Treatment of children with HIV infection

Use of Placebo Pills Before Treatment Initiation in Youth with HIV: Are They Ready?

Highly active antiretroviral therapy (HAART) nonadherence is related to negative health outcomes and is well-documented in adolescents and young adults (AYAs) with behaviorally acquired HIV. Few studies describe methods to improve adherence in this population. This retrospective study describes placebo pill trial use (ie, pills with inert substance prescribed to practice taking HAART) in AYAs initiating HAART and its relation to disease outcomes. Sixty-two AYAs initiated HAART during the review period. Disease outcomes during the first year of standard clinical care were abstracted from medical records. In all, 72.6% of participants received ≥1 pill trial and 27.4% received ≥2 trials. Placebo trial use was not independently related to adherence post-HAART initiation. "Prescription" of a second trial was related to less optimal disease status over the first 6 months of treatment. Placebo trials have the potential to inform clinical care, aid in identifying AYAs at risk for nonadherence, and may provide a novel intervention strategy before/after HAART initiation.

A pilot study comparing traumatic stress symptoms by child and parent report across pediatric chronic illness groups

OBJECTIVE

Researchers have recently used a framework of traumatic stress to describe the psychological functioning of children experiencing a chronic illness and their families; however, few studies are available directly comparing symptoms across disease groups. This study compared traumatic stress symptoms of youth being considered for solid organ and bone marrow transplantation, youth diagnosed with human immunodeficiency virus, youth diagnosed with sickle cell disease and their parents. Correlates of traumatic stress across these populations were also examined.

METHOD

Participants included 64 youth and caregiver dyads with previously scheduled appointments at 1 of 3 specialty clinics. Parents completed measures of family demographics, traumatic stress symptoms, and child functional status. Youth (n = 45) and parents each completed self-report and parent-proxy measures of youth traumatic stress symptoms.

RESULTS

Ten percent of youth by self-report, 18% of youth by parent-proxy report, and 13% of caregivers described symptoms suggestive of posttraumatic stress disorder. Parents of pediatric transplant self-reported greater symptoms than caregivers of youth with human immunodeficiency virus and sickle cell disease (p < .05). Although child functional impairment did not predict child symptoms, a trend was found where parents experiencing more traumatic stress symptoms themselves reported their children experienced greater symptoms by parent-proxy report (p =.07).

CONCLUSION

Findings suggest that although most children and parents across disease groups report subclinical levels of traumatic stress symptoms, traumatic stress symptoms may be especially salient for families of pediatric transplant candidates. Although interventions are currently available to treat posttraumatic stress disorder symptoms, they will likely need to be individualized to meet the needs of specific disease groups.

The rhesus macaque pediatric SIV infection model - a valuable tool in understanding infant HIV-1 pathogenesis and for designing pediatric HIV-1 prevention strategies

Worldwide, the AIDS pandemic continues almost relentlessly. Women are now representing the fastest growing group of newly infected HIV-1 infected patients. The risk of mother-to-child-transmission (MTCT) of HIV-1 increases proportionally as many of these women are of childbearing age. The screening of pregnant women, the early diagnosis of HIV-1 infection, and the administration of antiretroviral therapy (ART) have helped to reduce MTCT significantly. However, this holds true only for developed countries. In many resource-poor countries, access to ART is limited, and breastfeeding, a major route of HIV-1 transmission, is essential to protect the infant from other infectious diseases preponderant in those geographic regions. HIV-1 infected children, in contrast to adult patients, have higher levels of virus replication that decline only slowly, and a subset progresses to AIDS within the first two years. Thus, it is imperative to understand pediatric HIV-1 pathogenesis to design effective prevention strategies and/or a successful pediatric HIV-1 vaccine. The review summarizes how MTCT of HIV-1 in humans can be modeled in the infant macaque model of SIV infection. Importantly, the infant macaque model of SIV infection provides the opportunity to study early virus-host interactions in multiple anatomic compartments. Furthermore, the review underlines the importance of evaluating SIV/HIV immune responses in the context of the normal developmental changes the immune system undergoes in the newborn. Thus, the pediatric SIV infection model provides a unique resource for preclinical studies of novel intervention therapies and vaccine strategies to stop MTCT of HIV-1.