Status Of HIV-infected Children Research Articles

Under-nutrition and associated factors among children on ART in Southern Ethiopia: a facility-based cross-sectional study

BackgroundMalnutrition is very common in HIV-infected individuals. Even though data from different settings are necessary to tackle it, pieces of evidence are limited especially in the case of the nutritional status of HIV-infected children. Hence, this study aims to assess the nutritional status and associated factors among children on antiretroviral therapy.MethodsAn institutional-based cross-sectional study was conducted among 383 HIV-positive children in Southern Ethiopia. Data were collected using an interviewer-administered questionnaire and anthropometry measurement. Data were coded and entered into Epi-Data Version 3.1 and analyzed using SPSS Version 25. Bi-variable and multi-variable binary logistic regression models were used to identify factors associated with nutritional status and variables with p-values <0.05 in multi-variable logistic regression were considered as statistically significant.ResultsThe prevalence of wasting among HIV-positive children in Southern Ethiopiaselected Hospitals was 36.3% (95% CI, 31.6–41.0) while stunting on the same study population was 5.5% (95% CI, 3.4–7.8). Rural residence, lack of maternal education, low CD4 counts (< 500), using an unprotected water source, having a non-biological mother and recurrent oral lesion were significantly associated with wasting. Furthermore, history of hospital admission, recurrent oral lesion, low CD4 counts (< 500), advanced WHO clinical stage were statically associated with stunting with p-value < 0.05.ConclusionThis study found that the prevalence of under-nutrition among HIV-positive children in Ethiopia was significantly high. Therefore, timely identification and monitoring of nutritional problems should be necessary to enhance the effectiveness of ART treatment and to prevent further related complications.

Health and nutritional status of HIV infected children living in the orphanages of Rajamahendravaram, Andhra Pradesh, India

Background: HIV infected orphan children are the most vulnerable and neglected group in the society. They are more susceptible to constant illness, malnutrition and social discrimination. Aim: To assess the health and nutritional status of HIV infected children living in the orphanages of Rajamahendravaram.Methods: This was a community based cross-sectional study, conducted among the HIV infected children aged 1 to 15 years, living at two orphanages in Rajamahendravaram. Study subjects were selected by consecutive sampling method. A semi-structured schedule was used for the collection of data. Health status was assessed by a schedule for morbidity profile; Nutritional status was assessed by anthropometric measurements, clinical examination and by a schedule for dietary intake. Z scores were calculated using the anthropometric measurements of the study participants; WHO reference growth charts were used to assess the nutritional status. Results were presented as percentages, proportions, mean and standard deviation.Results: Total 150 HIV infected children were enrolled in the study. The mean age of children was 9.28±2.88 years. 26% of children were born with birth weight &lt;2.5 kg. Out of 150 children, 46.65% were underweight, 50% were stunted, and 22.6% were thin. The mean energy intake of HIV infected children indicates deficiency in comparison to reference standards of WHO.Conclusions: Unhealthy condition and undernutrition is highly prevalent in HIV infected children living in orphanages. Hence, their needs are to be addressed and all efforts need to be directed at alleviating undernutrition and ill health.

A Comparative Study on Effect of Caregivers Training on Health Outcomes of HIV Infected Children on Antiretroviral Therapy in Kenya

The purpose of this cohort study was to assess the effect of caregiver training on health outcomes of HIV-infected children aged 1-14 years on antiretroviral therapy in South Rift Valley, Kenya. Three hundred and twenty children of trained caregivers and 778 children of non-trained caregivers were targeted from four hospitals. Population proportionate to size sampling technique was used to calculate number of children enrolled. Children medical chart for trained and non-trained caregivers were stratified as per year of training, 2014, 2015, 2016 and randomly selected numbers matched with corresponding medical record. Data was collected through review of medical records, questionnaires and caregivers interview. There was significant association between caregiver training and adherence (Fisher's Exact Test X 2 =22.740, p = .001). Children of trained caregivers had significant reductions in viral load (Kruskal Wallis X 2 =7.124, p = .028); significant difference in viral loads was also observed between trained and non-trained caregivers (Mann-Whitney U=19846, p =.012), significant association in episodes of opportunistic infections before, after and among non-trained caregivers (Fisher's Exact Test X 2 =76.768, p = .001). Nutritional status of children was not associated with caregivers training (Pearson Chi-square X 2 = 11.616, p =.072). Most caregivers perceived training to be useful. The study found that, training enables caregivers to improve adherence levels of HIV infected children on antiretroviral therapy. Even though there are HIV information in public domain, the study found, if this information is provided in a structured manner, enables suppression of viral loads of HIV infected children. Training caregivers significantly reduces frequency of opportunistic infections among HIV infected children on antiretroviral therapy. Providing information on nutrition to caregivers does not affect nutritional status of HIV infected children. Training caregivers on HIV information improves health outcomes of HIV infected children thus study provide evidence–based decision making in rolling out caregivers training nationally. Keywords: HIV, Caregivers, Training, Children, Adherence, DOI: 10.7176/JHMN/76-05 Publication date: June 30th 2020

Adherence status of HIV infected children at ART centre of South India

Background: Adherence to antiretroviral therapy (ART) is a principal determinant of virologic suppression. A variety of factors: including formulation of medicine, dose frequencing, drug toxicities, child’s age, as well as psychosocial, behavioral, and sociodemographic characteristics of children and caregivers have been associated with nonadherence. Still no consistent predictors of either good or poor adherence in children have been consistently identified.Methods: Data was collected from the ART Centre. Record based data from the year 2008 to 2018 April of pediatric age group i.e. from 0-18 years. All the cases registered at the center whose data were available were included for the study. Adherence was assessed calculating the average monthly consumption of ARV assessed by pill count as per NACO guidelines.Results: At the ART Centre, 139 (73.5%) were on treatment i.e. 75.7% of boys registered and 70.9% of registered girls. Average monthly adherence and treatment interruptions among the 73 children alive on ART, majority i.e. 90.4% were on good adherence with 8.2% on less than 80% adherence.Conclusions: Overall a good adherence indicates efficient functioning of the programme and determined efforts from the ART Centre.

Growth and Neurodevelopmental Status in HIV Infected Children

Background: HIV infected children are at risk of growth and developmental disorders. Objectives: We assessed growth and neurodevelopment outcomes in 0 - 5 years old HIV infected children. Methods: A cohort study was carried out in a referral HIV clinic. Twenty eight HIV infected children and 47 healthy children aged 0 - 5 years were compared with regard to growth and neurodevelopmental status within two consecutive 6 months. During this period, some parent based interventions were achieved and antiretroviral treatment was optimized in case of necessity. Results: Among the growth parameters measured, the only significant difference between case and control groups at the beginning of the study was the head circumference percentile (P = 007) and for the developmental variables, abnormality in speech and language ability were more common in case group than in control group (P = 0.04). The difference between controlled and uncontrolled HIV patients at enrollment was marginally significant in gross motor function (P = 0.059) and a significant difference was seen in social ability (P = 0.01). The score changes among parameters before and after intervention between case and control groups were significant in language ability (P = 0.01), fine motor (P = 0.001) and social ability (P = 0.02). The score changes among parameters before and after intervention were also significant in head circumference percentile (P = 0.02) between the two groups, and for weight percentile (P = 0.04) and length percentile (P = 0.04) between well and poorly HIV controlled patients. Conclusions: The growth and developmental disorders could be preventable with antiretroviral treatment and some simple parent based interventions.

Early treated HIV-infected children remain at risk of growth retardation during the first five years of live: Results from the ANRS-Pediacam cohort in Cameroon

Introduction Little is known about the long-term outcome of growth in early treated infants in resources limited countries. Here, we compared growth parameters over the first 5 years of life of early treated HIV-infected and uninfected children and identified factors associated with growth retardation, taking into account informative censorship. Methods Data used in this study were obtained from the ANRS-Pediacam cohort based in three referral hospitals in Cameroon (The Maternity of the Central hospital/Mother and Child Center of the Chantal Biya Foundation in Yaounde, the Essos Hospital Center in Yaounde and the Laquintinie Hospital in Douala). Anthropometric indices [weight-for-age (WAZ), weight-for-length (WLZ), and length-for-age (LAZ) Z-scores] were calculated using data from this observational study. Of the four groups included, three were followed from the first week of life: HIV-infected (HI, n = 69), HIV-exposed uninfected (HEU, n = 205) and HIV-unexposed uninfected (HUU, n = 196), and the last group constituted of HIV-infected infants not followed from first week of life but diagnosed before 7 months of age (HIL, n = 141). We performed under the Missing At Random hypothesis a multiple imputation by a conditional approach of missing data on different covariates, except the anthropometric parameters. To take account of informative censorship, recurrent events and interval censoring, we used markov multi-state model for panel data to describe the incidence of growth retardation (defined as WAZ or WLZ or LAZ Results During the first 5 years, 27.5% of children experienced underweight (WAZ P P = 0.01 respectively) and stunting for HIL (aHR = 8.4 (95%CI: 2.4–29.7). HEU and HUU infants were not different according to stunting and wasting. However, the risk of underweight was higher in HEU compared to HUU children (aHR = 5.0 (CI: 1.4–10.0), P = 0.001). Others associated factors were younger age, chronic pathologies, small size at birth, diarrhea, CD4 Conclusions Despite early antiretroviral treatment HIV-infected children are at high risk of wasting and stunting within the first 5 years period of follow up. Nutritional status of HIV infected children should be closely monitored even in the context of early treatment.

Therapeutic patient education and disclosure of status of HIV infected children in Yaounde, Cameroon Achievements and competence.

Psychosocial support and therapeutic patient education are recommended practices that are poorly reported. Our objective was to describe the main achievements after a patient therapeutic education program conducted for pre-adolescents and adolescents with HIV infection. This qualitative study of 37 children with a mean age of 11 years assessed the outcome of an educational program of 8 sessions that ended by the disclosure of their HIV status. Semistructured interviews that took place 8 weeks after the last session and lasted 20 minutes evaluated the following areas: knowledge of the disease, its treatment, its prevention, and their skills in managing their treatment and the secret. The level of knowledge was acceptable except about HIV transmission, and specifically, how they had acquired the disease. In all, 33/37 (89%) of the children were able to cite or write the name of their disease; 29/37 (78%) had acquired knowledge of their treatment (name of the drugs, objective, and daily treatment times); they were able to manage treatment intake away from home; and secrecy was the standard for all. However, many were unable to explain how they had acquired the virus. Therapeutic patient education for HIV status disclosure enables adolescents to acquire knowledge about their disease and the ability to manage it. The poor results observed for knowledge of transmission needs to be improved after disclosure in support groups.

Impact of highly active antiretroviral therapy on nutritional and immunologic status in HIV-infected children in the low-income country of Ethiopia

ObjectiveHIV/AIDS and malnutrition combine to undermine the immunity of individuals and are inextricably interrelated. Although the effect of highly active antiretroviral therapy (HAART) on growth in HIV-infected children is well known, the influence of prior nutritional and immunologic status on the response to HAART is not well documented. The aim of the present study was to determine the effects of HAART on nutritional and immunological status in HIV-infected children in the low-income country of Ethiopia. MethodsA multicenter, retrospective cohort study was conducted on HIV-infected children receiving antiretroviral therapy at the pediatric units of public hospitals in Addis Ababa (Black Lion, Zewditu, Yekatit 12 and ALERT hospitals), Ethiopia. Nutritional status was defined as stunting (height-for-age Z score [HAZ] <–2), wasting (weight-for-height Z score [WHZ] <–2), and underweight (weight-for-age Z score [WAZ] <–2). Multivariable logistic regression was used to analyze factors associated with treatment success and to establish whether growth (baseline nutritional status) in children predicts immunologic outcomes. In all, 556 HIV-infected children receiving HAART from January 2008 to December 2009 were included in this study. ResultsOver the 24-mo follow-up period, the study showed that the immunologic recovery of stunted and underweight children, regardless of their baseline nutritional status, responded equally to treatment. However, wasted children showed less immunologic recovery at the different follow-up visits. Predictors of positive shift in WHZ after 24 mo of follow-up were advanced disease stage (World Health Organization clinical stages 3 and 4) with odds ratio (OR), 0.25 (95% confidence interval [CI], 0.34–0.99; P = 0.045) and baseline severe underweight OR, 0.19 (95% CI, 0.09–0.56; P = 0.003). The independent predictors of positive shift of growth shift in WAZ over 24 mo were lower baseline age (<36 mo) with OR, 0.21 (95% CI, 0.04–0.90; P = 0.036) and baseline moderate underweight itself with OR, 0.11 (95% CI, 0.05–0.25; P = 0.0001) were predictors of positive shift (shift to normal). ConclusionDespite the apparent growth response in HIV-infected children after initiation of HAART, moderate and severe underweight are both independent predictors of a positive shift. The latter suggests that children on HAART require nutritional supplementation, especially during the early initiation of HAART.

Health & nutritional status of HIV infected children in Hyderabad, India.

Information on nutritional status of HIV infected children from India is lacking and is required before taking up nutritional supplementation trials. Thus, the aim of the present study was to assess the growth and morbidity status of HIV infected children over a period of one year in a city in southern India. This was an observational study carried out between July 2009 and February 2011, at two orphanages in Hyderabad, India. Seventy seven HIV-positive children aged between 1 and half and 15 years, both on and not on antiretroviral therapy (ART) were included. Nutritional status was assessed longitudinally for one year by weight gain, linear growth and body composition. Serum samples were analyzed for haemoglobin, micronutrients, CD4 and CD8 counts. Dietary intakes were assessed by institutional diet survey and morbidity data were recorded every day for 12 months. Mean energy intakes were less than recommended dietary allowance (RDA) in all age groups. Iron and folate intakes were less than 50 per cent of RDA; 46 (59.7%) children were stunted, 36 (46.8%) were underweight and 15 (19.5%) had low BMI for age. Anaemia was observed in 35 (45.5%) children. Micronutrient deficiencies such as vitamin D (40/77; 51.9%), vitamin A (11/77; 14.3%), folate (37/77; 48.1%), iron (38/77; 49.3%) were widely prevalent. HIV viral load was higher in children not on ART and those with morbidity. Respiratory (36.6%) and dermatological illnesses (18.8%) were the commonest presentations. Acute, chronic malnutrition and micronutrient deficiencies were common in HIV infected children, especially in those not on ART and having morbidity. With severe malnutrition being an alarming consequence of HIV, prophylactic nutritive care should be considered for integration into HIV care strategies besides initiation of ART to improve the nutritional status and quality of life of these children.

Health & nutritional status of HIV infected children.

Health & nutritional status of HIV infected children.

Sero-negative Antibody Status in HIV-Infected Children Initiated on Early Anti-Retroviral Therapy in Jos, Nigeria

Aim: To determine the association between the age at initiation of anti-retroviral therapy (ART) and the 18 month antibody status of human immunodeficiency virus (HIV)-infected children in Jos, Nigeria. Study Design: This was a retrospective cohort study. Place and Duration of Study: AIDS Prevention Initiative in Nigeria (APIN)-supported HIV clinic at Jos University Teaching Hospital, Jos, Nigeria between July 2008 and June 2012. Methods: We reviewed the clinical records of all children confirmed to be HIV-infected with 2 positive HIV deoxyribonucleic acid polymerase chain reaction (DNA PCR) results who were initiated on ART before 12 months of age. We studied the association between the age at initiation of ART and their antibody status at 18months of age. We also studied the association between the viral load and the antibody status.

P4.047 Disclosure of HIV Status in HIV Infected Children in Kenya

BackgroundGreater access to ART has resulted in more HIV-infected children surviving into adolescence and adulthood. Adolescence is associated with a sense of independence and sexual debut, therefore knowledge of HIV...

Positive association between dietary iron intake and iron status in HIV-infected children in Johannesburg, South Africa

Anemia is a common complication of pediatric HIV infection and is associated with suboptimal cognitive performance and growth failure. Routine iron supplementation is not provided to South African HIV-infected children. We hypothesized that dietary iron intake without supplementation is sufficient to protect against iron deficiency (ID) in HIV-infected children receiving highly active antiretroviral therapy. In this prospective study, the difference between dietary intakes of iron-deficient children (soluble transferrin receptor >9.4 mg/L) and iron-sufficient children after 18 months on highly active antiretroviral therapy was examined. The association between iron intake and hemoglobin (Hb) concentration was also assessed. Longitudinal data collected for 18 months from 58 HIV-infected African children were assessed by generalized estimation equations, with adjustment for demographic information, dietary intakes, growth parameters, and CD4%. After adjustment for covariates, the longitudinal association between dietary iron intake and Hb concentration remained significant. This association shows that for every 1-mg increase in iron intake per day, Hb increases by 1.1 g/L (P < .001). Mean Hb increased significantly after 18 months of follow-up (106 ± 14 to 129 ± 14 g/L, P < .01), but soluble transferrin receptor also increased (7.7 ± 2.7 to 8.9 ± 3.0 mg/L, P < .01). The incidence of ID increased from 15.2% at baseline to 37.2% after 18 months. Children with animal protein intakes greater than >20 g/d had significantly lower odds for ID at 18 months than did children with lower intakes (odds ratio, 0.40; 95% confidence interval, 0.21-0.77). Dietary iron intake was insufficient to protect against ID, pointing to a need for low-dose iron supplementation for iron-deficient HIV-infected children and interventions to increase the consumption of animal protein.

Abnormalities in body composition and nutritional status in HIV-infected children and adolescents on antiretroviral therapy

This cross-sectional study aimed to compare growth, nutritional status and body composition outcomes between a group of 94 HIV-infected children and adolescents on antiretroviral therapy (ART) and 364 healthy controls, and to evaluate their association with clinical and lifestyle variables within the HIV-infected group. When compared with the control group, HIV patients had higher risk of stunting (odds ratio [OR] 5.33, 95% confidence interval [CI]: 2.83-10.04) and thinness (OR 4.7, 95% CI: 2.44-9.06), higher waist-to-hip ratios (medians 0.89 versus 0.82 for boys and 0.90 versus 0.77 for girls, P < 0.001), and lower prevalence of overweight or obesity (OR 0.33, 95% CI: 0.14-0.78). Protease inhibitor usage was associated with thinness (OR 3.51, 95% CI 1.07-11.44) and lipoatrophy (OR 3.5, 95% CI 1.37-8.95). HIV-infected children on ART showed significant nutritional status and body composition abnormalities, consistent with the severity of vertical HIV infection and the consequences of prolonged ART.

Multiple micronutrient supplementation improves vitamin B12and folate concentrations of HIV infected children in Uganda: a randomized controlled trial

BackgroundThe effect of multiple micronutrient supplementation on vitamin B12 and folate has hither to not been reported in African HIV infected children. This paper describes vitamin B12 and folate status of Ugandan HIV infected children aged 1-5 years and reports the effect of multiple micronutrient supplementation on serum vitamin B12 and folate concentrations.MethodsOf 847 children who participated in a multiple micronutrient supplementation trial, 214 were assessed for vitamin B12 and folate concentrations pre and post supplementation. One hundred and four children were randomised to two times the recommended dietary allowance (RDA) of a 14 multiple micronutrient supplement (MMS) and 114 to a 'standard of care' supplement of 6 multivitamins (MV). Serum vitamin B12 was measured by an electrochemiluminescence immunoassay and folate by a competitive protein-binding assay using Modular E (Roche) automatic analyzer. Vitamin B12 concentrations were considered low if less than 221picomoles per litre (pmol/L) and folate if < 13.4 nanomoles per litre (nmol/L). The Wilcoxon Signed Ranks test was used to measure the difference between pre and post supplementation concentrations.ResultsVitamin B12 was low in 60/214 (28%) and folate in 62/214 (29.0%) children. In the MMS group, the median concentration (IQR) of vitamin B12 at 6 months was 401.5 (264.3 - 518.8) pmol/L compared to the baseline of 285.5 (216.5 - 371.8) pmol/L, p < 0.001. The median (IQR) folate concentrations increased from 17.3 (13.5 - 26.6) nmol/L to 27.7 (21.1 - 33.4) nmol/L, p < 0.001. In the 'standard of care' MV supplemented group, the median concentration (IQR) of vitamin B12 at 6 months was 288.5 (198.8 - 391.0) pmol/L compared to the baseline of 280.0 (211.5 - 386.3) pmol/L while the median (IQR) folate concentrations at 6 months were 16.5 (11.7 - 22.1) nmol/L compared to 15.7 (11.9 - 22.1) nmol/L at baseline. There was a significant difference in the MMS group in both vitamin B12 and folate concentrations but no difference in the MV group.ConclusionsAlmost a third of the HIV infected Ugandan children aged 1-5 years had low serum concentrations of vitamin B12 and folate. Multiple micronutrient supplementation compared to the 'standard of care' supplement of 6 multivitamins improved the vitamin B12 and folate status of HIV infected children in Uganda.Trial registrationhttp://ClinicalTrials.govNCT00122941)

Prevalence and Pattern of Disclosure of HIV Status in HIV-Infected Children in Ghana

With the advent of highly active antiretroviral therapy (HAART) HIV-infected children are surviving into adulthood. Despite emerging evidence of the benefits of disclosure, when and how to disclose the diagnosis of HIV to children remain a clinical dilemma. We investigated the prevalence and determinants of HIV disclosure in a cross-sectional study of 71 caregiver-child dyads from the Pediatric HIV/AIDS Care Program at Korle-Bu Teaching Hospital (Accra, Ghana). The children were between 8 and 14years of age (median age, 10.39years). The prevalence of disclosure was 21%. In the unadjusted analyses, the age of child, the level of education of child, deceased biologic father, administration of own HIV medications, and longer duration on HIV medication were significantly associated with disclosure. The low prevalence of disclosure underscores the need for a systematic and a staged approach in disclosing HIV status to infected children in resource limited countries.

Dental Caries Status of HIV Infected Children in Nigeria

HIV positive children may be prone to developing Dental Caries due to prolonged and frequent use of sucrose containing medications and poor feeding practices. To determine the caries status of primary and permanent dentition in HIV positive Nigerian children using dmft/DMFT indices. One hundred and twelve HIV positive children aged 4 months to 13 years attending two dedicated HIV outpatient clinics were examined for dental caries of primary and permanent dentition using the WHO criteria. Carious lesions were recorded using the dmft and DMFT indices in the primary and permanent dentition respectively. Forty four [39.3%] of the 112 children examined had dental caries mainly in the primary dentition in 96.7% of the cases. Mean dmft was 1.15 +/- 1.88, mean DMFT was 0.17 +/- 0.57. Dental caries was not significantly associated with the immune status of HIV positive children; chi2 = 2.58, P = 0.275. Dental caries experience in the primary dentition of these HIV positive children was greater than in the Nigerian paediatric population. Dental caries prevalence in these HIV positive children although lower than that seen in developed countries was however higher than in other reports of healthy Nigerian children. There was no significant association between dental caries and immune status of HIV positive children.

Effect of Bimonthly Supplementation With Oral Cholecalciferol on Serum 25-Hydroxyvitamin D Concentrations in HIV-Infected Children and Adolescents

Vitamin D insufficiency occurs commonly in HIV-infected youth in the United States. In light of the importance of vitamin D for skeletal and nonskeletal health, including innate immunity, developing methods for improving vitamin D status in HIV-infected children and adolescents is an important area of clinical research. The objective of this study was to evaluate the effect of administration of oral cholecalciferol, 100,000 IU every 2 months, and 1 g/day calcium on serum 25-hydroxyvitamin D concentrations, serum and urine calcium, and HIV disease progression during a 12-month period. HIV-infected children and adolescents who were aged 6 to 16 years were randomly assigned to receive vitamin D (100,000 IU bimonthly) and calcium (1 g/day; n = 29) or double placebo (n = 27). Serum 25-hydroxyvitamin D concentrations as measured by radioimmunoassay, albumin-corrected calcium concentrations, and spot urinary calcium-creatinine ratios were determined monthly. No abnormalities in serum calcium concentration were observed. One participant who received placebo developed hypercalciuria. No group differences were seen in the change in CD4 count or CD4% or viral load during 12 months. The overall mean monthly serum 25-hydroxyvitamin D concentrations were higher in the group that received vitamin D and calcium than in the placebo group, as was the monthly serum 25-hydroxyvitamin D area under the curve. After completing 12 months of study, 2 (6.7%) participants in the group that received vitamin D and calcium had a trough serum 25-hydroxyvitamin D concentration <20 ng/mL compared with 14 (50%) in the placebo group. Twelve (44.4%) in the group that received vitamin D and calcium had a trough serum 25-hydroxyvitamin D concentration of > or =30 ng/mL compared with 3 (11.1%) in the placebo group. Administration of oral cholecalciferol to HIV-infected children and adolescents at a dosage of 100,000 IU every 2 months, together with 1 g/day calcium, is safe and results in significant increases in serum 25-hydroxyvitamin D concentrations.

CD8+ T-Cell Interleukin-7 Receptor Alpha Expression as a Potential Indicator of Disease Status in HIV-Infected Children

BackgroundInitiation and modification of antiretroviral therapy in HIV-infected children depend on viral load and CD4+ T-cell count. However, these surrogates have limitations, and complementary immunological markers to assess therapeutic response are needed. Our aim was to evaluate CD8+ T-cell expression of CD127 as a marker of disease status in HIV-infected children, based on adult data suggesting its usefulness. We hypothesized that CD127 expression on CD8+ T-cells is lower in children with more advanced disease.MethodsIn a cross-sectional evaluation, we used flow cytometry to measure CD127+ expression on CD8+ T-cells in whole blood from HIV-infected children with varying disease status. This was compared with expression of CD38 on this subset, currently used in clinical practice as a marker of disease status.Results51 HIV-infected children were enrolled. There was a strong positive correlation between CD127 expression on CD8+ T-cells and CD4+ T-cell count, and height and weight z-scores, and a strong negative correlation between CD127 expression and viral load. In contrast, we found no association between CD38 expression and these disease status markers.ConclusionsCD8+ T-cell CD127 expression is significantly higher in children with better HIV disease control, and may have a role as an immunologic indicator of disease status. Longitudinal studies are needed to determine the utility of this marker as a potential indicator of HIV disease progression.

Predictors of Change in the Functional Status of Children With Human Immunodeficiency Virus Infection

The purpose of this study was to identify important clinical predictors of change in the functional status of children with perinatally acquired human immunodeficiency virus (HIV) infection. Children who were perinatally exposed to HIV underwent evaluation of growth, nutritional, and functional status parameters as part of a prospective study of HIV and nutrition in children. The main outcome measures for HIV-infected children were change over time in: 1) Total Health, 2) General Health, and 3) Responsiveness as measured by the Functional Status II(R) (FSII[R]). Candidate predictors included anthropometric measurements, social factors, HIV disease stage, CD4 T lymphocyte count, medications, and other clinical markers of illness. The parents or legal guardians of 35 perinatally HIV-infected children completed 2 FSII(R) surveys over a mean of 16 months. Functional Status scores were significantly correlated with number of times and days hospitalized in the past 6 months and with illness at the time of baseline evaluation. Functional status declined overtime on all 3 scales; however, only the change in Total Health score was statistically significant. Total, General Health, and Responsiveness scores declined by >/=5 points in 20.0%, 17.1%, and 14.3% of children, respectively. Significant univariate predictors of change in at least 1 component of the functional status survey included race, guardianship, height z score, prescription of antiviral medications other than antiretrovirals, and illness at time of baseline evaluation. In multivariate models, adjusting for baseline score and biologic relationship of guardian completing survey, significant predictors of a decline in Total Health scores included non-white race and lower baseline height z score. The General Health score declined with lower baseline absolute CD4 count and lower baseline height z score. Finally, Responsiveness scores declined in children whose guardian was their biologic parent and in children with lower baseline height z scores. The FSII(R) questionnaire correlates with other markers of disease severity in children with HIV infection. Growth parameters, immune status, and social factors are important predictors of functional status in HIV-infected children.