To define age at entry into Tanner stages in children with perinatal HIV-1 infection.
Multicentre longitudinal study including 212 perinatally HIV-1-infected children (107 girls and 105 boys) ...followed-up during puberty (from 8 and 9 years onwards in girls and boys, respectively). Healthy children (843 girls and 821 boys) provided reference percentiles. P2 or B2 stages in girls and P2 or G2 stages in boys defined onset of puberty.
The cumulative probability 95% confidence limit (CI) of entry into each stage at different ages was estimated by the Kaplan-Meier product-limit method; differences were evaluated by log rank test. Relationships were tested using the Spearman's rank correlation coefficient.
Ages of girls years (95%CI) at P2 12.9 (12.6-13.2), P3 13.4 (13.0-13.8), P4 14.6 (14.0-15.2), B2 12.7 (12.2-13.2), B3 13.3 (12.8-14.0) and B4 14.6 (14.0-15.2) stages were > 97th percentile (> or = 21 month delay) of controls. Ages of boys years (95%CI) at P2 12.6 (12.1-13.1), P3 13.9 (13.4-14.4), P4 14.9 (14.2-15.6), G2 12.1 (11.5-12.7), G3 13.6 (13.1-14.1) and G4 14.9 (14.1-15.7) stages were at the 75-97th percentiles (< or = 15 month delay). Age at onset of puberty was not related to clinical and immunological condition, antiretroviral treatment, weigh for height and age at onset of severe disease or immune suppression.
Perinatal HIV-1 infection interferes with sexual maturation. The mechanisms by which this occurs should be elucidated and intervention strategies designed. Intervention could save much psychological distress, since associated linear growth failure can exacerbate adolescents' feelings of being different and unwell.
Hematologic manifestations in perinatally human immunodeficiency virus-1-infected children have not been widely described in literature. Knowledge of the spontaneous evolution of this disease is ...essential for achieving optimum care of patients. We analyzed the main hematologic manifestations developed in the prehighly active antiretroviral therapy period of 1217 children, collected from the Italian Register for HIV infection. In 111 patients, the hematologic sign was the first clinical manifestation. Among anemic and neutropenic patients, the fraction of patients in clinical class C was significantly higher than the corresponding fraction in class B (76%, P<0.001 and 74%, P<0.01), and significantly lower in thrombocytopenic patients (42%, P<0.001). The overall progression from class B to C was overlapping to the control group; when separated, however, anemic patients progressed faster (P<0.0001), whereas thrombocytopenic patients had a slower progression, similar to the nonhematologic patients in class A. Anemic patients had a worse prognosis than the control group (P<0.0001), similar to the nonhematologic patients in class C. Finally, the negative prognostic value of anemia was independent from the immunologic condition. Anemia was associated with greater mortality risks. Thrombocytopenia appeared, paradoxically, to be a positive prognostic factor within class B. Centers for Disease Control and Prevention classification presently defines hematologic patients as a single entity; a finer distinction could improve its relevance for the rational design of prevention and therapy.
Summary
Non‐expensive and low‐complexity surrogate markers for monitoring the response to combined antiretroviral therapy (combined‐ART) are needed in poor‐resource settings where routine assessment ...of CD4+ T‐lymphocyte count and viral load can not be afforded. We longitudinally evaluated Ig serum levels in 234 HIV‐1 infected children receiving combined‐ART with ≥ 3 drugs. Since Ig levels physiologically vary with age, differences at different age periods were evaluated as differences in z‐scores calculated using the mean and standard deviation of the normal population for each age period. Data from 17 (7·3%) children with immunological failure and from 54 (23·1%) children with virological failure of combined‐ART were compared with data from not‐failed children. At baseline children with immunological failure showed higher IgM z‐scores (P = 0·042) than children without. After 3–12 months of therapy immunologically failed children displayed higher viral loads (P < 0·0001) and IgA (P = 0·043) z‐scores than not‐failed children. Similarly, at the same follow‐up time, children with virological failure showed lower CD4+ T‐lymphocyte percentages (P = 0·005) and higher IgA z‐scores (P < 0·0001) than not‐failed children. No difference in IgG or IgM z‐scores was evidenced between failed and not‐failed children after 3–12 months of therapy. In conclusion, IgA serum level is a cheap and low‐complexity marker of immunological or virological failure of combined‐ART which might be adopted in poor‐resource settings.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
ObjectiveTo verify whether vaccination against the A-H1N1 virus in the paediatric population was effective in preventing the occurrence of influenza-like illness (ILI) or was associated with adverse ...events of special interest.Design, setting and patientsA case–control analysis was performed as part of surveillance of children hospitalised through the emergency departments of eight paediatric hospitals/wards for ILI, neurological disorders, non-infectious muco-cutaneous diseases and vasculitis, thrombocytopaenia and gastroduodenal lesions.ResultsAmong 736 children enrolled from November 2009 to August 2010, only 25 had been vaccinated with the pandemic vaccine. Out of 268 children admitted for a diagnosis compatible with the adverse events of special interest, six had received the A-H1N1 vaccine, although none of the adverse events occurred within the predefined risk windows. Only 35 children out of 244 admitted with a diagnosis of ILI underwent laboratory testing: 11 were positive and 24 negative for the A-H1N1 virus. None of the A-H1N1 positive children had received the pandemic vaccine. The OR of ILI associated with any influenza vaccination was 0.9 (95% CI 0.1 to 5.5).ConclusionsThe study provides additional information on the benefit–risk profile of the pandemic vaccine. No sign of risk associated with the influenza A-H1N1 vaccine used in Italy was found, although several limitations were observed: in Italy, pandemic vaccination coverage was low, the epidemic was almost over by mid December 2009 and the A-H1N1 laboratory test was performed only during the epidemic phase (in <10% of children). This study supports the importance of the existing network of hospitals for the evaluation of signals relevant to new vaccines and drugs.
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