Growth velocity in children with Environmental Enteric Dysfunction is associated with specific bacterial and viral taxa of the gastrointestinal tract in Malawian children

Environmental enteric dysfunction (EED) is characterized by diffuse villous atrophy of the small bowel. EED is strongly associated with stunting, a major public health problem linked to increased childhood morbidity and mortality. EED and subsequent stunting of linear growth are surmised to have microbial origins. To interrogate this relationship, we defined the comprehensive virome (eukaryotic virus and bacteriophage) and bacterial microbiome of a longitudinal cohort of rural Malawian children with extensive metadata and intestinal permeability testing at each time point. We found thirty bacterial taxa differentially associated with linear growth. We detected many eukaryotic viruses. Neither the total number of eukaryotic families nor a specific viral family was statistically associated with improved linear growth. We identified 3 differentially abundant bacteriophage among growth velocities. Interestingly, there was a positive correlation between bacteria and bacteriophage richness in children with subsequent adequate/moderate growth which children with subsequent poor growth lacked. This suggests that a disruption in the equilibrium between bacteria and bacteriophage communities might be associated with subsequent poor growth. Future studies of EED and stunting should include the evaluation of viral communities in addition to bacterial microbiota to understand the complete microbial ecology of these poorly understood entities.

Bacteriophages Isolated from Stunted Children Can Regulate Gut Bacterial Communities in an Age-Specific Manner

Stunting, a severe and multigenerational growth impairment, globally affects 22% of children under the age of 5 years. Stunted children have altered gut bacterial communities with higher proportions of Proteobacteria, a phylum with several known human pathogens. Despite the links between an altered gut microbiota and stunting, the role of bacteriophages, highly abundant bacterial viruses, is unknown. Here, we describe the gut bacterial and bacteriophage communities of Bangladeshi stunted children younger than 38 months. We show that these children harbor distinct gut bacteriophages relative to their non-stunted counterparts. In vitro, these gut bacteriophages are infectious and can regulate bacterial abundance and composition in an age-specific manner, highlighting their possible role in the pathophysiology of child stunting. Specifically, Proteobacteria from non-stunted children increased in the presence of phages from younger stunted children, suggesting that phages could contribute to the bacterial community changes observed in child stunting.

Mitochondrial Impairment in Well-Suppressed Children with Perinatal HIV-Infection on Antiretroviral Therapy

Mitochondrial impairment is reported in HIV-infected children receiving antiretroviral therapy (ART), as well as those naive to ART. Whether mitochondrial function recovers with early initiation of ART and sustained viral suppression on long-term ART is unclear. In this study, we evaluate mitochondrial markers in well-suppressed perinatally HIV-infected children initiated on ART early in life. We selected a cross-sectional sample of 120 HIV-infected children with viral load <400 copies/mL and 60 age-matched uninfected children (22 HIV-exposed uninfected) enrolled in a cohort study in Johannesburg, South Africa. Complex IV (CIV) and citrate synthase (CS) activity were measured by spectrophotometry. Mitochondrial DNA (mtDNA) content relative to nuclear DNA (nDNA) was measured by quantitative real-time polymerase chain reaction and expressed as copies/nDNA. Mitochondrial markers were impaired in HIV-infected children, including lower mean CIV activities [1.76 vs. 1.40 optical densities (OD)/min], higher risk of a CIV/CS ratio ≤0.22 (third quartile; odds ratio = 3.03, 95% confidence interval: 1.38-6.66), and lower mtDNA content. Children with shorter versus longer ART duration (<6.3 vs. ≥6.3 years) had lower means of CIV activity (1.22-1.58 OD/min) and mtDNA content (386-907 copies/nDNA). There were no differences in mitochondrial markers between children who started ART earlier (<6 months) or later (6-24 months). CIV activity was impaired in children with lower height-for-age Z-scores (HAZs). Despite early treatment and prolonged viral suppression, HIV-infected children had detectable mitochondrial impairment, particularly among those with stunted growth. Further study is required to determine if continued treatment will lead to full recovery of mitochondrial function in HIV-infected children.

Etiology of Diarrhea, Nutritional Outcomes, and Novel Intestinal Biomarkers in Tanzanian Infants

OBJECTIVE

Diarrheal diseases are a leading cause of morbidity and mortality worldwide, but the etiology of diarrhea and its relation to nutritional outcomes in resource-limited settings is poorly defined. We sought to determine the etiology of community-acquired diarrhea in Tanzanian infants and to assess the association with anthropometrics and novel intestinal biomarkers.

METHODS

A convenience sample of infants in a trial of zinc and/or multivitamin supplementation in Tanzania was selected. Subjects were enrolled at age 6 weeks and studied for 18 months. Stool samples were obtained from children with acute diarrhea. A novel, polymerase chain reaction-based TaqMan array was used to screen stool for 15 enteropathogens. A subset of subjects had serum gastrointestinal biomarkers measured.

RESULTS

One hundred twenty-three subjects with diarrhea were enrolled. The mean ± SD age at stool sample collection was 12.4 ± 3.9 months. Thirty-five enteropathogens were identified in 34 (27.6%) subjects: 11 rotavirus, 9 Cryptosporidium spp, 7 Shigella spp, 3 Campylobacter jejuni/coli, 3 heat stable-enterotoxigenic Escherichia coli, and 2 enteropathogenic E coli. Subjects with any identified enteropathogen had significantly lower weight-for-length z scores (-0.55 ± 1.10 vs 0.03 ± 1.30, P = 0.03) at the final clinic visit than those without an identified pathogen. Fifty of the 123 subjects (40.7%) had serum analyzed for antibodies to lipopolysaccharide (LPS) and flagellin. Subjects with any identified enteropathogen had lower immunoglobulin (IgA) antibodies to LPS (0.75 ± 0.27 vs 1.13 ± 0.77, P = 0.01) and flagellin (0.52 ± 0.16 vs 0.73 ± 0.47, P = 0.02) than those without an identified pathogen.

CONCLUSIONS

This quantitative polymerase chain reaction method may allow identification of enteropathogens that place children at higher risk for suboptimal growth. IgA anti-LPS and flagellin antibodies hold promise as emerging intestinal biomarkers.

Growth of HIV-Exposed Uninfected Infants in the First 6 Months of Life in South Africa: The IeDEA-SA Collaboration

Background

HIV-exposed uninfected (HEU) infants are a growing population in sub-Saharan Africa especially with the increasing coverage of more effective prevention of mother-to-child transmission (PMTCT) antiretroviral therapy regimens. This study describes the characteristics of South African HEU infants, investigates factors impacting birth weight and assesses their growth within the first 28 weeks of life.

Methods

This is a retrospective cohort based on routine clinical data from two South African PMTCT programmes. Data were collected between 2007 and 2013. Linear regression assessed factors affecting birth weight-for-age z-scores (WAZ) while growth (longitudinal WAZ) was assessed using mixed effects models.

Results

We assessed the growth of 2621 HEU infants (median birth WAZ was -0.65 (IQR -1.46; 0.0) and 51% were male). The feeding modalities practised were as follows: 0.5% exclusive breastfeeding, 7.9% breastfeeding with unknown exclusivity, 0.08% mixed breastfeeding and 89.2% formula feeding. Mothers with CD4 <200 cells/μl delivered infants with a lower birth WAZ (adjusted ß -0.253 [95% CI -0.043; -0.072], p = 0.006) compared to mothers with aCD4 ≥500 cells/μl. Similarly, mothers who did not receive antiretroviral drugs delivered infants with a lower birth WAZ (adjusted ß -0.39 [95% CI -0.67; -0.11], p = 0.007) compared to mothers who received antenatal antiretrovirals. Infants with a birth weight <2 500g (ß 0.070 [95% CI 0.061; 0.078], p <0.0001) experienced faster growth within the first 28 weeks of life compared to infants with a birth weight ≥2 500g. Infants with any breastfeeding exposure experienced slower longitudinal growth compared to formula fed infants (adjusted ß -0.012 [95% CI 0.021; -0.003], p = 0.011).

Conclusion

Less severe maternal disease and the use of antiretrovirals positively impacts birth weight in this cohort of South African HEU infants. Formula feeding was common with breastfed infants experiencing marginally slower longitudinal growth.

Persistence of stunting after highly active antiretroviral therapy in HIV-infected children in South India

After one year of antiretroviral treatment in 49 HIV infected children compared to 53 children without, weight for age improved significantly and was highly correlated with baseline immune status and CD4% increase but height for age did not change. Stunting is a common feature of pediatric HIV, both on and off HAART.

The long-term impact of HIV and orphanhood on the mortality and physical well-being of children in rural Malawi

OBJECTIVE

To assess the influence of maternal HIV status and orphanhood on child mortality and physical well-being.

DESIGN

Retrospective cohort study with > 10 years of follow-up.

METHODS

From population-based surveys in Karonga District, Malawi in the 1980s, 197 individuals were identified as HIV-positive. These individuals and 396 HIV-negative individuals matched for age and sex, and their spouses and offspring, were sought in 1998-2000.

RESULTS

All but 11 of the index individuals were traced, identifying 2520 offspring; of these, 1106 offspring were included in analyses. Among those with HIV-positive mothers, mortality was 27% [95% confidence interval (CI), 17-38] in infants (1-30 days), 46% (95% CI, 34-58) in those under 5 years and 49% (95% CI, 38-61) in those under 10 years. The corresponding figures for those with HIV-negative mothers were 11% (95% CI, 8-13), 16% (95% CI, 13-19) and 17% (95% CI, 14-20). Death of HIV-positive mothers, but not of HIV-negative mothers or of fathers, was associated with increased child mortality. Among survivors who were still resident in the district, neither maternal HIV status nor orphanhood was associated with stunting, being wasted, or reported ill-health.

CONCLUSIONS

Mortality in children under 5 years is much higher in children born to HIV-positive mothers than in those born to HIV-negative mothers. With 10% of pregnant women HIV-positive, we estimate that approximately 18% of under-5 deaths in this population are attributable to HIV. Most of the excess is attributable to vertical transmission of HIV. Our findings suggest that, in terms of physical well-being, the extended family in this society has not discriminated against surviving children whose parents have been ill or have died as a result of HIV/AIDS.

The effect of a natural maedi-visna virus infection on the productivity of South African sheep

A cohort study was conducted in order to measure the effect of the chronic indurative lymphocytic mastitis caused by the South African strain of maedi visna virus (MVV) on the pre-weaning growth of lambs born either of naturally infected or uninfected ewes kept under similar conditions. Fifty naturally infected ewes as well as another 40 from a maedi-visna-free source to be used as control animals, were purchased and kept in separate flocks which were managed in a similar way. All the ewes were of the same breed and 3-4 years old. During the adaptation period, and through the mating, pregnancy and lactation periods they were periodically monitored for the presence of MVV serum antibodies. The lambs were weighed at birth and thereafter every 2 weeks until the age of 90 days, when they were weaned. The ewes were then slaughtered, and their udders examined histologically and the number of lymphocytic follicles were counted and assessed. Although the calculated values indicated a correlation between the number of follicles in the udder and the reduction in the growth rate of the lambs, this was not statistically significant. Similarly, despite higher counts of lymphoid follicles in the udders of sero-positive ewes as compared to those that were sero-negative and the lower ewe productivity indexes in infected ewes, no statistically significant differences were found in the indexes of ewes in different follicle categories.

Passively administered antibodies alleviate stunting syndrome in turkey poults

Stunting syndrome is an enteric disease of young turkeys that results in reduced growth (stunting) of poults and impaired feed efficiency. A virus, which has been termed the stunting syndrome agent (SSA), causes stunting syndrome. In this study passive immunity was evaluated as a method of protecting poults from stunting syndrome. One-day-old poults were injected with either tryptose phosphate broth, an anti-SSA antibody preparation, or an anti-Newcastle disease virus antibody preparation before challenge by placing them into SSA-contaminated isolators or control (nonchallenge) isolators. Poults that received anti-SSA antibodies were significantly heavier (P < 0.05) and did not display as severe clinical disease compared to birds that did not receive the anti-SSA antibodies. However, the birds that received anti-SSA antibodies and were challenged were significantly lighter (P < 0.05) than birds that were not challenged. The results of this trial demonstrate that the injection of anti-SSA antibodies benefited poults undergoing stunting syndrome. The role of passive immunity, either through breeder hen vaccination or through supplying antibodies to poults artificially (i.e., at the hatchery), may have future applications in alleviating stunting syndrome.

Characterization of the stunting syndrome agent: physicochemical properties

Stunting syndrome is an enteric disease of turkeys causing diarrhea, reduced weight gain, poor feed efficiency, and maldigestion. The etiologic agent is a newly identified, but unclassified, virus termed the stunting syndrome agent (SSA). The SSA is a pleomorphic, enveloped virus ranging from 60 to 95 nm in diameter. The objectives of this study were to characterize the physicochemical properties of SSA. SSA hemagglutinated rat erythrocytes at 4 C and room temperature. Treatment of SSA with ether resulted in loss of infectivity. SSA was resistant to pH changes between pH 3.0 and pH 9.0 at 37 C for 1 hr. The virus was inactivated at pH > or = 10. SSA was resistant to treatment with trypsin, chymotrypsin, pancreatin, phospholipase C, and sodium deoxycholate. Treatment of SSA with trypsin, chymotrypsin, and pancreatin resulted in enhanced viral infectivity. The viral genome extracted from purified SSA was sensitive to RNAse treatment. Using oligo d(T)16-18 and random hexamers as primers, the SSA genome was amplified using the reverse transcription-polymerase chain reaction conditions but was not amplified using polymerase chain reaction conditions. The enrichment of viral genome was achieved following poly-A+ selection. These studies provide evidence that the SSA is a positive-sense, single-stranded RNA virus having many characteristics (stability at acidic pH, resistant to proteolytic enzymes and bile salt) consistent with other enveloped enteric viruses.

Characterization of the stunting syndrome agent: relatedness to known viruses

An enteric disease of young turkeys, referred to as stunting syndrome (SS), causes reduced growth and impaired feed efficiency. A recently isolated virus, stunting syndrome agent, (SSA) has been found to be the etiologic agent of SS. The objective of the present study was to determine relatedness of the SSA with other viral agents. Serologic (viral neutralization and enzyme-linked immunosorbent assay [ELISA]) assays and a reverse transcriptase-polymerase chain reaction (RT-PCR) were used. The antisera against turkey enteric coronavirus (bluecomb agent), bovine coronavirus (BCV), bovine Breda-1 virus, bovine Breda-2 virus, avian infectious bronchitis virus (IBV), avian influenza virus, Newcastle disease virus (NDV), and transmissible gastroenteritis virus (TGEV) of swine were evaluated by dot-immunobinding avidin-biotin-enhanced ELISA and did not react with SSA. The homologous (anti-SSA) antiserum was positive by ELISA. Similarly, anti-SSA antiserum did not react when NDV, IBV, BCV, or TGEV was used as antigen but did react with the homologous (SSA) virus. The virus neutralization assay was performed by inoculating 24-to-25-day-old turkey embryos via the amniotic route and by assessing the embryo infectivity on the basis of gross intestinal lesions and intestinal maltase activity at 72 hr postinoculation. None of the aforementioned antisera neutralized SSA infectivity in embryos except for the homologous anti-SSA antiserum. A RT-PCR was performed with known primers specific for NDV, IBV, BCV, and TGEV. The known primers failed to amplify SSA genome but amplified their respective viral genomes. We concluded that the SSA was distinct from the viral agents that were evaluated.

Symptomatic HIV-infection in infants according to serostatus of mothers during pregnancy

OBJECTIVE

To ascertain the pattern of symptomatic HIV infections, HIV seropositivity and mother to child transmission (MTCT) rate during a two-year follow up period at 6, 12, 18, and 24 months according to mothers serostatus during pregnancy.

DESIGN

A longitudinal cohort study with socio-economic, medical, and demographic history of all participating pregnant women from recruitment; and of the child at birth recorded separately on pre-constructed questionnaire. The medical condition of each infant was recorded at the periodic follow-ups.

SETTING

The maternal and paediatric wards of the Harare Central Hospital, Harare, Zimbabwe.

SUBJECTS

Three hundred and eighty six HIV-seropositive and 372 HIV-seronegative Zimbabwean pregnant women attending maternal and paediatric wards of Harare Central Hospital.

INTERVENTIONS

About 10 ml of umbilical (venous) blood was collected at birth, centrifuged after clotting and stored frozen until HIV tests were carried out. Also capillary blood for filter paper storage was taken at six and 16 months and venous blood at one and two years of age for HIV serology, using ELISA. HIV serostatus was confirmed using Western Blot (WB) technique.

MAIN OUTCOME MEASURES

The HIV-serostatus of participating pregnant women and of infants at birth, patterns of symptomatic HIV infections and HIV seropositivity among infants and the number of deaths during a two year follow up at periodic intervals.

RESULTS

A total of 108 infant deaths occurred within the follow up period. Significantly more deaths (82 versus 25, p < 0.0001; excluding one infant whose HIV serostatus was not determined), parotitis, palpable neck and groin lymph nodes occurred among infants born to HIV positive than those born to HIV negative mothers. Palpable axillary lymph nodes were significantly more common at 12, 18, and 24 months of follow up in infants born to HIV positive women. The maternal HIV serostatus during pregnancy and of infants at all periodic follow ups showed no association with persistent diarrhoea, fever and cough. However prolonged fever became significantly associated at 24 months.

CONCLUSION

Mother to child transmission (MTCT) rate based on the HIV-serostatus of 272 infants; 17.4% in utero and 11.1% via breast milk respectively. Multivariate analysis showed that an infant presenting with faltering growth (Odds Ratio [OR] = 5.597), palpable neck (OR = 5.919) and axillary lymph nodes (OR = 4.197) was likely to be HIV positive at 24 months.

Nutritional assessment for children who are HIV-infected

Pathophysiologic, psychosocial, and economic considerations are important in nutritional assessment of infants and children who are HIV-infected. Nutritional assessment guidelines vary based on the child's circumstances. Specific assessment guidelines are proposed for (a) ongoing ambulatory care; (b) when growth decelerates or its below the fifth percentile; (c) acute illness; and (d) home and community care. The guidelines are based on data collected from a sample of 16 children who were HIV-infected and their families during a pilot study of transitional nursing care using advanced practice nurses. The guidelines were inductively derived from patient care records and from a review of the literature.

Growth hormone secretion in HIV-positive versus HIV-negative hemophilic males with abnormal growth and pubertal development. The Hemophilia Growth and Development Study

Growth and pubertal development in hemophilic males, age 6-19 years at baseline, were evaluated over a 3.5-year period in 207 HIV-positive and 126 HIV-negative subjects as part of the Hemophilia Growth and Development Study.

METHODS

Thyroid function, insulin-like growth factor I (IGF-1) levels, bone age, cranial magnetic resonance image normality, CD4+ counts, and serum testosterone levels of study participants were measured at baseline. An extensive endocrine evaluation was performed in subjects who demonstrated declines in height for age (measurement <5th percentile with two pervious heights >10th percentile), who had not achieved Tanner stage 4 level of pubertal development by age 15 years or who had abnormal growth velocity, which included assessment of peak stimulated growth hormone response after clonidine stimulation, 12-hour growth hormone profiles, and serum beta carotene levels (triggered protocol).

RESULTS

For almost the entire group (-99%), thyroid function tests were normal for age. IGF-1 levels were normal for 93% of the cohort. A total of 120 subjects, 89 HIV-positive and 31 HIV-negative, had an abnormality of growth, pubertal development, or both; 34 (11.1%) HIV-positive and 4 (3.6%) HIV-negative subjects had declines in height (p = .001), 20 (23.3%) HIV-positive and 5 (15.8%) HIV-negative subjects had not achieved Tanner stage 4 by 15 years of age (p = .372) and 59 (43.4%) HIV-positive and 23 (25.6) HIV-negative subjects had abnormal growth velocity (p < 0.001). Among subjects with abnormal height or growth velocity, the HIV-positive group had significantly lower mean age-adjusted testosterone levels than did the HIV-negative group (p = .030). Within the HIV-positive group, older subjects with abnormal height or growth velocity had significantly lower mean bone age than subjects of similar age without growth abnormalities (p = .0092). Extensive testing was done in 39 patients (32 HIV-positive, 7 HIV-negative). Half of the HIV-positive subjects had mean 12-hour growth hormone levels <3 ng/ml, 47% had peak stimulated levels <10 ng/ml, 28% had peak spontaneous values <10 ng/ml, and 38% had low levels of IGF-1. In the HIV-positive cohort, there was no difference in the rate of abnormalities of growth hormone secretion between those with CD4+ counts > or = or <200 cells/mm3 and between those subjects that met the 1987 Centers for Disease Control (CDC) surveillance definition of AIDS. In the subset of HIV-positive patients with abnormal peak growth hormone levels after clonidine stimulation, growth hormone response correlated positively with CD4+ count (r = .657, p = .0056) and beta carotene concentration (R = .596, p = .0192).

CONCLUSIONS

The results of this longitudinal study suggest that abnormalities of growth and pubertal development, particularly an abnormal growth velocity, are common in HIV-infected hemophilic boys and adolescents. These abnormalities might serve as indicators of the presence of HIV infection in this at-risk population. Since thyroid function tests and IGF-1 levels were normal, the etiology of growth impairment in HIV infection does not appear to be secondary to inadequate caloric intake or acquisition, or severe illness such as that caused by recurrent or persistent infection. Rather, HIV infection appears to lead to diminished growth hormone production or release and decreased androgen secretion, even before the development of AIDS and immunocompromise. These results provide a rationale for trials of treatment with growth hormone or androgens in patients with abnormalities of endocrine function.

Avian influenza A virus induced stunting syndrome-like disease in chicks

Two-day-old specific-pathogen free chicks were inoculated with type A influenza virus (A/whistling swan/Shimane/499/83 (H5N3) through the air sac. Inoculated chicks showed mild to severe diarrhea and lesions of pancreatitis and atrophy of the pancreas, thymus and bursa of Fabricius. One chick died on each of days 4, 6 and 14 postinoculation (PI). Reduced weight gain was conspicuous from day 22 PI. Positive immunoreaction to the virus antigen was detected in the pancreas, kidneys, liver, lungs and air sacs, and cecal lamina propria. Virus recovery persisted longer in the pancreas. Some of these findings conformed to those of stunting syndrome.

Variants able to cause growth hormone deficiency syndrome are present within the disease-nil WE strain of lymphocytic choriomeningitis virus

Persistent infection of C3H/St mice with lymphocytic choriomeningitis virus (LCMV) strain Armstrong leads to disordered growth and hypoglycemia. Both host and viral determinants contribute to this growth hormone (GH) deficiency syndrome (GHDS). Development of the GHDS correlates with the virus's ability to replicate in the GH-producing cells and cause reduced levels of GH synthesis. LCMV strain WE infects few GH-producing cells and does not cause GHDS in C3H/St mice. We show here that clonal variants isolated from the GHDS-nil WE population are able to replicate at high levels in GH-producing cells and cause GHDS in C3H/St mice. These variants are stably maintained, but phenotypically silent, within the GHDS-nil WE population.

A single amino acid change in the glycoprotein of lymphocytic choriomeningitis virus is associated with the ability to cause growth hormone deficiency syndrome

Persistent infection of C3H/St mice with certain strains of lymphocytic choriomeningitis virus (LCMV) causes a growth hormone (GH) deficiency syndrome (GHDS) manifested as growth retardation and hypoglycemia. Infected mice show high levels of viral replication in the GH-producing cells in the anterior pituitary leading to decreased synthesis of GH mRNA and protein despite the absence of detectable virus-induced cell structural damage. Virus clones isolated from the GHDS-negative LCMV WE strain can cause the disease, while others cannot. The genetic basis of this phenotypic difference is a nucleotide substitution resulting in a single amino acid difference in the viral glycoprotein. Reassortant studies indicate that the single amino acid substitution (Ser-153 to Phe) is sufficient to allow infection of the GH-producing cells and cause GHDS. These results show that a single change in the genome can affect viral pathogenicity by altering the tropism of the virus.

Roberts syndrome fibroblasts showing cisplatin hypersensitivity have normal host cell reactivation of cisplatin-treated adenovirus and normal capacity of cisplatin-treated cells for adenovirus DNA synthesis

Roberts syndrome (RS) is a rare, recessively inherited disorder characterized by growth retardation, limb reductions and craniofacial deformities. Cells from a subset of afflicted individuals, termed RS+, display unusual separation or puffing of the heterochromatic regions of their chromosomes and are hypersensitive to several DNA-damaging agents including mitomycin C (MMC) and cisplatin, both of which can induce interstrand crosslinks in DNA. For this reason, we have investigated the ability of RS+ fibroblasts to repair cisplatin-induced DNA lesions using adenoviris as a probe. Host cell reactivation of cisplatin-treated adenovirus (Ad) was significantly reduced in nucleotide excision repair (NER)-deficient xeroderma pigmentosum (XP) cells but was normal in the two RS+ fibroblast strains and the Fanconi's anemia (FA)fibroblast strain tested. The capacity of cisplatin-treated cells for Ad DNA synthesis was reduced in XP and FA cells compared to normal human cells, but was not reduced in RS+ cells. These results indicate that the hypersensitivity of RS+ cells to cisplatin is not due to a deficiency in NER nor due to a deficiency in the pathway which leads to cisplatin hypersensitivity in FA cells. It is possible that the abnormal heterochromatin organisation of RS+ cells selectively renders the heterochromatic regions of the genome more susceptible to mutagen damage and/or less available for repair.

Longitudinal growth during the first 2 years of life in children born to HIV-infected mothers in Malawi, Africa

To evaluate the longitudinal growth patterns of infants born to HIV-infected and uninfected mothers in Malawi, Africa, 92 HIV-infected infants, 270 uninfected infants born to HIV-infected mothers, and 686 infants born to uninfected mothers between birth and 24 months of life were studied. Weight and length were evaluated longitudinally utilizing generalized estimating equations. HIV-infected children were compared with uninfected children born to HIV-infected and uninfected mothers, and to United States National Center for Health Statistics (NCHS) growth standards. Median weight and length-for-age of seronegative infants born to either seronegative or seropositive mothers approximated the NCHS median from birth to approximately 4 months of age. Median weight and length of HIV-infected infants deviated from the NCHS median at an earlier age, and the deviation was more pronounced than was observed for uninfected infants. Mean growth curves constructed by generalized estimating equations indicated that HIV-infected and uninfected infants born to HIV-infected mothers weighed less and were smaller than infants born to HIV-uninfected mothers initially. Mean weight and length of uninfected infants attained the median of infants born to uninfected mothers by 24 months of age, while HIV-infected infants remained below this median. The difference in mean weight-for-age for HIV-infected and uninfected infants born to HIV-infected mothers was statistically significant from birth. The difference in mean length-for-age was statistically significant after 5 months of age. Thus, although infants born to HIV-infected mothers were smaller and weighed less initially, uninfected infants caught up, while HIV-infected infants remained below the median, and the deficit in weight occurred earlier in life than the deficit in length.