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Farmania R, Sharma S, Handa R, Seth A. Progressive Multifocal Leukoencephalopathy as the Initial Presentation in an Apparently Healthy Child. Ann Indian Acad Neurol 2021; 24:612-614. [PMID: 34728969 PMCID: PMC8513966 DOI: 10.4103/aian.aian_818_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/08/2020] [Accepted: 08/18/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rajni Farmania
- Consultant Pediatric Neurologist, BLK Super Speciality Hospital, New Delhi, India
| | - Suvasini Sharma
- Department of Pediatrics (Neurology Division), Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Rahul Handa
- Consultant Neurologist, BLK Super Speciality Hospital, New Delhi, India
| | - Anju Seth
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
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McEntire CR, Fong KT, Jia DT, Cooper ER, Cervantes-Arslanian AM, Mateen FJ, Anand P, Thakur KT. Central nervous system disease with JC virus infection in adults with congenital HIV. AIDS 2021; 35:235-244. [PMID: 33394671 PMCID: PMC7945987 DOI: 10.1097/qad.0000000000002734] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to describe the natural history of individuals with congenital HIV who develop JC virus (JCV) infection of the central nervous system (CNS). METHODS We retrospectively evaluated individuals with congenital HIV who met criteria for progressive multifocal leukoencephalopathy (PML) or JCV granule cell neuronopathy (JCV GCN) at three major healthcare centres in the northeast USA. Data on adherence to combined antiretroviral therapy (cART), neurologic symptoms, serum markers of immunity and HIV infection, cerebrospinal fluid (CSF) analyses, radiographic features, modified Rankin Scale (mRS) scores and survival were collected from the electronic medical record up to a censoring date of 1 August 2020. RESULTS Among 10 adults with congenitally acquired HIV, nine were diagnosed with definitive PML and one was diagnosed with probable JCV GCN. Individuals presented at the time of their PML or JCV GCN diagnosis with a mean mRS of 2.0 (standard deviation 1.0). A premorbid mRS was documented for six patients and was zero in all cases. The most common risk factor was confirmed cART nonadherence in nine individuals. Five individuals with PML and one with JCV GCN died, with a latency from symptom onset to death of approximately 3 months for three individuals, and approximately 2 years for the remaining two. CONCLUSION Youth-adulthood transition is a high-risk point for dropping off from medical care. The study of this timepoint in people living with HIV could help inform effective care in these individuals.
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Affiliation(s)
| | - Kathryn T. Fong
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032
| | - Dan Tong Jia
- Department of Neurology, Northwestern Memorial Hospital, Chicago, IL 60611
| | - Ellen R. Cooper
- Department of Pediatrics, Boston University School of Medicine, Boston, MA 02215
| | - Anna M. Cervantes-Arslanian
- Departments of Neurology, Neurosurgery, and Medicine (Infectious Disease), Boston Medical Center, Boston, MA 02118
| | - Farrah J. Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114
| | - Pria Anand
- Departments of Neurology, Neurosurgery, and Medicine (Infectious Disease), Boston Medical Center, Boston, MA 02118
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032
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Dean O, Buda A, Adams HR, Mwanza-Kabaghe S, Potchen MJ, Mbewe EG, Kabundula PP, Moghaddam SM, Birbeck GL, Bearden DR. Brain Magnetic Resonance Imaging Findings Associated With Cognitive Impairment in Children and Adolescents With Human Immunodeficiency Virus in Zambia. Pediatr Neurol 2020; 102:28-35. [PMID: 31604645 PMCID: PMC7924094 DOI: 10.1016/j.pediatrneurol.2019.08.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 08/24/2019] [Accepted: 08/29/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cognitive impairment is common in children and adolescents with human immunodeficiency virus (HIV). Brain magnetic resonance imaging (MRI) is a potentially useful tool to investigate the pathophysiology of HIV-associated cognitive impairment and may serve as a biomarker in future clinical trials. There are few published data on brain imaging in children with HIV in sub-Saharan Africa. METHODS Thirty-four perinatally infected subjects with HIV and age-matched HIV-exposed uninfected controls between the ages nine and 17 years were recruited from the Pediatric Center of Excellence in Lusaka, Zambia, as part of the HIV-associated Neurocognitive Disorders in Zambia study. Brain MRI sequences were acquired, and clinical and volumetric assessments were performed. Subjects underwent a comprehensive neuropsychologic battery, and cognitive impairment status was classified using a global deficit score approach. Regression models were used to evaluate relationships between MRI findings and cognitive function. RESULTS We identified cerebrovascular disease in seven of 34 subjects with HIV compared with zero of 17 controls (21% vs 0%, P = 0.04). We also identified decreased total brain volumes (1036 vs 1162 cm3, P = 0.03) and decreased cortical thickness in the right temporal lobes (3.12 vs 3.29 mm; P = 0.01) and right fusiform gyri (3.10 vs 3.25 mm; P = 0.02) of HIV-infected subjects with cognitive impairment. CONCLUSIONS These findings support the hypothesis that brain volumes may be useful biomarkers for cognitive outcomes in children with HIV. Further studies are necessary to investigate mechanisms of cerebrovascular disease and volume loss in children with HIV.
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Affiliation(s)
- Owen Dean
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Alexandra Buda
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Heather R. Adams
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, New York, USA
| | | | - Michael J. Potchen
- Department of Radiology, University of Rochester School of Medicine, Rochester, New York, USA
| | - Esau G. Mbewe
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | | | | | - Gretchen L. Birbeck
- Division of Epilepsy, Department of Neurology, Rochester, New York, USA,University of Zambia School of Medicine, Lusaka, Zambia
| | - David R. Bearden
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, New York, USA
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Lockney DT, Kresak JL. Progressive multifocal leukoencephalopathy in an apparently healthy child: an unsuspected diagnosis. Pediatr Neurosurg 2015; 50:109-11. [PMID: 25791985 DOI: 10.1159/000375128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 01/11/2015] [Indexed: 11/19/2022]
Affiliation(s)
- D Tim Lockney
- Department of Neurosurgery, University of Florida, Gainesville, Fla., USA
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Abstract
Progressive multifocal leukoencephalopathy is a rare, demyelinating disease of the central nervous system caused by JC virus. Fewer than 30 cases have been reported in HIV- and non-infected children. We report the case of a 15-year-old girl with progressive multifocal leukoencephalopathy and AIDS who presented with nystagmus, dysarthria and ataxia. Following combined antiretroviral therapy, she developed immune reconstitution inflammatory syndrome, which proved fatal.
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Guillaume-Czitrom S, Bachelez H, Berthelot JM, Bouhnik Y, Bruckert E, Claudepierre P, Constantin A, de Bandt M, Fautrel B, Gaudin P, Goëb V, Gossec L, Gottenberg JE, Goupille P, Hachulla E, Huet I, Jullien D, Launay O, Lemannf M, Lequerré T, Maillefert JF, Mariette X, Marolleau JP, Martinez V, Masson C, Morel J, Mouthon L, Pham T, Pol S, Puéchal X, Richette P, Saraux A, Schaeverbeke T, Sellam J, Blacher J, Soubrier M, Sudre A, Viguier M, Vittecoq O, Wendling D, Sibilia J. Biologic targeted therapies in pediatric rheumatology. Joint Bone Spine 2014; 81 Suppl 1:2-48. [DOI: 10.1016/s1297-319x(14)70020-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Siberry GK, Abzug MJ, Nachman S, Brady MT, Dominguez KL, Handelsman E, Mofenson LM, Nesheim S, National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association of the Infectious Diseases Society of America, Pediatric Infectious Diseases Society, American Academy of Pediatrics. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. Pediatr Infect Dis J 2013; 32 Suppl 2:i-KK4. [PMID: 24569199 PMCID: PMC4169043 DOI: 10.1097/01.inf.0000437856.09540.11] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- George K Siberry
- 1National Institutes of Health, Bethesda, Maryland 2University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado 3State University of New York at Stony Brook, Stony Brook, New York 4Nationwide Children's Hospital, Columbus, Ohio 5Centers for Disease Control and Prevention, Atlanta, Georgia
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Nesheim SR, Hardnett F, Wheeling JT, Siberry GK, Paul ME, Emmanuel P, Bohannon B, Dominguez K. Incidence of opportunistic illness before and after initiation of highly active antiretroviral therapy in children. Pediatr Infect Dis J 2013; 32:1089-95. [PMID: 24067552 PMCID: PMC3785006 DOI: 10.1097/inf.0b013e31829ee893] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about immune reconstitution inflammatory syndrome in children in the United States. METHODS LEGACY is a longitudinal cohort study of HIV-infected participants 0-24 years at enrollment during 2005 to 2007 from 22 US clinics. For this analysis, we included participants with complete medical record abstraction from birth or time of HIV diagnosis through 2006. Opportunistic illness (OI) included AIDS-defining conditions and selected HIV-related diagnoses. We calculated the incidence (#/100 patient-years) of OI diagnosed in the months pre- and postinitiation of the first highly active antiretroviral therapy (HAART) regimen which was followed by ≥1 log reduction in HIV viral load. We defined OI as immune reconstitution inflammatory syndrome if an OI incidence increased after HAART initiation. "Responders" were defined as experiencing ≥1 log decline in viral load within 6 months after HAART initiation. RESULTS Among 575 patients with complete chart abstraction, 524 received HAART. Of these 524 patients, 343 were responders, 181 were nonresponders and 86 experienced OI. Responders accounted for 98 of 124 (79%) of OI. Pre-HAART and post-HAART OI incidences were 43.7 and 24.4 (P = 0.003), respectively, among responders and 15.9 and 9.1 (P = 0.2), respectively, among nonresponders. Overall, OI incidences among responders and nonresponders were 33.8 and 12.3, respectively (P = 0.002). Responders were more likely than nonresponders to experience herpes simplex and herpes zoster before HAART initiation (all, P < 0.002). CONCLUSIONS The lack of immune reconstitution inflammatory syndrome in participants initiating HAART may be due to low overall OI rates. The unexpectedly higher OI prevalence comprised mainly of herpes simplex and zoster, before HAART initiation among responders, may have motivated them to better adhere to HAART.
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Affiliation(s)
- Steven R. Nesheim
- Emory University School of Medicine
- Epidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention
| | - Felicia Hardnett
- Epidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention
| | | | - George K. Siberry
- Pediatric Adolescent Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
| | | | | | - Beverly Bohannon
- Epidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention
| | - Kenneth Dominguez
- Epidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention
| | - the LEGACY Consortium
- Epidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention
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Kiebala M, Polesskaya O, Yao Z, Perry SW, Maggirwar SB. Nuclear factor-kappa B family member RelB inhibits human immunodeficiency virus-1 Tat-induced tumor necrosis factor-alpha production. PLoS One 2010; 5:e11875. [PMID: 20686703 PMCID: PMC2912378 DOI: 10.1371/journal.pone.0011875] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 07/06/2010] [Indexed: 12/02/2022] Open
Abstract
Human Immunodeficiency Virus-1 (HIV-1)-associated neurocognitive disorder (HAND) is likely neuroinflammatory in origin, believed to be triggered by inflammatory and oxidative stress responses to cytokines and HIV protein gene products such as the HIV transactivator of transcription (Tat). Here we demonstrate increased messenger RNA for nuclear factor-kappa B (NF-κB) family member, transcription factor RelB, in the brain of doxycycline-induced Tat transgenic mice, and increased RelB synthesis in Tat-exposed microglial cells. Since genetic ablation of RelB in mice leads to multi-organ inflammation, we hypothesized that Tat-induced, newly synthesized RelB inhibits cytokine production by microglial cells, possibly through the formation of transcriptionally inactive RelB/RelA complexes. Indeed, tumor necrosis factor-alpha (TNFα) production in monocytes isolated from RelB deficient mice was significantly higher than in monocytes isolated from RelB expressing controls. Moreover, RelB overexpression in microglial cells inhibited Tat-induced TNFα synthesis in a manner that involved transcriptional repression of the TNFα promoter, and increased phosphorylation of RelA at serine 276, a prerequisite for increased RelB/RelA protein interactions. The Rel-homology-domain within RelB was necessary for this interaction. Overexpression of RelA itself, in turn, significantly increased TNFα promoter activity, an effect that was completely blocked by RelB overexpression. We conclude that RelB regulates TNFα cytokine synthesis by competitive interference binding with RelA, which leads to downregulation of TNFα production. Moreover, because Tat activates both RelB and TNFα in microglia, and because Tat induces inflammatory TNFα synthesis via NF-κB, we posit that RelB serves as a cryoprotective, anti-inflammatory, counter-regulatory mechanism for pathogenic NF-κB activation. These findings identify a novel regulatory pathway for controlling HIV-induced microglial activation and cytokine production that may have important therapeutic implications for the management of HAND.
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Affiliation(s)
- Michelle Kiebala
- Department of Microbiology and Immunology, the University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Oksana Polesskaya
- Department of Microbiology and Immunology, the University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Zhenqiang Yao
- Department of Pathology and Laboratory Medicine, the University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Seth W. Perry
- Center for Neural Development and Disease, Department of Neurology, the University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Sanjay B. Maggirwar
- Department of Microbiology and Immunology, the University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- * E-mail:
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