HIV-infected Boy Research Articles

A Case Report of Achalasia in HIV-Tuberculosis Co-Infected Adolescent

Aims: To sensitize clinicians on the need to consider achalasia in HIV infected children presenting with dysphagia.
 Presentation of Case: A 14-year-old HIV-infected boy presented with 4years of difficulty and painful swallowing. It was initially to solid food and progressed to liquid diet and water. There were associated intermittent vomiting, weight loss, and recurrent fever. Examination revealed a stunted and chronically ill-looking boy, weighed 22.5Kg and measured 139cm in height, 48.3% and 86.3% of the expected for age respectively. He had generalized lymphadenopathy and whitish patches on the tongue. Initial differential diagnoses were oesophageal candidiasis and achalasia with pulmonary tuberculosis. Chest X-ray and stool gene Xpert confirmed Mycobacterium tuberculosis. The cluster of differentiation (CD) 4 count was 380 cells/ml. He had anti-Koch’s drugs and oral fluconazole for 6 months and 8 weeks respectively, and later highly active antiretroviral therapy. Despite the completion of the fluconazole, the presented symptoms got worsened and the patient could not even take his medications, and his weight dropped to 15kg. Barium swallow and upper GI endoscopy done later confirmed achalasia. He had a successfully modified Heller’s myotomy procedure after which he could eat, drink and take his medications. He was discharged and kept his regular clinic appointments with appreciable weight gain.
 Conclusion: Achalasia could occur in HIV-infected children when presented with dysphagia and therefore, a high index of suspicion is needed to make a timely diagnosis to avoid complications and death.

Sexual maturation of HIV-infected and uninfected male children in Abakaliki, South-East, Nigeria: a cross-sectional study.

IntroductionHIV infection, through various mechanisms causes a derangement in sexual maturation. This study compared the Marshal and Tanner staging of HIV-infected and uninfected males. The aim of the study was to determine the sexual maturation in male children infected with HIV on HAART in Abakaliki.Methodsthis was a cross-sectional and comparative study involving 80 HIV-infected boys aged 8-17 years and 80 uninfected counterparts matched for age and socio-economic class. Stages of sexual maturation (testicular size and pubic hair) were determined according to the method proposed by Marshall and Tanner. The testicular size was measured using an orchidometer. Data analysis was done with SPSS version 20. Structured questionnaire was used to collect information on socio-demographics.Resultsassessment of pubic hair development, showed that 45 (56.2%) of the subjects were in the pre-pubertal stage compared to 27 (33.8%) among the controls, this relationship was statistically significant (p=0.005, OR = 2.5, C.I=1.3-4.8). The mean testicular volume among subjects was found to be 8.29 ± 8.26mls compared to 11.57 ± 8.26mls found in controls. This relationship was also statistically significant. There were significant statistical relationships between duration on HAART and clinical stages of disease with both pubic hair development and testicular volume of subjects and controls.ConclusionHIV-infected males had significantly delayed onset and progression of sexual maturation. Routine assessment of the sexual maturation of HIV-infected children as well as addressing the modifiable variables influencing sexual maturity is recommended.

Spontaneous remission of acute myeloblastic leukemia with improvement in CD4 counts in HIV-infected child co-infested with Demodex mite

Abstract Improvement in CD4 counts in children with human immunodeficiency virus (HIV) has been reported with some infections. We present an 11-year-old HIV-infected boy who developed acute myeloid leukemia that showed spontaneous remission along with improvement in CD4 counts with documented Demodex mite infestation. The child presented with fever without localization during course of illness, and developed crusted lesion at angle of mouth. Direct microscopy of skin biopsy revealed Demodex mite infestation. The child was continued on highly active antiretroviral treatment along with single dose of ivermectin and local application of permethrin. The crusted lesion improved within a weeks’ time. His CD4 counts improved from baseline of 534/μL to 1674/μL over a period of 4 weeks.

Sex differences in responses to antiretroviral treatment in South African HIV-infected children on ritonavir-boosted lopinavir- and nevirapine-based treatment

BackgroundWhile studies of HIV-infected adults on antiretroviral treatment (ART) report no sex differences in immune recovery and virologic response but more ART-associated complications in women, sex differences in disease progression and response to ART among children have not been well assessed. The objective of this study was to evaluate for sex differences in response to ART in South African HIV-infected children who were randomized to continue ritonavir-boosted lopinavir (LPV/r)-based ART or switch to nevirapine-based ART.MethodsART outcomes in HIV-infected boys and girls in Johannesburg, South Africa from 2005–2010 were compared. Children initiated ritonavir-boosted lopinavir (LPV/r)-based ART before 24 months of age and were randomized to remain on LPV/r or switch to nevirapine-based ART after achieving viral suppression. Children were followed for 76 weeks post-randomization and then long-term follow up continued for a minimum of 99 weeks and maximum of 245 weeks after randomization. Viral load, CD4 count, lipids, anthropometrics, drug concentrations, and adherence were measured at regular intervals. Outcomes were compared between sexes within treatment strata.ResultsA total of 323 children (median age 8.8 months, IQR 5.1-13.5), including 168 boys and 155 girls, initiated LPV/r-based ART and 195 children were randomized. No sex differences in risk of virological failure (confirmed viral load >1000 copies/mL) by 156 weeks post-randomization were observed within either treatment group. Girls switched to nevirapine had more robust CD4 count improvement relative to boys in this group through 112 weeks post-randomization. In addition, girls remaining on LPV/r had higher plasma concentrations of ritonavir than boys during post-randomization visits. After a mean of 3.4 years post-randomization, girls remaining on LPV/r also had a higher total cholesterol:HDL ratio and lower mean HDL than boys on LPV/r.ConclusionsSex differences are noted in treated HIV-infected children even at a young age, and appear to depend on treatment regimen. Future studies are warranted to determine biological mechanisms and clinical significance of these differences.Trial registrationClinicalTrials.gov Identifier: NCT00117728

Coagulase-negative staphylococci in an HIV-infected child causing pancytopaenia

Although coagulase-negative staphylococci (CONS) constitute normal flora of the human body, some species can produce human infections, particularly when the host defense is breached. There is little evidence of the pathogenicity of CONS in HIV-infected individuals. We present the case of a 14-year-old HIV-infected boy who presented with a right lower zone pneumonia and a cutaneous abscess, following which he developed pancytopaenia due to underlying CONS infection that responded to antibiotic treatment.

Immune Reconstitution Inflammatory Syndrome: Cutaneous and Bone Histoplasmosis Mimicking Leprosy after Treatment

We present a case of disseminated histoplasmosis in a 12-year-old HIV infected boy. This is a rare presentation of Histoplasma capsulatum var. capsulatum which presented as Immune Reconstitution Inflammatory Syndrome with osteoarticular involvement. He was treated with fluconazole for five years and healed with shortening of all the digits.

Recurrent thrombosis in an HIV-1 infected child

Though thromboembolic complications in HIV infected patients have been described in literature, recurrent thrombosis is very rare. We present a six-year-old HIV infected boy who presented with recurrent thrombosis. He initially had renal artery thrombosis, then middle cerebral artery thrombosis and finally hepatic vein thrombosis that was fatal.

Clinical manifestation of Kaposi’s sarcoma in HIV-infected boy

Clinical manifestation of Kaposi’s sarcoma in HIV-infected boy

R2264 Epidemiologic characteristics of Clostridium difficile infection in a tertiary hospital in Korea

Improvement in CD4 counts in children with human immunodeficiency virus (HIV) has been reported with some infections. We present an 11-year-old HIV-infected boy who developed acute myeloid leukemia that showed spontaneous remission along with improvement in CD4 counts with documented Demodex mite infestation. The child presented with fever without localization during course of illness, and developed crusted lesion at angle of mouth. Direct microscopy of skin biopsy revealed Demodex mite infestation. The child was continued on highly active antiretroviral treatment along with single dose of ivermectin and local application of permethrin. The crusted lesion improved within a weeks’ time. His CD4 counts improved from baseline of 534/μL to 1674/μL over a period of 4 weeks.

Progressive Multifocal Leukoencephalopathy in an HIV-Infected Child

Progressive multifocal leukoencephalopathy is an infection of the immunosuppressed, especially of AIDS, patients. The disease is caused by the JC virus and is exceptionally rare in children. The diagnosis is based on MRI and on the detection of JC virus DNA in the cerebrospinal fluid. Progression is relentless in most cases. The only treatment of proven benefit is restoration of the immune system by highly active antiretroviral therapy. We report the case of a 15S-year-old HIV-infected boy. After several months of fatigue he developed apathy, head tilt, diplopia, motor apraxia and unsteady gait. Physical examination revealed mild cerebellar signs. MRI showed a 30-mm large, non-enhancing, hyper-intense area in the right cerebellar hemisphere and the middle cerebellar peduncle. JC virus DNA was detected in the cerebrospinal fluid. Two weeks later the MRI showed progression. The patient's condition rapidly worsened and he died four months after the onset of the disease. Autopsy revealed widespread lesions of the cerebellar hemispheres and the brainstem. The case presented is peculiar owing to the young age of the patient, the unusual localization and the unifocal nature of the lesion.

Leptomeningeal Lymphoma in a Child with Acquired Immune Deficiency Syndrome

Primary non-Hodgkin lymphoma of the central nervous system is rare in pediatric AIDS patients. We report a seven-year-old HIV-infected boy, in stage C3 of the disease, who developed non-Hodgkin lymphoma in the central nervous system with a leptomeningeal location. The patient started with signs and symptoms of increased intracranial pressure, impaired consciousness and then became blind. The diagnosis was based on brain biopsy, immunophenotypic studies of B cells, and Epstein-Barr virus serology of the cerebrospinal fluid. The boy was treated with intrathecal and systemic chemotherapy. Fifteen months after diagnosis he had clinically improved, but he then relapsed with a thalamic tumor. He was treated with radiotherapy and he died four months later. In the present article, we discuss diagnostic difficulties, evolution, treatment, and the association of this neoplasm with the Epstein-Barr virus.

Nontypeable Haemophilus influenzae Meningitis Complicated by Hearing Loss in a 9-Year-Old HIV-Infected Boy

A 9-year old boy with perinatal HIV infection developed meningitis due to nontypeable Haemophilus influenzae. His course was complicated by progressive hearing loss due to labyrinthitis ossificans. Placement of cochlear implant improved hearing thresholds. Nontypeable H. influenzae meningitis and use of cochlear implants have not previously been in HIV-infected children.

Pulmonary Sporothrix schenckii Infection in a HIV Positive Child

Sporothrix schenckii is a ubiquitous fungus, causing mostly non life-threatening localized infections of the skin and subcutaneous tissues that can be treated with oral antifungal agents. Meningeal, pulmonary and osteoarticular dissemination occur mainly in immunosuppressed patients. Pulmonary sporotrichosis is rare and responds poorly to treatment. Cases of disseminated sporotrichosis have most frequently been reported in patients residing in South America and Asia, and have increasingly been reported in AIDS patients. The distribution and pathogenicity of S. schenckii in Sub-Saharan Africa is not well known. We report a case of invasive pulmonary sporotrichosis in an eleven year old HIV-infected boy in Kinshasa, Democratic Republic of the Congo, successfully treated with oral fluconazole.

Body composition in prepubertal children with human immunodeficiency virus type 1 infection.

To characterize the body composition of human immunodeficiency virus (HIV)-infected children, especially those with growth failure (GF), using laboratory-based methods. A cross-sectional study of body composition measurements. Urban, hospital-based body composition laboratory. Thirty-four prepubertal children with HIV infection, aged 4 to 11 years, recruited from a pediatric HIV clinic. Eighteen HIV-infected children with GF, 16 HIV-infected children with normal rates of growth, and 52 healthy children were studied. Anthropometrics, body cell mass (BCM) by total body potassium counting, body fat percent, fat mass, and fat-free mass (FFM) by dual-energy x-ray absorptiometry were determined. Both groups of boys with HIV infection had significantly lower FFM/height ratios compared with healthy boys. The mean BCM/height ratio was also lower in HIV-infected boys with GF compared with healthy boys. Measures of fat of the HIV-infected boys with GF did not differ from healthy controls, but a statistical trend suggesting decreased body fat percent and fat mass/height ratio was observed in HIV-infected boys without GF (P=.06 and .07, respectively). Mean height-for-age, weight-for-age, and weight-for-height percentiles were significantly decreased in HIV-infected boys regardless of growth status as compared with healthy boys. The mean FFM/ height and BCM/height ratios were decreased in HIV-infected girls with GF compared with healthy girls. Body fat percentage and fat mass/height ratio did not differ among the 3 groups of girls. The mean weight-for-height percentiles were not different among the 3 groups of girls. The HIV-infected girls with GF had significantly lower mean height-for-age and weight-for-age percentiles than HIV-infected girls without GF and healthy girls. The mean height-for-age percentiles of the HIV-infected girls with GF did not differ from the healthy girls. Boys and girls with HIV-associated GF had diminished FFM and BCM. The decrease in FFM and BCM was in striking contrast to the fat compartment, which was normal. Decreased FFM was also detected in boys with HIV infection and normal growth but not in girls with HIV infection and normal growth, suggesting that HIV infection may affect boys differently than girls. The preferential decrease in FFM and BCM over fat observed in these children is similar to findings reported in adults with acquired immunodeficiency syndrome wasting.

Delayed somatic growth and pubertal development in human immunodeficiency virus-infected hemophiliac boys: Hemophilia Growth and Development Study

As part of the Hemophilia Growth and Development Study, we investigated the impact of human immunodeficiency virus (HIV) infection on statural growth, weight gain, and skeletal and sexual maturity in more than 300 boys with moderate to severe hemophilia, of whom 62% were infected with HIV. Age-adjusted height and weight were reduced in the HIV-infected subjects (p < 0.001). However, mean weight for height and triceps skin-fold thickness of the infected-boys closely resembled those of the uninfected group. In HIV-infected boys, height for age was positively related to the CD4+ lymphocyte count when the count was < 200 cells/mm3. Age-adjusted serum testosterone levels did not differ by HIV status, but in the infected participants the mean age-adjusted bone age was significantly reduced (p = 0.038) and the distribution of Tanner stages, adjusted for age, differed significantly (p = 0.003). The probability of advancing one or more Tanner stages in the first study year was significantly slowed in HIV-infected boys more than 14 years of age (p = 0.0003). We conclude that linear growth was significantly impaired in boys with hemophilia and HIV infection, but the wasting of malnutrition was not found. The delays in bone age and pubertal maturation strongly suggest that part of the growth failure seen in acquired immunodeficiency syndrome can be attributed to pubertal delay. We speculate that the lack of demonstrable difference in age-adjusted testosterone concentrations might reflect subtle differences in the pattern of secretion of testosterone or in the concentration of sex-hormone binding globulin.

Life events and coping patterns reported in HIV-infected hemophiliacs a year after diagnosis

A nationwide study of the psychosocial situation of HIV-infected hemophiliacs was made in Sweden. Forty-three HIV-infected hemophiliacs aged between 12 and 72 years were compared with 30 age matched non-infected hemophiliacs. A group of 17 parents of HIV-infected boys was also studied. An unexpectedly high number of residential moves was found in the infected group during the period of diagnosis. The HIV infection diagnosis was rated the most disastrous event compared to all other studied events (including death of family member), particularly among parents of HIV-infected boys. With regard to coping, subjects were asked to record their "content of life" for the past, the present and the future. The most striking findings were the pessimistic ratings of expected number of activities with other people in the future. Such activities were assumed to decrease significantly in the infected, but not in the non-infected group. Furthermore, the ratings of possibility to influence activities were lower in the infected group compared to the non-infected. The content of activities, on the other hand, differed very little between the two groups, although non-infected men reported more hobbies and leisure activities and social activities than infected men.

A Prospective Study of HIV-Infected Haemophilic Boys and the Prognostic Significance of Immune and Haematological Abnormalities

Fifty-seven haemophilic boys have been studied prospectively determining T lymphocyte subsets and haematological parameters over a period of 26 months. Clinical follow up of these patients has continued for a further 41 months. At the beginning of the study 21 boys were HIV antibody seropositive and seroconversion was documented in a further 9 during the study period, giving a 52.6% incidence of HIV seropositivity. It has been possible to define a group of patients with persistently falling T4 values and these have shown clinical evidence of HIV infection. Although persistent generalized lymphadenopathy has been observed in 30% of HIV antibody positive boys and some boys have had unexplained fevers, only one boy has progressed to have the acquired immune deficiency syndrome (AIDS) some 5 years and 3 months from HIV seroconversion. This boy had a persistently falling T4 value. The importance of these findings is discussed. To date the abnormalities found in these haemophilic boys irrespective of their age are similar to those already reported in adult haemophiliacs.