Abnormalities In HIV-infected Children Research Articles

POS-424 PREVALENCE OF KIDNEY ABNORMALITIES SINCE 2015-WHO “TREAT ALL” STRATEGY IN HIV INFECTED CHILDREN

In 2015, the WHO adopted the strategy “Treat all” which recommends the initiation of ART in everyone living with HIV regardless of the number of CD4 count. This strategy has decreased the mortality and increased the survival of HIV infected individuals. However, limited information is available regarding the burden of kidney abnormalities in HIV infected children since the implementation of this strategy. Our study aimed to describe the prevalence of kidney abnormalities in HIV infected children living in the Democratic Republic of Congo (DRC) since 2015-WHO therapeutic recommendations.

Proximal renal tubular function in HIV-infected children on tenofovir disoproxil fumarate for treatment of HIV infection at two tertiary hospitals in Harare, Zimbabwe.

Renal abnormalities in HIV infected children may be due to the HIV infection or treatment among other factors. Tenofovir disoproxil fumarate (TDF) is associated with proximal renal tubular dysfunction, proteinuria and decrease in glomerular function. Studies in developed countries have shown variable prevalence of proximal renal tubular dysfunction in children on TDF. There are no known studies in developing countries, including Zimbabwe, documenting the proximal tubular function in HIV infected children on TDF. The aim of this study was to assess renal and proximal renal tubular function in HIV infected children receiving TDF and determine factors associated with proximal tubular dysfunction. A descriptive cross-sectional study was conducted in HIV infected patients below 18 years of age attending outpatient clinics at two tertiary hospitals in Harare, who received a TDF-containing antiretroviral regimen for at least six months. Dipstick protein and glucose, serum and urine phosphate and creatinine levels were measured. Fractional excretion of phosphate was calculated. Estimated glomerular filtration rate (eGFR) was calculated using the Schwartz formula. Tubular dysfunction was defined by at least two of the following characteristics: normoglycaemic glycosuria, hypophosphatemia and fractional excretion of phosphate > 18%. One hundred and ninety-eight children below 18 years of age were recruited over a period of six months. The prevalence of tubular dysfunction was 0.5%. Normoglycaemic glycosuria occurred in 1 (0.5%), fractional excretion of phosphate >18% in 4 (2%), and hypophosphatemia in 22 [11.1%] patients. Severe stunting was associated with increased risk of hypophosphatemia (OR 9.31 CI (1.18, 80.68) p = 0.03). Reduction in estimated glomerular filtration rate (eGFR) < 90ml/min/1.73m2 and proteinuria was evident in 35.9% and 32.8% of children, respectively. Concurrent TDF and HIV-1 protease inhibitor-based regimen was the only independent factor associated with reduction in GFR (OR 4.43 CI (1.32; 4.89) p = 0.016). Tubular dysfunction was uncommon in Zimbabwean children on a TDF-based ART regimen. Hypophosphatemia, proteinuria and reduction in eGFR were common. Reassessing renal function using more sensitive biomarkers is needed to examine the long-term tolerance of TDF.

Prevalence of Electrocardiogram Abnormalities in Human Immunodeficiency Virus-Infected Children

HIV is an important cause of childhood morbidity and mortality affecting more than 1.3 million children worldwide, one of the morbidity is cardiac abnormalities. Cardiovascular abnormalities are still subclinical during childhood then become symtomatic in adulthood. Electrocardiography is effective to detect cardiac diseases. This study aimed to assess ECG changes in HIV infected children and describe ECG abnormalities in HIV-infected children with or without HAART. From 70 subjects, we found the most common abnormality was sinus tachycardia in 17 patients (24.3%), sinus bradycardia 1 patient (1.4%) and 2 patients with sinus arrhythmia (2.9%). The mean QTc interval was 0.42 seconds (±0.07) and 14 patients (20%) had prolongation. The mean PR interval was 0.12 seconds (±0.02), 11 patients (15.7%) experienced prolongation of PR interval. The mean QRS duration was 0.06 seconds (±0.09). Left ventricular enlargement was present in 6 patients (8.6%), conduction disturbance which is characterized by Bundle branch block was found in 2 patients (2.9%) and ST changes was seen in 2 patients (2.9%). Other ECG abnormalities are characterized by right ventricle hyperthropy in 4 patients and a patient had T tall. The prevalence of cardiac abnormalities based on ECG examination from this study was 51.3%, consist of heart rhythm abnormality, prolonged PR interval, prolonged QTc interval, bundle branch block, ventricle hypertrophy and ST changes.

Need for active cardiovascular screening in HIV-infected children under antiretroviral therapy in Africa.

Unacceptably high incidence of pediatric HIV despite worldwide increased access to antiretroviral therapy. The routine management of these children includes provision of antiretroviral therapy, and periodic assessment of its results and complications. However, no systematic assessment of the nutritional status, lipid profile or screening for cardiovascular disease is done. Our study aimed at describing the occurrence of cardiovascular abnormalities in HIV-infected children under antiretroviral therapy, and at determining the vital outcomes 5 years after. A prospective observational study was implemented at a dedicated HIV center in Maputo City, where we gathered detailed socio-demographic data and performed full cardiovascular evaluation, including transthoracic cardiac ultrasound. A total of 47 children were examined (24 male) of which 10 had abnormal cardiac ultrasound: impaired systolic function (5 children); three had congenital heart defects; one had severe rheumatic aortic regurgitation and one had tuberculous pericarditis. Heart failure was present in five children. The study also uncovered the presence of malnutrition (36 patients; 80% had BMI below 18.5 kg/m2) and anemia in a considerable proportion of children. On 5 year follow up there was one death due to malária; three new cases of left ventricular dysfunction occurred among children who had normal ultrasound on recruitment. Our results support systematic cardiovascular risk profiling and disease screening in HIV-infected children on antiretroviral therapy, using cardiac ultrasound wherever possible.

Endocrinological Abnormalities and Growth Impairment in Human Immunodeficiency Virus-Infected Children

Background Pediatric human immunodeficiency virus (HIV) is an important emerging disease and many children are surviving into adulthood with effective antiretroviral therapy. Growth dysregulation is common in these children and endocrine abnormalities are likely to be a possible comorbidity. There is a paucity of data on these endocrinological abnormalities in this population. Against this background, a study to evaluate the endocrinological profile in HIV-infected children and its relationship with growth failure was performed. Methods A cross-sectional descriptive study was performed in children less than 18 years attending the pediatric HIV clinic at a tertiary care hospital in central India. Blood samples for T3, T4, thyroid-stimulating hormone (TSH), growth hormone (GH), dehydroepiandrosterone (DHEA), cortisol, and insulin-like growth factor-binding protein 3 (IGFBP3) were collected during routine visit, preserved at –70°C, and subsequently assayed. Statistical analysis for the data with respect to the endocrinological abnormalities and growth failure was performed. Results A total of 100 children were included in the study. The prevalence of growth failure was high. Nineteen percent children had height less than − 3 standard deviation (SD) and 59% children had height less than 2SD. The prevalence of endocrinological abnormalities was also high. Fifty-four percent children had low T3 levels, 12% had low T4 levels, 4% had high TSH levels, 44% had low cortisol levels, and 25% had low DHEA. Fifty-eight percent children had low GH levels, while IGFBP3 levels were low in the entire cohort. There was a statistically significant association between growth failure and levels of T3 and GH. Conclusion Our results show a high prevalence of growth failure and endocrinological abnormalities in HIV-infected children. A significant association between growth failure and endocrine abnormalities was found for T3 and GH.

Hematologic abnormalities and associated factors among HIV infected children pre- and post-antiretroviral treatment, North West Ethiopia.

IntroductionThere are few studies on the hematologic parameters of HIV-infected individuals in Ethiopia; of these, almost all studies researched adults. Our current study is unique in that it mainly focused on the pediatric population and compared both pre- and post-antiretroviral therapy (ART) children. Inference from this study can be used for other developing countries where the burden of HIV disease is high.ObjectiveThe aim of this study was to identify hematologic abnormalities in HIV-infected children before and after initiation of ART.MethodologyA cross-sectional study was conducted on HIV-infected children from June 1 to August 30, 2015. Data were collected using a pretested and structured questionnaire. Statistical analysis was performed using SPSS 20 version.ResultsThe median age of study subjects was 10 years with an interquartile range (IQR) of (6, 12). Two-thirds (74.3%) of study subjects received ART for >1 year. The median of CD4 count before ART was 490 cells/mm3 with an IQR of (286, 765); this increased to 663 cells mm3 with an IQR of (499, 908) after ART. Likewise, the median of hemoglobin before ART was 11.5 mg/dL with an IQR of (9.9, 13), which increased after ART to 13 mg/dL with an IQR of (11.8, 14). The prevalence of anemia was 42.8% before and 18.9% after ART initiation. The median of absolute neutrophil count before ART was 3×103 with an IQR of (2.1, 4.6) and after ART, it became 3×103 with IQR of (1.9, 4.2). Age <5 years (adjusted odds ratio [AOR]: 2.76; 95% CI: 1.5, 5.0), an advanced stage of AIDS (AOR: 2.8; 95% CI: 1.4, 5.6) and CD4% <25% (AOR: 2.4; 95% CI: 1.2, 4.9) were significantly associated with anemia before ART initiation, while opportunistic infections were associated with anemia after initiation of ART (AOR: 2.3; 95% CI: 1.08, 4.8).ConclusionART positively or negatively affects the hematologic profile of HIV-infected children. The current study demonstrated a significant reduction of anemia after initiation of ART.

Renal Function Abnormalities in HIV-infected Children and Adolescents on Antiretroviral Therapy at the University of Abuja Teaching Hospital, Gwagwalada, Nigeria: A Cross-sectional Study

Renal Function Abnormalities in HIV-infected Children and Adolescents on Antiretroviral Therapy at the University of Abuja Teaching Hospital, Gwagwalada, Nigeria: A Cross-sectional Study

Bone health in HIV-infected children and adolescents.

Chronic HIV infection and exposure to antiretroviral therapy compromises bone health in children and adolescents, potentially impacting their long-term quality of life. Thus, the purpose of this article is to review the most recent literature on this topic in HIV-infected children and adolescents. Recent studies continue to demonstrate bone abnormalities in HIV-infected children and adolescents, whether HIV is acquired perinatally or during adolescence. Researchers have employed new modalities, both high tech and those that can be utilized in resource-limited settings, to better assess bone health. New data suggest that this population may also be experiencing an increase incidence of fractures, and they may not acquire the same peak bone mass as their HIV-uninfected counterparts. Reassuringly, however, in-utero tenofovir exposure does not appear to have a significant impact on bone health in HIV-exposed, uninfected infants. HIV-infected children and adolescents are exposed to HIV and antiretroviral therapy for many decades starting early in life and during the most critical time for skeletal growth and bone mass accrual. Recent findings underscore the need for further research on bone in this population. Longitudinal studies are especially needed to evaluate long-term risk of osteoporosis and fracture.

A Study of Prevalence of Lipid Abnormalities in HIV Infected Children among Indian Population

Introduction: With the universal availability of Highly active antiretroviral therapy (HAART), HIV is increasingly recognized as a chronic manageable disease, rather than terminal illness. However the cost of increased longevity has resulted in to various metabolic abnormalities, mainly lipids. These metabolic abnormalities could be due to the HIV disease itself or due to the effects of antiretroviral therapy. Data on the prevalence of these metabolic abnormalities particularly in the pediatric population is limited, hence this study was conducted to find out the prevalence of lipid abnormalities in HIV infected children among the Indian population. Materials & Methods: This was a cross-sectional study conducted at Pediatric HIV clinic of a tertiary care hospital in western state of India from Sep 2010 to Aug 2012 among HIV infected children up to 18 years of age. After taking detail history and examination, fasting samples were taken for complete lipid profile. All enrolled HIV positive children were categorized according to clinical and immunological status as per WHO guidelines of 2010. The lipid abnormalities in HIV infected children on antiretroviral therapy & not on antiretroviral therapy were analysed. Statistical analysis was done by Z test for continuous variables and chi square test for dichotomous variables using Graph pad Prism 5 software. Results: 140 HIV positive children were enrolled, of which 93 were on ART. Mean age of the study population was 8.8 years with male to female ratio of 1.1:1. The mode of HIV transmission was vertical in 137(97.8%) children. WHO clinical categories at the time of enrolment were cat I, II, III and IV in 40%, 39%, 20% and 1%, while immune cat 42%, 18%, 16% and 24% cases respectively. Ninety three (64%) children were on antiretroviral therapy. Of the total, 80(57%) children were found to have lipid abnormalities, of which most common was high triglycerides levels in 74(52.8%) children followed by low HDL in 64(46%), high cholesterol in 19(13.5%) and high LDL in 3(2%) children. Mean levels of cholesterol, triglycerides and LDL were higher in the ART group at 156, 126, 50 and 56 mg/dl as compared to ART naive group with levels of 129, 119, 39 and 50 respectively and the association between the mean levels of cholesterol and ART was statistically significant (P value=0.0002). Conclusion: The prevalence of lipid abnormalities was higher in HIV infected children, mainly triglycerides and cholesterol. Also the prevalence was higher in HIV infected children on ART as compared to ART naive children. These metabolic abnormalities may contribute to the increased risk of cardiovascular diseases in these children, who are likely to be facing a life time exposure to antiretroviral therapy, hence regular screening is recommended to identify and manage the abnormalities early.

Hematological manifestation in HIV infected children.

To determine the common hematological abnormalities in HIV infected children and any association of these abnormalities with HIV disease severity. Cross-sectional study. Regional Pediatric ART centre, Medical College and Hospital, Kolkata, West Bengal, India, from November 2011 to November 2012. Children up to 12 years with confirmed diagnosis of HIV infection were clinically examined and tested for complete hemogram and CD4 count. Bone marrow study was done in selected patient depending on hemogram report. Children were divided in different stages according to WHO clinical staging. Each of the hematological parameters was assessed for any association with progression of disease. Fisher's Exact Test was used for determining the association between WHO clinical staging and abnormal blood parameters. P-value < 0.05 was taken as significant. Sixty nine percent of the study population was anemic; 47.37% (18/38), 66.67% (8/12), 71.43% (15/21) and 93.10% (27/29) of stage 1, 2, 3 and 4 respectively were anemic in the study population (p=0.001). Leucopenia was present in 34% (34/100) children. Neutropenia and lymphopenia was present in 19% (19/100) and 22% (22/100) children. Lymphopenia was present in 7.89% (3/38), 16.67% (2/12), 19.05% (4/21) and 44.83% (13/29) of patient with stage 1, 2, 3 and 4 respectively (p=0.020). Eosinophilia was present in 17% (17/100) and thrombocytopenia in 11% (11/100) children. 2 patients with stage 4 disease were with hypoplastic bone marrow. Anemia was the most common hematological abnormality in HIV infected children. Anemia and lymphopenia had a significant association with the stage of the disease.

G387 Spectrum of Cardiac manifestations in HIV infected children in India

BackgroundHIV/AIDS is an important cause of morbidity and mortality affecting 2 million children less than 15 Years of age. The incidence of cardiovascular abnormalities in HIV infected children is not...

Swallowing abnormalities in HIV infected children: an important cause of morbidity

BackgroundSwallowing disorders, well recognised in adults, contribute to HIV-infection morbidity. Little data however is available for HIV-infected children. The purpose of this study is to describe swallowing disorders in a group of HIV-infected children in Africa after the introduction of combined anti-retroviral therapy.MethodsWe describe 25 HIV-infected children referred for possible swallowing disorders. Clinical and videofluoroscopic assessment of swallowing (VFSS), HIV stage, and respiratory and neurological examination were recorded.ResultsMedian age was 8 months (range 2.8-92) and 15 (60%) were male. Fifteen (60%) were referred for recurrent respiratory complaints, 4 (16%) for poor growth, 4 (16%) for poor feeding and 2 (8%) patients for respiratory complaints and either poor growth or feeding. Twenty patients (80%) had clinical evidence of swallowing abnormalities: 11 (44%) in the oral phase, 4 (16%) in the pharyngeal phase, and 5 (25%) in both the oral and pharyngeal phases. Thirteen patients had a videofluoroscopic assessment of which 6 (46%) where abnormal. Abnormalities were detected in the oral phase in 2, in the pharyngeal phase in 3, and in the oral and pharyngeal phase in 1; all of these patients also had evidence of respiratory involvement. Abnormal swallowing occurred in 85% of children with central nervous system disease. CNS disease was due to HIV encephalopathy (8) and miscellaneous central nervous system diseases (5). Three of 4 (75%) patients with thrush had an abnormal oral phase on assessment. No abnormalities of the oesophagus were found.ConclusionsThis report highlights the importance of swallowing disorders in HIV infected children. Most patients have functional rather than structural or mucosal abnormalities. VFSS makes an important contribution to the diagnosis and management of these patients.

Cardiovascular Dysfunction in HIV-infected Children in a Sub-Saharan African Country: Comparative Cross-sectional Observational Study

Cardiac dysfunction is rarely diagnosed in HIV-infected children in our setting and standard care does not include baseline and follow-up echocardiography. We aimed to determine the prevalence, pattern and predictors of HIV-related cardiac dysfunction. Pre-diagnosed HIV-infected children aged 18 months to 12 years from a tertiary teaching hospital in Lagos, South-West Nigeria were enrolled in a comparative, observational cross-sectional study; matched with apparently healthy controls of the same age group, were recruited sequentially between May 2004 and 2007. Proportions of pre-defined cardiac abnormalities such as heart failure diagnosed by clinical examination and dilated cardiomyopathy and ventricular dysfunction by echocardiography were determined. Prevalence of cardiac abnormalities in HIV-infected children was 75.9%. Abnormalities included heart failure, dilated cardiomyopathy (33.7%), decreased LVSF of ≤ 25% in 33.7%, increased left ventricular mass (20.5%) and pericardial effusion (14.5%). Structural and functional abnormalities are prevalent in HIV-infected African children and therefore justify inclusion of routine echocardiography in their standard care.

Serum Adiponectin and Leptin Concentrations in HIV-Infected Children with Fat Redistribution Syndrome

Human immunodeficiency virus (HIV)-related lipodystrophy is characterized by adipose tissue redistribution, dyslipidemia, and insulin resistance. We hypothesized that fat redistribution and metabolic abnormalities in HIV-infected children are related to alterations in endocrine function of adipose tissue. A multicenter study was conducted in 130 HIV-infected children. Lipodystrophy definition was based on the central to peripheral skinfold ratio. Fasting adiponectin, leptin, insulin concentrations, glycemia, and lipid profile were measured in all children. Fat redistribution syndrome was apparent in 32 children: 14 with atrophic (LPDA) and 18 with hypertrophic lipodystrophy (LPDH). Mean serum adiponectin levels were significantly decreased in LPDA and LPDH groups compared with the group with no lipodystrophy (LPD-). Fasting insulin concentration was significantly higher in LPDA and LPDH groups versus LPD-. Mean serum leptin concentration was significantly increased only in LPDH compared with LPDA and LPD- groups. Triglyceride levels were significantly increased and high-density lipoprotein (HDL)-cholesterol concentration decreased in the LPDA versus LPD- group. Controlling for puberty stage, gender, percentage of total fat mass, serum lipids, HIV treatment, and disease severity, adiponectin was significantly and inversely associated with central obesity and insulin/glucose ratio. Fat redistribution had no significant effect on leptin concentration, which was directly related to the percentage of body fat, female gender, and insulin/glucose ratio. In conclusion, HIV-infected children with symptoms of fat redistribution have decreased levels of adiponectin, associated with insulin resistance and dyslipidemia.

INCIDENCE OF CARDIAC ABNORMALITIES IN CHILDREN WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION: THE PROSPECTIVE P2C2 HIV STUDY

Starc TJ, Lipshultz SE, Easley KA, et al. J Pediatr . 2002;141:327–334 Human immunodeficiency virus (HIV) infection may be associated with severe cardiac complications. The objective of this study was to describe the 5-year cumulative incidence of cardiac abnormalities in HIV-infected children. A prospective cohort was developed involving children from 10 hospitals throughout the United States. Group I included 205 HIV-infected children enrolled at a median age of 1.9 years and group II consisted of 600 HIV-exposed …

Energy balance, viral burden, insulin-like growth factor-1, interleukin-6 and growth impairment in children infected with human immunodeficiency virus.

To determine the relationship between energy metabolism and growth abnormalities in HIV-infected children and to assess clinical or laboratory characteristics which may be contributing factors to their growth impairment. A comparative study. We measured energy intake by inpatient calorie count/outpatient 24 h food recalls, resting energy expenditure by indirect calorimetry, total energy expenditure by the doubly-labeled water technique, iron metabolism, protein metabolism, and lipid metabolism markers as well as CD4 count, viral load, insulin-like growth factor-1 (IGF-1), serum interleukin-6 (IL-6), and whole blood stimulated IL-6 levels in prepubertal congenitally HIV-infected children with normal and impaired growth patterns. Differences in energy expenditures were not found between normal and growth-impaired HIV-infected children. Energy intake but not energy expenditure was significantly reduced when HIV-infected children were compared to expected normal values for age and gender. Advanced HIV clinical disease, severe immune suppression, increased viral burden, increased IL-6 activity, decreased total serum protein, and decreased IGF-1 levels were more likely to be found in HIV-infected children with growth impairment in comparison with HIV-infected children with normal growth.

Cardiac complications in children with human immunodeficiency virus infection. Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection (P2C2 HIV) Study Group, National Heart, Lung, and Blood Institute.

Although numerous cardiac abnormalities have been reported in HIV-infected children, precise estimates of the incidence of cardiac disease in these children are not well-known. The objective of this report is to describe the 2-year cumulative incidence of cardiac abnormalities in HIV-infected children. Prospective cohort (Group I) and inception cohort (Group II) study design. A volunteer sample from 10 university and public hospitals. Group I consisted of 205 HIV vertically infected children enrolled at a median age of 22 months. This group was comprised of infants and children already known to be HIV-infected at the time of enrollment in the study. Most of the children were African-American or Hispanic and 89% had symptomatic HIV infection at enrollment. The second group included 611 neonates born to HIV-infected mothers, enrolled during fetal life or before 28 days of age (Group II). In contrast to the older Group I children, all the Group II children were enrolled before their HIV status was ascertained. According to the study protocol, children underwent a series of cardiac evaluations including two-dimensional echocardiogram and Doppler studies of cardiac function every 4 to 6 months. They also had a 12- or 15-lead surface electrocardiogram (ECG), 24-hour ambulatory ECG monitoring, and a chest radiograph every 12 months. Main outcome measures were the cumulative incidence of an initial episode of left ventricular (LV) dysfunction, cardiac enlargement, and congestive heart failure (CHF). Because cardiac abnormalities tended to cluster in the same patients, we also determined the number of children who had cardiac impairment which we defined as having either left ventricular fractional shortening (LV FS) </=25% after 6 months of age, CHF, or treatment with cardiac medications. CARDIAC ABNORMALITIES: In Group I children (older cohort), the prevalence of decreased LV function (FS </=25%) was 5.7% and the 2-year cumulative incidence (excluding prevalent cases) was 15.3%. The prevalence of echocardiographic LV enlargement (LV end-diastolic dimension z score >2) at the time of the first echocardiogram was 8. 3%. The cumulative incidence of LV end-diastolic enlargement was 11. 7% after 2 years. The cumulative incidence of CHF and/or the use of cardiac medications was 10.0% in Group I children. There were 14 prevalent cases of cardiac impairment (LV FS </=25% after 6 months of age, CHF, or treatment with cardiac medications) in Group I. After excluding these prevalent cases, the 2-year cumulative incidence of cardiac impairment was 19.1% among Group I children and 80.9% remained free of cardiac impairment after 2 years of follow-up. Within Group II (neonatal cohort), the 2-year cumulative incidence of decreased LV FS was 10.7% in the HIV-infected children compared with 3.1% in the HIV-uninfected children. LV dilatation was also more common in Group II infected versus uninfected children (8.7% vs 2.1%). The cumulative incidence of CHF and/or the use of cardiac medications was 8.8% in Group II infected versus 0.5% in uninfected subjects. The 1- and 2-year cumulative incidence rates of cardiac impairment for Group II infected children were 10.1% and 12.8%, respectively, with 87.2% free of cardiac impairment after the first 2 years of life. In the Group I cohort, the 2-year cumulative death rate from all causes was 16.9% [95% CI: 11.7%-22. 1%]. The 1- and 2-year mortality rates after the diagnosis of CHF (Kaplan-Meier estimates) were 69% and 100%, respectively. In the Group II cohort, the 2-year cumulative death rate from all causes was 16.3% [95% CI: 8.8%-23.9%] in the HIV-infected children compared with no deaths among the 463 uninfected Group II children. Two of the 4 Group II children with CHF died during the 2-year observation period and 1 more died within 2 years of the diagnosis of CHF. The 2-year mortality rate after the

Somatosensory Evoked Potential Abnormalities in HIV-Infected Children are More Frequent Than in HIV-Exposed Children, Reflecting the Degree of HIV-Related Neurological Disease

Somatosensory Evoked Potential Abnormalities in HIV-Infected Children are More Frequent Than in HIV-Exposed Children, Reflecting the Degree of HIV-Related Neurological Disease