Human Immunodeficiency Virus Children Research Articles

Follow-up for 3 years of a pediatric population diagnosed in 2018 with mother-to-child transmission of HIV in 8 Latin American countries in the PLANTAIDS cohort

IntroductionThe frequency of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) in Latin America has decreased considerably. However, new infections continue to be recorded, and the pediatric population remains one of the most vulnerable groups in this region. The main objective of the study was to describe the clinical, epidemiological and psychosocial characteristics of new diagnoses of HIV MTCT in 2018 in the PLANTAIDS network (Paediatric Network for Prevention, Early Detection and Treatment of HIV in Children) during the 3 years following diagnosis.MethodologyRetrospective, multicenter, descriptive study based on a 3-year follow-up of patients diagnosed with HIV infection due to MTCT in 2018 in 10 hospitals in 8 Latin American countries (Costa Rica, Ecuador, Mexico, Honduras, El Salvador, Panama, Guatemala and Venezuela). The hospitals belonged to the PLANTAIDS network, which is included in CYTED (Ibero-American Programme of Science and Technology for Development).ResultsThe study population comprised 72 pediatric patients (38.9% male). The median age at diagnosis was 2.4 years (IQR: 0.8–5.4). There were 35 cases of opportunistic infections corresponding to 25 patients (34.7%), with tuberculosis being the most common. Adequate childhood vaccination coverage was achieved in 80.5%. There were 3 cases of acute SARS-CoV-2 infection, and these were asymptomatic or mildly symptomatic. According to the Centers for Disease Control and Prevention (CDC) classification, the most frequent clinical-immunological stage at all check-ups was C1. Three patients died from opportunistic infections and/or advanced HIV infection.ConclusionsIt is important to diagnose HIV infection early in pediatrics, since early initiation of ART is associated with a decrease in mortality. Despite this, HIV infection has a poor prognosis in children, necessitating adequate follow-up to ensure adherence to health care and ART, although it can sometimes prove difficult in children.

Adverse childhood experiences, mental illness, HIV and offending among female inmates in Durban, South Africa.

Childhood adversities and adult trauma are common among female inmates. Associations have been documented with childhood adversities and mental illness, personality disorders, human immunodeficiency virus (HIV) and violent offending. However, no such study had been conducted in South Africa (SA), despite the high prevalence of HIV and trauma in SA. To measure the prevalence of childhood adversities and adult trauma; and to determine if there is a relationship between childhood adversities, mental illness, personality disorders, HIV and violent offending among female inmates. The study was conducted at the largest correctional centre in Durban, KwaZulu-Natal, South Africa. This cross-sectional, descriptive study randomly recruited 126 female inmates. The World Health Organization's Adverse Childhood Experiences- International Questionnaire (WHO ACE-IQ) was used to measure childhood adversities; the Structured Clinical Interview for the Diagnostics and Statistical Manual-5 Research Version (SCID 5-RV) was used to diagnose mental illness; and a structured questionnaire was used to measure adult trauma. Human immunodeficiency virus data was confirmed from prison medical records. Elevated rates of individual childhood adversities and adult trauma were found. Associations were found between cumulative childhood adversities and post-traumatic stress disorder (PTSD), alcohol use disorder, substance use disorder, borderline personality disorder, and HIV. Female inmates are a highly traumatised population. Prison mental health services should provide trauma-informed and trauma-focussed care to improve inmates' mental health outcomes and decrease recidivism. This study contributes to the emerging literature on adverse childhood experiences (ACEs) and their associations among incarcerated female populations, in a low- and middle-income, South African setting.

Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2022.

For 30 years the Australian Paediatric Surveillance Unit (APSU) has conducted national surveillance of rare communicable diseases and rare complications of communicable diseases. In this report, we describe the results of thirteen such studies surveyed by the APSU in 2022, including reported case numbers and incidence estimates, demographics, clinical features, management and short-term outcomes. Conditions described are: acute flaccid paralysis (AFP); congenital cytomegalovirus (cCMV); neonatal and infant herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV) and paediatric HIV infection; severe complications of influenza; juvenile-onset recurrent respiratory papillomatosis (JoRRP); congenital rubella infection/syndrome; congenital varicella syndrome (CVS) and neonatal varicella infection (NVI); and the new conditions dengue; Q fever; and severe acute hepatitis. In 2022, cases of severe complications of influenza were reported to the APSU for the first time since 2019. This likely reflects the easing of government-mandated restrictions imposed in 2020-2021 to curb the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the re-emergence of a range of infectious diseases. As previously, AFP surveillance by the APSU contributed to Australia achieving a minimum target incidence of one AFP case per 105 children aged less than 15 years. Cases of JoRRP and NVI were reported in 2022. This indicates potential gaps in human papillomavirus (HPV) and varicella vaccination coverage respectively, especially in high-risk groups such as young migrant and refugee women of childbearing age from countries without universal vaccination programs. Paediatric HIV case numbers resulting from mother-to-child-transmission (MTCT) of HIV remain low in Australia due to use of effective intervention strategies. However, there has been an increase in the number of imported cases of HIV in children (mainly perinatally-acquired) from countries with a high HIV prevalence. Without effective vaccines, there has been no decline in the incidence of congenital CMV and neonatal HSV, indicating the importance of early identification and management to reduce morbidity and mortality. The first cases of dengue, Q fever and severe acute hepatitis were received by APSU in 2022, including two cases of acute hepatitis in which aetiology has not been confirmed to date. The APSU has an important ongoing role in monitoring rare childhood infections.

Revolutionizing pediatric HIV therapy: The latest breakthroughs in drug delivery techniques

Human Immunodeficiency Virus (HIV) is the root cause of acquired immunodeficiency syndrome (AIDS), which destroys the body's immune cells, thereby rendering the body unable to fight any infections. It is a sexually transmitted disease (STD) in adults but in children, it is passed on from an HIV-positive mother in the womb or through the birth canal, or via breastfeeding. According to a report by United Nations International Children's Emergency Fund (UNICEF) 2021, 2.73 million children have been infected with this virus globally. Current statistics for 2022–23 would be updated by July 2023. Many antiretroviral drugs (ARVs) are available in the market for preventing the vertical transmission of HIV which are not 100% effective. The regimen for treating HIV in children is of long duration and requires drug administration multiple times daily which makes it less compliant for the children as well as their parents. As a result, the children are unable to complete the regimen. Multiple new dosage forms such as microarray patches, buccal films, 3D-printed mini tablets, polymeric micelles, and food-based nanoparticles have been developed to overcome these problems. This article aims to discuss the problems with existing therapy and recent advances that have been made in HIV therapy for children along with the various clinical trials that are currently underway.

Prevention of mother to child transmission of Human Immunodeficiency virus (HIV): What do Ghanaian Midwives know?

BackgroundPrevention of Mother to Child Transmission (PMTCT) is an important public health intervention that has significantly reduced the risk of mother-to-child transmission of Human Immunodeficiency Virus (HIV) from 40% to close to 5%. Midwives need to have good knowledge of this important preventive strategy to be able to contribute to global efforts aimed at the elimination childhood HIV infections and all other forms of HIV infection. MethodsThis research employed an analytical cross-sectional study design and recruited 179 Midwives through purposive sampling. A self-administered questionnaire was completed by participants to test their knowledge regarding PMTCT for HIV. Analysis of data was done through STATA using ANOVA, binary logistic regression analysis with a level of significance set at < 0.05. FindingsThe knowledge levels observed in this study include High (48%), moderate (35.2%), and Low (16.8%) with an overall mean score of 67.82 indicating a moderate level of knowledge among the studied sample. Having a master’s degree (aOR = 1.3; 95 % CI = 0.1–0.9). and age (aOR = 14.9; 95 % CI = 0.6–0.9) were factors that showed statistically significant association with having good knowledge of the guidelines. ConclusionsEven though most of the participants were within the level of high knowledge of the guidelines, overall knowledge at among the studied sample was level moderate. Knowledge improved with increasing age. Midwives with master’s degree demonstrated good knowledge of the guidelines. Support in the form of training is needed to achieve optimum knowledge of the PMTCT guidelines among midwives who are the main implementers of the PMTCT strategy in Ghana.

Design, Implementation, and Assessment Approaches Within an Advanced Human Immunodeficiency Virus (HIV) Elective Course

Introduction: An estimated 38 million people are living with human immunodeficiency virus (HIV) worldwide. Pharmacists are well positioned to provide care to patients with HIV, but gaps in HIV education among pharmacists exist. Recognizing the need to educate and prepare future pharmacists, a 2-credit advanced HIV elective course was created for Doctor of Pharmacy students at Washington State University College of Pharmacy and Pharmaceutical Sciences in the United States, and Masters of Clinical Pharmacy students from University of Western Cape School of Pharmacy in South Africa. Methods: Course topics included diagnosis and treatment of HIV in children and adults, management of common comorbidities, pre-exposure prophylaxis, pharmacogenetic applications, and antiretroviral drug-drug interactions. Course effectiveness was evaluated using student examination results. Student perceptions were evaluated using pre- and post-course self-assessments involving abilities, confidence, and attitudes toward caring for people living with HIV. Results: Student pharmacists demonstrated competency in HIV knowledge, demonstrated skills in application to clinical-based scenarios, and reported significantly improved confidence and abilities as well as positive changes in attitudes toward people with HIV. Conclusion: This course contributed to student learning across different student cohorts in an institutional program in the United States including successful execution of distance learning and clinical application for students at a program in South Africa.

Awareness, attitude and practice on prevention of mother to child transmission of human-immunodeficiency virus among pregnant women in Taungoo Township, Myanmar

Background: Globally, about 1.3 million human-immunodeficiency virus (HIV)-positive women get pregnant once a year, and about 160,000 children are born with the HIV. This study was conducted to investigate pregnant women's awareness, attitude, and practice regarding the prevention of mother to child HIV transmission (PMTCT).Methods: This cross-sectional study collected qualitative data from 152 pregnant women registered in the health facilities in Taungoo township. Simple random sampling was applied to cull three out of total rural health centres and systematic random sampling was exercised to recruit the required pregnant women from all registered pregnancies. The semi-structured questionnaire and statistical package for the social sciences (SPSS) version 23 were used for data collection and analysis accordingly.Results: In overall, the pregnant women studied had good awareness (56.6%), favourable attitude (60.5%), and good practice (55.3%) on PMTCT services. 78.3% were aware of the PMTCT project and knew that a baby can be prevented from HIV transmission by an HIV mother, 57.8% agreed that counselling and testing for HIV during pregnancy are important and 85.5% were tested for HIV. The awareness was associated with the family type (p=0.049), the attitude was associated with age (p=0.048), residence (p=0.024), and frequency of antenatal visits during current pregnancy (p=0.021), and practice was associated with antenatal care delivery sites (p=0.038), husband's support for antenatal care (p=0.004) and taking antenatal services during a previous pregnancy (p=0.033).Conclusions: Many unsatisfactory findings regarding PMTCT services were noted. So, strategic interventions and effective approaches for getting the full coverage of PMTCT programs should be strengthened.

KAJIAN SITUASI PELAKSANAAN PREVENTION OF MOTHER-TO CHILD TRANSMISSION (PMTCT) DI RSUD KOTA C JAWA BARAT

Infection in pregnant women can be caused by several viruses, one of which is Human Immunodeficiency Virus (HIV). Mother-to-child transmission of HIV reaches 2.6% of all cases of HIV-AIDs, and more than 90% of the incidence of HIV in children is transmitted by mothers. The increase in HIV cases in infants occurred in line with the increase in HIV cases in women, namely 20% in 2007, 25% in 2008, and 27% in 2011. Objectives, Programs are developed to reduce the risk of mother-to-child and mother-to-child transmission of HIV. health workers to achieve improvement in maternal health, reduce infant mortality and protect health workers in RSUD city C. Preparation stage, identification of problems in the midwifery unit, shared perceptions of PMTCT. Implementation, seminars on PMTCT, formation of an education team in early screening (early screening) of pregnant women about PMTCT, making standard operating procedures (SOPs) in prenatal HIV screening, SOPs for delivery in HIV positive patients, SOPs in breastfeeding, and techniques breastfeeding for infants with HIV-positive mothers. Finally, evaluating the results of work related to making SOPs and implementing HIV screening for every prenatal patient. In conclusion, the screening format that has been prepared can capture pregnant women who are at high risk of HIV. Suggestion, HIV screening format needs to be integrated with antenatal care form.

Motivational interviewing retention counseling and adherence to early infant diagnostic HIV testing schedule in South Africa: The PAEDLINK randomized trial.

Introduction:We report the PAEDLINK randomized trial results on the effect of motivational interviewing (MI) retention counseling on the adherence of postpartum women to the early infant diagnostic human immunodeficiency virus (HIV) testing schedule.Methods:HIV positive women and their babies were enrolled 3 to 6 days after delivery at 4 midwife obstetric units in the Gauteng province of South Africa and randomized into (A) MI retention counseling and telephonic tracing, (B) biannual telephonic tracing, and (C) standard care. Mother–baby pairs were followed up for 18 months via medical records. The uptake of child HIV tests and maternal retention in the 0 to 6 and 7 to 18 month periods were modeled using Log-binomial regression.Results:Overall, 501/711 enrolled mother–baby pairs received a second HIV polymerase chain reaction test by 6 months (70.0%, 70.5%, and 70.0% in groups A, B, and C, respectively). A higher proportion of intervention children (60.9%) were tested at 7 to 90 days than group B (48.1%, adjusted risk ratio [aRR] 0.8 for B vs A, 95% confidence interval [CI]: 0.7–0.9) and group C children (52.7%, aRR 0.9 for C vs A, 95% CI: 0.9–1.0). Child testing between 7 and 18-months was also higher in group A than C (10.7% A, vs 5.5% C, RR 2.0, 95% CI: 1.0–3.7). However, maternal retention was similar across groups, with 41.6% and 16.3% retained during the 0 to 6 and the 7 to 18-months periods, respectively.Conclusion:MI retention counseling can reduce delays in the early infant diagnosis testing schedule for HIV-exposed infants. However, further support is necessary to maximize later HIV tests and maternal retention.

Mental Health in Uganda and Canada: A Descriptive Case Study of the Issue and Recommendations for Improved Mental Health

Mental health is a crucial part of overall wellbeing. Canada’s mental health system has progressed over the last decade but still has room for improvement. In comparison, developing countries, such as Uganda, have not shown the same progression with their mental health systems. The embedded experience, together with expert consultations in the field, was conducted over several months at a human immunodeficiency virus (HIV) specialized hospital, the Joint Clinical Research Center (JCRC) in Kampala, Uganda on the topic of mental health systems. The observations and consultations were thematically analyzed into four main themes: cultural attitudes towards mental illness, the interconnectedness of childhood HIV and mental health, a gap in education for mental health professionals to become certified, and barriers to addressment of mental health issues at the JCRC. The main barriers for Ugandans seeking professional treatment were also identified, which included the accessibility and availability of professional treatment. Local solutions are outlined, as well as recommendations for improvements and future research.

Perception and utilization of prevention of mother-to-child transmission of human immunodeficiency virus (HIV) services among women living with HIV.

INTRODUCTIONMother-to-child transmission is the major route of pediatric Human Immunodeficiency Virus (HIV) infection accounting for 90% of childhood HIV infection. Poor utilization of prevention of mother-to-child transmission (PMTCT) of HIV services has been shown in this situation. Hence, the study assessed the perception and utilization of PMTCT services among Women Living with HIV (WLHIV).METHODSA cross-sectional research design was used with a purposive sampling technique to select 182 WLHIV within reproductive age attending President’s Emergency Plan for Acquired Immunodeficiency Syndrome (AIDS) Relief (PEPFAR)/AIDS Prevention Initiative in Nigeria (APIN) clinic in two secondary Health facilities in Ibadan, Oyo State. A validated structured questionnaire was used for data collection. Descriptive and inferential statistics were used for data analysis.RESULTSThe mean age of the women was 37.0±6.5 years. Majority (74.2%) of the respondents had good knowledge on PMTCT of HIV, positive perception (89%) towards PMTCT services while only 42.9% of the respondents have utilized PMTCT services during pregnancy. However, some of the challenges to use of PMTCT services identified by the respondents were stigma (16.5%), discrimination (15.4%), financial constraint (11.5%) and non-involvement of partner (8.2%). There was a significant association between level of knowledge and PMTCT services utilization (χ2=6.244, p=0.012).CONCLUSIONSThere is need for improvement of knowledge and perception of HIV, MTCT and PMTCT among women through counseling and antenatal education, thereby increasing PMTCT services uptake. Partner involvement, good quality PMTCT services and lack of discrimination of people living with HIV in our society should be encouraged, hence promoting the utilization of PMTCT services.

Development of Spray-Dried Cyclodextrin-Based Pediatric Anti-HIV Formulations.

The human immunodeficiency virus (HIV) impacts up to 37 million people globally, of which 1.8 million are children. To date, there is no cure for HIV, although treatment options such as antiretroviral therapy (ART) are available. ART, which involves a patient taking a combination of antiretrovirals, is being used to treat HIV clinically. Despite the effectiveness of ART, there is currently no palatable pediatric formulation to treat HIV in children, which has hindered patient compliance and overall treatment efficacy. In addition, anti-HIV therapeutics are often poorly water-soluble, and hence have poor bioavailability. In the present study, we developed a pediatric-friendly formulation for anti-HIV therapeutics with improved dissolution characteristics of the therapeutic agents. Lopinavir (LPV) and ritonavir (RTV), available as FDA-approved fixed-dose combination products, were chosen as model ART drugs, and the formulation and processing parameters of spray-dried cyclodextrin (CD)-based LPV and RTV complexes were studied. Results showed that the spray-dried complexes exhibited enhanced dissolution profiles in comparison to pure drugs, particularly spray-dried β-CD complexes, which showed the most favorable dissolution profiles. This current formulation with enhanced dissolution and taste-masking ability through the use of cyclodextrin has the potential to address the unmet need for the development of suitable pediatric formulations.

Human Immune Deficiency Virus Serostatus and Associated Factors Among Children of Adult Index Cases in Northern Ethiopia

IntroductionChildren whose parents with human immunodeficiency virus (HIV) and family of index clients are at high risk of HIV infection. Family testing is an efficient and effective way of identifying children’s HIV. The number of children becoming newly infected with HIV remains unacceptably high. This study is to assess human immune deficiency, virus serostatus, and associated factors among children of adult index cases in central Tigrai, Northern Ethiopia, 2019.MethodsAn institution-based cross-sectional study design was conducted to select a total of 454 index cases from February 01 to April 30, 2019. Data were collected from adult clients on antiretroviral treatment who have children using administered questionnaires and data extraction from the hospital antiretroviral register. Simple random sampling was used to select the index cases using the medical record number. Binary logistic regression analysis, odds ratio, and 95% confidence interval were used to determine the strength of association between dependent and independent variables. Statistical significance was declared a P-value <0.05.ResultsThe prevalence of HIV in children from family index case testing was 8.9% with 95% CI (6.5–11.6). Female index clients [AOR=0.18, 95% CI: 06-0.55], the age of the child [AOR=0.86, 95% CI: 0.76, 0.97], importance of HIV testing [AOR=5.20, 95% CI: 2.2011.96], and discussion HIV testing [AOR=3.22, 95% CI: 1.5–16.84]. Participants who did not discuss HIV were 3.2 more likely have HIV positive child than who discussed with family members.ConclusionThe majority of the index clients test their children, but the prevalence rate of HIV in children from family index case testing is high. Strategies should be developed on how to communicate with household members about HIV.

A model for enhancing prevention of mother to child HIV transmission in a low resource setting

BackgroundThe prevention of mother-to-child transmission (PMTCT) programmes plays a significant role in the reduction of human immunodeficiency virus (HIV) infections in the under-five age group and maternal mortalities. A phenomenological study on the experiences of HIV-positive women who utilised the PMTCT services identified challenges affecting the use of those services. An enabling environment is required for the effectiveness of the PMTCT programme. PurposeThe purpose of this paper is to develop and describe a model for enhancing prevention of mother-to-child HIV transmission in a low-resource setting. MethodThe model was developed in three sequential phases: empirical foundation, development of the model and description of the model. The model was developed using Walker and Avant’s steps of theory development. Chinn and Kramer’s criteria were used to evaluate the model and the modified version of the Delphi technique was utilised for peer review and further refinement of the model. This emanated from findings of a doctoral thesis on the experiences of HIV-positive PMTCT clients at a central hospital in Zimbabwe. The procedure involved the use of systems theory, central concept identification, a literature review, the definition of key terms and the identification of the elements of the model, after which the model was developed, described, and evaluated. ResultsThe elements of the model encompass the context, input, process and outcome. ConclusionThe model will act as a reference framework for midwives and programme planners with a view of enhancing utilisation and the quality of PMTCT services.

Improving male involvement in antenatal care in low and middle-income countries to prevent mother to child transmission of HIV: A realist review.

BackgroundChildhood Human Immunodeficiency Virus (HIV) infection occurs almost exclusively via mother to child transmission (MTCT) during pregnancy, birth, or through breastfeeding. Recent studies have shown that male involvement (MI) in antenatal care (ANC) and HIV testing, including couples voluntary counselling and testing (CVCT), increases the likelihood that women will adhere to prevention advice and comply with HIV treatment if required during their pregnancy; hence reducing the rates of MTCT of HIV. This realist review investigates how, why, when, and for whom MI in ANC works best to provide contextual advice on how MI in ANC can be best used for prevention of mother to child transmission (PMTCT) of HIV.MethodsA realist review of existing evidence was conducted. Realist review seeks to explain how and why an intervention works, or does not work, in a given context. This was completed through the five stages of realist synthesis; Eliciting the program theory, search strategy, study selection criteria, data extraction, and data analysis and synthesis. Findings are presented as context-mechanism-outcome (CMO) configurations outlining the mechanisms that work in given contexts to give an outcome.ResultsThree CMO configurations were developed. These describe that 1) Couples in monogamous relationships have higher levels of trust, commitment and security leading to increased uptake of PMTCT programs together; 2) ANC spaces that make ‘male friendly’ adaptions promote normalisation of MI in PMTCT and are more welcoming, leading to increased willingness of male partners to participate in ANC; and 3) couples and communities with higher health literacy encourage increased informed decision making, ownership, and responsibility and thus increased participation in PMTCT of HIV.ConclusionsThe CMOs developed in this review give contextual advice on how one might improve ANC services to increase MI and help reduce MTCT of HIV. We propose that MI in ANC works best where couples are monogamous and trusting, where ANC spaces actively promote being a ‘male friendly space’ and where there are high levels of community education programs around MTCT.

ORAL MANIFESTATIONS OF VIRAL INFECTIONS IN CHILDREN

Viral diseases with oral manifestations are common in the practice of pedodontist, however, sometimes their diagnosis is complicated due to the similar clinical manifestations. A huge number of viruses are present in oral cavity, especially from Herpesviridae family, however, the most of them are asymptomatic. Cold, systemic diseases and stress provoke the activation of viruses with different clinical manifestations. Therefore, a dentist can be the first who diagnoses not only herpetic gingivostomatitis, but also other viral diseases.&#x0D; The aim of the article was to analyse the oral manifestations of viral diseases in children in order to optimize their diagnostics.&#x0D; This article analyses clinical cases and reviews of diseases in English in Google database from 2011 to May 2020 (and earlier publications) by&#x0D; Keywords:&#x0D; «herpetic gingivostomatitis», «recurrent aphthous stomatitis», «oral manifestations of infectious mononucleosis», «herpetic angina», «oral manifestations of cytomegalovirus infection», «recurrent herpetic gingivostomatitis», «oral manifestations of varicella virus», «oral manifestations of herpes zoster», «roseola infantum», «herpangina», «hand, foot and mouth disease», «oral manifestations of measles», «rubella», «oral manifestations of papillomavirus», and «oral manifestations of human immunodeficiency virus».&#x0D; Viruses which have oral manifestations were characterized by transmission. Mostly airborne viruses are represented by Herpesviridae family. The differential diagnosis of primary herpetic gingivostomatitis includes recurrent aphthous stomatitis which forms ulcers on non-keratinised oral mucosa without a vesicle phase. Recurrent herpetic infection doesn’t have difficulties in diagnostics, but could be complicated by erythema multiform with clear target lesions. Vesicles, erosions in oral cavity associated with vesicles on hear part of head help to distinguish chickenpox from herpetic infection. Compared to Herpes simplex virus infection, Herpes zoster has a longer duration, a more severe prodromal phase, unilateral vesicles and ulceration, with abrupt ending at the midline and postherpetic neuralgia. Roseola is characterized by small papules on skin and palate which appears when severe fever in prodromal period subsides and disappears after 1-2 days. Oral vesicles associated with foot and hand rush differentiate enterovirus stomatitis from chickenpox and roseola. The distribution of the lesions of herpangina (palate, tonsils) differentiates it from primary herpetic gingivostomatitis, which affects the gingivae.&#x0D; Comparing with roseola and rubella, measles has a bigger size of rush and specific oral localization on buccal mucosa. Mild fever and skin rush which appears on face and extensor surfaces of body and extremities help to distinguish rubella from measles and roseola.&#x0D; Viruses transmitted through biological liquids are represented in oral cavity by infectious mononucleosis and cytomegalovirus. The vesicles and ulcers on the tonsils and posterior pharynx in case of these infections can resemble herpetic stomatitis, but liver and spleen enlargement allows to exclude this diagnose; also cytomegalovirus erosions heal for long time. Cervical lymphoadenopathy differentiates them from herpetic angina. Laboratory diagnostics is based on detection of antibodies to virus or virus DNA in blood helps to make diagnosis of infectious mononucleosis and cytomegalovirus infections.&#x0D; Viruses transmitted through direct contact with mucosa and biological liquids represented by human papillomavirus (HPV) and human immunodeficiency virus (HIV). HPV in oral cavity represent by benign epithelial hyperplasia which might persist and transform to malignant. Therefore, histological examination plays important role in diagnostics of HPV.&#x0D; Oral manifestations such as candidiasis, herpes labialis, and aphthous stomatitis represent some of the first signs of HIV immunodeficiency. Oral lesions also associated with HIV in children are oral hairy leukoplakia, linear gingival erythema, necrotizing ulcerative gingivitis, and Kaposi’s sarcoma. Rapid necrotization and long-term healing of oral lesions help to suspect HIV and prescribe the blood test for the detection of antibodies to the virus.&#x0D; Oral mucosa is often the first to be affected by viral infections. A thorough anamnesis and examination is the key to accurate diagnostics of the most oral viral lesions and their adequate treatment. Biopsy, examination of antibodies to the virus in the blood or polymeraze-chain reaction to the virus in the bioptate or blood are performed in case of diagnostic difficulties. Laboratory methods had to use more widely for the diagnostics of recurrent or unclear lesions of the oral mucosa in children.

Empowering parents for human immunodeficiency virus prevention: Health and sex education at home.

BackgroundImproving health literacy amongst human immunodeficiency virus (HIV)-positive mothers could strengthen child and adolescent HIV prevention. The Amagugu intervention included health literacy materials to strengthen maternal communication and has demonstrated success in low-resource HIV-endemic settings.ObjectivesOur aims were to (1) evaluate whether Amagugu materials improved health literacy leading to changes in parental behaviour towards communicating on topics such as HIV, health behaviours and sex education, and (2) explore what additional information and materials mothers would find helpful.MethodThe Amagugu evaluation included 281 HIV-positive mothers and their HIV-uninfected children (6–10 years). Process evaluation data from exit interviews were analysed using content analysis and logistic regression techniques.ResultsOf 281 mothers, 276 (98.0%) requested more educational storybooks: 99 (35.2%) on moral development/future aspirations, 92 (32.7%) on general health, safety and health promotion, and 67 (23.8%) on HIV and disease management. Compared to baseline, mothers reported that the materials increased discussion on the risks of bullying from friends (150; 53.4%), teacher problems (142; 50.5%), physical abuse (147; 52.3%) and sexual abuse (126; 44.8%). Most mothers used the ‘HIV Body Map’ for health (274; 97.5%) and sex education (267; 95.0%). The use of a low-cost doll was reported to enhance mother–child communication by increasing mother–child play (264; 94.3%) and maternal attentiveness to the child’s feelings (262; 93.6%).ConclusionParent-led health education in the home seems feasible, acceptable and effective and should be capitalised on in HIV prevention strategies. Further testing in controlled studies is recommended.

The Intergenerational Impact of a Slow Pandemic: HIV and Children

Human immunodeficiency virus (HIV) has, over the last four decades, infected millions of young women and their children. Interventions developed in parallel with the spread of the virus have been able to reduce rates of vertical transmission from mother to child. The impact of HIV in children can be direct in children living with HIV (CLHIV) and exposed to HIV and uninfected, or indirect through impacts on their parents, caregivers, and family. In 2018, the United Nations joint programme on AIDS (UNAIDS) estimated that 1.7 million children were living with HIV, 160,000 were newly infected with HIV, and 100,000 died from HIV. Improvement in treatment regimens can improve the life chances of children, but adherence to treatment is a problem, especially for adolescents. Injectable long acting treatments, or interventions to improve service delivery and support for adolescents living with HIV may improve treatment success. In addition to failures of HIV prevention and treatment in CLHIV, there are concerns over exposure to the virus and antivirals leading to delayed child development. To improve the wellbeing of children affected by HIV, social support is necessary, but we need to find ways of enhancing the impact of interventions, perhaps through combining them.

Correlation between CD4 count and glomerular filtration rate or urine protein:creatinine ratio in human immunodeficiency virus-infected children.

BackgroundStudies on kidney complications in human immunodeficiency virus (HIV)-infected children are lacking. CD4 T lymphocytes are an important immune functions regulator and used as a basis for initiating antiretroviral therapy (ART) and monitoring disease progression. This study aims to determine the correlation between CD4 and estimated glomerular filtration rate (eGFR) or urine protein:creatinine ratio (uPCR) as markers of kidney complications.MethodsThis cross sectional study was conducted on HIV-infected children aged 5 to 18 years who visited the Teratai HIV Clinic at Hasan Sadikin Hospital for monthly monitoring in June 2019. CD4 count, eGFR based on the Schwartz formula, and uPCR were obtained. Correlation analysis was performed with the Pearson test.ResultsSubjects were 42 HIV-infected children, consisting of 23 males (54.8%) and 19 females (45.2%). Most children (65.0%) were in an advanced clinical stage and had been diagnosed with HIV for an average of 8 ± 3 years. All subjects had received ART, and six received tenofovir. Compliance to medications were good, and most subjects (79.0%) had normal nutritional status and CD4 count. All subjects had eGFR > 90 mL/min/1.73 m2, of which 21 (50.0%) were above normal value. Proteinuria was found in 12 patients (28.6%), and it was not significantly associated with clinical stages of HIV infection. CD4 count was correlated positively with eGFR (r = 0.473, P = 0.001) and negatively with uPCR (r = -0.284, P = 0.034).ConclusionThe degree of immunodeficiency appears to correlate with severity of renal injury. Screening at diagnosis and periodic monitoring of kidney functions are crucial in all childhood HIV patients.

Tuberculosis in a Spanish cohort of children living with HIV: the CHOTIS study (Childhood HIV & TB study).

BACKGROUND: Tuberculosis (TB) is the leading opportunistic infection in children with human immunodeficiency virus (HIV), but is uncommon in low prevalence regions. We aim to describe the changing epidemiology and clinical presentation of TB-HIV co-infection in a cohort of HIV-infected children in Spain.METHODS: Children diagnosed with TB between 1995 and 2016 in the paediatric HIV cohort were identified. The incidence and clinical presentation were compared in three periods: 1995-1999 (P1, before initiation of combined antiretroviral therapy, cART), 2000-2009 (P2, increase in immigration), and 2010-2016 (P3, decrease in immigration).RESULTS: We included 29 TB cases among 1183 children aged <18 years (2.4%, 243/100 000 person-years). The proportion was stable in P1 and P2 (1.3%), but decreased in P3 (0.8%). The median age at TB diagnosis was 6.4 years (IQR 4-10.6); most children in P3 were aged >10 years (20% vs. 23.1% vs. 83.3%, P = 0.01). TB was diagnosed at HIV presentation in 11/29 children (37.9%). Foreign-born children accounted for respectively 0%, 8% and 67% of the total number of children in each period (P ≤ 0.0001). One third had extrapulmonary TB; four children died (13.8%).CONCLUSION: In our cohort, the incidence of TB-HIV co-infection decreased with decline in immigration. In regions with adequate cART coverage and low TB transmission, paediatric TB-HIV coinfection is uncommon, but associated with significant morbidity. Strategies for TB surveillance, diagnosis and treatment in this vulnerable population should be reinforced.