Persistent non-gastrointestinal metabolic acidosis in pediatric HIV-1 infection

Rhabdomyolysis as the first manifestation of human immunodeficiency virus infection

Renal tubular acidosis (RTA) is a known complication of anti-retroviral medications. The presence of RTA in treatment naive-HIV patients is rare. A 49-year-old Caucasian woman presented with recurrent non-anion gap metabolic acidosis, AKI, rhabdomyolysis and hypokalemia on several occasions. Diagnosis of acquired distal RTA due to HIV was made given the history and laboratory data. To the best of our knowledge, this is the first case of HIV diagnosed with an initial presentation of rhabdomyolysis. We believe that acute renal failure was due to hypokalemia precipitating rhabdomyolysis caused by HIV-induced dRTA which was further exacerbated by amphetamine use.

Nutritional Care of the Child with Human Immunodeficiency Virus Infection in the United States

In well-resourced settings, early infant diagnosis and administration of life-saving antiretrovirals (ARVs) have significantly improved clinical outcomes in pediatric human immunodeficiency virus (HIV) infection. The dramatic increase in survival rates is associated with enhancements in overall quality of life, which reflect a multidisciplinary, holistic approach to care. Current optimism starkly contrasts with the outlook and prognosis two decades ago, when failure to thrive and wasting syndrome from uncontrolled pediatric HIV infection resulted from poor oral intake, malabsorption, chronic diarrhea, and a persistently catabolic state. The tenets of care developed from that era still hold true in that all infants, children, and adolescents with HIV require comprehensive nutritional services in addition to effective combination antiretroviral therapy (cART). This chapter will review the principles of nutrition in the pre- and post-cART eras and discuss the etiologic factors associated with malnutrition, with an emphasis on interventions that have favorably impacted the growth and body composition of infants, children and adolescents with HIV.

Secondary complications and co-infections in the HIV-infected adolescent in the antiretroviral era

PURPOSE OF REVIEW

The number of HIV-infected adolescents is increasing dramatically. With combination antiretroviral therapy, they are expected to live well into adulthood. However, complications are emerging at a higher rate in the HIV-infected population compared to the general population. HIV-infected adolescents are also at a high risk of sexually transmitted co-infections. This article reviews the main secondary complications and co-infections in the HIV-infected adolescent.

RECENT FINDINGS

HIV-infected adolescents are at a high risk of sexually transmitted infections. A careful, age-appropriate and developmentally appropriate inquiry into the individual's sexual behavior to assess risk is paramount, in addition to regular screening at medical visits. Treating co-infections is not only important for HIV-infected individuals, but also limits HIV transmission to others. In addition, monitoring and addressing modifiable secondary risk factors for complications such as renal disease, osteopenia or osteoporosis, and cardiovascular disease are critical, well before the onset of clinically apparent disease. Using antiretroviral therapy to suppress viral replication and inflammation appears to be a promising strategy for decreasing secondary complication risk, and likely overshadows the toxicities associated with the long-term use of certain antiretrovirals.

SUMMARY

Assessing and addressing the risk of secondary complications and co-infections in the HIV-infected adolescent is crucial for optimal length and quality of life.

Hypercalciuria is the main renal abnormality finding in Human Immunodeficiency Virus-infected children in Venezuela

Kidney involvement in children with Human Immunodeficiency Virus (HIV) infection is increasing in prevalence in parallel with the longer survival of HIV-infected patients and the side-effects of new antiretroviral drugs. However, there are only a few reports describing renal tubular disorders in HIV+ children. This is a cross-sectional, case series study evaluating kidney disease in 26 Venezuelan HIV-infected children. The study cohort consisted of 15 girls and 11 boys, with a median age of 5.9 years (25-75th percentile: 3.6-7.8), who had been treated with antiretrovirals for 2.8 +/- 0.4 years, Overall, the patients were short for their age and gender (Z-height: -3.1; 25-75th percentile: -4.94 to -1.98), and 15 showed signs of mild to moderate malnutrition. All of the children had a normal estimated glomerular filtration rate (136 +/- 22.6 ml/min/1.73 m2), and glomerular involvement was only observed in one patient with isolated proteinuria. None had nephromegaly. In contrast, tubular disorders were commonly found. Hypercalciuria was detected in 16 of the patients (UCa/Cr = 0.28; 25-75th percentile: 0.17-0.54 mg/mg), with five of these showing crystalluria. Eight children showed hyperchloremia, and three had frank metabolic acidosis. Kidney stones were absent in all, but one boy had bilateral medullary nephrocalcinosis. Conclusion, in Venezuelan children, HIV infection per se, or its specific treatment, was commonly associated with renal tubular dysfunction, especially hypercalciuria and acidosis, potentially leading to nephrocalcinosis and growth impairment. We recommend renal tubular evaluation during the follow-up of children with HIV infection.

Infections and other causes of death in HIV-infected children in Africa

The human immunodeficiency virus (HIV) pandemic has dramatically reversed improvements in infant mortality and child survival in sub-Saharan Africa. However, accurate information on the specific causes of HIV-related morbidity and mortality arising from vertical transmission is infrequent and is constrained in resource-poor settings by infrastructure and local access to health care. Such knowledge is essential to improve clinical management of HIV-infected children in Africa. In this review, a global overview of the clinical aspects of HIV infection in children is given. Factors influencing HIV disease progression, morbidity and mortality are discussed from studies on a cohort of HIV-infected children that were followed at an orphanage in Nairobi between 1999 and 2001. These parameters are contrasted with available data on HIV-infected children residing in community settings in Africa.