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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Pellegrin S, Munoz FM, Padula M, Heath PT, Meller L, Top K, Wilmshurst J, Wiznitzer M, Das MK, Hahn CD, Kucuku M, Oleske J, Vinayan KP, Yozawitz E, Aneja S, Bhat N, Boylan G, Sesay S, Shrestha A, Soul JS, Tagbo B, Joshi J, Soe A, Maltezou HC, Gidudu J, Kochhar S, Pressler RM. Neonatal seizures: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2019; 37:7596-7609. [PMID: 31783981 PMCID: PMC6899436 DOI: 10.1016/j.vaccine.2019.05.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/09/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Serena Pellegrin
- Clinical Neuroscience, UCL-Institute of Child Health, London, UK; Department of Child Neuropsychiatry, University of Verona, Verona, Italy
| | - Flor M Munoz
- Baylor College of Medicine, Department of Pediatrics, Houston, TX, USA
| | | | - Paul T Heath
- Vaccine Institute, St Georges University of London, London, UK
| | - Lee Meller
- Syneos Health, Safety & Pharmacovigilance, Raleigh, NC, USA
| | - Karina Top
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Jo Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa
| | - Max Wiznitzer
- Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | | | - Cecil D Hahn
- Division of Neurology, The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Merita Kucuku
- National Agency for Medicines and Medical Devices, Tirana, Albania
| | - James Oleske
- Department of Pediatrics, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | | | - Elissa Yozawitz
- Saul R. Korey Department of Neurology, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Satinder Aneja
- Department of Pediatrics, School of Medical Sciences & Research, Sharda University, Gr Noida, India
| | - Niranjan Bhat
- Center for Vaccine Innovation and Access PATH, Seattle, WA, USA
| | | | - Sanie Sesay
- Clinical Sciences, Sanofi Pasteur, Marcy L'Etoile, France
| | | | - Janet S Soul
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Beckie Tagbo
- Institute of Child Health, University of Nigeria Teaching Hospital, Nigeria
| | - Jyoti Joshi
- Center for Disease Dynamics, Economics & Policy, New Delhi, India
| | - Aung Soe
- Medway NHS Foundation Trust, Kent, UK
| | - Helena C Maltezou
- Department for Interventions in Healthcare Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Jane Gidudu
- Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, USA
| | - Sonali Kochhar
- Global Healthcare Consulting, New Delhi, India; Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Global Health, University of Washington, Seattle, USA
| | - Ronit M Pressler
- Clinical Neuroscience, UCL-Institute of Child Health, London, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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Cotton MF, Rabie H, Nemes E, Mujuru H, Bobat R, Njau B, Violari A, Mave V, Mitchell C, Oleske J, Zimmer B, Varghese G, Pahwa S. A prospective study of the immune reconstitution inflammatory syndrome (IRIS) in HIV-infected children from high prevalence countries. PLoS One 2019; 14:e0211155. [PMID: 31260455 PMCID: PMC6602181 DOI: 10.1371/journal.pone.0211155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 05/31/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The immune reconstitution inflammatory syndrome (IRIS) in HIV-infected infants and young children is relatively understudied in regions endemic for HIV and TB. We aimed to describe incidence, clinical features and risk factors of pediatric IRIS in Sub-Saharan Africa and India. METHODS AND FINDINGS We conducted an observational multi-centred prospective clinical study from December 2010 to September 2013 in children <72 months of age recruited from public antiretroviral programs. The main diagnostic criterion for IRIS was a new or worsening inflammatory event after initiating antiretroviral therapy (ART). Among 198 participants, median age 1.15 (0.48; 2.21) years, 38 children (18.8%) developed 45 episodes of IRIS. Five participants (13.2%) had two IRIS events and one (2.6%) had 3 events. Main causes of IRIS were BCG (n = 21; 46.7%), tuberculosis (n = 10; 22.2%) and dermatological, (n = 8, 17.8%). Four TB IRIS cases had severe morbidity including 1 fatality. Cytomegalovirus colitis and cryptococcal meningitis IRIS were also severe. BCG IRIS resolved without pharmacological intervention. On multivariate logistic regression, the most important baseline associations with IRIS were high HIV viral load (likelihood ratio [LR] 10.629; p = 0.0011), recruitment at 1 site (Stellenbosch University) (LR 4.01; p = 0.0452) and CD4 depletion (LR 3.4; p = 0.0654). Significantly more non-IRIS infectious and inflammatory events between days 4 and 17 of ART initiation were noted in cases versus controls (35% versus 15.2%: p = 0.0007). CONCLUSIONS IRIS occurs commonly in HIV-infected children initiating ART and occasionally has severe morbidity. The incidence may be underestimated. Predictive, diagnostic and prognostic biomarkers are needed.
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Affiliation(s)
- Mark F. Cotton
- Department of Pediatrics & Child Health, Stellenbosch University, Tygerberg, South Africa
| | - Helena Rabie
- Department of Pediatrics & Child Health, Stellenbosch University, Tygerberg, South Africa
| | - Elisa Nemes
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease & Molecular Medicine and Division of Immunology, Pathology, University of Cape Town, Cape Town, South Africa
| | - Hilda Mujuru
- Department of Pediatrics, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Raziya Bobat
- Department of Pediatrics & Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Boniface Njau
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Avy Violari
- Department of Pediatrics & Child Health, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Charles Mitchell
- Department of Pediatric Immunology, University of Miami, Miami, FL, United States of America
| | - James Oleske
- Department of Pediatrics & Child Health, Rutgers New Jersey Medical School, Newark, NJ, United States of America
| | - Bonnie Zimmer
- Frontier Science & Technology Research Foundation, Amherst, NY, United States of America
| | - George Varghese
- Department of Pediatrics & Child Health, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Savita Pahwa
- Department of Pediatrics & Child Health, University of Miami Miller School of Medicine, Miami, FL, United States of America
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Woerner A, Pourmalek F, Panozzo C, Pileggi G, Hudson M, Caric A, Abraham S, Varricchio F, Velasco C, Oleske J, Bauwens J, Bonhoeffer J. Acute aseptic arthritis: Case definition & guidelines for data collection, analysis, and presentation of immunisation safety data. Vaccine 2018; 37:384-391. [PMID: 30342899 DOI: 10.1016/j.vaccine.2017.08.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Andreas Woerner
- University of Basel Children's Hospital, Basel, Switzerland.
| | | | - Catherine Panozzo
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Gecilmara Pileggi
- School of Medicine of Ribeirão Preto, University of São Paulo, Brazil; School of Medicine, University Federal of São Carlos, Brazil
| | | | | | - Sonya Abraham
- Imperial National Institute of Health Research/Wellcome CRF, Imperial College, London, United Kingdom
| | | | - Cesar Velasco
- Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | | | | | - Jan Bonhoeffer
- University of Basel Children's Hospital, Basel, Switzerland; Brighton Collaboration Foundation, Basel, Switzerland
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Slogrove AL, Schomaker M, Davies MA, Williams P, Balkan S, Ben-Farhat J, Calles N, Chokephaibulkit K, Duff C, Eboua TF, Kekitiinwa-Rukyalekere A, Maxwell N, Pinto J, Seage G, Teasdale CA, Wanless S, Warszawski J, Wools-Kaloustian K, Yotebieng M, Timmerman V, Collins IJ, Goodall R, Smith C, Patel K, Paul M, Gibb D, Vreeman R, Abrams EJ, Hazra R, Van Dyke R, Bekker LG, Mofenson L, Vicari M, Essajee S, Penazzato M, Anabwani G, Q. Mohapi E, N. Kazembe P, Hlatshwayo M, Lumumba M, Goetghebuer T, Thorne C, Galli L, van Rossum A, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaia L, Rojo P, Fortuny C, Naver L, Rudin C, Le Coeur S, Volokha A, Rouzier V, Succi R, Sohn A, Kariminia A, Edmonds A, Lelo P, Ayaya S, Ongwen P, Jefferys LF, Phiri S, Mubiana-Mbewe M, Sawry S, Renner L, Sylla M, Abzug MJ, Levin M, Oleske J, Chernoff M, Traite S, Purswani M, Chadwick EG, Judd A, Leroy V. The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis. PLoS Med 2018; 15:e1002514. [PMID: 29494593 PMCID: PMC5832192 DOI: 10.1371/journal.pmed.1002514] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/24/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia. METHODS AND FINDINGS Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.3-8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. CONCLUSION To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses.
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Affiliation(s)
| | - Amy L. Slogrove
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Paige Williams
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Suna Balkan
- Epicentre, Médecins Sans Frontières, Paris, France
| | | | - Nancy Calles
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | | | - Charlotte Duff
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Tanoh François Eboua
- Yopougon University Hospital, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | | | - Nicola Maxwell
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Jorge Pinto
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - George Seage
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Chloe A. Teasdale
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Sebastian Wanless
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Josiane Warszawski
- Inserm (French Institute of Health and Medical Research), CESP UMR Villejuif, France
| | - Kara Wools-Kaloustian
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Marcel Yotebieng
- College of Public Health, Ohio State University, Columbus, Ohio, United States of America
| | - Venessa Timmerman
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Intira J. Collins
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Ruth Goodall
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Colette Smith
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Kunjal Patel
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mary Paul
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Diana Gibb
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Rachel Vreeman
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Elaine J. Abrams
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Rohan Hazra
- National Institute of Child Health and Human Development (NICHD), US National Institutes of Health, Rockville, Maryland, United States of America
| | - Russell Van Dyke
- Tulane University, New Orleans, Louisiana, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | | | | | | | - Gabriel Anabwani
- Baylor International Pediatric AIDS Initiative, Gaborone, Botswana
| | - Edith Q. Mohapi
- Baylor International Pediatric AIDS Initiative, Maseru, Lesotho
| | - Peter N. Kazembe
- Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi
| | | | - Mwita Lumumba
- Baylor International Pediatric AIDS Initiative, Mbeya, Tanzania
| | | | - Claire Thorne
- Institute of Child Health, University College London, London, United Kingdom
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Annemarie van Rossum
- Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | | | - Magdalena Marczynska
- Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
| | | | | | | | - Liubov Okhonskaia
- Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation
| | | | - Claudia Fortuny
- Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Lars Naver
- Karolinska University Hospital, Stockholm, Sweden
| | | | - Sophie Le Coeur
- Institut de Recherche pour le Développement (IRD) 174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Institut National d'Etudes Démograhiques (Ined), F-75020 Paris, France
| | - Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | | | - Regina Succi
- Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Andrew Edmonds
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Patricia Lelo
- Pediatric Hospital Kalembe Lembe, Lingwala, Kinshasa, Democratic Republic of Congo
| | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Patricia Ongwen
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Sam Phiri
- Lighthouse Trust Clinic, Lilongwe, Malawi
| | | | - Shobna Sawry
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Lorna Renner
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | | | - Mark J. Abzug
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Myron Levin
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - James Oleske
- Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Miriam Chernoff
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Shirley Traite
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Murli Purswani
- Bronx-Lebanon Hospital Center (Icahn School of Medicine at Mount Sinai), Bronx, New York, United States of America
| | - Ellen G. Chadwick
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, United States of America
| | - Ali Judd
- MRC Clinical Trials Unit at University College London, London, United Kingdom
- * E-mail: (AJ); (VL)
| | - Valériane Leroy
- Inserm (French Institute of Health and Medical Research), UMR 1027 Université Toulouse 3, Toulouse, France
- * E-mail: (AJ); (VL)
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Affiliation(s)
- A Minnefor
- University of Medicine and Dentistry, Newark, N.J
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Krogstad P, Patel K, Karalius B, Hazra R, Abzug MJ, Oleske J, Seage GR, Williams P, Borkowsky W, Wiznia A, Pinto J, Van Dyke RB. Incomplete immune reconstitution despite virologic suppression in HIV-1 infected children and adolescents. AIDS 2015; 29:683-93. [PMID: 25849832 PMCID: PMC4391276 DOI: 10.1097/qad.0000000000000598] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Some perinatally infected children do not regain normal CD4(+) T-cell counts despite suppression of HIV-1 plasma viremia by antiretroviral therapy (ART). The frequency, severity and significance of these discordant treatment responses remain unclear. DESIGN We examined the persistence of CD4(+) lymphocytopenia despite virologic suppression in 933 children (≥ 5 years of age) in the USA, Latin America and the Caribbean. METHODS CD4(+) T-cell trajectories were examined and Kaplan-Meier methods used to estimate median time to CD4(+) T-cell count at least 500 cells/μl. RESULTS After 1 year of virologic suppression, most (99%) children achieved a CD4(+) T-cell count of at least 200 cells/μl, but CD4(+) T-cell counts remained below 500 cells/μl after 1 and 2 years of virologic suppression in 14 and 8% of children, respectively. Median times to first CD4(+) T-cell count at least 500 cells/μl were 1.29, 0.78 and 0.46 years for children with less than 200, 200-349 and 350-499 cells/μl at the start of virologic suppression. New AIDS-defining events occurred in nine children, including four in the first 6 months of virologic suppression. Other infectious and HIV-related diagnoses occurred more frequently and across a wide range of CD4(+) cell counts. CONCLUSION ART improved CD4(+) cell counts in most children, but the time to CD4(+) cell count of at least 500 cells was highly dependent upon baseline immunological status. Some children did not reach a CD4(+) T-cell count of 500 cells/μl despite 2 years of virologic suppression. AIDS-defining events occurred in 1% of the population, including children in whom virologic suppression and improved CD4(+) T-cell counts were achieved.
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Affiliation(s)
- Paul Krogstad
- Departments of Pediatrics (Infectious Diseases) and Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - Kunjal Patel
- Department of Epidemiology, Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA
| | - Brad Karalius
- Department of Epidemiology, Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA
| | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health & Human Development, Bethesda, Maryland
| | - Mark J. Abzug
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO
| | - James Oleske
- Department of Pediatrics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - George R. Seage
- Department of Epidemiology, Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA
| | - Paige Williams
- Department of Epidemiology, Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA
| | | | - Andrew Wiznia
- Albert Einstein College of Medicine, New York City, NY
| | - Jorge Pinto
- Department of Pediatrics, Federal University of Minas Gerais, Minas Gerais, Brazil
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Abstract
Slit ventricle syndrome is a rare condition whereby brain compliance is reduced and can be associated with intermittent intracranial hypertension. A 19-year-old male with a ventriculoperitoneal shunt for congenital hydrocephalus presented with a 1-day history of headache and drowsiness-symptoms from which he suffered in many recurrent episodes over the past 5 years. The improvement of headaches without surgical intervention led to the diagnosis of migraine. During this hospitalization, episodes of intermittent intracranial hypertension were documented along with the remission and relapse of the symptoms. While the patient's intracranial pressure was within normal range in over 90% of his monitoring period, which postponed shunting, replacement of his ventriculoperitoneal shut eventually resolved his symptoms. Slit ventricle syndrome with reduced ventricular compliances should be considered in patients with clinical evidence of intermittent intracranial hypertension and small ventricular size. The authors advocate shunt replacement as an appropriate treatment for this condition.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, Department of Neurology and Neurosciences, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA
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Brogly SB, Abzug MJ, Watts DH, Cunningham CK, Williams PL, Oleske J, Conway D, Sperling RS, Spiegel H, Van Dyke RB. Birth defects among children born to human immunodeficiency virus-infected women: pediatric AIDS clinical trials protocols 219 and 219C. Pediatr Infect Dis J 2010; 29:721-7. [PMID: 20539252 PMCID: PMC2948952 DOI: 10.1097/inf.0b013e3181e74a2f] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Some studies have detected associations between in utero antiretroviral therapy (ARV) exposure and birth defects but evidence is inconclusive. METHODS A total of 2202 human immunodeficiency virus (HIV)-exposed children enrolled in the Pediatric AIDS Clinical Trials Group 219 and 219 C protocols before 1 year of age were included. Birth defects were classified using the Metropolitan Atlanta Congenital Defects Program coding. Logistic regression models were used to evaluate associations between first trimester in utero ARV exposure and birth defects. RESULTS A total of 117 live-born children had birth defects for a prevalence of 5.3% (95% confidence interval [CI]: 4.4, 6.3). Prevalence did not differ by HIV infection status or overall ARV exposure; rates were 4.8% (95% CI: 3.7, 6.1) and 5.8% (95% CI: 4.2, 7.8) in children without and with first trimester ARV exposure, respectively. The defect rate was higher among children with first trimester efavirenz exposure (5/32, 15.6%) versus children without first trimester efavirenz exposure (adjusted odds ratio [aOR] = 4.31 [95% CI: 1.56, 11.86]). Protective effects of first trimester zidovudine exposure on musculoskeletal defects were detected (aOR = 0.24 [95% CI: 0.08, 0.69]), while a higher risk of heart defects was found (aOR = 2.04 [95% CI: 1.03, 4.05]). CONCLUSIONS The prevalence of birth defects was higher in this cohort of HIV-exposed children than in other pediatric cohorts. There was no association with overall ARV exposure, but there were some associations with specific agents, including efavirenz. Additional studies are needed to rule out confounding and to evaluate newer ARV agents.
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Affiliation(s)
- Susan B Brogly
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, USA.
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10
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Sejvar JJ, Kohl KS, Gidudu J, Amato A, Bakshi N, Baxter R, Burwen DR, Cornblath DR, Cleerbout J, Edwards KM, Heininger U, Hughes R, Khuri-Bulos N, Korinthenberg R, Law BJ, Munro U, Maltezou HC, Nell P, Oleske J, Sparks R, Velentgas P, Vermeer P, Wiznitzer M. Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2010; 29:599-612. [PMID: 20600491 DOI: 10.1016/j.vaccine.2010.06.003] [Citation(s) in RCA: 420] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 06/01/2010] [Indexed: 11/26/2022]
Affiliation(s)
- James J Sejvar
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
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11
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Andiman WA, Chernoff MC, Mitchell C, Purswani M, Oleske J, Williams PL, Spiegel H, Gona P, Seage GR. Incidence of persistent renal dysfunction in human immunodeficiency virus-infected children: associations with the use of antiretrovirals, and other nephrotoxic medications and risk factors. Pediatr Infect Dis J 2009; 28:619-25. [PMID: 19561425 PMCID: PMC3192653 DOI: 10.1097/inf.0b013e31819ca49a] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Survival of HIV-infected children continues to increase and the use of antiretrovirals (ARVs) is expanding; however there are few data regarding the incidence of renal dysfunction and associated risk factors among HIV-infected children and youth. METHODS A total of 2102 children enrolled in Pediatric AIDS Clinical Trials Group Study 219/219C, were followed and assessed prospectively for >30 months. Occurrence of clinical events and laboratory abnormalities were recorded using standardized criteria and forms. Therapeutic decisions were made by clinicians at each site. Occurrence of persistent renal laboratory abnormalities was the main outcome measure. RESULTS Four hundred forty-six (22%) enrollees exhibited at least one persistent renal laboratory abnormality. Elevated serum creatinine (Cr) was more common than persistent proteinuria (15% vs. 8%). The incidence of new renal laboratory abnormalities was 3.7 events per 100 person-years with rates increasing between 1993 and 2005. Older age (>or=6 years vs. <6 years), Hispanic ethnicity, and Black non-Hispanic race were associated with increased risk of renal dysfunction, but CDC clinical class and plasma HIV RNA levels were not. Subjects exposed to ARV regimens containing tenofovir and/or indinavir had approximately twice the risk of developing renal dysfunction compared with persons exposed to other ARVs. The risk of renal dysfunction was also elevated for other antivirals (hazard ratio = 5.4) and amphotericin B (hazard ratio = 28). CONCLUSIONS Persistent renal function abnormalities occur frequently in HIV-infected children. Improved survival, Black race and Hispanic ethnicity, and exposure to tenofovir, indinavir, and other antimicrobial agents increase the risk for renal dysfunction. All HIV-infected children should be monitored closely for evidence of renal disease.
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Affiliation(s)
- Warren A. Andiman
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
- Department of Public Health, Yale University School of Medicine, New Haven, CT
| | - Miriam C. Chernoff
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA
| | | | - Murli Purswani
- Division of Pediatric Infectious Diseases, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY
| | - James Oleske
- University of Medicine and Dentistry of New Jersey, Newark, NJ
| | - Paige L. Williams
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA
| | - Hans Spiegel
- Children’s National Medical Center, Washington, DC
| | - Phil Gona
- Statistical Consulting Unit, Department of Mathematics and Statistics, Boston University, Boston, MA
| | - George R. Seage
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
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Nachman SA, Chernoff M, Gona P, Van Dyke RB, Dankner WM, Seage GR, Oleske J, Williams PL. Incidence of noninfectious conditions in perinatally HIV-infected children and adolescents in the HAART era. ACTA ACUST UNITED AC 2009; 163:164-71. [PMID: 19188649 DOI: 10.1001/archpedi.163.2.164] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To estimate highly active antiretroviral therapy (HAART)-era incident rates for the first episode of noninfectious conditions in human immunodeficiency virus (HIV)-infected youth in order to identify HAART-era changes in the natural history of perinatal HIV infection. DESIGN Multicenter prospective cohort study. SETTING More than 80 sites in the United States including Puerto Rico. PATIENTS Perinatally HIV-infected youth. MAIN OUTCOME MEASURES Incidence rates (IRs) per 100 person-years were calculated for targeted noninfectious conditions occurring in perinatally HIV-infected children. A chi(2) test for linear trend was used to evaluate changes in the rates from 2001 to 2006. RESULTS Two thousand five hundred seventy-five perinatally HIV-infected children (51%, female; 59%, black, non-Hispanic) were enrolled in Pediatric AIDS Clinical Trials Group (PACTG) 219C between 2000 and 2006 and were followed up for a median of 59 months. The 10 most common noninfectious conditions were pregnancy conditions (IR = 6.16; 95% confidence interval (CI), 3.9-9.3), birth defects (IR = 0.19; 95% CI, 0.1-0.3), gynecological dysplasias (IR = 5.92; 95% CI, 3.9-8.6), condyloma (IR = 0.15; 95% CI, 0.1-0.2), encephalopathy (IR = 0.38; 95% CI, 0.3-0.5), pancreatitis (IR = 0.30; 95% CI, 0.2-0.4), cardiac disorders (IR = 0.28; 95% CI, 0.2-0.4), renal disorders (IR = 0.26; 95% CI, 0.2-0.4), peripheral neuropathy (IR = 0.23; 95% CI, 0.2-0.4), and idiopathic thrombocytic purpura (IR = 0.15; 95% CI, 0.1-0.3). Among these conditions, 5 showed significant trends, with IRs increasing over time in pregnancy-related conditions (P < .001) and gynecological dysplasias (P = .02) while IRs decreased over time for encephalopathy (P < .001), pancreatitis (P = .002), and cardiac disorders (P = .007). CONCLUSIONS Between 2001 and 2006, the incidence for 3 conditions decreased and increased for 2 others, demonstrating the change in medical issues and conditions in perinatally infected youth. Continued surveillance with appropriate tools will be needed to assess the long-term effects of HAART and HIV as well as development of new noninfectious conditions of HIV.
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Affiliation(s)
- Sharon A Nachman
- Department of Pediatrics, Stony Brook University Medical Center, Stony Brook, NY 11794-8111, USA.
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13
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Williams PL, Van Dyke R, Eagle M, Smith D, Vincent C, Ciupak G, Oleske J, Seage GR. Association of site-specific and participant-specific factors with retention of children in a long-term pediatric HIV cohort study. Am J Epidemiol 2008; 167:1375-86. [PMID: 18413359 DOI: 10.1093/aje/kwn072] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Minimizing loss to follow-up (LTFU) in long-term cohort studies is essential for reducing bias and maintaining statistical stability. However, factors associated with attrition of children in observational studies have received little attention. The authors used survival analysis methods to evaluate the association of participant and site characteristics with time to LTFU in a multicenter cohort study conducted in the United States of 2,693 human immunodeficiency virus (HIV)-infected and 1,370 HIV-exposed-but-uninfected children enrolled in 2000-2004. As of 2004, 91% of HIV-infected and 86% of uninfected children had been retained in the study. Among the HIV infected, factors associated with higher risk of LTFU included site prohibition of participant compensation, low caregiver educational level, age >15 years, and higher viral load, whereas death of a family member was associated with better retention. Among uninfected children, sites accruing low numbers of subjects, social worker responsible for retention, young age (1-2 years), and birth abnormalities were associated with higher risk of LTFU. Occurrences of certain stressful life events, such as a death in the family or financial instability, were associated with higher retention, but risk of LTFU increased when children started school or mothers began employment. Although participant characteristics are difficult to modify, the authors identified several potentially modifiable site practices that could be targeted to improve retention.
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Affiliation(s)
- Paige L Williams
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA 02115-6017, USA.
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14
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Rath B, Linder T, Cornblath D, Hudson M, Fernandopulle R, Hartmann K, Heininger U, Izurieta H, Killion L, Kokotis P, Oleske J, Vajdy M, Wong V. “All that palsies is not Bell's [1]”—The need to define Bell's palsy as an adverse event following immunization. Vaccine 2007; 26:1-14. [DOI: 10.1016/j.vaccine.2007.10.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 10/16/2007] [Accepted: 10/18/2007] [Indexed: 12/01/2022]
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15
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Brogly SB, Ylitalo N, Mofenson LM, Oleske J, Van Dyke R, Crain MJ, Abzug MJ, Brady M, Jean-Philippe P, Hughes MD, Seage GR. In utero nucleoside reverse transcriptase inhibitor exposure and signs of possible mitochondrial dysfunction in HIV-uninfected children. AIDS 2007; 21:929-38. [PMID: 17457086 DOI: 10.1097/qad.0b013e3280d5a786] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is equivocal evidence of in utero nucleoside reverse transcriptase inhibitor (NRTI) exposure and the occurrence of mitochondrial dysfunction (MD) in HIV-uninfected children born of HIV-infected women. METHODS The primary analysis included 1037 HIV-uninfected children born in 1991-2002 and enrolled in Pediatric AIDS Clinical Trials Group protocols 219/219C. Possible cases with unexplained signs of MD according to the Enquête Périnatale Française criteria were identified through retrospective review. Associations between overall in utero NRTI exposure, and trimester of first in utero NRTI exposure and possible MD were estimated with exact logistic regression. RESULTS Cases (n = 20) were significantly more likely to be male and to be born in earlier years than non-cases (n = 1017). There was no association between overall in utero NRTI exposure and MD. In unadjusted models there were higher odds of first in utero exposure in the third trimester to lamivudine (3TC) [odds ratio (OR), 3.76 versus 3TC unexposed; 95% confidence interval (CI), 1.09-11.78] and to zidovudine (ZDV) and 3TC in combination (ZDV/3TC) (OR, 3.29 vs. ZDV/3TC unexposed; 95% CI, 0.96-10.25) among cases than noncases. When adjusted for year of birth the odds of first exposure in the third trimester to 3TC (OR, 10.57; 95% CI, 1.93-75.61) and ZDV/3TC (OR, 9.84; 95% CI, 1.77-71.68) were significantly higher among cases than non-cases. Incomplete data precluded control of possible confounding by maternal viral load and psychoactive drug use. CONCLUSIONS Our study suggests that first exposure to 3TC or ZDV/3TC in the third trimester may be associated with the occurrence of possible MD. Further studies that rigorously assess MD and better control confounding are needed.
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Affiliation(s)
- Susan B Brogly
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts 02115, USA
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Sejvar JJ, Kohl KS, Bilynsky R, Blumberg D, Cvetkovich T, Galama J, Gidudu J, Katikaneni L, Khuri-Bulos N, Oleske J, Tapiainen T, Wiznitzer M. Encephalitis, myelitis, and acute disseminated encephalomyelitis (ADEM): case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2007; 25:5771-92. [PMID: 17570566 DOI: 10.1016/j.vaccine.2007.04.060] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- James J Sejvar
- Division of Viral and Rickettsial Diseases and Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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17
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Brogly SB, Watts DH, Ylitalo N, Franco EL, Seage GR, Oleske J, Eagle M, Van Dyke R. Reproductive health of adolescent girls perinatally infected with HIV. Am J Public Health 2007; 97:1047-52. [PMID: 17463385 PMCID: PMC1874205 DOI: 10.2105/ajph.2005.071910] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to describe the reproductive health of adolescent girls perinatally infected with HIV. METHODS We estimated the incidence of first pregnancy, genital infections, and abnormal cervical cytology for 638 girls aged 13 years and older in the Pediatric AIDS Clinical Trials Group protocol 219C. RESULTS Thirty-eight girls became pregnant, for a first pregnancy rate of 18.8/1000 person-years; 7 of these girls had additional pregnancies (95% confidence interval [CI]=13.3, 25.7). Thirty-two pregnancies resulted in live births. All girls received antiretroviral therapy during pregnancy. One infant was HIV infected, 29 were uninfected, and 2 had unknown infection status, for a rate of mother-to-child transmission of HIV in infants with known infection status of 3.3% (95% CI=0.1, 18.6). Condylomata and trichomoniasis were the most frequent genital infections. Forty-eight (47.5%) of 101 girls with Papanicolaou test examinations had abnormal cervical cytology, including atypical cells of undetermined significance (n=18), low-grade squamous intraepithelial lesions (SIL; n=27), and high-grade SIL (n=3). Many abnormalities persisted despite intervention. CONCLUSIONS Pregnancy rates were lower and cervical abnormalities were higher than among non-HIV-infected adolescents. These findings underscore the importance of Papanicolaou tests and promotion of safer sexual practices in this population.
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Affiliation(s)
- Susan B Brogly
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Mass 02115-6017, USA.
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18
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Farley J, Gona P, Crain M, Cervia J, Oleske J, Seage G, Lindsey J. Prevalence of elevated cholesterol and associated risk factors among perinatally HIV-infected children (4-19 years old) in Pediatric AIDS Clinical Trials Group 219C. J Acquir Immune Defic Syndr 2005; 38:480-7. [PMID: 15764965 DOI: 10.1097/01.qai.0000139397.30612.96] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [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: 12/14/2022]
Abstract
BACKGROUND HIV protease inhibitors (PIs) are known to disturb lipid metabolism in adults, leading to hypercholesterolemia. A number of cross-sectional studies have also reported this phenomenon in perinatally HIV-infected children but differ greatly with respect to prevalence and/or methodology. METHODS The Pediatric AIDS Clinical Trials Group 219C (PACTG 219C) is a prospective cohort study designed to examine long-term outcomes in children born to HIV-infected women. The outcome of interest in this analysis was total cholesterol, and patients were classified as hypercholesterolemic if their total cholesterol was above the 95th percentile of US Third National Health and Nutrition Survey (NHANES III) standards for gender, race/ethnicity, and age. We hypothesized that hypercholesterolemia would be more common among older children receiving PI therapy who demonstrated excellent adherence and might be associated with hypertension and obesity. Information regarding treatment, adherence, and laboratory values was obtained using the date closest to the cholesterol measurement. Crude and adjusted effect measures were estimated using exposure odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) from univariate and multivariate logistic regression models. RESULTS Among 1812 HIV-infected participants between 4 and 19 years of age, 229 children had hypercholesterolemia (prevalence = 13.0%, 95% CI: 11.1-14.3) compared with 9 of 187 HIV-uninfected children (prevalence = 4.8%, 95% CI: 2.2-8.8). After adjusting for confounders, current PI use (OR = 5.3, 95% CI: 3.1-9.2), age from 4 to <6 years (OR = 2.9, 95% CI: 1.7-4.9), HIV-1 RNA <400 copies/mL (OR = 2.3, 95% CI: 1.7-3.2), self-report of no missed doses in the past 3 days (OR = 2.2, 95% CI: 1.3-3.8), white race (OR = 2.2, 95% CI: 1.4-3.3), age from 6 to <12 years (OR = 1.9, 95% CI: 1.3-2.9), Hispanic ethnicity (OR = 1.8, 95% CI: 1.2-2.5), and current nonnucleoside reverse transcriptase inhibitor use (OR = 1.7, 95% CI: 1.2-2.3) were independently associated with the presence of hypercholesterolemia among the HIV-infected children. There was a positive association with elevated systolic blood pressure in univariate but not multivariate analysis, and no association was present with body mass index. CONCLUSIONS Among the HIV-infected children, the overall prevalence of hypercholesterolemia was 13.0% and the strongest associated risk factor for hypercholesterolemia was current use of a PI in the antiretroviral regimen. Continued follow-up is needed to assess the long-term effects of hypercholesterolemia in children.
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Affiliation(s)
- John Farley
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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19
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Abstract
OBJECTIVES To determine the incidence of and factors associated with malignancy in perinatally human immunodeficiency virus (HIV)-infected children in the United States. METHODS Included were 2969 children followed in the Pediatric AIDS Clinical Trials Group (PACTG) 219/219C cohort from 1993 through 2003. Cancer incidence by sex, race, age, histology and highly active antiretroviral therapy (HAART) era (pre-HAART, 1993-1997; HAART, 1998-2003) was estimated, and the standardized incidence ratio contrasting infected and uninfected children was determined. Poisson regression was used to further investigate the relation between HAART use (> or =3 drugs of > or =2 classes, 1 of which was a protease inhibitor), CD4% and cancer. RESULTS There were 37 cancers (17 prevalent and 20 incident) diagnosed in 2969 children for a prevalence of 0.6% [95% confidence interval (CI), 0.3, 0.9] and an incidence of 1.56/1000 person-years (95% CI 0.95, 2.41). Compared with uninfected children, the standardized incidence ratio was 10.08 (95% CI 5.87, 16.14). Incidence did not significantly differ by sex, race, age or HAART era. Of the cases, 35% were immunocompetent (CD4 > or =25%), 25% were moderately immunosuppressed (15%< or = CD4 < or =24%) and 40% were severely immunosuppressed (CD4 <15%) at diagnosis. In multivariate regression, the cancer rate was 3.09 (95% CI 1.22, 7.85) times higher in children with < or =2 years of HAART use than in children with >2 years of HAART and 3.20 (95% CI 1.32, 7.76) times higher in children with CD4 <15% at cohort enrollment than in children with CD4 > or =15%. CONCLUSION Cancer incidence in this U.S. pediatric cohort was lower than that of European cohorts but was markedly higher than that of HIV-uninfected children. Cancer incidence was highest in children who were severely immunosuppressed and in children who received HAART for < or =2 years.
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Affiliation(s)
- Helen Kest
- Division of Infectious Disease, St. Joseph Regional Medical Center of New Jersey, Paterson, NJ, USA
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Mofenson LM, Oleske J, Serchuck L, Van Dyke R, Wilfert C. Treating Opportunistic Infections among HIV-Exposed and Infected Children: Recommendations from CDC, the National Institutes of Health, and the Infectious Diseases Society of America. Clin Infect Dis 2005; 40 Suppl 1:S1-84. [DOI: 10.1086/427295] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Mofenson LM, Oleske J, Serchuck L, Van Dyke R, Wilfert C. Treating opportunistic infections among HIV-exposed and infected children: recommendations from CDC, the National Institutes of Health, and the Infectious Diseases Society of America. MMWR Recomm Rep 2004; 53:1-92. [PMID: 15577752] [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: 05/01/2023] Open
Abstract
In 2001, CDC, the National Institutes of Health, and the Infectious Diseases Society of America convened a working group to develop guidelines for therapy of human immunodeficiency virus (HIV)-associated opportunistic infections to serve as a companion to the Guidelines for Prevention of Opportunistic Infections Among HIV-Infected Persons. In recognition of unique considerations related to HIV infection among infants, children, and adolescents, a separate pediatric working group was established. Because HIV-infected women coinfected with opportunistic pathogens might be more likely to transmit these infections to their infants than women without HIV infection, guidelines for treating opportunistic pathogens among children should consider treatment of congentially acquired infections among both HIV-exposed but uninfected children and those with HIV infection. In addition, the natural history of opportunistic infections among HIV-infected children might differ from that among adults. Compared with opportunistic infections among HIV-infected adults, which are often caused by reactivation of pathogens acquired before HIV infection when host immunity was intact, opportunistic infections among children often reflect primary acquisition of the pathogen and, among children with perinatal HIV infection, infection acquired after HIV infection has been established and begun to compromise an already immature immune system. Laboratory diagnosis of opportunistic infections can be more difficult with children. Finally, treatment recommendations should consider differences between adults and children in terms of drug pharmacokinetics, dosing, formulations, administration, and toxicities. This report focuses on treatment of opportunistic infections that are common in HIV-exposed and infected infants, children, and adolescents in the United States.
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Affiliation(s)
- Lynne M Mofenson
- Pediatric, Adolescent and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20852, USA
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Gerrity TR, Papanicolaou DA, Amsterdam JD, Bingham S, Grossman A, Hedrick T, Herberman RB, Krueger G, Levine S, Mohagheghpour N, Moore RC, Oleske J, Snell CR. Immunologic aspects of chronic fatigue syndrome. Report on a Research Symposium convened by The CFIDS Association of America and co-sponsored by the US Centers for Disease Control and Prevention and the National Institutes of Health. Neuroimmunomodulation 2004; 11:351-7. [PMID: 15467349 DOI: 10.1159/000080144] [Citation(s) in RCA: 24] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2003] [Accepted: 12/15/2003] [Indexed: 11/19/2022] Open
Abstract
Chronic fatigue syndrome (CFS) is a serious health concern affecting over 800,000 Americans of all ages, races, socioeconomic groups and genders. The etiology and pathophysiology of CFS are unknown, yet studies have suggested an involvement of the immune system. A symposium was organized in October 2001 to explore the possibility of an association between immune dysfunction and CFS, with special emphasis on the interactions between immune dysfunction and other abnormalities noted in the neuroendocrine and autonomic nervous systems of individuals with CFS. This paper represents the consensus of the panel of experts who participated in this meeting. Data suggest that persons with CFS manifest changes in immune responses that fall outside normative ranges, but current research does not provide definitive evidence on whether these immune abnormalities are a cause or result of the illness. It has become clear that CFS cannot be understood based on single measurements of immune, endocrine, cardiovascular, or autonomic nervous system dysfunction. This panel encourages a new emphasis on multidisciplinary research into CFS.
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Howland LC, Gortmaker SL, Mofenson LM, Spino C, Gardner JD, Gorski H, Fowler MG, Oleske J. Effects of negative life events on immune suppression in children and youth infected with human immunodeficiency virus type 1. Pediatrics 2000; 106:540-6. [PMID: 10969100 DOI: 10.1542/peds.106.3.540] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [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: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the association of negative stressful life events experienced over 12 months and the risk of moderate to severe immune suppression among children and youth infected with human immunodeficiency virus type 1 (HIV-1). METHODS Longitudinal study of 618 HIV-1-infected children, baseline ages 1 to 20 years (mean age: 6.4 years), who completed 52 weeks of participation in the Pediatric Late Outcomes Study (Pediatric AIDS Clinical Trials Group Protocol 219). Severity of immune suppression was indicated by the Centers for Disease Control and Prevention Pediatric HIV Disease Classification System, based on CD4 percentages. The total number of negative life events-categorized as none, 1, or >1 life event reported as having occurred in the previous 12 months (previous 6 months for children <3 years of age)-was the predictor variable. Multiple logistic regressions were estimated to assess the relationship of negative life events and immune suppression at outcome, controlling for baseline measures of immune suppression, continuous CD4%, negative life events, age, race/ethnicity, gender, primary caretaker, education level of caretaker, and acquired immunodeficiency syndrome status. RESULTS At week 52, 379 subjects (61% of total study population) had moderate to severe immune suppression. Of 275 children with normal immune function at baseline, 68 (24.7%) subsequently developed moderate to severe suppression levels by week 52 of follow-up. Of 343 children with immune suppression at baseline, 32 (9.2%) had recovered to normal CD4% levels by week 52. More than 1 negative life event was associated with an increased risk (prevalence) of immune suppression (odds ratio [OR]: 2.76; 95% confidence interval [CI]: 1.44,5.31), controlling for baseline CD4%, total life events, and other covariates. Children without immune suppression at baseline who experienced >1 negative life event had an increased incidence of immune suppression (OR: 2.93; 95% CI: 1.34,6.39), controlling for baseline covariates. CONCLUSIONS Results indicate that negative stressful life events increase the risk of children with HIV-1 infection having impaired immune function. Further research is needed to identify potential mechanisms of the relationship between stressful life events and impaired immune function. These mechanisms include psychoneuroendocrinologic response and difficulties in adherence to therapy after exposure of a child to major negative life events.
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Affiliation(s)
- L C Howland
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA.
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Kostrikis LG, Neumann AU, Thomson B, Korber BT, McHardy P, Karanicolas R, Deutsch L, Huang Y, Lew JF, McIntosh K, Pollack H, Borkowsky W, Spiegel HM, Palumbo P, Oleske J, Bardeguez A, Luzuriaga K, Sullivan J, Wolinsky SM, Koup RA, Ho DD, Moore JP. A polymorphism in the regulatory region of the CC-chemokine receptor 5 gene influences perinatal transmission of human immunodeficiency virus type 1 to African-American infants. J Virol 1999; 73:10264-71. [PMID: 10559343 PMCID: PMC113080 DOI: 10.1128/jvi.73.12.10264-10271.1999] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/1999] [Accepted: 09/07/1999] [Indexed: 11/20/2022] Open
Abstract
There are natural mutations in the coding and noncoding regions of the human immunodeficiency virus type 1 (HIV-1) CC-chemokine coreceptor 5 (CCR5) and in the related CCR2 protein (the CCR2-64I mutation). Individuals homozygous for the CCR5-Delta32 allele, which prevents CCR5 expression, strongly resist HIV-1 infection. Several genetic polymorphisms have been identified within the CCR5 5' regulatory region, some of which influence the rate of disease progression in adult AIDS study cohorts. We genotyped 1,442 infants (1,235 uninfected and 207 HIV-1 infected) for five CCR5 and CCR2 polymorphisms: CCR5-59353-T/C, CCR5-59356-C/T CCR5-59402-A/G, CCR5-Delta32, and CCR2-64I. The clinical significance of each genotype was assessed by measuring whether it influenced the rate of perinatal HIV-1 transmission among 667 AZT-untreated mother-infant pairs (554 uninfected and 113 HIV-1 infected). We found that the mutant CCR5-59356-T allele is relatively common in African-Americans (20.6% allele frequency among 552 infants) and rare in Caucasians and Hispanics (3.4 and 5.6% of 174 and 458 infants, respectively; P < 0.001). There were 38 infants homozygous for CCR5-59356-T, of whom 35 were African-Americans. Among the African-American infants in the AZT-untreated group, there was a highly significant increase in HIV-1 transmission to infants with two mutant CCR5-59356-T alleles (47.6% of 21), compared to those with no or one mutant allele (13.4 to 14.1% of 187 and 71, respectively; P < 0.001). The increased relative risk was 5.9 (95% confidence interval, 2.3 to 15.3; P < 0.001). The frequency of the CCR5-59356-T mutation varies between population groups in the United States, a low frequency occurring in Caucasians and a higher frequency occurring in African-Americans. Homozygosity for CCR5-59356-T is strongly associated with an increased rate of perinatal HIV-1 transmission.
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Affiliation(s)
- L G Kostrikis
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York
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Bardeguez AD, Connor E, Stephens R, Denny TN, Holland B, Oleske J. Effect of human immunodeficiency virus infection on serum beta2-microglobulin levels in pregnant women. Obstet Gynecol 1999; 94:537-42. [PMID: 10511355 DOI: 10.1016/s0029-7844(99)00343-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess serum beta2-microglobulin levels in human immunodeficiency virus (HIV)-infected and uninfected pregnant women, variations of serum beta2-microglobulin levels during pregnancy and postpartum, factors that might influence beta2-microglobulin levels in pregnant women, and the association between beta2-microglobulin and perinatal HIV-1 transmission. METHODS We assayed 374 stored (-70C) serum samples from pregnant women enrolled in the Newark perinatal HIV-1-transmission study and 18 nonpregnant women for beta2-microglobulin using a microparticulate enzyme immunoassay. The Student t test, Wilcoxon rank test, binomial test, and Spearman correlation coefficient were used for statistical analysis, with P < .05 considered statistically significant. A linear regression model was used to assess the effect of independent variables on serum beta2-microglobulin levels. RESULTS There were no significant differences (P = .16) in serum beta2-microglobulin levels between pregnant and nonpregnant HIV-negative women (1.07+/-0.35 versus 0.99+/-0.18 mg/L). Beta2-Microglobulin levels did not vary throughout pregnancy and postpartum, irrespective of HIV serostatus. Substance abuse did not alter beta2-microglobulin levels. Human immunodeficiency virus infection caused significant increases of this surrogate marker, but it could not discriminate among disease stages. Beta2-Microglobulin levels at delivery were lower among women who delivered HIV-infected infants. CONCLUSION Human immunodeficiency virus infection was associated with increased serum beta2-microglobulin levels in pregnant women and was the most significant correlate of increases of that marker. Pregnancy and substance use during pregnancy did not influence levels of serum beta2-microglobulin significantly.
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Affiliation(s)
- A D Bardeguez
- Department of Obstetrics, Gynecology, and Women's Health, New Jersey Medical School, Newark 07103, USA.
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26
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Culnane M, Fowler M, Lee SS, McSherry G, Brady M, O'Donnell K, Mofenson L, Gortmaker SL, Shapiro DE, Scott G, Jimenez E, Moore EC, Diaz C, Flynn PM, Cunningham B, Oleske J. Lack of long-term effects of in utero exposure to zidovudine among uninfected children born to HIV-infected women. Pediatric AIDS Clinical Trials Group Protocol 219/076 Teams. JAMA 1999; 281:151-7. [PMID: 9917118 DOI: 10.1001/jama.281.2.151] [Citation(s) in RCA: 246] [Impact Index Per Article: 9.8] [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: 01/13/2023]
Abstract
CONTEXT With the success of zidovudine chemoprophylaxis for prevention of perinatal transmission of the human immunodeficiency virus (HIV), an increasing number of HIV-exposed but uninfected children will have in utero exposure to zidovudine and other antiretroviral drugs. OBJECTIVE To evaluate the long-term effects of in utero exposure to zidovudine vs placebo among a randomized cohort of uninfected children. DESIGN Prospective cohort study based on data collected during Pediatric AIDS Clinical Trials Group Protocol 076, a perinatal zidovudine HIV prevention trial, and Protocol 219, a long-term observational protocol. SETTING Pediatric research clinics in the United States. PATIENTS Two hundred thirty-four uninfected children born to 230 HIV-infected women enrolled in Protocol 076 and followed up through February 28, 1997, in Protocol 219 (122 in the zidovudine group and 112 in the placebo group). MAIN OUTCOME MEASURES Physical growth measurements, immunologic parameters, cognitive/developmental function, occurrence of neoplasms, and mortality data assessed every 6 months for children younger than 24 months and yearly thereafter or as clinically indicated. Baseline echocardiogram and funduscopic evaluations were collected before 36 months of age. RESULTS Median age of children at time of last follow-up visit was 4.2 years (range, 3.2-5.6 years). There were no significant differences between children exposed to zidovudine and those who received placebo in terms of sequential data on lymphocyte subsets; weight, height, and head circumference z scores; and cognitive/developmental function. No deaths or malignancies occurred. Two children (both exposed to zidovudine) are being followed up for abnormal, unexplained ophthalmic findings. One child exposed to zidovudine had a mild cardiomyopathy on echocardiogram at the age of 48 months; the child is clinically asymptomatic. CONCLUSIONS No adverse effects were observed in HIV-uninfected children with in utero and neonatal exposure to zidovudine followed up for as long as 5.6 years. Continued prospective evaluations of children born to HIV-infected women who are exposed to antiretroviral or immunotherapeutic agents are critical to assess the long-term safety of interventions that prevent perinatal HIV transmission.
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Affiliation(s)
- M Culnane
- Pediatric Medicine Branch, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-7620, USA.
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Natelson BH, LaManca JJ, Denny TN, Vladutiu A, Oleske J, Hill N, Bergen MT, Korn L, Hay J. Immunologic parameters in chronic fatigue syndrome, major depression, and multiple sclerosis. Am J Med 1998; 105:43S-49S. [PMID: 9790481 DOI: 10.1016/s0002-9343(98)00165-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to evaluate the immune dysfunction hypothesis of chronic fatigue syndrome (CFS) by comparing immunologic data from patients with CFS with data from patients with other fatiguing illnesses--major depression and multiple sclerosis (MS)--and with data from healthy sedentary controls. The subjects were 65 healthy sedentary controls, 71 CFS patients (41 with no axis-I diagnosis), 23 patients with mild MS, and 21 patients with major depression. Blood was sampled and assayed for the following: (1) immunologic serologic variables--circulating immune complexes (i.e., Raji cell and C1q binding), immunoglobulins A, E, G, and M, and IgG subclasses; (2) cell surface activation markers--the proportion of CD4+ cells expressing CD45RA+ and CD45RO+ and the proportion of CD8+ cells expressing CD38+, CD11b-, HLA-DR+ and CD28+; and (3) natural killer (NK) total cell count as well as the proportion of lymphocytes expressing NK cell surface markers (i.e., CD3-/CD16+ and CD56+. Of the 18 variables studied, differences between CFS patients and controls were found only for IgG1 and IgG3. When CFS patients were stratified by the presence or absence of concurrent axis-I disease, it was the group with axis-I disorder that had the lowest IgG1 values-contrary to expectation. When data from patients with MS and major depression were also evaluated, the subclass deficiency was no longer significant. The one group to show evidence for immune activation (i.e., an elevated proportion of CD4+ cells expressing the CD45RA+ activation marker) was the group with mild MS. These data support neither immune dysfunction nor immune activation in CFS or in major depression, for the variables studied. The reductions in IgG subclasses may be an epiphenomenon of patient or control subject composition. In contrast, MS, even in the mild and early stages, as in the patients studied here, is associated with immune activation.
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Affiliation(s)
- B H Natelson
- Department of Neurosciences, Chronic Fatigue Syndrome Cooperative Research Center, University of Medicine and Dentistry of New Jersey--New Jersey Medical School, Newark 07018, USA
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Oyarzun JR, Cotroneo JV, DiDonato RM, McCormick JR, Le Boeuf MB, Di Carlo F, Oleske J. The role of lung biopsy in children with perinatally acquired AIDS. AIDS Patient Care STDS 1998; 12:367-71. [PMID: 11361972 DOI: 10.1089/apc.1998.12.367] [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: 11/12/2022] Open
Abstract
There is a need for a rapid and efficacious method of diagnosis of pulmonary infiltrates in perinatal HIV infection. However, controversy still exists about which method--open lung biopsy (OLB) versus bronchoscopic techniques--is the best for this population. We present our results with OLB in 24 children with HIV-related lung disease. Over a 6-year period, 27 OLBs were performed on 24 children with diagnosis of HIV infection. The procedures were performed under general anesthesia using a limited anterolateral thoracotomy. Suspicious areas were removed with the autostapler. The specimens were studied for the presence of non-infectious as well as bacterial, viral, fungal, and mycobacterial diseases. There were no operative deaths related to the procedure. Morbidity was limited to prolonged but self-resolving air leaks in two patients (8.3%). Five hospital deaths occurred between 3 and 12 weeks postoperatively and 11 late deaths between 3 months and 6.5 years. All deaths were related to AIDS. Eight patients (33.3%) are still alive 2 to 8 years postoperatively. A total of 43 pathologies were found in 27 specimens. A positive pathologic finding was obtained in all patients, with two patients having nonspecific minimal changes. This resulted in a change of therapy in all but one case. The technique of OLB in children with AIDS is safe and simple. It should be performed early in the course of the disease and, a careful selection of candidates can minimize the incidence of complications.
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Affiliation(s)
- J R Oyarzun
- Division of Pediatric Cardiothoracic Surgery, Children's Hospital of New Jersey, Newark, USA
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29
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Rohowsky-Kochan C, Molinaro D, Devereux C, Troiano R, Bansil S, Zito G, Wolansky L, Jotkowitz A, Denny T, Oleske J, Dowling P, Cook SD. The effect of total lymphoid irradiation and low-dose steroids on T lymphocyte populations in multiple sclerosis: correlation with clinical and MRI status. J Neurol Sci 1997; 152:182-92. [PMID: 9415540 DOI: 10.1016/s0022-510x(97)00156-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 02/05/2023]
Abstract
We have monitored the cell surface phenotypic changes occurring in T, B and NK cells of chronic progressive multiple sclerosis (MS) patients after total lymphoid irradiation (TLI) plus low-dose prednisone (TLI-LDP) therapy in comparison to sham TLI-LDP. TLI-LDP resulted in a marked reduction in the relative and absolute number of total CD3+ T cells, CD4+ helper T cells, CD4+ CD45RA+ naive T cells and CD19+ B cells for at least 1 year after treatment. No change occurred in the percent CD8+ T cells although the number of these cells declined after radiotherapy. The CD4/CD8 T cell ratio was also decreased. The relative percent of CD16+ NK cells increased steadily after TLI-LDP while the number of NK cells transiently declined but returned to baseline values 1 year later. An increase in the percent of CD2+ CD3- cells and a decrease in their number after therapy was also observed. In contrast, no significant changes in the number of T, B or NK cells were seen in the MS patients receiving sham TLI-LDP. These results provide further evidence that radiotherapy causes a reduction of immunocompetent T and B cells and that a population of possibly NK cells and/or immature T cells appears to be repopulating the circulation after TLI. In addition, a correlation was observed between alterations in lymphocyte populations and the presence or absence of contrast enhancing or new T2 lesions on brain magnetic resonance imaging (MRI) in the TLI-LDP treated MS patients. Patients devoid of contrast enhancing or new T2 lesions had a decreased percentage of CD3+ and CD4+ T cells prior to therapy and at six months following TLI-LDP compared to patients with such lesions. An association was also observed between stability in disease activity as determined on the Expanded Disability Status Scale and relative values of CD3 T cells.
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Affiliation(s)
- C Rohowsky-Kochan
- Department of Neurosciences, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, USA
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Nielsen K, McSherry G, Petru A, Frederick T, Wara D, Bryson Y, Martin N, Hutto C, Ammann AJ, Grubman S, Oleske J, Scott GB. A descriptive survey of pediatric human immunodeficiency virus-infected long-term survivors. Pediatrics 1997; 99:E4. [PMID: 9099779 DOI: 10.1542/peds.99.4.e4] [Citation(s) in RCA: 22] [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: 02/04/2023] Open
Abstract
OBJECTIVE To identify the population of human immunodeficiency virus-infected pediatric long- term survivors (LTS) followed in major medical institutions in California, Florida and New Jersey. METHODS A cross-sectional survey was performed with data collection forms sent to all investigators. Demographic, clinical, and laboratory data were obtained on all living patients >/=8 years infected in the perinatal period with human immunodeficiency virus. RESULTS A total of 143 perinatally infected and 54 children infected by neonatal transfusion were identified. Fifty-four children (27%) had absolute CD4 counts >/=500 cells/mm (group 1: mean age 9.8 years), 54 children (27%) had CD4 counts between 200 and 500 cells/mm (group 2: mean age 10.1 years), and 89 children (45%) had CD4 counts <200 cells/mm (group 3: mean age 10.4 years). Ninety-five (48%) patients had developed AIDS defining conditions; 14 (26%) in group 1, 26 (48%) in group 2, and 55 (62%) in group 3. Ninety-two percent of patients had received antiretrovirals. Perinatally human immunodeficiency virus-infected children tended to be younger (mean age 9.8 years) than children infected via a blood transfusion (mean age 11 years). Generalized lymphadenopathy was the most prevalent clinical finding. Lymphoid interstitial pneumonia and recurrent bacterial infections were the most prevalent acquired immune deficiency syndrome-defining conditions. Twenty percent of LTS had CD4 counts >/=500 cells/mm and no immune deficiency syndrome-defining conditions. CONCLUSIONS Pediatric LTS were in variable stages of disease progression. The proportion of children within each CD4 strata did not differ by mode of acquisition of infection. Increased CD4 counts were inversely proportional to age. Only 20% of pediatric LTS had minimal to no disease progression.
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Affiliation(s)
- K Nielsen
- Department of Pediatrics, UCLA School of Medicine, Los Angeles, California, USA
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31
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Mintz M, Tardieu M, Hoyt L, McSherry G, Mendelson J, Oleske J. Levodopa therapy improves motor function in HIV-infected children with extrapyramidal syndromes. Neurology 1996; 47:1583-5. [PMID: 8960752 DOI: 10.1212/wnl.47.6.1583] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [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: 02/03/2023] Open
Abstract
Five children with human immunodeficiency virus type-1 (HIV-1) infection, aged 4 to 13 years, manifested extrapyramidal dysfunction characterized by rigidity/stiffness, ambulation difficulties/shuffling gait, dysarthria/drooling/swallowing dysfunction, hypomimetic/inexpressive facies, and bradykinesia. Levodopa therapy caused an initial improvement in all symptoms, and the effect was sustained in most patients. Levodopa is a useful adjunctive therapy in HIV-1-infected children with extrapyramidal syndromes, by enhancing motor function and improving their quality of life.
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Affiliation(s)
- M Mintz
- Division of Pediatric Neurology, UMDNJ-Robert Wood Johnson Medical School at Camden 08103, USA
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Oleske J, Bardequez A. Research shows AZT therapy reduces mother-child AIDS transmission. N J Med 1994; 91:274. [PMID: 8202277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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33
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Rohowsky-Kochan C, Eiman D, Denny T, Oleske J, Cook SD. Induction of autologous mixed lymphocyte culture responses by myelin basic protein-reactive T cell clones. J Neuroimmunol 1994; 50:59-70. [PMID: 7507939 DOI: 10.1016/0165-5728(94)90215-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Myelin basic protein is an autoantigen present in the central nervous system suspected to be the target of destruction in multiple sclerosis. In the present study, we have demonstrated that T cell clones specific for myelin basic protein have the ability to induce proliferative responses in resting T lymphocytes in the autologous mixed lymphocyte culture (AMLC). T cell recognition of the AMLC stimulatory determinants on the clones required the presence of autologous monocytes. T lymphocytes primed against an autologous myelin basic protein-specific T cell clone displayed specific memory responses against the original stimulating clone and failed to exhibit secondary reactivity to 'sister' myelin basic protein-reactive clones and to autologous T cell clones specific for another antigen. Monoclonal antibodies specific for class II HLA-DR antigens inhibited secondary AMLC responses. Modulation of the T cell receptor from the surface of the clones decreased their AMLC stimulatory ability. These results indicate that idiotype-like determinants on the T cell receptor of autoantigen-specific T cell clones are capable of triggering anti-idiotypic T cell responses.
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Affiliation(s)
- C Rohowsky-Kochan
- Department of Neurosciences, University of Medicine & Dentistry of New Jersey, New Jersey Medical School, Newark 07103
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Ferraro FJ, Rush BF, Ruark D, Oleske J. Enucleation of parotid lymphoepithelial cyst in patients who are human immunodeficiency virus positive. Surg Gynecol Obstet 1993; 177:524-526. [PMID: 8211607] [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] [Indexed: 05/22/2023]
Abstract
The incidence of benign lymphoepithelial lesions of the parotid gland in patients afflicted with HIV has increased. Enucleation is a safe and effective procedure that provides the patient with complete removal of the cyst and a low recurrence rate. Enucleation of these parotid cysts should be considered in treating these patients.
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Affiliation(s)
- F J Ferraro
- Department of Surgery, University Hospital, Newark, New Jersey
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35
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Oleske J. Pediatric AIDS--Johns Hopkins grand rounds. Neonatal Netw 1993; 12:7-15. [PMID: 8510628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Connor E, Morrison S, Lane J, Oleske J, Sonke RL, Connor J. Safety, tolerance, and pharmacokinetics of systemic ribavirin in children with human immunodeficiency virus infection. Antimicrob Agents Chemother 1993; 37:532-9. [PMID: 8460922 PMCID: PMC187703 DOI: 10.1128/aac.37.3.532] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Eleven pediatric patients, aged 1 to 10 years and with symptomatic human immunodeficiency virus infection, were treated with 6 or 10 mg of oral ribavirin per kg of body weight daily for 60 days. Safety and pharmacokinetic parameters were monitored; five children had comprehensive pharmacokinetic evaluations. The children tolerated the drug well, and treatment was not associated with any clinically significant adverse effects. Peak concentrations in plasma of 2.5 and 3.0 microM were reached at 90 min after single oral doses of 6 and 10 mg/kg, respectively. The mean systemic availability of oral ribavirin was 42.3%. After 60 days of ribavirin administration, mean trough concentrations in plasma of 2.6 and 4.1 microM were obtained. Ribavirin penetrated well into the cerebrospinal fluid, achieving 70% of the concentration in plasma at steady state.
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Affiliation(s)
- E Connor
- Department of Pediatrics, Children's Hospital of New Jersey, Newark
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Connor E, Wang Z, Stephens R, Holland B, Palumbo P, McSherry G, Oleske J, Denny T. Enzyme immunoassay for detection of human immunodeficiency virus-specific immunoglobulin A antibodies. J Clin Microbiol 1993; 31:681-4. [PMID: 8458962 PMCID: PMC262841 DOI: 10.1128/jcm.31.3.681-684.1993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Early diagnosis of human immunodeficiency virus (HIV) infection may be difficult in adults with acute or recent HIV infection and in infants with perinatally acquired HIV. Detection of HIV-specific immunoglobulin A (IgA) antibodies in infant serum by Western blot (immunoblot) has been suggested as a reliable method to identify HIV-infected infants, especially those over the age of 6 months, and as an adjunct to diagnosis of acute HIV infection in adults. We developed a simple enzyme immunoassay for detection of HIV-specific IgA, using standard commercially available reagents. Enzyme immunoassay was comparable to Western blot for detection of HIV-specific IgA in sera from adults (n = 216), older children (n = 49), and infants born to HIV-infected mothers (n = 65). Specificity was 100% and sensitivity ranged from 80 to 92%. IgA-enzyme immunoassay is a simple, highly sensitive method for detection of HIV-specific IgA antibodies and is easily adapted to the standard clinical laboratory.
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Affiliation(s)
- E Connor
- Department of Pediatrics, UMD-New Jersey Medical School, Newark 07103
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Abstract
This study reports the course of measles and results of measles immunization in a cohort of human immunodeficiency virus-infected children. Six cases of measles were identified. All had typical clinical manifestations, 5 of 6 developed pneumonia and 3 of 6 died. A measles intervention program consisting of serologic screening and active immunization (measles-mumps-rubella (MMR)) was instituted in 1990. Among 127 children with data available for analysis (mean age, 6.7 years), only 35% had documentation of prior immunization with MMR. Among 80 children who had preimmunization measles serology reported, 56% were measles antibody-negative and 40% were antibody-positive; following intervention 36% remained measles antibody-negative. Six children lost measles antibody over time. MMR nonresponders had lower CD4 lymphocyte counts (303 +/- 394) compared with responders (865 +/- 677; P = 0.0058). Measles is a potentially fatal illness in human immunodeficiency virus-infected children. Prevention strategies are limited by low rates of age-appropriate MMR immunization, poor antibody responses to MMR in older human immunodeficiency virus-infected children and seroreversion.
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Affiliation(s)
- P Palumbo
- Department of Pediatrics, UMD-New Jersey Medical School, Newark 07103
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Aronson JE, McSherry G, Hoyt L, Boland M, Oleske J, Connor E, Persaud D, Borkowsky W, Krasinski K, Bakshi S. Varicella does not appear to be a cofactor for human immunodeficiency virus infection in children. Pediatr Infect Dis J 1992; 11:1004-8. [PMID: 1281308 DOI: 10.1097/00006454-199211120-00003] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We performed a retrospective analysis of longitudinal clinical and immunologic data obtained from 22 children in the early stages of infection with human immunodeficiency virus (HIV) when they developed varicella. We studied the course of HIV infection to determine whether clinical deterioration occurred after chickenpox. We examined the following indices: growth and development; neurologic status; helper T lymphocyte counts; blood values of core (p24) antigen of HIV; changes in the stage of HIV infection; and need for administration of zidovudine. We studied children for a mean of 2.8 years and for as long as 9.8 years after onset of varicella. There was little evidence that chickenpox affected HIV infection. Three (14%) children developed clinical zoster, 2 of whom (9%) had evidence of chronic infection with varicella-zoster virus. One additional child (5%) had 2 episodes of chickenpox. These observations suggest that children with early HIV infection could be considered for immunization with live attenuated varicella vaccine, which would be predicted to decrease their morbidity from varicella-zoster virus.
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Affiliation(s)
- J E Aronson
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032
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Reitz MS, Guo HG, Oleske J, Hoxie J, Popovic M, Read-Connole E, Markham P, Streicher H, Gallo RC. On the historical origins of HIV-1 (MN) and (RF). AIDS Res Hum Retroviruses 1992; 8:1950. [PMID: 1489582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Reitz MS, Guo HG, Oleske J, Hoxie J, Popovic M, Read-Connole E, Markham P, Streicher H, Gallo RC. On the historical origins of HIV-1 (MN) and (RF). AIDS Res Hum Retroviruses 1992; 8:1731. [PMID: 1457185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Reitz MS, Guo HG, Oleske J, Hoxie J, Popovic M, Read-Connole E, Markham P, Streicher H, Gallo RC. On the historical origins of HIV-1 (MN) and (RF). AIDS Res Hum Retroviruses 1992; 8:1539-41. [PMID: 1457197 DOI: 10.1089/aid.1992.8.1539] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Abstract
In an attempt to prevent disease exacerbations, intravenous gamma globulin (500 mg to 2 g/kg) plus methylprednisolone was administered monthly to 14 patients with progressive multiple sclerosis, 11 of whom were steroid dependent. Seventeen exacerbations of disease activity were seen in 11 patients over a mean follow-up period of 7.8 months. Four exacerbations occurred in 3 patients within one month of receiving 1.6 to 2.0 g/kg of intravenous gamma globulin (IVGG). Most exacerbations occurred within 2 weeks of steroids being tapered; thus a steroid sparing effect of IVGG could not be demonstrated. We conclude that IVGG plus methylprednisolone can be given safely at monthly intervals for a prolonged period but in the dosage administered did not prevent exacerbations in 80% of patients with progressive multiple sclerosis.
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Affiliation(s)
- S D Cook
- Department of Neurosciences, UMDNJ-New Jersey Medical School, Newark
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Abstract
Among 139 children with acquired immunodeficiency syndrome at Children's Hospital of New Jersey, 20 had positive cultures for non-tuberculous mycobacteria. Eighty-five percent had Mycobacterium avium complex isolated and 70% had definite evidence of disseminated disease. Ninety-three percent had CD4 lymphocyte counts less than 100 cells/mm3 and 95% had met acquired immunodeficiency syndrome criteria before the time of first positive culture. Clinical findings included failure to gain weight, anorexia, fever, abdominal pain/tenderness and anemia. The median age at onset of symptoms was 46 months and the median time between onset of symptoms and positive culture was 9 months. Outcome for patients with positive cultures for nontuberculous mycobacteria was poor, with 75% of the children surviving for less than or equal to 10 months. Nontuberculous mycobacteria are increasingly important causes of morbidity and indirect mortality in human immunodeficiency-infected children. Children with severe immunodeficiency are at particular risk. In addition to M. avium complex, other species of nontuberculous mycobacteria may be involved.
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Affiliation(s)
- L Hoyt
- Department of Pediatrics, Children's Hospital of New Jersey, Newark
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Denny T, Yogev R, Gelman R, Skuza C, Oleske J, Chadwick E, Cheng SC, Connor E. Lymphocyte subsets in healthy children during the first 5 years of life. JAMA 1992; 267:1484-8. [PMID: 1347086] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
OBJECTIVE To assess whether relative and absolute values of CD4 and CD8 lymphocytes and CD4/CD8 ratio change in relation to age, and to estimate the fifth and 95th percentiles for these values in children of various ages. PATIENTS AND METHODS Phenotypic analysis of lymphocyte subsets was performed on blood samples from 208 healthy children, aged 1 through 59 months, using standard flow cytometric techniques. RESULTS Regression analysis demonstrated that CD4 and CD8 lymphocyte counts declined significantly with advancing age (P less than .000001 and P = .03, respectively). Since CD4 and CD8 counts depend on total lymphocyte count, the percentage of total lymphocytes of each phenotype was also analyzed and demonstrated that the CD4 percentage was highly age dependent (P less than .000001). The CD8 percentage increased with age (P = .0001) but not as much as the CD4 percentage decreased. Median CD4 counts (fifth and 95th percentiles) for children 2 through 3, 4 through 8, 12 through 23, and 24 through 59 months of age were 2.83 (1.46 to 5.11), 2.95 (1.69 to 4.61), 2.07 (1.02 to 3.60), and 1.80 (0.90 to 2.86) x 10(9)/L, respectively. CONCLUSION Healthy children's CD4 lymphocyte counts are considerably higher than previously established adult values. These data demonstrate that age is an important consideration in interpretation of lymphocyte subsets in children. This may be especially relevant in children who are infected with the human immunodeficiency virus, where CD4 lymphocyte values play a central role in monitoring disease progression and determining thresholds for medical interventions.
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Affiliation(s)
- T Denny
- Department of Pediatrics, New Jersey Medical School, Newark
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Connor E, Bagarazzi M, McSherry G, Holland B, Boland M, Denny T, Oleske J. Clinical and laboratory correlates of Pneumocystis carinii pneumonia in children infected with HIV. JAMA 1991; 265:1693-7. [PMID: 1672168] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The case histories of 27 children with Pneumocystis carinii pneumonia (PCP) who were followed up in the AIDS Program at the Children's Hospital of New Jersey, Newark, are reviewed. The mean and median age at PCP diagnosis were 10.8 and 7.7 months, respectively. All of the children had other clinical evidence of infection with the human immunodeficiency virus that was documented prior to the diagnosis of PCP or found at the time of PCP diagnosis. Most patients who presented to the hospital were acutely ill, and complications of treatment occurred in 70%. Overall, 89% of the patients died and 70% survived for less than 6 months after diagnosis of PCP. Median survival after the diagnosis of PCP was only 2.0 months and the median life span of children with PCP was only 14.4 months. Only 40% of children with PCP had CD4 lymphocyte counts at or below the threshold for institution of PCP prophylaxis in adults of 200 x 10(6) cells/L (200 cells/mm3).
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Affiliation(s)
- E Connor
- Children's Hospital AIDS Program, Children's Hospital of New Jersey, Newark 07107
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Rohowsky-Kochan C, Eiman D, Troiano R, Bansil S, Oleske J, Denny T, Cook SD. Decreased suppressor-inducer T lymphocytes in multiple sclerosis and other neurological diseases. J Neuroimmunol 1990; 28:161-6. [PMID: 2141847 DOI: 10.1016/0165-5728(90)90030-q] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Decreased numbers of CD4+CD45R+ suppressor-inducer T cells have been reported in patients with a variety of autoimmune diseases including systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis but not in patients with other neurological diseases. We now report our findings using murine monoclonal antibodies and two-color flow cytometric analysis on CD4+CD45R+ T cells in 22 patients with chronic progressive multiple sclerosis, 23 patients with other neurological diseases and 42 normal, healthy controls. Suppressor-inducer T cells were significantly reduced (p less than 0.001) in both patients with multiple sclerosis and other neurological diseases as compared to controls. Both patient populations had elevated helper T cell subset ratios. Thus, our data suggests that decreases in suppressor-inducer T cells may represent a common immunological defect among autoimmune and presumably non-autoimmune neurological disorders.
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Affiliation(s)
- C Rohowsky-Kochan
- University of Medicine & Dentistry of New Jersey, New Jersey Medical School, Newark 07103
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Connor E, Boccon-Gibod L, Joshi V, Just J, Grimfeld A, Morrison S, McSherry G, Oleske J. Cutaneous acquired immunodeficiency syndrome-associated Kaposi's sarcoma in pediatric patients. Arch Dermatol 1990; 126:791-3. [PMID: 2346323] [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] [Indexed: 12/31/2022]
Abstract
Kaposi's sarcoma has only rarely been reported in children with acquired immunodeficiency syndrome. In contrast to adult patients, in whom the disease is predominantly cutaneous, among pediatric patients with acquired immunodeficiency syndrome, Kaposi's sarcoma is primarily limited to the lymphadenopathic form. We describe two children with the acquired immunodeficiency syndrome who developed diffuse nodular skin lesions of Kaposi's sarcoma.
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Affiliation(s)
- E Connor
- Department of Pediatrics, Children's Hospital of New Jersey, Newark 07107
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Palumbo P, Jandinski J, Connor E, Fenesy K, Oleske J. Medical management of children with HIV infection. Pediatr Dent 1990; 12:139-42. [PMID: 2077487] [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: 12/30/2022]
Affiliation(s)
- P Palumbo
- University of Medicine and Dentistry, New Jersey Medical School
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