Human Immunodeficiency Virus Negative Children Research Articles

Microalbuminuria in Children: A Comparative Study of HIV-Infected and Non-Infected Children in Jos, Nigeria

Background and Aim: Kidney disease occurs frequently in human immunodeficiency virus (HIV) infected individuals and is a leading contributor to morbidity and mortality in patients with HIV. Early detection of kidney damage will aid in instituting interventional measures that could slow down or halt the progression of kidney disease. The aim of this study was to determine the prevalence and risk factors of microalbuminuria in HIV infected children in Jos, Nigeria and compare them with those of HIV negative children. Methods: A total of 135 HIV infected and 135 HIV uninfected children aged 1-18 years were screened for microalbuminuria using microalbumin 2-1 combo test strips. Logistic regression analysis was used for determination of the association between microalbuminuria and various predicted risk factors. Results: Thirty (22.2%) HIV infected and 13 (9.6%) uninfected children had microalbuminuria (p = 0.001). Logistic regression analysis showed that an increase in the WHO clinical stage was significantly associated with the presence of microalbuminuria in HIV infected children (p = 0.004). Conclusion: The prevalence of microalbuminuria is higher in HIV infected children, as such the detection of microalbuminuria as early as possible in the course of the disease and prompt initiation of therapy are very important in our resource poor environment.

Echocardiographic Assessment of Ventricular Function in Children with Human Immunodeficiency Virus on Highly Active Antiretroviral Therapy

Background: Children with Human Immunodeficiency Virus (HIV) infection could present with varying degrees of cardiac abnormalities, however the effect of Highly Active Antiretroviral Therapy (HAART) has not been extensively studied in them.
 Objectives: To compare the ventricular functions of HIV positive children on HAART with that of HIV negative children using echocardiography.
 Methods: This was a comparative cross sectional descriptive study involving 54 HIV positive children on HAART and 50 HIV negative controls. Using transthoracic echocardiography, trans annular plane systolic excursion (TAPSE), Left ventricular ejection fraction (LVEF), Left ventricular fractionating shortening (LVFS), Left ventricular (LV) mitral inflow velocities, left ventricular mass index (LVMI) and Left ventricular hypertrophy (LVH) were used to assess right ventricular (RV) and left ventricular (LV) function.
 Results: The mean TAPSE for subjects and controls were 26.78±5.92mm and 25.82±3.59mm respectively (t = 1.0, p = 0.32). The prevalence of right ventricular systolic dysfunction using TAPSE was significantly higher among the subjects; 29.63% compared with 8.0% in controls (χ2 = 7.82, p=0.005). There was no significant correlation between TAPSE and CD4 counts (Spearman’s correlation coefficient = 0.15, p = 0.31). The mean left ventricular mass index (LVMI) in subjects was 141.6±45.5g/M2. Forty-one (75.9%) of the subjects had left ventricular hypertrophy (LVMI > 103G/M2) compared with 26.0% (13/50) of the controls and the difference in proportion was significant (Chi-square = 30.49, p<0.001). Left ventricular systolic function was similar in subjects and controls. The prevalence of left ventricular diastolic dysfunction was significantly higher in subjects (15.5%) than in controls (4.0%); {χ2 = 37.89, p<00.1)
 Conclusion: This study shows that children with HIV on HAART regimen have a very high prevalence of ventricular dysfunction compared with normal controls.

Revised Antituberculosis Drug Doses and Hepatotoxicity in HIV Negative Children.

To compare the incidence of anti tuberculosis drug-induced hepatotoxicity (ATDH) with those on old vs. revised WHO doses in human immunodeficiency virus (HIV) negative children. The secondary objective was to determine the overall incidence of hepatitis in children on Anti tubercular treatment (ATT) and isoniazid prophylactic therapy (IPT). Children attending pediatric outpatient / admitted in wards, on ATT/ IPT between January 2007 and December 2017 (11 y) were included. Children were divided into Group 1 (treated based on old doses, from January 2007 to December 2011) and Group 2 (treated based on revised doses from January 2012 to December 2017). Children with multi drug resistant tuberculosis (MDRTB) and pre-existing liver disease were excluded. A total of 515 children were enrolled. Twelve children developed ATDH with an overall incidence of 2.3%. Five out of 260 (1.9%) developed hepatitis with old doses vs. 7 of the 255 (2.7%) with revised doses; this difference was not statistically significant. When calculated only for active TB (excluding children on IPT), overall incidence of hepatitis was 2.7%. Comparison between group 1 (2.04%) and group 2 (3.5%) was again not statistically significant. Ten out of 12 children who developed hepatitis were restarted on ATT without recurrence. No child on IPT developed hepatitis. There was no mortality. Revised WHO dosing does not increase incidence of hepatitis compared to old dosing in HIV negative children. Overall incidence was 2.3%. Hepatitis did not occur with IPT.

Pharmacokinetics of First-Line Drugs Among Children With Tuberculosis in Rural Tanzania.

Dosing recommendations for treating childhood tuberculosis (TB) were revised by the World Health Organization, yet so far, pharmacokinetic studies that have evaluated these changes are relatively limited. We evaluated plasma drug concentrations of rifampicin (RIF), isoniazid (INH), pyrazinamide (PZA), and ethambutol (EMB) among children undergoing TB treatment in Tanzania when these dosing recommendations were being implemented. At the end of intensive-phase TB therapy, blood was obtained 2 hours after witnessed medication administration to estimate the peak drug concentration (C2h), measured using high-performance liquid chromatography or liquid chromatography-tandem mass spectrometry methods. Differences in median drug concentrations were compared on the basis of the weight-based dosing strategy using the Mann-Whitney U test. Risk factors for low drug concentrations were analyzed using multivariate regression analysis. We enrolled 51 human immunodeficiency virus-negative children (median age, 5.3 years [range, 0.75-14 years]). The median C2hs were below the target range for each TB drug studied. Compared with children who received the "old" dosages, those who received the "revised" WHO dosages had a higher median C2h for RIF (P = .049) and PZA (P = .015) but not for INH (P = .624) or EMB (P = .143); however, these revised dosages did not result in the target range for RIF, INH, and EMB being achieved. A low starting dose was associated with a low C2h for RIF (P = .005) and PZA (P = .005). Malnutrition was associated with a low C2h for RIF (P = .001) and INH (P = .001). Among this cohort of human immunodeficiency virus-negative Tanzanian children, use of the revised dosing strategy for treating childhood TB did not result in the target drug concentration for RIF, INH, or EMB being reached.

Prevalence of hepatitis C Antibody in Human Immunodeficiency Virus infected children

Background: Hepatitis C virus (HCV) is a major public health problem for Human Immunodeficiency virus (HIV) infected population. Both infections share same routes of transmission, and quite often co-exist, with dual infections associated with reciprocal and mutually more rapid progression than either infection alone. Co-infection also adversely impacts on the course and management of both infections. This study was carried out to document the prevalence and determinants of HCV sero-positivity in HIVinfected children.Methodology: A total of 132 HIVinfected children attending the Paediatric Antiretroviral Clinic were recruited as subjects. Another 132 HIV negative children matched for age and sex were recruited as controls. Relevant demographic data was taken from each child. Blood samples were also obtained from each child and from their mothers when available, and assayed for the presence of anti-HCV using a membranebased immune-assay kit.Results: The sero-prevalence of HCV antibodies was 9.8% among HIV-infected children and 3.0% among the controls. This was a statistically significant difference (p = 0.042, Fisher exact). HCV sero-postivity was more frequent in children after 5 years of age in both subjects (92.3%) and controls (100.0%). Injection at patent medicine vendor (PMV) was noted to be the most risky practice leading to HCV in children, with more than thrice the chances of HCV sero-positivity than in those who didn’t receive injections at PMV. Four mothers of the HIV-infected children were co-infected with HCV and none in the control group. All 4 children of these dually infected mothers were also co-infected. Controlling for other factors, children of HIV infected mothers were more than twice as likely to have HCV antibody as children whose mothers were HIV negative (RR = 2.67). Similarly, HCV infected mothers have 12% greater chance of transmitting HCV to their children than noninfected mothers and children delivered vaginally were 1.6 times more likely to have HCV antibody than those delivered via caesarean section.Conclusions: The prevalence of anti-HCV in HIV-infected children is significantly higher than that of HIV uninfected peers. Factors strongly associated with HCV sero -positivity identified are maternal HIV and HCV infections, vaginal delivery and injections at patent medicine vendor.Keywords: HCV; HIV; children

Salivary IgA versus HIV and Dental Caries.

The inter-relationship of Human Immunodeficiency Virus (HIV) infection and dental caries as well as Salivary Immunoglobulin-A (S-IgA) level appear to remain under explored while a manual and electronic search of the literature was made. Hence, the present study was undertaken to assess the relationship of S-IgA and dental caries status in HIV positive children. The aim of this study was to find out the relationship of S-IgA antibody with dental caries by measuring the concentration of IgA in saliva of HIV positive and negative children and determine the dental caries status in HIV positive and HIV negative children, which may help in treatment planning and prevention of the same. A total of 28 HIV positive children aged between 6-14 years and 28 age matched HIV negative children were included in this study and both samples were randomly selected from the same Non-Governmental Organization (NGO). The HIV status of both these samples was confirmed from their medical records provided by the NGO. Only 2cc of unstimulated saliva was collected from both groups in special tubes coded numerically using the method described by Collins and Dawes and the samples were analyzed to measure the concentration of IgA using commercially available ELISA kit (DRG Diagnostics, Germany). Examination of dental caries was carried out according to WHO criteria (1997) using a flat mouth mirror and CPI probe. In HIV +ve group mean S-IgA level was calculated as 81.61 ± 6.20 μg/ml, mean DMFT was 3.86 ± 3.37, mean deft was 4.75 ± 2.86. In HIV -ve group mean S-IgA level was calculated as 145.57 ± 17.83μg/ml, mean DMFT was 2.54 ± 0.69, mean deft was 2.43 ± 2.01. Strong-ve correlation between S-IgA and DMFT (r = -0.781, t = 6.38, p < 0.001) and negative but Not Significant (N.S.) correlation (r = -0.19, t = 0.99, p > 0.05) between S-IgA and deft was found in HIV +ve group. Strong -ve correlation between S-IgA and DMFT (r = -0.655, t = 4.42, p < 0.001), S-IgA and deft (r = -0.942, t =14.32, p=<0.001) was found in HIV-ve group. This study suggests that the individuals who are suffering from IgA deficiency in general, are more susceptible to dental caries than normal individuals.

Tuberculosis in children of HIV-infected parents

Context: Tuberculosis (TB) in children of human immunodeficiency virus (HIV) infected parents is of concern.Aims: To study the proportion of children of HIV-infected parents who suffered from TB and to study some of the associated risk factors.Settings and Design: Cross-sectional study design.Materials and Methods: Ethical approval and informed consent were taken. A total of 385 children of HIV-infected parents were studied for TB.Statistical Analysis Used: Proportion, Chi-square test.Results: In the study, it was found that there were 191 (49.6%) HIV-positive children, 136 (35.6%) HIV negative children and in 58 (14.8%) children, the HIV status was unknown. 53 (13.8%) out of 385 children had suffered from TB. Among these 50 children were HIV positive and three children were HIV negative.Conclusions: The only significant risk factor for TB in children of HIV-infected parents was HIV infection in children. Therefore, it is recommended that the HIV positive parents should be counseled to get their children tested at an integrated counseling and testing center because it was found that 15% of children had unknown HIV status. Once it is known that the child has HIV infection, effective measures should be taken to prevent TB since they are significantly at an increased risk of TB.

Age, nutritional status and INH acetylator status affect pharmacokinetics of anti-tuberculosis drugs in children

The currently recommended dosages of rifampicin (RMP), isoniazid (INH), pyrazinamide (PZA) and ethambutol in children are extrapolated from adult pharmacokinetic studies, and have not been adequately evaluated in children. To describe the pharmacokinetics of RMP, INH and PZA given thrice weekly in children with tuberculosis (TB), and to relate pharmacokinetics to treatment outcomes. Eighty-four human immunodeficiency virus negative children with TB aged 1-12 years in Chennai and Madurai, India, were recruited. Phenotypic INH acetylator status was determined. Nutritional status was assessed using Z scores. During the intensive phase of anti-tuberculosis treatment, a complete pharmacokinetic study was performed after directly observed administration of drugs. At 2 and 6 months, drug levels were measured 2 h post-dose. Drug concentrations were measured using high performance liquid chromatography and pharmacokinetic variables were calculated. Multivariable regression analysis was performed to explore factors impacting drug levels and treatment outcomes. Children aged <3 years had significantly lower RMP, INH and PZA concentrations than older children, and 90% of all children had sub-therapeutic RMP Cmax (<8 μg/ml). Age, nutritional status and INH acetylator status influenced drug levels. Peak RMP and INH concentrations were important determinants of treatment outcome. Recommendations for anti-tuberculosis treatment in children should take these factors into consideration.