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Baumann U, Schulze Sturm U, Königs C. HIV-Infektion und -Exposition bei Kindern und Jugendlichen. DIE GYNÄKOLOGIE 2022. [PMCID: PMC9748901 DOI: 10.1007/s00129-022-05046-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ulrich Baumann
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Bereich Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, Deutschland
| | - Ulf Schulze Sturm
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
| | - Christoph Königs
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Deutschland
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HIV-Infektion und -Exposition bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2022; 170:997-1010. [PMID: 36213300 PMCID: PMC9524331 DOI: 10.1007/s00112-022-01614-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/24/2022]
Abstract
Hintergrund Seit 1997 steht mit den antiretroviralen, kombinierbaren Wirkstoffen eine effektive Prävention und Behandlung einer Infektion mit dem „human immunodeficiency virus“ (HIV) zur Verfügung. Fragestellung Was wurde in dieser Zeit durch die Transmissionsprophylaxe und Behandlung der HIV-Infektion bei Kindern in Deutschland erreicht? Material und Methoden Darstellung der Entwicklung der Transmissionsprophylaxe und der epidemiologischen Erhebungen des Robert Koch-Instituts, Darstellung der Arzneimittelentwicklung und der Leitlinien zur antiretroviralen Therapie (ART) bei Kindern und Jugendlichen, Vorstellung von Erhebungen der deutschen Kinder-HIV-Kohorte („German pediatric and adolescent HIV cohort“, GEPIC). Ergebnisse Die Einführung der HIV-Testung Schwangerer hat die regelmäßige ART HIV-positiver Schwangerer und die Einführung von transmissionsmindernden Maßnahmen möglich gemacht. Damit konnte das Risiko der vertikalen Transmission von ca. 30 % auf < 1 % gesenkt werden. Gegenwärtig wird untersucht, ob HIV-exponierte Kinder ohne Risiko gestillt werden können. Die ART bei Kindern hat die Überlebensraten sowie die körperliche und die kognitive Entwicklung HIV-positiver Kinder entscheidend verbessert. Neue Wirkstoffe haben ein günstigeres Nebenwirkungsprofil. In Deutschland konnten die WHO-Ziele, bei 90 % der Kinder eine vollständige Suppression der Viruslast zu erzielen, erreicht werden. Späte Diagnosen sind bei Kindern und Jugendlichen weiterhin mit schweren Infektionen verbunden. Die HIV-Infektion ist weiterhin eine Erkrankung mit Stigma geblieben und wird deswegen meist gegenüber den Kindern und ihrer Umwelt geheim gehalten. Schlussfolgerung Mit der jetzt möglichen Transmissionsprophylaxe und Therapie gelingt es, Transmissionen weitgehend zu verhindern und HIV-positiven Kindern bei frühzeitiger Diagnose ein weitgehend gesundes Leben zu ermöglichen. Das Ziel, dass Kinder ihre Krankheit ohne Angst kennen und nennen können, ist nach wie vor nicht erreicht.
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Jesson J, Crichton S, Quartagno M, Yotebieng M, Abrams EJ, Chokephaibulkit K, Le Coeur S, Aké‐Assi M, Patel K, Pinto J, Paul M, Vreeman R, Davies M, Ben‐Farhat J, Van Dyke R, Judd A, Mofenson L, Vicari M, Seage G, Bekker L, Essajee S, Gibb D, Penazzato M, Collins IJ, Wools‐Kaloustian K, Slogrove A, Powis K, Williams P, Matshaba M, Thahane L, Nyasulu P, Lukhele B, Mwita L, Kekitiinwa‐Rukyalekere A, Wanless S, Goetghebuer T, Thorne C, Warszawski J, Galli L, van Rossum AM, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaya L, Navarro M, Frick A, Naver L, Kahlert C, Volokha A, Chappell E, Pape JW, Rouzier V, Marcelin A, Succi R, Sohn AH, Kariminia A, Edmonds A, Lelo P, Lyamuya R, Ogalo EA, Odhiambo FA, Haas AD, Bolton C, Muhairwe J, Tweya H, Sylla M, D'Almeida M, Renner L, Abzug MJ, Oleske J, Purswani M, Teasdale C, Nuwagaba‐Biribonwoha H, Goodall R, Leroy V. Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis. J Int AIDS Soc 2022; 25:e25871. [PMID: 35255197 PMCID: PMC8901148 DOI: 10.1002/jia2.25871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females. CONCLUSIONS Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.
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Yasuoka J, Yi S, Okawa S, Tuot S, Murayama M, Huot C, Chhoun P, Yem S, Yuzuriha K, Mizutani T, Kikuchi K. Nutritional status and dietary diversity of school-age children living with HIV: a cross-sectional study in Phnom Penh, Cambodia. BMC Public Health 2020; 20:1181. [PMID: 32727433 PMCID: PMC7388459 DOI: 10.1186/s12889-020-09238-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/12/2020] [Indexed: 12/24/2022] Open
Abstract
Background HIV/AIDS continues to be a major public health concern for children. Each day, worldwide, approximately 440 children became newly infected with HIV, and 270 children died from AIDS-related causes in 2018. Poor nutrition has been associated with accelerated disease progression, and sufficient dietary diversity is considered a key to improve children’s nutritional status. Therefore, this study aims to 1) examine nutritional status of school-age children living with HIV in Phnom Penh, Cambodia, and 2) identify factors associated with their nutritional status, especially taking their dietary diversity into consideration. Methods This cross-sectional study was conducted in May 2018 within the catchment area of the National Pediatric Hospital, Cambodia. Data from 298 children and their caregivers were included in the analyses. Using semi-structured questionnaires, face-to-face interviews were conducted to collect data regarding sociodemographic characteristics, quality of life, and dietary diversity. To assess children’s nutritional status, body weight and height were measured. Viral load and duration of antiretroviral therapy (ART) were collected from clinical records. Multiple logistic regression analyses were performed to identify factors associated with stunting and wasting. Results Of 298 children, nearly half (46.6%) were stunted, and 13.1% were wasted. The mean number of food groups consumed by the children in the past 24 h was 4.6 out of 7 groups. Factors associated with children’s stunting were age (adjusted odds ratio [AOR] 2.166, 95% confidence interval [CI]: 1.151, 4.077), household wealth (AOR 0.543, 95%CI: 0.299, 0.986), duration of receiving ART (AOR 0.510, 95%CI: 0.267, 0.974), and having disease symptoms during the past 1 year (AOR 1.871, 95%CI: 1.005, 3.480). The only factor associated with wasting was being male (AOR 5.304, 95%CI: 2.210, 12.728). Conclusions Prevalence of stunting was more than double that of non-infected school-age children living in urban areas in Cambodia. This highlights the importance of conducting nutritional intervention programs, especially tailored for children living with HIV in the country. Although dietary diversity was not significantly associated with children’s nutritional status in this study, the findings will contribute to implementing future nutritional interventions more efficiently by indicating children who are most in need of such interventions in Cambodia.
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Affiliation(s)
- Junko Yasuoka
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo, 183-8508, Japan.
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,KHANA Center for Population Health Research, #33, St 71, Tonle Bassac, Chamkarmon, Phnom Penh, Cambodia.,Center for Global Health Research, Touro University California, Valejo, CA, USA
| | - Sumiyo Okawa
- Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka-shi, Osaka, 541-8567, Japan
| | - Sovannary Tuot
- KHANA Center for Population Health Research, #33, St 71, Tonle Bassac, Chamkarmon, Phnom Penh, Cambodia
| | - Makoto Murayama
- Kawasaki City Dentists Association, 2-10-10, Sunago, Kawasaki, Kanagawa, Japan
| | - Chantheany Huot
- National Pediatric Hospital, Cambodia, #100, Street 110, Teuk Laak 1 Commune, Toulkok District, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, #33, St 71, Tonle Bassac, Chamkarmon, Phnom Penh, Cambodia
| | - Sokunthea Yem
- KHANA Center for Population Health Research, #33, St 71, Tonle Bassac, Chamkarmon, Phnom Penh, Cambodia
| | - Kazuki Yuzuriha
- Graduate School of Systems Life Sciences, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, Japan
| | - Tetsuya Mizutani
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo, 183-8508, Japan
| | - Kimiyo Kikuchi
- Graduate Education and Research Training Program in Decision Science for Sustainable Society, Kyushu University, Motooka 744, Nishi-ku, Fukuoka-shi, Fukuoka, 819-0395, Japan
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