatment. The aim of this study was to investigate the impact of ART on the incidence of TB among Children infected with HIV in Southwest Ethiopia. A retrospective cohort study was conducted on randomly selected 800 samples from ART clinic between 2009 and 2014. We used chi-square test, and Mann–Whitney U test to compare HAART naïve and HAART cohort. We used marginal structural models to estimate the effect of HAART on survival while accounting for time-dependent confounders affected by exposure. A total of 800 children were followed for 2942.99 child-years. The children were observed for a median of 51 months with IQR 31 and for a total of 2942.99 child-years. From 506 OIs that occurred, the most common reported OIs were Pneumonia (22%) and TB (23.6%). The overall TB incidence rate was 7.917 per 100 child years (95% CI, 6.933–9.002). Whereas among HAART (7.667 per 100-years (95% CI, 6.318–9.217) and 8.1686 per 100 person-years (95% CI 6.772–9.767) for HAART naïve. The mortality hazard ratio comparing HAART with no HAART from a marginal structural model was 0.642 (95% CI 0.442–0.931, p < 0.02). HAART reduced the hazard of TB in HIV-infected children by 36%. This is by far less than expected.
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Affiliation(s)
- Firew Tiruneh
- Department of Midwifery, College of Health Science, Mizan Tepi University, PO box 260, Mizan Teferi, Ethiopia.
| | - Yared Deyas
- Department of Midwifery, College of Health Science, Mizan Tepi University, PO box 260, Mizan Teferi, Ethiopia
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Immunologic and Clinical Failure of Antiretroviral Therapy in People Living with Human Immunodeficiency Virus within Two Years of Treatment. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5474103. [PMID: 32462003 PMCID: PMC7222595 DOI: 10.1155/2020/5474103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022]
Abstract
Background Early initiation of highly active antiretroviral therapy (HAART) decreases human immunodeficiency virus- (HIV-) related complications, restores patients' immunity, decreases viral load, and substantially improves quality of life. However, antiretroviral treatment failure considerably impedes the merits of HAART. Objective This study is aimed at determining the prevalence of immunologic and clinical antiretroviral treatment failure. Methods A cross-sectional study design using clinical and immunologic treatment failure definition was used to conduct the study. Sociodemographic characteristics and clinical features of patients were retrieved from patients' medical registry between the years 2009 and 2015. All patients who fulfilled the inclusion criteria in the study period were studied. Predictors of treatment failure were identified using Kaplan-Meier curves and multivariable Cox regression analysis. Data analysis was done using SPSS version 21 software, and the level of statistical significance was declared at a p value < 0.05. Results A total of 770 were studied. The prevalence of treatment failure was 4.5%. The AZT-based regimen (AHR = 16.95, 95% CI: 3.02-95.1, p = 0.001), baseline CD4 count ≥ 301 (AHR = 0.199, 95% CI: 0.05-0.76, p = 0.018), and bedridden during HAART initiation (AHR = 0.131, 95% CI: 0.029-0.596, p = 0.009) were the predictors of treatment failure. Conclusion The prevalence of treatment failure was lower with the risk being higher among patients on the AZT-based regimen. On the other hand, the risk of treatment failure was lower among patients who started HAART at baseline CD4 count ≥ 301 and patients who were bedridden during HAART initiation. We recommend further prospective, multicenter cohort studies to be conducted to precisely detect the prevalence of treatment failure using viral load determination in the whole country.
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García-Navarro C, Jimenez de Ory S, Velo Higueras C, Zamora B, Prieto L, Ramos JT, Navarro ML, Escosa-García L, Jurado-Barba R, Falcón D, Moreno D, González-Tomé MI. Significant differences between verbal and non-verbal intellectual scales on a perinatally HIV-infected cohort: from pediatrics to young adults. Heliyon 2020; 6:e03600. [PMID: 32368635 PMCID: PMC7184518 DOI: 10.1016/j.heliyon.2020.e03600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/09/2019] [Accepted: 03/10/2020] [Indexed: 11/30/2022] Open
Abstract
Delayed neurodevelopment is a common outcome in perinatally HIV-infected children. Our aim was to assess the intellectual profile of our cohort, considering both the infection and socio-environmental related variables. A cross-sectional cohort study was undertaken at seven major hospitals in Spain belonging to the CoRISpeS cohort (n = 97). Patients were followed up according to a standard protocol. Intellectual measures, psychosocial profile and HIV infection-related data have been analysed. The average patient age was 15 years. The median CD4 cell percentage was 35% (1,59). Viral load was undetectable in 80% of the patients and 27% were on AIDS category; 38% of whom had encephalopathy. The average composite score of both crystallized intelligence (CI) and intelligence quotient (IQ) for the cohort was lower than that of the general population (p < 0.001). Results revealed a significant difference of 38% between crystallized and fluid intelligence. There was a clear association between IQ and age of diagnosis (p = 0.022); CI and CDC classification (p = 0.035), CD4 count (p = 0.011) and CD4 nadir (p = 0.001). Higher parental education was associated with better performance across all intelligence scales (p < 0.002). A regression model showed that CI was influenced by the academic level of caregivers (p = 0.002), age at start of cART (p = 0.050) and primary language (p = 0.058). Findings revealed significant differences in verbal and non-verbal intellectual scales resulting in a misleading IQ Composite score. Crystallized intelligence demonstrated the highest level of impairment despite adequate treatment and good immunovirological status, while fluid intelligence results were average. Caregiver level of education was the strongest factor across all intelligence measures.
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Affiliation(s)
- C García-Navarro
- Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 de Octubre (i+12), Spain
| | - S Jimenez de Ory
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IisGM), Spain
| | - C Velo Higueras
- Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 de Octubre (i+12), Spain
| | - B Zamora
- Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Prieto
- Department of Pediatrics, Hospital Universitario de Getafe, Madrid, Spain
| | - J T Ramos
- Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain.,Departamento de Salud Pública y Materno-Infantil UCM, Spain.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Spain
| | - M L Navarro
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IisGM), Spain.,Departamento de Salud Pública y Materno-Infantil UCM, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Spain
| | - L Escosa-García
- Department of Pediatric HIV and Infectious Diseases, Hospital Universitario La Paz, Madrid, Spain.,La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - R Jurado-Barba
- Research Institute Hospital 12 de Octubre (i+12), Spain.,Department of Psychology, Facultad de Educación y Salud, Universidad Camilo José Cela, Madrid, Spain
| | - Dolores Falcón
- Department of Paediatrics, Hospital Virgen del Rocío, Sevilla, Spain
| | - David Moreno
- Department of Pediatrics, Pediatric Infectology & Immunodeficiency Unit, Regional University Children's Hospital of Malaga, Malaga, Spain.,IBIMA Multidisciplinary Group for Pediatric Research of Malaga, Malaga University, Malaga, Spain
| | - M I González-Tomé
- Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
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8
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Ouyang Y, Wei F, Qiao L, Liu K, Dong Y, Guo X, Wang S, Pang L, Lin M, Zhang F, Lin D, Chen D. Mitochondrial DNA mutations accumulated in HIV-1-infected children who have an excellent virological response when exposed to long-term antiretroviral therapy. J Antimicrob Chemother 2019; 73:3114-3121. [PMID: 30351437 DOI: 10.1093/jac/dky282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 06/19/2018] [Indexed: 01/29/2023] Open
Abstract
Objectives There is growing concern about mitochondrial DNA (mtDNA) mutations with long-term NRTI exposure in HIV-1 infected children. Methods Twenty-four HIV-1 infected children who started ART more than 2 years earlier who had an excellent virological response and had not changed their regimen were enrolled retrospectively. Their corresponding PBMCs in 2009 (T1), 2010 (T2) and 2013 (T3) were included. Sequencing of the entire mtDNA using next-generation sequencing revealed the spectrum of mtDNA variants. Results The trend showed that the number of mtDNA mutations during ART occurred as T1 < T2 < T3 (P = 0.086). Interestingly, the numbers of whole mtDNA mutations at T3 (median 41, range 24-62) were significantly greater than at T1 (34, 25-46, P = 0.029). A positive correlation was found between total mtDNA mutations and treatment time (r = 0.352, P = 0.002). During the observation period, mtDNA mutations more frequently occurred in the D-loop, cytochrome b (CYTB) and 12S rRNA regions. The heteroplasmic ratio of T3 was higher than that of T1 in CYTB and 12S rRNA (P = 0.034 and P = 0.042, respectively). High heteroplasmic population levels were found at nt 263 (A263G, D-loop) and nt 8860 (A8860G, ATPase6). A significant difference in heteroplasmy between T1, T2 and T3 occurred at nt 14783 (T14783C, CYTB, P = 0.048, T3 > T2 > T1). Conclusions Our findings reveal the spectrum of mtDNA variants in HIV-1-infected children who had an excellent virological response. mtDNA mutations accumulated during ART may play an important role in facilitating the occurrence of mitochondrial dysfunction.
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Affiliation(s)
- Yabo Ouyang
- Beijing YouAn Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Hepatology, Beijing, China.,Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing, China
| | - Feili Wei
- Beijing YouAn Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Hepatology, Beijing, China.,Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing, China
| | - Luxin Qiao
- Beijing YouAn Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Hepatology, Beijing, China.,Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing, China
| | - Kai Liu
- Beijing YouAn Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Hepatology, Beijing, China.,Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing, China
| | - Yaowu Dong
- Branch of Shang Cai, Henan province, Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Zhumadian, China
| | - Xianghua Guo
- Beijing YouAn Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Hepatology, Beijing, China.,Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing, China
| | - Shanshan Wang
- Beijing YouAn Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Hepatology, Beijing, China.,Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing, China
| | - Lijun Pang
- Beijing YouAn Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Hepatology, Beijing, China.,Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing, China
| | - Minghua Lin
- Beijing YouAn Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Hepatology, Beijing, China.,Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing, China
| | - Fujie Zhang
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dongdong Lin
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Dexi Chen
- Beijing YouAn Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Hepatology, Beijing, China.,Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing, China
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9
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Abstract
Sepsis in children is typically presumed to be bacterial in origin until proven otherwise, but frequently bacterial cultures ultimately return negative. Although viruses may be important causative agents of culture-negative sepsis worldwide, the incidence, disease burden and mortality of viral-induced sepsis is poorly elucidated. Consideration of viral sepsis is critical as its recognition carries implications on appropriate use of antibacterial agents, infection control measures, and, in some cases, specific, time-sensitive antiviral therapies. This review outlines our current understanding of viral sepsis in children and addresses its epidemiology and pathophysiology, including pathogen-host interaction during active infection. Clinical manifestation, diagnostic testing, and management options unique to viral infections will be outlined.
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Affiliation(s)
- Neha Gupta
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert Richter
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Stephen Robert
- Division of Pediatric Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Michele Kong
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
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10
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Igulot P, Magadi MA. Socioeconomic Status and Vulnerability to HIV Infection in Uganda: Evidence from Multilevel Modelling of AIDS Indicator Survey Data. AIDS Res Treat 2018; 2018:7812146. [PMID: 29983999 PMCID: PMC6011175 DOI: 10.1155/2018/7812146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/23/2018] [Accepted: 04/19/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is controversy on the association between socioeconomic status (SES) and HIV infection. Some evidence claims higher SES is negatively associated with HIV infection while others report the reverse. OBJECTIVES To examine the association between SES and HIV infection in Uganda and to examine whether the SES-HIV relationship varies by gender, rural-urban place of residence, and time (2004-2005 and 2011) in Uganda. METHODS Multilevel analysis was applied to 39,766 individual cases obtained in 887 clusters of Uganda HIV/AIDS Indicators Survey conducted in 2004-2005 and 2011. RESULTS Household wealth is associated with increased vulnerability in the general population and in rural areas. Compared with no educational attainment, secondary or higher education is associated with reduced vulnerability to the risk of HIV infection by 37% in the general population. However, this effect was stronger in urban than rural areas. Besides individual-level factors, unobserved community factors too play an important role and account for 9% of unexplained variance after individual-level factors are considered. CONCLUSION Household wealth increases vulnerability but education reduces it. The social environment influences vulnerability to HIV infection independent of individual-level factors. HIV/AIDS awareness targeting sexual practices of wealthy individuals and those with primary-level educational attainment together with improving educational attainment and addressing contextual factors influencing vulnerability to HIV infection are necessary strategies to reduce HIV infections in Uganda.
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11
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Abstract
BACKGROUND Data on pediatric HIV in Peru are limited. The National Institute of Child Health (Instituto Nacional de Salud del Niño: INSN) cares for the most HIV-infected children under the age of 18 years in the country. We describe the outcomes of children seen at INSN's HIV clinic over the 10 years when antiretroviral therapy and prevention of mother-to-child transmission (PMTCT) interventions became available in 2004. METHODS We conducted a retrospective review of INSN HIV clinic patients between 2003 and 2012. Deidentified data were collected and analyzed. RESULTS A total of 280 children were included: 50.0% (140/280) were male; 80.0% (224/280) lived in metropolitan Lima. Perinatal transmission was the mode of HIV infection in 91.4% (256/280) of children. Only 17% (32/191) of mothers were known to be HIV-infected at delivery; of these mothers, 41% (13/32) were receiving antiretroviral therapy at delivery, 72% (23/32) delivered by Cesarean section and 47% (15/32) of their infants received antiretroviral prophylaxis. Median age at HIV diagnosis for all children was 35.7 months (interquartile range 14.5-76.8 months), and 67% (143/213) had advanced disease (clinical stage C). After HIV diagnosis, the most frequent hospitalization discharge diagnoses were bacterial pneumonia, chronic malnutrition, diarrhea, anemia and tuberculosis. Twenty-four patients (8.6%) died at a median age of 77.4 months. CONCLUSIONS Most cases of pediatric HIV were acquired via perinatal transmission; few mothers were diagnosed before delivery; and among mothers with known HIV status, PMTCT was suboptimal even after national PMTCT policy was implemented. Most children were diagnosed with advanced disease. These findings underscore the need for improving early pediatric HIV diagnosis and treatment, as well as PMTCT strategies.
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12
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Ebonyi AO, Oguche S, Agbaji OO, Sagay AS, Okonkwo PI, Idoko JA, Kanki PJ. Mortality among pulmonary tuberculosis and HIV-1 co-infected Nigerian children being treated for pulmonary tuberculosis and on antiretroviral therapy: a retrospective cohort study. Germs 2016; 6:139-150. [PMID: 28053917 DOI: 10.11599/germs.2016.1099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mortality data, including the risk factors for mortality in HIV-infected children with pulmonary TB (PTB) being treated for PTB and who are on antiretroviral therapy (ART), are scarce in Nigeria. We determined the mortality rate and risk factors for mortality among such children, at the pediatric HIV clinic of the Jos University Teaching Hospital (JUTH) in Jos, Nigeria. METHODS We performed a retrospective cohort study on 260 PTB-HIV-1 co-infected children, aged 2 months to 13 years, being treated for PTB and on ART from July 2005 to March 2013. The mortality rate and associated risk factors were determined using multivariate Cox proportional hazards modelling. RESULTS The mortality rate for the study cohort was 1.4 per 100 child-years of follow-up. Median follow-up time was 5.2 years (IQR, 3.5-6.0 years) with total study time being 1159 child-years. The median age of those who died was lower than that of survivors, 1.9 years (IQR, 0.6-3.6 years) versus 3.8 years (IQR, 1.8-6.0 years), p=0.005). The majority of the deaths occurred in males (13, 81.2%), those <5 years of age (14, 87.4%) and those who had severe immunosuppression (11, 68.8%). Risk factors for death were age (with the risk of dying decreasing by 25% for every 1 year increase in age, adjusted hazard ratio (AHR)=0.75 [0.58-0.98], p=0.032), male gender (AHR=3.80 [1.07-13.5], p=0.039) and severe immunosuppression (AHR=3.35 [1.16-9.66], p=0.025). CONCLUSION In our clinic setting, mortality among our PTB-HIV co-infected children being treated for PTB and on ART was low. However, those presenting with severe immunosuppression and who are males and very young, should be monitored more closely during follow-up in order to further reduce mortality.
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Affiliation(s)
- Augustine O Ebonyi
- MBBS, MSc, Department of Pediatrics, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Stephen Oguche
- MBCH, Department of Pediatrics, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Oche O Agbaji
- MBBS, Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- MBBS, Department of Obstetrics and Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Prosper I Okonkwo
- MBBS, AIDS Prevention Initiative in Nigeria (APIN) Ltd. Gte, Abuja, Nigeria
| | - John A Idoko
- MBBS, National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - Phyllis J Kanki
- DVM, SD, Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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13
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Ouyang Y, Qiao L, Liu K, Zang Y, Sun Y, Dong Y, Liu D, Guo X, Wei F, Lin M, Zhang F, Chen D. Mitochondrial DNA mutations in blood samples from HIV-1-infected children undergoing long-term antiretroviral therapy. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2016; 805:1-6. [PMID: 27402477 DOI: 10.1016/j.mrgentox.2016.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 05/10/2016] [Indexed: 11/25/2022]
Abstract
We have analyzed mutations in whole mitochondrial (mt) genomes of blood samples from HIV-1-infected children treated with long-term antiretroviral therapy (ART), who had an excellent virological response. HIV-1-infected children who have undergone ART for 4 y with an excellent virological response (group A; 15 children) and ten healthy children (controls) without HIV-1 infection were enrolled retrospectively. Peripheral blood mononuclear cells (PBMCs) were obtained and mt DNA mutations were studied. The total number of mtDNA mutations in group A was 3 H more than in the controls (59 vs. 19, P<0.001) and the same trend was seen in all mtDNA regions. Among these mtDNA mutations, 140 and 28 mutations were detected in group A and the controls, respectively. The D-loop, CYTB and 12s rRNA were the three most common mutation regions in both groups, with significant differences between the groups observed at nucleotide positions C309CC, T489C CA514deletion, T16249C and G16474GG (D-loop); T14783C, G15043A, G15301A, and A15662G (CYTB); and G709A (12s rRNA). G15043A and A15662G had been associated with mitochondrial diseases. Our findings suggest that mtDNA mutations occur frequently in long-term ART-treated, HIV-1-infected children who have an excellent virological response, although they did not have obvious current symptoms. The CYTB region may play an important role in mtDNA mutation during ART, which might contribute to the development of subsequent mitochondrial diseases.
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Affiliation(s)
- Yabo Ouyang
- Beijing You An Hospital, Capital Medical University, Beijing, China; Beijing Institute of Hepatology, Beijing, China
| | - Luxin Qiao
- Beijing You An Hospital, Capital Medical University, Beijing, China; Beijing Institute of Hepatology, Beijing, China
| | - Kai Liu
- Beijing You An Hospital, Capital Medical University, Beijing, China; Beijing Institute of Hepatology, Beijing, China
| | - Yunjin Zang
- Beijing You An Hospital, Capital Medical University, Beijing, China
| | - Yu Sun
- Beijing You An Hospital, Capital Medical University, Beijing, China
| | - Yaowu Dong
- Branch of Shang Cai, Henan province, Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, China
| | - Daojie Liu
- Beijing You An Hospital, Capital Medical University, Beijing, China; Beijing Institute of Hepatology, Beijing, China
| | - Xianghua Guo
- Beijing You An Hospital, Capital Medical University, Beijing, China; Beijing Institute of Hepatology, Beijing, China
| | - Feili Wei
- Beijing You An Hospital, Capital Medical University, Beijing, China; Beijing Institute of Hepatology, Beijing, China
| | - Minghua Lin
- Beijing You An Hospital, Capital Medical University, Beijing, China; Beijing Institute of Hepatology, Beijing, China
| | - Fujie Zhang
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Dexi Chen
- Beijing You An Hospital, Capital Medical University, Beijing, China; Beijing Institute of Hepatology, Beijing, China.
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14
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Bila DCA, Boullosa LT, Vubil AS, Mabunda NJ, Abreu CM, Ismael N, Jani IV, Tanuri A. Trends in Prevalence of HIV-1 Drug Resistance in a Public Clinic in Maputo, Mozambique. PLoS One 2015; 10:e0130580. [PMID: 26151752 PMCID: PMC4494809 DOI: 10.1371/journal.pone.0130580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 05/22/2015] [Indexed: 11/30/2022] Open
Abstract
Background An observational study was conducted in Maputo, Mozambique, to investigate trends in prevalence of HIV drug resistance (HIVDR) in antiretroviral (ART) naïve subjects initiating highly active antiretroviral treatment (HAART). Methodology/Principal Findings To evaluate the pattern of drug resistance mutations (DRMs) found in adults on ART failing first-line HAART [patients with detectable viral load (VL)]. Untreated subjects [Group 1 (G1; n=99)] and 274 treated subjects with variable length of exposure to ARV´s [6–12 months, Group 2 (G2;n=93); 12-24 months, Group 3 (G3;n=81); >24 months (G4;n=100)] were enrolled. Virological and immunological failure (VF and IF) were measured based on viral load (VL) and T lymphocyte CD4+ cells (TCD4+) count and genotypic resistance was also performed. Major subtype found was C (untreated: n=66, 97,06%; treated: n=36, 91.7%). Maximum virological suppression was observed in G3, and significant differences intragroup were observed between VF and IF in G4 (p=0.022). Intergroup differences were observed between G3 and G4 for VF (p=0.023) and IF between G2 and G4 (p=0.0018). Viral suppression (<50 copies/ml) ranged from 84.9% to 90.1%, and concordant VL and DRM ranged from 25% to 57%. WHO cut-off for determining VF as given by 2010 guidelines (>5000 copies/ml) identified 50% of subjects carrying DRM compared to 100% when lower VL cut-off was used (<50 copies/ml). Length of exposure to ARVs was directly proportional to the complexity of DRM patterns. In Mozambique, VL suppression was achieved in 76% of individuals after 24 months on HAART. This is in agreement with WHO target for HIVDR prevention target (70%). Conclusions We demonstrated that the best way to determine therapeutic failure is VL compared to CD4 counts. The rationalized use of VL testing is needed to ensure timely detection of treatment failures preventing the occurrence of TDR and new infections.
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Affiliation(s)
- Dulce Celina Adolfo Bila
- National Institute of Health of Mozambique, Maputo, Mozambique
- Department of Genetic, Molecular Virology Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lídia Teodoro Boullosa
- Department of Genetic, Molecular Virology Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Celina Monteiro Abreu
- Department of Genetic, Molecular Virology Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nalia Ismael
- National Institute of Health of Mozambique, Maputo, Mozambique
| | | | - Amilcar Tanuri
- Department of Genetic, Molecular Virology Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
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15
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Sando D, Spiegelman D, Machumi L, Mwanyika-Sando M, Aris E, Muya A, Jackson E, Baernighausen T, Hertzmark E, Chalamilla G, Fawzi W. Time trends of baseline demographics and clinical characteristics of HIV infected children enrolled in care and treatment service in Dar es Salaam, Tanzania. BMC Infect Dis 2015; 15:157. [PMID: 25881135 PMCID: PMC4379717 DOI: 10.1186/s12879-015-0875-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 03/10/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Few studies have described time-based trends of clinical and demographic characteristics of children enrolling in HIV and AIDS care and treatment services. We present findings of a study that explored time-based trends of baseline characteristics among children enrolling into 26 public HIV care facilities in Dar es Salaam, Tanzania. METHODS Children enrolled between October 2004 and September 2011 was included in these analyses. The year of enrollment was used as the primary predictor of interest, and log linear and linear regressions model were used to analyze dichotomous and continuous variables respectively. P-values under 0.05 were considered significant. RESULTS Among the 6,579 children enrolled, the proportion with advanced disease at enrollment increased from 35% to 58%, mean age increasing from 5.0 to 6.2 years (p < 0.0001), proportion of children less than 2 years decreased from 35% to 29%. While the median hemoglobin concentration rose from 9.1 g/dl to 10.3 g/dl (P <0.0001), proportion with a history of past TB dropped from 25% to 12.8% (P < 0.0001). Over time, health centers and dispensaries enrolled more children as compared to hospitals (P < 0.0001). Temeke district, which has the lowest socioeconomic status among the three districts in Dar es Salaam, had a significant increase in enrollment from 22% to 25% (P = 0.02). CONCLUSION We found that as time progressed, children were enrolled in care and treatment services at an older age sicker status as evidenced by increase in mean age and more advanced disease stage at first contact with providers. We recommend more efforts be focused on scaling up early HIV infant diagnosis and enrollment to HIV care and treatment.
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Affiliation(s)
- David Sando
- Management and Development for Health (MDH), P.O. Box 79810, Dar es Salaam, Tanzania.
| | - Donna Spiegelman
- Harvard T.H. Chan School of Public Health (HSPH), P.O. Box 79810, Dar es Salaam, Tanzania.
| | - Lameck Machumi
- Management and Development for Health (MDH), P.O. Box 79810, Dar es Salaam, Tanzania.
| | - Mary Mwanyika-Sando
- Management and Development for Health (MDH), P.O. Box 79810, Dar es Salaam, Tanzania.
| | - Eric Aris
- Management and Development for Health (MDH), P.O. Box 79810, Dar es Salaam, Tanzania.
| | - Aisa Muya
- Management and Development for Health (MDH), P.O. Box 79810, Dar es Salaam, Tanzania.
| | - Elizabeth Jackson
- Harvard T.H. Chan School of Public Health (HSPH), P.O. Box 79810, Dar es Salaam, Tanzania.
| | - Till Baernighausen
- Harvard T.H. Chan School of Public Health (HSPH), P.O. Box 79810, Dar es Salaam, Tanzania.
| | - Ellen Hertzmark
- Harvard T.H. Chan School of Public Health (HSPH), P.O. Box 79810, Dar es Salaam, Tanzania.
| | - Guerino Chalamilla
- Management and Development for Health (MDH), P.O. Box 79810, Dar es Salaam, Tanzania.
| | - Wafaie Fawzi
- Harvard T.H. Chan School of Public Health (HSPH), P.O. Box 79810, Dar es Salaam, Tanzania.
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16
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Rojas Sánchez P, de Mulder M, Fernandez-Cooke E, Prieto L, Rojo P, Jiménez de Ory S, José Mellado M, Navarro M, Tomas Ramos J, Holguín Á. Clinical and virologic follow-up in perinatally HIV-1-infected children and adolescents in Madrid with triple-class antiretroviral drug-resistant viruses. Clin Microbiol Infect 2015; 21:605.e1-9. [PMID: 25680310 DOI: 10.1016/j.cmi.2015.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/29/2014] [Accepted: 02/01/2015] [Indexed: 11/16/2022]
Abstract
Drug resistance mutations compromise the success of antiretroviral treatment in human immunodeficiency virus type 1 (HIV-1)-infected children. We report the virologic and clinical follow-up of the Madrid cohort of perinatally HIV-infected children and adolescents after the selection of triple-class drug-resistant mutations (TC-DRM). We identified patients from the cohort carrying HIV-1 variants with TC-DRM to nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors and protease inhibitors according to IAS-USA-2013. We recovered pol sequences or resistance profiles from 2000 to 2011 and clinical-immunologic-virologic data from the moment of TC-DRM detection until December 2013. Viruses harbouring TC-DRM were observed in 48 (9%) of the 534 children and adolescents from 2000 to 2011, rising to 24.4% among those 197 with resistance data. Among them, 95.8% were diagnosed before 2003, 91.7% were Spaniards, 89.6% carried HIV-1-subtype B and 75% received mono/dual therapy as first regimen. The most common TC-DRM present in ≥50% of them were D67NME, T215FVY, M41L and K103N (retrotranscriptase) and L90M (protease). The susceptibility to darunavir, tipranavir, etravirine and rilpivirine was 67.7%, 43.7%, 33.3% and 33.3%, respectively, and all reported high resistance to didanosine, abacavir and nelfinavir. Despite the presence of HIV-1 resistance mutations to the three main antiretroviral families in our paediatric cohort, some drugs maintained their susceptibility, mainly the new protease inhibitors (tipranavir and darunavir) and nonnucleoside reverse transcriptase inhibitors (etravirine and rilpivirine). These data will help to improve the clinical management of HIV-infected children with triple resistance in Spain.
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Affiliation(s)
- P Rojas Sánchez
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal-IRyCIS and CIBERESP, Spain
| | - M de Mulder
- George Washington University, Washington, DC, USA
| | | | - L Prieto
- Hospital Universitario de Getafe, Spain
| | - P Rojo
- Hospital Universitario Doce de Octubre, Spain
| | | | | | - M Navarro
- Hospital General Universitario Gregorio Marañón, Spain
| | - J Tomas Ramos
- Servicio de Pediatría, Hospital Clinivo San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Á Holguín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal-IRyCIS and CIBERESP, Spain.
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17
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Abstract
BACKGROUND Contemporary trends in hospitalization patterns among perinatally HIV-infected (PHIV) patients are unknown. We describe rates and reasons for hospitalizations stratified by age group during 2003-2010 within a large cohort of PHIV patients. METHODS 579 PHIV patients engaged in care at 6 geographically diverse pediatric HIV centers affiliated through the HIV Research Network were included. Modified Clinical Classification Software assigned primary ICD-9 codes into diagnostic categories. Analysis was performed using negative binomial regression with generalized estimating equations. RESULTS There were 699 all-cause hospitalizations. The overall rate for the full cohort was 19.9/100 person-years, and overall rates for 0-4, 5-16 and 17-24 year-olds were 25.1, 14.7 and 34.2/100 person-years, respectively. Declines were seen in unadjusted all-cause rates for the whole group [incidence rate ratio per year, 0.93 (0.87-0.99)] and for 5-16 [0.87 (0.76-0.99)] and 17-24 year-olds [0.87 (0.80-0.95)]. After adjustment for CD4, HIV-1 RNA and demographics, rates were no longer declining. Non-AIDS-defining infections and AIDS-defining illnesses together caused 349 (50%) admissions. Declines in these categories drove the overall declines in unadjusted rates. No increases over time were seen for cardiovascular, renal or any other diagnostic categories. CONCLUSIONS While the declines in hospitalizations are reassuring, continued efforts are needed to address the persistently high infectious and non-infectious morbidity among PHIV patients. Innovative strategies may be most critical for 17-24 year-olds. Lack of increases in cardiovascular and renal admissions provides modest, preliminary reassurance against severe non-infectious complications from longstanding HIV infection and antiretroviral exposure.
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Palladino C, Briz V, Bellón JM, Climent FJ, de Ory SJ, Mellado MJ, Navarro ML, Ramos JT, Taveira N, de José MI, Muñoz-Fernández MÁ. Determinants of highly active antiretroviral therapy duration in HIV-1-infected children and adolescents in Madrid, Spain, from 1996 to 2012. PLoS One 2014; 9:e96307. [PMID: 24788034 PMCID: PMC4006876 DOI: 10.1371/journal.pone.0096307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 04/07/2014] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To investigate the duration of sequential HAART regimens and predictors of first-line regimen discontinuation among HIV-1 vertically infected children and adolescents. DESIGN Multicentre survey of antiretroviral-naïve patients enrolled in the HIV-Paediatric Cohor,t CoRISpeS-Madrid Cohort, Spain. METHODS Patients with a follow-up of ≥ 1 month spent on HAART, with available baseline CD4 count and HIV-viral load (VL) were included. Time spent on sequential HAART regimens was estimated and multivariable regression was used to identify predictors of time to first-line regimen discontinuation. RESULTS 104 patients were followed for a median 8 years after starting HAART among 1996-2012; baseline %CD4 was 21.5 (12.3-34.0)and viral load was 5.1 (4.6-5.6) log10 copies/mL. Patients received a mean of 1.9 regimens. Median time on first-line HAART (n = 104) was 64.5 months; second HAART (n = 56) 69.8 months; and third HAART (n = 21) 66.5 months. Eleven (11%) patients were lost to follow-up while on first-line HAART and 54% discontinued (cumulative incidence of 16% and 38% by 1 and 3-year, respectively). The main predictor of first-line regimen discontinuation was suboptimal adherence to antiretrovirals (AHR: 2.60; 95% CI: 1.44-4.70). CONCLUSIONS Adherence to therapy was the main determinant of the duration of the first-line HAART regimen in children. It is important to identify patients at high risk for non-adherence, such as very young children and adolescents, in provide special care and support to those patients.
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Affiliation(s)
- Claudia Palladino
- Instituto de Investigação do Medicamento (iMed. ULisboa), Faculty of Pharmacy, The University of Lisbon, Lisbon, Portugal
| | - Verónica Briz
- Hospital General Universitario “Gregorio Marañón” and Instituto de Investigación Sanitaria “Gregorio Marañón”, Madrid, Spain. Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - José María Bellón
- Unidad de Investigación, Fundación para la Investigación Biomédica, Hospital General Universitario “Gregorio Marañón”, Madrid, Spain
| | | | - Santiago J. de Ory
- Hospital General Universitario “Gregorio Marañón” and Instituto de Investigación Sanitaria “Gregorio Marañón”, Madrid, Spain. Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - María José Mellado
- Servicio de Pediatría, Hospital Universitario “Carlos III”, Madrid, Spain
| | - María Luisa Navarro
- Servicio de Pediatría, Hospital General Universitario “Gregorio Marañón”, Madrid, Spain
| | - José T. Ramos
- Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, Spain
| | - Nuno Taveira
- Instituto de Investigação do Medicamento (iMed. ULisboa), Faculty of Pharmacy, The University of Lisbon, Lisbon, Portugal
- Center of Interdisciplinary Investigation Egas Moniz (CiiEM), Institute of Health Sciences Egas Moniz, Caparica, Portugal
| | | | - María Ángeles Muñoz-Fernández
- Hospital General Universitario “Gregorio Marañón” and Instituto de Investigación Sanitaria “Gregorio Marañón”, Madrid, Spain. Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
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Long-term effectiveness of combination antiretroviral therapy and prevalence of HIV drug resistance in HIV-1-infected children and adolescents in Rwanda. Pediatr Infect Dis J 2014; 33:63-9. [PMID: 24352189 DOI: 10.1097/inf.0b013e31829e6b9f] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the long-term outcomes of treatment and prevalence of genotypic drug resistance in children and adolescents on combination antiretroviral therapy. METHODS A cross-sectional study (September 2009 to October 2010) in which clinical, immunologic and virologic outcomes were assessed at a single-study visit and through patient records in a cohort of HIV-infected children and adolescents. Risk factors for clinical and immunologic responses and virologic outcome were evaluated using logistic regression, and the accuracy of clinical and immunologic criteria in identifying virologic failure was assessed. RESULTS Four hundred twenty-four patients were enrolled with a median age of 10.8 years (range: 1.7-18.8) and a median duration on combination antiretroviral therapy of 3.4 years (range: 1.0-8.1). Thirty-three percent were stunted and 17% underweight. Eighty-four percent (95% confidence interval: 79-87) of children >5 years had CD4 ≥350 cells/mm and in 74% (95% confidence interval: 62-84) of younger children CD4% was ≥25. CD4 values and age at combination antiretroviral therapy initiation were independently associated with CD4 outcomes; 124 (29%) had HIV-1 RNA ≥1000 copies/mL, with no significant predictors. Sensitivity for weight-for-age and height-for-age and CD4 cells (<350/mm) remained under 50% (15-42%); CD4 cells showed the best specificity, ranging from 91% to 97%. Of 52 samples tested, ≥1 mutations were observed in 91% (nucleoside reverse transcriptase inhibitors) and 95% (non-nucleoside reverse transcriptase inhibitors); 1 to 2 thymidine analogue-associated mutations were detected in 16 (31%) and ≥3 thymidine analogue-associated mutations in 7 (13%). CONCLUSION Nearly 1 in 3 children showed virologic failure, and >10% of the subgroup of children with treatment failure in whom genotyping was performed demonstrated multiple HIV drug resistance mutations. Neither clinical condition nor CD4 cells were good indicators for treatment failure.
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Morbidity after antiretroviral therapy initiation in HIV-1-infected children in West Africa: temporal trends and relation to CD4 count. Pediatr Infect Dis J 2013; 32:354-60. [PMID: 23099424 DOI: 10.1097/inf.0b013e318278b222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although 90% of HIV-1-infected children live in sub-Saharan Africa, morbidity data after highly active antiretroviral therapy (HAART) initiation in these settings are limited. The objective of this study was to document the incidence of AIDS-defining events and non-AIDS-defining diseases in African children receiving HAART. METHODS Incidences rates (IRs) of AIDS-defining events and 10 other common diseases were estimated overall and by current CD4-strata (<15%, 15 - <25% and ≥25%) from 2 prospective cohorts of African children. RESULTS One hundred eighty-eight children contributing to 355 children-years were included. The documented morbidity IRs per 100 children-years were upper respiratory infections, 100 (87-114); infectious diarrhea, 37 (31-44); World Health Organization (WHO) stage 2 events, 22.9 (18.2-28.1); and WHO stage 3/4 events, 12.3 (9.1-16.7). IRs of WHO stage 2 events, severe bacterial infections, infectious diarrhea and pneumonia decreased linearly across all CD4%-strata, whereas WHO stage 3/4 events and viral infections occurred mostly when CD4% <15%. Overall, IRs decreased during the first 2 years on HAART except for upper respiratory infection, mycosis and oral candidiasis. CONCLUSION This incidence of AIDS- and non-AIDS-defining diseases declined substantially after HAART in 2 African cohorts, although estimates remained high compared with high-resource settings. Without renewed efforts to increase antiretroviral scale-up, children in developing countries will continue to have a high burden of infections.
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Abstract
BACKGROUND Drug resistance mutations compromise antiretroviral treatment (ART) effectiveness in HIV-1-infected children. Trends in drug resistance prevalence have not been previously evaluated in HIV-infected children in Spain. METHODS HIV-1 variants, drug resistance prevalence dynamics and drug susceptibility were analyzed from 1993 to 2010 in HIV-infected children with available pol sequence, sample or drug resistance profile. HIV-1 variants were characterized by phylogenetic analysis. Resistance mutations in pretreated and naive patients were identified according to International AIDS Society-2010 and the World Health Organization list, respectively. RESULTS In 232 patients, genotypic resistance profiles (n = 11) or pol sequences (n = 128) were recovered or newly generated from infected samples (n = 93). Patients were mainly in care at pediatric units (63%), were mostly Europeans (84%), with moderate AIDS symptoms (65%), on ART (91%) and infected by HIV-1 subtype B (89%). Transmitted major drug resistance mutations were selected in 6 (13.6%) of the 44 ART-naive children: 4.8%, 9.3% and 11.6%, for protease inhibitors, nucleoside reverse transcriptase inhibitors and nonnucleoside reverse transcriptase inhibitors, respectively. Overall resistance prevalence was higher (71.8%) among ART-exposed children: 39.9%, 66.5% and 35.3% for protease inhibitors, nucleoside reverse transcriptase inhibitors and nonnucleoside reverse transcriptase inhibitors, respectively. Resistance prevalence among ART-exposed children was higher in 2009 to 2010 relative to 1993 to 1999 for nonnucleoside reverse transcriptase inhibitors (42% versus 6%; P = 0.006), protease inhibitors (39% versus 13%; P = 0.004) and nucleoside reverse transcriptase inhibitors (63% versus 44%; P = NS). Susceptibility to each drug in resistant viruses was predicted. The rate of non-B infections increased in the last years, mainly caused by recombinant viruses. CONCLUSIONS The increasing resistance prevalence among the HIV-infected pediatric population in Spain highlights the importance of specific drug resistance and drug susceptibility surveillance in long-term pretreated children to optimize treatment regimens.
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Cardoso CAA, Pinto JA, Candiani TMS, Carvalho IRD, Linhares RM, Goulart EMA. The impact of highly active antiretroviral therapy on the survival of vertically HIV-infected children and adolescents in Belo Horizonte, Brazil. Mem Inst Oswaldo Cruz 2012; 107:532-8. [DOI: 10.1590/s0074-02762012000400014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 03/21/2012] [Indexed: 11/21/2022] Open
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Badillo K, Prieto L, Toledano M, Guillen S, Alvarez A, García Bermejo I, Ramos Amador JT. [Characteristics of human immunodeficiency virus-1 infected children receiving highly active antiretroviral therapy: a cross-sectional study]. An Pediatr (Barc) 2012; 76:317-23. [PMID: 22326511 DOI: 10.1016/j.anpedi.2011.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 12/19/2011] [Accepted: 12/21/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Since 1996, when HAART became available, there has been a change in the course of HIV-infection, leading it to become a chronic disease. Our aim was to describe the characteristics of the children followed up in our hospital. PATIENTS AND METHODS A cross-sectional study was conducted on 32 HIV-infected children followed up until December-2010, at the University-Hospital de Getafe. Clinical and laboratory information from the last visit was collected for the evaluation of patients. RESULTS Thirty-two children with HIV-1 were evaluated, 29 infected through vertical-transmission. The median age was 14 years. According to the CDC classification, 56% (18/32) of children were in category A, 28% (9/32) B and 16% (5/32) C. Immunological class was 3 in 75% of children, class 2 in 9% and class 1 in 16%. The median nadir of CD4 was 337 cells/ml (12%). The median current CD4 was 749 (31%). Only one adolescent had a CD4% below 200 cells/ml due to lack of adherence. Twenty-eight patients (87%) were receiving HAART, and 4 patients were off antiretroviral treatment. Among the patients treated, 26 (93%) had viral loads <200 copies/ml. The median viral-load was<20 copies/ml. Median time on antiretroviral treatment was 10 years. The combination more frequently used was two nucleoside reverse transcriptase inhibitors (NRTI) and one protease inhibitor (PI), that was given to 15 patients (47%), followed by 2 NRTI, and one non-nucleoside reverse transcriptase inhibitor (NNRTI) in 8 patients (29%). Two children received rescue therapy including raltegravir, one with tipranavir and the other with darunavir. A total of 12 patients (43%) received medication once a day, 7 of them with fixed-dose combinations in a single tablet (25%). There were metabolic complications, including hyperlipidaemia or lipodystrophy were observed in 17 children (53%). CONCLUSIONS Most of our patients are receiving HAART, with good virological and immunological control. The prevalence of metabolic abnormalities was high. Strategies to improve adherence and decrease toxicities are needed in perinatally-acquired HIV-infected children.
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Affiliation(s)
- K Badillo
- Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, Spain.
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Menson EN, Mellado MJ, Bamford A, Castelli G, Duiculescu D, Marczyńska M, Navarro ML, Scherpbier HJ, Heath PT. Guidance on vaccination of HIV-infected children in Europe. HIV Med 2012; 13:333-6; e1-14. [PMID: 22296225 DOI: 10.1111/j.1468-1293.2011.00982.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2011] [Indexed: 02/02/2023]
Affiliation(s)
- E N Menson
- Department of General Paediatrics, Evelina Children's Hospital @St Thomas' Hospital, London, UK.
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Timing of antiretroviral therapy initiation and its impact on disease progression in perinatal human immunodeficiency virus-1 infection. Pediatr Infect Dis J 2012; 31:53-60. [PMID: 21979798 PMCID: PMC3252403 DOI: 10.1097/inf.0b013e31823515a2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Treatment with highly active antiretroviral therapy (HAART) reduces overall perinatal human immunodeficiency virus (HIV) type 1-related mortality. The effect of timing of HAART initiation on reduction of morbidity is not well defined. We evaluated the association of timing of HAART initiation on progression to moderate or severe disease. METHODS Retrospective, population-based study of 196 perinatally HIV-infected children followed from birth in northern California from 1988 to 2009. RESULTS Of 196 children, 58% received HAART and were followed for a median of 6.2 years after HAART initiation. HAART use was associated with improved survival to the age of 5 years: no HAART, 50% versus HAART, 88%; P < 0.0001. However, the advantage of initial HAART over mono or dual therapy transitioning to HAART was small and not statistically significant (P = 0.23). Starting HAART before the development of moderate or severe disease delayed the median age of diagnosis of moderate disease from 0.4 years (interquartile range, [0.3-0.8]) without HAART to 3.0 years ([interquartile range, 1.9-5.8]; P < 0.0001) with HAART. HAART initiation after progression to moderate or severe disease was associated with decreased progression to severe disease or death, respectively (moderate to severe: 8% [3/36] with HAART vs. 84% [70/83] with no HAART, P < 0.0001; severe to death: 9% [6/68] with HAART vs. 73% [49/67] with no HAART, P < 0.0001). CONCLUSIONS In perinatal HIV infection, HAART is associated with delayed progression and reduced mortality regardless of disease severity at HAART initiation. This finding reinforces US guidelines regarding HAART initiation at >1 year of age if children present with most clinical category B diagnoses, regardless of CD4 measurements or plasma HIV RNA level.
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Sigaloff KCE, Calis JCJ, Geelen SP, van Vugt M, de Wit TFR. HIV-1-resistance-associated mutations after failure of first-line antiretroviral treatment among children in resource-poor regions: a systematic review. THE LANCET. INFECTIOUS DISEASES 2011; 11:769-79. [PMID: 21872531 DOI: 10.1016/s1473-3099(11)70141-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
HIV-positive children are at high risk of drug resistance, which is of particular concern in settings where antiretroviral options are limited. In this Review we explore resistance rates and patterns among children in developing countries in whom antiretroviral treatment has failed. We did a systematic search of online databases and conference abstracts and included studies reporting HIV-1 drug resistance after failure of first-line paediatric regimens in children (<18 years) in resource-poor regions (Latin America, Africa, and Asia). We retrieved 1312 citations, of which 30 studies reporting outcomes in 3241 children were eligible. Viruses with resistance-associated mutations were isolated from 90% (95% CI 88-93%) of children. The prevalence of mutations associated with nucleoside reverse transcriptase inhibitors was 80%, with non-nucleoside reverse transcriptase inhibitors was 88%, and with protease inhibitors was 54%. Methods to prevent treatment failure, including adequate paediatric formulations and affordable salvage treatment options are urgently needed.
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Affiliation(s)
- Kim C E Sigaloff
- PharmAccess Foundation, Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Centre of University of Amsterdam, Amsterdam, Netherlands. k.sigaloff @pharmaccess.org
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Viani RM, Araneta MRG, Lopez G, Chacón-Cruz E, Spector SA. Clinical Outcomes and Hospitalizations among Children Perinatally Infected with HIV-1 in Baja California, Mexico. ACTA ACUST UNITED AC 2011; 10:223-8. [DOI: 10.1177/1545109711409942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study characterizes temporal trends in HIV disease progression among perinatally infected children at a clinic in Baja California, Mexico. A total of 73 children were followed, 52% were categorized under US Centers for Disease Control and Prevention (CDC) classification group C with a mean age of 2.3 years (SD ± 3.16) at HIV diagnosis. For the years 1998 to 2001, 2002 to 2003, 2004 to 2005, and 2006 to 2007, highly active antiretroviral therapy (HAART) use increased to 60%, 75%, 83%, and 94% ( P < .001) as did mean CD4 percentage of 23.4%, 23.2%, 26.9%, and 29.0%, respectively ( P = .009), while HIV plasma RNA log10 decreased significantly (4.49, 4.23, 4.00, and 3.79, respectively; P = .019). Overall mortality was 31% (23 of 73), with pneumonia being the most common cause of death (43% of all deaths) followed by tuberculosis (22%). Mortality rates declined from 30.4% to 25%, 8.9%, and 9.3% ( p = 0.035) for the years 1998 to 2001, 2002 to 2003, 2004 to 2005, and 2006 to 2007, respectively. Kaplan-Meier survival analysis showed that median survival was 11.2 years; 1-, 2-, and 5-year survival was 87%, 83%, and 67%, respectively. These findings document a high but improving trend in morbidity and mortality of children perinatally infected with HIV in Tijuana, Baja California, Mexico.
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Affiliation(s)
- Rolando M. Viani
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA, USA
- Division of Infectious Diseases, University of California, San Diego School of Medicine, La Jolla, CA, USA
- Center for AIDS Research, University of California, San Diego School of Medicine, La Jolla, CA, USA
- School of Medicine, Rady Children’s Hospital, San Diego, CA, USA
| | - Maria Rosario G. Araneta
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Graciano Lopez
- Department of Pediatrics, Tijuana General Hospital, Tijuana, Mexico
| | | | - Stephen A. Spector
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA, USA
- Division of Infectious Diseases, University of California, San Diego School of Medicine, La Jolla, CA, USA
- Center for AIDS Research, University of California, San Diego School of Medicine, La Jolla, CA, USA
- School of Medicine, Rady Children’s Hospital, San Diego, CA, USA
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Souza ES, dos Santos NR, Valentini SZ, da Silva GA, Figueiroa JN, Falbo AR. Predictors of long-term anti-retroviral therapy effectiveness among Brazilian HIV-1-infected children in a hybrid scenario: what really matters? J Trop Pediatr 2011; 57:197-203. [PMID: 20823088 DOI: 10.1093/tropej/fmq082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The study objective was to evaluate the effectiveness and durability of highly active anti-retroviral therapy (HAART) in perinatally HIV-1-infected children and adolescents and its predictors. A historical cohort study was done at IMIP's Hospital in Recife, Brazil. The study included 195 subjects, 102 (52.3%) had successful response to HAART with a mean time of any HAART use of 4.9 [standard deviation (SD) 2.5; min. 0.7, max. 9.9] years. The time to failure of first HAART was negatively associated with male sex [relative hazard (RH) = 0.5, p = 0.021) and living out of metropolitan area (RH = 0.4, p = 0.009), and associated with Centres for Diseases Control and Prevention (CDC) immunological Stage 1 (RH = 2.9, p = 0.003) and patients who were adherent (RH = 2.2, p = 0.003). HAART success rate and mean time durability was similar to developed country data. However, the main predictors of success were: female sex, living in a metropolitan area, CDC1 immunological category and adherence.
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Lumbiganon P, Kariminia A, Aurpibul L, Hansudewechakul R, Puthanakit T, Kurniati N, Kumarasamy N, Chokephaibulkit K, Nik Yusoff NK, Vonthanak S, Moy FS, Razali KAM, Nallusamy R, Sohn AH. Survival of HIV-infected children: a cohort study from the Asia-Pacific region. J Acquir Immune Defic Syndr 2011; 56:365-71. [PMID: 21160429 PMCID: PMC3072816 DOI: 10.1097/qai.0b013e318207a55b] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Combination antiretroviral therapy (ART) has been used for HIV-infected children in many Asian countries since 2002. This study describes survival outcomes among HIV-infected children in a multicenter regional cohort in Asia. PATIENTS AND METHODS Retrospective and prospective data collected through March 2009 from children in 5 countries enrolled in TREAT Asia's Pediatric HIV Observational Database were analysed. Multivariate Cox proportional hazard models were used to assess factors associated with mortality in children who received ART. RESULTS Among 2280 children, 1752 (77%) had received ART. During a median follow-up of 3.1 years after ART, 115 (6.6%) deaths occurred, giving a crude mortality rate of 1.9 per 100 child-years [95% confidence interval (CI): 1.6 to 2.4]. The mortality rate was highest in the first 3 months of ART (10.2 per 100 child-years; 95% CI: 7.5 to 13.7) and declined after 12 months (0.9 per 100 child-years; 95% CI: 0.7 to 1.3). Those with a low recent CD4 percentage, who started ART with lower baseline weight-for-age Z score, or with WHO clinical stage 4 had an increased risk of death. Of 528 (23%) children who never received ART, 36 (6.8%) died after presenting to care, giving a crude mortality rate of 4.1 per 100 child-years (95% CI: 3.0 to 5.7), with a lost-to-program rate of 31.5 per 100 child-years (95% CI: 28.0 to 35.5). CONCLUSIONS The high mortality during the first 3 months of ART and in those with low CD4 percentage support the implementation of early diagnosis and ART initiation.
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Peacock-Villada E, Richardson BA, John-Stewart GC. Post-HAART outcomes in pediatric populations: comparison of resource-limited and developed countries. Pediatrics 2011; 127:e423-41. [PMID: 21262891 PMCID: PMC3025421 DOI: 10.1542/peds.2009-2701] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2010] [Indexed: 11/24/2022] Open
Abstract
CONTEXT No formal comparison has been made between the pediatric post-highly active antiretroviral therapy (HAART) outcomes of resource-limited and developed countries. OBJECTIVE To systematically quantify and compare major baseline characteristics and clinical end points after HAART between resource-limited and developed settings. METHODS Published articles and abstracts (International AIDS Society 2009, Conference on Retroviruses and Opportunistic Infections 2010) were examined from inception (first available publication for each search engine) to March 2010. Publications that contained data on post-HAART mortality, weight-for-age z score (WAZ), CD4 count, or viral load (VL) changes in pediatric populations were reviewed. Selected studies met the following criteria: (1) patients were younger than 21 years; (2) HAART was given (≥ 3 antiretroviral medications); and (3) there were >20 patients. Data were extracted for baseline age, CD4 count, VL, WAZ, and mortality, CD4 and virologic suppression over time. Studies were categorized as having been performed in a resource-limited country (RLC) or developed country (DC) on the basis of the United Nations designation. Mean percentage of deaths per cohort and deaths per 100 child-years, baseline CD4 count, VL, WAZ, and age were calculated for RLCs and DCs and compared by using independent samples t tests. RESULTS Forty RLC and 28 DC publications were selected (N = 17 875 RLCs; N = 1835 DC). Mean percentage of deaths per cohort and mean deaths per 100 child-years after HAART were significantly higher in RLCs than DCs (7.6 vs 1.6, P < .001, and 8.0 vs 0.9, P < .001, respectively). Mean baseline CD4% was 12% in RLCs and 23% in DCs (P = .01). Mean baseline VLs were 5.5 vs 4.7 log(10) copies per mL in RLCs versus DCs (P < .001). CONCLUSIONS Baseline CD4% and VL differ markedly between DCs and RLCs, as does mortality after pediatric HAART. Earlier diagnosis and treatment of pediatric HIV in RLCs would be expected to result in better HAART outcomes.
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Puthanakit T, Jourdain G, Hongsiriwon S, Suntarattiwong P, Chokephaibulkit K, Sirisanthana V, Kosalaraksa P, Petdachai W, Hansudewechakul R, Siangphoe U, Suwanlerk T, Ananworanich J. HIV-1 drug resistance mutations in children after failure of first-line nonnucleoside reverse transcriptase inhibitor-based antiretroviral therapy. HIV Med 2010; 11:565-72. [DOI: 10.1111/j.1468-1293.2010.00828.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sutcliffe CG, Moss WJ. Do children infected with HIV receiving HAART need to be revaccinated? THE LANCET. INFECTIOUS DISEASES 2010; 10:630-42. [DOI: 10.1016/s1473-3099(10)70116-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Israr M, Mitchell D, Alam S, Dinello D, Kishel JJ, Meyers C. The HIV protease inhibitor lopinavir/ritonavir (Kaletra) alters the growth, differentiation and proliferation of primary gingival epithelium. HIV Med 2010; 12:145-56. [PMID: 20722750 DOI: 10.1111/j.1468-1293.2010.00863.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study was designed to evaluate the effects of the HIV protease inhibitor lopinavir/ritonavir on gingival epithelium growth, integrity and differentiation. METHODS Organotypic (raft) cultures of gingival keratinocytes were established and treated with a range of lopinavir/ritonavir concentrations. To examine the effect of lopinavir/ritonavir on gingival epithelium growth and stratification, haematoxylin and eosin staining was performed. To investigate the effect of this drug on tissue integrity, transmission electron microscopy (TEM) was performed on untreated and drug-treated tissues. Further, immunohistochemical analysis of raft cultures was performed to assess the effect of lopinavir/ritonavir on the expression of key differentiation and proliferation markers including cytokeratins, proliferating cell nuclear antigen (PCNA) and cyclin A. RESULTS Lopinavir/ritonavir treatments drastically inhibited the growth of gingival epithelium when the drug was present throughout the growth period of the tissue. When the drug was added on day 8 of tissue growth, lopinavir/ritonavir treatments compromised tissue integrity over time and altered the proliferation and differentiation of gingival keratinocytes. Expression of cytokeratins 5, 14, 10 and 6, PCNA and cyclin A was induced, and their expression patterns were also altered over time in treated rafts. CONCLUSIONS The findings of our studies suggest that lopinavir/ritonavir treatments compromised tissue integrity over time and deregulated the cell cycle/proliferation and differentiation pathways, resulting in abnormal epithelial repair and proliferation. Our study provides a model of potential utility in studying the effects of antiretroviral drugs in vitro.
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Affiliation(s)
- M Israr
- Department of Microbiology and Immunology, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
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Israr M, Mitchell D, Alam S, Dinello D, Kishel JJ, Meyers C. Effect of the HIV protease inhibitor amprenavir on the growth and differentiation of primary gingival epithelium. Antivir Ther 2010; 15:253-65. [PMID: 20386081 DOI: 10.3851/imp1512] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND HIV-positive patients taking antiretroviral drugs, including protease inhibitors, have shown a significant increase in the development of oral complications; these complications are a major health issue for affected patients. The effect of these drugs on oral epithelium growth and differentiation is presently unknown. In this study, we explore for the first time the effect of the HIV protease inhibitor amprenavir on gingival epithelium growth and differentiation. METHODS Organotypic (raft) cultures of gingival keratinocytes were established and the raft cultures treated with a range of amprenavir concentrations. Haematoxylin and eosin staining was performed to examine the effect of amprenavir on gingival epithelium growth and stratification. The raft cultures were also immunohistochemically analysed to determine the effect of amprenavir on the expression of key differentiation and proliferation markers, including cytokeratins, proliferating cell nuclear antigen (PCNA) and cyclin A. RESULTS Amprenavir severely inhibited the growth of gingival epithelium when the drug was present throughout the growth period of the tissue. When the drug was added at day 8, amprenavir treatment altered the proliferation and differentiation of gingival keratinocytes. Expression of the cytokeratins 5, 14, 6 and 10, PCNA and cyclin A was increased; their expression pattern was also altered over time in treated rafts. Biochemically, the tissue exhibited characteristics of increased proliferation in the suprabasal layers of amprenavir-treated tissue. CONCLUSIONS Our results suggest that amprenavir treatment deregulates the cell cycle/proliferation and differentiation pathways, resulting in abnormal epithelial repair and proliferation. Our system could be developed as a potential model for studying the effects of highly active antiretroviral therapy in vitro.
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Affiliation(s)
- Mohd Israr
- Department of Microbiology and Immunology, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Banerjee T, Pensi T, Banerjee D, Grover G. Impact of HAART on survival, weight gain and resting energy expenditure in HIV-1-infected children in India. ACTA ACUST UNITED AC 2010; 30:27-37. [PMID: 20196931 DOI: 10.1179/146532810x12637745451915] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND In resource-limited countries, use of highly active antiretroviral therapy (HAART) in HIV-infected children is still poorly documented in terms of impact on survival, the immune system and growth. Since the availability of HAART, nutrition of HIV-infected children has been neglected. AIM To evaluate the effect of HAART on survival and immune response in HIV-infected children and to investigate the response to nutritional support. METHODS In December, 2002 a cohort study was carried out on vertically HIV-1-infected children and was observed longitudinally for CD4(+) T-cell count, antiretroviral treatment and weight until 31 December 2007. Z-scores were calculated for CD4(+) T-cell count to account for age-related differences. Nutritional supplementation was given to all the HIV-infected children and resting energy expenditure (REE) was calculated. Mortality rates were also calculated for the perinatally infected children followed up at the HIV clinic. RESULTS A total of 180 children were assessed, 100 (56%) of whom were on HAART. Baseline body mass index was lower in the HAART group (p<0.05). Median duration of survival from date of diagnosis was 15.1 years. Those who received HAART survived significantly longer. The average annual mortality rate was 1.2% during 2005-2006. During HAART, a CD4 Z-score increase of 1 SD was associated with a 0.35 increase in body weight Z-score (p<0.001). The increase in daily energy intake owing to nutritional supplementation was associated with increase in weight Z-score in both the no-HAART and HAART group. REE was independently associated with weight change in the models which tested association of changes in CD4(+) T-cell Z-score and daily REE/kg body weight with changes in body weight Z-score in both the HAART and no-HAART group and then separately in the two groups (p<0.001). CONCLUSION Survival rates of children improved which correlated with an increase in CD4(+) T-cell count concurrent with the expanded use of HAART. HAART had a positive effect on growth in HIV-1-infected children. Nutrition supplementation improved the health of children in both the no-HAART and HAART groups.
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Affiliation(s)
- T Banerjee
- Department of Statistics, University of Delhi, Delhi, India.
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McCabe CJ, Goldie SJ, Fisman DN. The cost-effectiveness of directly observed highly-active antiretroviral therapy in the third trimester in HIV-infected pregnant women. PLoS One 2010; 5:e10154. [PMID: 20405011 PMCID: PMC2854147 DOI: 10.1371/journal.pone.0010154] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 03/04/2010] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In HIV-infected pregnant women, viral suppression prevents mother-to-child HIV transmission. Directly observed highly-active antiretroviral therapy (HAART) enhances virological suppression, and could prevent transmission. Our objective was to project the effectiveness and cost-effectiveness of directly observed administration of antiretroviral drugs in pregnancy. METHODS AND FINDINGS A mathematical model was created to simulate cohorts of one million asymptomatic HIV-infected pregnant women on HAART, with women randomly assigned self-administered or directly observed antiretroviral therapy (DOT), or no HAART, in a series of Monte Carlo simulations. Our primary outcome was the quality-adjusted life expectancy in years (QALY) of infants born to HIV-infected women, with the rates of Caesarean section and HIV-transmission after DOT use as intermediate outcomes. Both self-administered HAART and DOT were associated with decreased costs and increased life-expectancy relative to no HAART. The use of DOT was associated with a relative risk of HIV transmission of 0.39 relative to conventional HAART; was highly cost-effective in the cohort as a whole (cost-utility ratio $14,233 per QALY); and was cost-saving in women whose viral loads on self-administered HAART would have exceeded 1000 copies/ml. Results were stable in wide-ranging sensitivity analyses, with directly observed therapy cost-saving or highly cost-effective in almost all cases. CONCLUSIONS Based on the best available data, programs that optimize adherence to HAART through direct observation in pregnancy have the potential to diminish mother-to-child HIV transmission in a highly cost-effective manner. Targeted use of DOT in pregnant women with high viral loads, who could otherwise receive self-administered HAART would be a cost-saving intervention. These projections should be tested with randomized clinical trials.
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Affiliation(s)
- Caitlin J. McCabe
- Child Health Evaluative Sciences, Research Institute of the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sue J. Goldie
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - David N. Fisman
- Child Health Evaluative Sciences, Research Institute of the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Guillén S, García San Miguel L, Resino S, Bellón JM, González I, Jiménez de Ory S, Muñoz-Fernández MA, Navarro ML, Gurbindo MD, de José MI, Mellado MJ, Martín-Fontelos P, Gonzalez-Tomé MI, Martinez J, Beceiro J, Roa MA, Ramos JT. Opportunistic infections and organ-specific diseases in HIV-1-infected children: a cohort study (1990-2006). HIV Med 2010; 11:245-52. [DOI: 10.1111/j.1468-1293.2009.00768.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Isaakidis P, Raguenaud ME, Te V, Tray CS, Akao K, Kumar V, Ngin S, Nerrienet E, Zachariah R. High survival and treatment success sustained after two and three years of first-line ART for children in Cambodia. J Int AIDS Soc 2010; 13:11. [PMID: 20302672 PMCID: PMC2851581 DOI: 10.1186/1758-2652-13-11] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 03/21/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term outcomes of antiretroviral therapy (ART) in children remain poorly documented in resource-limited settings. The objective of this study was to assess two-and three-year survival, CD4 evolution and virological response among children on ART in a programmatic setting in Cambodia. METHODS Children treated with first-line ART for at least 24 months were assessed with viral load testing and genotyping. We used Kaplan-Meier analysis for survival and Cox regression to identify risk factors associated with treatment failure. RESULTS Of 1168 registered HIV-positive children, 670 (57%) started ART between January 2003 and December 2007. Survival probability was 0.93 (95% CI: 0.91-0.95) and 0.91 (95% CI: 0.88-0.93) at 24 and 36 months after ART initiation, respectively. Median CD4 gain for children aged over five years was 704 cells/mm3 at 24 months and 737 at 36 months. Median CD4 percentage gain for children under five years old was 15.2% at 24 months and 15% at 36 months. One hundred and thirty children completed at least 24 months of ART, and 138 completed 36 months: 128 out of 268 (48%) were female. Median age at ART initiation was six years.Overall, 22 children had viral loads of >1000 copies/ml (success ratio = 86% on intention-to-treat-analysis) and 21 of 21 presented mutations conferring resistance mostly to lamivudine and non-nucleoside reverse transcriptase inhibitors. Risk factors for failure after 24 and 36 months were CD4 counts below the threshold for severe immunosupression at those months respectively. Only two out of 22 children with viral loads of >1000 copies/ml met the World Health Organization immunological criteria for failure (sensitivity = 0.1). CONCLUSIONS Good survival, immunological restoration and viral suppression can be sustained after two to three years of ART among children in resource-constrained settings. Increased access to routine virological measurements is needed for timely diagnosis of treatment failure.
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Affiliation(s)
| | | | - Vantha Te
- Pediatrics Department, Donkeo Referral Hospital, Ministry of Health, Takeo, Cambodia
| | | | - Kazumi Akao
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Varun Kumar
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Sopheak Ngin
- HIV/Hepatitis Laboratory, Pasteur Institute of Cambodia
| | | | - Rony Zachariah
- Médecins Sans Frontières, Operational Research Unit, Brussels, Belgium
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Pinheiro Neto CD, Weber R, Araújo-Filho BC, Miziara ID. Rhinosinusitis in HIV-infected children undergoing antiretroviral therapy. Braz J Otorhinolaryngol 2010; 75:70-5. [PMID: 19488563 PMCID: PMC9442235 DOI: 10.1016/s1808-8694(15)30834-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 11/02/2007] [Indexed: 11/29/2022] Open
Abstract
UNLABELLED The association of protease inhibitors (PI) to antiretroviral therapy has generated sensible changes in morbidity and mortality of HIV-infected patients. AIM Aims at evaluating the impact of this association on the prevalence of rhinosinusitis (RS) and CD4+ lymphocyte count in HIV-infected children. METHODS Retrospective cross-sectional study of the medical charts of 471 HIV-infected children. In 1996, protease inhibitors were approved for use as an association drug in antiretroviral therapy. Children were divided into two groups: one which did not receive PI and another which received PI after 1996. The prevalence of RS and CD4+ lymphocyte counts were compared between these groups. RESULTS 14.4% of HIV-infected children had RS. Chronic RS was more prevalent the its acute counterpart. Children under 6 years old who were taking protease inhibitors presented with a significant higher prevalence of acute RS. The association of PI with the antiretroviral regimen was associated to higher mean CD4+ lymphocyte count and lower prevalence of chronic RS. CONCLUSIONS The use of protease inhibitors was associated to higher mean CD4+ lymphocyte count. Children under 6 years of age in antiretroviral therapy associated with PI presented a lower likelihood of developing chronic RS.
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Affiliation(s)
- Carlos Diógenes Pinheiro Neto
- Divisão de Clínica Otorrinolaringológica, Departamento de Otorrinolaringologia e Oftalmologia, Faculdade de Medicina, Universidade de São Paulo
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Palacios GC, Sanchez LM, Briones E, Ramirez TJ, Castillo H, Rivera LG, Vazquez CA, Rodriguez-Padilla C, Holodniy M. Structured interruptions of highly active antiretroviral therapy in cycles of 4 weeks off/12 weeks on therapy in children having a chronically undetectable viral load cause progressively smaller viral rebounds. Int J Infect Dis 2010; 14:e34-40. [DOI: 10.1016/j.ijid.2009.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 02/19/2009] [Accepted: 03/01/2009] [Indexed: 11/27/2022] Open
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Palladino C, Bellón JM, Jarrín I, Gurbindo MD, De José MI, Ramos JT, González-Iome MI, Mellado MJ, Beceiro J, Amo JD, Muñoz-Fernández MÁ. Impact of highly active antiretroviral therapy (HAART) on AIDS and death in a cohort of vertically HIV type 1-infected children: 1980-2006. AIDS Res Hum Retroviruses 2009; 25:1091-7. [PMID: 19895191 DOI: 10.1089/aid.2009.0070] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We evaluated the population effectiveness of highly active antiretroviral therapy (HAART) on the risk of AIDS and death in a multicenter cohort of 346 HIV-1 vertically infected children born between 1980 and 2006 in the Comunidad Autónoma de Madrid (CAM), Spain. Risks of AIDS and death in patients with the same duration of HIV infection were compared in different calendar periods [CP1: 1980-1989, CP2: 1990-1993 (reference), CP3: 1994-1996, CP4: 1997-1998, CP5: 1999-2006] through cumulative incidence curves and Cox proportional hazards models, allowing for late entry, that included the calendar period as the time-dependent covariate and adjusting for gender and mother's transmission category. The median follow-up was 11.8 years [interquartile range (IQR), 6.3-15.9]. Median CD4+ T cell percentage increased up to 26.5 in CP5 (IQR, 19.5-36.7) while the viral load decreased (median log(10) copies/ml in CP5, 3.66; IQR, 3.07-4.22). Multivariate analysis showed significant reduction in the risk of death since 1997 onward [CP4: adjusted hazard ratios (AHR), 0.29; 95% confidence interval (CI), 0.12-0.69; CP5: AHR, 0.06; 95% CI, 0.03-0.15]. Reduction in progression to AIDS reached borderline significance in CP4 (AHR, 0.49; 95% CI, 0.23-1.05) and was more marked in the last period (CP5: AHR, 0.30; 95% CI, 0.16-0.59). The reductions in the incidence of AIDS and death observed since 1996 were largely attributable to HAART.
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Affiliation(s)
- Claudia Palladino
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario “Gregorio Marañón,” Madrid, Spain
- Istituto Pasteur, Fondazione Cenci-Bolognetti, Università degli Studi di Roma “La Sapienza,” 00185 Rome, Italy
- Università degli Studi di Roma “La Sapienza,” 00185 Rome, Italy
| | - Jose M. Bellón
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario “Gregorio Marañón,” Madrid, Spain
| | - Inmaculada Jarrín
- Centro Nacional de Epidemiología, Instituto de Salud “Carlos III,” Madrid, Spain
| | - Maria Dolores Gurbindo
- Sección Inmuno-Pediatría, Hospital Materno Infantil “Gregorio Marañón,” Madrid, Spain
- Unidad Asociada de Retrovirología Humana, HGUGM-CSIC, Madrid, Spain
| | - M. Isabel De José
- Servicio Infecciosas Infantil, Hospital Universitario “La Paz,” Madrid, Spain
| | - José T. Ramos
- Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, Spain
| | - M. Isabel González-Iome
- Servicio de Infecciosas Pediátricas, Hospital Universitario “Doce de Octubre,” Madrid, Spain
| | - Maria José Mellado
- Servicio de Pediatría, Hospital Universitario “Carlos III,”, Madrid, Spain
| | - José Beceiro
- Servicio de Pediatría, Hospital Universitario “Príncipe de Asturias,” Madrid, Spain
| | - Julia Del Amo
- Centro Nacional de Epidemiología, Instituto de Salud “Carlos III,” Madrid, Spain
| | - M. Ángeles Muñoz-Fernández
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario “Gregorio Marañón,” Madrid, Spain
- Unidad Asociada de Retrovirología Humana, HGUGM-CSIC, Madrid, Spain
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Predictors of virologic failure and genotypic resistance mutation patterns in thai children receiving non-nucleoside reverse transcriptase inhibitor-based antiretroviral therapy. Pediatr Infect Dis J 2009; 28:826-30. [PMID: 19654564 DOI: 10.1097/inf.0b013e3181a458f9] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonnucleoside reverse transcription inhibitor (NNRTI)-based antiretroviral therapy (ART) has been widely used as a first-line regimen for the treatment of HIV. This study aimed to determine the rate and predictors of virologic failure and describe patterns of resistance mutation. METHODS The inclusion criteria were children who were <18 years and receiving NNRTI-based ART. Plasma HIV-1 RNA and CD4 were monitored every 6 months. Virologic failure was defined as plasma HIVRNA >1000 copies/mL. RESULTS Forty (20%) of 202 children had virologic failure, of whom 33 (16%) failed in the first year of therapy. By multivariate analysis, the children who received nevirapine were 3.7 times more likely to develop virologic failure than those receiving efavirenz (P = 0.006). The prevalence's of patients with >or=1 major mutations conferring drug resistance to nucleoside reverse transcription inhibitors (NRTIs) and NNRTIs were 89% and 97%, respectively. The common NNRTI mutations were Y181C/I (58%) and K103N (34%). The NRTI mutations were M184V/I (84%), K65R (11%), Q151M (5%), and >or=3 TAMs (3%). CONCLUSIONS The virologic failure rate in children was high and mostly occurred in the first year of treatment. The most common resistance mutations were those conferring resistance to NNRTIs and lamivudine. There were few instances of multiNRTI resistance. Early detection of virologic failure might allow more options for second-line regimens.
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Bracher L, Valerius NH, Rosenfeldt V, Herlin T, Fisker N, Nielsen H, Obel N. Long-term effectiveness of highly active antiretroviral therapy (HAART) in perinatally HIV-infected children in Denmark. ACTA ACUST UNITED AC 2009; 39:799-804. [PMID: 17701719 DOI: 10.1080/00365540701203493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The long-term impact of highly active antiretroviral therapy (HAART) on HIV-1 infected children is not well known. The Danish Paediatric HIV Cohort Study includes all patients <16 y of age with HIV-1 infection in Denmark. We report the complete follow-up from 1996 to 2005 of 49 perinatally infected children treated with HAART. Initial HAART included 2 nucleoside reverse-transcriptase inhibitors in combination with either a protease inhibitor (n =38) or a non-nucleoside reverse-transcriptase inhibitor (n =12). 19 (39%) patients were previously treated with mono- or dual therapy. Baseline characteristics were median CD4 percentage 14% and HIV-RNA viral load 4.9 log(10). Within the first 12 weeks of therapy approximately 60% achieved HIV-RNA viral load <500 copies/ml, and this remained stable for up to 8 y, although many children changed the components of HAART. The proportion of children with CD4 percentage >25% increased to 60-70% over the y of treatment. For the total cohort, 245 patient-y of observation were available with only 1 death. During our observation period there were no signs of a waning impact. The challenge remains to maintain a high adherence to therapy as the children grow into adolescence and develop more independence from family and health care staff.
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Affiliation(s)
- Linda Bracher
- Department of Paediatrics, Copenhagen University Hospital, Hvidovre, Denmark
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Abstract
PURPOSE OF REVIEW Children have higher rates of virological failure than adults, often associated with more extensive resistance and limited second-line options. In order to maintain clinical benefits of highly active antiretroviral therapy (HAART) into adulthood, particularly for children starting at a young age, strategies are needed to limit the emergence of resistance and to offer highly effective subsequent lines of therapy. Similarly, well resourced settings face challenges regarding extensive resistance accumulated over the past decade or more, particularly resulting from suboptimal therapies. RECENT FINDINGS Rates of resistance at failure of nonnucleoside reverse-transcriptase inhibitor based HAART are higher in developing countries than in well resourced settings. In the latter, second-generation protease inhibitors tipranavir and darunavir are promising, with tipranavir now licensed for those above 2 years and darunavir showing good trial results in children above 6 years. However, combination with new classes such as integrase inhibitors (currently in phase I trials) and CCR5 antagonists (no paediatric data yet) will probably be necessary to gain maximal long-term benefits. SUMMARY Common goals in paediatric HIV for both resource-rich and resource-limited settings are to limit vertical transmission, minimize emergence of resistant viruses in both mother and child where prevention of mother-to-child transmission fails, and limit resistance in children starting HAART. Optimal sequencing of regimens in the absence of resistance testing is a priority research area. Paediatric studies using newer classes of agents are of paramount importance, as well as expanding access to existing antiretrovirals.
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Characterization of quantitative and functional innate immune parameters in HIV-1-infected Colombian children receiving stable highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2009; 49:348-57. [PMID: 19186348 DOI: 10.1097/qai.0b013e31818c16ff] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The immunological benefits of highly active antiretroviral therapy (HAART) in HIV-1-infected children include reconstitution of CD4+ T-cell count and functional activity. The effect of HAART on innate immune cells has not been well established. AIM To characterize innate immune responses in HAART-treated HIV-1-infected children. PATIENTS AND METHODS 23 HIV-1-infected children on stable HAART and 23 uninfected children were evaluated. The frequency of innate immune cells in peripheral blood was determined by flow cytometry and functional activity was evaluated using Toll-like receptor agonists. RESULTS Compared with uninfected children, HAART-treated HIV-1-infected children exhibited a significant decrease in the frequency of plasmacytoid dendritic cells and natural killer and T-cell receptor (TCR)-invariant CD1d-restricted T cells. This deficiency of innate immune cells was observed mainly in children with detectable viral load. We also compared the magnitude of the quantitative restoration of those cells comparing HIV-1-infected children with HIV-1-infected adults and found a partial effect of HAART on immune restoration that was independent of age. In both pediatric and adult subjects Toll-like receptor agonists induced expression of costimulatory molecules and production of proinflammatory cytokines by dendritic cells. Peripheral blood mononuclear cells of HIV-1-infected children produced significantly reduced amounts of interferon-alpha compared with uninfected children. CONCLUSIONS HAART administration to HIV-1-infected children does not lead to a complete increase of circulating innate immune cells, particularly in patients with incomplete suppression of HIV.
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Rigaud M, Borkowsky W, Muresan P, Weinberg A, Larussa P, Fenton T, Read JS, Jean-Philippe P, Fergusson E, Zimmer B, Smith D, Kraimer J. Impaired immunity to recall antigens and neoantigens in severely immunocompromised children and adolescents during the first year of effective highly active antiretroviral therapy. J Infect Dis 2008; 198:1123-30. [PMID: 18752430 DOI: 10.1086/592050] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND We studied whether severely immunocompromised, human immunodeficiency virus (HIV)-infected children who were beginning highly active antiretroviral therapy (HAART) or changing HAART regimens could spontaneously respond to a recall antigen (tetanus toxoid [TT] vaccine) or respond to a recall antigen and neoantigen (hepatitis A virus [HAV] vaccine) after 3 vaccinations. METHODS A total of 46 children who had CD4 cell percentages <15% and who demonstrated a >0.75-log reduction in plasma HIV RNA levels within 4 weeks of starting HAART were randomized to receive vaccinations with either TT or HAV vaccines during the first 6 months of HAART. Study subjects then received the alternate vaccine during the next 6 months of HAART. RESULTS Despite the early decline in viremia and the later increase in the percentage of CD4 T cells, spontaneous recovery of cell-mediated immunity (CMI) was not seen for TT. Serologic responses to TT required 3 vaccinations and were comparable in both groups. Serologic responses to HAV were infrequent and of low titer, although the group that received HAV vaccine after receiving TT vaccine performed somewhat better. CMI to HAV was virtually absent. CONCLUSIONS Severely immunocompromised children who are receiving HAART develop CMI and antibody to a recall antigen independent of the timing of vaccination, but they require a primary series of vaccinations. Antibodies to a neoantigen, HAV, developed when vaccination was delayed after initiation of HAART. CMI to a neoantigen was difficult to establish. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT00004735/PACTG P1006 .
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Affiliation(s)
- Mona Rigaud
- New York University School of Medicine, New York, NY, USA.
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Palacios GC, Montalvo MS, Fraire MI, Leon E, Alvarez MT, Solorzano F. Audiologic and vestibular findings in a sample of human immunodeficiency virus type-1-infected Mexican children under highly active antiretroviral therapy. Int J Pediatr Otorhinolaryngol 2008; 72:1671-81. [PMID: 18814921 DOI: 10.1016/j.ijporl.2008.08.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 08/06/2008] [Accepted: 08/09/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE There is little information about audiologic and vestibular disorders in pediatric patients infected with the Human Immunodeficiency Virus type-1 (HIV-1). The aim of this study was to evaluate audiologic and vestibular disorders in a sample of HIV-1-infected children receiving Highly Active Antiretroviral Therapy. METHODS Patients underwent pure tone audiometry, speech discrimination testing, auditory brainstem responses, electronystagmography, and rotatory testing. HIV-1 viral load and absolute CD4+ cell counts were registered. RESULTS Twenty-three patients were included, aged 4.5 years (median, range 5 months to 16 years). Pure tone audiometry was carried out in 12 children over 4 years of age: 4 (33%) showed hearing loss, 2 were conductive. Auditory brainstem responses were measured in all 23 patients, suggesting conductive hearing loss in 6 and sensorineural hearing loss in 2. Most patients with conductive hearing loss had the antecedent of acute or chronic suppurative otitis media but with dry ears at the time of evaluation (p=0.003). Abnormal prolongations of interwave intervals in auditory brainstem responses were observed in 3 children (13%, 4 ears), an abnormal morphology in different components of auditory brainstem responses in 4 (17.4%, 7 ears), and abnormal amplitude patterns in 11 patients (48%, 17 ears). Vestibular tests were abnormal in all six patients tested, with asymmetries in caloric and rotatory tests. Although differences were not significant, in general, audiologic abnormalities were more frequent in patients with more prolonged HIV-1 infections, higher viral loads, or lower absolute CD4+ cell counts. CONCLUSIONS Conductive hearing loss associated with previous otitis media events, abnormalities in auditory brainstem responses suggesting disorders at different levels of the auditory pathways, and unilateral vestibular hyporeflexia were frequent findings in our sample of HIV-1-infected children under Highly Active Antiretroviral Therapy. These findings suggest that HIV-1-infected children should be submitted to audiologic and vestibular evaluation as early as possible in order to reduce their impact on the psychosocial development of these patients.
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Affiliation(s)
- Gerardo C Palacios
- Departamento de Infectología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc 330 Colonia Doctores, Delegación Cuauhtemoc, Mexico City 06720, Mexico.
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Bahwere P, Piwoz E, Joshua MC, Sadler K, Grobler-Tanner CH, Guerrero S, Collins S. Uptake of HIV testing and outcomes within a Community-based Therapeutic Care (CTC) programme to treat severe acute malnutrition in Malawi: a descriptive study. BMC Infect Dis 2008; 8:106. [PMID: 18671876 PMCID: PMC2536666 DOI: 10.1186/1471-2334-8-106] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 07/31/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Malawi and other high HIV prevalence countries, studies suggest that more than 30% of all severely malnourished children admitted to inpatient nutrition rehabilitation units are HIV-infected. However, clinical algorithms designed to diagnose paediatric HIV are neither sensitive nor specific in severely malnourished children. The present study was conducted to assess : i) whether HIV testing can be integrated into Community-based Therapeutic Care (CTC); ii) to determine if CTC can improve the identification of HIV infected children; and iii) to assess the impact of CTC programmes on the rehabilitation of HIV-infected children with Severe Acute Malnutrition (SAM). METHODS This community-based cohort study was conducted in Dowa District, Central Malawi, a rural area 50 km from the capital, Lilongwe. Caregivers and children admitted in the Dowa CTC programme were prospectively (Prospective Cohort = PC) and retrospectively (Retrospective Cohort = RC) admitted into the study and offered HIV testing and counseling. Basic medical care and community nutrition rehabilitation was provided for children with SAM. The outcomes of interest were uptake of HIV testing, and recovery, relapse, and growth rates of HIV-positive and uninfected children in the CTC programme. Student's t-test and analysis of variance were used to compare means and Kruskall Wallis tests were used to compare medians. Dichotomous variables were compared using Chi2 analyses and Fisher's exact test. Stepwise logistic regression with backward elimination was used to identify predictors of HIV infection (alpha = 0.05). RESULTS 1273 and 735 children were enrolled in the RC and PC. For the RC, the average age (SD) at CTC admission was 30.0 (17.2) months. For the PC, the average age at admission was 26.5 (13.7) months. Overall uptake of HIV testing was 60.7% for parents and 94% for children. HIV prevalence in severely malnourished children was 3%, much lower than anticipated. 59% of HIV-positive and 83% of HIV-negative children achieved discharge Weight-For-Height (WFH) > or = 80% of the NCHS reference median (p = 0.003). Clinical algorithms for diagnosing HIV in SAM children had poor sensitivity and specificity. CONCLUSION CTC is a potentially valuable entry point for providing HIV testing and care in the community to HIV infected children with SAM.
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Affiliation(s)
- Paluku Bahwere
- Valid International, Unit 9, Standingford House, 26 Cave Street, Oxford, OX4 1BA, UK.
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Candiani TMS, Pinto J, Cardoso CAA, Carvalho IR, Dias ACM, Carneiro M, Goulart EA. Impact of highly active antiretroviral therapy (HAART) on the incidence of opportunistic infections, hospitalizations and mortality among children and adolescents living with HIV/AIDS in Belo Horizonte, Minas Gerais State, Brazil. CAD SAUDE PUBLICA 2008; 23 Suppl 3:S414-23. [PMID: 17992347 DOI: 10.1590/s0102-311x2007001500009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Accepted: 11/29/2006] [Indexed: 12/16/2022] Open
Abstract
The impact of highly active antiretroviral therapy (HAART) can be evaluated using indicators, such as rates of opportunistic infections, hospitalizations by cause of infection, and associated death. This study aimed to estimate the impact of HAART on the incidence of these indicators, in children and adolescents with HIV/AIDS. It was a hybrid cohort study; 371 patients were followed from 1989 to 2003. In December 2003, 76% of the patients were still being followed, while 12.1% had died, 9.5% had dropped out, and 2.4% had been transferred. The overall rate of opportunistic infections was 18.32 infections/100 persons-year and 2.63 in the pre- and post-HAART periods, respectively. In the multivariate analysis, the risk of developing an opportunistic infection was 5.4 times greater and 3.3 times greater for hospitalization risk before HAART. Respiratory causes represented 65% of the hospitalizations and they were reduced by 44.6% with therapeutic intervention. The average hospital stay of 15 days was reduced to 9. There was a post-HAART decline in deaths of 38%. This study demonstrates the effectiveness of HAART in significantly reducing opportunistic infections, hospitalizations, and deaths in this Brazilian cohort.
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Affiliation(s)
- Talitah M S Candiani
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Miziara ID, Weber R. Oral lesions as predictors of highly active antiretroviral therapy failure in Brazilian HIV-infected children. J Oral Pathol Med 2008; 37:99-106. [PMID: 18197855 DOI: 10.1111/j.1600-0714.2007.00598.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Evaluate the accuracy of HIV-related oral lesions to predict immune and virologic failure on HIV-infected children in use of highly active antiretroviral therapy (HAART). STUDY DESIGN Data for this cross-sectional analysis come from a longitudinal study being conducted through the HIV-AIDS Outpatient Unit, ENT Division, Hospital das Clinicas, Sao Paulo University Medical School. The study began in January 1990 and is still ongoing. The cut-off point for analyses purposes was December 2004. Subjects were 471 HIV-infected consecutive children attending the outpatient unit during this period, who enrolled regardless of medical or immunological status. The children have undertaken oral cavity examination, serum CD4(+) T-lymphocyte count, and, 271 of them, viral load measurement. Sensitivity, specificity, positive predictive value, negative predictive value and relative risk were calculated. RESULTS Oral lesions had moderate sensitivity, high specificity and positive predictive value to predict immune failure. It had low sensitivity and positive predictive value, and high specificity to predict virologic failure. DISCUSSION AND CONCLUSIONS Oral manifestations of HIV can be important markers for immune suppression and for virologic failure, in Brazilian children undergoing HAART.
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Affiliation(s)
- Ivan Dieb Miziara
- ENT Discipline, Sao Paulo University Medical School - Group of Otorhinolaryngology and AIDS, Sao Paulo, Brazil.
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