Immunological Stage Research Articles

The cascade of care for children and adolescents with HIV in the UK and Ireland, 2010 to 2016.

IntroductionThe UNAIDS 90‐90‐90 targets for the cascade of care are widely used to monitor the success of HIV care programmes but there are few studies in children. We assessed the cascade for children and adolescents living with HIV in the national Collaborative HIV Paediatric Study (CHIPS) in the UK and Ireland.MethodsUtilizing longitudinal data from CHIPS we compared the cascade of care for 2010, 2013 and 2016. Among children diagnosed with HIV and not known to be lost to follow‐up at the start of each calendar year, we summarized the proportion in active paediatric care during that year (defined as having ≥1 clinic visit, CD4 or viral load measurement, or change to antiretroviral therapy (ART) regimen), and of these, the proportion on ART at last visit in that year. Among those on ART, the proportion with viral suppression (<200 copies/mL) and good immune status (WHO immunological stage none‐/mild‐for‐age) at last visit in the year were summarized. Among those in care in 2016, outcomes were compared by current age, place of birth (born abroad vs. UK/Ireland) and sex.ResultsOf children in paediatric HIV care at the start of 2010, 2013 and 2016 (n = 1249, 1157, 905 respectively), the proportion in active care during that calendar year was high throughout at 97 to 99%. Of those in active care, the proportion on ART increased from 79% to 85% and 92% respectively (p < 0.001). Among those on ART, the proportion with viral suppression and good immune status was stable at 83% to 86% and 85% to 88%, respectively, across the years. Among children in care in 2016, those aged ≥15 years were less likely to be virally suppressed (79% vs. 91%, p < 0.001) or to have good immune status (78% vs. 94%, p < 0.001) compared to younger children; there were no differences by place of birth or sex.ConclusionsChildren and adolescents in the UK and Ireland national cohort had high retention in care. The proportion on ART increased significantly over time although there was no change in viral suppression or good immune status. Poorer outcomes among adolescents highlight the need for targeted support for this population.

Toxoplasmosis and abortion: pro- and anti-inflammatory cytokines gene expression of the host immune cells

BackgroundToxoplasmosis during pregnancy is known for inducing variable serious outcomes. In many previous studies, pregnancy was evaluated as a single event while in reality; it has different distinct immunological stages depending on gestational time and possible external factors as infectious agents. A state of immunological balance as well as a state of maternal-fetal tolerance should be established; otherwise, atypical unwelcomed outcomes might occur as a result of such infectionAimThis work aimed to study the gene expression profile of some pro- and anti-inflammatory cytokines in Toxoplasma seropositive casesResultsAll studied cytokines were significantly upregulated in group I, with a remarkable bias towards IFN-γ, denoting a predominant inflammatory state in group I. In group II; tested cytokines were approximately in a balanced state with a little shift towards anti-inflammatory cytokines (IL-10 and TGF-β). A significant positive correlation was detected between pro-inflammatory together (p = 0.002, r = 0.96) and between anti-inflammatory cytokines together (p = 0.0008, r = 0.99) in group II, indicating the harmonized and synchronized expression of both pro- and anti-inflammatory cytokines. In group III, IL-10 was relatively higher with negative correlation with IFN-γ (p = 0.006, r = 0.93), indicating the possible role of IL10 in saving some of the pregnancies’ outcomes in group III.ConclusionThe present study suggests a potential role of these cytokines in the upcoming prognostic or/and therapeutic concerns of toxoplasmosis among pregnant women.

The inflammation-nutrition score supports the prognostic prediction of the TNM stage for colorectal cancer patients after curative resection.

Inflammation and the nutritional and immunologic status are known to be associated with the prognosis of malignant tumors. We aimed to examine inflammation-nutrition scores and predict the prognosis of colorectal cancer (CRC) patients by integrating nutritional and immunologic factors and tumor stage. This study investigated 511 patients with CRC from 2007 to 2013: 380 in a training set (TS) and 131 in a validation set (VS). The Osaka Prognostic Score (OPS) used comprised 1 point each for C-reactive protein > 1.0mg/dL, albumin (< 3.5g/dL), and lymphocyte count < 1600. Patients were classified according to the total points. The modified Glasgow Prognostic Score and the Prognostic Nutritional Index were also examined. A nomogram for predicting the disease-free survival (DFS) and overall survival (OS) was constructed based on the OPS and TNM stage. In the TS, a high OPS and high TNM stage were significant predictors of the DFS and OS. The C-indexes of the OPS for the DFS and OS were higher than those of other reported scoring systems. The C-index of the nomogram for the DFS was 0.762 in the TS and 0.675 in the VS. The C-index of the nomogram for the OS was 0.805 in the TS and 0.743 in the VS. Integrating the TNM stage and OPS accurately predicted the prognosis of patients with CRC.

Use and Outcomes of Antiretroviral Monotherapy and Treatment Interruption in Adolescents With Perinatal HIV Infection in Asia

PurposeAntiretroviral monotherapy and treatment interruption are potential strategies for perinatally HIV-infected adolescents (PHIVA) who face challenges maintaining effective combination antiretroviral therapy (ART). We assessed the use and outcomes for adolescents receiving monotherapy or undergoing treatment interruption in a regional Asian cohort. MethodsRegional Asian data (2001–2016) were analyzed to describe PHIVA who experienced ≥2 weeks of lamivudine or emtricitabine monotherapy or treatment interruption and trends in CD4 count and HIV viral load during and after episodes. Survival analyses were used for World Health Organization (WHO) stage III/IV clinical and immunologic event-free survival during monotherapy or treatment interruption, and a Poisson regression to determine factors associated with monotherapy or treatment interruption. ResultsOf 3,448 PHIVA, 84 (2.4%) experienced 94 monotherapy episodes, and 147 (4.3%) experienced 174 treatment interruptions. Monotherapy was associated with older age, HIV RNA >400 copies/mL, younger age at ART initiation, and exposure to ≥2 combination ART regimens. Treatment interruption was associated with CD4 count <350 cells/μL, HIV RNA ≥1,000 copies/mL, ART adverse event, and commencing ART age ≥10 years compared with age <3 years. WHO clinical stage III/IV 1-year event-free survival was 96% and 85% for monotherapy and treatment interruption cohorts, respectively. WHO immunologic stage III/IV 1-year event-free survival was 52% for both cohorts. Those who experienced monotherapy or treatment interruption for more than 6 months had worse immunologic and virologic outcomes. ConclusionsUntil challenges of treatment adherence, engagement in care, and combination ART durability/tolerability are met, monotherapy and treatment interruption will lead to poor long-term outcomes.

Macrophages promote a profibrotic phenotype in orbital fibroblasts through increased hyaluronic acid production and cell contractility

Graves’ orbitopathy (GO) is an autoimmune inflammatory disease affecting the orbit. Orbital fibroblasts are a key component in GO pathogenesis, which includes inflammation, adipogenesis, hyaluronic acid (HA) secretion, and fibrosis. Macrophages are thought to participate in the immunological stage of GO, but whether they can directly affect the fibroblasts phenotype and modulate disease progression is unknown. We previously showed that GO adipogenic and fibrotic phenotypes could be modelled in a pseudo-physiological 3D environment in vitro. Here, we introduced macrophages in this 3D culture model to investigate role for macrophages in modulating adipogenesis, HA production, and contractility in orbital fibroblasts. Macrophages had a minimal effect on lipid droplet formation in fibroblasts, but significantly increased HA production and cell contractility, suggesting that they may promote the fibrotic phenotype. This effect was found to be mediated at least in part through phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K) activation and linked to an increase in actin polymerization and protrusive activity in fibroblasts. Overall our work shows for the first time a direct role for macrophages in modulating the fibroblasts’ phenotype in GO, supporting a role for macrophages in the progression of the fibrotic phenotype through induction of HA production and stimulation of the contractile phenotype in orbital fibroblasts.

Prevalence and Clinical Outcomes of Poor Immune Response Despite Virologically Suppressive Antiretroviral Therapy Among Children and Adolescents With Human Immunodeficiency Virus in Europe and Thailand: Cohort Study.

In human immunodeficiency virus (HIV)-positive adults, low CD4 cell counts despite fully suppressed HIV-1 RNA on antiretroviral therapy (ART) have been associated with increased risk of morbidity and mortality. We assessed the prevalence and outcomes of poor immune response (PIR) in children receiving suppressive ART. Sixteen cohorts from the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) contributed data. Children <18 years at ART initiation, with sustained viral suppression (VS) (≤400 copies/mL) for ≥1 year were included. The prevalence of PIR (defined as World Health Organization advanced/severe immunosuppression for age) at 1 year of VS was described. Factors associated with PIR were assessed using logistic regression. Rates of acquired immunodeficiency syndrome (AIDS) or death on suppressive ART were calculated by PIR status. Of 2318 children included, median age was 6.4 years and 68% had advanced/severe immunosuppression at ART initiation. At 1 year of VS, 12% had PIR. In multivariable analysis, PIR was associated with older age and worse immunological stage at ART start, hepatitis B coinfection, and residing in Thailand (all P ≤ .03). Rates of AIDS/death (95% confidence interval) per 100 000 person-years were 1052 (547, 2022) among PIR versus 261 (166, 409) among immune responders; rate ratio of 4.04 (1.83, 8.92; P < .001). One in eight children in our cohort experienced PIR despite sustained VS. While the overall rate of AIDS/death was low, children with PIR had a 4-fold increase in risk of event as compared with immune responders.

Impact of Anemia on Outcome of HIV-Infected Pediatric Patients: A Prospective Observational Study.

Introduction:Anemia has been widely reported to predict a poorer prognosis for HIV-infected patients, both in terms of progression to AIDS and in survival. This study aimed to determine the etiology of anemia and its immunological correlation in HIV-infected children.Materials and Methods:Four hundred and eighty-nine HIV-infected children were screened, of which 86 HIV-infected children with anemia were enrolled. Standard WHO definitions were used for anemia, HIV staging, and growth parameters. Chi-square test, t-tests, and univariate and multivariate logistic regression analyses were used to analyze the data.Results:Anemia was present in 17.58% (86/489) of HIV-infected children, including 84.6% with moderate anemia, 11.5% with severe anemia, and 2.32% with mild anemia. The mean hemoglobin (Hb) among patients with CD4 count <350 cell/mm3 was lower (7.90 g%) (standard deviation 1.48) compared to those having CD4 >350 cell/mm3 (P = 0.02). Children with severe immunological stage had a significantly lower mean Hb (adjusted estimate: −1.61, 95% confidence interval: −2.65, −0.56) compared to those who had normal immune status. No statistically significant differences in mean Hb at baseline when compared to various demographic and clinical characteristics were observed in unadjusted and adjusted regression models.Conclusion:Hb is an easy and inexpensive tool to measure and can be used for monitoring disease progression in a resource-limited setting.

Gut Microbiota in Human Immunodeficiency Virus-Infected Individuals Linked to Coronary Heart Disease.

Human immunodeficiency virus (HIV) infection is an independent risk factor for coronary heart disease (CHD) and is associated with perturbation of the gut microbiota. We analyzed gut microbiota in 30 HIV-infected individuals with CHD (CHD+) and 30 without CHD (CHD-) of the HIV-HEART study group. Gut microbiota linked to CHD was associated with lower α-diversity. Despite insignificant differences in β-diversity, co-occurrence networks of bacterial genera clearly diverged between CHD+ and CHD- individuals. Multidimensional scaling separated HIV-infected individuals into 2 microbiome clusters, dominated by the genus Prevotella or Bacteroides. The relative abundance of 49 other genera was significantly different between both clusters. The Prevotella-rich cluster was largely composed of men who have sex with men (MSM) (97%), whereas the Bacteroides-rich cluster comprised both MSM (45%) and heterosexual individuals (55%). MSM of the Bacteroides-rich cluster were characterized by reduced α-diversity, advanced immunological HIV stage, longer antiretroviral therapy with more ART regimens, and longer use of protease inhibitors, compared with Prevotella-rich MSM. Community structures of gut microbiota rather than individual species might facilitate risk assessment of CHD in HIV-infected individuals. Sexual behavior appears to be an important factor affecting gut microbiota β-diversity and should be considered in future studies.

Association of serum ferritin levels with immunological status and clinical staging of HIV patients: a retrospective study

Serum ferritin has long known as an acute phase reactant during inflammation. It works as an oxidative stress marker beside its role in the storage of intracellular iron. The increase of serum ferritin levels (SFL) has been reported found in HIV patients. It remains unclear though whether it causes, or is the cause, to the progressivity of the disease. The purpose of this study was to find the association between the SFL and the progressivity of the HIV disease. A retrospective study of 91 patients was carried out at the Haji Adam Malik Central General Hospital. All of the study population were HIV positive inpatients admitted from January to December 2016. The data needed to be all obtained from the patient’s medical records. The WHO Clinical Staging System was used to assess the HIV clinical staging. An inverse relationship was found between the SFL with the immunological status of the HIV patients (r=-0.213) based on their CD4+ count. There was no association found between the SFL with the clinical staging of the HIV patients (p=0.953). The elevated SFL is a feature found in HIV-diagnosed patients with the low CD4+ count, and it affects the progressivity of the disease.

Current and Future Directions of Management of Hepatitis B: Steps Toward a Cure

Universal hepatitis B virus vaccination has been effective in reducing incident chronic hepatitis B but will not have the requisite effect on the prevalence of end-stage liver disease in chronically infected persons. The natural history and immunological stages of hepatitis B virus infection are still being defined. Over three decades, current therapies have reduced morbidity from chronic hepatitis B. The majority require nucleoside analog maintenance therapy. The preferential preservation of covalently closed circular DNA (cccDNA), and capsid reverse transcriptase–cccDNA interactions currently precludes cure in most. A functional cure in the host may require several synergistic antiviral and immunological intercessions. The correct sequencing and combinations of treatment with either host or viral targeting agents have yet to be determined. Proven surrogates for cccDNA for clinical trials are required. Different strategies may become apparent for patients at different stages of the disease. Curative therapies will require affordability. This review focuses on steps toward a cure.

Factors associated with abnormal glomerular filtration rate among HIV-positive children at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria

Background: Renal disease is commonly encountered in patients with HIV infection. The estimated glomerular filtration rate (eGFR) provides a good assessment of the renal function and is widely used in screening populations that are at risk of renal dysfunction. We determined the prevalence of abnormal eGFR among HIV-positive children and factors associated with it. Methods: In a cross-sectional study, children aged 15 years and below were recruited through systematic random sampling from the Paediatrics Infectious Disease Clinic of the University of Maiduguri Teaching Hospital until the desired sample size of 250 was reached. Clinical and laboratory information was obtained from the patient records and used for clinical staging and immunological classification. Serum creatinine was measured using Jaffe’s reaction and eGFR calculated using the Schwartz formula. The data obtained were analysed using SPSS version 16. Results: A total of 157 (62.8%) children were on antiretroviral therapy (HAART) for periods ranging from 1 to 168 months (mean duration 66.1 ± 46.5 months). Ninety-three (37.2%) children had advanced disease representing WHO clinical stages 3 and 4, whereas 103 (41.2%) had advanced or severe immunosuppression. The mean eGFR of the study population was 102 ± 41 mL/min/1.73 m2. Fifty-two children (20.1%) had low eGFR ( 2 SD above the mean eGFR for age and sex). A total of 23 (9.2%) children had moderate to severe renal impairment, defined as eGFR <60 mL/min/1.73 m2. Age, sex, socio-economic status, mode of transmission as well as history of HAART usage were not significantly associated with abnormal eGFR. However, relatively shorter duration of treatment with HAART, as well as advanced clinical or immunological stage were all significantly associated with abnormal eGFR. Conclusion: Renal dysfunction is common among children with HIV disease in Maiduguri with over a third of those affected having moderate to severe renal dysfunction. Abnormal renal function is more frequent among children with advanced clinical and immunological disease. We recommend the regular determination of eGFR and early initiation of HAART in all children with HIV disease.

Malnutrition among HIV infected children under 5 years of age at the Laquintinie hospital Douala, Cameroon.

IntroductionThe aim of this study was to assess the prevalence of malnutrition among HIV infected children under five years of age followed up at the Laquintinie Hospital Douala (LHD).MethodsMedical records of children aged 13 days-59 months enrolled at initiation of antiretroviral treatment in the Day Care Unit/LHD, were reviewed for a period of 14 years (from 2002 to 2015). We used standard Z-scores, with cut-off point of <-2 SD to define low height-for-age (HAZ), low weight-for-height (WHZ) and low weight-for-age (WAZ). Factors associated with malnutrition were assessed according to World Health Organization (WHO) criteria.ResultsOverall, 217 medical records were included and 52.5% were records of boys. The median weight, height and age of the children was 9.5 kg (range: 2.5-20), 76 cm (range: 46- 117) and 22 months (range: 0.03-59), respectively. The overall prevalence of malnutrition among HIV-infected children was 68.7%; 63.6% were stunted (HAZ<-2), 37.8% were underweight (WAZ<-2) and 18.4 % were wasted (WHZ<-2). Severe and advanced immunological stages of HIV according to WHO were found in 42.4%, (39/92) and 17.4%, (16/92) of children respectively, and most of them (21.7%) were aged 12-36 months. The overall prevalence of anemia, oropharyngeal candidiasis and pulmonary tuberculosis were 34.6%, 12% and 8.8%, respectively. Oropharyngeal candidiasis was a risk factor independently associated with severe underweight and wasting (OR = 4.9, 95% CI: 1.8-13.5, p = 0.002) and (OR = 5.1, 95% CI: 1.5-17.1, p = 0.007).ConclusionHIV infection negatively affects the nutritional status of children under five years of age. Early detection of malnutrition is necessary and adequate nutrition should be integrated into the management of pediatric HIV.

Effect of Helminth Infestationin Children Infected with Human Immunodeficiency Virus (HIV)

Introduction: Infection by human immunodeficiency virus results in immune destruction, while studies among the Ethiopian immigrants in Israel showed that chronic helminthiasis induces immune dysregulation. With destruction of CD4+ cell and consequently progression to AIDS, the host may be more susceptible to invading organisms such as helminths. This study was aimed at determining the effect of immune state on the prevalence and intensity of helminth infection in HIV infected children in two hospitals in Abakaliki.Material and Methods: It was a cross sectional study that involved consecutive recruitment of 84 confirmed HIV infected children attending the ART clinic. Stool analysis for subjects was done, using the Kato-Katz technique. Blood sample for estimation of CD4 cell count was carried outusing flow cytometer from the HIV positive subjects.Results: A total of 84 subjects were recruited during the study period, majority were males (58.3%). Male to female ratio was 1.4:1. The age range of participants was 2-17 years, while mean age of subjects infected with helminthiasis was 6.10± 3.34 year. A significant number of subjects in advanced and severe immunological stages had helminthiasis (χ2 =12.49, p=0.001). There was however no significant relationship between intensity of helminthiasis and immunologic stages of subjects.Conclusion: The study suggests that immunodeficiency state may increase the susceptibility of helminth infection in HIV infected children. Hence children with HIV/AIDS may benefit from routine testing and/or de-worming of helminth infection.

Magnetic resonance imaging brain findings of pediatric HIV cases and its correlation with clinical and immunological stages of the disease: A study from a tertiary care center of Rajasthan

Objective: To study the magnetic resonance imaging (MRI) brain findings in pediatric HIV patients and to correlate them with clinical and immunological staging. Methods: This study was conducted in the Department of Pediatrics of a Teaching Institute of Rajasthan. It was a prospective longitudinal study, conducted over a period of 15 months (April 2008-July 2009). Diagnosis of HIV was confirmed and classified in clinical stages and immunologic stages as per NACO guidelines. MRI brain was done in every patient. Patients with abnormal MRI brain findings were further studied and correlated with clinical findings and CD4+ cell counts. Results: We had total 109 HIV-positive patients registered with us; out of these, 90 were in regular follow-up. Out of these 90 patients, 16 subjects (17.78%) showed abnormal neuroimaging features on MRI brain. No case presented with abnormal MRI features in clinical Stage I and II. 4 were in clinical Stage III, and 12 were in Stage IV. No case presented with abnormal MRI in immunological Stage I and II. 5 cases (31.25%) were in immunological Stage III and 11 (68.75%) in Stage IV. Out of total 90 subjects, only 10 patients had abnormal clinical (neurological) manifestations and rested 80 patients were neurologically and developmentally normal. 6 out of 16 (37.5%) patients with abnormal MRI brain findings did not show any neurological manifestations. The most common MRI brain abnormality noted was cerebral atrophy in 7 (43.75%) cases followed by nonspecific demyelination in 31.25% cases, and ventriculomegaly, nonspecific calcification, and infarcts in 3 (18.75%) subjects each and cerebellar atrophy in 2 subjects. Conclusions: Our study demonstrated that abnormalities of MRI brain increases with increasing immunosuppression and advancing clinical stage. We did not found any significant correlation with age and sex with abnormal MRI brain findings. Importantly, HIV?positive children may present with only abnormal MRI brain findings without any clinical manifestation.

A study of clinico-immunological response to art in HIV infected children in western Rajasthan

Background: Study of clinico immunological response to antiretroviral drugs in HIV infected children.Methods: 50 HIV positive children after immunological categorization put on first line pediatric ART treatment according to pediatric ART NACO guideline, side effect, clinical response (in the form of change of WHO clinical staging), and immunological response (in the form of change of CD4 count, and immunological staging) were noted on follow up study.Results: The Correlation between WHO clinical staging and immunological staging was poor so initiating anti retro viral treatment should be preferably based on CD4 count. Children who were initiated on ART have a significant improvement in both WHO clinical and immunological staging at the six and twelve months follow up and ART found to be well tolerated.Conclusions: Significant clinical and immunological improvement occur in the children who were put on ART based on CD4 counts provided if the adherence level is very good.

Echocardiographic characteristics of pulmonary arterial hypertension in children with horizontally transmitted HIV.

The prevalence of primitive pulmonary arterial hypertension (PAH) in patients with human immunodeficiency virus infection (HIV) is estimated at approximately 0.5%, significantly higher than in the general population. This study aimed to assess the echocardiographic modifications in HIV-associated pulmonary arterial hypertension (PAH). A group of 117 patients, aged under 16, with horizontally transmitted HIV staged according to the U.S. Center for Disease Control and Prevention criteria, were included in this prospective study, with echocardiographic abnormalities in 79 children. The study group consisted of 27 HIV-infected patients with PAH, while the control group consisted of 38 patients with normal ultrasound features. The diagnostic criterion for PAH was the presence of a mean pulmonary artery pressure above 25 mm Hg, determined at 2 consecutive measurements having at least 6 months distance between them. All subjects underwent a complex echocardiographic assessment, including assessment of left and right ventricular hypertrophy and evaluation of left ventricular function, associated with determination of the immunological stage. We recorded the presence of PAH in 27 patients (23.08%), in whom an average value of 31.48 mm Hg was recorded for pulmonary artery pressure. All patients had mild forms of PAH. Age, gender and immunological stage showed no significant differences in the PAH group compared to patients in the control group. Right ventricular hypertrophy was encountered in 95.23% and left ventricular hypertrophy in 88.88% of the patients with PAH. Left ventricular dysfunction, a complication of pulmonary hypertension, was relatively rare (11.11%). In children with HIV infection, PAH is present in a relatively mild form and does not correlate with the clinical and immunological stage of HIV infection, evolving as a seemingly primitive condition.

A study of clinical spectrum of opportunistic infections in HIV infected children and its correlation with CD4 count and anti-retroviral therapy

Background: To determine the clinical spectrum and prevalence of opportunistic infections (OIs) in HIV infected children and correlate the occurrence of opportunistic infections with their CD4 count and Anti-retroviral treatment (ART).Methods: A total of 100 HIV infected children diagnosed with opportunistic infections were included in the study. Demographic details, clinical examination and relevant investigations were done for all the children. Clinical spectrum of OIs and HIV staging was recorded. CD4 counts were done at baseline and were repeated at 6 monthly intervals.Results: Mean age of the patients was 7.08±3.48 years (ranging from 6 months to 15 years) at enrollment with male to female ratio of 1.2:1. Fever (91%) was a common presenting symptom followed by weight loss (74%), cough (37%), abdominal pain (29%) and breathlessness (16%). CD4 count was significantly associated with presence of opportunistic infection in the study group. Tuberculosis - pulmonary (32%) and extra-pulmonary (29%) was the most common oppurtunistic infections, followed by oral thrush (13%), Herpes zoster (10%), Molluscum Contagiosum (9%), Pneumocystis jiroveci pneumonia (3%), Parvovirus infection (3%) and Pruritic Papular Eruptions (2%). 70% children were on ART as per clinical and immunological staging of HIV.Conclusions: Low CD4 count is significantly associated with severe opportunistic infections, therefore drop in CD4 count should serve as an alarming signal for the treating physician. High index of suspicion is required to detect opportunistic infections and therefore CD4 counts should be done more frequently to predict occurrence of OIs.

A clinico-epidemiological study of HIV infected children in western Rajasthan

Background: Assessment of clinico demographic characteristics of HIV infected children in western Rajasthan.Methods:All the children who were attending Antiretroviral treatment (ART) center for one year period were enrolled for study as pre-ART and ART group. All the data pertaining to clinical and demographic characteristics were recorded. They were further classified into clinical staging as per WHO guideline and immunological staging based on CD4 count in accordance with CDC classification of immunodeficiency.Results: Perinatal transmission is the most common mode of acquiring HIV in Pediatric age, who most commonly presented with Fever and diarrhoea along with failure to thrive. Tuberculosis and oral candidiasis were the commonest opportunistic infections in this geographic area. Conclusions: A proper history, detailed clinical examination and high index of suspicion would therefore help in making early diagnosis to institute an appropriate management plan.

Neurocognitive Function of School-aged HIV-infected Children in Enugu, Nigeria.

Evidence has shown neurocognitive problems often exist among human immunodeficiency virus (HIV)-infected children. There are limited data for children in Nigeria. This was a cross-sectional study of 100 school-aged perinatally HIV-infected children seen in the paediatric HIV clinic and age/sex-matched controls from the general paediatric clinic. Neuro-cognitive functioning was assessed using the Raven's progressive matrices (RPM) that has been adapted for the Nigerian population. The mean RPM score of subjects was 22.97 ± 11.35 compared with 32.93 ± 15.71 among controls (p < 0.001). Twenty-two percent of subjects in the HIV-infected group vs. 56% of controls were in the above-average intelligence group on the RPM. Thirty-four percent had average scores, while 22% were in the below-average scoring range. Neuro-cognitive functioning of the subjects was significantly affected by immunologic staging and socio-economic status. Neurocognitive functioning of the HIV-infected children was significantly lower than those of their un-infected counterparts. Neurodevelopmental evaluation should be part of standard care in HIV-infected children in Nigerian setting.

The impact of HIV and antiretroviral therapy on TB risk in children: a systematic review and meta-analysis

BackgroundChildren (<15 years) are vulnerable to TB disease following infection, but no systematic review or meta-analysis has quantified the effects of HIV-related immunosuppression or antiretroviral therapy (ART) on their TB...