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Mahtab S, Frigati LJ, Ntusi NAB, Nyathi M, Asafu-Agyei NA, Myer L, Zar HJ, Jao J. The Determinants of Elevated Pathobiological Determination of Atherosclerosis in Youth Risk Score in Perinatally HIV-Infected Adolescents in South Africa. J Acquir Immune Defic Syndr 2024; 95:82-89. [PMID: 37851954 PMCID: PMC10840672 DOI: 10.1097/qai.0000000000003304] [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: 09/02/2022] [Accepted: 08/14/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Youth living with perinatally acquired HIV infection (YLPHIV) are at risk of developing atherosclerotic cardiovascular disease. METHODS We determined the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) coronary arteries (CA) and abdominal aorta (AA) risk scores among YLPHIV who are ≥15 years old in Cape Town Adolescent and Antiretroviral Cohort. PDAY score was calculated using non-high-density lipoprotein, high-density lipoprotein cholesterol, hyperglycemia, hypertension, obesity, and smoking; a score ≥1 was considered elevated. HIV viremia was categorized as sustained (SV) = viral load (VL) >50 copies/mL, transient (TV) = mix of VL >50 and ≤50 copies/mL, or sustained-virologic suppression = VL <50 copies/mL throughout the study. Among YLPHIV, logistic models were fit to assess factors associated with elevated PDAY. RESULTS Overall, 218 YLPHIV [median age 16.8 (interquartile range: 15.9-17.8) years, male 47%] were included. Among YLPHIV, 8% (n = 17) had SV, and 54% (n = 118) had TV. Median antiretroviral therapy (ART) duration was 12 (interquartile range: 8-14) years. Among YLPHIV, 30.3% and 18.4% had elevated PDAY for CA and AA, respectively.Among YLPHIV, SV [adjusted odds ratio (aOR) = 18.4, P < 0.01] and TV (aOR = 2.10, P = 0.04) compared with virologic suppression and ART duration in years (aOR = 1.12, P = 0.03) were associated with elevated CA. Male sex was associated with both elevated CA and AA (aOR = 2.14, P = 0.02, and aOR = 3.43, P = 0.01, respectively) and association of SV with elevated AA (aOR = 3.24, P = 0.09). CONCLUSIONS A substantial proportion of YLPHIV have PDAY scores reflecting increased aggregate atherosclerotic risk. Among YLPHIV, viremia, lifetime ART duration, and male sex contribute to this risk, highlighting the importance of HIV control and the need to monitor cardiometabolic health.
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Affiliation(s)
- Sana Mahtab
- Department of Pediatrics & Child Health, Red Cross War Memorial Children’s Hospital, and SA MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa, 7700
| | - Lisa J Frigati
- Department of Paediatrics and Child Health, Tygerberg hospital, Stellenbosch University, Cape Town, South Africa
| | - Ntobeko A. B. Ntusi
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mothabisi Nyathi
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, 7925
| | - Nana Akua Asafu-Agyei
- Department of Pediatrics & Child Health, Red Cross War Memorial Children’s Hospital, and SA MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa, 7700
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, 7925
| | - Heather J Zar
- Department of Pediatrics & Child Health, Red Cross War Memorial Children’s Hospital, and SA MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa, 7700
| | - Jennifer Jao
- Department of Pediatrics, Division of Infectious diseases, Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Hematologic Manifestations of Childhood Illness. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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McCart MR, Sheidow AJ, Letourneau EJ. Risk Reduction Therapy for Adolescents: Targeting Substance Use and HIV/STI-Risk Behaviors. COGNITIVE AND BEHAVIORAL PRACTICE 2014; 21:161-175. [PMID: 25419101 PMCID: PMC4235161 DOI: 10.1016/j.cbpra.2013.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper describes a family-based intervention for addressing both substance use and unprotected sexual behavior in adolescents presenting for outpatient substance use treatment. The intervention combines contingency management (CM) for adolescent substance use, which is a behavioral intervention modeled on the Community Reinforcement Approach, with a sexual risk reduction protocol that mirrors aspects of the CM model. As a family-based intervention, caregivers attend every session and actively collaborate with the therapist to address their youth's behavior problems. The treatment is criterion-based with treatment duration determined by the youth's achievement of reduced substance use and unprotected sexual behavior goals. A case study describes the implementation of this treatment with an adolescent presenting a history of polysubstance use and unprotected sexual intercourse. Following the adolescent and caregiver's participation in weekly sessions, the adolescent demonstrated improvements in substance use, unprotected sexual behavior, and other behavior problems. Clinical summary data from two outpatient clinics reveal similar positive outcomes for youth receiving the intervention. This paper illustrates the potential utility of an integrated treatment approach targeting substance use and unprotected sexual behavior in an adolescent population.
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Hilburn N, Potterton J, Stewart A. Paediatric HIV encephalopathy in sub-Saharan Africa. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x10y.0000000013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Patel K, Wang J, Jacobson DL, Lipshultz SE, Landy DC, Geffner ME, Dimeglio LA, Seage GR, Williams PL, Van Dyke RB, Siberry GK, Shearer WT, Young L, Scott GB, Wilkinson JD, Fisher SD, Starc TJ, Miller TL. Aggregate risk of cardiovascular disease among adolescents perinatally infected with the human immunodeficiency virus. Circulation 2013; 129:1204-12. [PMID: 24366631 DOI: 10.1161/circulationaha.113.001978] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Perinatally HIV-infected adolescents may be susceptible to aggregate atherosclerotic cardiovascular disease risk, as measured by the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) coronary arteries and abdominal aorta risk scores, as a result of prolonged exposure to HIV and antiretroviral therapy. METHODS AND RESULTS Coronary arteries and abdominal aorta PDAY scores were calculated for 165 perinatally HIV-infected adolescents, using a weighted combination of modifiable risk factors: dyslipidemia, cigarette smoking, hypertension, obesity, and hyperglycemia. Demographic and HIV-specific predictors of scores ≥1 were identified, and trends in scores over time were assessed. Forty-eight percent and 24% of the perinatally HIV-infected adolescents had coronary arteries and abdominal aorta scores ≥1, representing increased cardiovascular disease risk factor burden. Significant predictors of coronary arteries scores ≥1 included male sex, history of an AIDS-defining condition, longer duration of use of a ritonavir-boosted protease inhibitor, and no prior use of tenofovir. Significant predictors of abdominal aorta scores ≥1 included suppressed viral load, history of an AIDS-defining condition, and longer duration of boosted protease inhibitor use. No significant changes in coronary arteries and abdominal aorta risk scores were observed over the 4-year study period. CONCLUSIONS A substantial proportion of perinatally HIV-infected youth have high PDAY scores, reflecting increased aggregate atherosclerotic cardiovascular disease risk factor burden. High scores were predicted by HIV disease severity and boosted protease inhibitor use. PDAY scores may be useful in identifying high-risk youth who may benefit from early lifestyle or clinical interventions.
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Affiliation(s)
- Kunjal Patel
- Department of Epidemiology, Harvard School of Public Health, Boston, MA (K.P., G.R.S.); Center for Biostatistics in AIDS Research, Boston, MA (K.P., J.W., D.L.J., G.R.S., P.L.W.); Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit (S.E.L.); Division of Pediatric Clinical Research and Division of Pediatric Infectious Disease and Immunology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL (D.C.L., G.B.S., J.D.W., T.L.M.); Saban Research Institute of Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA (M.E.G.); Section of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis (L.A.D.M.); Department of Pediatrics, Tulane University Health Sciences Center, New Orleans, LA (R.B.V.D.); Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (G.K.S.); Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston (W.T.S.); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Children's Memorial Hospital, Chicago, IL (L.Y.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (S.D.F.); and Department of Pediatrics, Division of Pediatric Cardiology, Presbyterian Hospital/Columbia University, College of Physicians and Surgeons, New York City, NY (T.J.S.)
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Gupta S, Shah DM, Shah I. Neurological disorders in HIV-infected children in India. ACTA ACUST UNITED AC 2013; 29:177-81. [DOI: 10.1179/027249309x12467994693734] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Miller TI, Borkowsky W, DiMeglio LA, Dooley L, Geffner ME, Hazra R, McFarland EJ, Mendez AJ, Patel K, Siberry GK, Van Dyke RB, Worrell CJ, Jacobson DL, Shearer W, Cooper N, Harris L, Purswani M, Baig M, Cintron A, Puga A, Navarro S, Patton D, Burchett S, Karthas N, Kammerer B, Yogev R, Malee K, Hunter S, Cagwin E, Wiznia A, Burey M, Nozyce M, Chen J, Gobs E, Grant M, Knapp K, Allison K, Garvie P, Acevedo-Flores M, Rios H, Olivera V, Silio M, Borne C, Sirois P, Spector S, Norris K, Nichols S, McFarland E, Barr E, Chambers C, Watson D, Messenger N, Belanger R, Dieudonne A, Bettica L, Adubato S, Scott G, Himic L, Willen E. Metabolic abnormalities and viral replication are associated with biomarkers of vascular dysfunction in HIV-infected children. HIV Med 2011; 13:264-75. [PMID: 22136114 DOI: 10.1111/j.1468-1293.2011.00970.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2011] [Indexed: 01/07/2023]
Abstract
OBJECTIVES HIV-infected children may be at risk for premature cardiovascular disease. We compared levels of biomarkers of vascular dysfunction in HIV-infected children (with and without hyperlipidaemia) with those in HIV-exposed, uninfected (HEU) children enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS), and determined factors associated with these biomarkers. METHODS A prospective cohort study was carried out. Biomarkers of inflammation [C-reactive protein (CRP), interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP1)], coagulant dysfunction (fibrinogen and P-selectin), endothelial dysfunction [soluble intracellular cell adhesion molecule-1 (sICAM), soluble vascular cell adhesion molecule-1 (sVCAM) and E-selectin], and metabolic dysfunction (adiponectin) were measured in 226 HIV-infected and 140 HEU children. Anthropometry, body composition, lipids, glucose, insulin, HIV disease severity, and antiretroviral therapy were recorded. RESULTS The median ages of the children were 12.3 years in the HIV-infected group and 10.1 years in the HEU group. Body mass index (BMI) z-scores, waist and hip circumferences, and percentage body fat were lower in the HIV-infected children. Total and non-high-density lipoprotein (HDL) cholesterol and triglycerides were higher in HIV-infected children. HIV-infected children also had higher MCP-1, fibrinogen, sICAM and sVCAM levels. In multivariable analyses in the HIV-infected children alone, BMI z-score was associated with higher CRP and fibrinogen, but lower MCP-1 and sVCAM. Unfavourable lipid profiles were positively associated with IL-6, MCP-1, fibrinogen, and P- and E-selectin, whereas increased HIV viral load was associated with markers of inflammation (MCP-1 and CRP) and endothelial dysfunction (sICAM and sVCAM). CONCLUSIONS HIV-infected children have higher levels of biomarkers of vascular dysfunction than do HEU children. Risk factors associated with higher biomarkers include unfavourable lipid levels and active HIV replication.
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Affiliation(s)
- T I Miller
- Department of Pediatrics, Division of Pediatric Clinical Research, Miller School of Medicine at the University of Miami, Miami, FL, USA
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Biomarkers of vascular dysfunction in children infected with human immunodeficiency virus-1. J Acquir Immune Defic Syndr 2010; 55:182-8. [PMID: 20531209 DOI: 10.1097/qai.0b013e3181e222c9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND : We compared biomarkers of vascular dysfunction among HIV-infected children to a demographically similar group of uninfected children and determined factors associated with these biomarkers. METHODS AND RESULTS : We measured several biomarkers of vascular dysfunction: C-reactive protein (CRP), interleukin-6 (IL-6), and monocyte chemoattractant protein -1 (MCP-1) (inflammation); fibrinogen and P-selectin (coagulant dysfunction); soluble intracellular cell adhesion molecule-1 (sICAM), soluble vascular cell adhesion molecule-1 (sVCAM), and E-selectin (endothelial dysfunction); and leptin (metabolic dysfunction). Anthropometry, body composition, CD4%, HIV viral load, and antiretroviral therapy were recorded. Mean age was 14.8 years (106 HIV-infected children) and 12.3 years (55 control children). Sex and body mass index Z scores were similar. Infected children had higher sICAM, sVCAM, MCP-1, IL-6, and fibrinogen levels. E-selectin (P = 0.07), and CRP (P = 0.08) trended to be greater in the HIV group, yet leptin and P-selectin were similar. In multivariable analyses in the HIV-infected children alone, each 1 standard deviation increase in waist to hip ratio was associated with increases in sICAM (17%), MCP-1 (19%), IL6 (18%), and CRP (59%). CD4% was inversely associated with sVCAM, MCP-1, IL6, fibrinogen, and CRP. CONCLUSIONS : HIV-infected children have higher levels of biomarkers of vascular dysfunction than healthy children. Risk factors associated with these biomarkers include higher waist to hip ratios and HIV disease severity.
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Fair CD, Sullivan K, Gatto A. Best practices in transitioning youth with HIV: Perspectives of pediatric and adult infectious disease care providers. PSYCHOL HEALTH MED 2010; 15:515-27. [DOI: 10.1080/13548506.2010.493944] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
In 2005, it was estimated that 2.3 million children below 15 years of age were living with human immunodeficiency virus (HIV)/AIDS and 570,000 children below 15 years died. Maternal-infant or vertical transmission is the most common mode of HIV infection in children. As transplacental passage of maternal anti-HIV antibodies, diagnosis of HIV infection in young infants relies on virologic assays. Infants older than 18 months of age can be diagnosed by serology alone. Pediatric HIV infections are classified according to Center for Disease Control and Prevention 1994 revised classification system. The understanding of viral pathogenesis, the development of highly active antiretroviral therapy, and the ability to quantitate viral burden have led to significant reduction in disease progression and morbidity in HIV-infected children. As survival improves, these children will require anesthesia care and pain treatment during the course of their illness. Considerations for the anesthesiologist include: possible involvement of multiple organ systems, adverse reactions and drug interactions of antiretroviral agents and adequate infection control to prevent HIV transmission in hospital and other infections to the immunocompromised patients. Finally, care should be taken not to violate confidentiality.
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Chakraborty R, Uy CS, Oleske JM, Coen PG, McSherry GD. Persistent non-gastrointestinal metabolic acidosis in pediatric HIV-1 infection. AIDS 2003; 17:673-7. [PMID: 12646789 DOI: 10.1097/00002030-200303280-00004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To determine the incidence and to identify the clinical parameters associated with non-gastrointestinal renal tubular and high anion gap acidosis in a cohort of HIV-1-infected children. METHODS Records of 202 HIV-1-infected children were reviewed to identify patients with metabolic acidosis. Serum and urine chemistries of those children with persistent non-gastrointestinal acidosis were then studied prospectively. Serum and urinary anion gaps (SAG and UAG) were calculated. Those with acidosis (group 1) were compared with children without acidosis (group 2). Associations were determined with Pediatric HIV classification, height, weight, antiretroviral therapy, and Pneumocystis carinii pneumonia prophylaxis. RESULTS Persistent acidosis was noted in 34 out of 202 children (17%): 16 out of 34 (47%, group 1A) had elevated SAG acidosis, and 18 out of 34 (53%) had normal SAG acidosis with a positive UAG (distal renal tubular) acidosis (group 1B). Those with acidifying defects more often received P. carinii pneumonia prophylaxis (P = 0.02 and 0.01 for groups 1 and 1A, respectively) independently of HIV-1 classification. This group was shorter in height than group 2 (P = 0.007). Differences in weight were not significant (P = 0.1). However, acidotic subjects were more immunocompromised than those in group 2 (multivariate P < 0.001 for HIV classification C3). CONCLUSIONS Elevated SAG acidosis and renal tubular acidosis are not uncommon among HIV-infected children with advanced disease. These disorders may be associated with height growth failure and prophylaxis with sulfur/sulfone containing antibiotics. HIV infection and/or its associated therapies may cause renal tubular damage. The causes of elevated SAG acidosis require further investigation.
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Affiliation(s)
- Rana Chakraborty
- Department of Child Health, St. George's Hospital and Medical School, London UK
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Rauner MS. Using simulation for AIDS policy modeling: benefits for HIV/AIDS prevention policy makers in Vienna, Austria. Health Care Manag Sci 2002; 5:121-34. [PMID: 11993747 DOI: 10.1023/a:1014433117269] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In spite of advanced therapies and the success of additional prevention programs, the HIV/AIDS epidemic still remains a challenge. Our paper refers academics, health care managers, and policy makers to the relevance of AIDS policy simulators in better decision-making. By highlighting the types of decisions AIDS policy models can support, we demonstrate the strategic role of AIDS policy simulators for the efficient and effective planning of scarce resources to fight the epidemic. For each type of decision, we then review exemplary AIDS policy simulators that have helped policy makers make better decisions. Finally, we present the benefits of an AIDS policy simulator for HIV/AIDS prevention policy makers in Vienna, Austria.
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Affiliation(s)
- Marion S Rauner
- Department of Innovation and Technology Management, Institute of Business Studies, University of Vienna, School of Business, Economics, and Computer Science, Austria.
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Abstract
1. The human immunodeficiency virus invades the central nervous system early after infection where it later gives rise to cognitive, motor, and behavioral manifestations in children and adults. 2. Ranging from mild impairments to frank dementia, CNS manifestations can be diagnosed and measured with standard neuropsychological test batteries. 3. Great strides have been made with treatment: CNS manifestations are treatable, as are depression, psychosis, and delirium which sometimes accompany HIV disease at different stages. 4. With startling advances in antiretroviral therapy and lower mortality, patients face a constellation of new concerns stemming from HIV's transformation to a more chronic disease. 5. There are many compelling research directions ahead, including the psychosocial impact of living with HIV as a chronic disease, the development of medications expressly targeted to the CNS, and basic research on neuropathogenesis, including trafficking of virus into the CNS.
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Affiliation(s)
- D M Rausch
- Center for Mental Health Research on AIDS, National Institute of Mental Health, Bethesda, Maryland 20892-9623, USA.
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