HIV-seropositive Children Research Articles

The Neuropathology of HIV-infected African Children in Abidjan, Côte dʼlvoire

In an autopsy study of HIV-infected children in Abidjan, Côte d'Ivoire, the neuropathology of 76 HIV-1- and 2 HIV-2-positive children was compared with that of 77 frequency-matched HIV-negative children, in whom the systemic pathology was also known. Seventy of the 78 HIV-seropositive children were confirmed as HIV-infected, as determined by combined serology, IgA Western blots and clinicopathological criteria. The HIV-negative children showed a high background level (n = 49, 64%) of neuropathological abnormalities, including nonspecific inflammatory infiltrates, micromineralization, and bacterial and lymphocytic meningitis. In the HIV-positive children, HIV encephalitis was found in 4 (6%), cytomegalovirus in 2 (3%), toxoplasmosis in 3 (4%) and measles encephalitis in one (1%). Bacterial meningitis was equally common in both groups, but cerebral malaria was less common (n = 2, 3%) in HIV-positive than in HIV-negative children (n = 11, 14%). The low prevalence of HIV encephalitis may reflect comparatively early death in HIV infection in Africa as compared with our experience in Europe and the US.

Study of 176 HIV-seropositive children in Santa Catarina State

The incidence of the acquired immunodeficiency syndrome (AIDS) has increased in Santa Catarina State in Brazil over the last years, with a high number of infected women and children. The purpose of this study was to establish the main characteristics of the children from this State whose HIV serologic tests were positive. This was a descriptive study of 176 children with positive serologic tests to HIV, conducted in the Hospital Infantil Joana de Gusmão, Florianópolis City, Santa Catarina State, Brazil. Most of the children (105 cases, 59.6%) were born in Florianópolis, Capital of Santa Catarina State, and Itajaí (22 cases, 12.5%). Vertical transmission of HIV was observed in 167 patients (94.9%). Among 167 HIV-positive mothers, 77 (46.1%) of them acquired the virus by sexual transmission and 35 (21.0%) by use of injectable drugs. However, among 89 HIV-positive fathers, 63 (70.7%) of them used to take drugs. The average age of the HIV-positive children whose serologic tests became negative was 10.5 months. Among 103 symptomatic patients, 87 (84.5%) presented hepatomegaly, 81 (78.6%) lymphadenopathy, 66 (64.0%) splenomegaly, 59 (57.3%) skin bruises, 54 (52.4%) recurrent bronchopneumonia and 50 cases (48.5%) recurrent diarrhea. The most frequent opportunistic infection was mucocutaneous candidiasis that occurred in 41 children (39.8%). The characteristics were similar to those reported in the literature. A great concentration of HIV infected persons was observed in the coast area where there are three harbor towns, an elevated number of injectable drug users and presence of many tourists.

POSSIBLE HAZARDS OF ROUTINE BACILLUS CALMETTE-GUÉRIN IMMUNIZATION IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN

POSSIBLE HAZARDS OF ROUTINE BACILLUS CALMETTE-GUÉRIN IMMUNIZATION IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN

The Plight of Rural Parents Caring for Adult Children with HIV

The author used a qualitative research design to study the impact of an HIV-seropositive adult child on parents living in rural communities. In-depth, informal conversational interviews were conducted with eight mothers and two fathers of eight seropositive adult children on two separate occasions during a four-month period in three mid' western states. The author discusses three themes: physical and mental problems related to HIV/AIDS, HIV/AIDS stigma, and health care. Although no single theme was dominant in the interviews, HIV/AIDS stigma showed the highest degree of interrelatedness. Rural parents of HIV-seropositive children have few places or people in their communities to turn to in dealing with the consequences of their child's HIV status. Recommendations for rural health care professionals are provided.

Auxotrophic vaccines for tuberculosis

Tuberculosis is responsible for the deaths of more people each year than any other single infectious disease, with greater than 7 million new cases and 2 million deaths annually. It remains the largest attributable cause of death in HIV-infected individuals, responsible for 32% of deaths of HIV-infected individuals in Africa. The only currently available vaccine for tuberculosis, bacille Calmette-Guerin (BCG) is the most widely used vaccine in the world, being administered to approximately 100 million children each year. Although untoward effects were not seen in several studies of HIV-seropositive children, the safety of live attenuated BCG vaccine in HIV-positive adults remains unknown and a matter of some concern. To obviate potential adverse affects of BCG vaccines in immunodeficient individuals, we have studied five auxotrophic strains of BCG produced by insertional mutagenesis for safety in administration to mice with severe combined immunodeficiency disease (SCID), and for protection in a susceptible strain of mice. The results indicate that viable BCG could no longer be detected in mice receiving the auxotrophs after 16-32 weeks, and that infected SCID mice survived for at least 230 days. In contrast, all SCID mice succumbed within eight weeks to conventional BCG vaccine. When susceptible BALB/c mice were immunized with auxotrophs and subsequently challenged with virulent Mycobacterium tuberculosis, several of the auxotrophs produced comparable protection against intravenous and intratracheal challenge with M. tuberculosis relative to conventional BCG. These results suggest that auxotrophic strains of BCG represent a potentially safe and useful vaccine against tuberculosis for populations at risk for HIV.

Impact of the human immunodeficiency virus type-1 on common pediatric illnesses in Zambia.

The seroprevalence of HIV-1 and in-patient mortality in children with common pediatric illnesses was studied. Between October 1990 and July 1991 at the Department of Paediatrics and Child Health, University Teaching Hospital (UTH), Lusaka, Zambia, mothers of all pediatric admissions were interviewed and counselled for enrollment of their children into the study. Of a total of 1323 children seen, 1266 children (600 female and 666 male) were enrolled into the study. Pneumonia (28 per cent), malaria (24 per cent), malnutrition (18 per cent), and diarrhoea (10 per cent) constituted over 80 per cent of the total admission diagnoses. Tuberculosis (5 per cent) was the fifth commonest cause of admission (61 out of 1266 children). A total of 354 out of the 1266 (28 per cent) children were found to be seropositive for HIV-1 compared to a seroprevalence rate of 9 per cent in children attending accident and emergency for traumatic injuries (P=0.001). High HIV-1 seroprevalence rates were found in children with tuberculosis (69 per cent), malnutrition (41 per cent), pneumonia (28 per cent). and diarrhoea (24 per cent). The overall mortality in hospital among HIV-seropositive children (19 per cent) was significantly higher than those who were HIV-seronegative (9 per cent) (P = < 0.0001).

Psychological Response to HIV Positivity in Hemophilia

To compare the psychological and family adaptation of children and adolescents with hemophilia who were seropositive for human immunodeficiency virus type 1 (HIV-1) with an HIV-negative group of comparable age, demographic characteristics, and disease severity in a multi-site study. Cross-sectional, controlled study. Thirty-three hemophilia treatment centers throughout the United States. Ninety-one children and adolescents with hemophilia who were seropositive for HIV and 92 children and adolescents with hemophilia who were seronegative and of comparable age, demographic characteristics, and disease severity. HIV-seropositive children and adolescents reported less positive affect [(lower well being) (P < .05)], and more frequent hemophilia-related school absences were identified among HIV-infected patients (P < .005). However, the two groups demonstrated surprisingly comparable levels of psychological, social, hemophilia-related adjustment, general family relations, and hemophilia-related family adaptation, as reported by patients and parents. However, mothers of HIV-seropositive children and adolescents reported higher levels of general psychological distress (P < .008) and higher levels of distress related to hemophilia (P < .0002) than parents of HIV-negative children. Seropositive children and adolescents with hemophilia demonstrate psychological resilience and levels of psychological adjustment that were comparable to seronegative counterparts. However, mothers of seropositive children were more distressed than mothers of HIV-negative children. Practitioners should ensure that stressed mothers obtain necessary psychological support.

Intestinal Parasites in HIV-seropositive Zambian Children with Diarrhoea

We undertook a study over a period of 9 months to define the frequency of parasitic infections in hospitalized children with diarrhoea between the ages of 15 months and 5 years. Every alternate day, mothers of all children admitted with diarrhoea between 09.00 hours and 12.00 hours to one of the wards of the Department of Pediatrics and Child Health of the University Teaching Hospital (UTH) in Lusaka, Zambia, were interviewed for enrollment of their children into the study. A total of 178 children with diarrhoea were enrolled in the study. Of these 44 (25 per cent) were HIV seropositive and 134 (75 per cent) were seronegative for HIV. Out of 44 HIV-seropositive patients, 20 (45 per cent) had acute diarrhoea and 24 (55 per cent) had chronic diarrhoea. Of the 134 HIV-seronegative patients, 68 had acute diarrhoea (51 per cent) and 66 (49 per cent) had chronic diarrhoea. At least one intestinal parasite was found in 34 out of the 178 children enrolled. The commonest parasites identified were Ascaris and Cryptosporidia. No associations were identified between parasite isolation and the following: age, sex, or socio-economic status. Cryptosporidium spp. was isolated from 6 out of 44 (14 per cent) HIV-seropositive children, while 8 out of 134 (6 per cent) seronegative children had the parasite (P = 0.01). HIV-seropositive children with chronic diarrhoea had significantly higher cryptosporidium identification rates than those HIV-seropositive children with acute diarrhoea [5 out of 24 (21 per cent) patients with chronic diarrhoea compared to 1 out of 20 (5 per cent) patients with acute diarrhoea; (P > or = 0.01)].(ABSTRACT TRUNCATED AT 250 WORDS)

Pediatric Human Immunodeficiency Virus Infection

To measure the utilization and costs of pediatric human immunodeficiency virus (HIV)-related health care services. Cohort survey. Eight outpatient departments serving large numbers of HIV-infected children in five standard metropolitan areas with high prevalence of HIV-infected children. One hundred forty-one HIV-seropositive children older than 15 months of age or children whose clinical conditions meet the definition of acquired immunodeficiency syndrome (AIDS) at any age who visited the selected providers during the second quarter of 1991. None. Quarterly interview survey (via adult proxies) of health care services utilization during each preceding 3-month period, repeated six times between March 1991 and August 1992. Charge data were abstracted from inpatient, outpatient, home health care, and pharmacy bills. Children with AIDS averaged 1.4 hospitalizations, 16 inpatient days, two emergency department visits, 18 ambulatory care visits, 15 professional home health care visits, and one dental visit per year, generating an estimated $37,928 in annual charges. The HIV-infected children used fewer services, with annual charges of $9382. We found lower utilization than reported in prior research on pediatric HIV and similar unit costs after inflation adjustment. Increasing experience in clinical management and expanded ambulatory care may have contributed to reductions in inpatient services utilization and total costs since the mid-1980s.

Changes of blood CD16/CD56 (NK) and HLA-DR/CD3-positive lymphocyte amounts in HIV-infected children, as related to clinical progression and p24-antigen/p24-antibody presence.

This study describes a series of immunological investigations carried out on a group of 37 HIV-seropositive children, aged 3-4 years, in two different stages of disease defined according to the CDC classification; the Primary stage, an asymptomatic one, showing abnormal immune function (P1-Class, B-Subclass) and the Secondary stage, 6-8 months later, in which patients exhibited non-specific findings, i.e., loss of weight, persistent generalized lymphadenopathy and hepatosplenomegaly, associated with abnormal immune function (P2-Class, A-Subclass). In both stages, immune function was considered 'abnormal' when lymphopenia and a decrease of the CD4/CD8-cell ratio were found. The phenotypes CD16+/56+ (NK) and HLA-DR+/CD3+ (T-activated?)-positive cells, were assessed by flow cytometry, and the following supplementary systemic humoral markers were investigated in homologus serum samples; total HIV(gp)-antibody, HIV(p24)-antibody and p24-antigen presence. If at the primary stage, no significant difference from to the reference values corresponding to the age was noticed, at the Secondary stage the obtained data is presented separately in two subgroups, namely the A-subgroup characterized by the presence of total HIV(gp)-antibody, the presence of HIV(p24)-antibody and the absence of p24-antigenaemia, and the B-subgroup, where total HIV(gp)-antibody was present, HIV(p24)-antibody absent and p24-antigenaemia present. A significant decrease of CD16+/56+ (NK)-cells was found within the two subgroups. As far as HLA-DR+ from CD(3+)-cells was concerned, only those within the B-subgroup showed a high percentage level, compared to the reference values. The importance of the present findings, linked to immune monitoring of HIV infection among children, is discussed.

Behavioral Adaptation to Human Immunodeficiency Virus-Seropositive Status in Children and Adolescents With Hemophilia

To examine the behavioral adaptation to human immunodeficiency virus (HIV)-seropositive status, as defined by parental report, in children and adolescents with hemophilia. A clinical descriptive study of two groups of patients as part of a longitudinal design. A university-based comprehensive hemophilia center and department of neurology acquired immunodeficiency syndrome dementia center. Forty-six male children with hemophilia divided into two groups based on HIV-seropositive (n = 18) or -seronegative (n = 28) status. None of the patients were symptomatic for acquired immunodeficiency syndrome. All pediatric patients with documented factor VII or IX deficiency aged between 4 and 19 years at study onset and their families were eligible to participate. All subjects were recruited without regard to human immunodeficiency virus status. None. Profiles of behavioral adjustment were obtained from parents' reports on the Child Behavior Checklist for the HIV-seropositive and HIV-seronegative groups. The two groups did not differ on any of the major indexes of the Child Behavior Checklist, even after adjusting for maternal education and severity of hemophilia. There also was no difference between the groups when individual cases were examined for the number of child behavior checklist scales falling within a clinically significant range. The current findings fail to confirm any clear evidence of behavioral problems in an asymptomatic group of HIV-seropositive children and adolescents with hemophilia.

HIV infection and severe malnutrition

To define a clinical profile indicative of HIV infection in a population of severely malnourished children in Burkina Faso. A total of 433 children (average age, 19 months) were recruited at the Sanou Souro National Hospital, Bobo Dioulasso, Burkina Faso. Sixty-three per cent presented with marasmus, 13% with kwashiorkor and 24% with both forms of malnutrition. The prevalence of HIV infection in children aged over 12 months was 13.8%, with a marked predominance of HIV-1 (95.8%). Mother-to-child transmission was proven in 77% of the cases; in 10% of the observed paediatric AIDS cases, transmission may have occurred through multi-injections with contaminated equipment. Marasmus was the form of malnutrition most frequently associated with HIV (P < 0.001); its severity was exacerbated by HIV infection. Adenopathy (P < 0.0001), oral candidiasis (P < 0.0006), skin disorders (P < 0.01) and hepatomegaly (P = 0.01) appeared to be significantly related to HIV infection. Discriminant analysis revealed that the presence of adenopathies was the strongest indicator symptom of HIV infection. Multivariate analysis revealed that a clinical profile of marasmus, adenopathies and oral candidiasis (specificity, 82%) was indicative of HIV infection in this population. The short-term clinical prognosis was poor and usually led to the death of the child when seropositive (P < 0.001). Among children exhibiting severe malnutrition, HIV-positive children are distinguished by a high horizontal transmission rate, a high specific clinical profile and a very poor prognosis.

EEG and evoked potentials in HIV-infected children.

Forty-seven HIV-seropositive children were investigated by EEG and evoked potentials (BAEP, SEP). Twenty-three children were symptomatic (P2), 8 seropositive without symptoms (P1), and 16 children were less than 15 months of age (P0). Some of them were investigated at different stages of HIV infection. During the neonatal period, 7 newborns of drug-addicted mothers had seizures and frequent spikes and sharp waves in their EEGs. Among (P2) children 6/23 showed background slowing and 1 had rhythmic theta activity (6 with and 1 without neurological symptoms). In BAEP, bilateral prolonged interpeak latencies (IPL) were found in 1 child with severe AIDS encephalopathy. Side differences greater than or equal to 0.4 ms in IPL were seen in 2 (P2), 1 without and 1 with neurological symptoms. A late onset was seen in 2 (P1) and 4 (P2) children. Median SEPs were normal in 24/26 patients; N20/N13 amplitude ratio was reduced in 2 (P1) patients. EEG and BAEP revealed nonspecific abnormal features in HIV encephalopathy. The the progression of the disease. However, also in the symptomatic group, normal results of EEG and BAEP dominated. SEP in the symptomatic group revealed only normal values. For monitoring the effectiveness of AZT treatment in HIV encephalopathy, EEG seems to be a relevant investigation; for evoked potentials more data and experience are needed.

Parotid enlargement in children seropositive for human immunodeficiency virus: imaging findings.

We investigated the clinical, immunologic, and imaging features of parotid enlargement in 10 children seropositive for human immunodeficiency virus (HIV) who were infected prenatally. In seven patients, sonography revealed many small hypoechoic areas suggestive of lymphoid infiltration. In three older children, large anechoic areas suggesting lymphoepithelial cysts were present. The lesions probably represent generalized lymphoid infiltration akin to pulmonary lymphoid hyperplasia, although only two of our patients had radiologic evidence of pulmonary lymphoid hyperplasia. Four of five of the children with parotid enlargement who had immunologic studies were phenotypically HLA-DR5, an immunophenotype associated with improved immune response, occurring in less than one in four in the normal population. This suggests that painless parotid enlargement may be a good prognostic sign in HIV-seropositive children. Parotid enlargement was found in 10 HIV-positive children from 6 months to 11 years old. All except one were infected prenatally.

Prevalence of HIV-1 Infection and Symptomatology of AIDS in Severely Malnourished Children in Dar Es Salaam, Tanzania

In Dar es Salaam, Tanzania, 200 children with severe malnutrition and controls matched for age, sex, and area of residence were screened for serological evidence of infection with the human immunodeficiency virus type 1 (HIV-1) over 5 months in 1988. The prevalence of HIV-1 antibodies in the malnourished group was 25.5% (51 of 200) compared with 1.5% (three of 200) in the controls. The seroprevalence rate was equally high in malnourished children above the age of 18 months (26 of 102; 25.5%), as in those below this age (25 of 98; 25.5%). The prevalence rate was higher in children with marasmus (38.2%) as compared to children with marasmic-kwashiorkor (12.3%) or kwashiorkor (12.2%). The prevalence of clinical features known to be associated with AIDS was higher in the HIV seropositive malnourished children as compared to the seronegative children. The modified World Health Organization clinical case definition of AIDS in children was also evaluated and found to have a low sensitivity and positive predictive value (62.8 and 57.1%, respectively) but a fairly high specificity (83.9%). It is recommended to routinely rule out HIV infection in malnourished children, especially those with marasmus.

CNS Involvement in HIV Infection

The neurological findings in 41 HIV-seropositive children are described from the Departments of Paediatric Neurology and Hematology and Oncology, Zentrum der Kinderheilkunde, Goethe Universitat, Frankfurt, Germany.

Ambulatory care of HIV-seropositive infants and children

The ambulatory care of HIV-seropositive infants and children is a critical part of their overall health care. Ambulatory care should be provided in medical facilities that have the capacity to provide comprehensive, family-centered primary health care. The system of care should be accessible and flexible; it should be available 24 hours a day; and there should be a means of ready communication between the community-based hospital clinic, emergency room. and inpatient service providers. Physicians, nurses, social workers, and other involved professionals should be knowledgeable about HIV disease, its diagnosis and management, and its associated social, cultural, political, and legal issues. Nonjudgmental care is integral to the care of HIV-affectcd families, and an ability to respond to the needs of an individual or family in crisis is essential. The protection of every patient's confidentiality is of major importance. These issues are especially important in the care of adolescents with HIV infection, who may not want to disclose their status to their families. Comprehensive health care combines healthy child care (immunizations and general health maintenance), care for acute illnesses, and continuous care for chronic conditions. In addition, it includes medical, psychosocial, and behavioral assessments and provides access or referral to ancillary services (e.g., dental, rehabilitation, financial, legal aid, mental health).

Central Nervous System Involvement of Children with Hiv Nfection

The neurological findings in 41 HIV-seropositive children are described. 23 children were symptomatic, eight seropositive but without symptoms and 10 seropositive children less than 15 months of age had no other evidence of immunodeficiency. Acquired microcephaly, developmental regression and progressive motor deterioration indicated HIV encephalopathy, as did developmental delay, mental retardation, cerebellar symptoms and behavioural changes. Three children with progressive encephalopathy improved after treatment with azidothymidine (AZT). In eight children treated with prophylactic intravenous immunoglobulin therapy (IVIG) and seven treated with both IVIG and AZT, no mental deterioration has been observed since the beginning of therapy. One child with advanced encephalopathy and severe pyramidal tract involvement did not improve.

In vitro synthesis of human immunodeficiency virus-specific antibodies in peripheral blood lymphocytes of infants.

An assay system was developed for the analysis of antibodies secreted in vitro against human immunodeficiency virus (HIV) by cultured peripheral blood lymphocytes of HIV-infected individuals. Cultures of peripheral blood lymphocytes were established with medium alone or with medium containing Epstein-Barr virus (EBV) or pokeweed mitogen. HIV antibodies were determined by an ELISA performed with commercial kits in which a whole virus extract served as antigen. Optimal antibody secretion was detected in 7-day peripheral blood lymphocyte cultures to which EBV had been added to provide polyclonal B-cell activation. Pokeweed mitogen-induced antibody secretion and spontaneous antibody secretion were less consistent. With EBV as a stimulus, the sensitivity and specificity of this assay for determining HIV infection status were each 100% in adults. When the assay was applied to infants and children, 23 of 24 symptomatic HIV-seropositive children (class P-2) and 11 of 33 asymptomatic seropositive infants aged less than or equal to 15 months (class P-0) tested positive for EBV-induced antibody secretion. Six of the 11 P-0 patients who tested positive have progressed to develop symptomatic disease, while the remainder are still seropositive at ages 2-15 months. Of the infants who were negative in this assay, all have remained asymptomatic. Treatment with 3'-azido-3'-deoxythymidine in infected adults and children has resulted in transient suppression of the in vitro antibody response in some instances. Thus EBV-induced synthesis of HIV-specific antibodies in vitro is a sensitive and specific indicator of HIV infection and is of help in determining infection status of asymptomatic seropositive infants who are classified as having "indeterminate" infection.

Prognostic factors in HIV seropositive children by materno-fetal transmission

Ninety-four cases with HIV seropositive children who were found in the Hospital Necker Enfants Malades in France from April 1983 till September 1988 due to materno-fetal transmission were surveyed for immunological studies as well as the relationship between clinical symptoms and the prognosis. Lymphoadenopathy and/or hepatosplenomegaly were found in 98% of the total cases. Opportunistic infections, severe neurological problems and LIP were found in 28%, 16% and 15%, respectively. At the first laboratory examination, cases showing under 500/mm3 of OKT4 lymphocytes and with negative antigen-induced proliferative responses were observed in 24% and 44% of the cases, respectively. Negative serological profiles of antibodies to P18 and P25 HIV antigens appeared to show low values of OKT4 lymphocytes and abnormal responses to antigens. The survival cases with these findings were minimum. These data indicate that it is very much worth, while to estimate the degree of immunological deficiency and infectious complications.