Human Immunodeficiency Virus Infection In Adolescents Research Articles

Potential of Long-Acting Products to Transform the Treatment and Prevention of Human Immunodeficiency Virus (HIV) in Infants, Children, and Adolescents.

Long-acting antiretroviral products have the potential to transform human immunodeficiency virus (HIV) prevention and treatment approaches in pediatric populations. Broadly neutralizing antibodies and/or long-acting antiretroviral formulations by injection could dramatically improve provision of HIV prophylaxis and/or early treatment to newborns and infants at risk of HIV infection. Challenges in daily oral antiretroviral administration to toddlers and school age children living with HIV may be relieved by use of long-acting formulations, but the pharmacokinetics and safety of these products in children must be studied before they can enter routine clinical use. Although some initial studies of broadly neutralizing antibodies and injectable long-acting agents in infants and young children are underway, more studies of these and other long-acting products are needed. For many adolescents, compliance with daily medication administration is especially challenging. Long-acting products hold particular promise for adolescents living with HIV as well as those at high risk of HIV acquisition, and adolescents can usually be included in the drug development pipeline simultaneously with adults. Long-acting products have the potential to provide alternatives to lifelong daily oral drug administration across the pediatric age spectrum, leading to more effective prevention and treatment of HIV infection in infants, children, and adolescents.

Video directly observed therapy to improve adherence of human immunodeficiency virus infected adolescents to combination antiretroviral therapy: a proof-of-concept study

ABSTRACT Adherence to antiretroviral therapy (ART) is a major challenge for many youth living with HIV (YLWH). In this prospective proof-of-concept study, we assessed the feasibility and acceptability of conducting a study of video directly observed therapy (VDOT) as a method of improving medication adherence in YLWH who had a history of poor adherence to ART. The study had four phases; phase I – VDOT daily (4 months) using Facetime®; phase II – daily texting (2 months); phase III – weekly texting (3 months); phase IV – no intervention (3 months). Participants were seen in clinic on a monthly basis for assessment and laboratory evaluation. Five of eight eligible participants were enrolled. All achieved virologic suppression one month after enrollment. Three of five completed the study protocol and maintained virologic suppression through the 12-month period of study. Participant responses to the end-of-study questionnaire indicated satisfaction with the intervention and thought VDOT was helpful to them. Healthcare providers thought that the intervention was effective for some youth but was at times burdensome. This proof-of-concept study demonstrated that VDOT may be effective at improving medication adherence in previously poorly adherent YLWH and that larger studies of VDOT for such patients are both feasible and warranted.

Perinatally Human Immunodeficiency Virus-Infected Adolescents and Young Adults Demonstrate Distinct BNT162b2 Messenger RNA Coronavirus Disease 2019 Vaccine Immunogenicity.

BackgroundImmunization of vulnerable populations with distinct immunity often results in suboptimal immunogenicity, durability, and efficacy.MethodsSafety and immunogenicity profiles of BNT162b2 messenger RNA coronavirus disease 2019 (COVID-19) vaccine, among people living with human immunodeficiency virus (HIV), were evaluated in 28 perinatally HIV-infected patients under antiretroviral therapy (ART) and 65 healthy controls (HCs) with no previous history of COVID-19. Thus, we measured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–specific humoral and CD4+ T cell responses. Samples were collected before vaccination (baseline, day [D] 0), at the second dose (D21), and at 4 weeks (D28) and 6 months (D180) after D0. Proteomic profiles at D0 and D28 were assessed with a multiplexed proximity extension assay (Olink) on plasma samples.ResultsAll HIV-infected patients mounted similar anti–SARS-CoV-2 humoral responses to those of HCs, albeit with lower titers of anti-trimeric S at D28 (P = .01). Only peripheral blood mononuclear cells of HIV-infected patients demonstrated at D28 an impaired ability to expand their specific (CD40L+) CD4+ T-cell populations. Similar humoral titers were maintained between the 2 groups at 6-months follow-up. We additionally correlated baseline protein levels to either humoral or cellular responses, identifying clusters of molecules involved in immune response regulation with inverse profiles between the 2 study groups.ConclusionsResponses of ART-treated HIV-infected patients, compared to those of HCs, were characterized by distinct features especially within the proteomic compartment, supporting their eligibility to an additional dose, similarly to the HC schedule.

Manifestations of Stigma among HIV Infected Adolescents in Samia Sub-County, Busia, Kenya

Human immunodeficiency virus (HIV) is a leading cause of global burden of disease. Recently, significant progress has been made in increasing access to antiretroviral therapy (ART) for people living with HIV to suppress the replication of the virus. Suppressed viral replication facilitates restoration of the immune function and significantly reduces the risk of onward HIV transmission. Despite the increasing access to ART, compelling evidence indicate suboptimal levels of viral suppression among adolescents in many low-resource settings. This has been associated with failure of adolescents to adhere to medication due to stigma. The purpose of this study was to examine the manifestations of enacted stigma among adolescents living with HIV in Samia Sub County, Busia County, Kenya. The study was guided by the theory of planned behavior and the Social cognitive theory. The study adopted the mixed method research design. The study population comprised 4 peer educators,740 caregivers, 1580 adolescent HIV+ boys and girls, and 1 Sub County Aids and Sexually Transmitted Infections Coordinator (SCASCO). The sample size was 4 Peer educators, each drawn from the four wards, 74 caregivers for HIV + adolescents, 158 HIV+ adolescents and the I SCASCO. The stratified and simple random sampling techniques were used to select the 158 HIV+ adolescents and 74 caregivers, while saturated sampling was employed to select 4 peer educators and one health officer. Questionnaires, Focus Group Discussion and interview schedule were used to collect data from the respondents. All the instruments were piloted before administration in order to determine their validity and reliability. The test-retest method was used and a reliability coefficient of 0.70 was accepted. Data wasanalysed using descriptive statistics such as the frequency counts and percentages. Qualitative data was organized in terms of relevant themes and sub-themes and interpreted. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) Version 23.0. The study established that enacted stigma mainly manifests itself in the form of discrimination towards infected adolescents in Samia Sub-County. They experience discrimination in health care settings, including being denied health services because of their HIV status and health care professionals disclosing their HIV status without their consent. In addition, these adolescents experienced negative stereotypes such as sexual promiscuity, deviant sexual behaviors and discrimination, all of which create social barriers including access to healthcare. It is recommended that there is need to address enactment of stigma in community, homes and schools in Samia Sub County which are significant settings for the safety and welfare of HIV infected adolescents.

Effectiveness of quality-of-life counselling with hatha yoga among human immunodeficiency virus-infected adolescents: Randomised control trial

Effectiveness of quality-of-life counselling with hatha yoga among human immunodeficiency virus-infected adolescents: Randomised control trial

Protection of Vaccine Preventable Diseases in a Population of HIV-Infected Children: A 3 Years Prospective Study.

Human Immunodeficiency Virus (HIV) infected children have a 30–70% chance of being incompletely immunized and may not respond serologically with the same magnitude or durability as uninfected children. The aim of the study was to describe the rate of protective antibodies titre and the persistence of the response against four recommended vaccinations in HIV infected children and adolescents. A two-phase observational study was performed in which protective IgG antibodies to measles, mumps, rubella and hepatitis B were determined and monitored for 12 and 24 months, in 26 perinatally HIV-infected children. The rate of protection for rubella and hepatitis B was significantly lower in the HIV group compared to the control group (92% vs. 65% for rubella and 78.4% vs. 45.4% for hepatitis B; p < 0.05). Children who received primary vaccination after initiating combination antiretroviral therapy (cART) had a higher rate of response. Seronegative patients who received a booster dose of vaccine had a good immunological response. HIV infection is associated with a lower response to vaccines against rubella and hepatitis. The beginning of cART before vaccination may be associated with a better response. The evaluation of the serological response is crucial in children with HIV infection in order to evaluate the protection of vaccine preventable diseases.

HIV Testing Strategies for Health Departments to End the Epidemic in the U.S.

An important goal of the Ending the HIV Epidemic in the U.S. initiative is the timely diagnosis of all people with HIV as early as possible after infection. To end the HIV epidemic, health departments were encouraged to propose new and innovative HIV testing strategies and improve the reach of existing programs. These activities were divided into 3 core strategies: expansion of routine screening in healthcare settings, locally tailored HIV testing initiatives in nonhealthcare settings, and specific efforts to increase the frequency of testing for individuals with increased potential for acquiring HIV. Because HIV testing is such a crucial part of the core activities of the Centers for Disease Control and Prevention's HIV prevention programs, there are many examples of evidence-based programs and best practices for HIV testing in both clinical and nonclinical settings. This article reviews the evidence base for these strategies and some of the activities proposed under the Diagnose pillar to achieve the goal of diagnosing all HIV infections as early as possible. All other Ending the HIV Epidemic in the U.S. activities start with an awareness of HIV status, which is actually the indicator for which most health departments are closest to the proposed targets. There are both proven and emerging approaches to increasing HIV screening and increasing the frequency of HIV screening available. The Ending the HIV Epidemic in the U.S. initiative provides the motivation, the resources, and a coordinated plan to bring them to scale.

The Impact of the Evolving Human Immunodeficiency Virus Response on the Epidemiology of Tuberculosis in South African Children and Adolescents.

Few studies have evaluated tuberculosis control in children and adolescents. We used routine tuberculosis surveillance data to quantify age- and human immunodeficiency virus (HIV)-stratified trends over time and investigate the relationship between tuberculosis, HIV, age, and sex. All children and adolescents (0-19 years) routinely treated for drug-susceptible tuberculosis in South Africa and recorded in a de-duplicated national electronic tuberculosis treatment register (2004-2016) were included. Age- and HIV-stratified tuberculosis case notification rates (CNRs) were calculated in four age bands: 0-4, 5-9, 10-14, and 15-19 years. The association between HIV infection, age, and sex in children and adolescents with tuberculosis was evaluated using multivariable logistic regression. Of 719 400 children and adolescents included, 339 112 (47%) were 0-4 year olds. The overall tuberculosis CNR for 0-19 year olds declined by 54% between 2009 and 2016 (incidence rate ratio [IRR] = 0.46; 95% confidence interval [CI], .45-.47). Trends varied by age and HIV, with the smallest reductions (2013-2016) in HIV-positive 0-4 year olds (IRR = 0.90; 95% CI, .85-.95) and both HIV-positive (IRR = .84; 95% CI, .80-.88) and HIV-negative (IRR = 0.89; 95% CI, .86-.92) 15-19 year olds. Compared with 0- to 4-year-old males, odds of HIV coinfection among 15-19 year olds were nearly twice as high in females (adjusted odds ratio [aOR] = 2.49; 95% CI, 2.38-2.60) than in males (aOR = 1.35; 95% CI, 1.29-1.42). South Africa's national response to the HIV epidemic has made a substantial contribution to the observed declining trends in tuberculosis CNRs in children and adolescents. The slow decline of tuberculosis CNRs in adolescents and young HIV-positive children is concerning. Understanding how tuberculosis affects children and adolescents beyond conventional age bands and by sex can inform targeted tuberculosis control strategies.

Asymptomatic malaria parasitaemia among HIV infected children and adolescents

Background: Malaria manifests with life-threatening manifestations resulting in hospital admissions and sometimes death may ensue. This is more devastating among children due to high susceptibility resulting from impaired immune system following severe malaria. Human immunodeficiency virus (HIV) coinfection with malaria further compromises the immune system and increases the vulnerability. The effect of co-trimoxazole prophylaxis in curtailing malaria has not being well evaluated in our environment where both malaria and HIV are endemic. This study sets out to determine the magnitude of asymptomatic malaria among HIV-infected children and adolescents receiving care at our facility. Study Design: This was a descriptive cross-sectional study. Materials and Methods: A prospective study among HIV-infected children aged 2–18 years was enrolled in our care. Nonprobability convenience sampling was used to recruit individuals who fulfilled the criteria. Questionnaire and patients' medical records were used to gather some data. A sample was taken for malaria parasite microscopy. The analysis was done using the Statistical Package for the Social Sciences version 20. Categorical variables were presented as percentages and association assessed using Chi-square test, whereas continuous variables were presented as mean and standard deviation, and the association between two means was checked using Student's t-test. Results: The mean age of the study population is 7.02 ± 2.97 years. Of the 420 participants in this study, 92 (45.7%) had confirmed malaria. There was no significant difference in the gender, age groups, and viral loads of patients with malaria. Conclusion: There is a high prevalence of malaria coinfection with HIV in this study.

Assessing the clinical and anthropological profile of HIV+ Adolescents in Surat, Gujarat: a cross-sectional study

Introduction: Adolescents (10–19 years) and young people (20–24 years) continue to be vulnerable to Human Immunodeficiency Virus (HIV) infection despite efforts to date. HIV-infected adolescents with long standing HIV infection often face considerable physical challenges - delayed growth and development, stunting/wasting and malnutrition. Objectives: (a) To study the clinical profile of HIV infected adolescents (b) To assess the anthropometric profile using age-standardized scores. Method: The cross-sectional study was conducted at HIV clinic, at Anti-retroviral Treatment (ART) Centre, Surat (Tertiary Care Level Institute) among adolescents between age-group 13-19 years during December-2015 to February-2016. Based on the desk review, total 134 adolescents were identified, out of which 105, could be contacted during study period and fit in the inclusion criteria. Participants who were alive, on Pre-ART/ART and their status had been disclosed and gave consent for the interview were included in the study. Results: Majority of the participants were on ART (95.3%). About half (55.6%) of the participants had suffered from opportunistic infection. Majority of the patients were at WHO stage I (93.75). Mean CD4 count during study was 640 cells/cubic mm (SD±401.42). Out of 105 participants, 14.5% were suffering from severe thinness and 14.5% were suffering from thinness &amp; 36.2% participants were suffering from severe stunting and 16.4% were suffering from stunting. Mean age of participants was 15.64 years (SD ±2.02). Majority of the participants belonged to Socio-economic class IV (36.8%) and class III (31.1%) followed by Class V (17%), class II (13.2%) and Class I (1.9%). Conclusion: The anthropometric measurements suggest that nutrition aspect is not fully recovered, as majority of the participants suffer from stunting and wasting; stunting more than wasting indicating chronic malnutrition.

Disclosure of status among Human Immunodeficiency Virus-infected adolescents

Background: Disclosing a positive Human Immunode ciency Virus (HIV)-infection status to a child pose major challenges to caregivers for various reasons. Objective: This study aims to determine the prevalence, pattern and effect of disclosure among HIV-infected adolescents attending a tertiary hospital in Nigeria. Materials and Methods: A cross-sectional study among adolescents attending the HIV Paediatric clinic at the University of Abuja Teaching Hospital, Gwagwalada. A questionnaire was administered after ethically age-appropriate consent and assent had been obtained from the adolescents or adolescent/caregiver pairs. Blood was also drawn for CD4 count and viral load assay. Results: One hundred and forty-five adolescents participated in the study. Eighty (55.2%) were males, 78(53.8%) aged 10-13 years while 91(62.7%) had secondary level of education. Fifty-nine (40.7%) adolescents had been disclosed to. The mean age of disclosure was 14.6±2.2. Disclosure was mostly by mothers (n = 32; 22.1%), at home (n = 43; 29.7%) and their status revealed by 14 (23.7%) of the adolescents to mainly their siblings (n = 10; 6.9%). At disclosure, 19 (13.1%) felt bad/sad while 18 (12.4%) were indifferent. The preferred age for disclosure was 14–16 years (n = 33; 22.8%). There was a statistically significant relationship between disclosure and; adolescents' age (P =

Cytomegalovirus co-infection with HIV in children and adolescents on antiretroviral therapy in Abuja, Nigeria

Background: Cytomegalovirus (CMV) co-infection with human immunodeficiency virus (HIV) is known to accelerate HIV disease progression. It has the potential of being a killer disease or a silent lifetime companion in HIV patients. There is dearth of information on CMV prevalence among HIV infected children and adolescents in our environment. We therefore conducted this study to determine its sero-prevalence, and risk factors for co-infection among HIV infected children and adolescents on highly active antiretroviral therapy (HAART) in our center. Method: A descriptive cross sectional study of HIV-infected children and adolescents aged 2 months to 18 years on HAART was conducted over a 6 month period between October 2017 and March 2018 in our health facility. Blood samples of subjects were screened for CMV IgM using commercial test kits. Biodata of subjects, CD4 cell count, and viral load were collected into a designed proforma, and statistical analysis was done with SPSS version 22.0.Result: A total of 161 HIV-infected children and adolescents were recruited, 103 (64.0%) were males, 83 (51.6%) were between the ages of 5 and 0.05). Multivariate analysis however did not show any significant difference in age, weight, length/height, and systolic blood pressure. Conclusion: The prevalence of active CMV infections among HIV infected children and adolescents on HAART in our centre is high. Low CD4 cell count and high viral load were not associated with active CMV disease, and no risk factor for co-infection was also identified. Identifying those with primary/active infection will be necessary for possible treatment with anti-herpes drugs before development of reactivated CMV disease. Keywords: CMV; HIV; co-infection; anti-retroviral; children; adolescents

Neurocognitive Development in Perinatally Human Immunodeficiency Virus-infected Adolescents on Long-term Treatment, Compared to Healthy Matched Controls: A Longitudinal Study.

A cross-sectional analysis of the Neurological, cOgnitive and VIsual performance in hiv-infected Children cohort showed significant cognitive impairment in combination antiretroviral therapy (cART)-treated, perinatally human immunodeficiency virus (HIV)-infected adolescents (PHIV+) compared to age-, sex-, ethnicity- and socioeconomic status (SES)-matched HIV-negative controls (HIV-). In this longitudinal study, we compared cognitive development in the same adolescents over time. We repeated the standardized cognitive test battery after a mean of 4.6 years (standard deviation 0.3). In participants who completed both assessments, we compared cognitive trajectories between groups in the domains of intelligence quotient (IQ), processing speed, working memory, executive functioning, learning ability, and visual-motor function, using linear mixed models. We explored associations with disease- and treatment-related factors and used multivariate normative comparison (MNC) to determine the prevalence of cognitive impairment. There were 21 PHIV+ and 23 HIV- participants that completed 2 assessments and were similar concerning age, sex, ethnicity, and SES. Compared to HIV- participants, in PHIV+ participants the IQ score increased significantly more over time (group*time 6.01, 95% confidence interval [CI] 1.5-10.50; P = .012), whereas executive functioning decreased significantly more (group*time -1.43 z score, 95% CI -2.12 to -0.75; P < .001), resulting in the disappearance and appearance of significant differences. Processing speed, working memory, learning ability, and visual-motor function trajectories were not statistically different between groups. Univariately, those who had started cART at an older age deviated more in executive functioning (-0.13 z score, 95% CI -0.24 to -0.02; P = .043). The prevalence of cognitive impairments by MNC was similar in both groups, at both time points. The cART-treated PHIV+ adolescents appeared to have similar global cognitive development, compared to their healthy peers. Executive functioning trajectory appears to deviate, potentially explained by earlier brain damage.

Causal comparative effectiveness analysis of dynamic continuous-time treatment initiation rules with sparsely measured outcomes and death.

Evidence supporting the current World Health Organization recommendations of early antiretroviral therapy (ART) initiation for adolescents is inconclusive. We leverage a large observational data and compare, in terms of mortality and CD4 cell count, the dynamic treatment initiation rules for human immunodeficiency virus-infected adolescents. Our approaches extend the marginal structural model for estimating outcome distributions under dynamic treatment regimes, developed in Robins et al. (2008), to allow the causal comparisons of both specific regimes and regimes along a continuum. Furthermore, we propose strategies to address three challenges posed by the complex data set: continuous-time measurement of the treatment initiation process; sparse measurement of longitudinal outcomes of interest, leading to incomplete data; and censoring due to dropout and death. We derive a weighting strategy for continuous-time treatment initiation, use imputation to deal with missingness caused by sparse measurements and dropout, and define a composite outcome that incorporates both death and CD4 count as a basis for comparing treatment regimes. Our analysis suggests that immediate ART initiation leads to lower mortality and higher median values of the composite outcome, relative to other initiation rules.

Craniofacial morphology of HIV infected adolescents on highly active antiretroviral therapy (HAART): An original research

Background: Numerous studies have illustrated the therapeutic effects of the highly active antiretroviral therapy (HAART) while simultaneously leading to a plethora of associated adverse effects including changes in the craniofacial growth and development. The present study was planned to analyze the craniofacial morphology in adolescents by evaluating the skeletal cephalometric profile of the human immunodeficiency virus (HIV)-infected patients in this age group and comparing them with the HIV-negative controls. Methods: The present study was a planned case–control study that included 25 HIV-positive adolescent patients aged between 10 and 19 years (study group) who were compared with 25 age and sex-matched HIV-negative adolescent controls (control group). All the patients had been HIV-infected via vertical transmission with positive serology confirmed in two different tests and had been on HAART since they were born. Results: In the 10 to 12-year age group, positions of maxilla and mandible in the study group were found to be retruded in relation to the skull base when compared with the control group whereas in the 13 to 15 and 16 to 18-year age groups, maxilla was retruded slightly while the mandible was found to be protruded in the study group in relation to the skull base. Conclusion: Although the differences in majority of the measurements made were not found to be significant enough, the study highlighted the significance of further studies to be conducted in this regard, especially, the longitudinal study designs wherein the said variables can be studied on a follow-up basis to have an idea of the exact changes observed and their pattern in the included groups.

Measles Seroprevalence and Vaccine Responses in Human Immunodeficiency Virus-infected Adolescents and Adults: A Systematic Review.

The World Health Organization (WHO) recommends an additional dose of measles-containing vaccine (MCV) for human immunodeficiency virus (HIV)-infected children receiving highly active antiretroviral therapy following immune reconstitution. We conducted a systematic review to synthesize available evidence regarding measles seroprevalence and measles vaccine immunogenicity, efficacy, and safety in HIV-infected adolescents and adults to provide the evidence base for recommendations on the need for measles vaccination. We conducted searches of 8 databases through 26 September 2017. Identified studies were screened independently by 2 reviewers. The search identified 30 studies meeting inclusion criteria. Across studies, measles seroprevalence among HIV-infected adolescents and adults was high (median, 92%; 27 studies), with no significant difference compared to HIV-uninfected participants (10 studies). In 6 studies that evaluated the immunogenicity of MCVs among seronegative HIV-infected adults, measles seropositivity at end of follow-up ranged from 0% to 56% (median, 39%). No severe adverse events were reported following measles vaccination in HIV-infected patients. Based on similar measles seroprevalence between HIV-infected and HIV-uninfected adolescents and adults, and the low response to vaccination, these studies do not support the need for an additional dose of MCV in HIV-infected adolescents and adults. These findings support WHO guidelines that measles vaccine be administered to potentially susceptible, asymptomatic HIV-infected adults, and may be considered for those with symptomatic HIV infection if not severely immunosuppressed. Measles-susceptible adolescents and adults, regardless of HIV status, may require targeted vaccination efforts to reach critical vaccination thresholds and achieve regional elimination goals.

Mental Health Problems Experienced by HIV Positive Adolescents; A Case of Choma District, Zambia

Several scholars have reported high mental health problems among adolescents with Human Immunodeficiency Virus (HIV) globally. However, little is known about the mental health of this peculiar group of young people in Choma district. This study aimed to determine the mental health problems experienced by HIV positive adolescents in Choma District. Using the Strengths and Difficulties Questionnaire (SDQ), data were obtained from 103 HIV positive adolescents receiving treatment at Choma General Hospital plus a corresponding number of parents/care givers. Information about mental health services was obtained qualitatively from 10 nurses working in the mental health unit and the Antiretroviral (ART) clinic. The results showed that more than three quarters of the adolescents had mental health problems. Of this number, 57.3 percent had multiple mental health problems: predominantly emotional and peer problems. The study also found a statistically significant relationship between level of stigma and presence of mental health problems (X2 = 1.123, P = 0.003). In conclusion, the study demonstrated that multiple mental health problems particularly emotional and peer problems are prevalent among adolescents with HIV/AIDS yet are most often undiagnosed. In addition, adolescents with high levels of internalized stigma are more likely to have multiple mental health problems. The findings suggest the need to integrate psychiatric services into routine care of HIV infected adolescents, routine screening for mental health problems and provision of continued professional development among nurses managing these patients.

Premature Atherosclerosis in HIV-Infected Pediatric Patients: Literature Review and Clinical Approach

Human immunodeficiency virus infected children and adolescents are a pediatric group with increased risk of premature cardiovascular disease. The virus itself, the antiretroviral therapy and the lifestyle establish a complex interplay of factors that promotes an accelerated atherosclerosis. This process is probably mediated by dyslipidaemia, dysregulation of glucose metabolism, lipodystrophy, inflammation, endothelial dysfunction and a prothrombotic state. The clinical approach to this population in terms of cardiovascular prevention is mainly based on efficient treatment of the infection, reduction of the modifiable risk factors and promotion of lifestyle changes.

Incidence and Predictors of Viral Suppression in a Cohort of Perinatally Human Immunodeficiency Virus-Infected Children and Adolescents

Incidence and Predictors of Viral Suppression in a Cohort of Perinatally Human Immunodeficiency Virus-Infected Children and Adolescents

Influence of Early Combined Antiretroviral Therapy on Maintenance of Long-Term Serological and Cellular Immune Response to Varicella Vaccination in Perinatally Human Immunodeficiency Virus-Infected Children and Adolescents

Influence of Early Combined Antiretroviral Therapy on Maintenance of Long-Term Serological and Cellular Immune Response to Varicella Vaccination in Perinatally Human Immunodeficiency Virus-Infected Children and Adolescents