HIV-infected Pediatric Patients Research Articles

A cross-sectional study on adherence to antiretroviral therapy among HIV-infected pediatric patients attending medical college and hospital, Kolkata

Background: HIV infection is a serious lifelong health risk, leading to increased illness and death. In children, adhering to antiretroviral therapy (ART) is crucial to reduce these harmful effects. Yet, due to the challenges of pediatric patients and the social issues related to HIV, sticking to ART can be difficult in this group. Aims and Objectives: The study was conducted to evaluate the adherence of pediatric patients to their daily ART dosages. We also tried to understand the causes that led to the failure to follow the scheduled dosages and evaluate how these factors affected our study population. Materials and Methods: We examined the adherence to ART in 49 patients, aged 2–15, who had been on ART for at least 12 months. They visited the ART center at Medical College and Hospital, Kolkata, between August 01 and September 30, 2022. Ethical clearance was granted by the Institution’s Ethics Committee. The participants were chosen through systematic random sampling. We collected data through interviews and chart reviews and analyzed it using SPSS version 19. Results: Out of the 49 participants, 34 (69.38%) adhered to ART in the preceding month. For the non-adherent patients (n=15), the main reasons included conflicting ART dosage timing with school hours and children falling asleep at dosing time. Most (53.1%) were in the 5–10 age groups, with 93.88% in WHO Stage 1 of the disease and 6.12% in Stage II. In 77.6% of cases, mothers were the primary caregivers, and 79.6% of caregivers were HIV positive. Many children (71.43%) were unaware of their disease. Out of the 31 children whose disease status was known to others, grandparents of 23 and siblings of 12 were aware. Six of these children faced stigma from relatives and neighbors. ART adherence was significantly associated (P<0.05) with the caregiver’s occupation (P=0.006), the child’s age when starting ART (P=0.001), parents’ AIDS-related deaths (P=0.003), and travel time to the ART center from home (P<0.02). Conclusion: Although most children adhered to their ART regimen, there is room for improvement. Caregivers, especially for younger children, play a crucial role. Empathetic education for caregivers and children, tailored to their age, along with regular adherence checks, can enhance medication adherence significantly.

High resting energy expenditure, less fat-free mass, and less muscle strength in HIV-infected children: a matched, cross-sectional study.

Many improvements have been made in the treatment of human immunodeficiency virus (HIV) in pediatric patients; however, challenges remain in terms of achieving normal growth, body composition, and metabolism during treatment, etc. Current nutritional recommendations are based on studies performed in adults, with limited data on the HIV-infected pediatric population. Therefore, this study aimed to compare the resting energy expenditure (REE) of asymptomatic HIV-infected pediatric patients with healthy counterparts and to compare body composition, dietary intake, and physical activity between the two groups. This was a cross-sectional study of asymptomatic HIV-infected children who were receiving antiretroviral therapy; the infected group was compared with the uninfected group, matched by age (± 6 months), sex, and body mass index (± 0.5 z-score). Participants were recruited between 2021 and 2022, as outpatients. In both groups, REE was determined by indirect calorimetry and body composition by bioelectrical impedance analysis and hand strength, measured using a hydraulic hand dynamometer. Seventy-eight participants were enrolled, where n = 39 HIV-infected children and n = 39 controls, with a mean age of 11.6 ± 3.4 years old. REE was significantly higher in the HIV group (1254.4 ± 334.7 kcal/day vs. 1124.7 ± 321 kcal/day, p = 0.013) than in the control group. Fat-free mass (FFM) was lower in the HIV group (28.2 ± 10.5 kg vs. 32 ± 11.2 kg, p = 0.001); this trend continued when the index skeletal muscle was evaluated (7.2 ± 1.2 vs. 7.6 ± 1.5, p = 0.04). The strength of the dominant hand was also lower in the HIV group (12 (8-18) kg vs. 20 (10.5-26) kg, p < 0.0001). Children with asymptomatic HIV infection have higher REE than their uninfected peers. They also present decreased FFM, skeletal muscle mass index, and muscle strength. These parameters should be considered during nutritional assessment in this population to have a favorable impact on nutritional status and growth.

Investigation of Oral and Fecal Colonization with Candida Species and Associated Factors in Human Immunodeficiency Virus-Infected Children in Türkiye

Abstract Objective The risk of endogenous infections in human immunodeficiency virus (HIV)-infected individuals increases with Candida species colonized in mouth and intestinal areas. The predisposing factors for colonization and the prevalence of different Candida spp. in HIV-infected Turkish children remain unknown. This study aimed to determine the colonization frequency and risk factors of colonization with Candida species in oral and fecal samples of HIV-infected pediatric patients in relation to a control group. Methods Oral and feces samples of 22 HIV-infected and 52 healthy children were plated onto CHROMagar and CHROM-Pal-agar. Yeasts were identified by conventional methods, and strains with insufficient identification were identified by molecular techniques. Results Candida spp. were detected in oral/fecal samples of 50%/68.2% HIV-infected and 36.5%/73.1% healthy children. The most common species was Candida albicans in oral and fecal samples of HIV-infected (31.8 and 31.8%) and healthy (26.9 and 48.1%) children. The most frequently non-albicans species in oral samples was Candida dubliniensis (18.2%) in HIV-infected children and Candida parapsilosis (3.8%) in healthy children. In feces samples, C. parapsilosis, Candida glabrata, and Candida krusei were most frequent (13.6%, each) in HIV-infected patients, and Candida kefyr (11.5%) was most frequent in controls. There was a significant association between oral C. dubliniensis colonization and HIV infection (p = 0.006). Yeast carriage was not associated with gender and viral load in HIV-infected patients. Conclusion The isolation of C. dubliniensis from oral and fecal samples of pediatric HIV patients was done for the first time in Türkiye in the present study. Additional studies are needed to clarify the factors associated with oral and fecal Candida colonization in these children.

Drug resistance in children and adolescents with HIV in Panama.

The inadequacy of resistance monitoring in Latin America leads to circulation of HIV strains with drug resistance mutations (DRMs), compromising ART effectiveness. This study describes the DRM prevalence in HIV-infected paediatric patients in Panama. During 2018-19, plasma was collected from 76 HIV-infected children/adolescents (5 ART-naive, 71 treated) in Panama for HIV-1 DRM pol analysis, predicted antiretroviral (ARV) susceptibility by Stanford, and HIV-1 variant phylogenetic characterization. HIV-1 pol sequences were recovered from 67 (88.2%) of 76 children/adolescents (median age 12 years), carrying 65 subtype B, 1 subtype G and 1 unique recombinant URF_A1B. Five were ART-naive and 62 ART-treated under virological failure (viraemia >50 copies/mL) with previous exposure to NRTIs, (100%), NNRTIs (45.2%), PIs (95.2%) and integrase strand transfer inhibitors (INSTIs, 17.7%). Among the treated patients, 34 (54.8%) carried resistant strains, with major DRMs to one (40.3%), two (9.7%) or three (4.8%) ARV families. Most of them harboured DRMs to NRTIs (58.5%) or NNRTIs (39%), but also major DRMs to PIs (4.9%) and INSTIs (6.5%). We also found dual-class NRTI + NNRTI (12.2%) and NNRTI + PI (2.6%) resistance. Two naive subjects carried viruses with DRMs to NRTIs and NRTI + NNRTI, respectively. Sequenced viruses presented high/intermediate resistance mainly to emtricitabine/lamivudine (48.9% each) and efavirenz/nevirapine (33.3% each). Most participants were susceptible to PIs (91.3%) and INSTIs (88.1%). The high DRM prevalence to NRTIs and NNRTIs observed among treated HIV-infected children/adolescents in Panama justifies the need for routine resistance monitoring for optimal rescue therapy selection in this vulnerable population.

Nonpruritic hypopigmented macules on an immunocompromised patient

Nonpruritic hypopigmented macules on an immunocompromised patient

Highdrug resistance levelscould compromisethe control of HIV infection in paediatric and adolescent population in Kinshasa, the Democratic Republic of Congo.

BackgroundThe inadequacy of HIV viraemia and resistance monitoring in Africa leads to uncontrolled circulation of HIV strains with drug resistance mutations (DRM), compromising antiretroviral therapy (ART) effectiveness. This study describes the DRM prevalence and its therapeutic impact in HIV-infected pediatric patients from Kinshasa (Democratic Republic of Congo, DRC).MethodsFrom 2016–2018, dried blood were collected from 71 HIV-infected children and adolescents under ART in two hospitals in Kinshasa for HIV-1 DRM pol analysis, predicted ARV-susceptibility by Stanford and phylogenetic characterization.ResultsHIV-1 sequences were recovered from 55 children/adolescents with 14 years of median-age. All had received nucleoside and non-nucleoside reverse transcriptase inhibitors (NRTI, NNRTI), 9.1% protease inhibitors (PI) and only one integrase inhibitor (INI). Despite the use of ART, 89.1% showed virological failure and 67.3% carried viruses with major-DRM to one (12.7%), two (47.3%), or three (5.5%) ARV-families. Most children/adolescents harbored DRM to NNRTI (73.5%) or NRTI (61.2%). Major-DRM to PI was present in 8.3% and minor-DRM to INI in 15%. Dual-class-NRTI+NNRTI resistance appeared in 53.1% of patients. Viruses presented high/intermediate resistance to nevirapine (72.9% patients), efavirenz (70.9%), emtricitabine/lamivudine (47.9%), rilpivirine (41.7%), etravirine (39.6%), doravidine (33.3%), zidovudine (22.9%), among others. Most participants were susceptible to INI and PI. Great diversity of variants was found, with a high rate (40%) of unique recombinants.ConclusionThe high DRM prevalence observed among HIV-infected children and adolescents in Kinshasa could compromise the 95-95-95-UNAIDS targets in the DRC. It also reinforces the need for routine resistance monitoring for optimal rescue therapy election in this vulnerable population to control the spread of resistant HIV in the country.

Prognostic factors affecting survival in children and adolescents with HIV and Hodgkin lymphoma in South Africa

South African children with Hodgkin lymphoma (HL) and human immunodeficiency virus (HIV) have low 5-year overall survival (OS) rates. In this retrospective multicenter study, 271 South African pediatric patients with HL were studied to determine OS and prognostic factors in those with HIV and HL. Univariate risk factor analysis was performed to analyze prognostic factors. The 29 HIV-infected patients were younger (p = .021), more likely to present with wasting (0.0573), stunting (0.0332), and Stage IV disease (p = .000) than HIV-uninfected patients. The 5- and 10-year OS of HIV-infected patients of 49% and 45% versus 84% and 79%, respectively for HIV-uninfected patients (p = .0001) appeared to be associated with hypoalbuminemia (<20 g/dL) and CD4 percentage of <15%. Causes of death in the HIV-infected group included disease progression (6/14), infection (4/14), unknown (3/14), and second malignancy (1/14). HIV-infected pediatric patients with HL experience increased mortality due to post-therapy opportunistic and nosocomial infections.

The Anti-Cancer Properties of the HIV Protease Inhibitor Nelfinavir.

Simple SummaryTo this day, cancer remains a medical challenge despite the development of cutting-edge diagnostic methods and therapeutics. Thus, there is a continual demand for improved therapeutic options for managing cancer patients. However, novel drug development requires decade-long time commitment and financial investments. Repurposing approved and market-available drugs for cancer therapy is a way to reduce cost and the timeframe for developing new therapies. Nelfinavir is an anti-infective agent that has extensively been used to treat acquired immunodeficiency syndrome (AIDS) in adult and pediatric patients. In addition to its anti-infective properties, nelfinavir has demonstrated potent off-target anti-cancer effects, suggesting that it could be a suitable candidate for drug repurposing for cancer. In this review, we systematically compiled the therapeutic benefits of nelfinavir against cancer as a single drug or in combination with chemoradiotherapy, and outlined the possible underlying mechanistic pathways contributing to the anti-cancer effects.Traditional cancer treatments may lose efficacy following the emergence of novel mutations or the development of chemoradiotherapy resistance. Late diagnosis, high-cost of treatment, and the requirement of highly efficient infrastructure to dispense cancer therapies hinder the availability of adequate treatment in low-income and resource-limited settings. Repositioning approved drugs as cancer therapeutics may reduce the cost and timeline for novel drug development and expedite the availability of newer, efficacious options for patients in need. Nelfinavir is a human immunodeficiency virus (HIV) protease inhibitor that has been approved and is extensively used as an anti-infective agent to treat acquired immunodeficiency syndrome (AIDS). Yet nelfinavir has also shown anti-cancer effects in in vitro and in vivo studies. The anti-cancer mechanism of nelfinavir includes modulation of different cellular conditions, such as unfolded protein response, cell cycle, apoptosis, autophagy, the proteasome pathway, oxidative stress, the tumor microenvironment, and multidrug efflux pumps. Multiple clinical trials indicated tolerable and reversible toxicities during nelfinavir treatment in cancer patients, either as a monotherapy or in combination with chemo- or radiotherapy. Since orally available nelfinavir has been a safe drug of choice for both adult and pediatric HIV-infected patients for over two decades, exploiting its anti-cancer off-target effects will enable fast-tracking this newer option into the existing repertoire of cancer chemotherapeutics.

Pre-HAART CD4+ T-lymphocytes as biomarkers of post-HAART immune recovery in HIV-infected children with or without TB co-infection

BackgroundInfection with the Human Immunodeficiency Virus (HIV) dramatically increases the risk of developing active tuberculosis (TB). Several studies have indicated that co-infection with TB increases the risk of HIV progression and death. Sub-Saharan Africa bears the brunt of these dual epidemics, with about 2.4 million HIV-infected people living with TB. The main objective of our study was to assess whether the pre-HAART CD4+ T-lymphocyte counts and percentages could serve as biomarkers for post-HAART treatment immune-recovery in HIV-positive children with and without TB co-infection.MethodsThe data analyzed in this retrospective study were collected from a cohort of 305 HIV-infected children being treated with HAART. A Lehmann family of ROC curves were used to assess the diagnostic performance of pre- HAART treatment CD4+ T-lymphocyte count and percentage as biomarkers for post-HAART immune recovery. The Kaplan–Meier estimator was used to compare differences in post-HAART recovery times between patients with and without TB co-infection.ResultsWe found that the diagnostic performance of both pre-HARRT treatment CD4+ T-lymphocyte count and percentage was comparable and achieved accuracies as high as 74%. Furthermore, the predictive capability of pre-HAART CD4+ T-lymphocyte count and percentage were slightly better in TB-negative patients. Our analyses also indicate that TB-negative patients have a shorter recovery time compared to the TB-positive patients.ConclusionsPre-HAART CD4+ T-lymphocyte count and percentage are stronger predictors of immune recovery in TB-negative pediatric patients, suggesting that TB co-infection complicates the treatment of HIV in this cohort. These findings suggest that the detection and treatment of TB is essential for the effectiveness of HAART in HIV-infected pediatric patients.

Effectiveness of vaccination against influenza in HIV-infected pediatric patients in the 2016-2017 epidemic season.

Pediatric patients infected with the human immunodeficiency virus (HIV) are at risk of developing severe influenza. Vaccination against influenza in HIV (+) children in Poland is recommended and free of charge. The aim of the study was to evaluate the effectiveness of influenza vaccination in this group of patients. The study group consisted of 25 HIV-infected children, patients of the Department of Paediatric Infectious Diseases in Wrocław, vaccinated against influenza from September to December 2016. The incidence of influenza and influenza-like diseases was monitored from December 1, 2016 to April 15, 2017. IgG / IgM against influenza A and B by ELISA and against AH1N1 by HI method before vaccination and 4-6 weeks after vaccination were determined. Nasopharyngeal swabs of influenza RNA for PCR testing were collected in each patient during each hospitalization in the epidemic season. In the 2016/2017 epidemic season, none of the patients developed symptomatic influenza or any other flu-like infection with fever. Influenza A virus RNA was detected in nasopharyngeal swabs in 8 patients, none of them presented any clinical symptoms of infection. Positive pre-vaccination IgG levels against influenza A and B were detected in 36% (9/25) and 68% (17/25) of patients, respectively. After vaccination, positive concentrations were found in 56% (14/25) and 80% (20/25) of patients, respectively. Positive concentration of IgM antibodies was achieved by 60% (15/25) of the respondents - for influenza A and 52% (13/25) - for influenza B. In 11 patients (45.8%) before vaccination, protective titres of antibodies against H1 haemagglutinin were obtained, after the vaccination the proportion of patients with a protective titer was 52.4%. Influenza vaccination in HIV-infected children is effective in preventing symptomatic influenza virus infection but does not prevent transmission of infection in the population. Annual influenza vaccination and seasonal natural infections with influenza viruses result in the persistence of measurable antibody levels until the next epidemic season.

An Exclusively Skewed Distribution of Pediatric Immune Reconstitution Inflammatory Syndrome Toward the Female Sex Is Associated With Advanced Acquired Immune Deficiency Syndrome.

In human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) patients with very low CD4 cell counts, there is a temporal relationship between administration of antiretroviral therapy (ART) and an increased inflammatory response state known as the immune reconstitution inflammatory syndrome (IRIS). The predominant clinical presentation of IRIS is an infectious disease that can be life-threatening. IRIS-related infectious events are distributed similarly between adult males and females, albeit a few studies have shown a skewing toward the male sex in pediatric IRIS. Here, we assessed sex-specific differences in the causes and extent of IRIS infectious events in HIV-infected pediatric patients on ART. We carried out a prospective clinical analysis (from 2000 to 2018) of IRIS-related infectious events after ART in a cohort of 82 Brazilian children and adolescents infected with HIV-1 through mother-to-child transmission as well as a comprehensive cross-referencing with public records on IRIS-related infectious causes in pediatric HIV/AIDS. Twelve events fulfilling the criteria of IRIS occurred exclusively in 11 females in our cohort. The median age at IRIS events was 3.6 years. The infectious causes included Mycobacterium bovis, varicella-zoster virus, molluscum contagiosum virus, human papillomavirus, cytomegalovirus, and Mycobacterium tuberculosis. In one female, there was regional bacillus Calmette-Guérin dissemination and cytomegalovirus esophagitis. There was complete health recovery after 10 IRIS events without the use of corticosteroids or ART interruption. One case of IRIS-associated miliary tuberculosis was fatal. The biological female sex was a significant risk factor for IRIS events (odds ratio: 23.67; 95% confidence interval 95%: 1.341–417.7; P = 0.0016 and P < 0.01 by the multivariable analysis). We observed an effect of the advanced HIV/AIDS variable in IRIS females as compared with non-IRIS females (mean CD4+ T cell percentage 13.36 vs. 18.63%; P = 0.0489 and P < 0.05 by the multivariable analysis), underpinning the exclusively skewed distribution toward the female sex of this cohort. Moreover, the IRIS females in our cohort had higher mean CD4+ T cell percentages before (13.36%) and after IRIS (26.56%) than those of the IRIS females (before IRIS, 4.978%; after IRIS, 13.81%) in previous studies conducted worldwide. The exclusively skewed distribution of pediatric IRIS toward the female sex in the cohort was not linked to preferential X-chromosome inactivation rates. We concluded that the exclusively skewed distribution of pediatric IRIS toward females is associated with more advanced AIDS.

Effect of Lactobacillus plantarum IS-10506 on blood lipopolysaccharide level and immune response in HIV-infected children

HIV enteropathy may cause disruption of the intestinal barrier, leading to a loss of CD4+ T cells, increased intestinal permeability, and microbial translocation. Lactobacillus plantarum IS-10506 has the ability to improve gut barrier function. This study investigated the effect of L. plantarum IS-10506 on a number of biomarkers of enteropathy-related damage in HIV-infected paediatric patients undergoing antiretroviral therapy (ARV). A randomized, double-blind, placebo-controlled study was conducted on 2-18 year-old children, diagnosed as HIV infected according to the WHO 2007 criteria who had received ARV for ≥ 6 months. Subjects were excluded if ARV therapy was discontinued or the patients took probiotics ≥ 2 weeks prior to the study or during the study period. Subjects were randomized into a probiotic group and placebo group. The probiotic group received L. plantarum IS-10506 2.86 × 1010 cfu/day for 6 days. Blood lipopolysaccharide (LPS) level, serum CD4+ T cell count, serum CD8+ T cell count, CD4+/CD8+ T cell ratio, and faecal sIgA level were assessed as biomarkers. Twenty-one subjects completed this study. The blood LPS level decreased significantly in the probiotic group (p = 0.001). There was no significant difference in absolute CD4+ T cell count, percent CD4+ cells, absolute CD8+ T cell count, CD4+/CD8+ T cell ratio, or faecal sIgA. No serious adverse events were reported. The probiotic L. plantarum IS-10506 reduced the blood LPS level but showed no effect on the humoral mucosa and systemic immune response in HIV-infected children undergoing ARV therapy.

Tolerability of Isoniazid Preventive Therapy in an HIV-Infected Cohort of Paediatric and Adolescent Patients on Antiretroviral Therapy from a Resource-Limited Setting: A Retrospective Cohort Study

BackgroundTreating patients with latent tuberculosis infection (LTBI) to prevent development of active disease is an essential strategy for eliminating TB. There are concerns regarding the use of isoniazid due to the potential for hepatotoxicity. This study was conducted to determine the incidence of adverse hepatic events after isoniazid preventive therapy (IPT) commencement in a cohort of HIV-infected paediatric and adolescent patients on antiretroviral therapy (ART).MethodsThis was a retrospective records review, using data from HIV-infected paediatric and adolescent patients collected during routine clinical visits at Newlands Clinic, Harare, Zimbabwe. Patients included in the analysis had commenced IPT between January 2014 and June 2015 (inclusive) whilst receiving ART. A survival analysis was conducted for the period that participants were receiving IPT with end-points defined by grade 3 or grade 4 elevations in alanine aminotransferase (ALT) levels.ResultsData from 438 patients commenced on IPT were analysed; 202 (46.1%) of them were female. The median age at IPT commencement was 10 (IQR = 7–12) years. Twenty-eight patients developed grade 3 or 4 elevations in ALT. Concomitant use of nevirapine as part of an ART regimen was the only factor that showed a statistically significant association with ALT elevation [relative risk (RR): 2.7; confidence interval (CI): 1.2–6.3, p = 0.012] compared with those not receiving nevirapine. The incidence of grade 3 or 4 elevations in ALT was 31.5/100 person-years (CI 20.9–45.5).ConclusionThe incidence of IPT-associated ALT elevations was high in this population. We recommend vigilant monitoring of liver enzymes for patients receiving IPT, especially in patients concomitantly receiving nevirapine.

Impact of Anemia on Outcome of HIV-Infected Pediatric Patients: A Prospective Observational Study.

Introduction:Anemia has been widely reported to predict a poorer prognosis for HIV-infected patients, both in terms of progression to AIDS and in survival. This study aimed to determine the etiology of anemia and its immunological correlation in HIV-infected children.Materials and Methods:Four hundred and eighty-nine HIV-infected children were screened, of which 86 HIV-infected children with anemia were enrolled. Standard WHO definitions were used for anemia, HIV staging, and growth parameters. Chi-square test, t-tests, and univariate and multivariate logistic regression analyses were used to analyze the data.Results:Anemia was present in 17.58% (86/489) of HIV-infected children, including 84.6% with moderate anemia, 11.5% with severe anemia, and 2.32% with mild anemia. The mean hemoglobin (Hb) among patients with CD4 count <350 cell/mm3 was lower (7.90 g%) (standard deviation 1.48) compared to those having CD4 >350 cell/mm3 (P = 0.02). Children with severe immunological stage had a significantly lower mean Hb (adjusted estimate: −1.61, 95% confidence interval: −2.65, −0.56) compared to those who had normal immune status. No statistically significant differences in mean Hb at baseline when compared to various demographic and clinical characteristics were observed in unadjusted and adjusted regression models.Conclusion:Hb is an easy and inexpensive tool to measure and can be used for monitoring disease progression in a resource-limited setting.

The efficacy of nelfinavir and lopinavir/ritonavir in the treatment of HIV-infected pediatric patients

Objective: to characterize the efcacy of nelfnavir and lopinavir/ritonavir in the starting regimens of antiretroviral therapy for HIV-infected pediatric patients.Materials and methods: 50 HIV-infected patients aged 24-36 months were treated with abacavir and lamivudine in combination with nelfnavir (24 children) or lopinavir/ritonavir (26 patients).Results: Using both antiretroviral therapy schemes leads to suppression of HIV replication, improvement of clinical and immunological parameters. However, the treatment with lopinavir/ritonavir revealed a signifcant positive changes of HIV blood viral load, immune status and clinical picture. With the help of mathematical modeling, the signifcance of lopinavir/ritonavir appointment as an independent predictor of effectiveness prolongation of antiretroviral therapy has been proved. As a side effect of lopinavir/ritonavir developed dyspeptic symptoms.Conclusion: Te results of the study indicate the high efcacy and safety of lopinavir/ritonavir use compared to nelfnavir in HIV-infected pediatric patients.

Age and HIV stage at initiation of highly active antiretroviral therapy determine non-reversal of stunting at 3 years of treatment

Background Highly active antiretroviral therapy (HAART) has been reported to improve growth, especially in the first 2 years of treatment. It is not clear whether catch up growth is maintained after 2 years of HAART.&#x0D; Objective To assess growth in stunted children with HIV after 3 years of HAART and analyze possible risk factors for non-reversal of stunting.&#x0D; Methods This study was done from May 2016 to April 2017 to follow children with HIV who started HAART between January 2009 and April 2014, and continued for 3 years. Inclusion criteria were children with HIV, aged &lt; 18 years, compliance to the regimen, and stunting. Exclusion criteria were patients lost to follow up or who died prior to 3 years of HAART. Non-reversal of stunting was defined as HAZ ≤ -2SD after 3 years of HAART. Possible risk factors for non-reversal were analyzed using Chi-square test with P&lt;0.05, as well as risk ratio (RR) and 95% confidence intervals (CI).&#x0D; Results Of 150 HIV-infected pediatric patients, 115 were on HAART and 55 (47.8%) were stunted at HAART initiation. Of the 55 stunted and HAART-treated children, 31 (56.4%) were male. Baseline median age was 3.6 years (interquartile range 0.37-8.48). Non-reversal occurred in 32 (58.2%) subjects. Multivariate Cox regression model analysis showed predictors of non-reversal after 3 years of HAART to be age &gt;2 years (RR 16.05; 95%CI 2.89 to 89.02; P=0.002) and HIV stage III-IV (RR 8.93; 95%CI 1.47 to 54.37; P=0.017).&#x0D; Conclusion HAART initiation at age &gt;2 years and HIV clinical stage III-IV at diagnosis are risk factors for non-reversal of stunting after 3 years of HAART.

Oral candidiasis profile of the Indonesian HIV-infected pediatric patients at UPIPI Dr. Soetomo General Hospital, Surabaya, Indonesia

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Mensana M, Ernawati D, Nugraha A, et al. Oral candidiasis profile of the Indonesian HIV-infected pediatric patients at UPIPI Dr. Soetomo General Hospital, Surabaya, Indonesia. HIV & AIDS Review. International Journal of HIV-Related Problems. 2018;17(4):272-277. doi:10.5114/hivar.2018.80259. APA Mensana, M., Ernawati, D., Nugraha, A., Soebadi, B., Triyono, E., & Husada, D. et al. (2018). Oral candidiasis profile of the Indonesian HIV-infected pediatric patients at UPIPI Dr. Soetomo General Hospital, Surabaya, Indonesia. HIV & AIDS Review. International Journal of HIV-Related Problems, 17(4), 272-277. https://doi.org/10.5114/hivar.2018.80259 Chicago Mensana, Mario P., Diah S. Ernawati, Alexander P. Nugraha, Bagus Soebadi, Erwin A. Triyono, Dominicus Husada, and Remita A. Prasetyo et al. 2018. "Oral candidiasis profile of the Indonesian HIV-infected pediatric patients at UPIPI Dr. Soetomo General Hospital, Surabaya, Indonesia". HIV & AIDS Review. International Journal of HIV-Related Problems 17 (4): 272-277. doi:10.5114/hivar.2018.80259. Harvard Mensana, M., Ernawati, D., Nugraha, A., Soebadi, B., Triyono, E., Husada, D., Prasetyo, R., Utami, S., and Sufiawati, I. (2018). Oral candidiasis profile of the Indonesian HIV-infected pediatric patients at UPIPI Dr. Soetomo General Hospital, Surabaya, Indonesia. HIV & AIDS Review. International Journal of HIV-Related Problems, 17(4), pp.272-277. https://doi.org/10.5114/hivar.2018.80259 MLA Mensana, Mario P. et al. "Oral candidiasis profile of the Indonesian HIV-infected pediatric patients at UPIPI Dr. Soetomo General Hospital, Surabaya, Indonesia." HIV & AIDS Review. International Journal of HIV-Related Problems, vol. 17, no. 4, 2018, pp. 272-277. doi:10.5114/hivar.2018.80259. Vancouver Mensana M, Ernawati D, Nugraha A, Soebadi B, Triyono E, Husada D et al. Oral candidiasis profile of the Indonesian HIV-infected pediatric patients at UPIPI Dr. Soetomo General Hospital, Surabaya, Indonesia. HIV & AIDS Review. International Journal of HIV-Related Problems. 2018;17(4):272-277. doi:10.5114/hivar.2018.80259.

A Review on Various Aspects of HIV Infection

Many people are affected by HIV infection worldwide, lack of ability of modern medication in developing an active vaccine against HIV is a global public health importance. Various aspects such as diseases associated with HIV infection, role of immune cells in diagnosis and treatment, significance of molecular changes during infection, complications in infants, impact of gender and social behaviour and diagnosis of disorders associated with HIV infection were discussed in this review. Affected patients would be associated with acute kidney injury, arterial stiffness, cardiovascular disease, Tuberculosis, intestinal parasite carriage and disruptive sleep apnea. Immune cells like CD4, CD8, CD38 T cells and natural killer cells have a vital role in diagnosis and treatment. DNA vaccines could play a major role to prevent or treat infectious diseases including HIV and would elicit T cell immunity, protective antibody responses and local mucosal immunity protective vaccine against HIV infection. Health professionals are responsible for diagnosis of disorders associated with HIV infection and follow-up of HIV-infected paediatric patients. There is a crucial need to improve and evaluate novel interventions that are tailored for this helpless population. Several factors such as income deficit, Pre-college residence, pornographic film viewing and believe in sexual abstinence for HIV prevention were found to be significant predictors of initiating premarital sex. Younger generations could be advised to maintain the virginity as cultural norm. Incorporation of socio-structural elements and geospatial techniques in analytical approaches would lead to better understanding of local dynamics and develop mediations that increase our facility of targeted HIV prevention services.

Treatment Outcomes of Children With HIV Infection and Drug-resistant TB in Three Provinces in South Africa, 2005-2008.

To describe outcomes of HIV-infected pediatric patients with drug-resistant tuberculosis (DR TB). Demographic, clinical and laboratory data from charts of pediatric patients treated for DR TB during 2005-2008 were collected retrospectively from 5 multi-DR TB hospitals in South Africa. Data were summarized, and Pearson χ test or Fisher exact test was used to assess differences in variables of interest by HIV status. A time-to-event analysis was conducted using days from start of treatment to death. Variables of interest were first assessed using the Kaplan-Meier method. Cox proportional hazard models were fit to estimate crude and adjusted hazard ratios. Of 423 eligible participants, 398 (95%) had culture-confirmed DR TB and 238 (56%) were HIV infected. A total of 54% were underweight, 42% were male and median age was 10.7 years (interquartile range: 5.5-15.3). Of the 423 participants, 245 (58%) were successfully treated, 69 (16%) died, treatment failed in 3 (1%), 36 (9%) were lost to follow-up and 70 (17%) were still on treatment, transferred or had unknown outcomes. Time to death differed by HIV status (P = 0.008), sex (P < 0.001), year of tuberculosis diagnosis (P = 0.05) and weight status (P = 0.002). Over the 2-year risk period, the adjusted rate of death was 2-fold higher among participants with HIV compared with HIV-negative participants (adjusted hazard ratio = 2.28; 95% confidence interval: 1.11-4.68). Male, underweight and HIV-infected children with DR TB were more likely to experience death when compared with other children with DR TB within this study population.

Impact of Single Nucleotide Polymorphisms on Plasma Concentrations of Efavirenz and Lopinavir/Ritonavir in Chinese Children Infected with the Human Immunodeficiency Virus.

Single nucleotide polymorphisms (SNPs) in the genes that encode the cytochrome P450 (CYP) drug metabolizing enzymes and drug transporters have been reported to influence antiretroviral drug pharmacokinetics. Although primarily metabolized by CYP2B6 and -3A, efavirenz (EFV) and lopinavir/ritonavir (LPV/r) are substrates of P-glycoprotein and the solute carrier organic (SLCO) anion transporter, respectively. We investigated the association between SNPs and efavirenz (EFV) or lopinavir/ritonavir (LPV/r) concentrations in Chinese children infected with the human immunodeficiency virus (HIV). Genotyping was performed on CYP2B6 516G→T, -1459C→T, and -983T→C, ABCB1 3435C→T, and SLCO1B1 521T→C in 229 HIV-infected Chinese pediatric patients (age range 4.0 to 17.5 yrs). Plasma concentrations of EFV and LPV/r were measured using validated high-performance liquid chromatography coupled with the mass spectrum method among 39 and 69 children who received EFV- and LPV/r-containing regimens, respectively. The frequencies of CYP2B6 516G→T in the study participants were 71%, 25%, and 4% for the G/G, G/T, and T/T genotypes, respectively. Among the children under therapeutic drug monitoring, 21% and 39% experienced EFV and LPV concentrations, respectively, above the upper threshold of the therapeutic window. CYP2B6 516G→T was significantly associated with EFV concentrations (p<0.001). Older children (older than 10 yrs) were more likely to have significantly higher EFV concentrations than the younger ones (p=0.0314). CYP2B6 genotyping and EFV concentration monitoring may help optimize antiretroviral therapy in pediatric patients who initiate an EFV-based regimen.