1
|
Amato A. Viral Infections of the Oral Cavity in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1325. [PMID: 37628324 PMCID: PMC10453176 DOI: 10.3390/children10081325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
Various viral infections can affect the oral cavities of pediatric patients [...].
Collapse
Affiliation(s)
- Alessandra Amato
- Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| |
Collapse
|
2
|
Tesfahunegn TB, Berhe N, Abraha TH, Hintsa S, Yohanes G, Desta K, Alema HB, Hagos E, Gidey G, Teshahunegn GB. Adherence to Antiretroviral Therapy and Associated Factors Among HIV-Infected Children in Public Health Institutions of Adwa, Axum, and Shire Towns of Tigray, Northern Ethiopia: A Cross-Sectional Study. HIV AIDS (Auckl) 2023; 15:217-224. [PMID: 37163177 PMCID: PMC10164383 DOI: 10.2147/hiv.s282938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 06/28/2021] [Indexed: 05/11/2023] Open
Abstract
Background Antiretroviral therapy (ART) provision was among the major challenge of treatments. Maintaining the optimal level of adherence among children living with HIV/AIDS is a pivotal step towards achieving treatment success. However, there are limited studies on child's ART adherence. Therefore, this study aimed to assess the level of adherence to antiretroviral therapy and associated factors among HIV-infected children in health institutions of Adwa, Axum, and Shire towns, Tigray, Northern Ethiopia. Methods An institutional-based cross-sectional study was conducted among human immunodeficiency virus (HIV)-infected children in between February and April, 2016. A total of 255 children who were taking antiretroviral therapy in the randomly selected three health facilities from Adwa, Axum and Shire towns were included. Data were collected using pretested and structured questionnaires using a face-to-face interview. The collected data were entered into Epi Info version 7 and then exported to SPSS version 21 for analysis. Bivariate and multivariate binary logistic regression models were used to determine the factors associated with adherence to antiretroviral therapy among HIV-infected children. Results A total of the 255 study participants were included in the study. The level of ART adherence among HIV-positive children was 212 (84.8%). Knowledge of caregivers about ART treatment (AOR = 2.78, 95% CI: 1.18, 6.53), occupational status (AOR = 4.78, 95% CI: 1.26, 18.91), appointment to ART less than two months (AOR = 3.05, 95% CI: 1.21, 7.70) and use of memory aids (AOR = 4.58, 95% CI: 1.73, 12.13) were independently associated with adherence to ART. Conclusion The level of adherence to antiretroviral therapy was low. Healthcare providers should reinforce adherence intervention and counseling sessions during follow-up and address the proper use of medication reminders to help children take their drugs appropriately.
Collapse
Affiliation(s)
- Tadis Brhane Tesfahunegn
- Department of Reproductive Health, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Negassie Berhe
- Department of Human Nutrition, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | | | - Solomon Hintsa
- Department of Epidemiology, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Goitom Yohanes
- Department of Reproductive Health, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Kahsay Desta
- School of Medicine, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | | | - Elsa Hagos
- Department of Medical Laboratory, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Gebreamlak Gidey
- Department of Midwifery, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | | |
Collapse
|
3
|
Domaoal RA, Sleeman K, Sawadogo S, Dzinamarira T, Frans N, Shatumbu SP, Kakoma LN, Shuumbwa TK, Cox MH, Stephens S, Nisbet L, Metz M, Saito S, Williams DB, Voetsch AC, Patel H, Parekh B, Duong YT. Successful Use of Near Point-of-Care Early Infant Diagnosis in NAMPHIA to Improve Turnaround Times in a National Household Survey. J Acquir Immune Defic Syndr 2021; 87:S67-S72. [PMID: 34166314 PMCID: PMC8754064 DOI: 10.1097/qai.0000000000002706] [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: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the population-based HIV impact assessment surveys, early infant diagnosis (EID) was provided to infants <18 months without a prior diagnosis. For the Namibia population-based HIV impact assessment (NAMPHIA), the GeneXpert platform was assessed for the feasibility of near POC EID testing compared with the standard Roche COBAS AmpliPrep/COBAS TaqMan (CAP/CTM) platform. Quality assurance measures and turnaround time were compared to improve EID results reporting. METHODS NAMPHIA participants were screened for HIV exposure using Determine HIV-1/2 rapid test; samples reactive on Determine received EID testing on the GeneXpert instrument and Xpert HIV-1 Qual assay using whole blood. Results were confirmed at the Namibia Institute of Pathology using dried blood spots on the Roche CAP/CTM platform per national guidelines. RESULTS Of the 762 screened infants, 61 (8.0%) were Determine-reactive and considered HIV-exposed. Of the 61 exposed infants, 2 were found to be HIV-infected whereas 59 were negative on both GeneXpert and Roche platforms, achieving 100% concordance. Average turnaround time was 3.4 days for the Xpert HIV-1 Qual assay, and average time from collection to testing was 1.0 days for GeneXpert compared with 10.7 days for Roche. No samples failed using GeneXpert whereas 1 sample failed using Roche and was repeated. CONCLUSION Quality POC EID testing is feasible in a national survey through extensive training and external quality assurance measures. The use of decentralized POC EID for national testing would provide rapid diagnosis and improve TATs which may prevent loss to follow-up, ensure linkage to care, and improve clinical outcomes for infants.
Collapse
Affiliation(s)
- Robert A. Domaoal
- International Laboratory Branch, Division of Global HIV & TB, CGH, CDC, Atlanta, GA, USA
| | - Katrina Sleeman
- International Laboratory Branch, Division of Global HIV & TB, CGH, CDC, Atlanta, GA, USA
| | | | | | | | | | | | | | - Mackenzie Hurlston Cox
- International Laboratory Branch, Division of Global HIV & TB, CGH, CDC, Atlanta, GA, USA
| | - Sally Stephens
- University of California San Francisco, Windhoek, Namibia
| | - Lydia Nisbet
- University of California San Francisco, Windhoek, Namibia
| | | | | | | | - Andrew C. Voetsch
- Epidemiology and Surveillance Branch, Division of Global HIV & TB, CGH, CDC, Atlanta, GA, USA
| | - Hetal Patel
- International Laboratory Branch, Division of Global HIV & TB, CGH, CDC, Atlanta, GA, USA
| | - Bharat Parekh
- International Laboratory Branch, Division of Global HIV & TB, CGH, CDC, Atlanta, GA, USA
| | | |
Collapse
|
4
|
GebreEyesus F, Mitku D, Tarekegn T, Temere B, Terefe T, Belete A, Legas G, Feleke D, Taye MG, Baye N, Admasu F, Dagnew E, Liyeh T, Jimma M, Chanie E. Levels of Adherence and Associated Factors Among Children on ART Over Time in Northwest, Ethiopia: Evidence from a Multicenter Follow-Up Study. HIV AIDS (Auckl) 2021; 13:829-838. [PMID: 34434060 PMCID: PMC8380805 DOI: 10.2147/hiv.s323090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background Despite the increased availability of antiretroviral therapy (ART), its success depends on a high level of adherence to a life-long antiretroviral therapy. However, the extent and factors associated with adherence to ART are not well known, especially in the current study setup. Therefore, this study aimed to assess the level of adherence and associated factors among children on ART in Northwest, Ethiopia. Methods A retrospective follow-up study was conducted on human immunodeficiency virus (HIV)-infected children receiving ART at South Gondar public hospitals. Children receiving ART from January 1, 2015, to November 30, 2020, were included in the study. A computer-generated simple random sampling technique was employed. The data were entered into the EpiData version 3.1 and analyzed by STATA 14 statistical software. Bivariable logistic regression was fitted for each predictor variable. Moreover, those variables having a p-value ≤0.25 in bivariate analysis were fitted into a multivariable logistic regression model. P-value <0.05 was used to declare significance. Results A total of 363 HIV-infected children were involved in the study. From 363 HIV-infected children, the level of adherence to ART was found to be 78.2%, 95% CI (73.6, 82.2). TB co-infection [adjusted odds ratio (AOR) = 3.8, 95% CI (1.41, 10.1)], short duration on ART (AOR = 3.4, 95% CI (1.60, 7.20)), treatment failure (AOR = 10.2, 95% CI (3.95, 26.2)), and Zidovudine containing ART regimen (AOR = 3.5, 95% CI (1.1, 10.9)) were significant predictors of poor adherence. Conclusion The current study showed that the level of adherence to ART was found to be low TB co-infection, short duration of ART, Zidovudine-containing ART regimen, and treatment failure were found to be significantly associated with poor adherence. Further studies on adherence rate and its determinants with multiple adherence measurements using prospective and multicenter studies were recommended.
Collapse
Affiliation(s)
- Fisha GebreEyesus
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
- Correspondence: Fisha GebreEyesus Email
| | | | - Tadesse Tarekegn
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Bogale Temere
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Tamene Terefe
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | | | | | | | | | - Nega Baye
- DebreTabor University, DebreTabor, Ethiopia
| | | | | | | | - Melkamu Jimma
- Department of Nursing, College of Health Sciences, Assosa University, Assosa, Ethiopia
| | | |
Collapse
|
5
|
Walubo A, Baleni R, Mukudu H, Kambafwile H, Dheda M, Thengwa T, Jiane T. Clinical Characteristics of Children with HIV Initiated on Antiretroviral Treatment at HIV Clinics in Bloemfontein, South Africa. Int J MCH AIDS 2021; 10:146-155. [PMID: 34290903 PMCID: PMC8285671 DOI: 10.21106/ijma.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/24/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Over the past 15 years, there have been three major updates to the South African national guidelines for the management of human immunodeficiency virus (HIV) in children. The purpose of this study is to describe the clinical characteristics of children who were initiated on antiretroviral therapy (ART) in Bloemfontein, South Africa, following these national treatment guidelines. METHODS Clinical information during initiation of ART in children aged 0-13 years was obtained from five HIV clinics in Bloemfontein from 2004 to 2019 as part of the establishment of an antiretroviral (ARV) pediatric registry at the University of the Free State. Data were analyzed for patient demographics, clinical presentation (World Health Organization (WHO) HIV-staging, growth rate and comorbid conditions), types of investigations done, and medicines prescribed. RESULTS The number of children initiated on ART increased from 168 in the period 2004-2009 to 349 (107.8%) in 2010-2014, and then dropped to 162 in the period 2015-2019. The increase in 2010-2014 was mainly in the <2 years age group by 54.8%, and in the 5 to 10 years age group by 344.4%. In the same period, the number of children with severe illness (WHO HIV-stage 4) decreased by 20.7%, while those with mild to moderate illness (WHO HIV-stage 2 and 3) increased by 17.3%. HIV infection was more severe in children under two years as more patients in this age group presented with WHO HIV-stages 3 and 4, severe underweight (below 3rd percentile), severely suppressed CD4 count (< 25%), and a high viral load (> 1000 copies/ml). There was increased use of ABC/3TC/LPVr in the < 3-year age group and ABC/3TC/EFV in the > 3-year age group. There was reduced use of the stavudine and other regimens. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS More children were started on ART and safer ARV drugs. Children under 2 years were the most debilitated by HIV, and there was an increase in HIV prevalence among children > 5 years. New strategies for the prevention and management of HIV among children in these two age groups are needed.
Collapse
Affiliation(s)
- Andrew Walubo
- Department of Pharmacology, University of the Free State, Bloemfontein, 9301, South Africa
| | - Refuoe Baleni
- Department of Pharmacology, University of the Free State, Bloemfontein, 9301, South Africa
| | - Hillary Mukudu
- Department of Pharmacology, University of the Free State, Bloemfontein, 9301, South Africa
| | - Henry Kambafwile
- National Pharmacovigilance Center, National Department of Health, Pretoria, South Africa
| | - Mukesh Dheda
- National Pharmacovigilance Center, National Department of Health, Pretoria, South Africa
| | - Thanduxolo Thengwa
- Department of Pharmacology, University of the Free State, Bloemfontein, 9301, South Africa
| | - Tshepang Jiane
- Department of Pharmacology, University of the Free State, Bloemfontein, 9301, South Africa
| |
Collapse
|
6
|
Currenti J, Chopra A, John M, Leary S, McKinnon E, Alves E, Pilkinton M, Smith R, Barnett L, McDonnell WJ, Lucas M, Noel F, Mallal S, Conrad JA, Kalams SA, Gaudieri S. Deep sequence analysis of HIV adaptation following vertical transmission reveals the impact of immune pressure on the evolution of HIV. PLoS Pathog 2019; 15:e1008177. [PMID: 31821379 PMCID: PMC6924686 DOI: 10.1371/journal.ppat.1008177] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/20/2019] [Accepted: 10/31/2019] [Indexed: 12/25/2022] Open
Abstract
Human immunodeficiency virus (HIV) can adapt to an individual’s T cell immune response via genomic mutations that affect antigen recognition and impact disease outcome. These viral adaptations are specific to the host’s human leucocyte antigen (HLA) alleles, as these molecules determine which peptides are presented to T cells. As HLA molecules are highly polymorphic at the population level, horizontal transmission events are most commonly between HLA-mismatched donor/recipient pairs, representing new immune selection environments for the transmitted virus. In this study, we utilised a deep sequencing approach to determine the HIV quasispecies in 26 mother-to-child transmission pairs where the potential for founder viruses to be pre-adapted is high due to the pairs being haplo-identical at HLA loci. This scenario allowed the assessment of specific HIV adaptations following transmission in either a non-selective immune environment, due to recipient HLA mismatched to original selecting HLA, or a selective immune environment, mediated by matched donor/recipient HLA. We show that the pattern of reversion or fixation of HIV adaptations following transmission provides insight into the replicative cost, and likely compensatory networks, associated with specific adaptations in vivo. Furthermore, although transmitted viruses were commonly heavily pre-adapted to the child’s HLA genotype, we found evidence of de novo post-transmission adaptation, representing new epitopes targeted by the child’s T cell response. High-resolution analysis of HIV adaptation is relevant when considering vaccine and cure strategies for individuals exposed to adapted viruses via transmission or reactivated from reservoirs. Highly mutable pathogens utilise genetic variations within T cell epitopes as a mechanism of immune escape (viral adaptation). The diversity of the human leucocyte antigen (HLA) molecules that present viral targets to T cells in human populations partially protects against rapid population-level accumulation of human immunodeficiency virus (HIV) adaptations through horizontal transmissions. In contrast, vertical transmissions occur between haplo-identical mother/child pairs, and potentially include adaptive changes through father-mother-child transmission, representing a pathway to complete pre-adaptation to HLA alleles in child hosts over only two transmission events. We utilised next-generation sequencing to examine HIV evolution in the unique setting of vertical HIV transmission. We predict the in vivo replicative cost and immune benefit of specific HIV adaptations that could be used to inform vaccine design and cure strategies to combat viral immune adaptation.
Collapse
Affiliation(s)
- Jennifer Currenti
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Abha Chopra
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Mina John
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
- Department of Clinical Immunology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Shay Leary
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Elizabeth McKinnon
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Eric Alves
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Mark Pilkinton
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Rita Smith
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Louise Barnett
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Wyatt J. McDonnell
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Michaela Lucas
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | | | - Simon Mallal
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Joseph A. Conrad
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Spyros A. Kalams
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Silvana Gaudieri
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| |
Collapse
|
7
|
Williams M, Van Rooyen DRM, Ricks EJ. Provision of antiretroviral therapy for children in Nelson Mandela Bay: Health care professionals' challenges. Afr J Prim Health Care Fam Med 2018; 10:e1-e10. [PMID: 29781680 PMCID: PMC5913768 DOI: 10.4102/phcfm.v10i1.1490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 10/13/2017] [Accepted: 10/25/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The human immunodeficiency virus and/or acquired immune deficiency syndrome (HIV/AIDS) pandemic continues to increase in prevalence worldwide, particularly in South Africa, and includes the often overlooked paediatric population. The provision of paediatric antiretroviral treatment (ART) is as essential for children as for adults, and has numerous obstacles, not least of which is lack of decentralisation of facilities to provide essential treatment. Optimising ART, care and support for HIV-positive children, and their caregivers, at public sector primary health care (PHC) clinics is crucial to improve morbidity and mortality rates in children. AIM To explore the experiences of health care professionals regarding the provision of ART for children at PHC clinics. SETTING The study was conducted in six PHC clinics in Nelson Mandela Bay Health District, Eastern Cape, South Africa. METHODOLOGY The researchers used a qualitative, explorative, descriptive and contextual research design with in-depth interviews. We used non-probability purposive sampling. Data collected were thematically analysed using Creswell's data analysis spiral. We used Lincoln and Guba's model to ensure trustworthiness. Ethical standards were applied. RESULTS Health care professionals experienced numerous challenges, such as lack of resources, need for training, mentoring and debriefing, all related to providing decentralised ART for HIV-positive children at the PHC level. CONCLUSION Capacitation of the health care system, integration of services, competent management and visionary leadership to invoke a collaborative interdisciplinary team approach is required to ensure that HIV is treated as a chronic disease at the PHC clinic level.
Collapse
Affiliation(s)
- Margaret Williams
- Department of Nursing Science, Nelson Mandela Metropolitan University.
| | | | | |
Collapse
|
8
|
Kassa SM. Three-level global resource allocation model for hiv control: A hierarchical decision system approach. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2018; 15:255-273. [PMID: 29161835 DOI: 10.3934/mbe.2018011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Funds from various global organizations, such as, The Global Fund, The World Bank, etc. are not directly distributed to the targeted risk groups. Especially in the so-called third-world-countries, the major part of the fund in HIV prevention programs comes from these global funding organizations. The allocations of these funds usually pass through several levels of decision making bodies that have their own specific parameters to control and specific objectives to achieve. However, these decisions are made mostly in a heuristic manner and this may lead to a non-optimal allocation of the scarce resources. In this paper, a hierarchical mathematical optimization model is proposed to solve such a problem. Combining existing epidemiological models with the kind of interventions being on practice, a 3-level hierarchical decision making model in optimally allocating such resources has been developed and analyzed. When the impact of antiretroviral therapy (ART) is included in the model, it has been shown that the objective function of the lower level decision making structure is a non-convex minimization problem in the allocation variables even if all the production functions for the intervention programs are assumed to be linear.
Collapse
Affiliation(s)
- Semu Mitiku Kassa
- Department of Mathematics and Statistical Sciences, Botswana International University of Science and Technology (BIUST), P/Bag 16, Palapye, Botswana
| |
Collapse
|
9
|
Crux NB, Elahi S. Human Leukocyte Antigen (HLA) and Immune Regulation: How Do Classical and Non-Classical HLA Alleles Modulate Immune Response to Human Immunodeficiency Virus and Hepatitis C Virus Infections? Front Immunol 2017; 8:832. [PMID: 28769934 PMCID: PMC5513977 DOI: 10.3389/fimmu.2017.00832] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 06/30/2017] [Indexed: 12/13/2022] Open
Abstract
The genetic factors associated with susceptibility or resistance to viral infections are likely to involve a sophisticated array of immune response. These genetic elements may modulate other biological factors that account for significant influence on the gene expression and/or protein function in the host. Among them, the role of the major histocompatibility complex in viral pathogenesis in particular human immunodeficiency virus (HIV) and hepatitis C virus (HCV), is very well documented. We, recently, added a novel insight into the field by identifying the molecular mechanism associated with the protective role of human leukocyte antigen (HLA)-B27/B57 CD8+ T cells in the context of HIV-1 infection and why these alleles act as a double-edged sword protecting against viral infections but predisposing the host to autoimmune diseases. The focus of this review will be reexamining the role of classical and non-classical HLA alleles, including class Ia (HLA-A, -B, -C), class Ib (HLA-E, -F, -G, -H), and class II (HLA-DR, -DQ, -DM, and -DP) in immune regulation and viral pathogenesis (e.g., HIV and HCV). To our knowledge, this is the very first review of its kind to comprehensively analyze the role of these molecules in immune regulation associated with chronic viral infections.
Collapse
Affiliation(s)
- Nicole B Crux
- Faculty of Medicine and Dentistry, Department of Dentistry, University of Alberta, Edmonton, AB, Canada.,Faculty of Medicine and Dentistry, Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
| | - Shokrollah Elahi
- Faculty of Medicine and Dentistry, Department of Dentistry, University of Alberta, Edmonton, AB, Canada.,Faculty of Medicine and Dentistry, Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
10
|
Impact of HIV-Status Disclosure on Adherence to Antiretroviral Therapy Among HIV-Infected Children in Resource-Limited Settings: A Systematic Review. AIDS Behav 2017; 21:59-69. [PMID: 27395433 DOI: 10.1007/s10461-016-1481-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pediatric HIV remains a significant global health dilemma, especially in resource-constrained nations. As access to ART increases around the world, areas of concern in pediatric HIV treatment include age-appropriate disclosure of HIV status to children and development of adherence habits over time. This review was conducted to synthesize quantitative associations reported between disclosure and adherence among children living with HIV in resource-limited settings. An electronic database search of PubMed, MEDLINE and Cochrane returned 1348 results after removal of duplicates, 14 of which were found to meet inclusion criteria. Review of these reports showed conflicting results regarding the impact of disclosure on adherence, with 5 showing no association, 4 showing a negative impact of disclosure on adherence, and 5 showing positive benefits of disclosure for adherence habits. Thus, there was no clear consensus on the effect, if any, that disclosure has on medication adherence. Longitudinal, prospective research needs to be conducted to evaluate further impacts that disclosure may have on adherence habits over time, and interventions must be structured to link the two processes together in order to maximize health benefit to the child or adolescent.
Collapse
|
11
|
Differences in virologic and immunologic response to antiretroviral therapy among HIV-1-infected infants and children. AIDS 2016; 30:2835-2843. [PMID: 27603293 DOI: 10.1097/qad.0000000000001244] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Virologic and immunologic responses to antiretroviral treatment (ART) in infants may differ from older children due to immunologic, clinical, or epidemiologic characteristics. METHODS Longitudinal ART responses were modeled and compared in HIV-infected infants and children enrolled in cohorts in Nairobi, Kenya. Participants were enrolled soon after HIV diagnosis, started on ART, and followed for 2 years. Viral load decline was compared between infant and child cohorts using a nonlinear mixed effects model and CD4% reconstitution using a linear mixed effects model. RESULTS Among 121 infants, median age at ART was 3.9 months; among 124 children, median age was 4.8 years. At baseline, viral load was higher among infants than children (6.47 vs. 5.91 log10 copies/ml, P < 0.001). Infants were less likely than children to suppress viral load to less than 250 copies/ml following 6 months of ART (32% infants vs. 73% children, P < 0.0001). CD4% was higher at baseline in infants than children (19 vs. 7.3%, P < 0.001). Older children had more rapid CD4% reconstitution than infants, but failed to catch up to infant CD4%. CONCLUSION Despite substantially higher CD4% at ART initiation, viral suppression was significantly slower among infants than older children. New strategies are needed to optimize infant outcomes on ART.
Collapse
|
12
|
Maternal HIV infection alters the immune balance in the mother and fetus; implications for pregnancy outcome and infant health. Curr Opin HIV AIDS 2016; 11:138-45. [PMID: 26679415 DOI: 10.1097/coh.0000000000000239] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW With the rapid roll-out of combination antiretroviral therapy to prevent mother-to-child transmission of HIV, there is an annual increase in the number of uninfected infants born to HIV-infected women. Although the introduction of combination antiretroviral therapy has vastly improved pregnancy outcome and the health of infants born to HIV-infected women, concerns remain regarding the impact the maternal HIV infection on the pregnancy outcome and the health of HIV-exposed uninfected infants. RECENT FINDINGS Maternal HIV infection is associated with negative pregnancy outcomes such as low birth weight. In addition, an increased susceptibility to infections is reported in HIV-exposed uninfected infants compared with infants born to uninfected women. Studies have shown that HIV-exposure affects the maternal/fetal unit, with increase of proinflammatory cytokine produced by placental cells, as well as altered infant immune responses. These changes could provide the underlying conditions for negative pregnancy outcomes and facilitate mother-to-child transmission of HIV in the infant. Further studies are required to understand the underlying mechanisms and investigate whether these altered infant immune responses persist and have clinical consequences beyond childhood. SUMMARY HIV infection in pregnant women is associated with altered immune responses in HIV-infected women and their offspring with clinical consequences for pregnancy outcome and the HIV-exposed uninfected infant. Further studies are required to address the origin and long-term consequences of prenatal HIV-exposure and subsequent immune activation for infant health.
Collapse
|
13
|
Altfeld M, Bunders MJ. Impact of HIV-1 infection on the feto-maternal crosstalk and consequences for pregnancy outcome and infant health. Semin Immunopathol 2016; 38:727-738. [PMID: 27392971 DOI: 10.1007/s00281-016-0578-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/16/2016] [Indexed: 12/21/2022]
Abstract
Adaptation of the maternal immune system to establish maternal/fetal equilibrium is required for a successful pregnancy. Viral infections, including HIV-1 infection, can alter this maternal/fetal equilibrium, with significant consequences for pregnancy outcome, including miscarriages, impaired fetal growth, and premature delivery. Furthermore, maternal HIV-1 infection has been shown to have a long-term impact on the developing fetal immune system also when the infant is not infected with the virus. In this review, we discuss the consequences of maternal HIV-1 infection and antiretroviral therapy on pregnancy outcome and the health of the uninfected HIV-1-exposed infant.
Collapse
Affiliation(s)
- Marcus Altfeld
- Department of Virus Immunology, Heinrich-Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - Madeleine J Bunders
- Department of Virus Immunology, Heinrich-Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany. .,Department of Experimental Immunology, University of Amsterdam (UvA), Academic Medical Center (AMC), Amsterdam, The Netherlands. .,Emma Childrens Hospital,UvA, AMC, Amsterdam, The Netherlands.
| |
Collapse
|
14
|
Redmond AM, McNamara JF. The road to eliminate mother‐to‐child HIV transmission. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
15
|
|
16
|
Martínez-Bonet M, Puertas MC, Fortuny C, Ouchi D, Mellado MJ, Rojo P, Noguera-Julian A, Muñoz-Fernández MA, Martinez-Picado J. Establishment and Replenishment of the Viral Reservoir in Perinatally HIV-1-infected Children Initiating Very Early Antiretroviral Therapy. Clin Infect Dis 2015; 61:1169-78. [PMID: 26063721 PMCID: PMC4560905 DOI: 10.1093/cid/civ456] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/21/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) generally suppresses the replication of the human immunodeficiency virus type 1 (HIV-1) but does not cure the infection, because proviruses persist in stable latent reservoirs. It has been proposed that low-level proviral reservoirs might predict longer virologic control after discontinuation of treatment. Our objective was to evaluate the impact of very early initiation of cART and temporary treatment interruption on the size of the latent HIV-1 reservoir in vertically infected children. METHODS This retrospective study included 23 perinatally HIV-1-infected children who initiated very early treatment within 12 weeks after birth (n = 14), or early treatment between week 12 and 1 year (n = 9). We measured the proviral reservoir (CD4(+) T-cell-associated HIV-1 DNA) in blood samples collected beyond the first year of sustained virologic suppression. RESULTS There is a strong positive correlation between the time to initiation of cART and the size of the proviral reservoir. Children who initiated cART within the first 12 weeks of life showed a proviral reservoir 6-fold smaller than children initiating cART beyond this time (P < .01). Rapid virologic control after initiation of cART also limits the size of the viral reservoir. However, patients who underwent transient treatment interruptions showed a dramatic increase in the size of the viral reservoir after discontinuation. CONCLUSIONS Initiation of cART during the first 12 weeks of life in perinatally HIV-1-infected children limits the size of the viral reservoir. Treatment interruptions should be undertaken with caution, as they might lead to fast and irreversible replenishment of the viral reservoir.
Collapse
Affiliation(s)
- Marta Martínez-Bonet
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN)
- Spanish HIV HGM BioBank
| | - Maria Carmen Puertas
- AIDS Research Institute IrsiCaixa, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Claudia Fortuny
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues del Llobregat
| | - Dan Ouchi
- AIDS Research Institute IrsiCaixa, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Maria José Mellado
- Servicio de Pediatría Hospitalaria y E. Infecciosas y Tropicales Pediátricas. Hospital Universitario Infantil LA PAZ- H. Carlos III, Madrid
| | - Pablo Rojo
- Servicio de Pediatría. Hospital 12 de Octubre, Madrid
| | - Antoni Noguera-Julian
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues del Llobregat
| | - Ma Angeles Muñoz-Fernández
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN)
- Spanish HIV HGM BioBank
| | - Javier Martinez-Picado
- AIDS Research Institute IrsiCaixa, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
- Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| |
Collapse
|
17
|
Adland E, Paioni P, Thobakgale C, Laker L, Mori L, Muenchhoff M, Csala A, Clapson M, Flynn J, Novelli V, Hurst J, Naidoo V, Shapiro R, Huang KHG, Frater J, Prendergast A, Prado JG, Ndung’u T, Walker BD, Carrington M, Jooste P, Goulder PJR. Discordant Impact of HLA on Viral Replicative Capacity and Disease Progression in Pediatric and Adult HIV Infection. PLoS Pathog 2015; 11:e1004954. [PMID: 26076345 PMCID: PMC4468173 DOI: 10.1371/journal.ppat.1004954] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/13/2015] [Indexed: 11/18/2022] Open
Abstract
HLA class I polymorphism has a major influence on adult HIV disease progression. An important mechanism mediating this effect is the impact on viral replicative capacity (VRC) of the escape mutations selected in response to HLA-restricted CD8+ T-cell responses. Factors that contribute to slow progression in pediatric HIV infection are less well understood. We here investigate the relationship between VRC and disease progression in pediatric infection, and the effect of HLA on VRC and on disease outcome in adult and pediatric infection. Studying a South African cohort of >350 ART-naïve, HIV-infected children and their mothers, we first observed that pediatric disease progression is significantly correlated with VRC. As expected, VRCs in mother-child pairs were strongly correlated (p = 0.004). The impact of the protective HLA alleles, HLA-B*57, HLA-B*58:01 and HLA-B*81:01, resulted in significantly lower VRCs in adults (p<0.0001), but not in children. Similarly, in adults, but not in children, VRCs were significantly higher in subjects expressing the disease-susceptible alleles HLA-B*18:01/45:01/58:02 (p = 0.007). Irrespective of the subject, VRCs were strongly correlated with the number of Gag CD8+ T-cell escape mutants driven by HLA-B*57/58:01/81:01 present in each virus (p = 0.0002). In contrast to the impact of VRC common to progression in adults and children, the HLA effects on disease outcome, that are substantial in adults, are small and statistically insignificant in infected children. These data further highlight the important role that VRC plays both in adult and pediatric progression, and demonstrate that HLA-independent factors, yet to be fully defined, are predominantly responsible for pediatric non-progression.
Collapse
Affiliation(s)
- Emily Adland
- Department of Paediatrics, University of Oxford, Peter Medawar Building for Pathogen Research, Oxford, United Kingdom
| | - Paolo Paioni
- Department of Paediatrics, University of Oxford, Peter Medawar Building for Pathogen Research, Oxford, United Kingdom
| | - Christina Thobakgale
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Leana Laker
- Paediatric Department, Kimberley Hospital, Northern Cape, South Africa
| | - Luisa Mori
- Paediatric Department, Kimberley Hospital, Northern Cape, South Africa
| | - Maximilian Muenchhoff
- Department of Paediatrics, University of Oxford, Peter Medawar Building for Pathogen Research, Oxford, United Kingdom
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Anna Csala
- Department of Paediatrics, University of Oxford, Peter Medawar Building for Pathogen Research, Oxford, United Kingdom
| | - Margaret Clapson
- Department of Paediatric Infectious Diseases, Great Ormond St Hospital for Children, London, United Kingdom
| | - Jacquie Flynn
- Department of Paediatric Infectious Diseases, Great Ormond St Hospital for Children, London, United Kingdom
| | - Vas Novelli
- Department of Paediatric Infectious Diseases, Great Ormond St Hospital for Children, London, United Kingdom
| | - Jacob Hurst
- The Institute for Emerging Infections, The Oxford Martin School, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, Oxford, United Kingdom
- Oxford National Institute of Health Research, Biomedical Research Centre, Oxford, United Kingdom
| | - Vanessa Naidoo
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Roger Shapiro
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Kuan-Hsiang Gary Huang
- The Institute for Emerging Infections, The Oxford Martin School, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, Oxford, United Kingdom
| | - John Frater
- The Institute for Emerging Infections, The Oxford Martin School, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, Oxford, United Kingdom
- Oxford National Institute of Health Research, Biomedical Research Centre, Oxford, United Kingdom
| | - Andrew Prendergast
- Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Julia G. Prado
- AIDS Research Institute IrsiCaixa, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Thumbi Ndung’u
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- The Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard University, Boston, Massachusetts, United States of America
- KwaZulu-Natal Research Institute for Tuberculosis and HIV, University of KwaZulu-Natal, Durban, South Africa
- Max Planck Institute for Infection Biology, Berlin, Germany
| | - Bruce D. Walker
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- The Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard University, Boston, Massachusetts, United States of America
| | - Mary Carrington
- The Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard University, Boston, Massachusetts, United States of America
- Center for Cancer Research, National Cancer Institute, Frederick, Maryland, United States of America
| | - Pieter Jooste
- Paediatric Department, Kimberley Hospital, Northern Cape, South Africa
| | - Philip J. R. Goulder
- Department of Paediatrics, University of Oxford, Peter Medawar Building for Pathogen Research, Oxford, United Kingdom
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Department of Paediatric Infectious Diseases, Great Ormond St Hospital for Children, London, United Kingdom
| |
Collapse
|
18
|
Banks LM, Zuurmond M, Ferrand R, Kuper H. The relationship between HIV and prevalence of disabilities in sub-Saharan Africa: systematic review (FA). Trop Med Int Health 2015; 20:411-29. [PMID: 25495989 DOI: 10.1111/tmi.12449] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To systematically review evidence on the prevalence and risk of disabilities among children and adults living with HIV in sub-Saharan Africa. METHODS Articles were identified from 1980 to June 2013 through searching seven electronic databases. Epidemiological studies conducted in sub-Saharan Africa that explored the association between HIV status and general disability or specific impairments, with or without an HIV-uninfected comparison group, were eligible for inclusion. RESULTS Of 12 867 records initially identified, 61 papers were deemed eligible for inclusion. The prevalence of disability was high across age groups, impairment types and study locations. Furthermore, 73% of studies using an HIV- comparator found significantly lower levels of functioning in people living with HIV (PLHIV). By disability type, the results were as follows: (i) for studies measuring physical impairments (n = 14), median prevalence of limitations in mobility and motor function among PLHIV was 25.0% (95% CI: 21.8-28.2%). Five of eight comparator studies found significantly reduced functioning among PLHIV; for arthritis, two of three studies which used an HIV- comparison group found significantly increased prevalence among PLHIV; (ii) for sensory impairment studies (n = 17), median prevalence of visual impairment was 11.2% (95%CI: 9.5-13.1%) and hearing impairment was 24.1% (95%CI: 19.2-29.0%) in PLHIV. Significantly increased prevalence among PLHIV was found in one of four (vision) and three of three studies (hearing) with comparators; (iii) for cognitive impairment in adults (n = 30), median prevalence for dementia was 25.3% (95% CI: 22.0-28.6%) and 40.9% (95% CI: 37.7-44.1%) for general cognitive impairment. Across all types of cognitive impairment, twelve of fourteen studies found a significant detrimental effect of HIV infection; (iv) for developmental delay in children with HIV (n = 20), median prevalence of motor delay was 67.7% (95% CI: 62.2-73.2%). All nine studies that included a comparator found a significant difference between PLHIV and controls; for cognitive development and global delay, a significant detrimental effect of HIV was found in five of six and one of two studies, respectively. In the nine cohort studies comparing vertically infected and uninfected children, eight showed a significant gap in development over time in children with HIV. Finally, fifteen of thirty-one (48%) studies found a statistically significant dose-response relationship between indicators of disease progression (CD4 or WHO stage) and disability. CONCLUSIONS HIV is widespread in sub-Saharan Africa and the evidence suggests that it is linked to disabilities, affecting a range of body structures and functions. More research is needed to better understand the implications of HIV-related disability for individuals, their families as well as those working in the fields of disability and HIV so that appropriate interventions can be developed.
Collapse
Affiliation(s)
- Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | |
Collapse
|
19
|
Kitt H. The importance of effectively combating HIV/AIDS through tackling the social aspects of the pandemic post-2015. Med J Aust 2014; 201:424-5. [PMID: 25296070 DOI: 10.5694/mja14.00830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 08/07/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Heather Kitt
- School of Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK.
| |
Collapse
|
20
|
Predicting mortality in HIV-infected children initiating highly active antiretroviral therapy in a resource-deprived setting. Pediatr Infect Dis J 2014; 33:1148-55. [PMID: 24945879 DOI: 10.1097/inf.0000000000000454] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND While highly active antiretroviral therapy (HAART) programs have been scaled up across sub-Saharan Africa, no prognostic models for the prediction of mortality risk for children initiating HAART are widely available. Current clinical prediction tools for human immunodeficiency virus (HIV)-infected children are derived from pre-HAART data and therefore cannot predict mortality for children initiating HAART. The purpose of this study was to develop a mortality risk scoring system for HIV-infected children beginning HAART in a resource-deprived setting. METHODS Observational data from HIV-infected children initiating HAART from December 2004 through March 2012 in Kinshasa, Democratic Republic of Congo, were analyzed. Cox proportional hazards models were constructed to assess associations between demographic and clinical characteristics at the time of HAART initiation and mortality. Each child received a model-based risk score predicting mortality after HAART initiation. RESULTS By 31 March 2012, 1010 children had started HAART. One hundred three children (10.2%) died at a median of 5.3 months post-HAART initiation, yielding a mortality rate of 3.4 deaths per 100 child-years. The final mortality prediction model included undernutrition, low CD4 count, HIV symptoms, and low total lymphocyte count. These factors were highly predictive of mortality in the study population (C statistic = 0.79) and performed well when applied to the validation population (C statistic = 0.77). CONCLUSIONS Mortality among children starting HAART in resource-deprived settings can be predicted using a simple scoring system incorporating several readily available factors. Identifying predictors of mortality will help clinicians target modifiable risk factors, such as undernutrition, which are not directly addressed by HAART.
Collapse
|
21
|
Westerlund E, Jerene D, Mulissa Z, Hallström I, Lindtjørn B. Pre-ART retention in care and prevalence of tuberculosis among HIV-infected children at a district hospital in southern Ethiopia. BMC Pediatr 2014; 14:250. [PMID: 25280967 PMCID: PMC4287195 DOI: 10.1186/1471-2431-14-250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 09/23/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The Ethiopian epidemic is currently on the wane. However, the situation for infected children is in some ways lagging behind due to low treatment coverage and deficient prevention of mother-to-child transmission. Too few studies have examined HIV infected children presenting to care in low-income countries in general. Considering the presence of local variations in the nature of the epidemic a study in Ethiopia could be of special value for the continuing fight against HIV. The aim of this study is to describe the main characteristics of children with HIV presenting to care at a district hospital in a resource-limited area in southern Ethiopia. The aim was also to analyse factors affecting pre-ART loss to follow-up, time to ART-initiation and disease stage upon presentation. METHODS This was a prospective cohort study. The data analysed were collected in 2009 for the period January 2003 through December 2008 at Arba Minch Hospital and additional data on the ART-need in the region were obtained from official reports. RESULTS The pre-ART loss to follow-up rate was 29.7%. Older children (10-14 years) presented in a later stage of their disease than younger children (76.9% vs. 45.0% in 0-4 year olds, chi-square test, χ2 = 8.8, P = 0.01). Older girls presented later than boys (100.0% vs. 57.1%, Fisher's exact test, P = 0.02). Children aged 0-4 years were more likely to be lost to follow-up (40.0 vs. 21.8%, chi-square test, χ2 = 5.4, P = 0.02) and had a longer time to initiate ART (Cox regression analysis, HR: 0.50, 95% CI: 0.25-0.97, P = 0.04, controlling for sex, place of residence, enrollment phase and WHO clinical stage upon presentation). Neither sex was overrepresented in the sample. Tuberculosis prevalence upon presentation and previous history of tubercolosis were 14.5% and 8% respectively. CONCLUSIONS The loss to follow-up is alarmingly high and children present too late. Further research is needed to explore specific causes and possible solutions.
Collapse
Affiliation(s)
| | - Degu Jerene
- />Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- />Management Sciences for Health-HEAL TB Project, Addis Ababa, Ethiopia
| | - Zewdie Mulissa
- />Columbia University- International center for AIDS care and treatment program, Addis Ababa office, Addis Ababa, Ethiopia
| | | | - Bernt Lindtjørn
- />Centre for International Health, University of Bergen, Bergen, Norway
| |
Collapse
|
22
|
Chabikuli ON, Gwarzo U, Olufunso A, Reidpath D, Allotey P, Ibrahim M, Hamelmann C. Closing the prevention of mother-to-child transmission gap in Nigeria: an evaluation of service improvement intervention in Nigeria. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2013.10874310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- ON Chabikuli
- Family Health International 360; Department of Family Medicine, Medunsa
| | - U Gwarzo
- Family Health International 360, Nigeria
| | - A Olufunso
- Monitoring and Evaluation, Family Health International 360, Nigeria
| | - D Reidpath
- Jeffrey Cheah School of Medicine and Health Services, Monash University, Malaysia
| | - P Allotey
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia
| | - M Ibrahim
- Family Health International 360, Nigeria
| | - C Hamelmann
- Regional Practice Leader HIV, Health and Development, Europe and Central Asia, United Nations Development Program
| |
Collapse
|
23
|
Arage G, Tessema GA, Kassa H. Adherence to antiretroviral therapy and its associated factors among children at South Wollo Zone Hospitals, Northeast Ethiopia: a cross-sectional study. BMC Public Health 2014; 14:365. [PMID: 24735561 PMCID: PMC4002537 DOI: 10.1186/1471-2458-14-365] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 04/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor adherence to antiretroviral therapy negatively affects the suppression of viral replication. It increases risks of drug resistance, treatment failure, Acquired Immuno Deficiency Syndrome (AIDS)-related morbidity and mortality among children. This study assessed the level of adherence to antiretroviral therapy and its associated factors among children at hospitals in South Wollo Zone, Northeast Ethiopia. METHODS An institution-based cross-sectional study was conducted among Human Immunodeficiency Virus (HIV)-infected children in April 2013. A total of 464 children who were taking Antiretroviral Therapy (ART) in the hospitals were included. Data were collected using pretested and structured questionnaires using a face-to-face interview method. Descriptive and summary statistics were employed. Bivariate and multiple logistic regressions were computed. Odds ratios and their 95% confidence intervals were computed to determine the level of significance. RESULTS Of the 464 study samples, 440 children with their caregivers were included in the final analysis. A total of 78.6% of the caregivers reported that their children were adherent to antiretroviral therapy in the month prior to the interview. Caregivers' knowledge about antiretroviral treatment [AOR = 2.72(95% CI: 1.82, 5.39)], no current substance use of the caregivers [Adjusted Odds Ratio (AOR) = 2.21(95% Confidence Interval (CI): 1.34, 7.13)], proximity to the health care facility [AOR = 2.31(95% CI: 1.94, 4.63)], if the child knows HIV-positive status [AOR = 3.47(95% CI: 2.10, 6.81)] and caregiver's educational status [AOR = 0.59(95% CI: 0.21, 0.82)] were significantly and independently associated with adherence of children to antiretroviral therapy. CONCLUSION Adherence of antiretroviral therapy in this study was comparable to other studies conducted in developing countries. Caregiver's knowledge about antiretroviral therapy, no current use of substances, close proximity to health facilities, and letting child's know his/her HIV status improves adherence to antiretroviral therapy. Health care providers should educate caregivers about antiretroviral therapy and encourage HIV positive status disclosure to the child.
Collapse
Affiliation(s)
| | - Gizachew Assefa Tessema
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | | |
Collapse
|
24
|
Chaillon A, Samleerat T, Zoveda F, Ballesteros S, Moreau A, Ngo-Giang-Huong N, Jourdain G, Gianella S, Lallemant M, Depaulis F, Barin F. Estimating the timing of mother-to-child transmission of the human immunodeficiency virus type 1 using a viral molecular evolution model. PLoS One 2014; 9:e90421. [PMID: 24717647 PMCID: PMC3981669 DOI: 10.1371/journal.pone.0090421] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 01/30/2014] [Indexed: 11/19/2022] Open
Abstract
Background Mother-to-child transmission (MTCT) is responsible for most pediatric HIV-1 infections worldwide. It can occur during pregnancy, labor, or breastfeeding. Numerous studies have used coalescent and molecular clock methods to understand the epidemic history of HIV-1, but the timing of vertical transmission has not been studied using these methods. Taking advantage of the constant accumulation of HIV genetic variation over time and using longitudinally sampled viral sequences, we used a coalescent approach to investigate the timing of MTCT. Materials and Methods Six-hundred and twenty-two clonal env sequences from the RNA and DNA viral population were longitudinally sampled from nine HIV-1 infected mother-and-child pairs [range: 277–1034 days]. For each transmission pair, timing of MTCT was determined using a coalescent-based model within a Bayesian statistical framework. Results were compared with available estimates of MTCT timing obtained with the classic biomedical approach based on serial HIV DNA detection by PCR assays. Results Four children were infected during pregnancy, whereas the remaining five children were infected at time of delivery. For eight out of nine pairs, results were consistent with the transmission periods assessed by standard PCR-based assay. The discordance in the remaining case was likely confused by co-infection, with simultaneous introduction of multiple maternal viral variants at the time of delivery. Conclusions The study provided the opportunity to validate the Bayesian coalescent approach that determines the timing of MTCT of HIV-1. It illustrates the power of population genetics approaches to reliably estimate the timing of transmission events and deepens our knowledge about the dynamics of viral evolution in HIV-infected children, accounting for the complexity of multiple transmission events.
Collapse
Affiliation(s)
- Antoine Chaillon
- Université François-Rabelais, Institut National de la Santé et de la Recherche Médicale - Unité 966 et Laboratoire de Virologie, Centre Hopsitalier Universitaire Bretonneau, Tours, France
- University of California San Diego, Department of Pathology, San Diego, California, United States of America
- * E-mail:
| | - Tanawan Samleerat
- Université François-Rabelais, Institut National de la Santé et de la Recherche Médicale - Unité 966 et Laboratoire de Virologie, Centre Hopsitalier Universitaire Bretonneau, Tours, France
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Faustine Zoveda
- Laboratoire Ecologie et Evolution, Centre National de la Recherche Scientifique - Unité Mixte de Recherche 7625- Ecole Normale Supérieure, Paris, France
| | - Sébastien Ballesteros
- Laboratoire Ecologie et Evolution, Centre National de la Recherche Scientifique - Unité Mixte de Recherche 7625- Ecole Normale Supérieure, Paris, France
| | - Alain Moreau
- Université François-Rabelais, Institut National de la Santé et de la Recherche Médicale - Unité 966 et Laboratoire de Virologie, Centre Hopsitalier Universitaire Bretonneau, Tours, France
| | - Nicole Ngo-Giang-Huong
- Institut de Recherche pour le Développement, Chiang Mai, Thailand
- Harvard School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts, United States of America
| | - Gonzague Jourdain
- Institut de Recherche pour le Développement, Chiang Mai, Thailand
- Harvard School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts, United States of America
| | - Sara Gianella
- University of California San Diego, Department of Pathology, San Diego, California, United States of America
| | - Marc Lallemant
- Institut de Recherche pour le Développement, Chiang Mai, Thailand
- Harvard School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts, United States of America
| | - Frantz Depaulis
- Laboratoire Ecologie et Evolution, Centre National de la Recherche Scientifique - Unité Mixte de Recherche 7625- Ecole Normale Supérieure, Paris, France
| | - Francis Barin
- Université François-Rabelais, Institut National de la Santé et de la Recherche Médicale - Unité 966 et Laboratoire de Virologie, Centre Hopsitalier Universitaire Bretonneau, Tours, France
| |
Collapse
|
25
|
Callens SFJ, McKellar MS, Colebunders R. HIV care and treatment for children in resource-limited settings. Expert Rev Anti Infect Ther 2014; 6:181-90. [DOI: 10.1586/14787210.6.2.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
26
|
Abstract
BACKGROUND There is scant data on young children receiving protease inhibitor-based therapy in real-life resource-limited settings and on the optimal timing of therapy among children who survive infancy. Our aim was to evaluate outcomes at the Hospital del Niño, Panama, where children have been routinely treated with lopinavir/ritonavir (LPV/r)-based therapy since 2002. METHODS Retrospective cohort analysis of all HIV-infected children enrolled in care between January 1, 1991, and June 1, 2011. Kaplan-Meier method and Cox proportional hazards regression were used to evaluate death, virologic suppression and virologic rebound. RESULTS Of 399 children contributing 1944 person-years of follow-up, 254 (63.7%) were treated with LPV/r and 94 (23.6%) were never treated with antiretrovirals (ARVs). Among infants, improved survival was associated with male gender (hazard rate of death[HRdeath] 0.54, 95% confidence interval [CI]: 0.32-0.92) and treatment with highly active antiretroviral therapy (HRdeath 0.32, 95% CI: 0.12-0.83), whereas residence outside of Panama City was associated with poorer survival (HRdeath 1.72, 95% CI: 1.01-2.94). Among children who survived to 1 year of age without exposure to ARVs, LPV/r-based therapy improved survival (HRdeath 0.07, 95% CI: 0.01-0.33). Virologic suppression was achieved in 42.1%, 70.5% and 85.1% by 12, 24 and 60 months of follow-up among children treated with LPV/r. Virologic suppression was not associated with prior ARV exposure or age at initiation of therapy but was associated with residence outside of Panama City (HR suppression 1.93, 95% CI: 1.19-3.14). Patients with a baseline viral load >100,000 copies/mL were less likely to achieve suppression (HR suppression 0.37, 95% CI: 0.21-0.66). No children who achieved virologic suppression after initiating LPV/r died. CONCLUSIONS LPV/r-based therapy improved survival not only in infants but also in children over 1 year of age. Age at initiation of LPV/r-based therapy or prior ARVs did not impact virologic outcomes.
Collapse
|
27
|
King CC, Ellington SR, Kourtis AP. The role of co-infections in mother-to-child transmission of HIV. Curr HIV Res 2013; 11:10-23. [PMID: 23305198 PMCID: PMC4411038 DOI: 10.2174/1570162x11311010003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/11/2012] [Accepted: 12/14/2012] [Indexed: 01/27/2023]
Abstract
In HIV-infected women, co-infections that target the placenta, fetal membranes, genital tract, and breast tissue, as well as systemic maternal and infant infections, have been shown to increase the risk for mother-to-child transmission of HIV (MTCT). Active co-infection stimulates the release of cytokines and inflammatory agents that enhance HIV replication locally or systemically and increase tissue permeability, which weakens natural defenses to MTCT. Many maternal or infant co-infections can affect MTCT of HIV, and particular ones, such as genital tract infection with herpes simplex virus, or systemic infections such as hepatitis B, can have substantial epidemiologic impact on MTCT. Screening and treatment for co-infections that can make infants susceptible to MTCT in utero, peripartum, or postpartum can help reduce the incidence of HIV infection among infants and improve the health of mothers and infants worldwide.
Collapse
Affiliation(s)
- Caroline C King
- Division of Reproductive Health, NCCDPHP, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS-K34, Atlanta, GA 30341, USA.
| | | | | |
Collapse
|
28
|
Bunders MJ, Frinking O, Scherpbier HJ, van Arnhem LA, van Eck-Smit BL, Kuijpers TW, Zwinderman AH, Reiss P, Pajkrt D. Bone mineral density increases in HIV-infected children treated with long-term combination antiretroviral therapy. Clin Infect Dis 2012; 56:583-6. [PMID: 23097583 DOI: 10.1093/cid/cis917] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The long-term treatment of human immunodeficiency virus (HIV)-infected children with combination antiretroviral therapy (cART) requires assessment of potential adverse effects, such as osteoporosis. Longitudinal data on bone mineral density (BMD) in HIV-infected children showed that cumulative treatment with cART had a positive impact on BMD over time.
Collapse
Affiliation(s)
- Madeleine J Bunders
- Department of Paediatric Immunology, Haematology, and Infectious Diseases, Emma Children Hospital, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Workneh G, Scherzer L, Kirk B, Draper HR, Anabwani G, Wanless RS, Jibril H, Gaetsewe N, Thuto B, Tolle MA. Evaluation of the effectiveness of an outreach clinical mentoring programme in support of paediatric HIV care scale-up in Botswana. AIDS Care 2012; 25:11-9. [PMID: 22533352 DOI: 10.1080/09540121.2012.674096] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Clinical mentoring by providers skilled in HIV management has been identified as a cornerstone of scaling-up antiretroviral treatment in Africa, particularly in settings where expertise is limited. However, little data exist on its effectiveness and impact on improving the quality-of-care and clinical outcomes, especially for HIV-infected children. Since 2008, the Botswana-Baylor Children's Clinical Centre of Excellence (COE) has operated an outreach mentoring programme at clinical sites around Botswana. This study is a retrospective review of 374 paediatric charts at four outreach mentoring sites (Mochudi, Phutadikobo, Molepolole and Thamaga) evaluating the effectiveness of the programme as reflected in a number of clinically-relevant areas. Charts from one visit prior to initiation of mentoring and from one visit after approximately one year of mentoring were assessed for statistically-significant differences (p<0.05) in the documentation of clinically-relevant indicators. Mochudi showed notable improvements in all indicators analysed, with particular improvements in documentation of pill count, viral load (VL) results, correct laboratory monitoring and correct antiretroviral therapy (ART) dosing (p<0.0001, p<0.0001, p<0.0001 and p<0.0001, respectively). Broad and substantial improvements were also seen in Molepolole, with the most improvement in disclosure documentation of all four sites. At Thamaga, improvements were restricted to CD4 documentation (p<0.001), recent VL and documented pill count (p<0.05 and p<0.05, respectively). Phuthadikobo showed the least amount of improvement across indicators, with only VL documentation and correct ART dosing showing statistically-significant improvements (p<0.05 and p<0.0001, respectively). These findings suggest that clinical mentoring may assist improvements in a number of important areas, including ART dosing and monitoring; adherence assessment and assurance; and disclosure. Clinical mentoring may be a valuable tool in scale-up of quality paediatric HIV care-and-treatment outside specialised centres. Further study will help refine approaches to clinical mentoring, including assuring mentoring translates into improved clinical outcomes for HIV-infected children.
Collapse
Affiliation(s)
- Gelane Workneh
- Botswana-Baylor Children's Clinical Centre of Excellence, Princess Marina Hospital, Gaborone, Botswana
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Suboptimal immune reconstitution in vertically HIV infected children: a view on how HIV replication and timing of HAART initiation can impact on T and B-cell compartment. Clin Dev Immunol 2012; 2012:805151. [PMID: 22550537 PMCID: PMC3328919 DOI: 10.1155/2012/805151] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/21/2011] [Accepted: 12/10/2011] [Indexed: 11/18/2022]
Abstract
Today, HIV-infected children who have access to treatment face a chronic rather than a progressive and fatal disease. As a result, new challenges are emerging in the field. Recent lines of evidence outline several factors that can differently affect the ability of the immune system to fully reconstitute and to mount specific immune responses in children receiving HAART. In this paper, we review the underlying mechanisms of immune reconstitution after HAART initiation among vertically HIV-infected children analyzing the possible causes of suboptimal responses.
Collapse
|
31
|
Long-term impact of the Kenya postelection crisis on clinic attendance and medication adherence for HIV-infected children in western Kenya. J Acquir Immune Defic Syndr 2012; 59:199-206. [PMID: 22027872 DOI: 10.1097/qai.0b013e31823b4448] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kenya experienced a political and humanitarian crisis after presidential elections on December 27, 2007. We sought to describe both the immediate and long-term impact of this conflict for HIV-infected children in western Kenya. METHODS We conducted a retrospective study of a cohort of these children for 3 periods: period 1, before the election (October 26, 2007, to December 25, 2007); period 2, immediately after the election (December 26, 2007, to April 15, 2008); and period 3, long-term postelection (April 16, 2008, to December 31, 2008). Two outcome variables of loss-to-follow-up (LTFU) were assessed: initial LTFU and complete LTFU. We assessed clinic adherence by evaluating the difference between actual visits and expected visits. Among children on antiretroviral therapy (ART), we assessed overall medication adherence and changes in medication adherence. RESULTS Two thousand five hundred forty-nine HIV-infected children <14 years were seen in period 1. Children on ART had less initial LTFU (3.0% compared with 5.1%, P < 0.01) and less complete LTFU (2.6% compared with 6.8%, P < 0.001) than children not on ART. For children not on ART, clinic adherence improved in period 3 compared with period 2. For children on ART with a more strict measure of clinic adherence, clinic adherence declined over time. Orphans had better clinic adherence than nonorphans. Among children on ART, there were few demographic differences when comparing medication adherence between time. CONCLUSIONS HIV-infected children are at risk for disruptions in clinic follow-up and medication adherence after a humanitarian crisis. Individual and contextual factors moderate the effects of these disruptions.
Collapse
|
32
|
Jordan JA, Ibe CO, Moore MS, Host C, Simon GL. Evaluation of a manual DNA extraction protocol and an isothermal amplification assay for detecting HIV-1 DNA from dried blood spots for use in resource-limited settings. J Clin Virol 2012; 54:11-4. [PMID: 22293626 DOI: 10.1016/j.jcv.2012.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 01/05/2012] [Accepted: 01/09/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND In resource-limited settings (RLS) dried blood spots (DBS) are collected on infants and transported through provincial laboratories to a central facility where HIV-1 DNA PCR testing is performed using specialized equipment. Implementing a simpler approach not requiring such equipment or skilled personnel could allow the more numerous provincial laboratories to offer testing, improving turn-around-time to identify and treat infected infants sooner. OBJECTIVES Assess performances of a manual DNA extraction method and helicase-dependent amplification (HDA) assay for detecting HIV-1 DNA from DBS. STUDY DESIGN 60 HIV-1 infected adults were enrolled, blood samples taken and DBS made. DBS extracts were assessed for DNA concentration and beta globin amplification using PCR and melt-curve analysis. These same extracts were then tested for HIV-1 DNA using HDA and compared to results generated by PCR and pyrosequencing. Finally, HDA limit of detection (LOD) studies were performed using DBS extracts prepared with known numbers of 8E5 cells. RESULTS The manual extraction protocol consistently yielded high concentrations of amplifiable DNA from DBS. LOD assessment demonstrated HDA detected ∼470 copies/ml of HIV-1 DNA extracts in 4/4 replicates. No statistical difference was found using the McNemar's test when comparing HDA to PCR for detecting HIV-1 DNA from DBS. CONCLUSIONS Using just a magnet, heat block and pipettes, the manual extraction protocol and HDA assay detected HIV-1 DNA from DBS at levels that would be useful for early infant diagnosis. Next steps will include assessing HDA for non-B HIV-1 subtypes recognition and comparison to Roche HIV-1 DNA v1.5 PCR assay.
Collapse
Affiliation(s)
- Jeanne A Jordan
- The George Washington University, School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Washington, DC 20037, USA.
| | | | | | | | | |
Collapse
|
33
|
Goulder PJR, Prendergast AJ. Approaches towards avoiding lifelong antiretroviral therapy in paediatric HIV infection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 719:25-37. [PMID: 22125032 DOI: 10.1007/978-1-4614-0204-6_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
34
|
de Moraes-Pinto MI. Interaction between pediatric HIV infection and measles. Future Virol 2011. [DOI: 10.2217/fvl.11.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Infections by measles virus and by HIV cause a state of immunodeficiency in the host. While measles virus leads to a transient immunodeficiency with depression of cellular mediated immunity, natural HIV infection leads to a progressive immunodeficiency of both humoral and cellular immunity. This review will focus on the interaction between HIV and measles virus in pediatric patients. Different scenarios of virus interaction will be dissected and their implications for a practical approach in terms of the individual patient and strategies to eliminate measles virus will be discussed.
Collapse
Affiliation(s)
- Maria Isabel de Moraes-Pinto
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Federal University of Sao Paulo, Rua Pedro de Toledo, 781, 9 andar, 04039–32 Sao Paulo SP, Brazil
| |
Collapse
|
35
|
Taylor BS, Hunt G, Abrams EJ, Coovadia A, Meyers T, Sherman G, Strehlau R, Morris L, Kuhn L. Rapid development of antiretroviral drug resistance mutations in HIV-infected children less than two years of age initiating protease inhibitor-based therapy in South Africa. AIDS Res Hum Retroviruses 2011; 27:945-56. [PMID: 21345162 PMCID: PMC3161115 DOI: 10.1089/aid.2010.0205] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Data on the development of antiretroviral drug resistance in HIV-1-infected children receiving protease inhibitor (PI)-based antiretroviral therapy (ART) are limited. We examined antiretroviral resistance among a cohort of 323 South African HIV-infected children <2 years old exposed to nevirapine for prevention of mother-to-child transmission. Ritonavir (RTV) was used initially for 138 children who were <6 months old or receiving antimycobacterial therapy; otherwise children received lopinavir/ritonavir (LPV/r)-based ART. HIV-1 population sequencing of the pol gene was conducted on all pretreatment samples and on posttreatment samples for children who did not achieve HIV-1 plasma RNA <400 copies/ml by 52 weeks. Among children in the cohort, 38 died, 22 had <24 weeks follow-up, 209 achieved virologic suppression, and 54 did not. Of 41 children without virologic suppression with posttreatment HIV genotype data available, major resistance mutations were found in 32 (78%): 14 (36%) had PI mutations including V82A, M46I, and L90M; 29 (71%) had M184V/I; and three had NNRTI mutations (K103N, Y181C, and G190A). Among the children who did not achieve virologic suppression, none of the seven children treated exclusively with LPV/r developed PI-related mutations, compared with 14 of 32 (44%) who received RTV-based regimens (p=0.036); PI genotypes were unavailable for two children. Seventy-eight percent of children without virologic suppression developed resistance mutations that impact second-line ART options. Only children who received RTV-based ART developed major PI-related resistance mutations, and use of this regimen should be avoided.
Collapse
Affiliation(s)
- Barbara S. Taylor
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas and College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
| | - Gillian Hunt
- AIDS Research Unit, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Elaine J. Abrams
- International Center for AIDS Programs, Mailman School of Public Health, Columbia University, New York, New York
| | - Ashraf Coovadia
- Empilweni Services and Research Unit, Rahima Moosa Mothers and Children Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Tammy Meyers
- Harriet Shezi Clinic, Chris Hani Baragwanath Hospital, Enhancing Childhood HIV Outcomes (ECHO), University of the Witwatersrand, Johannesburg, South Africa
| | - Gayle Sherman
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, and National Health Laboratory Service, Johannesburg, South Africa
| | - Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mothers and Children Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Lynn Morris
- AIDS Research Unit, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| |
Collapse
|
36
|
Thobakgale CF, Streeck H, Mkhwanazi N, Mncube Z, Maphumulo L, Chonco F, Prendergast A, Tudor-Williams G, Walker BD, Goulder PJ, Altfeld M, Ndung'u T. Short communication: CD8(+) T cell polyfunctionality profiles in progressive and nonprogressive pediatric HIV type 1 infection. AIDS Res Hum Retroviruses 2011; 27:1005-12. [PMID: 21288139 DOI: 10.1089/aid.2010.0227] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pediatric HIV-1 infection is characterized by rapid disease progression and without antiretroviral therapy (ART), more than 50% of infected children die by the age of 2 years. However, a small subset of infected children progresses slowly to disease in the absence of ART. This study aimed to identify functional characteristics of HIV-1-specific T cell responses that distinguish children with rapid and slow disease progression. Fifteen perinatally HIV-infected children (eight rapid and seven slow progressors) were longitudinally studied to monitor T cell polyfunctionality. HIV-1-specific interferon (IFN)-γ(+) CD8(+) T cell responses gradually increased over time but did not differ between slow and rapid progressors. However, polyfunctional HIV-1-specific CD8(+) T cell responses, as assessed by the expression of four functions (IFN-γ, CD107a, TNF-α, MIP-1β), were higher in slow compared to rapid progressors (p=0.05) early in infection, and was associated with slower subsequent disease progression. These data suggest that the quality of the HIV-specific CD8(+) T cell response is associated with the control of disease in children as has been shown in adult infection.
Collapse
Affiliation(s)
- Christina F. Thobakgale
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Hendrik Streeck
- Ragon Institute of MGH, MIT and Harvard University, Charlestown, Massachusetts
| | - Nompumelelo Mkhwanazi
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Zenele Mncube
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Lungile Maphumulo
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Fundisiwe Chonco
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Prendergast
- Department of Paediatrics, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, United Kingdom
| | - Gareth Tudor-Williams
- Department of Paediatrics, Division of Medicine, Imperial College, London, United Kingdom
| | - Bruce D. Walker
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Ragon Institute of MGH, MIT and Harvard University, Charlestown, Massachusetts
- Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - Philip J.R. Goulder
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Department of Paediatrics, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, United Kingdom
| | - Marcus Altfeld
- Ragon Institute of MGH, MIT and Harvard University, Charlestown, Massachusetts
| | - Thumbi Ndung'u
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
37
|
The PEDVAC trial: Preliminary data from the first therapeutic DNA vaccination in HIV-infected children. Vaccine 2011; 29:6810-6. [DOI: 10.1016/j.vaccine.2010.12.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
38
|
Kiser JJ, Rutstein RM, Samson P, Graham B, Aldrovandi G, Mofenson LM, Smith E, Schnittman S, Fenton T, Brundage RC, Fletcher CV. Atazanavir and atazanavir/ritonavir pharmacokinetics in HIV-infected infants, children, and adolescents. AIDS 2011; 25:1489-96. [PMID: 21610486 PMCID: PMC3177533 DOI: 10.1097/qad.0b013e328348fc41] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the pharmacokinetics of atazanavir (ATV) and ritonavir-boosted ATV (ATV/r) in children aged 91 days to 21 years. DESIGN A phase I/II, open-label, multicenter study of once-daily ATV and ATV/r as part of combination antiretroviral treatment in HIV-infected treatment-experienced and treatment-naive children. SETTING Sites in the United States and South Africa. PARTICIPANTS One hundred and ninety-five children enrolled; 172 had evaluable ATV pharmacokinetics on day 7. INTERVENTION Children were entered in age, dose, and formulation (powder or capsule) cohorts. Intensive pharmacokinetic sampling occurred 7 days after starting ATV. ATV doses were increased or decreased if the 24-h area under the concentration time curves (AUC0-24hr) were less than 30 or more than 90 μg × h/ml, respectively. MAIN OUTCOMES Cohorts satisfied protocol-defined pharmacokinetic criteria if the median ATV AUC0-24hr was 60 μg × h/ml or less, and AUC0-24hr and ATV concentrations 24-h postdose (C24) were more than 30 μg × h/ml and at least 60 ng/ml, respectively, in at least 80% of the children, with no individual AUC0-24hr less than 15 μg × h/ml. RESULTS Unboosted ATV capsules satisfied pharmacokinetic criteria at a dose of 520 mg/m for those aged more than 2 to 13 years or less and 620 mg/m for those aged more than 13 to 21 years or less. ATV/r capsules satisfied criteria at a dose of 205 mg/m for those aged more than 2 to 21 years or less. ATV/r powder satisfied criteria at a dose of 310 mg/m for those aged more than 2 to 13 years or less, but pharmacokinetics in those aged 2 years or less were highly variable. CONCLUSION Body surface area-determined doses of ATV capsules and of ATV/r powder and capsules provide ATV exposures in children of more than 2 years that approximate concentrations in adults receiving ATV/r.
Collapse
Affiliation(s)
| | | | | | - Bobbie Graham
- Frontier Science Technology Research Foundation, Amherst, NY
| | | | - Lynne M. Mofenson
- Pediatric, Adolescent and Maternal AIDS Branch, NICHD, NIH, Bethesda, MD
| | | | | | | | | | | |
Collapse
|
39
|
Zanoni BC, Phungula T, Zanoni HM, France H, Feeney ME. Risk factors associated with increased mortality among HIV infected children initiating antiretroviral therapy (ART) in South Africa. PLoS One 2011; 6:e22706. [PMID: 21829487 PMCID: PMC3146475 DOI: 10.1371/journal.pone.0022706] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 07/05/2011] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To identify demographic and clinical risk factors associated with mortality after initiation of antiretroviral therapy (ART) in a cohort of human immunodeficiency (HIV) infected children in KwaZulu-Natal, South Africa. METHODS We performed a retrospective cohort study of 537 children initiating antiretroviral therapy at McCord Hospital in KwaZulu-Natal, South Africa. Data were extracted from electronic medical records and risk factors associated with mortality were assessed using Cox regression analysis. RESULTS Overall there were 47 deaths from the cohort of 537 children initiating ART with over 991 child-years of follow-up (median 22 months on ART), yielding a mortality rate of 4.7 deaths per 100 child years on ART. Univariate analysis indicated that mortality was significantly associated with lower weight-for-age Z-score (p<0.0001), chronic diarrhea (p = 0.0002), lower hemoglobin (p = 0.002), age <3 years (p = 0.003), and CD4% <10% (p = 0.005). The final multivariable Cox proportional hazards mortality model found age less than 3 years (p = 0.004), CD4 <10% (p = 0.01), chronic diarrhea (p = 0.03), weight-for-age Z-score (<0.0001) and female gender as a covariate varying with time (p = 0.03) all significantly associated with mortality. CONCLUSION In addition to recognized risk factors such as young age and advanced immunosuppression, we found female gender to be significantly associated with mortality in this pediatric ART cohort. Future studies are needed to determine whether intrinsic biologic differences or socio-cultural factors place female children with HIV at increased risk of death following initiation of ART.
Collapse
Affiliation(s)
- Brian C. Zanoni
- The Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard, Charlestown, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Sinikithemba Clinic and Philani Program, McCord Hospital, Durban, South Africa
| | - Thuli Phungula
- Sinikithemba Clinic and Philani Program, McCord Hospital, Durban, South Africa
| | - Holly M. Zanoni
- Sinikithemba Clinic and Philani Program, McCord Hospital, Durban, South Africa
| | - Holly France
- Sinikithemba Clinic and Philani Program, McCord Hospital, Durban, South Africa
| | - Margaret E. Feeney
- The Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard, Charlestown, Massachusetts, United States of America
- Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
| |
Collapse
|
40
|
Dearborn JL, Lewis J, Mino GP. Preventing mother-to-child transmission in Guayaquil, Ecuador: HIV knowledge and risk perception. Glob Public Health 2011; 5:649-62. [PMID: 19960396 DOI: 10.1080/17441690903367141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
An important step in preventing mother-to-child transmission is testing pregnant women for HIV. Health literacy measures, such as HIV knowledge and risk perception, may determine which women are tested in prenatal clinics where routine opt-out testing is not available. A survey was conducted in Guayaquil, Ecuador in 2006 (n=485), where approximately 0.7% of HIV tests in prenatal clinics were positive. Pregnant women over the age of 18 were invited to complete the survey in the waiting rooms at four city hospitals. There were 67.2% of women reported being tested previously for HIV. The most notable finding was that women who perceived a risk were 1.74 times more likely to request testing (p=0.021), but a woman's risk perception was not related to established risk factors. In addition, a physician's recommendation would result in the testing of nearly all women (94.3%). This data suggest that interventions in prenatal care clinics should incorporate educational strategies to increase accurate perception of personal risk. These efforts must occur in conjunction with increasing the access to HIV tests to achieve the goal of universal prenatal testing.
Collapse
Affiliation(s)
- J L Dearborn
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, CT, USA
| | | | | |
Collapse
|
41
|
Nabatiyan A, Parpia ZA, Elghanian R, Kelso DM. Membrane-based plasma collection device for point-of-care diagnosis of HIV. J Virol Methods 2011; 173:37-42. [PMID: 21219933 DOI: 10.1016/j.jviromet.2011.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 12/22/2010] [Accepted: 01/04/2011] [Indexed: 11/25/2022]
Abstract
A major requirement for the development of point-of-care tests for the detection of disease analytes is the need to separate plasma from whole blood in an efficient and rapid manner. Furthermore, the separated plasma must be able to elute efficiently the analyte of interest and serve effectively as a physical matrix to deliver the equivalent of neat plasma for downstream diagnostic analysis. Additionally, many applications require the use of heat shock to liberate immunocomplexed antigen found in the collected plasma. A membrane-based filter method is reported for rapid and efficient collection of plasma from a whole blood sample that is compatible with heat shock. Using pediatric human immunodeficiency virus as an example, this device elutes 100% of the input p24 core antigen post-collection and enables heat shock of plasma samples identical to neat plasma treatment.
Collapse
Affiliation(s)
- Arman Nabatiyan
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.
| | | | | | | |
Collapse
|
42
|
Impact of tuberculosis cotreatment on viral suppression rates among HIV-positive children initiating HAART. AIDS 2011; 25:49-55. [PMID: 20935555 DOI: 10.1097/qad.0b013e32833f9e04] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the association between treatment of HIV-tuberculosis (TB) coinfection and primary virologic failure among children initiating antiretroviral therapy in South Africa. DESIGN We performed a retrospective cohort study of 1029 children initiating antiretroviral therapy at two medical centers in KwaZulu Natal, South Africa, a region of very high TB incidence. METHODS Data were extracted from electronic medical records and charts and the impact of TB cotreatment on viral suppression at 6 and 12 months was assessed using logistic regression. RESULTS The overall rate of virologic suppression (<400 HIV RNA copies/ml) was 85% at 6 months and 87% at 12 months. Children who received concurrent treatment for TB had a significantly lower rate of virologic suppression at 6 months (79 vs. 88%; P = 0.003). Those who received nonnucleoside reverse transcriptase inhibitor-based HAART had similar rates of viral suppression regardless of whether they received concurrent TB therapy. In contrast, children who received protease inhibitor-based HAART had significantly lower viral suppression rates at both 6 and 12 months if treated concurrently for TB (P = 0.02 and 0.03). Multivariate logistic regression revealed that age at initiation, protease inhibitor therapy, and TB coinfection were each independently associated with primary virologic failure. CONCLUSION Concurrent treatment for TB is associated with lower rates of viral suppression among children receiving protease inhibitor-based HAART, but not among those receiving nonnucleoside reverse transcriptase inhibitor-based HAART. Guidelines for the care of young HIV-TB coinfected infants should be continually evaluated, as protease inhibitor-based antiviral therapy may not provide optimal viral suppression in this population.
Collapse
|
43
|
Nataraja RM, Fishman JR, Naseer A, Dodge J, Walters SMD, Clarke SA, Haddad MJ. Percutaneous endoscopic gastrostomy placement in a human immunodeficiency virus-positive pediatric population leads to an increase in minor complications. J Laparoendosc Adv Surg Tech A 2010; 21:171-5. [PMID: 21194306 DOI: 10.1089/lap.2010.0139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM The development of effective multiple drug regimens for treating human immunodeficiency virus (HIV) are associated with nonadherence in children. HIV-positive children also have a higher incidence of malnutrition. Placement of a percutaneous endoscopic gastrostomy (PEG) is a potential solution. Primary outcome was to determine the complications of PEG placement in a pediatric HIV-positive population. MATERIALS AND METHODS A 10 year retrospective data analysis was carried out on all HIV-positive children undergoing insertion of a PEG at two institutions. Parameters examined included infections, leakage, displacement, reasons for removal, total time in situ, HIV stage, CD4 count, and serological investigation. Data were compared against published data for PEG insertion in pediatric oncology patients and other comparable pediatric series using Fisher's exact test. RESULTS Eighteen children were identified, with a median age 35 months and follow-up of 62 months. The majority of patients had advanced disease (Stage C; 65%). Fifty percent of PEGs were inserted for feeding supplementation and all were used for the administration of medications. Sixty-one percent experienced a minor complication; 5/18 (27.7%) experienced peristomal infection; 2/18 (11.1%) experienced either bleeding, leakage, or excessive granulation; and 1/18 (5.6%) experienced dislodgement. Stage of HIV did not affect the incidence of bleeding or infection: 5/11(Stage C) versus 2/7(Stage B) (P = .3). There was no significant difference for major complications when compared with any series though comparison with a large pediatric series revealed a significant difference for minor complications 11/18 versus 27/120 (P = .0003). CONCLUSIONS There is a low rate of serious complications with PEG insertion in our patients, and the rate is comparable to that seen in pediatric oncology patients. The minor complication rate is, however, higher than a nonimmune compromised population; and careful follow-up for these patients is recommended so that the appropriate therapy can be promptly initiated.
Collapse
Affiliation(s)
- Ramesh M Nataraja
- Department of Paediatric Surgery, Chelsea & Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
44
|
Ferrand RA, Weiss HA, Nathoo K, Ndhlovu CE, Mungofa S, Munyati S, Bandason T, Gibb DM, Corbett EL. A primary care level algorithm for identifying HIV-infected adolescents in populations at high risk through mother-to-child transmission. Trop Med Int Health 2010; 16:349-55. [PMID: 21176006 PMCID: PMC3132444 DOI: 10.1111/j.1365-3156.2010.02708.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To present an algorithm for primary-care health workers for identifying HIV-infected adolescents in populations at high risk through mother-to-child transmission. Methods Five hundred and six adolescent (10–18 years) attendees to two primary care clinics in Harare, Zimbabwe, were recruited. A randomly extracted ‘training’ data set (n = 251) was used to generate an algorithm using variables identified as associated with HIV through multivariable logistic regression. Performance characteristics of the algorithm were evaluated in the remaining (‘test’) records (n = 255) at different HIV prevalence rates. Results HIV prevalence was 17%, and infection was independently associated with client-reported orphanhood, past hospitalization, skin problems, presenting with sexually transmitted infection and poor functional ability. Classifying adolescents as requiring HIV testing if they reported >1 of these five criteria had 74% sensitivity and 80% specificity for HIV, with the algorithm correctly predicting the HIV status of 79% of participants. In low-HIV-prevalence settings (<2%), the algorithm would have a high negative predictive value (≥99.5%) and result in an estimated 60% decrease in the number of people needing to test to identify one HIV-infected individual, compared with universal testing. Conclusions Our simple algorithm can identify which individuals are likely to be HIV infected with sufficient accuracy to provide a screening tool for use in settings not already implementing universal testing policies among this age-group, for example immigrants to low-HIV-prevalence countries.
Collapse
Affiliation(s)
- Rashida A Ferrand
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Chaudhuri S, Mundle M, Konar H, Das C, Talukdar A, Ghosh US. Utilization of therapeutic intervention to prevent mother to child transmission of HIV in a teaching hospital in Kolkata, India. J Obstet Gynaecol Res 2010; 36:619-25. [PMID: 20598046 DOI: 10.1111/j.1447-0756.2009.01161.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To assess the uptake of an HIV screening program and therapeutic intervention to minimize the risk of mother to child transmission. METHODS This was a cross-sectional, observational study with retrospective data obtained from patient medical records. Pregnant women presenting to a tertiary care center in Kolkata, India, from 1 January 2004 - 31 December 2007 underwent HIV serology by rapid test after receiving group counseling. Care was administered using a standard national protocol by a multi-disciplinary team of health-care personnel. Main outcome measures were: acceptance of pretest counseling and HIV testing by pregnant women attending antenatal clinic services, post-test counseling rate, coverage rate of nevirapine to mother-child pairs, and averted HIV infection in children. RESULTS Of the 52 127 new antenatal booking visits, 49 580 (95.11%) women attended pretest counseling and 47 506 (91.13%) women accepted HIV testing. Eighty-six women were found to be seropositive. The seroprevalence rate of HIV infection was 0.17%. Thirty-seven mothers (88%) and all newborn infants (100%) had received nevirapine prophylaxis. Overall nevirapine coverage rate was 48%. Twenty-four of the mother-infant pairs that we assessed had infants who were aged over 18 months by June 2008. Eleven (45.83%) of these women turned up with their babies for a blood test at 18 months. Three (27.27%) babies tested reactive. CONCLUSION As uptake of testing is high and detection of HIV-infected women in pregnancy remains very low, a radical rethinking of policies on therapeutic intervention and their implementation now needs to be undertaken.
Collapse
Affiliation(s)
- Snehamay Chaudhuri
- Department of Obstetrics & Gynecology, NRS Medical College, West Bengal State AIDS Control and Prevention Society, Kolkata, India.
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
Accurate HIV diagnostic testing continues to pose challenges, but there are also opportunities for assay performance improvements in key areas for specific intended-use settings. The genetic diversity of HIV can result in false and discordant results in assays that fail to detect new variant strains. The use of antiretroviral therapies has resulted in drug-resistant variants that require monitoring by sequencing and genotyping methods. Nucleic acid testing is the most sensitive and reliable platform for detection, but it is costly and limited to centralized testing facilities, making implementation difficult in resource-limited settings where HIV has hit the hardest. Rapid antibody tests suitable for point-of-care use are becoming more accessible in resource-limited settings, but these tests may not detect HIV during the acute infection stage. Emerging antigen/antibody combination assays are viable alternatives to nucleic acid testing for diagnosis of recent infections. Although patient monitoring (e.g., via CD4+ T-cell count and viral load determination) and infant diagnoses still rely on clinical laboratory-based testing, point-of-care options are being developed. There are other technical challenges to HIV diagnostic testing and emerging biodetection technologies that may be able to address them, but they are not yet proven.
Collapse
Affiliation(s)
- Eric Y Wong
- Laboratory of Molecular Virology, Center for Biologics Evaluation & Research, Food & Drug Administration, 8800 Rockville Pike, Building 29B, Room 4NN16, Bethesda, MD 20892, USA
| | - Indira K Hewlett
- Laboratory of Molecular Virology, Center for Biologics Evaluation & Research, Food & Drug Administration, 8800 Rockville Pike, Building 29B, Room 4NN16, Bethesda, MD 20892, USA
| |
Collapse
|
47
|
Enarson PM, Gie RP, Enarson DA, Mwansambo C, Graham SM. Impact of HIV on standard case management for severe pneumonia in children. Expert Rev Respir Med 2010; 4:211-20. [PMID: 20406087 DOI: 10.1586/ers.10.14] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is estimated that 2 million children under 5 years of age die from pneumonia each year and that half of these deaths occur in sub-Saharan Africa. Over 85% of the more than 2.3 million children living with HIV worldwide reside in sub-Saharan Africa. HIV infection is likely to have a major impact on current recommendations for the standard case management of pneumonia in children and is the rationale for undertaking this review of published studies. The studies identified indicate an overall sixfold (range 2.5-13.5-fold) increase in pneumonia-related fatality in HIV-infected compared with HIV-uninfected African infants and children. They are more likely to have disease due to mixed infection and from a wider range of pathogens including Pneumocystis pneumonia, TB and cytomegalovirus. Scaling-up of the implementation of strategies that prevent HIV and Pneumocystis pneumonia remains an important strategy to reduce the burden of HIV-related pneumonia in the region. Research is urgently required to address the most effective pneumonia case management strategy in HIV-infected infants and children.
Collapse
Affiliation(s)
- Penny M Enarson
- Child Lung Health Division, International Union Against Tuberculosis and Lung Disease (The Union), 68 Boulevard St Michel, 75006 Paris, France.
| | | | | | | | | |
Collapse
|
48
|
Affiliation(s)
- Alan Davidson
- Department of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
49
|
Santilli V, Mora N, Aquilani A, Tchidjou HK, Pontrelli G, De Vito R, Lombardi A, Bernardi S, Palma P. Burkitt's lymphoma mimicking EBV disease as first sign of vertical HIV infection in an adolescent. Ital J Pediatr 2010; 36:34. [PMID: 20416074 PMCID: PMC2873400 DOI: 10.1186/1824-7288-36-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 04/23/2010] [Indexed: 11/19/2022] Open
Abstract
Burkitt's Lymphoma (BL) rarely represents the first clinical manifestation of vertical HIV infection in adolescent in Western Europe. We report the case of a 17 year-old boy with two week history of fever and enlarged cervical lymph nodes firstly misdiagnosed as EBV infection, subsequently diagnosed as Burkitt's Lymphoma and vertical HIV infection.
Collapse
Affiliation(s)
- Veronica Santilli
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
| | - Nadia Mora
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
| | - Angela Aquilani
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
| | - Hyppolite K Tchidjou
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
| | - Giuseppe Pontrelli
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
| | - Rita De Vito
- Unit of Anatomical Pathology- Children's Hospital Bambino Gesù, Rome, Italy
| | | | - Stefania Bernardi
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
| | - Paolo Palma
- DPUO, University Department of Pediatrics- Children's Hospital Bambino Gesù, Rome, Italy
| |
Collapse
|
50
|
Early clinical outcomes in children enrolled in human immunodeficiency virus infection care and treatment in lesotho. Pediatr Infect Dis J 2010; 29:340-5. [PMID: 20019645 DOI: 10.1097/inf.0b013e3181bf8ecb] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children are largely underrepresented among those accessing treatment of HIV infection in Africa. Reported outcomes of children enrolled in national care and treatment programs are needed to inform the widespread scale-up of pediatric HIV care in resource-limited settings. METHODS The objective of this article is to report on the early outcomes of a pediatric HIV infection care and treatment program in Lesotho during its first 14 months of operation. Clinical protocols are described, and characteristics and outcomes of the first cohort of children enrolled in care are reported, derived from a retrospective review of medical records. RESULTS In the program's first 14 months, 1566 children and adolescents aged between 0 and 16 years were evaluated for HIV, with 567 (36%) confirmed to be infected. Of infected patients, 61% presented with advanced or severe symptoms of HIV disease and 65% presented with CD4 profiles consistent with advanced or severe immunodeficiency, based on World Health Organization 2006 guidelines. Two hundred and eighty four children received highly active antiretroviral therapy. The mortality rate was 18.6 deaths per 100 patient years of follow-up. Ninety-nine percent of deaths occurred within 90 days of enrollment. Deceased patients were significantly younger, had higher rates of stunting and wasting, and were more likely to present with low CD4 cell counts. CONCLUSION Highly active antiretroviral therapy was well tolerated, but the early mortality rate was high despite concurrent management of HIV and comorbidities. Given that hundreds of thousands of children remain without access to HIV care, renewed efforts are needed to reach this underserved population.
Collapse
|