1
|
Soriano-Arandes A, Noguera-Julian A, López-Lacort M, Soler-Palacín P, Mur A, Méndez M, Mayol L, Vallmanya T, Almeda J, Carnicer-Pont D, Casabona J, Fortuny C. Pregnancy as an opportunity to diagnose human-immunodeficiency virus immigrant women in Catalonia. Enferm Infecc Microbiol Clin 2016; 36:9-15. [PMID: 27609632 DOI: 10.1016/j.eimc.2016.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/13/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Mother-to-child transmission (MTCT) is relevant in the global epidemiology of human-immunodeficiency virus (HIV), as it represents the main route of infection in children. The study objectives were to determine the rate of HIV-MTCT and its epidemiological trend between the Spanish-born and immigrant population in Catalonia in the period 2000-2014. METHODS A prospective observational study of mother-child pairs exposed to HIV, treated in 12 hospitals in Catalonia in the period 2000-2014. HIV-MTCT rate was estimated using a Bayesian logistic regression model. R and WinBUGS statistical software were used. RESULTS The analysis included 909 pregnant women, 1,009 pregnancies, and 1,032 children. Data on maternal origin was obtained in 79.4% of women, of whom 32.7% were immigrants, with 53.0% of these from sub-Saharan Africa. The overall HIV-MTCT rate was 1.4% (14/1,023; 95% CI; 0.8-2.3). The risk of MTCT-HIV was 10-fold lower in women with good virological control (P=.01), which was achieved by two-thirds of them. The proportion of immigrants was significantly higher in the period 2008-2014 (P<.0001), for the HIV-diagnosis (P<.0001), and antiretroviral administration (P=.02) during pregnancy, and for undetectable viral load next to delivery (P<.001). There were no differences in the rate of MTCT-HIV among Spanish-born and immigrant women (P=.6). CONCLUSIONS There is a gradual increase in HIV pregnant immigrants in Catalonia. Although most immigrant women were diagnosed during pregnancy, the rate of MTCT-HIV was no different from the Spanish-born women.
Collapse
Affiliation(s)
- Antoni Soriano-Arandes
- Unidad de Enfermedades Infecciosas e Inmunodeficiencias Pediátricas, Servicio de Pediatría, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Antoni Noguera-Julian
- Unidad de Infectologia, Servei de Pediatria, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - Mónica López-Lacort
- FISABIO, Centro de Salud Pública de la Generalitat de Valencia, Valencia, España
| | - Pere Soler-Palacín
- Unidad de Enfermedades Infecciosas e Inmunodeficiencias Pediátricas, Servicio de Pediatría, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Antonio Mur
- Hospital Universitari del Mar, Universidad Autónoma de Barcelona, Barcelona, España
| | - María Méndez
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Lluís Mayol
- Hospital Universitari Josep Trueta, Girona, España
| | | | - Jesús Almeda
- Centre d'Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT), Catalunya, España
| | - Dolors Carnicer-Pont
- Centre d'Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT), Catalunya, España
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT), Catalunya, España
| | - Claudia Fortuny
- Unidad de Infectologia, Servei de Pediatria, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| |
Collapse
|
2
|
Noyola DE, Alarcón A, Noguera-Julian A, Muntasell A, Muñoz-Almagro C, García J, Mur A, Fortuny C, López-Botet M. Dynamics of the NK-cell subset redistribution induced by cytomegalovirus infection in preterm infants. Hum Immunol 2015; 76:118-23. [PMID: 25636568 DOI: 10.1016/j.humimm.2015.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/02/2015] [Accepted: 01/14/2015] [Indexed: 12/22/2022]
Abstract
Human cytomegalovirus (HCMV) infection promotes an expansion of NK-cells expressing the CD94/NKG2C receptor. We prospectively monitored the effects of HCMV on the NK-cell receptor (NKG2C, NKG2A, KIR, LILRB1) distribution in preterm infants. As compared to non-infected moderately preterm newborns (n=19, gestational age: 32-37 weeks), very preterm infants (n=5, gestational age: <32 weeks) suffering symptomatic postnatal HCMV infection displayed increased numbers of NKG2C+, KIR+ NK-cells, encompassed by a reduction of NKG2A+ NK-cells. A similar profile was observed in HCMV-negative newborns (n=4) with asymptomatic infection, during follow-up at ~4 and 10 months of age. Of note, viremia remained detectable in three symptomatic cases at ~10 months despite the persistent expansion of NKG2C+ NK-cells. Our study provides original insights on the dynamics of the imprint exerted by primary HCMV infection on the NK-cell compartment, revealing that the expansion of NKG2C+ NK-cells may be insufficient to control viral replication in very preterm infants.
Collapse
Affiliation(s)
- Daniel E Noyola
- Immunology Unit, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain.
| | - Ana Alarcón
- Department of Neonatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain.
| | - Antoni Noguera-Julian
- Infectious Diseases Unit, Hospital Sant Joan de Déu, Pediatrics Department, Universitat de Barcelona, Spain
| | - Aura Muntasell
- Hospital del Mar Medical Research Institute (IMIM), Doctor Aiguader 88, 08003 Barcelona, Spain
| | | | - Jordi García
- Neonatal Unit, Pediatrics Department, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim de la Barceloneta, 25-29, 08003 Barcelona, Spain
| | - Antonio Mur
- Neonatal Unit, Pediatrics Department, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim de la Barceloneta, 25-29, 08003 Barcelona, Spain
| | - Claudia Fortuny
- Infectious Diseases Unit, Hospital Sant Joan de Déu, Pediatrics Department, Universitat de Barcelona, Spain
| | - Miguel López-Botet
- Immunology Unit, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Doctor Aiguader 88, 08003 Barcelona, Spain.
| |
Collapse
|
3
|
Madrigal I, Alvarez-Mora MI, Karlberg O, Rodríguez-Revenga L, Elurbe DM, Rabionet R, Mur A, Pie J, Ballesta F, Sauer S, Syvänen AC, Milà M. Efficient application of next-generation sequencing for the diagnosis of rare genetic syndromes. J Clin Pathol 2014; 67:1099-103. [PMID: 25271213 DOI: 10.1136/jclinpath-2014-202537] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS The causes of intellectual disability, which affects 1%-3% of the general population, are highly heterogeneous and the genetic defect remains unknown in around 40% of patients. The application of next-generation sequencing is changing the nature of biomedical diagnosis. This technology has quickly become the method of choice for searching for pathogenic mutations in rare uncharacterised genetic diseases. METHODS Whole-exome sequencing was applied to a series of families affected with intellectual disability in order to identify variants underlying disease phenotypes. RESULTS We present data of three families in which we identified the disease-causing mutations and which benefited from receiving a clinical diagnosis: Cornelia de Lange, Cohen syndrome and Dent-2 disease. The genetic heterogeneity and the variability in clinical presentation of these disorders could explain why these patients are difficult to diagnose. CONCLUSIONS The accessibility to next-generation sequencing allows clinicians to save much time and cost in identifying the aetiology of rare diseases. The presented cases are excellent examples that demonstrate the efficacy of next-generation sequencing in rare disease diagnosis.
Collapse
Affiliation(s)
- Irene Madrigal
- Biochemistry and Molecular Genetics Department, Hospital Clínic and IDIBAPS, Barcelona, Spain Centre for Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - Maria Isabel Alvarez-Mora
- Biochemistry and Molecular Genetics Department, Hospital Clínic and IDIBAPS, Barcelona, Spain Centre for Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - Olof Karlberg
- Department of Medical Sciences, Molecular Medicine and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Laia Rodríguez-Revenga
- Biochemistry and Molecular Genetics Department, Hospital Clínic and IDIBAPS, Barcelona, Spain Centre for Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - Dei M Elurbe
- Biochemistry and Molecular Genetics Department, Hospital Clínic and IDIBAPS, Barcelona, Spain Centre for Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - Raquel Rabionet
- Centre for Genomic Regulation (CRG) and UPF and CIBERESP, Barcelona, Spain
| | - Antonio Mur
- Paediatrics Service, Hospital Universitario del Mar, Barcelona, Spain Paediatrics and Obstetrics Department, Universidad de Barcelona, Barcelona, Spain
| | - Juan Pie
- Unit of Clinical Genetics and Functional Genomics, Departments of Pharmacology-Physiology, Medical School, University of Zaragoza, Zaragoza, Spain
| | - Francisca Ballesta
- Biochemistry and Molecular Genetics Department, Hospital Clínic and IDIBAPS, Barcelona, Spain
| | - Sascha Sauer
- Max-Planck Institute for Molecular Genetics, Berlin, Germany
| | - Ann-Christine Syvänen
- Department of Medical Sciences, Molecular Medicine and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Montserrat Milà
- Biochemistry and Molecular Genetics Department, Hospital Clínic and IDIBAPS, Barcelona, Spain Centre for Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| |
Collapse
|
4
|
Álvarez-Mora MI, Madrigal I, Rodriguez-Revenga L, Mur A, Calvo D, Pascual i Bardají J, Milà M. A170P mutation in SHOXgene in a patient not presenting with Madelung deformity: Figure 1. Clin Mol Pathol 2012; 65:844-6. [DOI: 10.1136/jclinpath-2011-200626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
5
|
Flores-le Roux JA, Sagarra E, Benaiges D, Hernandez-Rivas E, Chillaron JJ, Puig de Dou J, Mur A, Lopez-Vilchez MA, Pedro-Botet J. A prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes mellitus. Diabetes Res Clin Pract 2012; 97:217-22. [PMID: 22537519 DOI: 10.1016/j.diabres.2012.03.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 02/29/2012] [Accepted: 03/15/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyse first-day-of-life glucose levels in infants of women with gestational diabetes (GDM) and the influence of maternal, gestational and peripartum factors on the development of neonatal hypoglycaemia. STUDY DESIGN Prospective cohort study including newborns of GDM mothers. Capillary blood glucose (CBG) was measured serially on the first day of life. CBG values were defined as normal (≥ 2.5 mmol/l), mild hypoglycaemia (2.2-2.4 mmol/l), moderate hypoglycaemia (1.6-2.1 mmol/l) and severe hypoglycaemia (<1.6 mmol/l). RESULTS One hundred and ninety infants were included: 23 (12.1%) presented mild, 20 (10.5%) moderate and only 5 (2.6%) severe hypoglycaemia. Hypoglycaemic infants were more frequently large-for-gestational-age (29.3% vs 11.3%, p=0.003), had lower umbilical cord pH (7.28 vs 7.31, p=0.03) and their mothers had more frequently been hyperglycaemic during labour (18.8% vs 8.5%, p=0.04). In multivariate analysis Pakistani origin (OR: 2.94; 95% CI: 1.14-7.55) and umbilical cord venous pH (OR: 0.04, 95% CI: 0.261-0.99) were significantly and independently associated with hypoglycaemia. CONCLUSIONS Mild and moderate neonatal hypoglycaemias were common although severe episodes were unusual in infants of women with GDM. Hypoglycaemia is mainly influenced by ethnicity and cord blood pH, although maternal peripartum glycaemic control and large-for-gestational-age condition may also play a role.
Collapse
|
6
|
Madrigal I, Fernández-Burriel M, Rodriguez-Revenga L, Cabrera JC, Martí M, Mur A, Milà M. Xq26.2-q26.3 microduplication in two brothers with intellectual disabilities: clinical and molecular characterization. J Hum Genet 2010; 55:822-6. [PMID: 20861843 DOI: 10.1038/jhg.2010.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Partial duplications involving the long arm of the X chromosome are associated with mental retardation, short stature, microcephaly, hypopituitarism and a wide range of physical findings. We identified an inherited Xq26.2-Xq26.3 duplication in two brothers with severe mental retardation, hypotonia, growth delay, craniofacial disproportion and dental malocclusion. Chromosome analysis was normal and multiplex ligation-dependent probe amplification analysis detected duplication on Xq26. Further characterization by array comparative genomic hybridization and quantitative PCR helped to determine proximal and distal duplication breakpoints giving a size of approximately 2.8 Mb. The duplication encompasses 24 known genes, including the X-linked mental retardation genes ARHGEF6, PHF6, HPRT1 and SLC9A6. Clinical and molecular characterization of Xq duplications will shed more light into the phenotypic implication of functional disomy of X-chromosome genes.
Collapse
|
7
|
García-Algar O, López-Vílchez MA, Martín I, Mur A, Pellegrini M, Pacifici R, Rossi S, Pichini S. Confirmation of gestational exposure to alprazolam by analysis of biological matrices in a newborn with neonatal sepsis. Clin Toxicol (Phila) 2008; 45:295-8. [PMID: 17453885 DOI: 10.1080/15563650601072191] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Different biological matrices are suitable for drug testing in newborns presenting with an acute withdrawal syndrome. CASE REPORT The newborn of a mother reporting alprazolam use during pregnancy presented with respiratory distress and clinical features consistent with neonatal withdrawal syndrome or neonatal sepsis of vertical transmission. Alprazolam and its main metabolite (alpha-hydroxyalprazolam) were detected in cord serum, neonatal urine and also in neonatal hair, meconium and placenta, accounting for both acute and chronic exposure to this benzodiazepine during intrauterine life. At the same time, the clinical diagnosis of neonatal sepsis was confirmed by isolation of Streptococcus agalactiae from otic cultures. The infant received oxygen therapy and antibiotic treatment and recovered completely at the age of 11 days. Although no congenital anomalies or behavioral alterations were diagnosed during hospitalization, periodic follow-ups were requested to check for potential long-term effects of prenatal exposure to alprazolam.
Collapse
|
8
|
Martí-Almor J, Berrueco R, García-Algar O, Mur A, Bazán V, Recasens L, Pérez-Rodón J, Bruguera J. QT interval in newborns of different ethnic origin: usefulness of neonatal ECG screening. Rev Esp Cardiol 2008; 61:980-982. [PMID: 18775242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The cost-effectiveness of neonatal electrocardiographic (ECG) screening has been questioned. The objective of this study was to establish normal values for the QT interval in newborns of different ethnic origin. Between 2005 and 2006, ECGs were obtained during the first 48 h of life from 1305 at-term newborns at the Hospital del Mar in Barcelona, Spain. The mean corrected QT interval (QTc) was 417.79+/-28.47 ms. A QTc longer than 440 ms was observed in 240 newborns (18.33%). The frequency of a pathologic QTc in Spanish newborns was 17.9%, compared with 27.7% in those of Maghreb or Near Eastern origin (P=.016), and 28.2% in those of Indian or Pakistani origin (P=.033). The QTc may vary for genetic reasons. A routine neonatal ECG is advisable only in ethnic groups in which the QTc is lengthened, to help counter the greater risk of sudden death in these infants.
Collapse
|
9
|
Martí-Almor J, Berrueco R, García-Algar Ó, Mur A, Bazán V, Recasens L, Pérez-Rodón J, Bruguera J. Intervalo QT en recién nacidos de diferente origen étnico: utilidad del cribado con ECG neonatal. Rev Esp Cardiol 2008. [DOI: 10.1157/13125522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
10
|
Martín I, López-Vílchez MA, Mur A, García-Algar O, Rossi S, Marchei E, Pichini S. Neonatal withdrawal syndrome after chronic maternal drinking of mate. Ther Drug Monit 2007; 29:127-9. [PMID: 17304161 DOI: 10.1097/ftd.0b013e31803257ed] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The premature newborn of a mother who reported drinking mate during pregnancy presented with increased jitteriness and irritability, high-pitched cry, hypertonia in the limbs, and brisk tendon reflexes consistent with neonatal withdrawal syndrome. High concentrations of caffeine and theobromine were detected in various maternal and neonatal biological matrices (placenta, cord serum, neonatal urine, maternal and neonatal hair, meconium, and breast milk), demonstrating both acute and chronic prenatal and postnatal exposure to these methylxanthines, contained in high amounts in homemade mate. Symptoms progressively disappeared at 84 hours of age, although intermittent irritability was still present when the infant was discharged at 24 days of age. Fluctuating caffeine (and theobromine) content in different breast milk feeds likely generated the baby's irritability, due to either the physiological stimulatory effects of the methylxanthines or postnatal withdrawal syndrome as the substances cleared from the body. The mother was strongly advised to initiate a considerable, progressive, constant reduction of mate consumption to a maximum of 2 cups a day for the duration of breastfeeding.
Collapse
Affiliation(s)
- Itziar Martín
- Neonatology Unit, Service of Pediatrics, Hospital Universitari del Mar, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
Areca-nut chewing occurs widely in South Asia and the Indian subcontinent. Here we present a case of neonatal withdrawal syndrome in an infant born to a woman who was a chronic areca-nut user. Arecoline, the principal neuroactive alkaloid in areca nuts, was found in the mother's placenta.
Collapse
|
12
|
Ramos JT, De José MI, Dueñas J, Fortuny C, González-Montero R, Mellado MJ, Mur A, Navarro M, Otero C, Pocheville I, Muñoz-Fernández MA, Cabrero E. Safety and antiviral response at 12 months of lopinavir/ritonavir therapy in human immunodeficiency virus-1-infected children experienced with three classes of antiretrovirals. Pediatr Infect Dis J 2005; 24:867-73. [PMID: 16220083 DOI: 10.1097/01.inf.0000180574.18804.90] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Many human immunodeficiency virus type 1 (HIV-1)-infected children have already failed treatment with 2 or even 3 classes of antiretrovirals. Coformulation of lopinavir with low dose ritonavir exhibits a potent antiretroviral effect. However, the data in heavily pretreated children are still scarce. This study evaluated the safety and effectiveness of combination therapy including lopinavir/ritonavir in children with prior exposure to all classes of oral antiretrovirals. METHODS This was an open label multicenter observational study, in which data were reviewed according to a standardized protocol. The study population included all HIV-1-infected children with virologic failure (HIV-1 RNA >5000 copies/mL) followed in 12 Spanish hospitals for >12 months, experienced with the 3 classes of oral antiretrovirals, in whom a lopinavir/ritonavir-containing regimen was started. RESULTS By March 2003, 45 patients had been treated with lopinavir/ritonavir for a median of 18 months (range, 3-28). The median age at baseline was 9.7 years (range, 4.3-17.1). The median times of prior treatment were 88 months (range, 31-145) with nucleoside reverse transcription inhibitors and 42 months (range, 19-63) with protease inhibitors. Twenty-five patients were classified as Centers for Disease Control and Prevention clinical category C. Median values for absolute and percentage CD4 at baseline were 501 (range, 6-1512) and 19% (range, 0.5-49), respectively, and plasma HIV-RNA was 5.0 log10 copies/mL (range, 4.1-6.1). During follow-up, 11 (24%) children switched from liquid to solid formulation. At 48 weeks, the median values for absolute and percentage CD4 increased by 199 cells/microL and 3%, respectively, and median plasma viral load declined 1.75 log10 copies/mL. Forty-two percent of children achieved a plasma RNA of <400 copies/mL (intent to treat analysis). Baseline genotypic resistance was available in 40 children. Nonresponders had 7.0 +/- 1.6 protease inhibitor-associated mutations at baseline compared with 4.8 +/- 1.7 in children achieving virologic suppression (P = 0.06). Adverse events were described in 18 children. Three children permanently discontinued and 4 transiently withdrew lopinavir/ritonavir. At 12 months, there were mild but not significant increases in plasma cholesterol and triglycerides. CONCLUSIONS Lopinavir/ritonavir when given as part of salvage regimen is well-tolerated, although switching to pills is frequently required. The regimen has a potent and durable antiretroviral activity in most heavily pretreated children, despite the presence of multiple mutations to all classes of oral antiretrovirals.
Collapse
|
13
|
Mur A, Seidel V, López-Vílchez MA, Bonet M, Gilaberte M. Acanthosis nigricans as an adverse effect of highly active antiretroviral therapy in an adolescent girl with human immunodeficiency virus infection. Pediatr Infect Dis J 2005; 24:742-3. [PMID: 16094236 DOI: 10.1097/01.inf.0000172936.20623.fd] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report an 11-year-old girl with acanthosis nigricans that appeared after 4 years of treatment with didanosine, stavudine and amprenavir. Laboratory studies showed hyperglycemia, hyperinsulinemia and hypertriglyceridemia. Withdrawal of amprenavir resulted in disappearance of acanthosis nigricans and improvement of metabolic abnormalities.
Collapse
Affiliation(s)
- Antonio Mur
- Service of Pediatrics, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | |
Collapse
|
14
|
Ramos JT, de José MI, Polo R, Fortuny C, Mellado MJ, Muñoz-Fernández MA, Beceiro J, Bertrán JM, Calvo C, Chamorro L, Ciria L, Guillén S, González-Montero R, González-Tomé MI, Gurbindo MD, Martín-Fontelos P, Martínez-Pérez J, Moreno D, Muñoz-Almagro MC, Mur A, Navarro ML, Otero C, Rojo P, Rubio B, Saavedra J. Recomendaciones CEVIHP/SEIP/AEP/PNS respecto al tratamiento antirretroviral en niños y adolescentes infectados por el VIH. Enferm Infecc Microbiol Clin 2005; 23:279-312. [PMID: 15899180 DOI: 10.1157/13074970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To update antiretroviral recommendations in antiretroviral therapy (ART) in HIV-infected children and adolescents. METHODS Theses guidelines have been formulated by a panel of members of the Plan Nacional sobre el SIDA (PNS) and the Asociacion Espanola de Pediatria (AEP) by reviewing the current available evidence of efficacy, safety, and pharmacokinetics in pediatric studies. Three levels of evidence have been defined according to the source of data: Level A: randomized and controlled studies; Level B: Cohort and case-control studies; Level C: Descriptive studies and experts' opinion. RESULTS When to start ART should be made on an individual basis, discussed with the family, considering the risk of progression according to age, CD4 and viral load, the ART-related complications and adherence. The ART goal is to reach a maximum and durable viral suppression. This is not always possible, even with clinical and immunologic improvement. The difficulties of permanent adherence and side-effects are resulting in a more conservative trend to initiate ART, and to less toxic and simpler strategies. Currently, combinations of at least three drugs are of first choice both in acute and chronic infection. They must include 2 NA 1 1 NN or 2 NA 1 1 PI. ART is recommended in all symptomatic patients and, with few exceptions, in all infants in the first year of life. Older asymptomatic children should start ART according to CD4 count, especially CD4 percentage, that vary with age. Despite potent salvage therapies, it is common not to reach viral undetectability. Therapeutical options when ART fails are scarce due to cross-resistance. The cause of failure must be identified. Occasionally, there exists clinical and/or immunological progression, and a change of therapy with at least two new drugs still active for the patient, is warranted with the aim of increasing the CD4 count to a lower level of risk. Toxicity and adherence must be regularly monitored. Some aspects about post exposure prophylaxis and coinfection with HCV or HBV are discussed. CONCLUSIONS A higher level of evidence with regard to ART effectiveness and toxicity in pediatrics is currently available, leading to a more conservative and individualized approach. Clinical symptoms and CD4 count are the main determinants to start and change ART.
Collapse
Affiliation(s)
- José Tomás Ramos
- Unidad de Inmunodeficiencias, Departamento de Pediatría, Hospital 12 Octubre, 28041 Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Bellón Cano JM, Sánchez-Ramón S, Ciria L, León JA, Gurbindo D, Fortuny C, Bertrán JM, Ruiz Contreras J, Ramos JT, Asensi O, Mur A, Resino R, Muñóz-Fernández MA. The effects on infants of potent antiretroviral therapy during pregnancy: a report from Spain. Med Sci Monit 2004; 10:CR179-84. [PMID: 15114266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/11/2003] [Accepted: 07/24/2003] [Indexed: 09/28/2022]
Abstract
BACKGROUND The purpose of our study was to assess the effects on infants of protease inhibitor (PI)-based antiretroviral therapy (ART) given to their HIV-positive mothers during pregnancy. MATERIAL/METHODS A multicenter observational study was carried out at 11 centers in Spain, involving 124 HIV-1-infected pregnant women under ART and their infants. The mothers were classified according to the ART protocols used during pregnancy into two groups: group A, 52 women with > or =2 nucleoside reverse transcriptase inhibitors (NRTI) with or without NNRTI, for a mean time of 4.7+/-2.2 months; and group B, 72 women on protease inhibitor (PI)-based regimens for 5.4+/-2.6 months. RESULTS Maternal therapy was well tolerated, with no serious adverse effects on pregnancy course. No newborn was infected with HIV-1. There were two deaths at birth (group B), both with extreme prematurity. Among the 126 ART-exposed infants (4 siblings), the most common toxicity was anemia (29%), without significant differences between the two groups. Low birthweight and prematurity were also common (21% and 14%, respectively). CONCLUSIONS Optimal management of HIV-1 infection in women, regardless of their pregnancy status, can be recommended in more developed countries, without adverse effects on pregnancy outcome, and dramatically decreasing vertical transmission. HAART with PI versus potent ART during pregnancy was effective and safe for infants throughout the 12-month follow-up. In the light of recent advances in anti-HIV-1 pregnancy therapy, the long-term safety of these prophylactic and therapeutical strategies should be studied.
Collapse
Affiliation(s)
- Jose Ma Bellón Cano
- Unit of Paediatric Epidemiology and Biostatistics, Hospital General Universitario Gregorio Marańón, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Thorne C, Newell ML, Botet FA, Bohlin AB, Ferrazin A, Giaquinto C, de José Gomez I, Mok JYQ, Mur A, Peltier A. Older children and adolescents surviving with vertically acquired HIV infection. J Acquir Immune Defic Syndr 2002; 29:396-401. [PMID: 11917245 DOI: 10.1097/00126334-200204010-00011] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article describes the characteristics of children infected vertically with HIV surviving 10 years or more who were enrolled in the prospective European Collaborative Study. Thirty-four of 187 infected children were identified with a median age of 11.4 years (range, 10.1-15.9 years). Factors examined included clinical status, immunologic and virologic characteristics, type of antiretroviral therapy, and psychosocial characteristics. By 10 years of age, 6 (18%) children had progressed to Class A as determined by the system of the U.S. Centers for Disease Control and Prevention (CDC), 17 (52%) to class B, 7 (21%) to class C, and 3 (9%) had remained asymptomatic. At 73% (904 of 1234) of scheduled clinic visits, these children had no symptoms of HIV disease. Most children were in CDC immune categories 1 (18, 56%) or 2 (11, 34%) at their last visit. Three quarters (24 patients) were on combination therapy with three or more drugs, although 3 children had never received any antiretroviral therapy. Nineteen (56%) children were living with at least 1 parent and the mothers of 13 (38%) children had died. Most (77%) children had been told about their HIV infection. Children infected vertically with HIV who have survived their first 10 years are mainly free of serious symptoms. As they enter adolescence, additional services are needed including support with disclosure to others, therapy, and sexual health.
Collapse
Affiliation(s)
- Claire Thorne
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Rovira MT, Antorn MT, Payá A, Castellanos E, Mur A, Carreras R. Human immunodeficiency virus infection in pregnant women, transmission and zidovudine therapy. Eur J Obstet Gynecol Reprod Biol 2001; 97:46-9. [PMID: 11435008 DOI: 10.1016/s0301-2115(00)00499-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the rate of mother to child transmission of HIV infection in women treated with zidovudine (ZDV). PATIENTS AND METHODS A consecutive series of 52 HIV-positive pregnant women who either received antenatal care or delivered at our institution. Forty-three women were known to be HIV positive before delivery. Forty were treated with ZDV, 36 intravenously. Twelve had no antenatal care and one refused antenatal treatment. All neonates were treated with ZDV. RESULTS The HIV transmission rate in children born to mothers treated with ZDV was 6.6%. This compares with a transmission rate of 14% before we used ZDV. All three mothers who transmitted infection had low compliance, initiated therapy late in pregnancy or had advanced disease. CONCLUSION Our experience supports the idea that ZDV treatment has reduced HIV transmission rate.
Collapse
Affiliation(s)
- M T Rovira
- Department of Obstetrics and Gynecology, Hospital Universitario del Mar, Universidad Autónoma de Barcelona, Passeig Maritim 25-29, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
18
|
Machuca A, Gutiérrez M, Mur A, Soriano V. Quantitative p24 antigenaemia for monitoring response to antiretroviral therapy in HIV-1 group O-infected patients. Antivir Ther 2000; 3:187-9. [PMID: 10682137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Failure to recognize infection caused by human immunodeficiency virus type 1 (HIV-1) group O variants has been described using both serological and genetic techniques. Moreover, the monitoring of response to antiretroviral therapy is difficult in persons carrying this infection since most currently available tests for quantifying viral load are not reliable for group O viruses. Considering the low level of divergence between the p24 proteins of group M and O viruses, we have examined whether the quantification of circulating p24 antigenaemia might be used as a surrogate marker of response to therapy in three subjects with HIV-1 group O infection treated with antiretroviral drugs. In summary, all three patients showed a significant decline in circulating plasma p24 antigenaemia, although only one achieved undetectable levels. The decline in p24 antigenaemia was parallel to an increase in the CD4 count and was associated with an improvement in clinical status.
Collapse
Affiliation(s)
- A Machuca
- Service of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | |
Collapse
|
19
|
Machuca A, Gutiérrez M, Mur A, Soriano V. Quantitative p24 Antigenaemia for Monitoring Response to Antiretroviral Therapy in HIV-1 Group O-Infected Patients. Antivir Ther 1998. [DOI: 10.1177/135965359800300305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Failure to recognize infection caused by human immunodeficiency virus type 1 (HIV-1) group 0 variants has been described using both serological and genetic techniques. Moreover, the monitoring of response to antiretroviral therapy is difficult in persons carrying this infection since most currently available tests for quantifying viral load are not reliable for group 0 viruses. Considering the low level of divergence between the p24 proteins of group M and 0 viruses, we have examined whether the quantification of circulating p24 antigenaemia might be used as a surrogate marker of response to therapy in three subjects with HIV-1 group 0 infection treated with antiretroviral drugs. In summary, all three patients showed a significant decline in circulating plasma p24 antigenaemia, although only one achieved undetectable levels. The decline in p24 antigenaemia was parallel to an increase in the CD4 count and was associated with an improvement in clinical status.
Collapse
Affiliation(s)
- Ana Machuca
- Service of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Maite Gutiérrez
- Service of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Mur
- Service of Pediatrics, Hospital del Mar, Barcelona, Spain
| | - Vincent Soriano
- Service of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
20
|
Nadal M, Milà M, Pritchard M, Mur A, Pujals J, Blouin JL, Antonarakis SE, Ballesta F, Estivill X. YAC and cosmid FISH mapping of an unbalanced chromosomal translocation causing partial trisomy 21 and Down syndrome. Hum Genet 1996; 98:460-6. [PMID: 8792823 DOI: 10.1007/s004390050240] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Most cases of Down syndrome (DS) result from a supernumerary chromosome 21; however, there are rare cases in which DS is due to partial trisomy of chromosome 21, involving various segments of the chromosome. The characterization of cases of DS that are due to partial trisomy 21 allows the phenotype to be correlated with the genotype. We present a case with features of DS and a partial trisomy of chromosome 21 inherited from a paternal balanced translocation involving chromosomes 13 and 21. Fluorescence in situ hybridization analysis using yeast artificial chromosome (YAC) probes mapped the breakpoint to 21q22.1, within YAC 230E8, which contains markers CBR, D21S333 and D21S334. Further mapping using cosmids positioned the breakpoint proximal to CBR. The patient was also monosomic for the distal portion of chromosome 13 (q33-qter). Many phenotypic features of DS were present including hypotonia, flat occiput, flat facies, up-slanted palpebral fissures, epicanthic folds, flat nasal bridge, macroglossia, open mouth, small ears and a heart murmur. This case further supports the contention that the majority of the phenotypic features of DS map to 21q22-qter and further refines the location of some of them. In addition to the DS phenotype, the patient had a prominent upper maxilla with protruding upper incisors, and low levels of the coagulation factors VII and X, consistent with a syndrome resulting from monosomy 13q33-qter. Since some features overlap between the two syndromes, including severe mental retardation, it is unclear to what extent monosmy for 13q33-qter, trisomy for 21q22.1-qter, or a combination of both, contributed to the common features of the phenotype.
Collapse
Affiliation(s)
- M Nadal
- Departament de Genètica Molecular, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Just JJ, Casabona J, Bertrán J, Montané C, Fortuny C, Rodrigo C, Mur A, Bosque M, Jovane L, King MC. MHC class II alleles associated with clinical and immunological manifestations of HIV-1 infection among children in Catalonia, Spain. Tissue Antigens 1996; 47:313-8. [PMID: 8773321 DOI: 10.1111/j.1399-0039.1996.tb02559.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Children with perinatally-acquired HIV-1 infection were studied to determine if major histocompatibility complex (MHC) genes are involved in progression to pediatric AIDS. Molecular genetic techniques were used to genotype loci in the class II region (DRB1, DQA1, DQB1, DPA1, DPB1, LMP2 and LMP7). HIV-infected children were classified by clinical manifestations and degree of immunosuppression using age-specific CD4 T-lymphocyte counts at enrollment. Alleles at the DPB1 and DQB1 loci showed independent and opposite associations; DPB1*0301 showed a trend toward protection while DQB1*0201 appeared to be a risk factor for developing severe immunosuppression and severe clinical outcomes. Presence of DQB1*0201 conferred a greater than 10-fold increased odds of having severe clinical manifestations and a 2.8-fold increased odds of severe immunosuppression. Presence of DPB1*0301 was associated with a greater than 8-fold decreased odds of severe immunosuppression and severe clinical manifestations. These results support host genetic influences on HIV-1 outcomes in children.
Collapse
Affiliation(s)
- J J Just
- School of Public Health, University of California, Berkeley, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
|
23
|
García A, Mur A. [Marijuana and pregnancy: impact on the pregnant woman, the fetus and the newborn infant]. Med Clin (Barc) 1991; 96:106-9. [PMID: 2033970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- A García
- Sección de Neonatología, Hospital del Mar, Barcelona
| | | |
Collapse
|
24
|
Llorens-Terol J, Martinez-Roig A, Mur A. Pneumonia associated with meningococcal bacteremia and/or meningitis. Helv Paediatr Acta 1984; 39:187-92. [PMID: 6543842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Four children between 5 and 12 years of age had pneumonia as a secondary complication of meningococcal bacteremia and/or meningitis. The diagnosis of meningococcal disease was established by culture of blood and/or cerebrospinal fluid. Fine inspiratory rales were found in one patient. In the other three cases pulmonary infiltrates were evidenced on chest roentgenogram. All patients recovered with penicillin G sodium therapy.
Collapse
|