HIV-positive Pediatric Patients Research Articles

Clinical Non-Adherence and Its Associated Factors Among HIV-Positive Pediatric Patients Attending HIV Care in South Gondar Zone Public Health Facilities, Northwest Ethiopia, 2021.

BackgroundPoor clinical adherence is the main factor that hinders ART adherence level in children and its ultimate effect on viral load suppression and decreasing morbidity and mortality of children. Although data from different settings are necessary to tackle such types of problems, the pieces of evidence are limited in the case of clinical adherence level. Therefore, this study was intended to assess clinical non-adherence and its associated factors among HIV-infected pediatrics on highly active antiretroviral therapy.MethodsA multi-center cross-sectional study was conducted from July 1 to August 30, 2021, among HIV-infected children receiving ART in the South Gondar Zone. Data were collected through face-to-face interviews, and reviewing patients’ documents using a structured checklist. Data were entered into Epi-data version 4.6 and exported to the Statistical Package for Social Science version 23 for analysis. Binary logistic regression was used to assess the association between the factors and the outcome variable. The significance of variables was declared when a p-value was less than 0.05.ResultsFrom 422 participants, 383 have involved in the study making the response rate of 90.7%. Almost half of the study participants 190 (49.6%) were girls. Two hundred ninety-one (76%) of caretakers were biological mothers, and 203 (53%) did not have adherence supporters. About 179 (46.7%) of caretakers did not disclose the status of the child about the illness. The overall prevalence of non-adherence among children on ART was 31.9% (95% CI: 27.2–36.6). Rural residency, diagnostic status non-disclosure, no adherence supporter, having no biological caretaker and co-morbid illness were significantly associated with clinical non-adherence of HIV positive children.ConclusionClinical non-adherence among children among HIV-positive children attending care in south Gondar zone health facilities is unacceptably high. Attention shall be given to HIV-positive pediatrics who reside in rural areas, whose status was not disclosed, had no adherence supporter, had a non-biological caretaker, and had comorbidity to have good clinical adherence on ART service.

Metabolic Changes in Pediatric HIV-Positive Patients and Potential Lifestyle Interventional Strategies.

Metabolic changes in the HIV population have been well-studied, particularly after the advent of antiretroviral therapy. More notably, the emergence of the metabolic syndrome within the HIV population, due to prolonged survival, has led to an increasing rate of cardiovascular occurrence and mortality within the population in adult life. Importance of early intervention in HIV children, particularly lifestyle modifications, is necessary to reduce cardiovascular disease (CVD) risk and mortality in adulthood. Potential clinical interventions include routine anthropometric measurements as a measure of CVD risk, a low saturated fat and high fiber diet, and vigorous aerobic exercise have been shown to decrease CVD risk in the HIV population. The literature review found multiple knowledge gaps due to minimal studies completed on the HIV population and even less on HIV-positive children. Overall, a standardized protocol was required to better care for HIV-positive children and potential future CVD mortality.

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.

Pattern of Otorhinolaryngological Disorders in HIV Positive Paediatric Patients at the University of Port Harcourt Teaching Hospital (UPTH)

Background: HIV is a worldwide disease and affects all systems of the body. Despite the high burden of Paediatric HIV in Nigeria, few studies have been done on Otolaryngological disorders in children living with HIV. This study aimed to determine the pattern and prevalence of Otorhinolaryngological disorders among HIV positive paediatric patients and to compare them with age and sex-matched control.
 Methods: This was a descriptive cross-sectional case-control study carried out among 130 HIV positive and 130 HIV negative children aged 6 to 15 years at the University of Port Harcourt Teaching Hospital (UPTH). Eligible patients were recruited via a systematic sampling method and matched with HIV negative controls and an interviewer-administered questionnaire was used to extract relevant information. All patients had Otorhinolaryngological examination and CD4 count determination, while children with tonsillar enlargement underwent X-ray of the post nasal space. HIV patients were graded for severity using WHO clinical Staging.
 Results: A higher proportion of the HIV positive patients had allergic rhinitis (66.9% vs.30.8%, p=0.01), pharyngitis (40.8% vs.18.5%, p=0.01), tonsillitis (34.6% vs.20.8%, p=0.013), adenotonsilar disease (24.6% vs. 13.8%, p=0.028), cervical lymphadenopathy (15.4% vs. 5.4%, p=0.001) and otitis media (5.4% vs. 0.8%, p=0.031). There was a significantly higher prevalence of ORL disorders among HIV positive children (95.4%) compared to HIV negative children (78.5%). (P=0.001).
 Conclusion: Pattern of ORL disorder appeared similar in both HIV-positive and -negative children. However, the overall high prevalence of the findings among the HIV-positive children required regular ORL assessment in these children.

2523. Optimizing Disclosure of HIV Status to a Diverse Population of HIV-Positive Pediatric Patients at an Urban HIV Clinic in the Southeastern United States

BackgroundDevelopmentally-appropriate disclosure of human immunodeficiency virus (HIV) status to children living with HIV (CLWH) is essential to achieve optimal health outcomes, but stigma and fear result in delaying disclosure into adolescence. The American Academy of Pediatrics recommends disclosure of HIV status to school-age children. The objective of this quality improvement (QI) project was to increase the proportion of CLWH > 10 years of age who are disclosed about their HIV status from 57% to 80% by 18 months.MethodsThe Institute for Healthcare Improvement’s Model for Improvement was utilized for this QI project. This model accelerates quality improvement by implementing Plan-Do-Study-Act (PDSA) cycles to determine whether changes lead to improvement. The target population included CLWH followed at an urban pediatric HIV clinic. The primary outcome measure was the proportion of children > 10 years of age who are disclosed about their HIV status. PDSA cycles included monthly clinic check-ins to discuss new disclosures, quarterly team meetings to discuss implementation of new changes to improve disclosure and modifying a note template to prompt providers to document disclosure status and plan for undisclosed patients. Our process measure was the proportion of undisclosed children who have a documented disclosure status/plan. Annotated run charts were used to track the data.ResultsPrior to our first PDSA cycle, 57% of CLWH > 10 years of age were disclosed to about their HIV status, and none of the undisclosed children had a disclosure status/plan documented in their medical record. The proportion of CLWH disclosed to about their HIV status increased to 66% since meeting with the team regularly to discuss disclosure status (figure). Four months after introduction of the modified note template, the proportion of CLWH with documentation of their disclosure status and plan increased to 54%.ConclusionTeam awareness of the importance of disclosure and a modified clinic note template were associated with increases in the proportion of CLWH with age-appropriate HIV disclosure and documentation of disclosure status. Future interventions will include adapting methods of step-wise disclosure which have been proven effective in other settings. Disclosures All authors: No reported disclosures.

Virologic Failure in Different Antiretroviral Regimens Among Pediatric Patients with HIV Referring to a Voluntary Counseling and Testing (VCT) Center in Tehran, Iran (2004 - 2017)

Objectives: This study aimed to evaluate the virologic failure rate of treatment for various types of antiretroviral treatment (ART) regimens in pediatric patients with HIV. Methods: The present study was conducted among 75 HIV-positive pediatric patients characterized by the presence of a viral load of 200 or more copies per mL after six months of effective, continuous ART regimen. Therefore, treatment failure was defined based on virologic failure. We designed a questionnaire that included patients’ demographic characteristics, viral load markers, TCD4+ count, antiretroviral regimen received, and the probable treatment failure, along with the results of the drug resistance tests. Results: In total, 22 (29.2%) children experienced treatment failure. The most common primary antiretroviral regimen was Zidovudine (AZT)/Lamivudine (3TC)/Nevirapine (NVP) (59.2%), followed by AZT/3TC/Efavirenz (EFV) (29.6%). The highest rate of virologic failure was related to the AZT/3TC/NVP regimen (68.2%). In children who used NVP, the virologic failure was significantly higher than in children on other regimens (P = 0.02). Conclusions: The present study showed that patients receiving ART regimens based on reverse transcriptase non-nucleoside inhibitors, especially NVP, experienced more treatment failure than patients receiving other regimens.

Sociodemographic characteristics of pediatric human immunodeficiency virus-positive patients in Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria

Introduction: Approximately 2.5 million children below 15 years are infected with the human immunodeficiency virus (HIV), with 90% in sub-Saharan Africa. The Federal Teaching Hospital Abakaliki has been a treatment center for HIV since 2006. Objective: The aim of this study was to analyze the sociodemographic and anthropometric characteristics of pediatric HIV-positive patients seen at this facility. Methods: This was a cross-sectional and descriptive study carried out from January to July 2014 of all HIV-positive children aged 0–18 years. The sociodemographic and anthropometric indices were obtained from the patients and/or their accompanying caregiver. Results: There were 89 children (mean age 7.12 ± 4.10 years; range 2–16 years), of which, 54 (60.7%) were male and 35 (39.3%) were female, with a male:female ratio of 1.5:1. Fifty-two children (58.4%) belonged to the lower socioeconomic class by Olusanya, of which, 25 (28.1%) orphans, 15 (16.9%) had stopped schooling whereas 66 (74.2%) were fully immunized according to National Programme on Immunization schedule. Maternal HIV-status was positive in 87 (97.8%) of the children whereas 33 (37.1%) of their fathers were HIV-positive. Paternal HIV-status was unknown in 32 (36.0%). Orphans were more likely to drop out of school. Conclusion: Most children with HIV are from parents of low socioeconomic status while a good number have been orphaned by acquired immunodeficiency syndrome. Vertical transmission was the means of acquiring the infection in most cases. Reinforcement of services for prevention of mother-to-child transmission of HIV is therefore recommended.

Methicillin Resistant Staphylococcus aureus among HIV Infected Pediatric Patients in Northwest Ethiopia: Carriage Rates and Antibiotic Co-Resistance Profiles.

BackgroundMRSA infections are becoming more prevalent throughout the HIV community. MRSA infections are a challenge to both physicians and patients due to limited choice of therapeutic options and increased cost of care.ObjectivesThis study was aimed to determine the prevalence of colonization and co-resistance patterns of MRSA species among HIV positive pediatric patients in the Amhara National Regional State, Northwest Ethiopia.MethodsCulture swabs were collected from the anterior nares, the skin and the perineum of 400 participants. In vitro antimicrobial susceptibility testing was done on Muller Hinton Agar by the Kirby-Bauer disk diffusion method, using 30 μg cefoxitin (OXOID, ENGLAND) according to the recommendations of the Clinical and Laboratory Standards Institute. Methicillin sensitivity/resistance was tested using cefoxitin. Data was analyzed by descriptive statistics and logistic regression model using Epi Info 7.Results S. aureus was detected in 206 participants (51.5%). The prevalence of MRSA colonization in this study was 16.8%. Colonization by S. aureus was associated with male gender (OR = 0.5869; 95% CI: 0.3812–0.9036; p-value = 0.0155), history of antibiotic use over the previous 3 months (OR = 2.3126; 95% CI: 1.0707–4.9948; p-value = 0.0329) and having CD4 T-cell counts of more than 350 x 106 cells / L (OR = 0.5739; 95% CI = 0.3343–0.9851; p-value = 0.0440). Colonization by MRSA was not associated with any one of the variables. Concomitant resistance of the MRSA to clindamycin, chloramphenicol, co-trimoxazole, ceftriaxone, erythromycin and tetracycline was 7.6%, 6%, 5.25%, 20.9%, 23.9% and 72.1%, respectively.ConclusionHigh rates of colonization by pathogenic MRSA strains is observed among HIV positive pediatric patients in the Amhara National Regional state.

Efavirenz as a cause of ataxia in children.

Acute ataxia in childhood is often caused by toxin ingestion. With the increasing number of paediatric patients on antiretroviral medication, we observe more side-effects of these drugs. Acute ataxia is defined as unsteadiness of walking or fine motor movement of <72 hours. The most common causes are postinfectious acute cerebellar ataxia, toxin ingestion and Guillain-Barré syndrome. However, the possibility of a mass lesion must always be excluded. Reported neurological abnormalities in HIV-positive children range from 10% to 68%. A South African study found the prevalence of neurological complications to be 59%, the most common of which were HIV encephalopathy and long-tract motor signs; however, no cases of cerebellar dysfunction were documented. Ataxia rarely occurs in an HIV-positive person, the chronic sequelae being neurocognitive impairment and polyneuropathy. Ataxia in the setting of HIV is generally secondary to an infectious, vascular or neoplastic cerebellar lesion. However, most infections are opportunistic and unlikely to occur when CD4 levels are adequate. The vascular or mass lesions are readily excluded with neuro-imaging. We report 2 cases of efavirenz toxicity that caused ataxia. We treated 2 children who presented in a 1-month period, which highlighted an important differential to consider in HIV-positive paediatric patients presenting with ataxia.

HIV Morbidity and Mortality in the Pediatric Population of Côte d’Ivoire

Introduction: The aim of our study was to describe the morbidity and mortality patterns in HIV-positive pediatric patients followed at the unit in charge of Pediatric HIV, in the pediatrics department of Cocody University Teaching Hospital (CHU-Cocody). Method: This hospital-based retrospective study focused on 218 pediatric patients enrolled at the CHU-Cocody from November 28th 2005 until June 30th 2010. Outcomes of children with anti-retroviral therapy (group A) and children without (Group B) anti-retroviral therapy were described and compared. Antiretroviral Therapy (ART) - eligibility followed national guidelines thus withholding treatment for immune-competent children or those with contraindications to ARTs such as increased transaminases (>10x) or vital distress. Results: The average age of children in group A, was 66.11 months, they were symptomatic in 84.74% of cases, and presented with severe immunodeficiency in 54.74%. The children in group B were younger (mean age=49.14 months), mostly only mildly symptomatic (39.80%) and thus usually without severe immunodeficiency (64.29%). Nearly all children were infected with HIV-1 and receiving cotrimoxazole prophylaxis. There were 764 disease events that occurred during follow-up including 633 in group A and 131 in group B. Anemia (p=0.036) and pneumonia (p=0.011) were more frequent in group A. Hospitalizations were more common in group A children (124/190) than group B children (10/28, p=0.0027). In Group B, the mortality rate was very high (75%) (OR=16, 95% CI [5.79-45.90.], P<0.001) and concerned predominantly children under the age of 24 months (OR=0.08, 95% CI [0.01-0.47.], p=0.0017) and earlier (OR=0.21, 95% CI [0.03-1.25.], P=0.047). Conclusion: Much remains to be done in countries with limited resources to improve pediatric HIV- treatment and survival, especially among the very young, which are weakened by childhood diseases. The implementation of WHO recommendations by the government must become a priority, this in order to improve the survival of affected children.

Long-Term Persistence of Hepatitis A Antibodies in Pediatric HIV-Infected Patients after Primary Immunization: Association with Immunological Profile and Response to Revaccination

Background: We analyzed the persistence of hepatitis A virus (HAV) antibodies 7 years after primary immunization in pediatric HIV-positive patients and its association with the immunological profile. Methods: 29 vertically HIV-infected adolescents (median age, 12.9 years) were enrolled. All of them had been HAV-vaccinated with two HAV vaccine doses 7 years before and all had seroconverted. HAV antibodies were measured by electrochemiluminescence. Lymphocyte immunophenotyping was performed by flow cytometry. Adolescents who lost HAV antibodies were revaccinated. Results: 23/29 patients (79.3%) persisted HAV seropositive (HAV antibodies≥20mlU/mL) 7 years after primary immunization. Age, gender, clinical progression of HIV infection, median viral load, and antiretroviral therapy were similar between those who persisted HAV seropositive and those who lost seropositivity. HIV adolescents who lost HAV antibodies had lower median CD4+ T cells/mm3 (200 vs. 634, p=0.004), lower median B cells/mm3 (103 vs. 335, p<0.001), lower median NK cells/mm3 (67 vs. 209, p=0.002), lower median percentage of naive CD4+ T cells (20% vs. 30%, p=0.026), lower median percentage of naive B cells (52% vs. 68%, p=0.009), higher median percentage of activated memory B cells (19% vs. 7%, p=0.004), higher median percentage of activated CD8+ T cells (51% vs. 22%, p=0.002), and higher median percentage of exhausted memory B cells (23% vs. 8%, p=0.031) than HAV-positive adolescents. 83.3% adolescents responded to revaccination. Conclusion: Persistence of HAV antibodies occurred in 79.3% of patients. Both antibody maintenance and response to revaccination are closely associated with low immune activation and adequate CD4+ T and B cell levels.

Characteristics of Hepatitis B Co-infection and Disease Evolution in HIV-Positive Paediatric Patients in Romania.

Infection with hepatitis B virus (HBV) contributes to morbidity and mortality in people living with human immunodeficiency virus (HIV). The aim of the present study is to assess the influence of HBV co-infection in clinical characteristics and disease evolution among nosocomial HIV infected youth in Romania. Retrospective study. We assessed HBsAg in 179 young people with nosocomial paediatric HIV infection. Demographic data, ALAT level, CD4-count, HIV-RNA, antiretroviral therapy and clinical behaviour were all statistically compared in patients who were HIV mono-infected and HBV-co-infected. THE CHARACTERISTICS OF PATIENTS ARE AS FOLLOWS: sex ratio M/F: 55.3%, AIDS category 88%, median nadir CD4-count 126/mm(3). The prevalence of persistent HBsAg was 44.6%. The mortality rate was 11.1%, but no correlation with HBsAg was found. An average of three antiretroviral combinations is experienced by 97.7% of patients, including Lamivudine for over 5 years in 76% of cases and Tenofovir/Emtricitabine in 16.75% of patients. Patients under antiretroviral therapy achieved 53.07% sustained undetectable HIV-RNA and 40.78% restored immunity CD4-count >500/mm(3). ALAT enzyme was found to be high in 54.75% of patients. During our research, we noticed that HBsAg was elevated in young people with HIV in Romania. Mortality rate was not statistically correlated to HBsAg. High ALAT levels are related with HBV, HDV co-infections, virological failure to antiretroviral treatment and the risk of death.

Food Insecurity, CD4 Counts, and Incomplete Viral Suppression Among HIV+ Patients from Texas Children’s Hospital: A Pilot Study

Determine the relationship between food insecurity and CD4 counts and viral suppression among pediatric HIV-positive patients. Food insecurity was assessed by validated survey. CD4 counts and viral load were abstracted from patients' charts. We used linear regression for the dependent variable of the natural log of CD4 counts and logistic regression for viral suppression, with backward deletion of covariates with p > 0.1. Food insecurity (β = -0.23, 95 % CI [-0.40, -0.01]) was associated with lower CD4 counts and higher odds of incomplete viral suppression (OR = 4.07, 95 % CI [1.02, 13.92]). Food insecurity may adversely impact pediatric HIV outcomes.

The prevalence of hearing impairment in the 6 months – 5 years HIV/AIDS-positive patients attending paediatric infectious disease clinic at Mulago Hospital

IntroductionHearing impairment is one form of disability in children living with HIV/AIDS. It greatly interferes with their language development, communication and performance. These are stressful to the children and their caretakers. With increasing availability of free anti-retroviral therapy, children with HIV/AIDS are living much longer. Therefore efforts must be made to reduce the disability resulting from hearing impairment among children living with HIV. ObjectiveThe objective of this study was to determine the prevalence, types and severity of hearing loss in HIV positive pediatric patients between 6 months and 5 years of age attending PIDC, Mulago Hospital Uganda. MethodsThis was a descriptive cross sectional study among 370 HIV/AIDS pediatric patients between 6 months and 5 years of age at PIDC Mulago. In this study, hearing impairment was defined as any auditory brainstem response (ABR) average threshold of over 25 dBnHL at frequencies of 500Hz to 4000Hz. This was done using a VIVOSONIC VIVOLINK ABR machine and a tympanogram was acquired from each ear. Systematic random sampling was carried out to reach individual participants. Proportions were used to estimate prevalence of hearing impairment in this age group. ResultsA total of 370 participants were recruited, with mean age of 38 months and median age of 36 months. The ratio of male to female was 1:1. The majority 172/370 (46.5%) of the participants were of WHO stage III. The prevalence of hearing loss in the 6 months to 5 years HIV/AIDS positive patients was found to be 121/370 (33.0%). The majority 77/121 (64.0%) of the participants had sensorineural hearing loss (SNHL). Of these with SNHL 44% had mild (26–40 dBHL) hearing loss. ConclusionsThe prevalence of hearing among pediatric HIV/AIDS patients between the 6 months and 5 years was found to be high with sensorineural hearing loss being the most prevalent. Therefore HIV/AIDS paediatric patients should have routine screening for hearing impairment. A prospective cohort study should be designed to assess the risk of acquisition of hearing loss in children living with HIV.

Socio-demographic Characteristics of a Cohort of HIV Positive Nigerian Children

Objetivo: Descrever as caracteristicas socio-demograficas e identificar fatores de risco em pacientes pediatricos HIV positivos atendidos no Hospital de Ensino da Universidade de Lagos, Nigeria. Metodos: Estudo transversal no qual foi aplicado um questionario para avaliar as caracteristicas socio-demograficas de pacientes infantis HIV durante um periodo de 12 meses. Os dados foram analisados com o software Epi-Info 2002. Resultados: A maioria dos pais tinha abaixo do nivel terciario de educacao (maes, 72,7% e pais, 69,1%). Setenta por cento das maes HIV positiva, assim, a transmissao vertical parece ser o fator de risco mais prevalente. A maioria das criancas (68,1%) nasceu em hospitais privados e 78,2% oriundas de parto normal. Historias de hospitalizacoes anteriores foram relatadas em 58,2% com a transfusao de sangue previa em 30,9%. Mais de um terco das criancas (40,0%) pesava entre 2,5 e 2,9 kg ao nascimento. Conclusao: O nivel de alfabetizacao, baixo nivel socioeconomico e status de HIV familiar foram os principais fatores que contribuiram entre as criancas estudadas. Intervencoes orientadas sobre as barreiras a assistencia e conhecimento da infeccao pelo HIV deve ser uma parte integrante do programa de prevencao do HIV.

Estimated use of abacavir among adults and children enrolled in public sector antiretroviral therapy programmes in Gauteng, South Africa

In South Africa, abacavir (ABC) is currently recommended as part of first- and second-line antiretroviral therapy (ART) for HIV-positive paediatric patients. Concerns about overprescribing of the drug, particularly to adults, led to an analysis of ABC use in public sector ART programmes. We investigated current prescription of the drug to adults and children accessing ART in 4 public sector programmes across Gauteng Province, South Africa. ABC was almost exclusively prescribed to children initiating ART and adults requiring regimen changes due to drug toxicities. Patterns of ABC use among HIV-positive paediatric patients followed national ART treatment guidelines on the application of the drug. Although ABC is commonly used in the private sector for adults, the current national ART treatment guidelines for adults and adolescents should include ABC as an alternative to standard first- or second-line ART.

Confirmation of HIV-like sequences in respiratory tract bacteria of Cambodian and Kenyan HIV-positive pediatric patients

SummaryBackgroundBacteria and yeasts isolated from respiratory tracts of 39 Cambodian and 28 Kenyan HIV-positive children were tested for the presence of HIV-1 sequences.Material/MethodsBacteria and yeasts from the respiratory tract (nose, pharyngeal swabs) were isolated from 39 Cambodian and 28 Kenyan HIV-positive children. Bacterial chromosomal DNA was prepared by standard protocol and by Qiagen kit. The PCR specific for HIV sequences was carried out using HIV-1-specific primers. The analysis was performed by colony and dot-blot hybridization using HIV-1-specific primers which represent gag, pol and env genes of the virus. The sequencing of some PCR products was performed on the ABI 373 DNA Sequencer.ResultsThe majority of microbes were characterized as Staphylococcus aureus, Klebsiella pneumoniae, and resp. Candida albicans. In some cases E. coli, Streptococcus pyogenes, Proteus mirabilis and Candida tropicalis were identified. Bacteria of 16 Cambodian (41%) and 8 Kenyan (31%) children were found to be positive in colony and dot-blot DNA hybridization. By the sequencing of PCR products synthesized on the template of patients’ bacterial DNA using primers 68;69 for env HIV-1 gene, homology of greater than 90% with HIV-1 isolate HXB2 (HIVHXB2CG) was revealed.ConclusionsBacteria and yeasts from the respiratory tract of 41% of Cambodian and 31% of Kenyan HIV-positive children bear HIV-like sequences. The role of bacteria in the HIV disease process is discussed.

Tools for early detection of risk for developing insulin resistance

Insulin resistance (IR) is becoming of increasing concern in pediatric populations, and HIV positive pediatric patients may be at an increased risk for developing IR. We developed novel, multifactorial tools, the GlucIndex (GI), LipidIndex (LI), and Cumulative Indices Assessment (CIA), which incorporate the fasting glucose to insulin ratio (FGIR), quantitative insulin sensitivity check index (QUICKI), computer version of the homeostasis model assessment (HOMA2‐IR), insulin sensitivity index (ISI), and triglyceride to high‐density lipoprotein ratio (TG/HDL). High risk and low risk for developing IR according to each index is indicated by a + or −, respectively. These novel tools were used to assess 46 HIV positive pediatric patients’ risk for developing IR at Shands Hospital in Gainesville, FL. The table indicates risk based on each index. Notably, no patient had impaired fasting glucose values during the study. These tools may be beneficial for detecting risk for developing IR before glucose values become impaired. Index Percent of Patients GI−,LI− (no detectable risk) 61% GI+,LI− (risk for glucose intolerance) 17% GI−,LI+ (risk for dyslipidemia) 13% GI+,LI+ (risk for glucose intolerance and dyslipidemia) 9%

An assessment of adverse effects of antiretroviral therapy on the development of HIV positive children by observation of dental mineralization chronology

The difference between dental age (DA) and chronological age (CA) indicates an advance or delay in comparison with the normal standard. Considering that DA has a very close correlation with CA in a developing child, this study aimed to investigate the relationship between the effects of antiretroviral therapy on the development of HIV positive children, by observing the timing of dental mineralization. A retrospective examination was made of the medical records and dental panoramic radiographs of 50 HIV-positive pediatric patients, aged 37-168 months of age. Through these radiographs, their DA was estimated and compared with their CA. The mean DA was significantly lower than the mean CA in the entire studied sample (P < 0.01). There was a statistical difference between children who received antiretroviral drugs and those who used no drugs (P = 0.02), i.e. the non-treated individuals presented practically no difference between CA and DA, while the treated patients showed a difference of 10.67 months. We conclude that the DA of HIV infected children was delayed when compared to the CA, and there was a positive association between the use of antiretroviral therapy and a delay in the chronology of dental mineralization in the sample.

Access to Oral Health Care and Treatment Needs of HIV Positive Paediatric Patients

Resumen en: Objective: An assessment of the oral manifestations, oral health status and treatment needs of paediatric patients with HIV infection. Method: This is a ...