Pediatric HIV infection

Comparison of auditory brainstem response in HIV-1 exposed and unexposed newborns and correlation with the maternal viral load and CD4+ cell counts

OBJECTIVE

The effects of maternal HIV infection and antiretroviral therapy on hearing of HIV-exposed newborns in sub-Saharan Africa have not been investigated. We determined the prevalence of sensorineural hearing loss among HIV-exposed newborns and the association between the hearing threshold and maternal and newborn parameters.

DESIGN

A cohort audiometric study of newborns between October 2012 and April 2013.

SETTINGS

A secondary and tertiary hospital-based study.

PARTICIPANTS

Consecutive 126 HIV-exposed and 121 HIV-unexposed newborns.

INTERVENTION

Hearing screening of the newborns was done with Auditory Brainstem Response and compared with maternal HAART, CD4 cell counts, RNA viral loads and newborn CD4 cell count percentage.

MAIN OUTCOME MEASURE

Hearing threshold levels of both groups were measured and analysed.

RESULTS

Around 11.1% of HIV-exposed and 6.6% of unexposed newborns had hearing impairment (P = 0.2214). About 6.4% of HIV-exposed and 2.5% HIV-unexposed newborns had hearing threshold of more than 20 dBHL (P = 0.1578). There was no significant association between the hearing thresholds of HIV-exposed newborns and maternal CD4 cell counts (P = 0.059) but there was with maternal viral load (P = 0.034). There was significant difference between the hearing thresholds of HIV-exposed newborns with CD4% of 25 or less and more than 25. This study showed significant difference in the hearing of the 119 HAART-exposed newborns and seven unexposed newborns [P = 0.002; risk ratio, 0.13 (0.05-0.32)].

CONCLUSION

There was a trend towards more hearing loss in HIV-exposed newborns. However, hearing thresholds increase with increasing mothers' viral load. The background information supports the need for further studies on the role of in-utero exposure to HIV and HAART in newborn hearing loss.

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

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

Immunopathogenesis of feline immunodeficiency virus infection in the fetal and neonatal cat

The global incidence of pediatric HIV infection is estimated at 2.3 million children, most acquiring the infection from their mothers in utero, peripartum, or postpartum. Pediatric HIV infection typically causes a rapidly progressive disease when compared with adult infection, due in part to the profound susceptibility of the neonatal thymus to productive infection or degenerative changes. Failed production of naive T-lymphocytes further limits the success of antiviral therapy to restore immunologic function. In this review, we explore the use of feline immunodeficiency virus (FIV) infection of domestic cats as an animal model for pediatric HIV infection. Cats infected with FIV represent the smallest host of a naturally occurring lentivirus, and the immunodeficiency syndrome elicited by FIV infection is similar to that of HIV-AIDS. The feline-FIV model uniquely reproduces several key aspects of immunosuppressive lentivirus infection of the thymus, allowing investigators to define viral determinants of pathogenicity, influence of host age on disease outcome, and therapeutic strategies to restore thymus function.

Crianças e adolescentes vivendo com HIV/Aids e suas famílias: aspectos psicossociais e enfrentamento

O estudo teve por objetivos: descrever aspectos sociodemográficos, médico-clínicos e da organização familiar de crianças e adolescentes soropositivos infectados pela transmissão vertical; descrever dificuldades e estressores percebidos pelos cuidadores sobre aspectos psicossociais e do tratamento para o HIV e analisar estratégias de enfrentamento utilizadas. Participaram 43 cuidadores primários, a maioria (N = 24) mães soropositivas; a idade variou de 18 a 68 anos. Os instrumentos incluíram entrevista semi-estruturada e a Escala Modos de Enfrentamento de Problemas (EMEP). Os resultados revelaram a presença de dificuldades em áreas como adesão ao tratamento, revelação do diagnóstico para a criança/adolescente e informação sobre o diagnóstico na escola. Quanto às estratégias de enfrentamento, houve predomínio de busca de práticas religiosas/pensamento fantasioso e focalização no problema, segundo escores da EMEP. O estudo indica a necessidade das equipes de saúde se qualificarem para atendimento a demandas psicossociais, visando atenção integral e interdisciplinar a familiares e crianças/adolescentes vivendo com HIV/aids.

Cutaneous signs of neonatal and infantile immunodeficiency

Immunodeficiencies frequently present in the skin antepartum and in the first year of life. Although genetic immunodeficiencies are uncommon, the worldwide incidence of the acquired immunodeficiency human immunodeficiency virus (HIV) is growing. Early diagnosis and treatment of neonatal immunodeficiencies and associated infections result in improved quality of life and longer life expectancy for these patients. In developed countries, improvements in therapy of HIV during pregnancy have resulted in reduced transmission to the neonate. This article reviews the common presentations and therapy of genetic and acquired neonatal immunodeficiencies.