1
|
Kyobe S, Kisitu G, Mwesigwa S, Farirai J, Katagirya E, Retshabile G, Williams L, Mirembe A, Ketumile L, Wayengera M, Mukisa J, Sebetso G, Diphoko T, Amujal M, Kigozi E, Katabazi F, Oceng R, Mlotshwa B, Morapedi K, Nsangi B, Wampande E, Tsimako M, Brown C, Kasvosve I, Joloba M, Anabwani G, Mpoloka S, Mardon G, Kekitiinwa A, Hanchard NA, Kyosiimire-Lugemwa J, Matshaba M, Kiragga D. Long-term non-progression and risk factors for disease progression among children living with HIV in Botswana and Uganda: A retrospective cohort study. Int J Infect Dis 2024; 139:132-140. [PMID: 38036259 PMCID: PMC10843817 DOI: 10.1016/j.ijid.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES We utilize a large retrospective study cohort derived from electronic medical records to estimate the prevalence of long-term non-progression (LTNP) and determine the factors associated with progression among children infected with HIV in Botswana and Uganda. METHODS Electronic medical records from large tertiary HIV clinical centers in Botswana and Uganda were queried to identify LTNP children 0-18 years enrolled between June 2003 and May 2014 and extract demographic and nutritional parameters. Multivariate subdistribution hazard analyses were used to examine demographic factors and nutritional status in progression in the pre-antiretroviral therapy era. RESULTS Between the two countries, 14,246 antiretroviral therapy-naïve children infected with HIV were enrolled into clinical care. The overall proportion of LTNP was 6.3% (9.5% in Botswana vs 5.9% in Uganda). The median progression-free survival for the cohort was 6.3 years, although this was lower in Botswana than in Uganda (6.6 vs 8.8 years; P <0.001). At baseline, the adjusted subdistribution hazard ratio (aHRsd) of progression was increased among underweight children (aHRsd 1.42; 95% confidence interval [CI]: 1.32-1.53), enrolled after 2010 (aHRsd 1.32; 95% CI 1.22-1.42), and those from Botswana (aHRsd 2; 95% CI 1.91-2.10). CONCLUSIONS In our study, the prevalence of pediatric LTNP was lower than that observed among adult populations, but progression-free survival was higher than expected. Underweight, year of enrollment into care, and country of origin are independent predictors of progression among children.
Collapse
Affiliation(s)
- Samuel Kyobe
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Grace Kisitu
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda
| | - Savannah Mwesigwa
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John Farirai
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Eric Katagirya
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gaone Retshabile
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
| | - Lesedi Williams
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
| | - Angela Mirembe
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda
| | - Lesego Ketumile
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Misaki Wayengera
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John Mukisa
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gaseene Sebetso
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
| | - Thabo Diphoko
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
| | - Marion Amujal
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edgar Kigozi
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fred Katabazi
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Oceng
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda
| | - Busisiwe Mlotshwa
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
| | - Koketso Morapedi
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
| | - Betty Nsangi
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda
| | - Edward Wampande
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Chester Brown
- University of Tennessee Health Science Center, Memphis, USA
| | - Ishmael Kasvosve
- School of Allied Health Professionals, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Moses Joloba
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gabriel Anabwani
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda
| | - Sununguko Mpoloka
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
| | - Graeme Mardon
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, USA; Department of Pathology and Immunology, Baylor College of Medicine, Houston, USA
| | - Adeodata Kekitiinwa
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda; Pediatric Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
| | - Neil A Hanchard
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, USA; USDA/ARS/Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA; Childhood Complex Disease Genomics Section, Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | | | - Mogomotsi Matshaba
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana; Pediatric Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
| | - Dithan Kiragga
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda; Pediatric Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
| |
Collapse
|
2
|
Evangelous TD, Berry M, Venkatayogi S, LeMaster C, Geanes ES, De Naeyer N, DeMarco T, Shen X, Li H, Hora B, Solomonis N, Misamore J, Lewis MG, Denny TN, Montefiori D, Shaw GM, Wiehe K, Bradley T, Williams WB. Host immunity associated with spontaneous suppression of viremia in therapy-naïve young rhesus macaques following neonatal SHIV infection. J Virol 2023; 97:e0109423. [PMID: 37874153 PMCID: PMC10688376 DOI: 10.1128/jvi.01094-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/06/2023] [Indexed: 10/25/2023] Open
Abstract
IMPORTANCE Despite the advent of highly active anti-retroviral therapy, people are still dying from HIV-related causes, many of whom are children, and a protective vaccine or cure is needed to end the HIV pandemic. Understanding the nature and activation states of immune cell subsets during infection will provide insights into the immunologic milieu associated with viremia suppression that can be harnessed via therapeutic strategies to achieve a functional cure, but these are understudied in pediatric subjects. We evaluated humoral and adaptive host immunity associated with suppression of viremia in rhesus macaques infected soon after birth with a pathogenic SHIV. The results from our study provide insights into the immune cell subsets and functions associated with viremia control in young macaques that may translate to pediatric subjects for the design of future anti-viral strategies in HIV-1-infected infants and children and contribute to an understudied area of HIV-1 pathogenesis in pediatric subjects.
Collapse
Affiliation(s)
- Tyler D. Evangelous
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Madison Berry
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sravani Venkatayogi
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cas LeMaster
- Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Eric S. Geanes
- Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Nicole De Naeyer
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Todd DeMarco
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Xiaoying Shen
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Surgery, Division of Surgical Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hui Li
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bhavna Hora
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | | | - Thomas N. Denny
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - David Montefiori
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Surgery, Division of Surgical Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - George M. Shaw
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Wiehe
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Todd Bradley
- Children’s Mercy Kansas City, Kansas City, Missouri, USA
- Department of Pediatrics, UMKC School of Medicine, Kansas City, Missouri, USA
- Departments of Pediatrics and Pathology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Wilton B. Williams
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Surgery, Division of Surgical Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
3
|
Nielsen-Saines K. Perinatal HIV as an infectious cause of developmental regression. Neurosci Biobehav Rev 2020; 102:417-423. [PMID: 31176423 DOI: 10.1016/j.neubiorev.2019.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/24/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
Although many pathogens affect neurodevelopment, most do so by stalling or arresting developmental progress with damage to central nervous system (CNS) cells and circuits during fetal life, leaving lifelong sequelae after early neuronal infection. In utero infections with CNS repercussions generally result from direct infection of fetal neural cells, with varying degrees of CNS involvement depending on the stage of fetal development. Human Immunodeficiency Virus (HIV) is distinct from other conditions as it does not cause immediate repercussions to the CNS unless HIV perinatal infection is accompanied by other co-infections. Nevertheless, distinct from the other congenital infections which generally induce failure to attain developmental milestones, perinatal HIV infection causes developmental regression, with often indolent but progressive neurodevelopmental consequences. Loss of developmental milestones has long been recognized as an Acquired Immune Deficiency Syndrome defining condition, often with growth failure. HIV encephalopathy presents as developmental delay/loss of developmental milestones, with manifestations in motor, mental and expressive language functions. Perinatal HIV disease is herein reviewed, with focus on developmental outcomes, diagnosis and treatment.
Collapse
Affiliation(s)
- Karin Nielsen-Saines
- Division of Pediatric Infectious Diseases, David Geffen School of Medicine at UCLA, MDCC 22-442 10833 LeConte Ave, Los Angeles, CA 90095, United States.
| |
Collapse
|
4
|
D'Souza RR, Gopalan BP, Rajnala N, Phetsouphanh C, Shet A. Increased monocyte activation with age among HIV-infected long term non-progressor children: implications for early treatment initiation. HIV Med 2019; 20:513-522. [PMID: 31131542 DOI: 10.1111/hiv.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The key to newer therapeutic and eradication approaches often lies in understanding slow disease progression in HIV infection. The paediatric population has been poorly studied in this regard. We aimed to describe a cohort of perinatally infected long-term nonprogressor (LTNP) children living with HIV in India and to evaluate the immune biomarkers of disease progression. METHODS LTNPs (ART-naïve, with a CD4 count ≥ 500 cells/μL at age ≥ 7 years) among the cohort of HIV-infected children were identified and monitored longitudinally, and their CD4 T-cell counts and plasma viral loads were measured every 6 months. The plasma monocyte/macrophage activation markers, namely soluble CD14 (sCD14), soluble CD163 (sCD163) and interferon-inducible protein-10 (IP-10) were measured by enzyme-linked immunosorbent assay (ELISA) in LTNPs and progressors. The Mann-Whitney U-test was used to compare the two groups and P values < 0.05 were considered statistically significant. Spearman's rank or Pearson's correlation coefficient (r) was calculated to determine the associations between variables. RESULTS Among 378 children living with HIV-1 surveyed in our cohort, 40 (10.6%) were LTNPs. Longitudinal analysis of the LTNP data showed that both CD4 count and viral load declined significantly with age (P < 0.0001 for both). Plasma sCD14 levels were significantly (P < 0.005) higher in progressors and sCD163 levels were significantly (P < 0.0001) higher in LTNPs. CONCLUSIONS The prevalence of LTNPs in our cohort of perinatally infected children living with HIV was 10.6%. We observed a trend for associations between the increasing sCD163 monocyte/macrophage activation marker levels, declining CD4 counts and the gradual loss of nonprogressor status with age in the LTNPs. These findings underscore the need for early antiretroviral therapy in those children with proven slow disease progression.
Collapse
Affiliation(s)
- R R D'Souza
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK.,Division of Infectious Diseases, St John's Research Institute, Bangalore, India
| | - B P Gopalan
- Division of Infectious Diseases, St John's Research Institute, Bangalore, India.,The University of Trans-disciplinary Health Sciences and Technology, Bangalore, India
| | - N Rajnala
- Division of Infectious Diseases, St John's Research Institute, Bangalore, India
| | - C Phetsouphanh
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - A Shet
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
5
|
Zhang X, Zhang Z, He S, Fu Y, Chen Y, Yi N, Jiang Y, Geng W, Shang H. FOXO3, IRF4, and xIAP Are Correlated with Immune Activation in HIV-1-Infected Men Who Have Sex with Men During Early HIV Infection. AIDS Res Hum Retroviruses 2017; 33:172-180. [PMID: 27841661 DOI: 10.1089/aid.2015.0316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Forkhead box O (FOXO)1, FOXO3, interferon regulatory factor (IRF)4, X-linked inhibitor of apoptosis protein (xIAP), and E74-like factor (ELF)4 have been described as important regulators of T cell functions and differentiation. However, whether these molecules are associated with HIV-1 disease progression is still unknown. In this study, we showed that the levels of FOXO3, IRF4, and xIAP mRNA in rapid progressors (RPs) were significantly higher than in HIV-negative healthy controls (HCs). Moreover, FOXO3 expression was positively correlated with HIV-1 viral load and CD4+ T cell activation. Remarkably, increased CD4+ and CD8+ T cell activation was apparent in RPs compared with typical progressors and HCs. In addition, a profile of higher apoptosis, more CD8+ TEM cells, and fewer CD4+ and CD8+ Naive T cells were observed in early HIV infection patients with low CD4+ T cell counts. Furthermore, in vitro, IRF4 and xIAP expression was enhanced in peripheral blood mononuclear cells from healthy people following T cell receptor stimulation. T cell activation was decreased by treatment with siRNA inhibiting FOXO3, IRF4, and xIAP. Our results show that significantly increased levels of FOXO3, IRF4, and xIAP mRNA in Chinese HIV-1-infected patients were related to T cell immune activation, implicating them as potential targets for developing new therapeutic avenues to slow down HIV-1 disease progression.
Collapse
Affiliation(s)
- Xiaowei Zhang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zining Zhang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Sijia He
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yajing Fu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yanhong Chen
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Nan Yi
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yongjun Jiang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wenqing Geng
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| |
Collapse
|
6
|
Bunupuradah T, Matsuoka K, Imahashi M, Iwatani Y, Ananworanich J, Puthanakit T, Saphonn V, Aurpibul L, Sophonphan J, Yagi T, Phanuphak P, Sugiura W. APOBEC3G genotypes and proviral DNA hypermutations on HIV/AIDS disease progression in Thai and Cambodian children. Future Virol 2015. [DOI: 10.2217/fvl.15.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To evaluate the effect of APOBEC3G host factor on HIV/AIDS progression in perinatally HIV-infected Thai and Cambodian children with distinct clinical patterns; rapid progressors (RPs) and long-term nonprogressors (LTNPs). Materials & methods: APOBEC3G genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism in DNA samples. APOBEC3G-mediated G-to-A hypermutations were analyzed by sequencing of the vif/vpu genes from proviral DNA. Results: Frequency of APOBEC3G 186H/R genotypes, AA:AG:GG, in the RPs was 100:0:0% and 83:17:0% (p = 0.3) in LTNPs. Hypermutation of the vif-coding region was observed in none of the RPs and 8.3% of LTNPs (p = 0.5). Hypermutations at the vpu genes were not detected in either groups’ proviral DNA. Conclusion: We observed no significant association of APOBEC3G genotypes and hypermutation rates between children with different profiles of HIV/AIDS disease progression.
Collapse
Affiliation(s)
- Torsak Bunupuradah
- HIV-NAT, the Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok 10330, Thailand
| | - Kazuhiro Matsuoka
- Clinical Research Center, National Hospital Organization Nagoya MedicalCenter, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi 460-0001, Japan
| | - Mayumi Imahashi
- Clinical Research Center, National Hospital Organization Nagoya MedicalCenter, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi 460-0001, Japan
| | - Yasumasa Iwatani
- Clinical Research Center, National Hospital Organization Nagoya MedicalCenter, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi 460-0001, Japan
- Program in Integrated Molecular Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Jintanat Ananworanich
- HIV-NAT, the Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok 10330, Thailand
- Current address: US Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720 A, Rockledge Drive, Suite 400, Bethesda, MD 20817, USA
- SEARCH, the Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand
| | - Thanyawee Puthanakit
- HIV-NAT, the Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok 10330, Thailand
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, 1873, Rama IV Road, Pathumwan, Bangkok, Thailand 10330
| | - Vonthanak Saphonn
- Social Health Clinic, #2, St 289 (Kim Il Sung Blvd), Khan Toul Kok, Phnom Penh, Cambodia
| | - Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, 110 Intavaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Jiratchaya Sophonphan
- HIV-NAT, the Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok 10330, Thailand
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Praphan Phanuphak
- HIV-NAT, the Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok 10330, Thailand
| | - Wataru Sugiura
- Clinical Research Center, National Hospital Organization Nagoya MedicalCenter, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi 460-0001, Japan
- Program in Integrated Molecular Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
- GlaxoSmithKline KK, 6-15, Sendagaya 4-chome, Shibuya-ku, Zip: 151-8566, Tokyo, Japan
| |
Collapse
|
7
|
Agwu AL, Lee L, Fleishman JA, Voss C, Yehia BR, Althoff KN, Rutstein R, Mathews WC, Nijhawan A, Moore RD, Gaur AH, Gebo KA. Aging and loss to follow-up among youth living with human immunodeficiency virus in the HIV Research Network. J Adolesc Health 2015; 56:345-51. [PMID: 25703322 PMCID: PMC4378241 DOI: 10.1016/j.jadohealth.2014.11.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/17/2014] [Accepted: 11/14/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE In the United States, 21 years is a critical age of legal and social transition, with changes in social programs such as public insurance coverage. Human immunodeficiency virus (HIV)-infected youth have lower adherence to care and medications and may be at risk of loss to follow-up (LTFU) at this benchmark age. We evaluated LTFU after the 22nd birthday for HIV-infected youth engaged in care. LTFU was defined as having no primary HIV visits in the year after the 22nd birthday. METHODS All HIV-infected 21-year-olds engaged in care (2002-2011) at the HIV Research Network clinics were included. We assessed the proportion LTFU and used multivariable logistic regression to evaluate demographic and clinical characteristics associated with LTFU after the 22nd birthday. We compared LTFU at other age transitions during the adolescent/young adult years. RESULTS Six hundred forty-seven 21-year-olds were engaged in care; 91 (19.8%) were LTFU in the year after turning 22 years. Receiving care at an adult versus pediatric HIV clinic (adjusted odds ratio [AOR], 2.91; 95% confidence interval [CI], 1.42-5.93), having fewer than four primary HIV visits/year (AOR, 2.72; 95% CI, 1.67-4.42), and antiretroviral therapy prescription (AOR, .50; 95% CI, .41-.60) were independently associated with LTFU. LTFU was prevalent at each age transition, with factors associated with LTFU similar to that identified for 21-year-olds. CONCLUSIONS Although 19.8% of 21-year-olds at the HIV Research Network sites were LTFU after their 22nd birthday, significant proportions of youth of all ages were LTFU. Fewer than four primary HIV care visits/year, receiving care at adult clinics and not prescribed antiretroviral therapy, were associated with LTFU and may inform targeted interventions to reduce LTFU for these vulnerable patients.
Collapse
Affiliation(s)
- Allison L. Agwu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland,Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland,Address correspondence to: Allison L. Agwu, M.D., Sc.M., Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins Medical Institutions, 200 N. Wolfe Street, Room 3145, Baltimore, MD 21287. (A.L. Agwu)
| | - Lana Lee
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John A. Fleishman
- Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Cindy Voss
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Baligh R. Yehia
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richard Rutstein
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - W. Christopher Mathews
- Department of Clinical Medicine, University of California San Diego Medical Center, San Diego, California
| | - Ank Nijhawan
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas Texas
| | - Richard D. Moore
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Aditya H. Gaur
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kelly A. Gebo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
8
|
Rutar T, Youm J, Porco T, Tilton N, Muskat M, McNamara N, Wara D. Ophthalmic manifestations of perinatally acquired HIV in a US cohort of long-term survivors. Br J Ophthalmol 2014; 99:650-3. [PMID: 25416182 DOI: 10.1136/bjophthalmol-2014-305557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 11/02/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To determine the ophthalmic manifestations of HIV in a cohort of long-term survivors of perinatally acquired HIV. METHODS Twenty-two patients with perinatally acquired HIV who were aged ≥12 years were prospectively studied at a university clinic. They underwent complete ophthalmic examinations and fundus photography. Their medical histories, medications and CD4 counts were abstracted from the medical records. To evaluate for keratoconjunctivitis sicca, both HIV patients and 44 healthy controls (matched by age, gender and contact lens wear) underwent Schirmer testing and ocular surface staining. RESULTS Nine male and 13 female HIV patients with mean age of 16.6 years (SD, 3.4) were examined. Of the 22 HIV patients, 21 had been treated with highly active antiretroviral therapy (HAART). Only one patient had a CD4 count nadir of <200 cells/µL. The mean visual acuity of the eyes of the HIV subjects was 20/22 (SD, 1.6 lines). No patient had cytomegalovirus retinitis. Four of the 22 (18%) HIV patients had strabismus. HIV subjects and controls had similar rates of abnormal Schirmer (9% and 14%, p=0.62) and ocular staining scores (p=0.29). CONCLUSIONS In the post-HAART era, long-term survivors of perinatally acquired HIV exhibited little vision-threatening disease, but had a high prevalence of strabismus.
Collapse
Affiliation(s)
- Tina Rutar
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Jiwon Youm
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Travis Porco
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA Francis I. Proctor Institute for Research in Ophthalmology, University of California San Francisco, San Francisco, California, USA Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Nicole Tilton
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Mica Muskat
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Nancy McNamara
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA Francis I. Proctor Institute for Research in Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Diane Wara
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
9
|
Britto AMA, Amoedo ND, Pezzuto P, Afonso AO, Martínez AMB, Silveira J, Sion FS, Machado ES, Soares MA, Giannini ALM. Expression levels of the innate response gene RIG-I and its regulators RNF125 and TRIM25 in HIV-1-infected adult and pediatric individuals. AIDS 2013; 27:1879-85. [PMID: 24131985 DOI: 10.1097/qad.0b013e328361cfbf] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE TLRs (Toll-like receptors) and RLRs (RIG-I-like receptors) mediate innate immune responses by detecting microorganism invasion. RIG-I activation results in the production of interferon (IFN) type 1 and IFN responsive genes (ISGs). As the ubiquitin ligases RNF125 and TRIM25 are involved in regulating RIG-I function, our aim was to assess whether the levels of these three genes vary between healthy and HIV-infected individuals and whether these levels are related to disease progression. DESIGN Gene expression analyses for RIG-I, RNF125, and TRIM25 were performed for HIV-infected adults and the children's peripheral blood mononuclear cells (PBMCs). METHODS Reverse transcription-quantitative PCRs (RT-qPCRs) were performed in order to quantify the expression levels of RIG-I, RNF125 and TRIM25 from PBMCs purified from control or HIV-infected individuals. RESULTS Controls express higher levels of the three genes when compared to HIV-infected patients. These expressions are clearly distinct between healthy and progressors, and are reproduced in adults and children. In controls, RNF125 is the highest expressed gene, whereas in progressors, RIG-I is either the highest expressed gene or is expressed similarly to RNF125 and TRIM25. CONCLUSION A pattern of expression of RIG-I, RNF125, and TRIM25 genes in HIV patients is evident. The high expression of RNF125 in healthy individuals reflects the importance of keeping RIG-I function off, inhibiting unnecessary IFN production. Consistent with this assumption, RNF125 levels are lower in HIV patients and importantly, the RNF125/RIG-I ratio is lower in patients who progress to AIDS. Our results might help to predict disease progression and unveil the role of poorly characterized host genes during HIV infection.
Collapse
Affiliation(s)
- Alan M A Britto
- aDepartamento de Genética, Instituto de Biologia bInstituto de Bioquímica Médica, UFRJ, Rio de Janeiro cFaculdade de Medicina, UFRG, Rio Grande dHospital Universitário Gaffrée e Guinle, UNIRIO eInstituto de Puericultura e Pediatria Martagão Gesteira, UFRJ fPrograma de Genética, INCA, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Amoêdo ND, Afonso AO, Cunha SM, Oliveira RH, Machado ES, Soares MA. Expression of APOBEC3G/3F and G-to-A hypermutation levels in HIV-1-infected children with different profiles of disease progression. PLoS One 2011; 6:e24118. [PMID: 21897871 PMCID: PMC3163681 DOI: 10.1371/journal.pone.0024118] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 08/05/2011] [Indexed: 01/27/2023] Open
Abstract
Objective Increasing evidence has accumulated showing the role of APOBEC3G (A3G) and 3F (A3F) in the control of HIV-1 replication and disease progression in humans. However, very few studies have been conducted in HIV-infected children. Here, we analyzed the levels of A3G and A3F expression and induced G-to-A hypermutation in a group of children with distinct profiles of disease progression. Methodology/Principal Findings Perinatally HIV-infected children were classified as progressors or long-term non-progressors according to criteria based on HIV viral load and CD4 T-cell counts over time. A group of uninfected control children were also enrolled in the study. PBMC proviral DNA was assessed for G-to-A hypermutation, whereas A3G and A3F mRNA were isolated and quantified through TaqMan® real-time PCR. No correlation was observed between disease progression and A3G/A3F expression or hypermutation levels. Although all children analyzed showed higher expression levels of A3G compared to A3F (an average fold of 5 times), a surprisingly high A3F-related hypermutation rate was evidenced in the cohort, irrespective of the child's disease progression profile. Conclusion Our results contribute to the current controversy as to whether HIV disease progression is related to A3G/A3F enzymatic activity. To our knowledge, this is the first study analyzing A3G/F expression in HIV-infected children, and it may pave the way to a better understanding of the host factors governing HIV disease in the pediatric setting.
Collapse
Affiliation(s)
- Nívea D. Amoêdo
- Instituto de Bioquímica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adriana O. Afonso
- Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Centro de Ciências da Saúde, Universidade Católica de Petrópolis, Petrópolis, Brazil
| | | | - Ricardo H. Oliveira
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elizabeth S. Machado
- Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo A. Soares
- Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Genética, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- * E-mail:
| |
Collapse
|
11
|
Gag-specific CD4+ T-cell responses are associated with virological control of paediatric HIV-1 infection. AIDS 2011; 25:1329-31. [PMID: 21505296 DOI: 10.1097/qad.0b013e3283478575] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HIV-specific Elispot responses were investigated in 57 antiretroviral therapy-naive children, of median age 9.9 years. CD8(+) T-cell responses were detected in 96% children; Nef was the immunodominant protein. Responses broadened over time, but there was no association between magnitude, breadth or specificity of response and viraemia. Gag-specific CD4(+) T-cell responses, detectable in 26% children, correlated inversely with viraemia (R = -0.43, P < 0.001), suggesting that preservation of this cell population may be an important goal of therapeutic/vaccine strategies.
Collapse
|
12
|
MacLean JE, Mahant S, Bitnun A, Read S, Capra M, Solomon M. Family matters: a twelve-year-old male with respiratory symptoms, cachexia and clubbing. J Paediatr Child Health 2006; 42:739-42. [PMID: 17044906 DOI: 10.1111/j.1440-1754.2006.00963.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The presentation of HIV in children varies between developed and developing countries. In addition, the presentation in adolescents may differ from that in younger children. This report highlights a rare presentation and complication of HIV in children and emphasizes the importance of cultural competency when approaching children and families from different cultural backgrounds.
Collapse
Affiliation(s)
- Joanna E MacLean
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
13
|
Paul ME, Mao C, Charurat M, Serchuck L, Foca M, Hayani K, Handelsman EL, Diaz C, McIntosh K, Shearer WT. Predictors of immunologic long-term nonprogression in HIV-infected children: implications for initiating therapy. J Allergy Clin Immunol 2005; 115:848-55. [PMID: 15806009 DOI: 10.1016/j.jaci.2004.11.054] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Early markers that predict immunologic long-term nonprogression in infants with perinatally acquired HIV infection might assist in subsequent antiretroviral treatment decisions. OBJECTIVES We sought to identify early markers of immunologic long-term HIV disease nonprogression. METHODS We analyzed immunologic and virologic characteristics at 1 and 2 months of age in HIV-infected children who were enrolled in the Women and Infants Transmission Study and born before 1995, comparing immunologic long-term nonprogressors (ILTNPs; n = 10) with non-ILTNPs (n = 127). ILTNPs were children who survived to 8 years or older with CD4 percentages of 25% or greater and counts of 500 cells/mm 3 or more without receiving highly active antiretroviral therapy. Non-ILTNPs were defined as all other HIV-infected children. Receiver operating characteristic curve analysis was used to assess combined sensitivity and specificity for each of these characteristics and to determine potential threshold values to discriminate between ILTNPs and non-ILTNPs. RESULTS Characteristics in the first 2 months of life associated with ILTNP status in univariate analysis included higher CD4 percentages, lower CD8 + percentages, lower CD8 + HLA-DR + percentages, and lower HIV-1 RNA PCR values. In receiver operating characteristic analysis CD8 + HLA-DR + percentage had the best combined sensitivity and specificity for discriminating between ILTNPs and non-ILTNPs. CD8 + HLA-DR + percentages of 5% or less predicted ILTNP status with 80% sensitivity and 80% specificity. In multivariate analysis CD8 + HLA-DR+ percentage of 5% or less remained a significant predictor of ILTNP status after adjusting for CD3 + CD4 + percentage and HIV-1 RNA PCR value (odds ratio, 15.4; 95% CI, 1.9-124.7). CONCLUSION CD8 + HLA-DR + T-lymphocyte percentage of less than 5% at 1 to 2 months of age might be predictive for ILTNP status but should not be used at this time to make treatment-deferral decisions. Immune activation in HIV-infected infants might herald more disease progression. Further study of the use of this subpopulation in early infancy to predict ILTNP status is warranted.
Collapse
Affiliation(s)
- Mary E Paul
- Section of Allergy and Immunology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Berrien VM, Salazar JC, Reynolds E, McKay K. Adherence to antiretroviral therapy in HIV-infected pediatric patients improves with home-based intensive nursing intervention. AIDS Patient Care STDS 2004; 18:355-63. [PMID: 15294086 DOI: 10.1089/1087291041444078] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Adherence to combination antiretroviral therapy (ART) has been shown to be a determining factor in controlling viral replication, maintaining immunologic function and long-term survival in HIV-positive individuals. Little information is available on strategies to improve adherence in pediatric HIV-infected patients. We conducted a randomized, nonblinded, pilot study to determine if a home-based nursing intervention would improve medication adherence. The study was offered to all eligible HIV-positive patients receiving care at Connecticut Children's Medical Center's (CCMC) Pediatric and Youth HIV Program. Sixty-seven percent (37/55) of the patients and their caretakers participated. We randomized participants to either standard of care or the intervention trial. The intervention was designed to improve knowledge and understanding of HIV infection and HIV medications and to resolve or modify barriers to adherence. Both groups completed pre- and post-intervention questionnaires, assessing their knowledge and understanding of HIV, ART, and adherence. Adherence was estimated objectively from medication refill history and subjectively from a self-report score. We also inferred adherence from pre- to post-test plasma viral load and CD4+ T-cell percentages. The knowledge score (p = 0.02) and medication refill history (p = 0.002) improved significantly in the intervention group. The adherence self-report score improved, although not significantly (p = 0.07). We did not observe statistical differences in CD4+ T-cell counts or viral load between groups. We conclude that our home-based nursing intervention helped HIV-positive children and their families in better adhering to prescribed medication regimens.
Collapse
Affiliation(s)
- Virginia M Berrien
- Connecticut Children's Medical Center, Pediatric and Youth HIV Program, Hartford, Connecticut 06106, USA
| | | | | | | |
Collapse
|
15
|
Resino S, Bellón JM, Pérez A, Gurbindo Gutiérrez MD, Muñoz-Fernández MA. Subpoblaciones de células T CD8+ en niños asintomáticos infectados verticalmente por el VIH-1. Med Clin (Barc) 2004; 122:6-11. [PMID: 14733867 DOI: 10.1016/s0025-7753(04)74125-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE HIV-infection has distinct patterns of disease progression with heterogeneous manifestations. We analyzed the subsets of CD8+ T cells in a group of long term asymptomatic (LTA) HIV-1-infected children who had stable CD4+ T cell counts (> 600/l). PATIENTS AND METHODS Cross-sectional study in HIV-1-vertically infected children older than 7 years who were rated into two groups according to the clinical and immunological classification: a) LTA: 7 asymptomatic HIV-1-infected children in A1, and b) rapid progressor (PR): 14 age-matched C3 HIV-1-infected children. Controls included 17 age-matched uninfected children. Characterization of CD8+ T-cell subsets was done by three-color flow cytometry. RESULTS LTA children displayed similar values of memory CD8+ T cells (CD8+CD45RO+, CD8+CD45RA-CD28+, CD8+ CD45RA-CD62L+) as controls but lower than PR children. LTA patients also showed similar values of naïve CD8+ T cells (CD8+CD45RA+CD62L+, CD8+CD45RA+CD28+, CD8+CD45RA+, CD8+CD28+ and CD8+CD62L+) as controls but higher values than PR children. The values of CD8+CD38+ T cells were similar in LTA and controls but lower in PR. However, LTA children had higher values of CD8+HLA-DR+CD38+ and CD8+HLA-DR+ T cells than controls. Additionally, LTA patients had higher values of pre-effector CD8+ T cells than controls yet the values of effector CD8+ T-cells were similar in both LTA and controls. Moreover, the LTA group had lower values of CD8+CD11b+ T cells than controls. CONCLUSIONS Asymptomatic HIV-1 infected children have an almost normal CD8+ subset distribution, with the exception of activated and pre-effector CD8+ T cells which were higher.
Collapse
Affiliation(s)
- Salvador Resino
- Laboratorio de Inmunobiología Molecular. Hospital General Universitario Gregorio Marañón. Madrid. Spain
| | | | | | | | | |
Collapse
|
16
|
Resino S, Correa R, Bellón JM, Muñoz-Fernández MA. Preserved immune system in long-term asymptomatic vertically HIV-1 infected children. Clin Exp Immunol 2003; 132:105-12. [PMID: 12653844 PMCID: PMC1808687 DOI: 10.1046/j.1365-2249.2003.02116.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The objective of this study was to study immune system status in long-term asymptomatic (LTA) HIV-1-infected children. A cross-sectional study was used, involving HIV-1-infected children over 7 years of age who were rated into two groups according to their clinical and immunological classification: (a) LTA: 7 asymptomatic HIV-1-infected children in A1; (b) Rapid progressor (RP): 14 age-matched C3 HIV-1-infected children. The control group consisted of 17 age-matched uninfected children. The characterization of CD4+ T-cell subsets was determined by three-colour flow cytometry. The proliferative response and cytokine production by activated peripheral blood T-cells were also measured. IL-7 levels were measured in serum. Thymic production of T-cells was quantified by TCR rearrangement excision circles (TRECs). The LTA children showed similar proliferative responses to PHA, PWM and anti-CD3+ anti-CD28, but lower responses to tetanus toxoid and streptokinase, in comparison with the controls but always higher responses in comparison with the RP group. The production of TNF-alpha and IFN-gamma was similar in the LTA and control groups, and both were higher than the levels in the RP group. The LTA group showed a lower percentage of memory CD4+ T-cells (CD4+ CD45RO+, CD4+ CD45RA-CD62L+) than the control and RP groups. The LTA group also showed lower percentages of CD4+ CD7- cells than the controls. As for naïve CD4+ T-cells (CD4+ CD45RA+ CD62L+), CD4+ CD45RA+ and CD4+ CD62L+ cells, the LTA group showed higher values than the control and RP groups. The LTA group showed higher percentages of CD4+ HLA-DR+ CD38+ than the controls, but lower values than the RP group. In contrast, the LTA group had percentages of CD4+ HLA-DR-CD38+ T-cells higher than both the control and RP groups, whereas CD4+ CD38+ levels were only higher in the LTA group in comparison with the controls. CD4+ HLA-DR+ CD38- and CD4+ HLA-DR+ cell numbers were lower in the LTA group in comparison with the RP group. We found almost normal values of TRECs and IL-7 in the LTA group, but lower values in the RP group. Moreover, we found an inverse relation between TREC levels and IL-7 in plasma from HIV-infected children. Asymptomatic HIV-1 infected children have a well preserved immune system similar to that of control uninfected children in spite of HIV-infection for more than 7 years. Moreover, our results identified new markers of HIV disease, such as TRECs and IL-7, that could be used to monitor disease.
Collapse
Affiliation(s)
- S Resino
- Laboratory of Immno-Molecular Biology, General University Hospital 'Gregorio Marañón', Madrid, Spain
| | | | | | | |
Collapse
|
17
|
Fallo AA, DobrzanskiNisiewicz W, Sordelli N, Cattaneo MA, Scott G, López EL. Clinical and epidemiologic aspects of human immunodeficiency virus-1-infected children in Buenos Aires, Argentina. Int J Infect Dis 2002; 6:9-16. [PMID: 12044295 DOI: 10.1016/s1201-9712(02)90129-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Argentina has the sixth largest number of cumulative pediatric cases of acquired immunodeficiency syndrome (AIDS) in the Americas; therefore, this study was designed to characterize human immunodeficiency virus-1 (HIV-1) infection in children in Buenos Aires, Argentina. MATERIALS AND METHODS Medical records of 389 children at risk and infected with HIV-1, an urban population followed by the AIDS Reference Center at the Hospital de Niños "Dr. Ricardo Gutiérrez" of Buenos Aires, from February 1990 to June 1997, were retrospectively reviewed. Mother-infant pairs were analyzed according to clinical and epidemiologic patterns. RESULTS Perinatal transmission occurred in 94.9% of the 389 cases classified as seroreverter (n=104, 26.7%), exposed (n=64, 16.4%), asymptomatic (n=13, 3.4%), and symptomatic patients (n=208, 53.5%); 132 patients met the Centers for Disease Control and Prevention (CDC) criteria for AIDS. The main maternal risk factor was sexual transmission 58.9% (73.4% of their sexual partners were injection drug users [IDU]). Among the AIDS patients, the most common AIDS-defining condition and death-related disease were severe bacterial infection and Pneumocystis carinii pneumonia, respectively. Death occurred in 51 of 221 HIV-infected children. Low CD4 was related to death (P < 0.001). Mortality was estimated for two periods: January 1990 to December 1995 (G1) and January 1996 to May 1997 (G2). In G1, 37 of 127 (29.1%) died compared with 14 of 154 (9.1%) in G2 (P=0.001). The median age of death was 10 months for G1 and 29 months for G2 (P=0.01). The 3-year survival rate was 72% for G1 and 87% for G2 (log rank P=0.06). CONCLUSIONS Intravenous drug use is the leading risk factor among parents of children exposed to HIV. Infant mortality was related to age less than 12 months, low CD4 count, severe bacterial infection and P. carinii pneumonia. In this study, P. carinii pneumonia prophylaxis and combined antiretroviral therapy routinely implemented since 1996 has demonstrated a trend toward increased survival rates (P=0.06) and a lower mortality rate (P=0.001).
Collapse
Affiliation(s)
- Aurelia A Fallo
- AIDS Reference Center, Division of Pediatric Infectious Disease Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | | | | | | | | | | |
Collapse
|
18
|
Smith R, Malee K, Charurat M, Magder L, Mellins C, Macmillan C, Hittleman J, Lasky T, Llorente A, Moye J. Timing of perinatal human immunodeficiency virus type 1 infection and rate of neurodevelopment. The Women and Infant Transmission Study Group. Pediatr Infect Dis J 2000; 19:862-71. [PMID: 11001110 DOI: 10.1097/00006454-200009000-00010] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identifying HIV-1-infected children who are at greatest risk for disease-related morbidities is critical for optimal therapeutic as well as preventive care. Several factors have been implicated in HIV-1 disease onset and severity, including maternal and infant host characteristics, viral phenotype and timing of HIV-1 infection. Early HIV-1 culture positivity, i.e. intrauterine infection, has been associated with poor immunologic, virologic and clinical outcomes in children of HIV-infected women. However, a direct effect of timing of infection on neurodevelopmental outcome in infancy has not yet been identified. METHODS Serial neurodevelopmental assessments were performed with 114 infants vertically infected with HIV-1 in a multicenter natural history, longitudinal study. Median mental and motor scores were compared at three time points. Longitudinal regression analyses were used to evaluate the neurodevelopmental functioning of children with early positive cultures and those with late positive cultures. RESULTS Early infected infants scored significantly lower than late infected infants by 24 months of age and beyond on both mental (P = 0.05) and motor (P = 0.03) measures. Early HIV-1 infection was associated with a decline in estimated motor scores of 1 standard score point per month compared with 0.28 point in the late infected group (P < 0.02). Estimated mental scores of the early infected group declined 0.72 point/ month, whereas the average decline of the late infected group was 0.30 point/month (P < 0.13). CONCLUSION Early HIV-1 infection increases a child's risk for poor neurodevelopmental functioning within the first 30 months of life.
Collapse
Affiliation(s)
- R Smith
- University of Illinois at Chicago, 60612, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
Caring for children with HIV infection is a much more optimistic process than in the beginning of the epidemic. Antiretroviral therapies are available, and additional drugs are receiving approval from the US Food and Drug Administration. Cautious optimism must be tempered with an understanding that living with the disease is a complicated and daunting process for these children and their families. Although scientific knowledge and medical treatments are moving forward, the social and environmental uncertainties remain for families. Comprehensive care is a balance of health care services and supportive, community-based services offered in a compassionate manner.
Collapse
Affiliation(s)
- M G Boland
- François-Xavier Bagnoud Center, University of Medicine and Dentistry of New Jersey, Newark, USA.
| |
Collapse
|
20
|
Salimi B, Yogev R, Kabat W, O'Gorman MR, Katz BZ. CD8+ T cell-mediated suppression of human immunodeficiency virus replication in older children with acquired immunodeficiency syndrome. Pediatr Infect Dis J 2000; 19:109-13. [PMID: 10693995 DOI: 10.1097/00006454-200002000-00005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Suppression of HIV replication by CD8+ T cells and/or their products correlated with the survival of infants. We sought to elucidate the role of CD8+ T cell-mediated suppression in seven older children with AIDS. METHODS After separation of each child's CD4+ and CD8+ T cells, three different HIV culture assays were performed: (1) patient CD4+ T cells and phytohemagglutinin (PHA)-stimulated donor peripheral blood mononuclear cells (PBMC); (2) patient CD8+ T cells added to the CD4+ T cells and the PHA-stimulated donor PBMC (to test for CD8-mediated T cell suppression of HIV); (3) patient CD8+ cells added across a semipermeable membrane to the CD4+ T cells and the PHA-stimulated donor PBMC [to determine whether the CD8 cells secreted a soluble factor(s) that suppressed HIV]. RESULTS Cultures from four of seven children showed greater HIV replication with CD4 cells alone than with CD4 and CD8 cells together, demonstrating CD8 suppression; evidence of soluble suppression was also seen. Cultures from two of the seven children showed HIV replication and no evidence of CD8 cell suppression. Cultures from one of the seven children had no appreciable replication of HIV even after removal of CD8 cells. CONCLUSIONS CD8-mediated suppression is present in at least some children with AIDS. Additional mechanisms may be operating to slow the progression of the disease.
Collapse
Affiliation(s)
- B Salimi
- Children's Memorial Hospital, Chicago, IL, USA
| | | | | | | | | |
Collapse
|
21
|
Affiliation(s)
- J M Oleske
- Department of Paediatrics, New Jersey Medical School, University Heights, Newark 07103-2714, USA
| | | |
Collapse
|
22
|
Abstract
The hospitalization of a chronically ill child requires meticulous orchestration. Treatment recommendations must be transmitted to the family in a coherent and supportive fashion. Patient comfort and nutrition must be maintained, and psychological support provided. Discharge planning is often extensive. To promote continuity of care, appointment of a case manager is recommended.
Collapse
Affiliation(s)
- J M Oleske
- Division of Pediatric Pulmonary Allergy, Immunology and Infectious Diseases, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, USA
| | | |
Collapse
|