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Acharya S, Palkar A, Sayed AP, Setia MS. Retrospective cohort analysis of survival of children living with HIV/AIDS in Mumbai, India. BMJ Open 2021; 11:e050534. [PMID: 34518268 PMCID: PMC8438856 DOI: 10.1136/bmjopen-2021-050534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To understand the survival in a cohort of children living with HIV/AIDS (CLHAs) and to study the factors associated with survival in CLHAs in government antiretroviral therapy (ART) centres in Mumbai, India. DESIGN This is a retrospective cohort analysis. SETTING Data from electronic ART records of children from 15 ART centres in Mumbai, Maharashtra, India. PARTICIPANTS 2224 CLHAs registered in one of these ART centres from 2004 until October 2019. CLHAs up to the age of 18 at the time of registration were considered for these analyses. PRIMARY AND SECONDARY OUTCOMES We accessed the following data: date of test, date of initiation of ART, date of last follow-up, age at the time of registration, gender, potential route of infection, baseline CD4 counts, ART regimen, adherence and presence of co-infection (TB). We estimated the survival probabilities, plotted the Kaplan-Meier survival graphs and estimated HRs for mortality. RESULTS The mortality rate in our population was 22.75 (95% CI 20.02 to 25.85) per 1000 person-years. The 1-year survival was 0.92 (95% CI 0.91 to 0.93), 0.89 (95% CI 0.88 to 0.91) at 5 years and 0.85 (95% CI 0.83 to 0.87) at 10 years after initiation of ART. Children with adherence less than 80% had lowest survival in the first year (0.54, 95% CI 0.46 to 0.61). It reduced drastically at 5 and 10 years. After adjusting for demographic and clinical parameters, mortality was associated with poor adherence (<80%) (HR 11.70, 95% CI 8.82 to 15.53; p<0.001). However, CD4 counts of greater than 200 and age more than 1 year were protective. CONCLUSIONS Poor adherence to ART and low CD4 counts were significantly associated with higher mortality. Adherence counselling should be an important component of CLHA monitoring in all ART centres. It is also important to identify children early in the infection and start ART medications appropriately.
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Affiliation(s)
| | - Amol Palkar
- Mumbai Districts AIDS Control Society, Mumbai, India
| | - Anwar Parvez Sayed
- UW International Training and Education Center for Health, New Delhi, India
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Parvez F, Akhtar E, Khan L, Haq MA, Islam T, Ahmed D, Eunus HEMM, Hasan AKMR, Ahsan H, Graziano JH, Raqib R. Exposure to low-dose arsenic in early life alters innate immune function in children. J Immunotoxicol 2019; 16:201-209. [PMID: 31703545 PMCID: PMC7041495 DOI: 10.1080/1547691x.2019.1657993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/01/2019] [Accepted: 08/16/2019] [Indexed: 01/06/2023] Open
Abstract
Early-life exposure to arsenic (As) increases risks of respiratory diseases/infections in children. However, data on the ability of the innate immune system to combat bacterial infections in the respiratory tracts of As-exposed children are scarce. To evaluate whether persistent low-dose As exposure alters innate immune function among children younger than 5 years-of-age, mothers and participating children (N = 51) that were members of the Health Effects of Arsenic Longitudinal Study (HEALS) cohort in rural Bangladesh were recruited. Household water As, past and concurrent maternal urinary As (U-As) as well as child U-As were all measured at enrollment. In addition, U-As metabolites were evaluated. Innate immune function was examined via measures of cathelicidin LL-37 in plasma, ex vivo monocyte-derived-macrophage (MDM)-mediated killing of Streptococcus pneumoniae (Spn), and serum bactericidal antibody (SBA) responses against Haemophilus influenzae type b (Hib). Cyto-/chemokines produced by isolated peripheral blood mononuclear cells (PBMC) were assayed using a Multiplex system. Multivariable linear regression analyses revealed that maternal (p < 0.01) and child (p = 0.02) U-As were positively associated with plasma LL-37 levels. Decreased MDM-mediated Spn killing (p = 0.05) and SBA responses (p = 0.02) were seen to be each associated with fractions of mono-methylarsonic acid (MMA; a U-As metabolite) in the children. In addition, U-As levels were seen to be negatively associated with PBMC formation of fractalkine and IL-7, and positively associated with that for IL-13, IL-17 and MIP-1α. These findings suggested that early-life As exposure may disrupt the innate host defense pathway in these children. It is possible that such disruptions may have health consequences later in life.
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Affiliation(s)
- Faruque Parvez
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - Evana Akhtar
- Infectious Diseases Division, icddr,b, Dhaka-1212, Bangladesh
| | - Lamia Khan
- Infectious Diseases Division, icddr,b, Dhaka-1212, Bangladesh
| | - Md. Ahsanul Haq
- Infectious Diseases Division, icddr,b, Dhaka-1212, Bangladesh
| | - Tariqul Islam
- Columbia University and University of Chicago Research office in Bangladesh, Dhaka-1212, Bangladesh
| | - Dilruba Ahmed
- Laboratory Sciences and Services Division, icddr,b, Dhaka-1212, Bangladesh
| | - HEM Mahbubul Eunus
- Columbia University and University of Chicago Research office in Bangladesh, Dhaka-1212, Bangladesh
| | - AKM Rabiul Hasan
- Columbia University and University of Chicago Research office in Bangladesh, Dhaka-1212, Bangladesh
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, Chicago, IL
| | - Joseph H. Graziano
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - Rubhana Raqib
- Infectious Diseases Division, icddr,b, Dhaka-1212, Bangladesh
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Du L, Lin Y, Wang M, Yan L, Bai L, Feng P, Tang H. Mortality-related risks in treatment-naive hospitalized AIDS patients with opportunistic infections in Southwest China. Future Virol 2019. [DOI: 10.2217/fvl-2019-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aim: We aimed to profile the characteristics and analyze the risk factors related to mortality in treatment-naive hospitalized AIDS patients with opportunistic infections (OIs) in Southwest China. Materials & methods: Two hundred and four treatment-naive patients diagnosed with AIDS-related OIs that were hospitalized in our hospital were enrolled. Their demographics, medical data and prognosis were described and analyzed. Result: Most patients were middle-aged married or cohabiting males. The infections in the respiratory system were the major OIs and leading cause of mortality. High CRP and IL-6 were identified as independent risk factors predicting mortality. Conclusion: Middle-aged treatment-naive males were the major victims of AIDS-related OIs. Respiratory infection should be monitored, and early intervention should be applied to improve prognosis if there is high CRP or IL-6 found.
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Affiliation(s)
- Lingyao Du
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Yixiao Lin
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, PR China
| | - Ming Wang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Libo Yan
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Lang Bai
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Ping Feng
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
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Cagigi A, Cotugno N, Giaquinto C, Nicolosi L, Bernardi S, Rossi P, Douagi I, Palma P. Immune reconstitution and vaccination outcome in HIV-1 infected children: present knowledge and future directions. Hum Vaccin Immunother 2012; 8:1784-94. [PMID: 22906931 PMCID: PMC3656066 DOI: 10.4161/hv.21827] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 08/07/2012] [Accepted: 08/14/2012] [Indexed: 01/09/2023] Open
Abstract
Current evidence on routine immunization of HIV-1 infected children point out the need for a special vaccine schedule in this population. However, optimal strategies for identifying individuals susceptible to infections, and then offering them sustained protection through appropriate immunization schedule, both in terms of timing and number of vaccine doses, still remain to be elucidated. Understanding the degree of immune recovery after HAART initiation is important in guiding administration of routine vaccination in HIV-1 infected children. Although quantitative measures (e.g., CD4+ T-cell counts and immunoglobulin levels) are frequently performed to evaluate immune parameters, these measures do not fully mirror functional immune recovery. Here, we will review the status of single mandatory and recommended vaccines for HIV-1 infected children in relation to immune recovery after HAART initiation with the aim of identifying new means to help design personalized vaccine schedules for this population.
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Affiliation(s)
- Alberto Cagigi
- University Department of Pediatrics; DPUO; Unit of Immunology and Infectious Diseases; Children's Hospital Bambino Gesù; Rome, Italy
| | - Nicola Cotugno
- Chair of Pediatrics; University of Rome “Tor Vergata”; Rome, Italy
| | | | - Luciana Nicolosi
- Department of Pediatric Medicine; Bambino Gesù Children’s Hospital; Rome, Italy
| | - Stefania Bernardi
- University Department of Pediatrics; DPUO; Unit of Immunology and Infectious Diseases; Children's Hospital Bambino Gesù; Rome, Italy
| | - Paolo Rossi
- University Department of Pediatrics; DPUO; Unit of Immunology and Infectious Diseases; Children's Hospital Bambino Gesù; Rome, Italy
- Chair of Pediatrics; University of Rome “Tor Vergata”; Rome, Italy
| | - Iyadh Douagi
- Center for Hematology and Regenerative Medicine; Karolinska Institutet; Huddinge, Sweden
| | - Paolo Palma
- University Department of Pediatrics; DPUO; Unit of Immunology and Infectious Diseases; Children's Hospital Bambino Gesù; Rome, Italy
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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.
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Kupka R, Msamanga GI, Aboud S, Manji KP, Duggan C, Fawzi WW. Patterns and predictors of CD4 T-cell counts among children born to HIV-infected women in Tanzania. J Trop Pediatr 2009; 55:290-6. [PMID: 19158163 PMCID: PMC2766782 DOI: 10.1093/tropej/fmn118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We assessed age-specific CD4 T-cell counts and their determinants among Tanzanian children born to HIV-infected mothers to address a major research gap. A total of 474 HIV-uninfected and 69 HIV-infected children were followed until age of 12 months. Maternal predictors were measured during pregnancy and child predictors at birth and throughout the follow up. Child CD4 T-cell counts were evaluated at the age of 3 months and subsequent 3-month intervals; they decreased linearly among HIV-infected (beta = -8 cells per week; 95% CI -12 to -4; P = 0.0003) and increased linearly among HIV-uninfected children (beta = 4 cells/week; 95% CI 2-7; P = 0.0008). Decreased child counts were predicted by low child anthropometry, maternal HIV stage > or =2, and maternal mid-upper arm circumference <27 cm among HIV-infected children; and by weight-for-height <-2 z-score, maternal HIV stage > or =2, maternal erythrocyte sedimentation rate <81 mm/h and maternal haemoglobin <8.5 g/dl among HIV-uninfected children. The maternal and child predictors described may serve as intervention targets among HIV-exposed children.
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Affiliation(s)
- Roland Kupka
- Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
| | - Gernard I. Msamanga
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Karim P. Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher Duggan
- Division of Gastroenterology and Nutrition, Children's Hospital, Boston, MA, USA
| | - Wafaie W. Fawzi
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Pahwa S, Read JS, Yin W, Matthews Y, Shearer W, Diaz C, Rich K, Mendez H, Thompson B. CD4+/CD8+ T cell ratio for diagnosis of HIV-1 infection in infants: Women and Infants Transmission Study. Pediatrics 2008; 122:331-9. [PMID: 18676551 PMCID: PMC4699439 DOI: 10.1542/peds.2007-2308] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE In this study, we tested the hypothesis that the CD4(+)/CD8(+) T cell ratio could predict HIV infection status in HIV-exposed infants. METHODS CD4(+)/CD8(+) T cell ratios were determined from data for live-born singleton infants who had been prospectively enrolled in the Women and Infants Transmission Study. Data for 2208 infants with known HIV infection status (179 HIV-infected and 2029 uninfected infants) were analyzed. RESULTS Receiver operating characteristic curves indicated that the CD4(+)/CD8(+) T cell ratio performed better than the proportion of CD4(+) T cells for diagnosis of HIV infection as early as 2 months of age, and this relationship was unaffected by adjustment for maternal race/ethnicity, infant birth weight, gestational age, and gender. At 4 months of age, 90% specificity for HIV diagnosis was associated with 60% sensitivity. For ease of use, graphical estimates based on cubic splines for the time-dependent parameters in a Box-Cox transformation (L), the median (M), and the coefficient of variation (S) were used to create LMS centile curves to show the sensitivity and specificity of CD4(+)/CD8(+) T cell ratios in HIV-infected and uninfected infants until 12 months of age. At 6 months of age, a simplified equation that incorporated sequential CD4(+)/CD8(+) T cell ratios and hematocrit values resulted in improved receiver operating characteristic curves, with 94% positive predictive value and 98% negative predictive value. The positive and negative predictive values remained above 90% in simulated infant populations over a wide range of HIV infection prevalence values. CONCLUSIONS In the absence of virological diagnosis, a presumptive diagnosis of HIV infection status can be made on the basis of CD4(+)/CD8(+) T cell ratios in HIV-1-exposed infants after 2 months of age; sensitivity and specificity can be improved at 6 months by using a discriminant analysis equation.
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Affiliation(s)
- Savita Pahwa
- Department of Microbiology and Immunology, University of Miami, Miller School of Medicine, Miami, Florida 33136, USA.
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Chiappini E, Galli L, Tovo PA, Gabiano C, de Martino M. Persistently high IgA serum levels are a marker of immunological or virological failure of combined antiretroviral therapy in children with perinatal HIV-1 infection. Clin Exp Immunol 2005; 140:320-4. [PMID: 15807857 PMCID: PMC1809368 DOI: 10.1111/j.1365-2249.2005.02756.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Non-expensive and low-complexity surrogate markers for monitoring the response to combined antiretroviral therapy (combined-ART) are needed in poor-resource settings where routine assessment of CD4+ T-lymphocyte count and viral load can not be afforded. We longitudinally evaluated Ig serum levels in 234 HIV-1 infected children receiving combined-ART with > or = 3 drugs. Since Ig levels physiologically vary with age, differences at different age periods were evaluated as differences in z-scores calculated using the mean and standard deviation of the normal population for each age period. Data from 17 (7.3%) children with immunological failure and from 54 (23.1%) children with virological failure of combined-ART were compared with data from not-failed children. At baseline children with immunological failure showed higher IgM z-scores (P = 0.042) than children without. After 3-12 months of therapy immunologically failed children displayed higher viral loads (P < 0.0001) and IgA (P = 0.043) z-scores than not-failed children. Similarly, at the same follow-up time, children with virological failure showed lower CD4(+) T-lymphocyte percentages (P = 0.005) and higher IgA z-scores (P < 0.0001) than not-failed children. No difference in IgG or IgM z-scores was evidenced between failed and not-failed children after 3-12 months of therapy. In conclusion, IgA serum level is a cheap and low-complexity marker of immunological or virological failure of combined-ART which might be adopted in poor-resource settings.
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Affiliation(s)
- Elena Chiappini
- Department of Paediatrics, University of Florence, Via Luca Giordano, 13, I-50132 Florence, Italy
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Lian YC, Della-Negra M, Rutz R, Ferriani V, de Moraes Vasconcelos D, da Silva Duarte AJ, Kirschfink M, Grumach AS. Immunological analysis in paediatric HIV patients at different stages of the disease. Scand J Immunol 2005; 60:615-24. [PMID: 15584973 DOI: 10.1111/j.0300-9475.2004.01492.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There are only few clinical studies on complement in well-defined (or characterized) paediatric HIV patients. Aim of this study was to evaluate the complement system and immunoglobulins in HIV-infected children and to correlate data to stage of disease. Blood samples of 127 HIV-infected children (11-134 months; 62 male : 65 female) were collected in order to evaluate humoral immunity. The patients were classified according to CDC clinical (N-asymptomatic; A-mild symptoms such as common recurrent infections; B-moderate symptoms such as Candidiasis and herpes infections, meningitis, sepsis and anaemia; C-severe symptoms such as opportunistic infections and neoplasia) and with respect to immunological criteria (T CD4(+) cell count). Analysis of complement system included the classical (CH50), alternative (APH50) pathway activities and plasma concentrations of mannan-binding lectin (MBL), of the C4 allotypic variants C4A and C4B. (ELISA), and of the C3 split product C3d (rocket immunoeletrophoresis). Immunodiagnosis also included CD4(+) and CD8(+) lymphocyte count and immunoglobulin concentrations. Complement activation and consumption was observed in all patients correlating with disease activity. Activated classical and alternative pathways and elevated C3d were significantly correlated with immunologic category 3. C3d levels were also significantly correlated with immunologic category 1. Undetectable CH50 and APH50 were found in two (group C) and 10 patients (n = 2, A = 2, B = 2, C = 4), respectively. Low MBL values were found in 13/127 but without correlation to disease severity. Undetectable C4B levels were observed in three patients, favouring the diagnosis of a complete deficiency. Although not related to clinical symptomatology, a strong ongoing complement activation can be observed in all stages of HIV infection. In contrast to earlier reports MBL could not be considered as a risk factor for HIV.
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Affiliation(s)
- Y C Lian
- Institute of Infectology Emílio Ribas, São Paulo, Brazil
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Abstract
OBJECTIVE To evaluate the effect of combined antiretroviral therapy on serum immunoglobulin (Ig) levels in HIV-1 perinatally infected children. METHODS Data from 1250 children recorded by the Italian Register for HIV Infection in Children from 1985 to 2002 were analysed. Since Ig levels physiologically vary with age, differences at different age periods were evaluated as differences in z-scores calculated using means and standard deviations of normal population for each age period. Combined antiretroviral therapy has become widespread in Italy since 1996, thus differences in Ig z-scores between the periods 1985-1995 and 1996-2002 were analysed. Data according to type of therapeutic regimen were also analysed. RESULTS Between the two periods 1985-1995 and 1996-2002, significant (P < 0.0001) decreases in IgG (6.29 +/- 4.72 versus 4.44 +/- 4.33), IgM (9.25 +/- 13.32 versus 5.61 +/- 7.93), and IgA (10.25 +/- 15.68 versus 6.48 +/- 11.56) z-scores, together with a parallel significant (P < 0.0001) increase in CD4 T-lymphocyte percentages, were found. These decreases were confirmed regardless of whether the children were receiving intravenous Ig or not. Ig z-scores were significantly higher in children receiving mono-therapy than in those receiving double-combined therapy (IgG, P < 0.0001; IgM, P = 0.003; IgA, P = 0.031) and in the latter children than in those receiving three or more drugs (P < 0.0001 for all z-scores). Ig z-scores correlated inversely with CD4 T-lymphocyte percentages and, directly, with viral loads. CONCLUSIONS Our data show that in HIV-1 infected children combined antiretroviral therapy leads to reduction of hyperimmunoglobulinemia which parallels restoration of CD4 T-lymphocyte percentage and viral load decrease, which it turn probably reflects improved B-lymphocyte functions.
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Obimbo EM, Mbori-Ngacha DA, Ochieng JO, Richardson BA, Otieno PA, Bosire R, Farquhar C, Overbaugh J, John-Stewart GC. Predictors of early mortality in a cohort of human immunodeficiency virus type 1-infected african children. Pediatr Infect Dis J 2004; 23:536-43. [PMID: 15194835 PMCID: PMC3380074 DOI: 10.1097/01.inf.0000129692.42964.30] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric human immunodeficiency virus type 1 (HIV-1) infection follows a bimodal clinical course with rapid progression in 10-45% of children before the age of 2 years and slower progression in the remainder. A prospective observational study was undertaken to determine predictors of mortality in HIV-1-infected African infants during the first 2 years of life. METHODS Infants in a perinatal cohort identified to be HIV-1-infected by DNA PCR were followed monthly to 1 year, then quarterly to 2 years or death. RESULTS Among 62 HIV-1-infected infants, infection occurred by the age of 1 month in 56 (90%) infants, and 32 (52%) died at median age of 6.2 months. All infant deaths were caused by infectious diseases, most frequently pneumonia (75%) and diarrhea (41%). Univariate predictors of infant mortality included maternal CD4 count <200 cells/microl [hazard ratio (HR), 3.4; P = 0.008], maternal anemia (HR = 3.7; P = 0.005), delivery complications (HR = 2.7; P = 0.01), low birth weight (HR = 4.1; P = 0.001), weight, length and head circumference </=5th percentile at age 1 month (HR = 3.7, P = 0.003; HR = 5.8, P < 0.001; and HR = 10.4, P < 0.001, respectively), formula-feeding (HR = 4.0; P = 0.01), infant CD4% </=15% (HR = 5.5; P = 0.01), infant CD4 count <750 (HR = 9.7; P = 0.006) and maternal death (HR = 2.9, P = 0.05). In multivariate analysis, maternal CD4 count <200 (HR = 2.7; P = 0.03) and delivery complications (HR = 3.4; P = 0.005) were independently associated with infant mortality. CONCLUSIONS Advanced maternal HIV disease, maternal anemia, delivery complications, early growth faltering, formula-feeding and low infant CD4 were predictors of early mortality in African HIV-1-infected infants. In resource-poor settings, these predictors may be useful for early identification and treatment of high risk infants.
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Al-Attar I, Orav EJ, Exil V, Vlach SA, Lipshultz SE. Predictors of cardiac morbidity and related mortality in children with acquired immunodeficiency syndrome. J Am Coll Cardiol 2003; 41:1598-605. [PMID: 12742303 DOI: 10.1016/s0735-1097(03)00256-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prevalence of cardiovascular dysfunction and its predictors in children with acquired immunodeficiency syndrome (AIDS). BACKGROUND Cardiovascular manifestations are common among children with AIDS but may be clinically occult. METHODS We reviewed the medical records, echocardiograms, electrocardiograms, and Holter monitor studies of 68 children with AIDS. We tested clinical and demographic characteristics at the time of AIDS diagnosis for their ability to predict serious cardiac events, death, and cardiac death. RESULTS The median time from AIDS diagnosis to death or end of follow-up was 1.0 year (range, 1 week to 7.9 years). Nineteen patients (28%) experienced serious cardiac events after AIDS diagnosis. Of 43 patients who died, 15 (35%) had cardiac dysfunction. Multivariable analyses revealed that recurrent bacterial infections, wasting, encephalopathy, male gender, and an earlier year of AIDS diagnosis were predictors of serious cardiac events (relative risk [RR] = 9.3, 6.9, 4.7, 4.1, and 0.76, respectively, p < 0.05). Wasting, encephalopathy, a low age-adjusted CD4 count, a low age-adjusted immunoglobulin G (IgG) level, and an earlier year of AIDS diagnosis increased the risk of all-cause mortality (RR = 8.9, 5.1, 2.7, 0.82, and 0.8, respectively, p <or= 0.02). Male gender, a low age-adjusted CD4 count, and a low age-adjusted IgG level increased the risk for cardiac death (RR = 16.9, 4.2, and 0.68, respectively, p <or= 0.05). CONCLUSIONS Serious cardiac events and cardiac death are common among children with AIDS. Factors such as recurrent bacterial infections, wasting, encephalopathy, male gender, low CD4 and IgG levels, and an earlier year at AIDS diagnosis may identify high-risk patients.
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Affiliation(s)
- Inas Al-Attar
- Department of Cardiology, Children's Hospital, Boston, Massachusetts, USA
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Jenson HB, Gauntt CJ, Easley KA, Pitt J, Lipshultz SE, McIntosh K, Shearer WT. Evaluation of coxsackievirus infection in children with human immunodeficiency virus type 1-associated cardiomyopathy. J Infect Dis 2002; 185:1798-802. [PMID: 12085328 PMCID: PMC4422982 DOI: 10.1086/340819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2001] [Revised: 02/25/2002] [Indexed: 11/04/2022] Open
Abstract
In a matched case-control study of the association between coxsackieviruses and cardiac impairment, 24 human immunodeficiency virus (HIV) type 1-infected children with cardiac impairment were compared with 24 HIV-1-infected control subjects. Serologic evidence of coxsackievirus infection was present in all children, with no significant difference in geometric mean antibody titers between case patients and control subjects. Conditional logistic regression to test for an association between coxsackievirus antibody titer and the presence or absence of cardiac impairment, by any indicator, showed an odds ratio of 1.11 (95% confidence interval, 0.58-2.10; P=.75), indicating no association between coxsackievirus infection and cardiac impairment. Coxsackievirus antibody titers correlated positively with total IgG levels in nonrapid progressors but not in rapid progressors. Paired serum samples taken before and after diagnosis of cardiac impairment in 5 patients showed no evidence of intervening coxsackievirus infection. These results do not identify a causal role for coxsackieviruses for cardiomyopathy in HIV-1-infected children.
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Affiliation(s)
- Hal B Jenson
- Department of Pediatrics, MC 7811, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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