HIV-infected Girls Research Articles

Pubertal Development Pattern in HIV-Infected Girls in Port Harcourt, Southern Nigeria

Background: Unidentified and untreated pubertal abnormalities in HIV-infected girls may result in adverse psychosocial consequences as well as a reduced final adult height. The aim of the study was to determine the pubertal development pattern in HIV-infected girls receiving care in two tertiary hospitals in Port Harcourt, Southern Nigeria.
 Materials and Methods: This was a comparative cross-sectional study involving 90 HIV-infected girls aged 10-18 years and 90 age, sex and socio-economic class matched non-HIV-infected girls.
 Results: The mean age of pubertal onset in HIV-infected girls was 11.57±1.05 which was significantly higher than the mean age of 10.78±0.69 seen in the non-HIV-infected group (ꭓ 2= 2.667, p=0.011). Sixty three (70%) of HIV-infected females had commenced puberty (Tanner stage 2 or above for breast development) compared to 83 (92.2%) of non-HIV-infected females. (χ2=16.277, p=0.003). Forty per cent (40%) of HIV-infected girls had attained menarche (40%) as against 52.2% in the comparison group but this difference was not statistically significant (χ2=2.705, p=0.100). There was a higher prevalence of pubertal delay in HIV-infected girls (6.7%) compared to non-HIV-infected girls (1.1%).
 Conclusion: The mean age of Pubertal onset was significantly later in HIV-infected girls compared to non-HIV-infected. This could have negative implications for psychosocial and reproductive health in HIV-infected girls.

A case study and proposal for publishing directed acyclic graphs: The effectiveness of the quadrivalent human papillomavirus vaccine in perinatally HIV Infected girls

BackgroundDeveloping a causal graph is an important step in etiologic research planning and can be used to highlight data flaws and irreparable bias and confounding. As a case study, we consider recent findings that suggest human papillomavirus (HPV) vaccine is less effective against HPV-associated disease among girls living with HIV compared to girls without HIV. ObjectivesTo understand the relationship between HIV status and HPV vaccine effectiveness, it is important to outline the key assumptions of the causal mechanisms before designing a study to investigate the effect of the HPV vaccine in girls living with HIV infection. MethodsWe present a causal graph to describe our assumptions and proposed approach to explore this relationship. We hope to obtain feedback on our assumptions before data analysis and exemplify the process for designing causal graphs to inform an etiologic study. ConclusionThe approach we lay out in this paper may be useful for other researchers who have an interest in using causal graphs to describe and assess assumptions in their own research before undergoing data collection and/or analysis.

Growth and Pubertal Development Among HIV Infected and Uninfected Adolescent Girls in Lagos, Nigeria: A Comparative Cross-Sectional Study.

This study aimed to compare growth and pubertal developmental parameters among HIV-infected and uninfected adolescent girls (11-19 years) in Lagos using a cross-sectional approach. Height, weight, BMI Z-scores, sexual maturity rating by Tanner stages and age at menarche, were compared in the 2 groups. The mean age was similar in both groups (13.2 [±2.3] years and 13.6 [±1.6] years for HIV positive and negative respectively [P = .13]). Majority (66.2%) were in Junior Secondary classes and the mean socioeconomic class was 2.5 (±0.9). HIV-infected girls had significantly lower height, weight, and BMI Z scores compared to their uninfected counterparts. The proportion that had attained Tanner stages 3 to 5 were significantly lower among the HIV-positive participants. The study identified lower growth parameters and pubertal delay among HIV-infected adolescent females compared to HIV uninfected girls. Growth and sexual maturation assessment should form part of routine care of adolescents living with HIV.

Analysis of the prevalence and severity of clinical manifestations of papillomavirus infection in HIV-infected women of childbearing age

Objective: to determine the prevalence and severity of clinical and cytological manifestations of papillomavirus infection in HIV-infected women of childbearing age in relation to immunological and virological parameters.Materials and methods. Statistical data were obtained through direct randomised inclusion of 182 HIV-infected women of fertile age who were being followed up at the AIDS Centre during their initial gynaecological examinations. Statistical processing of the findings was carried out using IBM SPSS Statistics software.Results and discussion. The results of the study showed a high detection rate of chronic papillomavirus infection of high carcinogenic risk (HPV HRS) among HIV-infected women, which is a prognostically unfavorable factor for the development of pathological changes in the cervix and was confirmed in a study by extended colposcopy. It was found that the concentration of HPV VKR increases against the background of a decrease in the immune status, and there is an indirect relationship between the level of HIV viral load and the concentration of HPV VKR.Conclusion. The feasibility of HPV vaccination among HIV-infected girls and women aged 9–45 has been demonstrated.

Antibody responses to prophylactic quadrivalent human papillomavirus vaccine at 48 months among HIV-infected girls and boys ages 9–14 in Kenya, Africa

ObjectivesHIV infected children remain at increased risk of HPV associated malignancies as they initiate sexual activity. Though they mount a vigorous immune response to the quadrivalent human papillomavirus (QHPV-6, -11,-16, and -18; Gardasil®) vaccine, durability of the immune response is uncertain. We assessed antibody responses to HPV 6, -11, -16 and -18 for up to 48 months following administration of quadrivalent human papillomavirus vaccine in HIV-infected girls and boys ages 9–14 years in Kenya. DesignOf 178 girls and boys who had previously received three doses of the quadrivalent HPV vaccine, 176 enrolled into extended follow up for 4 years. HPV antibodies to -6, -11, -16 and -18 were measured at 24, 36 and 48 months after the first vaccine dose using the total immunoglobulin G immunoassay (IgG LIA). We evaluated the magnitude and trend in HPV vaccine response and the effect of plasma HIV-1 RNA on HPV vaccine response from month 24 to month 48 of follow up. ResultsAt re-enrollment, 24 months after initial vaccination, median age of participants was 14 years (range 11–17); 167 (95%) were receiving antiretroviral therapy and 110 (66%) had plasma HIV RNA < 40 copies/mL. The rate of HPV seropositivity at 48 months was 83% for HPV-6; 80% for HPV-11; 90% for HPV-16; and 77% for HPV-18. There was a plateau in mean log10 HPV-specific antibody titer between month 24 and 48. The mean log10 HPV-type specific antibody titer for children with undetectable HIV viral load (<40) at the time of vaccination consistently remained higher for the 48 months of follow up compared to children with detectable viral load. ConclusionChildren with HIV infection may retain long term antibody response following HPV immunization. Further work to define whether HIV-infected children are protected from HPV acquisition with low levels of HPV antibodies is needed.

Comparison of Tanner staging of HIV-infected and uninfected girls at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria

This cross-sectional case-control study reports that 8 to 18-year-old girls with perinatal HIV infection are less likely to have attained thelarche, menarche and pubarche than healthy peers matched for age and socio-economic status. Girls with perinatal HIV infection were on average over 1.5 years older than healthy girls at the time they reached Tanner II breast development, and there were trends towards reaching menarche 0.5 years later, and Tanner II pubic hair 1.1-year later. Pubarche was earlier than thelarche in both cases and controls, as previously reported in the Nigerian population. Overall, less than half of the girls with perinatal HIV infection had reached thelarche and pubarche, which likely limited the study’s power to detect statistically significant differences in the attainment of more advanced pubertal stages. Interestingly, the average ages at thelarche (12.4±1.99 years) and menarche (12.8±1.3 years) in girls with perinatal HIV infection were quite similar, compared to the expected 2 to 2.5 years duration for individual girls to progress from Tanner II to menarche. Rather than implying a later onset but faster paced puberty, this finding may either result from reporting bias, or could suggest that those who reached menarche could represent a sub-group of girls with perinatal HIV infection who undergo normal puberty.

Adolescent girls and young women living with HIV: preconception counseling strategies.

BackgroundRates of pregnancy among women living with HIV are similar to those in the general population. Unintended pregnancies are also common, and among adolescents and young women perinatally infected (PHIV+) or behaviorally infected (BHIV+) with HIV, planning for both conception and contraception is an important element of HIV care that may be neglected. This pilot study examined the influence of intervention strategies targeting fertility planning, safer conception practices and patient-provider communication. It was hypothesized that preconception counseling interventions would enhance reproductive knowledge, planning and practices, as well as stimulate discussion with providers regarding conception.MethodsAdolescent girls and young women (N=34) perinatally (n=21) or behaviorally (n=13) infected with HIV, aged 16–29 years, were recruited from urban South Florida, and completed measures of reproductive knowledge, sexual practices and fertility intentions. Participants were randomized to condition, ie, video presentation plus Motivational Interviewing (MI), MI only, control.ResultsThe average age of women was 22 years (SD =3.27), and the majority of them were African American. Levels of depression were higher among BHIV+ compared to PHIV+ at baseline and 6 months. Pregnancy knowledge (pregnancy, safe conception and pregnancy planning) and the proportion of those engaging in birth control planning (condom use, long-term birth control, patient-provider discussions on preventing pregnancy and fertility desires) were similar between conditions at post-intervention and 6 months. Bayes factors indicated that the data were insensitive with regard to differences between conditions, limiting support for both the null and alternative hypotheses.ConclusionThe impact of interventions used in this study to stimulate pregnancy planning was inconclusive. Results suggest that pregnancy planning interventions may require greater intensity to influence sexual behavior in this population. Despite adequate reproductive knowledge, HIV-infected adolescent girls and young women may fail to engage in planning behavior.

Menarche among Peri-Natally HIV-Infected girls at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria

Menarche among Peri-Natally HIV-Infected girls at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria

Menarche among Peri-Natally Hiv-Infected girls at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria

Menarche among Peri-Natally Hiv-Infected girls at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria

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

Ethical tradeoffs in trial design: case study of an HPV vaccine trial in HIV-infected adolescent girls in lower income settings.

The Declaration of Helsinki and the Council of the International Organization of Medical Sciences provide guidance on standards of care and prevention in clinical trials. In the current and increasingly challenging research environment, the ethical status of a trial design depends not only on protection of participants, but also on social value, feasibility, and scientific validity. Using the example of a study assessing efficacy of a vaccine to prevent human papilloma virus in HIV-1 infected adolescent girls in low resource countries without access to the vaccine, we compare several trial designs which rank lower on some criteria and higher on others, giving rise to difficult trade-offs. This case demonstrates the need for developing more nuanced guidance documents to help researchers balance these often conflicting criteria.

Grade 3 Anal Intraepithelial Neoplasia in an HIV-infected African Girl

Women with HIV infection are at increased risk of anogenital dysplasia and cancer, related to human papillomavirus infection. These neoplasms are rare in perinatally HIV-infected girls before onset of sexual activity. We report a case of high-grade anal dysplasia in a 10-year-old African girl with untreated perinatal HIV infection.

Total body and spinal bone mineral density across Tanner stage in perinatally HIV-infected and uninfected children and youth in PACTG 1045

To characterize total body bone mineral content (BMC) and total body and spinal bone mineral density (BMD) in perinatally HIV-infected and uninfected children/youth across puberty. HIV-infected (7-24 years) were randomly selected from six strata based on Tanner stage/protease inhibitor use. HIV-uninfected were frequency-matched by Tanner group and sociodemographic background to the HIV-infected. Dual-energy X-ray absorptiometry (DXA) measured BMC and BMD. Linear regression models tested differences in bone outcomes by HIV and the interaction of HIV by Tanner group (1-2, 3-4, 5). Models were performed separately by sex and adjusted for DXA scanner, race/ethnicity, height, age and lean body mass. HIV-infected (N = 236) and uninfected (N = 143) were comparable on sex and race/ethnicity. HIV-infected were slightly older (median 12.6 versus 11.9 years). In adjusted models, HIV-infected males had significantly lower total body BMC and total body and spinal BMD at Tanner 5, lower BMC at Tanner 3-4 and similar BMC and BMD at Tanner 1-2, compared to HIV-uninfected males. HIV-infected and uninfected girls did not differ significantly on any bone outcome, but there was a marginally significant interaction of HIV and Tanner group for spinal BMD. Kaletra/ritonavir was associated with lower BMC and total body BMD and nevirapine was associated with higher spinal BMD in a model with all HIV-infected. Perinatally HIV-infected males showed more evidence of lower bone density especially in the final stage of pubertal development than HIV-infected girls and they may be at increased risk for bone disease during adulthood.

412: Pregnancy outcomes in perinatally HIV infected women

Due to advances in therapy, an increasing number of perinatally HIV infected girls are reaching childbearing age and becoming pregnant.These pregnancies can potentially be complicated by advanced stages of disease,complex drug regimens and risk of transmission of drug resistant mutations.The objective of this study is to analyze pregnancy outcomes in women perinatally infected with HIV. This is a prospective observational study conducted from 2000 to 2008 at a single center. There were 20 pregnancies identified in perinatally HIV infected women who received prenatal care at our clinic. The median age was18 years (range 14-23 yrs).17 women were primigravida and three women were in their second pregnancies. Of the 20 women, 15 received Anti Retroviral Therapy (ART) prior to pregnancy and five were ART naïve. At the first visit of pregnancy, the median viral load was 14400 copies/ml (range:Non Detectable to 42,000 copies/ml).The median CD4 count was 250 cells /mm3 (range:18- 590 cells /mm3).All women received Highly Active Anti Retroviral therapy (HAART) during pregnancy. The viral load at 35 weeks gestation was non detectable in all patients. One patient had chronic hypertension and HIV nephropathy. The pregnancy associated complications noted were mild preeclampsia (n=1), obstetric cholestasis (n=1) and PPROM at 30 weeks (n=1). Of the 20 patients, two transferred out to another state and three are currently pregnant. Among the 15 patients, two elected to terminate the pregnancy. There were no miscarriages or stillbirths. There were 13 liveborn infants (Preterm <37 weeks, n=4; Very preterm < 32 weeks, n=1).The mean birth weight was 2700±580 grams. Six women underwent cesarean delivery (maternal request, n=4and emergency cesarean in labor, n=2).All infants received Zidovudine(AZT) in the postpartum period and all are HIV negative With early prenatal care and adherence to HAART, perinatal HIV infection is not associated with an increased risk of adverse pregnancy outcome.

Persistence of human papillomavirus infection in HIV-infected and -uninfected adolescent girls: risk factors and differences, by phylogenetic type.

High rates of persistence of human papillomavirus (HPV) infection have been reported for adult women with human immunodeficiency virus (HIV) infection. Although most women are first infected with HPV during adolescence, persistence of specific HPV types has not been carefully examined among HIV-infected adolescents. The objective of this study was to examine the rates of and risk factors for persistence of HPV types among HIV-infected and -uninfected adolescent girls. This is a prospective cohort study of female adolescents, aged 13-18 years, participating in the Reaching for Excellence in Adolescent Care and Health project, a national study of HIV-infected and -uninfected adolescents. The main outcome measured was type-specific loss of initial HPV DNA detected. Loss of HPV DNA was defined for the following categories of HPV DNA types: low risk, which included types 6, 11, 42, 44, 54, 40, 13, 32, 62, 72, 2, 57, and 55; and high risk, which included types 16-like (16, 31, 33, 35, 52, 58, and 67), 18-like (18, 39, 45, 59, 68, 70, 26, 69, and 51), and 56-like (56, 53, and 66). Prevalent or incident HPV infection was detected in 334 girls. When type-specific loss of HPV was examined, HIV-uninfected girls had a shorter mean time to loss of initial infection than did HIV-infected girls (403 days vs. 689 days, respectively; P<.0001). By means of multivariate analysis, CD4 immunosuppression and the presence of multiple HPV-type subgroups were found to be associated with persistence of HPV. Since persistence of high-risk HPV types has been strongly linked with the development of invasive cancer, the prolonged persistence of HPV observed among HIV-infected adolescents who are relatively healthy underscores the importance of prevention of HPV infection in this group.

Retention, adherence, and compliance: special needs of HIV-infected adolescent girls and young women

Purpose To demonstrate that whereas all HIV-infected youth evidence complex factors that challenge retention in care and adherence to treatment, HIV-infected females have additional issues that are gender-specific. Methods Preliminary data from a subset of 21 adolescent/young women under age 25 from the Whole Life mental health-perinatal HIV care project were analyzed to illustrate the needs of these patients. Results Of the 21 young women assessed, all but one was of minority background, and a sizeable majority had limited education (<high school diploma) and were quite poor (incomes <$500/mo.). Nearly 67% first learned of their HIV status between ages 16 and 19 years. More than three-fourths were pregnant and, of these, more than one-third entered prenatal care in the last trimester. More than half had responsibility for one to two other children. Two-thirds reported having unprotected sex in the prior 6 months. Nearly 43% had CD4 counts of 500 or below. About one-third screened positive for a mental health problem, and the majority reported a striking frequency of exposure to abusive events and traumatic losses across their short lifetimes. Conclusions Adolescent girls and young women have unique needs for developmentally appropriate medical and psychosocial approaches to promote retention and adherence.

Prevalence of and risks for cervical human papillomavirus infection and squamous intraepithelial lesions in adolescent girls: impact of infection with human immunodeficiency virus.

Data suggest that in adults, human papillomavirus (HPV) infections and their sequalae, squamous intraepithelial lesions (SILs), occur more commonly among human immunodeficiency (HIV)-infected women because of the HIV-associated CD4+ T-cell immunosuppression. Since adolescents are more likely to be early in the course of HIV and HPV infections, the study of both infections in this age group may help elucidate their initial relationship. To examine the prevalence of and risks for cervical HPV infection and SILs by HIV status in a population of adolescent girls. Subjects recruited at each of the 16 different US sites participating in a national study of HIV infection in adolescents. Cervical HPV DNA findings using polymerase chain reaction detection techniques and Papanicolaou smear from baseline visits. Infection with HPV was categorized into low- (rarely associated with cancer) and high- (commonly associated with cancers) risk types. Of 133 HIV-infected girls, 103 (77.4%) compared with 30 (54.5%) of 55 noninfected girls were positive for HPV (relative risk [RR], 1.4; 95% confidence interval [CI], 1.1-1.8). The risk was for high-risk (RR, 1.8; 95% CI, 1.2-2.7) but not low-risk (RR, 1.2; 95% Cl, 0.4-3.9) HPV types. Among the girls with HPV infection, 21 (70.0%) of the non-HIV-infected girls had normal cytologic findings compared with only 29 (29.9%) of the HIV-infected girls (P<.001). Multivariate analysis showed that HIV status was a significant risk for HPV infection (odds ratio [OR], 3.3; 95% CI, 1.6-6.7) and SIL (OR, 4.7; 95% CI, 1.8-14.8), but CD4 cell count and viral load were not associated with infection or squamous intraepithelial lesions. Only 9 girls had a CD4+ T-cell count of less than 0.2 cell X 10(9)/L. High prevalence of HPV infection in both groups underscores the risky sexual behavior in this adolescent cohort. Rates of HPV infection and SILs were higher among HIV-infected girls, despite similar sexual risk behaviors and the relatively healthy state of our HIV-infected group. Infection with HIV may enhance HPV proliferation through mechanisms other than CD4 immunosuppression, particularly early in the course of HIV infection.

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.