Cerebrovascular complications of HIV in children

Two uncommon but important cerebrovascular manifestations of human immunodeficiency virus (HIV) infection in children are arteritis with formation of fusiform aneurysms and arterial sclerosis with vascular occlusion. We studied the CT and MR imaging features of HIV in two girls and one boy (9 to 18 years old) and compared them with autopsy findings in two patients. One of the children had findings consistent with small areas of subacute infarction and the other two had fusiform dilatation of the major vessels of the circle of Willis. The ischemic lesions and arteriopathy were confirmed at autopsy. In one patient, an incidental B-cell lymphoma (not visible on the imaging studies) was diagnosed.     

Serum lactate-dehydrogenase isoenzymes in HIV positive children. A longitudinal study

The impairment of humoral immunity with rapid turn-over of cellular B clones in children with HIV infection is known as well as the conduct of LDH isoenzymes in B cell lymphoproliferative diseases like Burkitt's lymphoma. Therefore, serum lactate-dehydrogenase activity (LD, EC 1.1.1.27) and its isoenzymes have been evaluated twice (within 12 months) in 11 children with HIV infection with respect to a control group (30 subjects). Furthermore, the relationship between those and other clinical and immunologic parameters (total lymphocytes, CD4/CD8, immunoglobulins, classification according to the Atlanta CDC 1987) has been studied. HIV infected children have shown a significant decrease in LD1 rates, which was directly correlated to CD4/CD8 values. After the follow-up, this correlation became even more significant. Thus, these findings may suggest the usefulness of LDH isoenzymes evaluation as a marker of disease activity in children with HIV infection.     

HIV infection in women and children. Special concerns in prevention and care

Unfortunately, HIV infection continues to spread rapidly among women in the United States, and infected women still have a poorer outcome than do infected men. Prevention, early diagnosis, and facilitation of care in women are critical to both their own and their children's health. Fortunately, significant advances continue to be made in prevention of HIV transmission to children. Not only HIV experts but also primary care physicians play an important role in identification and care of HIV-infected women and children. In addition, prevention of HIV infection requires the efforts of professionals throughout the healthcare spectrum.     

Influence of HIV epidemic on the incidence of Kaposi''s sarcoma in Zambian children

BACKGROUND: It has been suggested that suppression of adrenal androgens may provide benefit to patients with metastatic prostate cancer refractory to initial hormonal therapy (e.g., orchiectomy). METHODS: The records of 38 patients with metastatic prostate cancer that had progressed after orchiectomy who were placed subsequently on low dose dexamethasone (DXM) with no other concurrent therapy (36 patients received 0.75 mg twice daily and two received 0.75 mg three times daily) were reviewed. Symptomatic status, prostate specific antigen (PSA) measurements, and available radiographic assessments were recorded. Bone scans were reviewed by an independent, blinded evaluator. RESULTS: Symptomatic improvement was experienced by 24 patients (63%), 20 (83%) of whom also had decreases in PSA. Prostate specific antigen values decreased in 30 patients (79%) with decreases 50% or greater and 80% or greater in 23 (61%) and 13 (34%) patients, respectively. Of the 23 patients with PSA decreases 50% or greater, 8 (35%) had radiographic evidence of disease regression, 5 (22%) were stable, 7 (30%) had disease progression, and 3 (13%) did not have serial radiographic exams. Flutamide was discontinued shortly before DXM treatment for 2 of the 23 patients. CONCLUSIONS: Low dose DXM may produce important symptomatic improvement and decreased PSA levels in the majority of patients with hormone-refractory prostate cancer. In addition, a substantial percentage of those patients with decreases in PSA also will have radiographic evidence of disease regression. These results suggest the need for additional prospective controlled studies of DXM as a therapy for hormone-refractory prostate cancer.     

Implications and management of oral diseases in children and adolescents with HIV infection

Nurses and midwives may not be directly involved in treating menopausal patients, nevertheless they are in a unique position to offer support and advice to patients concerned about the menopause. Many women want to know about ways of dealing with uncomfortable symptoms and fears associated with going through the menopause. Homoeopathic treatment is one form of therapy which can be used during the menopause, which takes into account both the physical symptoms and the emotional responses. Homoeopathic treatment can be used as an alternative to treatment with hormone replacement therapy (HRT), or alongside HRT, in the management of menopausal symptoms. As well as exploring homoeopathic approaches to the treatment of menopausal symptoms, the current trend of promoting HRT is questioned in this article.     

Recurrent parotitis in children and HIV infection. Apropos of 4 cases]

Over a 2-year period at our institution, 6 patients underwent metallic stent treatment, 5 for malignant conditions and 1 for a benign condition of the esophagus. The use of expandable metallic stents for benign strictures has paralleled malignant indications but is limited and less understood from a clinical standpoint. A review of current literature in the treatment of benign strictures is presented. Treatment of benign strictures is associated with high morbidity and mortality as demonstrated by the cumulative experience of 21 patients. Migration, hyperplastic tissue obstruction at the terminal ends, reflux, and complications of perforation occur at a prohibitive rate. We conclude that expandable metallic stents should be reserved for palliative treatment of esophageal malignant obstructions and tracheoesophageal fistulas. Pharmacological management, necessary dilatations and operative corrections (antireflux procedures, esophagectomy) are recommended treatments for benign strictures.     

Maternal disclosure of mothers' HIV serostatus to their young children.

Mothers' disclosure of their RIV serostatus to their nonaffected young children and factors associated with disclosure were investigated among 135 families. Overall, 30% of the mothers had personally disclosed their serostatus to their children Mothers who disclosed reported higher levels of social support in their lives than mothers who did not disclose. Children whose mothers had disclosed to them displayed lower levels of aggressiveness and negative self-esteem compared to children whose mother had not disclosed. These findings indicate that for this sample, no negative effects were observed among young children to whom mother have personally disclosed their HIV serostatus. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of human immunodeficiency virus (HIV) type 1 RNA levels in cerebrospinal fluid and viral resistance to zidovudine in children with HIV encephalopathy

The amount of human immunodeficiency virus (HIV) type 1 RNA and the presence of a codon 215 mutation indicative of zidovudine resistance were evaluated in cerebrospinal fluid (CSF) and plasma obtained from HIV-1-infected children. The level of HIV-1 RNA in CSF was highest in children with severe encephalopathy (n = 25; median, 430 copies/mL; range, 0-2.2 x 10(5) copies/mL) followed by the moderately encephalopathic (n = 7; median, 330; range, 0-1130) and nonencephalopathic groups (n = 9; median, 0; range, 0-566) (P = .007). There was no correlation between CSF and plasma HIV-1 RNA levels. Five of 7 children with the codon 215 mutation in CSF had a progression of encephalopathy, while all 8 children with wild type codon 215 had improved or stable disease during zidovudine treatment (P = .007). These findings suggest that increased viral replication and emergence of drug-resistant HIV-1 variants within the central nervous system may play a role in progression of HIV encephalopathy.     

随州市受HIV/AIDS影响子女关怀支持调查

自2001年4月随州市发现首例艾滋病人以来,受艾滋病影响家庭的子女就面临着学习、家庭、心理和社会歧视等各方面的问题,他们对社会各方面的关怀支持也就显得十分迫切.因此,及时向受HIV/AIDS影响子女提供关怀支持,引导他们积极健康的成长显得尤为重要.2010年8月,对随州市受HIV/AIDS影响子女2009年获得的关怀支持情况进行了调查,以了解随州市对受HIV/AIDS影响子女的关怀支持现状.     

Prevalence of transfusion associated infections in multitransfused children in relation to mandatory screening of HIV in donated blood

Any change in risk behavior related to acquisition of human immunodeficiency virus (HIV) infection is likely to reduce simultaneously the risk for other agents transmitted through identical routes. A study carried out in the city of Delhi, India on the load of transfusion associated infections among multitransfused (MT) children in relation to mandatory screening of HIV infection in donated blood indicated unchanged prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV) infections among the group of MT children transfused after the implementation of mandatory screening of HIV infections in blood banks, i.e. post-implementation period (prevalence of HBV, HCV and HDV being 32.8%, 31.3% and 1.6% respectively) compared to a group of MT children transfused over a similar duration before the implementation of mandatory screening i.e. pre-implementation period (prevalence of HBV, HCV and HDV being 28.1%, 26.6% and 1.6% respectively). However, reduction could be recorded in the prevalence of IgM and IgG classes of antibodies to both CMV and HSV-2 infections among MT children receiving transfusion during the post-implementation period (prevalence of 3.1% and 37.1% for CMV IgM and CMV IgG respectively; prevalence of 3.1% and 25% for HSV-2 IgM and HSV-2 IgG, respectively) compared to the group of MT children transfused in the pre-implementation period (prevalence of 15.6% and 56.3% for CMV IgM and CMV IgG respectively; prevalence of 18.8% and 45.2% for HSV-2 IgM and HSV-2 IgG, respectively). These reductions were statistically significant (p values < 0.02 and < 0.05 for CMV IgM and CMV IgG; p values < 0.01 and < 0.02 for HSV-2 IgM and HSV-2 IgG respectively). These observations were in accordance with the recorded reduction in the prevalence of CMV and HSV-2 infections and unaltered prevalence of HBV, HCV and HDV infections in the group of donors donating blood during the post-implementation period compared to those donating in the pre-implementation period. Study of epidemiological risk factors among blood donors showed a change in behavior towards safer sex practice with only 13.0% of donors in the post-implementation period having history of sex with one or more female commercial sex workers during their donation periods compared to 41.5% of donors in the pre-implementation period having similar history (p < 0.001). However no change could be recorded in the proportion of donors donating at frequency higher than the permissible guidelines among the two groups. The present study points out nosocomial transmission as well as limitations in the existing guidelines for screening of infectious agents in blood banks as possible incriminating factors towards acquisition of hepatitis virus infections in blood donors as well as in MT children.     

Preventing HIV infection and AIDS in children and adolescents: Behavioral research and intervention strategies.

This article focuses on pediatric and adolescent AIDS. Literature is reviewed on the incidence of AIDS in various age groups, highlighting differences in demographic patterns among pediatric, adolescent, and adult AIDS cases. Behaviors that increase the likelihood that a child or adolescent will contract AIDS, as well as prevention strategies that target the prevention of human immunodeficiency virus (HIV) infection, are discussed. Finally, recommendations are made for social science research directed toward altering behavior associated with HIV. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Zidovudine therapy and HIV type 1 mutations in children with symptomatic HIV type 1 infection: effect of switching to didanosine or zidovudine plus didanosine therapy. Italian Multicenter Study Group on HIV Mutations in Children

Type and prevalence of zidovudine (ZDV) resistance mutations in HIV-1-infected children in clinically stable condition and on ZDV monotherapy were analyzed to evaluate the effect of switching to didanosine (ddI) monotherapy or to ZDV plus ddI on the pattern of mutations and on the clinical outcome. Monthly clinical and laboratory controls for HIV-1 infection status were performed; at enrollment and every 4 to 6 months after treatment randomization mutant proviral sequences were evaluated in all the children, whereas viral burden was performed only in a small subgroup of patients randomly selected in each of the three treatment groups. ZDV resistance-associated proviral DNA mutations were defined as low-level resistance (LLR) mutations or medium/high-level resistance (MHLR) mutations; clinical outcome was considered as stable or deteriorating. Results showed that at entry into the study the duration of ZDV therapy was significantly correlated with the presence of mutations, and that the level of resistance given by mutations was associated with the severity both of symptoms and immunodeficiency. After randomization to treatment, in patients with mutations that confer LLR a better clinical outcome with ddI monotherapy than with ZDV plus ddI and ZDV alone was observed in the subsequent 6 months, whereas in patients with mutations that confer MHLR no significant difference among the three treatment groups was found. Data showed also that levels of viral burden at the time of changing therapy are related to clinical outcome if measured by plasma viral load. These results suggest that genotypic resistance assays, together with viral load, may prove useful for rational treatment decisions both at the start of therapy and with failure.