Immunodeficiency Virus-infected Children Research Articles

Prevalence of cardiac complications in perinatally acquired human immunodeficiency virus infection in children in Southern India: an observational study

Background: Human immunodeficiency virus (HIV) infection is a multisystemic illness that impacts most organ system, to investigate prevalence of cardiovascular abnormalities in children with perinatally acquired HIV infection. Methods: This observational study was conducted in a tertiary care centre in Southern India. HIV-positive children between the ages of 18 months and 15 years were included. Cardiac abnormalities were defined as abnormalities identified on 2D echocardiography and/or electrocardiogram. Results: The 73 children with HIV infection had their cardiac manifestations assessed. Median age of children was 8 years with 52% of female participants, 22 (30.13%) children had cardiac abnormalities, of which 5 (27.27%) were symptomatic. Overall, 21/22 (95.45%) children had abnormalities on their ECG, 16 (72.72%) had abnormalities on 2D echocardiography. Of these, we found that children with delayed diagnosis of HIV infection and with more advanced clinical and immunological staging in HIV are more prone to develop cardiac complications irrespective of antiretroviral therapy (ART). Conclusions: HIV-related heart involvement is not uncommon, rather occur subclinical. A decreasing CD4 count and worsening clinical status are associated with increased risk. Hence its crucial to screen the children, diagnose at the earliest and timely manage the complications appropriately for prevention of early mortality.

Perceptions and challenges among health care providers about HIV-TB co-infected children- A qualitative study

BackgroundHuman immunodeficiency virus – Tuberculosis (HIV-TB) co-infected patients have a greater risk of mortality, treatment failure, and recurrence. The significant morbidity and mortality rates associated with tuberculosis and human immunodeficiency virus infection in children cause concern. India aims to enhance the detection and treatment of HIV-TB cases in children and coordinate TB & HIV care. ObjectiveTo explore the perceptions and challenges of health care providers regarding the diagnosis and treatment of Tuberculosis in HIV-TB co-infected children. Materials and methodIn-depth interviews among 14 health care providers were conducted in ART centers of 5 talukas of Belagavi district to identify health care providers' perceptions and challenges regarding pediatric HIV-TB diagnosis and treatment. Interviews were conducted after receiving informed consent. ResultsChallenges during HIV-TB diagnosis and treatment in children: difficult to get sputum sample for CBNAAT and child was unable to complain about symptoms, caregivers were not able to mention the signs/symptoms correctly, unavailability of a pediatrician in few Taluka ART centers, delay in receiving TB lab report, challenging to feed drugs to an infant, higher loss to follow-up, financial problem, distance from centers, low community awareness, poverty and illiteracy, stigma and death due to TB treatment default. ConclusionEfforts such as expanded health care providers, community education, and a constant supply of HIV rapid test kits are required to ensure successful diagnosis and treatment of HIV-TB co-infected children.

Regulation of T Helper and Regulatory T Cells by Lactobacillus Plantarum IS-10506 Supplementation to Human Immunodeficiency Virus-Infected Children Under Antiretroviral Therapy

Human immunodeficiency virus infection is associated with impairment of T helper 1, T helper 2, regulatory T, and T helper Type 17 homeostasis. While probiotics are widely known to improve these changes, understanding of their role on children’s immune system remains limited. In a randomized, double-blind, and placebo-controlled study conducted in Dr. Soetomo General Hospital, Surabaya from December 2012 to March 2013, we have investigated the effect of Lactobacillus plantarum IS-10506 on the regulation of T helper and regulatory T cell in children infected with human immunodeficiency virus receiving antiretroviral therapy for at least 6 months. Twenty-one human immunodeficiency virus infected children were divided into placebo and probiotic groups and L. plantarum IS-10506 was administered at a dose of 2.86 × 1010 colony forming units/day for 6 weeks. Levels of interferon-γ, interleukin-4, transforming growth factor-β, and interleukin-17 were analyzed before and after treatment as an indicator of T-cell regulation of T helper and regulatory T cells. The results show a significant increase in transforming growth factor-β level ( p = 0.003) after administration of L. plantarum IS-10506 compared to placebo with the first-line antiretroviral therapy group. There was no reported adverse effect in this study. In conclusion, L. plantarum IS-10506 increases the regulation of regulatory T cell in human immunodeficiency virus infection in children receiving first-line antiretroviral therapy treatment.

Lymphocytic interstitial pneumonia in an infant with diffuse cystic pulmonary tuberculosis

Background: Lymphocytic interstitial pneumonia (LIP) is a rare disorder causing diffuse involvement of the lung parenchyma, including cystic changes. It is generally associated with autoimmune diseases in adults and human immunodeficiency virus infection in children. Concurrent LIP with pulmonary tuberculosis (TB) is rare and has not been reported in the pediatric population. Clinical Description: An 8-month-old infant who was recently diagnosed with miliary pulmonary TB and on antitubercular treatment presented with fast breathing for 2 days. Salient examination findings were tachypnea, with oxygen saturation of 84% in room air. High-resolution computed tomography of the chest showed diffuse involvement of both lungs with bilateral cystic changes. Histopathological examination of a lung biopsy specimen was consistent with LIP. Management: First-line antitubercular therapy was continued as per the national guideline, and methylprednisolone pulse was administered for 3 days followed by maintenance prednisolone for 8 weeks. The child responded well clinically and was kept under close follow-up. Radiological improvement became apparent at 15-month follow-up. Conclusion: Presence of diffuse cystic lung disease in pulmonary TB should raise suspicion for LIP. Lung biopsy is diagnostic and should be considered in such cases.

Visual Status of HIV and Non-HIV Infected Children in Relation to Anti-retroviral Drug Use and CD4+ Count in Jos, Plateau State Nigeria

In immunodeficiency diseases such as Human Immunodeficiency Virus (HIV) infection, various body functions may be affected; visual function could be one of them. In a child, there are predictable adverse outcomes of the disease that bother physical and mental development. This study sought to investigate any potential compromise of visual function amongst HIV-infected children on anti-retroviral drugs known as Highly Active Antiretroviral Therapy (HAART) use by comparing the visual acuity, colour sense and field of vision in infected and non-infected children. One hundred (100) children aged between 5 to 15 years consisting of fifty (50) HIV infected and fifty (50) non-HIV infected were selected through random sampling. Visual acuity test (Snellen’s method), colour sense test (Ishihara chart method) and field of vision test (confrontational method) were carried out. Latest Cluster of Differentiation 4 (CD4+) count of the HIV infected subjects also was collected. Statistical analysis was carried out using the Student T Test and ANOVA. The mean visual acuity of Human Immunodeficiency Virus (HIV) infected children was slightly low compared to the negative group (94.2±4.61and 96.4±12.58 respectively) but was not statistically significant (p>0.05). The mean of Ishihara colour sense test and that of the field of vision test also showed no statistically significant change between infected and non-infected children. Mean CD4+ count of the HIV infected children increased with age and use of anti-retroviral drugs. From 11 to 15 years, percentage defect in visual acuity increased amongst the HIV infected children, compared to the other ages but not statistically significant (p>0.05). It was concluded that visual acuity decreases slightly with improving CD4+ count and increasing age, for HIV positive children on anti-retroviral drugs. These parameters could be observed in subsequent years and subjects monitored for further investigation.

Prevalence of Electrocardiogram Abnormalities in Human Immunodeficiency Virus-Infected Children

HIV is an important cause of childhood morbidity and mortality affecting more than 1.3 million children worldwide, one of the morbidity is cardiac abnormalities. Cardiovascular abnormalities are still subclinical during childhood then become symtomatic in adulthood. Electrocardiography is effective to detect cardiac diseases. This study aimed to assess ECG changes in HIV infected children and describe ECG abnormalities in HIV-infected children with or without HAART. From 70 subjects, we found the most common abnormality was sinus tachycardia in 17 patients (24.3%), sinus bradycardia 1 patient (1.4%) and 2 patients with sinus arrhythmia (2.9%). The mean QTc interval was 0.42 seconds (±0.07) and 14 patients (20%) had prolongation. The mean PR interval was 0.12 seconds (±0.02), 11 patients (15.7%) experienced prolongation of PR interval. The mean QRS duration was 0.06 seconds (±0.09). Left ventricular enlargement was present in 6 patients (8.6%), conduction disturbance which is characterized by Bundle branch block was found in 2 patients (2.9%) and ST changes was seen in 2 patients (2.9%). Other ECG abnormalities are characterized by right ventricle hyperthropy in 4 patients and a patient had T tall. The prevalence of cardiac abnormalities based on ECG examination from this study was 51.3%, consist of heart rhythm abnormality, prolonged PR interval, prolonged QTc interval, bundle branch block, ventricle hypertrophy and ST changes.

Composition of Gut Microbiota of Children and Adolescents With Perinatal Human Immunodeficiency Virus Infection Taking Antiretroviral Therapy in Zimbabwe.

BackgroundHuman immunodeficiency virus (HIV) infection causes impairment of the gastrointestinal barrier, with substantial depletion of CD4+ T cells in the gut. Antiretroviral therapy (ART) restores CD4+ counts and may have beneficial effects on gut microbiota in adults. Little is known about effect of long-term ART on gut microbiome in HIV-infected children. We investigated composition of gut microbiota in HIV-infected and -uninfected children and assessed associations between gut microbiota and patient characteristics.MethodsIn a cross-sectional study, rectal swabs were collected from 177 HIV-infected and 103 HIV-uninfected controls. Gut microbial composition was explored using 16S ribosomal ribonucleic acid sequencing.ResultsHuman immunodeficiency virus-infected children had significantly lower alpha-diversity and higher beta-diversity compared to HIV-uninfected. No association was observed between microbiome diversity and CD4+ T-cell count, HIV viral load, or HIV-associated chronic lung disease. We found enriched levels of Corynebacterium (P < .01), Finegoldia (P < .01), and Anaerococcus (P < .01) in HIV-infected participants and enrichment of Enterobacteriaceae (P = .02) in participants with low CD4+ counts (<400 cells/mm3). Prolonged ART-treatment (≥10 years) was significantly associated with a richer gut microbiota by alpha diversity.ConclusionsHuman immunodeficiency virus-infected children have altered gut microbiota. Prolonged ART may restore the richness of the microbiota closer to that of HIV-uninfected children.

Viral suppression rate among children tested for HIV viral load at the Amhara Public Health Institute, Bahir Dar, Ethiopia

BackgroundHuman immunodeficiency virus (HIV) infected children represent a very vulnerable population for anti-retroviral therapy (ART) drug resistance. As a global target, 90% of patients receiving ART should have HIV-RNA viral suppression. A threshold of > 1000 RNA copies/ml is used to define non-suppressed viral load. If it is confirmed in the laboratory, adherence should be addressed and should be followed by the switch to second-line ART. Therefore, the aim of this study was to assess the rate of viral load suppression among children tested at the Amhara Public Health Institute (APHI), Bahir Dar.MethodsInstitutional based cross-sectional study design was conducted from July 01, 2017 to June 30, 2018, in children under the age of 15 years. Socio-demographic, clinical and HIV1RNA viral load data were collected from the excel database. The data were analyzed in SPSS 20.0 statistical software.ResultsA total of 1567 children, age ranged from one to 14 years, were tested for HIV viral load. Of which, about 54% were males. Children were treated using nevirapine-based (76.7%), efavirenz-based (21.8%) and protease inhibitor-based (1.5%) anti-retroviral drugs. Non-suppressed HIV viral load was found in 28.3% of the participants. High viral load (> 1000 cp/ml) were found in 24% of the children below the age of five years. Children on nevirapine-based treatment had about two times more non-suppressed viral load (Adjusted odds ratio [AOR]: 1.90; 95%CI: 1.41–2.56; P < 0.001) compared to those who had efavirenz-based treatment. However, adherence (P: 0.204) was not associated with non-suppressed viral load.ConclusionsThere was a high rate of non-suppressed HIV viral load among children tested at APHI. Specifically, the odds of having a non-suppressed viral load was higher in NVP based treatment users. Hence, comprehensive management and follow up of children on ART, and testing for resistance as well as viral load could help to reduce the problem in advance.

Long-term efficacy evaluation of antiretroviral therapy and genotypic resistance analysis among human immunodeficiency virus 1-infected children in Yunnan

Objective To evaluate the long-term efficacy of antiretroviral therapy and drug resistance among human immunodeficiency virus-1 (HIV-1)-infected children in Yunnan. Methods In this retrospective study, CD4+ T cell counts, HIV viral loads and genetic drug resistance results were obtained from HIV-1-infected children who were treated with antiretroviral treatment between January 2004 to July 2015. Results A total of 1 078 HIV/acquired immune deficiency syndrome (AIDS) children were treated with antiviral therapy. Before treatment, the average CD4+ cell number was (466.8±397.2) cells/μL. The percentages of children with CD4+ cell count >750 cells/μL after 1-year, 3-year, 5-year and 8-year treatment were 54.31%, 62.87%, 68.46% and 74.19%, respectively. Virological failure occurred in 150 HIV/AIDS children (13.9%), and the virological failure rate was 4.3/100 child-years. Among those 150 patients with virological failure, 104 cases (69.33%) exhibited genetic resistance to antiretroviral drugs. The prevalent mutations associated with drug resistance were M184V/I (75.0% [78/104]), K103N (43.3% [45/104]), G190A (29.8% [31/104]), Y181C (22.1% [23/104]), T215Y/F (20.2% [21/104]). Conclusions After long-term antiretroviral treatment, most of the HIV-infected children have restored the immunity and suppressed HIV viral replication successfully. HIV resistance is the main cause of virological failure. Drug resistance mutations mainly occur in nucleoside reverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitor, and the resistance rate of proteinase inhibitor is low. Early genetic resistance testing and switch to second-line therapy will improve the treatment outcome. Key words: Child; Treatment outcome; Drug resistance; Antiretroviral treatment

Impact of Human Immunodeficiency Virus Drug Resistance on Treatment of Human Immunodeficiency Virus Infection in Children in Low- and Middle-Income Countries

Children living with human immunodeficiency virus (HIV) in low- and middle-income countries (LMICs) experience higher rates of virologic failure than adults. Human immunodeficiency virus drug resistance (HIVDR) plays a major role in pediatric HIV treatment failure because nonsuppressive maternal antiretroviral therapy (ART) during pregnancy and breastfeeding as well as infant antiretroviral prophylaxis lead to high rates of pretreatment drug resistance to regimens most commonly used in children living with HIV. Lack of availability of durable, potent drugs in child-friendly formulations in LMICs and adherence difficulties contribute to acquired drug resistance during treatment. Optimizing drugs available for treating children living with HIV in LMICs, providing robust adherence support, and ensuring virologic monitoring for children receiving ART are essential for reducing HIVDR and improving treatment outcomes for children living with HIV in LMICs.

Human Immunodeficiency Virus as Progressive Primary Myopathy

Abstract Human immunodeficiency virus infection in children has a different way of presentation. The involvement of muscular system is most commonly described as pyomyositis because of opportunistic infections or myopathy secondary to highly active antiretroviral therapy in both children and adults. Primary myopathy presenting as a progressive weakness is usually seen in adults and rarely observed in children with only a few cases described in the literature. In this case, we report a 7-year-old Indian girl with perinatal HIV infection presenting with progressive weakness and otherwise asymptomatic. An improvement was observed after antiretroviral and rehabilitative therapy.

Virological and Immunological Long-Term Outcome of Human Immunodeficiency Virus-1 Infected Children Treated before One Year and after Two Years of Age in a Resource-Limited Setting of South Africa

Introduction: Benefits of early Highly Active AntiRetroviral Therapy (HAART) to reduce infant mortality and morbidity have been demonstrated in resource-limited and rich settings. However, immunovirological data collected in Sub-Saharan Africa are scarce. This study describes the long-term outcome of South African children who started HAART before one year of age (Early Starters Cohort or ESC) and compare their immunovirological outcomes to children who started their therapy after two years of age (Late Starters Cohort or LSC). Immunovirological results will be compared in order to evaluate the long-term non-inferiority of early treatment initiation. Methods: Fifty-five children were included in the ESC (mean follow-up period 7.9 years) and 96 children were included in the LSC (mean follow-up period 6.3 years). Children from the ESC and the LSC were subdivided into three subgroups according to CD4+% at HAART initiation ( 100 cp/ml) was comparable in both cohorts but persistent undetectable viral load (<50 cp/ml) after initial virological suppression was more frequent in the ESC (p=0.008). Finally, the proportion of children with detectable viral loads (50 to 1000 cp/ml) at least one time during the entire follow-up period was higher in the LSC (p=0.0022). Conclusion: HAART appeared highly effective in terms of immunovirological outcomes both in children treated before one and after two years of age. The results of this study demonstrate that early treated children more often achieved normal CD4+%, tended to have higher mean CD4+% and more sustained virological suppression. These results encourage the current international recommendations to initiate HAART as soon as possible in RLS.

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

Is Routine Therapeutic Drug Monitoring of Antiretroviral Agents Warranted in Human Immunodeficiency Virus-Infected Children?

Is Routine Therapeutic Drug Monitoring of Antiretroviral Agents Warranted in Human Immunodeficiency Virus-Infected Children?

Misclassification of Antiretroviral Treatment Failure Using WHO 2006 and 2010/2013 Immunologic Criteria in HIV-Infected Children and Adolescents in Western Kenya.

We evaluated treatment failure misclassification in human immunodeficiency virus-infected Kenyan children whose targeted viral loads were determined after suspected immunologic/clinical failure according to 2006 and 2010/2013 World Health Organization guidelines. The misclassification rate was 21% for the 2006 guidelines and 46% for the 2010/2013 guidelines, which supports current recommendations for routine viral load monitoring but not necessarily the proposed CD4 thresholds.

Clinical profile of human immunodeficiency virus infection in children: an interesting prospective study

Background: HIV infection has become a pandemic affecting both industrialized & developing countries. The increase in pediatric HIV infection has had a substantial impact on childhood mortality both in industrialized countries and developing countries. It is believed that this study will motivate research worker to work for further improvement of the disease, clinical presentation, diagnostic measures and management in already existing health care delivery system in a tertiary care centre in the tribal area and which may lead to even better survival and quality of life for these children. With the above background, the study is taken up to find the clinical profile of HIV infection in pediatric population in the study area. Methods: The current hospital based prospective study was carried out in the department of pediatrics, Shri V. N. Government Medical College, Yavatmal (Maharashtra), India from 1st January 2011 to 30th June 2012. 108 cases of HIV attending the pediatric OPD and IPD were included in the study. Importance of test was explained to the parents. HIV was diagnosed by using Standard Protocol. All those who were positive by ELISA, confirmed it by repeat test after 3 months. Western blot was not possible due to non availability of kits. Confirmations of all infections were done as per strategies suggested by WHO. Due to non-availability of specific but expensive test like PCR, p24 antigen assay or HIV Culture, children of PPTCT positive mother were tested on follow up after 18 month age to determine whether the transmission was vertical. Results: Majority (60.18%) cases in this study are below 5 years of age. Maximum cases 33(30.55%) were between 5-10yrs of age and 5 cases (4.62%) were below 18 months. Males 69(63.88%) outnumbered females 39(36.11%) with M: F ratio of 1.76:1. In the present study predominant route of transmission of HIV to the child was by perinatal (vertical) transmission (98.15%). Maximum 64(59.25%) were home delivered cases followed by 29(26.85%) normal hospital delivered and 6(5.55%) LSCS/instrumental delivered cases. In present study 60(55.55%) severe malnutrition (Group III and IV) was the most common examination finding. Of the total 108 cases enrolled in the study, 75 cases had regular follow up for 250 times and 33 cases did not follow up. Majority of follow ups were for respiratory complaints (23.20%) and fever (17.60%). Only 7.20% patients came for follow up were asymptomatic. Most of the follow up were for OI’s. In this study, 108 cases of the study group visited 250 times in our hospital. Out of these 90 cases had 212 episodes of OI’s and 18 cases had no evidence of OI’s. Conclusions: HIV infection is an unpredictable disease in infants, children and adolescent which involves multiple organ system and is characterized by progressive clinical deterioration and ultimate development of severe immune dysfunction with opportunistic infections and secondary cancers resulting in a chronic and very complex illness. HIV infected infant and children now survive to adolescent and adulthood, and the challenges of providing HIV care are evolving into the challenges of providing both acute and chronic, lifelong care.

Optimization of Antiretroviral Therapy in Human Immunodeficiency Virus-Infected Children and Adolescents: Systematic Review and Meta-Analysis to Inform 2015 World Health Organization (WHO) Guidelines

Optimization of Antiretroviral Therapy in Human Immunodeficiency Virus-Infected Children and Adolescents: Systematic Review and Meta-Analysis to Inform 2015 World Health Organization (WHO) Guidelines

PO-0231 Cardiac Involvement, Major Problem In Human Immunodeficiency Virus Infection In Children

Objectives The present the main clinical aspects and diagnostic of cardiac involvement induced by human immunodeficiency virus infection in children. Methods Patients: 51 children (2–16 years) with HIV infection/AIDS in various stages of evolution, with diverse symptoms affecting many organs. Evaluation of patients:clinical, ECG, Chest X ray, echocardiography (echo). Results 60% of patients were included in group P2f clinical staging by clinical exam and CD4 lymphocytes values. Signs of cardiac involvement: heart failure (11 cases), tachycardia (20 cases), deafness of the heart sounds ± gallop rhythm ± systolic murmur of mitral regurgitation (12), dyspneea (14 cases), other non-symptomatic (14) or with signs of others diseases. ECG : disturbances of ventricular repolarisation. Rx. CT: cardiomegaly (30% cases) ± aspects of pulmonary infections. Echo exam: cardiac involvement (66% cases): dilated cardiomyopathy, the most severe changes (14 cases), pericarditis (10), isolated dilation of the left and right ventricle (6), LV diastolic dysfunctional (14 cases), pulmonary hypertension (6). The severity and incidence of cardiac disease was associated with significant reduction of CD4 value Conclusion By the high incidence (66% of cases) and severity of clinical manifestations, cardiac suffering during HIV infection/AIDS is one of the most important problems of these patients. Cardiological evaluation of patients is necessary in all the stages of the infection, even non-symptomatic, for the diagnosis and follow-up of evolution. Echocardiography is the most sensitive noninvasive method for highlighting cardiac damage in these patients.

Nonadherence to first-line antiretroviral therapy among human immunodeficiency virus-1 infected children at the Jos University Teaching Hospital, Jos, Nigeria

Background: Nonadherence to antiretroviral therapy (ART) may encourage the development of resistance to antiretroviral drugs (ARVs). Poor adherence is known to be associated with ART failure which could compromise the benefits of ART in children. Therefore, it is important to identify the reasons why children on ART may fail to take their ARVs. In this study, we described the characteristics of human immunodeficiency virus-1 (HIV-1) infected children with ART nonadherence as well as the reasons for their nonadherence.Methodology: A retrospective cohort study in which data on 580 HIV-1 infected children enrolled on ART between February 2006 and December 2010 at the pediatric HIV clinic of the Jos University Teaching Hospital, Jos, was analyzed. Subjects were aged 2 months to 15 years. Information on adherence was obtained by child or caregiver self-report. They also had repeated adherence counseling during each clinic follow-up visit and were taught the use of alarm clocks daily for reminding them of when the next ARV dose will be due.Results: There were 30 (5.2%) children with non-adherence to ART. Among children with nonadherence, majority were: Children aged 1-10 years (76.7%), males (53.3%) and did not know their diagnosis of HIV (90.9%). The odds of nonadherence was two times higher among children who failed first-line ART compared with those who did not (odds ratio [95% confidence interval], 2.28 [1.03-5.02], P = 0.04). The most common reason for nonadherence was: Forgot to take medications (46.7%).Conclusion: The low rate of nonadherence to ART in this study could be attributed to repeated adherence counseling during each clinic follow-up visit and the use of alarm clocks daily for reminders on when the next ARV dose will be due.