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With the availability of antiretroviral therapy (ART), HIV infection, which was once considered a progressively fatal illness, has now become a chronic treatable condition in children, as in adults. However, the challenges these children are forced to face are far more daunting. The most significant shortcoming in the response to paediatric HIV rem...
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Background
Combination antiretroviral therapy (cART) is the current strategy to prevent mother-to-child transmission (PMTCT) of HIV. Women initiated on cART should continue taking treatment life-long or stop after cessation of breastfeeding depending on their CD4 cell count or World Health Organization (WHO) staging. Keeping people living with HIV...
Background:
Early infant diagnosis with rapid access to treatment has been found to reduce HIV-associated infant mortality and morbidity considerably. In line with international standards, current South African guidelines advocate routine HIV-1 polymerase chain reaction (PCR) testing at 6 weeks of age for all HIV-exposed infants and 'fast-track' e...
Abstract Background Evidence of 24-months survival in the frame of prevention of mother-to-child transmission (PMTCT) cascade-care is scare from routine programs in sub-Saharan African (SSA) settings. Specifically, data on infant outcomes according to feeding options remain largely unknown by month-24, thus limiting its breath for public-health rec...
Introduction
Scaling up of antiretroviral therapy (ART) to HIV+ pregnant women is crucial for the elimination of HIV infection in children. The aim of this study was to evaluate the feasibility and effectiveness of triple ART for Prevention of Mother-to Child Transmission (PMTCT) in Cameroon.
Methods
HIV-positive pregnant women attending the DREAM...
Background
In the era of Option B+ and ‘treat all’ policies for HIV, challenges to retention in care are well documented. In Malawi, several large community-facility linkage (CFL) models have emerged to address these challenges, training lay health workers (LHW) to support the national prevention of mother-to-child transmission (PMTCT) programme. T...
Citations
... The spectrum of infections also varies in those on ART but non-adherent to therapy. WHO clinical criteria for presumptive diagnosis of severe HIV disease in infants and children less than 18 months of age is given below [8]. ...
... Another major benefit of ART is the possibility of preventing virus transmission, as this therapy manages to significantly reduce the number of maternal-fetal transmissions [2]. Highly active ART (HAART) has significantly reduced viremia, increased the body defense capacity, improved general condition, reduced the number of opportunistic infections, and prolonged survival, but with potentially significant side effects, reported since 1997, especially in the first generations of antiretrovirals (ARVs) [3,4]. ...
A major challenge in the management of antiretroviral therapy (ART) is to improve the 11 patient's adherence, reducing the burden caused by the high number of drugs that compose the 12 treatment regimens for human immunodeficiency virus positive (HIV+) patients. Selection of the 13 most appropriate treatment regimen is responsible for therapeutic success and aims to reduce vire-14 mia, increase the immune system response capacity, and reduce the incidence rate and intensity of 15 adverse reactions. In general, protease inhibitor (PI) is one of the pillars of regimens, and darunavir 16 (DRV), in particular, is frequently recommended, along with low doses of enzyme inhibitors as co-17 bicistat (COBI) or ritonavir (RTV), by the international guidelines. The potential of clinically signif-18 icant drug interactions in patients taking COBI or RTV is high due to the potent inhibitory effect on 19 cytochrome CYP 450, which attracts significant changes in the pharmacokinetics of PIs. Regardless 20 of the patient or type of virus, the combined regimens of DRV/COBI or DRV/RTV are available to 21 clinicians, proving their effectiveness, with a major impact on HIV mortality/morbidity. This study 22 presents current information on the pharmacokinetics, pharmacology, drug interactions, and ad-23 verse reactions of DRV; it not only compares the bioavailability, pharmacokinetic parameters, im-24 munological and virological responses, but also the efficacy, advantages, and therapeutic disad-25 vantages of DRV/COBI or DRV/RTV combinations. 26
... Entre los factores de riesgo para desarrollar la tuberculosis en niños se encuentran inmunodeficiencias tales como la infección por el virus de inmunodeficiencia humana (VIH), uso de fármacos inmunosupresores, diabetes mellitus (DM) y algunas características sociodemográficas como la pobreza y el hacinamiento (4) . La incidencia del VIH se ha mantenido estable en la población pediátrica en los últimos años (6) , en comparación con la DM que ha incrementado con el tiempo (7) . Esto podría contribuir al aumento de los casos de tuberculosis, ya que aquellos presentan un riesgo de 2 a 4 veces mayor de desarrollar tuberculosis activa (8) . ...
La tuberculosis es una de las principales causas de mortalidad en el mundo, a pesar de los múltiples controles y estrategias del tratamiento. La forma diseminada corresponde al 5 % de las presentaciones. Reportamos el primer caso en la literatura de una paciente adolescente con diabetes mellitus tipo 1 y tuberculosis diseminada quien presentó síntomas constitucionales asociados con un dolor lumbar, inicialmente interpretado como sacroileítis no infecciosa y una probable enfermedad inflamatoria intestinal.
... 8 in india, the HibCv is being introduced subnationally; however, it is not part of the program for Hiv-infected children. 4 An estimated 105,000 children with Hiv live in india, accounting for 1 in 24 children with Hiv globally; evaluating the impact of HibCv in Hiv-infected indian families is timely. 9 in addition to reducing Hib disease in vaccinated individuals, HibCv has indirect effects; it reduces nasopharyngeal carriage, and thus, the rate of Hib disease in unvaccinated individuals who live in the same community as vaccinated children. 10,11 Population-based studies have found the indirect effectiveness of HibCv among unvaccinated individuals to be 60%-94%. ...
Introduction:
In addition to reducing Haemophilus influenzae type b (Hib) disease in vaccinated individuals, the Hib conjugate vaccine (HibCV) has indirect effects; it reduces Hib disease in unvaccinated individuals by decreasing carriage. HIV infected children are at increased risk for Hib disease and live in families where multiple members may have HIV.
Objective:
To look at the impact of 2 doses of the HibCV on nasopharyngeal carriage of Hib in HIV infected Indian children (2-15 years) and the indirect impact on carriage in their parents.
Methods:
This prospective cohort study was conducted in HIV infected and uninfected families. Nasopharyngeal swabs were collected from children and parents before and after vaccination. HIV infected children ages 2-15 years got two doses of HibCV and were followed up for 20 months. Uninfected children age 2-5 years got 1 dose of HibCV as catch-up.
Results:
123 HIV infected and 44 HIV uninfected children participated. Baseline colonization in HIV infected children was13.8% and dropped to 1.8% (p=0.002) at 20 months. Baseline carriage in HIV uninfected children was 4.5%, and dropped to 2.3% after vaccination (p=0.3). HIV infected parents had 12.3 times increased risk of Hib carriage if their child was colonized (p=0.04) and 9.3 times increased risk if their child had persistent colonization post vaccine (p=0.05). No parent of HIV uninfected children had Hib colonization at any point. Pneumococcal colonization was associated with increased Hib colonization.
Conclusion:
Making the HibCV available to HIV infected children could interrupt Hib carriage in high risk families.
... Over the past twenty years, 190 countries have introduced HibCV, including many countries with a high burden of pediatric HIV infection [4]. India has an estimated 105,000 HIV-infected children and one of the highest numbers of HIV-infected pregnant women in the world [5,6]. Hib vaccines were recently introduced as a primary series of three doses of pentavalent vaccine (DTP, hepatitis B and Hib) [4,7]. ...
... All participants that received NVP were adherent with 90% of the participants rated as between very good and excellent. This is an important factor as poor adherence can lead to inadequate drug levels (with a decrease in both efficacy, but n=20) 1000 1189 1414 1682 2000 2378 2828 3364 4000 4757 5657 6727 8000 0014 also toxicity) and development of drug resistance [17]. ...
bstract
Background: Drugs that are included in treatment regimens, including prevention programmes for the Human
Immunodeficiency Virus (HIV), may place patients at risk of ototoxicity due to their side-effect profiles. Ototoxicity is part of
this side-effect profile but is comparatively understudied in HIV-positive patients receiving antiretroviral (ARVs) agents. Patient
safety has been identified as a part of the National Core Standards from the National Department of Health. As part of this
strategy and due to the limited information available on the possible ototoxicity of nevirapine (NVP) as part of the prevention
of mother-to-child transmission (PMTCT) in neonates, the study was conducted.
Method: The study aimed to determine if there was a possible association between neonates receiving NVP as part
of PMTCT and ototoxicity at Dr George Mukhari Academic Hospital (DGMAH). A descriptive, quantitative cohort study was
conducted prospectively. Participants were allocated purposively to either an experimental (received NVP) or control (NVP
not received) group. The research team consisted of pharmacists, who performed the screening for eligible participants, and
audiologists, who conducted all audiological assessments.
Results: A total of 165 participants were enrolled over a period of ten months; however, only 40 participants (24%)
completed the study. The two study arms were comparable in terms of demographic variables. All of the participants that
received NVP (n=20) were adherent. Both study arms (n=40) failed to pass the distortion product otoacoustic emission (DPOAE)
assessments at baseline (day 0). There were no statistically significant differences between the two study arms in terms of the
DPOAE results (p>0.05) tested at both two and six weeks.
Conclusion: Contrary to available literature, the results from this study showed that NVP administered as part of PMTCT
was not associated with hearing loss in neonates who participated in this study. Future monitoring is strongly suggested as
possible insults to the cochlea cannot be excluded at such an early age.
... Of an estimated 27 million pregnancies in India less than a quarter have HIV counseling and testing. [1] It is estimated that there are between 22,000 and 61,000 HIV pregnant women living with HIV in India. [1,2] With improving prevention of parent to child transmission (PPTCT) program services, perinatal transmission of HIV has decreased and the vast majority of infants born to known HIV-infected mothers are HIV-exposed but uninfected. ...
... [1] It is estimated that there are between 22,000 and 61,000 HIV pregnant women living with HIV in India. [1,2] With improving prevention of parent to child transmission (PPTCT) program services, perinatal transmission of HIV has decreased and the vast majority of infants born to known HIV-infected mothers are HIV-exposed but uninfected. At the same time, there remains a huge gap between the number of estimated HIV infections in pregnant women versus those actually diagnosed and availing of PPTCT services. ...
... [3,4] Resultant, a subset of HIV-infected pregnant women remains undiagnosed and untreated allowing disease progression, malnutrition, and immunosuppression. [1] Compared to the cohort of HIV-infected children, the health status of HIV-exposed but uninfected children is relatively less published especially in Indian context. [5,6] The present study was planned to assess the impact of maternal factors such as clinical stage of the HIV disease, CD4 count, and weight during pregnancy in HIV-infected mothers on anthropometric parameters of HIV-exposed but uninfected infants. ...
Background:
Compared to HIV-infected children, relatively little has been described regarding the health status, particularly growth of HIV-exposed but uninfected children in resource-limited settings. This is particularly relevant with widespread implementation of the prevention of parent to child transmission program.
Methods:
At a tertiary care health institute in India, a cohort of 44 HIV-exposed but uninfected children were followed through 6 months of age. The anthropometric parameters weight, length, and head circumference were investigated at birth, 3 weeks, 6 weeks, 3 months, and 6 months point of time. The information on maternal characteristics such as HIV clinical staging, CD4 count, and maternal weight were recorded. The linear regression analysis was applied to estimate the influence of maternal characteristics on infant anthropometric parameters.
Results:
Anthropometric parameters (weight, length and head circumference) were significantly reduced in uninfected new-borns of mothers in HIV Clinical stage III and IV and weight <50 kg compared to mothers in HIV Clinical stage I and II and weight >50 kg. Analysis conducted to find the effect of maternal immunosuppression on infant growth reveals a significant difference at CD4 300 cells/mm(3) and not at established cut-off of CD4 350 cells/mm(3). This trend of difference continued at 6 weeks, 3 months, and 6 months. The multiple linear regression analysis model demonstrated maternal HIV clinical stage and weight as predictors for birth weight and length, respectively.
Conclusions:
Advanced HIV disease in the mother is associated with poor infant growth in HIV-exposed, but uninfected children at a critical growth phase in life. These results underscore the importance, especially in resource-constrained settings, of early HIV diagnosis and interventions to halt disease progression in all pregnant women.
... In a country like India, other challenges which cannot be ignored are delayed presentation of patients to health care facilities, delayed diagnosis, increased frequency of malnutrition and susceptibility to infection which complicate disease presentation and the several social and economic factors which inhibit proper treatment compliance in our patients [17]. ...
The Eye is a vital sense organ and much like any other organ in the body can be afflicted by HIV. An ophthalmic referral at the time of presentation must be ensured by the treating physician. The ophthalmologist must take utmost care while examining and treating such patients to avoid patient to patient and patient to healthcare provider spread of HIV. A detailed ophthalmic examination for the various manifestations must be done and timely intervention for the same must be carried out which is critical to prevent ocular morbidity. Highly Active Anti Retroviral Therapy (HAART) is safe and has been instrumental in lowering sight threatening complications of HIV such as CMV retinitis.
... Some of these challenges include: concerns about HIV disclosure to the child, orphanhood and vulnerability occasioned by HIV infection, lack of appropriate pediatric antiretroviral formulations, adherence to lifelong antiretroviral therapy (ART), shortage of skilled health personnel, and issues concerning retention of children in care and treatment programs. [5][6][7][8] A comprehensive care and treatment package for HIV-infected children started in Benue State at the Federal Medical Centre (FMC), Makurdi, in May 2006, seven years after the commencement of the adult ART program in 1999. Since the inception of the program, there has been a progressive increase in enrollment, necessitating running a pediatric clinic twice per week (on Wednesdays and Fridays). ...
Background
Optimal adherence to antiretroviral therapy (ART) and retention-in-care are essential in HIV management. Through a Kiddies’ Club (KC), the study aimed at assessing the impact of social leisures and psychosocial support on ART adherence and clinic attendance in a pediatric ART program.
Methods
This was a descriptive, longitudinal study, conducted at the Federal Medical Centre, Makurdi, Nigeria, from June 2011 to June 2012. It included 33 ART-experienced children and their caregivers. The study was supplemented with a qualitative focused group discussion, involving 12 discussants. ART adherence, clinic attendance, and clinical and immunoviralogical responses of the children to ART were noted at 6 months and at 12 months of follow-up.
Results
The children comprised 17 males and 16 females, with a median age of 5 years. Financial constraint was the most common reason given for losses to follow-up in quantitative (32/33, 96.9%) and qualitative (12/12, 100.0%) assessments. But, unavailability of means of transportation may still override the benefit that financial assistance can provide, as reported in the qualitative study. The baseline mean hemoglobin level (8.50 g/dL), median CD4 count (187.00 cells/mm3); median weight for height z-score (−0.395), and the median body mass index (15.40) increased significantly to respective values of 10.03 g/dL, 1,030.00 cells/mm3, −0.090, and 18.50, at 6 months (P-values: 0.000), and 10.47 g/dL, 1,203.00 cells/mm3, 0.420, and 19.20, at 12 months (P-values: 0.000). The baseline median viral load (45,678.00 copies/mL) also decreased significantly, to 200.00 copies/mL at 6 months and at 12 months (P-values: 0.000). There was no attrition from death or loss to follow-up, and adherence to ART was 100%, at 6 months and at 12 months of follow-up.
Conclusion
Through the KC, children were retained in care, with excellent adherence to ART, and good clinical and immunoviralogical responses to ART, even after being previously lost to follow-up.
... The underlying social determinants of malnutrition may contribute to poor nutrition among these patients (27) . Common causes for inadequate nutrition are chronic illness, poverty, food insecurity and side-effects of drugs (35) . Most of the children and adolescents evaluated in the present study were from low-income backgrounds. ...
Objective:
Although the benefits of highly active antiretroviral therapy (HAART) have been documented, it is thought to be associated to disturbances in nutritional status. These disturbances may occur early in life and are poorly understood. The present study aimed to investigate the relationship between anthropometric parameters and body composition of perinatally HIV-infected children and adolescents under HAART, according to use and non-use of protease inhibitors.
Design:
Cross-sectional study undertaken between August and December 2007. Demographic, socio-economic, clinical and anthropometric data were collected from the patients. The χ 2 test, Wilcoxon rank sum test (Mann-Whitney) and t test were used to compare the following variables between users and non-users of protease inhibitors: age, gender, per capita income, HAART exposure, antiretroviral therapy adopted in the last three years, CD4 count, viral load, pubertal stage, nutritional status (BMI-for-age, height-for-age, waist and neck circumferences, triceps skinfold thickness, body fat percentage, upper-arm fat area and upper-arm muscle area).
Setting:
An HIV/AIDS out-patient clinic, São Paulo, Brazil.
Subjects:
One hundred and fifteen patients (children and adolescents aged 6-19 years).
Results:
Protease inhibitors users had a higher prevalence of stunting (P=0.03), lower BMI (P=0.03) and lower percentage of body fat (P=0.05) compared with non-users. There was no statistically significant difference between the HAART regimens and measurements of fat adiposity.
Conclusions:
The findings of the study suggest that children and adolescents under protease inhibitors are at higher risk of growth and development deviations, but not at risk of body fat redistribution.
