HIV-positive Children Research Articles

\u201cWhat will my child think of me if he hears I gave him HIV?\u201d: a sequential, explanatory, mixed-methods approach on the predictors and experience of caregivers on disclosure of HIV status to infected children in Gombe, Northeast Nigeria

BackgroundWith increasing access to effective Anti-Retroviral Therapy (ART), the proportion of children who survive into later childhood with HIV has increased. Consequently, caregivers are constantly being confronted with the dilemma of ‘if’, ‘when’, and ‘how’ to tell their children living with HIV their status. We aimed to determine the prevalence and predictors of disclosure and explore the barriers caregivers face in disclosing HIV status to children living with HIV in Gombe, northeast Nigeria.MethodsWe conducted a sequential, explanatory, mixed-methods study at the specialist Paediatric HIV clinic of the Federal Teaching Hospital Gombe, northeast Nigeria. The quantitative component was a cross sectional, questionnaire-based study that consecutively recruited 120 eligible primary caregivers of children (6–17 years) living with HIV. The qualitative component adopted an in-depth one-on-one interview approach with 17 primary caregivers. Primary caregivers were purposively selected to include views of those who had made disclosure and those who have not done so to gain an enhanced understanding of the quantitative findings. We examined the predictors of HIV status disclosure to infected children using binary logistic regression. The qualitative data was analysed using a combined deductive and inductive thematic analysis approach.ResultsThe mean age of the index child living with HIV was 12.2 ± 3.2 years. The prevalence of disclosure to children living with HIV was 35.8%. Children living with HIV were 10 times more likely to have been told their status if their caregivers believed that disclosure had benefits [AOR = 9.9 (95% CI = 3.2–15.1)], while HIV-negative compared to HIV-positive caregivers were twice more likely to make disclosures [AOR = 1.8 (95%CI = 0.7–4.9)]. Girls were 1.45 times more likely than boys to have been disclosed their HIV positive status even after adjusting for other variables [AOR = 1.45 (95% CI = 0.6–3.5)].Caregivers expressed deep-seated feeling of guilt and self-blame, HIV-related stigma, cultural sensitivity around HIV, and fears that the child might not cope as barriers to non-disclosure. These feeling were more prominent among HIV-positive caregivers.ConclusionThe process of disclosure is a complex one and caregivers of HIV positive children should be supported emotionally and psychologically to facilitate disclosure of HIV status to their children. This study further emphasises the need to address HIV-related stigma in resource constrained settings.

Echocardiographic Findings in HIV Positive Children on Anti-retroviral Therapy Attending Routine Outpatient Infectious Disease Clinics in the Niger Delta Region of Nigeria

Background: The aim of this study was to investigate the echocardiographic findings of stable HIV positive children on Highly Active Anti-retroviral Therapy (HAART) attending routine Paediatric Infectious disease clinics in the Niger Delta region of Nigeria.
 Methods: Over a 3 month period (1st October to 31st December 2019) 71 apparently stable HIV positive children who had been on HAART for at least 3 months had a transthoracic echocardiogram done after written informed consent. A proforma containing their clinical and socioeconomic information and the echocardiographic findings was filled. Data was entered into an Excel spread sheet and analysed using SPSS 22.0.
 Results: Among the 71 children studied, 34 (47.89%) were aged 6 – 10 years, 42 (59.15%) were females while 15 (26.01%) belonged to social class 3. Of the 71 participants studied, forty-four (61.97%) had abnormal echocardiographic findings on echocardiogram. Mild pulmonary regurgitation was the commonest finding and occurred in 32 (45.07%) of the patients. This was followed by Left Ventricular diastolic dysfunction (LVDD) which occurred in 9 (12.68%) patients, while Left Ventricular systolic dysfunction (LVSD) and Congenital heart defects occurred in 6 (8.45%) subjects each. There was no significant association between occurrence of echocardiographic findings and age, gender, duration of HIV disease, type of HAART and stage of disease at diagnosis and at the time of the study (p<0.05).
 Conclusion: This study shows that mild pulmonary regurgitation is the commonest echocardiographic finding among stable HIV patients followed by left ventricular dysfunction. Routine baseline and intermittent echocardiography are recommended for initial evaluation and continued care for early detection and quick intervention of cardiac diseases of children with HIV disease.

Environment and psychosocial factors are more important than clinical factors in determining quality of life of HIV-positive patients on antiretroviral therapy.

Assessing quality of life (QOL) outcome helps to show the effect of antiretroviral therapy (ART) on the subjective perception of its benefits among patients with HIV. A cross-sectional assessment of QOL, using the World Health Organization WHOQOL-HIV, on 204 HIV patients taking ART in western India showed patients with HIV on ART as having the best QOL score in the spiritual domain and the worst in the environment domain. Patients who are single, highly educated, of higher occupational status, with no HIV-positive children, not undergoing frequent hospital admissions, with access to a counsellor for support, who are not stigmatised or discriminated against due to HIV status, who do not have guilt or suicidal ideas, and who are theist, tend to have a better QOL, irrespective of their clinical condition or ART regimen. Patients' personal perceptions and feelings, societal support or stigma, and sociodemographic status have a more significant influence on QOL than clinical variables.

Anemia and Related Factors Among Highly Active Antiretroviral Therapy Experienced Children in Hawassa Comprehensive Specialized Hospital, Southern Ethiopia: Emphasis on Patient Management.

BackgroundHuman Immunodeficiency Virus (HIV) and its therapy cause a variety of hematological abnormalities that have been known to be one of the most common causes of morbidity and mortality in HIV-positive children. One of the commonly observed hematologic manifestations in HIV-positive children is anemia and it has a multifactorial source. We intended to assess the prevalence, as well as its related factors of anemia among Highly Active Antiretroviral Therapy (HAART), experienced children.MethodsA hospital-based cross-sectional study was employed at Hawassa comprehensive specialized hospital from February 15-June 15, 2018. Overall, 273 HAART-practiced children were included in the study. Socio-demographic variables and clinical data were collected using a standard and pretested questionnaire. Medical records were reviewed for each study participant using a standard checklist. Blood specimens were collected and examined for complete blood count, CD4 cell count and blood film for hemoparasites and morphological classification of anemia, whereas stool specimens were collected and examined for intestinal parasites. Data were entered into Epidata and transferred to SPSS (Statistical Package for Social Science) version 20 software. Descriptive analysis was done for prevalence and binary and multivariate logistic regression was used to determine factors associated with anemia. Statistical significance was stated at P-value<0.05.ResultsThe overall prevalence of anemia in this study was 11.4%. Morphologically the predominant anemia was Normocytic Normochromic anemia which accounted for 64.5%. In the current study, children within the age group of <7years (AOR: 3, CI: 1.2–7.5, P=0.02), those who were rural residents (AOR: 2.6, CI: 1.0–6.6, P=0.042) and those with viral load >150 copies/mL (AOR: 3.4, CI: 1.36–8.3, P=0.009) were found to be significantly associated with anemia.ConclusionThe prevalence of anemia in this study was 11.4%. It was significantly associated with different factors such as age, residence and viral load. Therefore, regular follow-up management should be emphasized for HAART-experienced children. Hence, there is a need for a longitudinal study to be conducted further to explore the causes of anemia due to HIV and the pattern of hemoglobin changes with HAART- experienced children will be very important.

HIV Disclosure in Children in a Tertiary Hospital in Southern Nigeria–Child’s Perspective

Background: Disclosure of HIV status to children is essential for disease management. Studies on disclosure in children have largely described it from the health provider’s perspective or caregiver’s perspective. Caregivers’ and children’s reports about children’s feelings and distress can however differ. Understanding the disclosure process from the perspective of HIV-positive children will therefore better portray the impact it had on them.&#x0D; Aim: The aim of the study was to explore from the child’s perspective the process of disclosure, the impact it had on them, how they have coped and suggestions on how they think it could be done better.&#x0D; Methods: A cross-sectional study of HIV-infected children and adolescents aged 8–18 years who are aware of their status attending paediatric HIV clinic at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria from April 2015 to March 2016. Data were collected using an open-ended questionnaire administered by a Paediatric health care provider. Information sought included: Biodata (age, gender), educational levels of the child, family characteristics (primary caregiver, orphan status), age at disclosure, process of disclosure, the impact of the disclosure, how they have coped, what they did not like about the way they were told and suggested better ways of telling the children.&#x0D; Results: Seventy-eight HIV-positive children and adolescents were interviewed. Their ages ranged from 8 – 18 yrs with a mean age of 14.74±2.23 years. Forty (51.3%) were males, 50 (64.1%) were in secondary schools, 43 (55.1%) were orphans and the mode of transmission was vertical in 70 (89.7%). In majority 33 (42.3%), the biologic mother was the primary caregiver. Majority of the children 34 (43.6%) had their status disclosed to them between 13 and 14 years. The mother alone did the disclosure in 30 (38.5%). Thirty-six (46.2%) were already aware of their status before disclosure. Disclosure was a one-off event without discussions in 48 (61.5%). The commonest immediate reactions was depression 48 (61.5%). The majority 48(61.5%) became more prayerful as a coping strategy. All 78 (100%) agreed that disclosure has positively impacted on their taking their ARV drugs and clinic attendance.&#x0D; Concerning suggestions from the children, 36 (46.2%) said the most appropriate age for disclosure should be 12-13 years, 54 (69.2%) suggest that both parents should do the disclosure while 60 (76.9%) said that the children should be told how they got infected. Their major concern was having to take drugs for life 60 (76.9%).&#x0D; Conclusion: Disclosure process is suboptimal. Understanding the disclosure process from the perspective of HIV-infected children, therefore, is critical to developing interventions to improve disclosure. Most of the parent’s fears of negative impact of status disclosure may be exaggerated. There is need for health care providers to develop a plan with the caregivers of HIV-infected children on the optimal disclosure process and how to anticipate and resolve questions the children may have following disclosure.

Caregiver self-efficacy to talk about sex predicts conversations about HIV transmission risk with perinatally infected young people in Zimbabwe

ABSTRACT Given advances in care and treatment for HIV, perinatally infected young people are surviving into adolescence. These young people are making decisions about engaging in sexual relationships and it is critical to ensure they have the information they need to engage responsibly in sexual activity, particularly in an era where adherence to treatment could make their virus undetectable. The main objective of this analysis was to examine whether an HIV-positive young person’s knowledge about forward transmission is associated with caregiver self-efficacy to talk about sex and general caregiver communication. Using data from a 12-month prospective cohort of caregivers of HIV-positive children aged 9–15 on ART and pre-ART in rural Zimbabwe, we found that caregiver self-efficacy to talk about sex predicted whether conversations about HIV transmission would occur between caregiver and the young person. However, by the end of 12-months, nearly two-thirds of caregivers of HIV-positive teenagers in our sample had still not explained how their adolescents could spread the virus to others despite these caregivers saying their adolescent should know this information at baseline. We discuss the implications for designing sexual and reproductive health (SRH) programs among populations of young people perinatally infected with HIV to ensure that this breakthrough generation receives the SRH support they need.

Determinants of Anemia among HIV-Positive Children on Highly Active Antiretroviral Therapy Attending Hospitals of North Wollo Zone, Amhara Region, Ethiopia, 2019: A Case-Control Study

Introduction. Anemia is one of the most commonly observed hematological abnormalities and an independent poor prognostic marker of HIV disease. The rate of progression and mortality in this subgroup of patients is high compared to nonanemic patients. WHO estimates that over two billion people are anemic worldwide and young children bear the world's highest prevalence rate of anemia. In Ethiopia, there is limited information about the determinant factors associated with anemia among HIV positive children. Thus, this study aimed to determine the determinant factors of anemia among HIV-infected children on HAART. Objective The main purpose of this study was to assess the determinants of anemia among children on highly active antiretroviral therapy attending hospitals of North Wollo Zone, Amhara Region, Ethiopia. Methods A case-control study was conducted on 350 HIV-infected children on HAART attending Hospitals of North Wollo Zone, from February 1 to March 30, 2019. The study participants were selected with a consecutive sampling technique. An adapted, interviewer-administered, and pretested questionnaire and chart review were employed to collect the data. Besides, blood and stool samples were investigated to determine hematologic indices and malaria and to investigate intestinal parasites, respectively. Data were analyzed by using the SPSS version 24 statistical software and bivariate and multivariate logistic regression was used to identify predictors. Results A total of 350 HIV positive children (117 cases and 234 controls) were included in this study with an overall response rate of 100%. On multivariate analysis, variables which have spastically significant association with anemia were as follows: had amebiasis (AOR = 7.29, 1.22–43.56), had history of opportunistic infections (AOR = 9.63, 1.94–47.85), had malaria infection (malaria pf) (AOR = 4.37, 1.16–16.42), eating nondiversified food (AOR = 10.39, 2.25–48.0), WGT-Age Z score value between −2_−3 (AOR = 9.80, 2.46–39.14), level of adherence (AOR = 2.31, 1.92, 7.77), and being from a rural area (AOR = 8.8, 2.07–37.79). Conclusion In this study, having parasitic infections, having a history of opportunistic infections, being malnourished, having poor adherence to ART, caregivers living in the rural area, and eating nondiversified foods were significantly associated with hemoglobin status. Therefore, intervention aimed at prevention, early diagnosis, and treatment of anemia is essential in these patients.

Strain-level analysis of gut-resident pro-inflammatory viridans group Streptococci suppressed by long-term cotrimoxazole prophylaxis among HIV-positive children in Zimbabwe

ABSTRACT Antimicrobials have become a mainstay of healthcare in the past century due to their activity against pathogens. More recently, it has become clear that they can also affect health via their impact on the microbiota and inflammation. This may explain some of their clinical benefits despite global increases in antimicrobial resistance (AMR) and reduced antimicrobial effectiveness. We showed in a randomized controlled trial of stopping versus continuing cotrimoxazole prophylaxis among HIV-positive Zimbabwean children taking antiretroviral therapy (ART), that continuation of cotrimoxazole persistently suppressed gut-resident viridans group streptococcal species (VGS) that were associated with intestinal inflammation. In this addendum, we provide a broader overview of how antibiotics can shape the microbiota and use high read-depth whole metagenome sequencing data from our published study to investigate whether (i) the impact of cotrimoxazole on gut VGS and (ii) VGS associated inflammation, is attributable to strain-level variability. We focus on S. salivarius, the VGS species that was most prevalent in the cohort and for which there was sufficient genome coverage to differentiate strains. We demonstrate that suppression of S. salivarius by cotrimoxazole is not strain specific, nor did stool concentration of the pro-inflammatory mediator myeloperoxidase vary by S. salivarius strain. We also show that gut-resident S. salivarius strains present in this study population are distinct from common oral strains. This is the first analysis of how cotrimoxazole prophylaxis used according to international treatment guidelines for children living with HIV influences the gut microbiome at the strain-level. We also provide a detailed review of the literature on the mechanisms by which suppression of VGS may act synergistically with cotrimoxazole’s anti-inflammatory effects to reduce gut inflammation. A greater understanding of the sub-clinical effects of antibiotics offers new insights into their responsible clinical use.

Newly diagnosed HIV positive children: a unique index case to improve HIV diagnosis and linkage to care of parents

ABSTRACT Newly diagnosed HIV positive children may be unique index cases to identify undiagnosed parents. Data was used from the Pediatric Urgent Start of HAART (NCT02063880) trial, which enrolled hospitalized, ART-naïve, HIV positive children ages 0–12 years in Kenya. Exact McNemar’s tests were used to compare proportions of mothers and fathers tested for HIV, linked to care, and on ART at baseline and 6 months. This analysis included 87 newly diagnosed children with HIV who completed 6 months of follow-up. Among 83 children with living mothers, there were improvements in maternal linkage to care and treatment comparing baseline to 6 months (36% vs. 78%; p < 0.0001 and 22% vs. 52%; p < 0.0001). Among 80 children with living fathers, there were increases from baseline to 6 months in the number of fathers who knew the child’s HIV status (34% vs. 78%; p < 0.0001), fathers ever tested for HIV (43% vs. 65%; p < 0.0001), fathers ever tested HIV positive (21% vs. 43%; p < 0.0001), fathers ever linked to care (15% vs. 35%; p < 0.0001), and fathers ever initiated on ART (11% vs. 23%; p = 0.0039). Newly diagnosed HIV positive children can be important index cases to identify parents with undiagnosed HIV or poor engagement in care.

Utilization of Healthcare Resources by HIV-Positive Children in the United States: A National Perspective.

We characterized and estimated the cost of inpatient hospital utilization by US pediatric patients who tested positive for the human immunodeficiency virus (HIV). The 2012 Kids' Inpatient Database was analyzed to provide a descriptive assessment of national inpatient hospital utilization. We analyzed a stratified probability sampling of 3.2 million pediatric hospital discharges weighted to 6.7 million national discharges. Descriptive statistics for hospital and patient characteristics were identified and binary variables were analyzed using the Student t test. The Kids' Inpatient Database is the largest available all-payer pediatric (20 years old and younger) inpatient care database in the United States, yielding national estimates of hospital inpatient stays. Children aged 17 years and younger were included in the study and conditions related to pregnancy and delivery. We estimated that 1344 pediatric discharges were associated with an HIV diagnosis, totaling 10,704 inpatient days at a cost of $91 million. Among pediatric patients with HIV, 55% were African American, 20% were white, 15% were Asian/Pacific Islander, 8% were other races (including Hispanics and Native Americans), and 51% were female. Children who were HIV positive were more likely to have longer mean hospital stays, have higher mean hospital charges, be of a higher median age (8 years and older), have Medicaid insurance, come from lower-income families, be treated in urban teaching hospitals, and be more likely to die during hospitalization (P < 0.01 for all). Among non-HIV-related pediatric discharges, 20% occurred in households with a mean annual income >$63,000 compared with only 12% for children who were HIV positive. During hospitalization, at least one procedure was performed in 56.6% of children with HIV compared with 45.65% of hospitalized children without HIV. The most frequently observed diagnoses associated with children infected with HIV were gastrointestinal disorders, mental disorders, and bacterial infections and sepsis. The results suggest that pediatric patients who were HIV positive were significantly older, from lower-income areas, and members of minority groups. They underwent more procedures during hospitalization, incurred more than twice the total cost, stayed in the hospital twice as long, and had statistically higher in-hospital mortality than children who were HIV negative. As we continue to explore effective and judicious treatment options for patients who are HIV positive, our national estimates of resource utilization can be used to conduct a more detailed examination of current medical practices and specific patterns of diagnoses associated with HIV infection in the US pediatric population.

Oral Manifestations in HIV-Positive Children: A Systematic Review.

Background: The number of pediatric patients affected by HIV still remains high, mainly in developing countries, where the main cause of infection is vertical transmission from the mother. Even today, a large number of these children do not have access to treatment, and, without proper care, they die in the first few years of life. Objective: The aim of our review was to assess the prevalence of oral hard and soft tissue lesions in HIV-positive pediatric patients by identifying the most common manifestations and the overall impact that they may have on the children’s quality of life. Study design: A systematic review of the articles in the English language in PubMed and Scopus was conducted in March 2019 in order to identify the main epidemiological and cross-sectional studies on the topic. Results: Oral diseases are still one of the most common manifestations in HIV-positive pediatric patients, and they often represent the first form in which immunosuppression shows itself. An analysis of the literature shows that candidiasis is the most common oral lesion found in HIV-positive children. A significant incidence of gingivitis and gingival disease is also evident, though not strictly correlated to HIV infection. However, thanks to the introduction of new antiretroviral therapies, the incidence of HIV-related oral lesions is decreasing. Conclusions: An HIV-positive children care program should also include dental protocols, as oral disease negatively influences the quality of life, affecting both functional and social aspects.

HIV Disclosure in Children in This Millenium – Should It still be an Issue?

Background: As more children with HIV survive into adolescence and adulthood, one of the most difficult issues that families with HIV-infected children face is disclosure of their children’s status to them.&#x0D; Objective: To explore factors associated with disclosure or none disclosure and whether disclosure is beneficial or not.&#x0D; Methods: The mothers of HIV positive children who brought their children aged 5-18 years to the Paediatric Infectious Disease Clinic of the University of Port Harcourt Teaching Hospital from January to December 2015 were interviewed using a structured investigator administered questionnaire.&#x0D; Results: Of the 100 caregivers interviewed, 26.0% have disclosed the HIV status to the children. The mean age at disclosure was 14.42 ± 2.45 years. Care givers that have disclosed were significantly older (45.58±8.32 years vs 38.18±9.2 years; p = .0002). The mean age of children whose status have been disclosed was significantly higher than those who were yet to be aware of their status (14.42±2.45years vs 10.97±3.11 years; p = 0.00001). There was no significant difference in the mode of transmission and orphan status between the two groups. Disclosure was significantly more among children who were diagnosed between 5-10 years of age (14; 53.8%) (p=0.013), have taken antiretroviral drugs for over 24 months (22; 84.6%) (p= 0.003) and had at least one HIV-infected sibling (21; 80.8%) (p=0.00001). Among 13 (50.0%) whose status have been disclosed and 59 (79.7%) whose status had not been disclosed, the caregiver had disclosed the child’s status to others (p= 0.004). The major reason for disclosing was because the child was either asking questions on why he/she is taking drugs or he/she is refusing to take drugs (15; 57.7%) respectively. Only 6 (23.1%) caregivers disclosed because they felt the child has a right to know. Most difficult question asked by the children during disclosure was how they got the HIV (22; 84.6%). Reasons given for non-disclosure included fear of disclosure to others (74; 100%), child too young to understand (70; 94.5%) and fear of impact on child’s emotional health (42; 56.7%). Majority 20 (76.9%) of the care givers felt relieved after disclosure. Twenty-four (92.3%) caregivers felt disclosure had improved child’s adherence to antiretroviral therapy and determination to survive (22; 84.6%).&#x0D; Conclusion: Disclosure is beneficial to both the child and caregiver. Healthcare providers should encourage caregivers to disclose HIV status to their children as soon as possible.

Religion, Spirituality and Resilience of HIV Positive Children in Zimbabwe

HIV has widely affected many people including children and young people and has posed a threat to their lives. Various studies have, therefore, focused on bringing about interventions directed at improving the lives of people living with HIV. Religion and spirituality emerge as other factors enhancing the coping capacity of children living with HIV. The study aimed to explore the impact of religion and spirituality on the resilience of HIV positive children in Zimbabwe. The study was qualitative in nature and it targeted clients of a not for profit organizations (NPO) that provides psycho-social support to HIV positive children in Bulawayo, Zimbabwe. The study was informed by the resilience theory which explains the importance of the coping capacity of children in adverse situations. A sample of 24 HIV positive children and three caregivers participated in the study. Data were collected through in-depth interviews, focus group discussions and key informant interviews. The findings reflected that religion and spirituality are crucial in offering psychosocial support to HIV positive children. The key findings indicated that religion and spirituality help with emotional healing, acceptance of HIV status, conflict resolution and strengthens bonds promoting their resilience. However, it was shown that they also have negative impacts including involuntary disclosure, stigma and discrimination, poor adherence to medication and caused depression and anxiety. It was therefore recommended that there is need to create platforms for child participation, promote inclusion of children in religious organizations and sensitize religious leaders on HIV and its effects on the lives of children infected.

User-provider experiences of the implementation of KidzAlive-driven child-friendly spaces in KwaZulu-Natal, South Africa

BackgroundKidzAlive is a child-centred intervention aimed at improving the quality of HIV care for children in South Africa. Through this intervention, 10 child-friendly spaces were created in 10 primary healthcare centres (PHCs) in KwaZulu-Natal to enhance child-centred HIV care. However, the user-provider experiences of these child-friendly spaces in these facilities have not been explored. This paper addresses this gap.MethodsWe conducted qualitative interviews with children (n = 30), their primary caregivers (PCGs) (n = 30), and KidzAlive trained healthcare workers (HCWs) (n = 20) using and providing child-friendly spaces, respectively. Data were generated, using a semi-structured interview guide printed in both English and IsiZulu. The interviews were audio-recorded transcribed and translated to English by a research team member competent in both languages. Data were imported to NVivo 10 for thematic analysis. The COREQ checklist was used to ensure that the study adheres to quality standards for reporting qualitative research.ResultsChild-friendly spaces contributed to the centredness of care for children in PHCs. This was evidenced by the increased involvement and participation of children, increased PCGs’ participation in the care of their children and a positive transformation of the PHC to a therapeutic environment for children. Several barriers impeding the success of child-friendly spaces were reported including space challenges; clashing health facility priorities; inadequate management support; inadequate training on how to maximise the child-friendly spaces and lastly the inappropriateness of existing child-friendly spaces for much older children.ConclusionChild-friendly spaces promote HIV positive children’s right to participation and agency in accessing care. However, more rigorous quantitative evaluation is required to determine their impact on children’s HIV-related health outcomes.

Determination rate of the Staphylococcus spp. and Candida spp. on skin of children living with HIV infection

On 01.07.2019, more than 1, 000 children were diagnosed with HIV infection in the Sverdlovsk region. Studies on the prevalence of dermatoses in HIV-positive children indicate a high incidence of viral, fungal and bacterial infections of the skin, compared with HIV-negative children. The skin is the environment in which a diverse community of microorganisms (microbiota) lives. The Global Human Microbiome Project proved the uniqueness of the human microbiome, and suggests to study the effect of human immunity on the formation of microbiome diversity models. The purpose of this study was to assess the incidence of S. aureus, S. spp., C. albicans, C. glabrata, C. krusei, C. tropicalis / C. parapsilosis as a part of skin microbiota in HIV-positive children by polymerase chain reaction.

Dental caries status of children receiving Highly active antiretroviral therapy (HAART) - A multicentric cross-sectional study in Tamil Nadu, India.

Background:Highly active antiretroviral therapy (HAART) has progressively improved the life expectancies in HIV positive children. These antiretroviral drugs could possibly have an influence on the oral health status. Different age groups of children under HAART with caries had implications in approach to dental treatment, which were attempted to be identified in the study.Aims/Objectives:The aim of the study was to assess the caries status among HIV positive children receiving HAART. To characterize the age group with high caries indices and treatment needs.Methods:A cross-sectional study was conducted among 313 HIV infected children aged 3–14 years receiving HAART from various ART centers Tamil Nadu, India. Dental examinations were performed and caries status of primary and permanent dentition was assessed using Decayed, Missing, and Filled teeth (DMFT)/Decayed, Missing, and Filled surface (DMFS) indices.Statistical Analysis:The one way ANOVA with post-hoc Tukey HSD test.Results:The mean deft/DMFT scores were 3.15 ± 2.72/2.07 ± 1.31 and defs/DMFS scores were 7.42 ± 5.90/4.30 ± 2.58. The caries incidence was significantly different across the three age groups compared. DMFT scores of 13 − 14 years age group were significantly higher than in the 3−6 years (P < 0.0000) and 7−12 years (P < 0.0001).Conclusion:A higher caries experience was present among children on HAART as compared to the general population in Tamil Nadu. A significant association with increasing age and DMFT scores was noted. Age groups of 13−14 had high caries prevalence than age groups of 3−6 and 7−12 years in given study population. The individualized treatment approaches based on the age groups is suggested.

Hearing Disorders among HIV Positive Children at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Background: Use of antiretroviral drugs (ART) has changed the epidemiology of HIV disease, making it a chronic illness and with many people developing long term sequelae of the disease such as hearing loss. This study compared hearing disorders, its types and severity among children with and without HIV disease.&#x0D; Methods: This was a hospital based comparative cross-sectional study carried out among eligible patients who were HIV positive, aged 6 to 15 years recruited via systematic sampling method and matched by age and sex with HIV negative controls. An interviewer-administered questionnaire was used to extract the sociodemographic characteristics of the subjects, patients/caregivers awareness of hearing impairment and to document the otoscopic, Pure tone audiometry (PTA) and tympanometry findings performed on the patients. CD4 count was done for all the study participants while all HIV positive patients were graded for severity using WHO clinical Staging. Obtained data was analysed using the statistical package for social sciences (SPSS) version 22. A p-value of less than 0.05 was considered statistically significant.&#x0D; Results: A total of 400 children aged 6 years to 15 years were recruited for the study out of which 200 were HIV positive (cases), while 200 were HIV negative (controls). Otitis media with effusion, otitis media and perforated tympanic membrane were the predominant tympanometry and otoscopic findings. Seventy-three (36.5%) of the HIV positive patients had hearing loss compared to 19(9.5%) of HIV negative patients and this was statistically significant (X2 = 41.1; p = 0.0001). Majority (95.9%) of persons with hearing loss had the conductive type and of mild degree 53 (72.6%). Only 3(4.1%) caregivers of the HIV positive children and 1 (5.6%) caregiver of the HIV negative children were aware of the hearing impairment in their children but none had complained to their primary health caregivers.&#x0D; Conclusion: This study has established a higher rate of hearing loss, of the conductive type and of mild degree among HIV positive patient. It is necessary to assess and monitor the hearing in HIV positive children by conducting interval PTA testing and Tympanometry to ensure timely intervention since parental awareness is poor.

Proteinuria in HIV Positive Children in Port Harcourt, Nigeria

Proteinuria in HIV Positive Children in Port Harcourt, Nigeria

Determinants of survival of HIV-infected children aged 6 months to 15 years on follow-up in the town of Ebolowa, Cameroon from 2008 to 2018

Introductionla survie des enfants infectés par le VIH demeure un défi dans les pays en voie de développement. Au Cameroun, la mortalité liée au VIH chez les enfants de moins de 15 ans en 2018 était de 20%. Paradoxalement, la région du Sud Cameroun, malgré une séroprévalence élevée chez les enfants de 4,1% et une couverture en traitement antirétroviral faible de l´ordre de 64%, ne fait pas partie des régions du Cameroun les plus touchées par la mortalité pédiatrique liée au VIH/SIDA. L´objectif de ce travail était de déterminer le taux de survie et identifier ses déterminants chez les enfants âgés de 6 mois à 15 ans, infectés par le VIH.Méthodesune étude de cohorte à collecte de données rétrospective et prospective a été menée de janvier 2008 à décembre 2018 dans trois formations sanitaires prenant en charge les enfants VIH positifs, à Ebolowa dans la région du Sud Cameroun. L´étude s´est faite en deux temps, une phase de collecte rétrospective pour la sélection des dossiers médicaux des enfants VIH positifs répondant aux critères d´inclusion dans les registres de consultation, et une phase de collecte prospective qui nous a permis d´avoir auprès des parents, les informations sur le devenir des enfants. Un consentement éclairé parental a été obtenu au cours de cette deuxième phase. Les données sociodémographiques, cliniques, paracliniques, thérapeutiques, ainsi que le devenir des enfants ont été collectées. Les temps moyens de survie, ainsi que les facteurs associés à la survie ont été déterminés à l´aide du modèle de Kaplan Meier. La régression à risque proportionnel de Cox, nous a permis d´identifier les déterminants de la survie. Notre critère de jugement était le décès. Le niveau de significativité a été fixé à 5%.Résultatsau total, 186 enfants ont été enrôlés. La durée médiane de suivi était de 18,5 mois. Le taux de survie était de 66,7%. La majorité des décès (67%) est survenue avant le sixième mois de suivi. Après analyse multivariée, l´âge inférieur à 2 ans [aHR: 18,6 (6,48-53,59); p=0,001], l´anémie sévère [aHR: 7,69 (1,02-57,9); p=0,04], et la présence d´infections opportunistes [aHR: 4,52 (2,51-8,14); p=0,05] étaient indépendamment et significativement associés à la survie.Conclusionen plus du traitement antirétroviral précoce, un bon suivi clinique et paraclinique est nécessaire pour améliorer la survie des enfants infectés par le VIH.

Electrocardiographic findings in human immunodeficiency virus-infected children in Benin City, Nigeria.

Human immunodeficiency virus (HIV) infection is a global pandemic affecting mostly sub-Saharan Africa. It is a multisystem disease. Cardiovascular involvement detected by electrocardiogram (ECG) has been described mostly in adult populations with few studies on children. In this study, the ECG findings of HIV-infected as against HIV-uninfected children were evaluated. This comparative cross-sectional study was conducted in two public hospitals in Benin City. Using convenience sampling, 200 each of HIV-positive children attending the HIV clinics of both hospitals and age- and sex-matched HIV-negative children attending follow-up clinics in the same hospitals were recruited. Biodata/sociodemographic information was obtained, while each participant underwent 12-channel ECG evaluation. The prevalence of abnormal ECG findings in HIV-positive children was 34.5% compared to 4.5% in HIV-negative children (P < 0.0001). The mean PR, QRS and QT intervals in the participants were 0.13 ± 0.02 s, 0.11 ± 0.15 s and 0.41 ± 0.03, respectively. They were statistically significantly longer than controls, 0.12 ± 0.02 s, 0.08 ± 0.09 s and 0.40 ± 0.02 s, respectively, P < 0.05, in each case. The prevalence of prolonged PR, QRS and QTc was significantly higher in the patients, 5%, 3.5% and 3.5%, respectively, than controls, 05, 0% and 0%, respectively (P < 0.05 in each case). A third of the HIV-infected children in the study had abnormal ECG changes. It is recommended that ECG be included in their routine management of HIV-positive children so as to better supervise the affected children, retard the deterioration and improve their quality of health.