We have shown previously that 20% of symptomatic children with perinatally acquired human immunodeficiency virus type 1 (HIV-1) infection have high transferase values that correlate with severe ...clinical outcome. Little is known about transferase values early in the course of infection whereas abnormalities could provide information in predicting HIV-1 infection status in infants not yet definitely diagnosed. In the present study this issue was addressed determining transferase values in infants during the indeterminate infection status. Results were correlated with infection status, immunologic data, eventual development of p24 antigenemia and clinical outcome.
Erythrocyte adenosine deaminase (ADA) activity was assessed in 33 children born to human immunodeficiency virus (HIV)-positive mothers. The enzyme values were significantly increased in infected, ...symptom-free children compared with a control group of HIV-negative subjects (mean ± SD0.34 ± 0.01 unit/ml red blood cells (RBC) vs. 0.25 ± 0.04 unit/ml RBC, P < 0.01) and a further significant increase was found in symptomatic children (0.45 ± 0.02 unit/ml RBC, P < 0.01 vs. infected, symptom-free children). ADA values were slightly enhanced also in the group of infants in whom the state of HIV infection was indeterminate (0.29 ± 0.03 unit/ml RBC, P not significant vs. controls).These data indicate that increased erythrocyte ADA activity may be a useful though indirect marker of HIV infection in children at risk and be of possible prognostic relevance. Since increased values were present also in children without overt infections or hematologic disorders, and ADA activity of erythrocytes obtained from healthy donors did not increase after 1 hour incubation with patientsʼ serum, HIV could induce large amounts of cellular enzyme infecting directly erythroid precursor cells.
Some data suggest that cesarean section reduces mother-to-child HIV-1 transmission. To assess the influence of mode of delivery and other maternal and infant factors on the rate of transmission, we ...analyzed the data of 1,624 children prospectively followed from birth. Of these, at the last visit 1,033 were >18 months of age or would have been had they not died of HIV-related illness. Among the 975 first singleton children, 180 18.5%; 95% confidence limits (CL), 16.1-20.9 acquired infection, as did 8 of 56 (14.3%; 95% CL, 5.1-23.5) second-born children. Multivariate stepwise analysis showed that vaginal delivery and development of symptoms in the mother were significantly and independently associated with a higher transmission rate (vaginal delivery: odds ratio, 1.69; 95% CL, 1.14-2.5; symptoms: odds ratio, 1.61; 95% CL, 1.12-2.3). In contrast, a history of maternal drug use, birth weight, breast-feeding (only 37 infants were breast-fed), and child's sex did not have a significant impact on viral transmission. The percentage of infected children was highest (30.7%) among very premature infants ( less than or equal to 32 weeks of gestation); this significant trend subsequently decreased to 11.9% at the week 42 (p < 0.001), suggesting a parallel reduction in peripartum transmission. The reduced rate of infection observed in infants born by cesarean section underlines the urgent need for randomized controlled trials to evaluate the protective role of surgical delivery in preventing perinatal HIV-1 transmission.
BACKGROUND Randomized controlled trials have demonstrated that zidovudine therapy decreases the mother-to-infant transmission of human immunodeficiency virus 1 (HIV-1). Data from large observational ...studies may provide further important findings on the effectiveness at the population level of combined treatments in decreasing transmission. OBJECTIVE To evaluate time trends in prophylactic interventions and the determinants of transmission both before and after the introduction of antiretroviral prophylaxis, and in treated and untreated mother-infant pairs after 1995. DESIGN AND SETTING Analysis of prospective data on 3770 children born to HIV-1–infected women between 1985 and 1999 and reported to the Italian Register for HIV Infection in Children. MAIN OUTCOME MEASURES Logistic regression random effects models were used to estimate crude and adjusted odds ratios for several factors potentially influencing vertical transmission for 2 periods—1985 through 1995 (January 1, 1985, through December 31, 1995) and 1996 through 1999 (January 1, 1996, through December 31, 1999), and between treated and untreated children after 1995. RESULTS The transmission rate was 15.5% in the 1985-1995 period and 5.8% in the 1996-1999 period. By 1999, prophylactic interventions had greatly increased. Antiretroviral treatment (ART) usage was 89.9%, (55.1% combination ART) and the elective cesarean delivery rate was 81.3%. In multivariate analysis, only elective cesarean delivery was associated with a lower risk of mother-to-infant transmission before 1995. After 1995, nonbreastfeeding and receipt of ART were protective whereas elective cesarean delivery was not significantly protective in multivariate analysis. Transmission risk was reduced by 76% with an incomplete zidovudine regimen, 88% with a complete regimen, and 93% when the mother received combination ART. In the 1996-1999 period, the transmission rate for nonbreastfeeding mother-infant pairs was 8.6% with elective cesarean delivery, 4.4% with any ART, and 2.4% with these interventions combined. CONCLUSION Prophylactic interventions, and in particular ART, reduced perinatal HIV-1 transmission at a population level in Italy.-->
We assessed the long-term feasibility, safety, and tolerability of two regimens of aerosolized pentamidine (AP) as primary prophylaxis of Pneumocystis carinii pneumonia (PCP) in a large sample of ...infants and children with symptomatic HIV infection in 21 pediatric departments. One hundred forty children were assigned to receive 60 mg every 2 weeks (n = 60) or 120 mg every 4 weeks (n = 80) of AP, delivered by the ultrasonic nebulizer Fisoneb under the supervision of trained personnel. Children underwent monthly clinical and laboratory controls for toxicity and/or development of PCP for an 18-month period. Baseline characteristics were similar in the two treatment groups. The median age was 5 years. The feasibility of administering AP was excellent in 84 (60%) and good in 38 (27%) children. All children aged <2 years showed excellent or good feasibility. Long-term compliance was good with both regimens. No child had severe adverse reactions requiring discontinuation of the treatment. Cough, sneezing, and bronchospasm were the most frequent side effects occurring, respectively, in 12, 3.7, and 0.7% of the 60-mg treatments and in 19.1, 6.1, and 2.8% of 120-mg treatments (p < 0.05). Their incidence was not different in children younger or older than 5 years. Two episodes of PCP were observed in the group receiving 120 mg monthly, whereas none of the 60 children in the biweekly schedule had PCP (p = 0.20). AP can be safely administered to very young children with few adverse side effects.
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