42 research outputs found
Therapeutic and other interventions to reduce the risk of mother-to-child transmission of HIV-1 in Europe. The European Collaborative Study
No full textC. Thorne, M.-L. Newell, A. Bailey, C.S. Peckham, C. Giaquinto, E. Ruga, A. De Rossi, D. Truscia, I. Grosch-Worner, A. Schafer, J. Mok, F. Johnstone, F. Omenaca, J. Jiminez, C.De Alba, M.C. Garcia-Rodriguez, I. Bates, I. De Jose, F. Hawkins, R. Martinez Zapico, F. Asensi-Botet, M.C. Otero, D. Perez-Tamarit, A. Gonzalez Molina, H. Canosa, H. Scherpbier, K. Boer, A.B. Bohlin, S. Lindgren, E. Belfrage, J. Levy, A. Alimenti, P. Barlow, A. Ferrazin, A. Dre Maria, C. Gotta, V. Maritati, A. Mur, M.T. Rovira, A. Paya, O. Coll,
C. Fortuny, J. Boguna, M. Casellas Caro, Y. Canet, G. Pardi, A.E. Semprini, M. Ravizza, C. Castagna,
S. Fiore, B. Guerra, S. Bianchi, L. Bovicelli, E. Prati, S. Zanelli, M. Duse, A. Soresina, G. Scaravelli,
M. Stegagno, M. De Santis, M.-L. Muggiasca, P. Marchisio, A. Iasci, A. Spinillo, A. Bucceri, E. Grossi,
L. Rancilio, R. Smith, A.-M. Lewi
The management of HCV infected pregnant women and their children European paediatric HCV network
No full textBACKGROUND/AIMS: As evidence accumulates relating to mother-to-child (vertical) transmission of hepatitis C virus (HCV), it is timely to draw up guidelines for the clinical management of HCV infected pregnant women and their children.
METHODS: A review of evidence from the European Paediatric HCV Network (EPHN) prospective study of HCV infected women and their children and other published studies. Meeting of EPHN clinical experts to reach a consensus on recommendations for management. Each recommendation was graded according to the level of evidence.
RESULTS/CONCLUSIONS: Although several risk factors for mother-to-child transmission have been identified, none are modifiable and there are currently no interventions available to prevent vertical transmission of HCV. Data on timing of loss of maternal antibodies and reliability of diagnostic tests inform the optimum follow-up schedule for confirmation or exclusion of infection in children born to HCV infected women. Based on the current evidence, routine antenatal screening for HCV should not be introduced and neither elective caesarean section nor avoidance of breastfeeding should be recommended to HCV infected women to prevent mother-to-child transmission of HCV. HCV/HIV co-infected women should follow existing HIV guidelines
Características sociofamiliares de los niños nacidos de mujeres infectadas por el virus de la inmunodeficiencia humana
No full textObjetivoEvaluar las características sociofamiliares de los niños nacidos de mujeres infectadas por el virus de la inmunodeficiencia humana (VIH). Como objetivos secundarios, analizar los aspectos de la escolarización, así como el número de ingresos y tiempo de estancia hospitalaria que han requerido estos niños.DiseñoEstudio observacional prospectivo.EmplazamientoUnidad VIH. Hospital Infantil.ParticipantesCriterios de inclusión: todos los niños reclutados en la Unidad VIH que tuvieran definido el estado de la infección durante el período de estudio, comprendido entre el primer caso conocido en 1985 y abril de 1994. La muestra es de 177 niños (62 VIH-infectados y 115 no infectados).Mediciones y resultados principalesMediante entrevista, se recogieron las variables sociofamiliares y escolares. Al comparar los niños infectados con los no infectados, no se detectaron diferencias importantes en cuanto a la situación de desamparo en el recién nacido (8,1 frente a 13%), escasa relación maternofilial (31,2 frente a 36,5%) o respecto a las personas responsables de la custodia de estos niños. Se detectó menor escolarización y mayores problemas de integración escolar en los casos infectados, con odds ratio de 2,68 (p = 0,004) y 11,36 (p = 0,004), respectivamente. Los niños infectados también necesitaron mayor número de ingresos (4,3 ± 5,7) que los no infectados (1,7 ± 0,9) (p = 0,001) y más días de estancia hospitalaria (75,1 ± 110,3 frente a 23,3 ± 19,6) (p = 0,0003).ConclusionesLas características sociofamiliares de los niños infectados fueron similares a las de los niños no infectados. Sin embargo, la menor escolarización, los problemas de integración escolar y el mayor número de ingresos y por más tiempo se relacionaron con la infección VIH en los niños, y no tanto por su condición de hijos de madres seropositivas.ObjectivesTo evaluate the social and family characteristics of children born to women infected by the human immunodeficiency virus (HIV). As secondary objectives, to analyse their schooling and the number of hospital admissions and lengths of stay that these children required.DesignA prospective observation study.SettingHIV unit in a children's hospital.Participants. Inclusion criteria: all the children recruited from the HIV unit who had their infection status defined during the study period, understood as between the first known case in 1985 and April 1994. The sample included 177 children (62 HIV-infected and 115 not infected).Measurements and main resultsThrough an interview the social, family and school variables were collected. On comparison between infected and non-infected children, there were no important differences as to the lack of protection of the new-born (8.1% vs 13%), scant mother-child relationship (31.2% vs 36.5%) or people responsible for the custody of these children. Less schooling and greater problems of school integration were detected in infected cases, with odds ratios of 2.68 (p = 0.004) and 11.36 (p = 0.004), respectively. Children infected also needed more admissions (4.3 ± 5.7) than the non-infected (1.7 ± 0.9) (p = 0.001), and more days of hospital stay (75.1 ± 110.3 vs 23.3 ± 19.6) (p = 0.0003).ConclusionsInfected children and non-infected children had similar social and family characteristics. However, less schooling, problems of school integration, and more and longer hospital admissions were related to HIV infection in children, and not so much to their status as children of seropositive mothers
Infecciones graves de piel y tejidos blandos por Haemophilus influenzae tipo b a lo largo de 30 años
No full textCD4 cell response to antiretroviral therapy in children with vertically acquired HIV infection: Is it associated with age at initiation?
No full textBackground. Considerable uncertainty remains as to whether early initiation of antiretroviral therapy (ART) in children with vertically acquired human immunodeficiency virus (HIV) infection increases the benefit in terms of immunological response. Methods. The association between immunological outcome and early initiation of and/or more-potent ART was investigated, using age-standardized z scores for CD4 cell counts (hereafter, "CD4 z scores"), in 131 HIV-infected children enrolled in the European Collaborative Study, a birth cohort study. Results. Median age at initiation of the most-potent ART was 4 years (range, 0.1-15.5 years). Initiation of treatment after 5 months of age resulted in nonsignificantly lower CD4 z scores 6 months after initiation. Time to a 20% increase in CD4 z score was associated with age at initiation of the most-potent ART (adjusted hazard ratios [AHRs], 0.37 [P<.01] and 0.43 [P = .05] for 5 months-5 years of age and >5 years of age, respectively, compared with <5 months of age), ethnicity (AHR, 0.48 [P = .01], for black vs. white), and highly active ART (HAART) with or without prior ART (AHRs, 3.16 [P<.01] and 3.95 [P<.001], vs. mono or dual ART, respectively). The risk of subsequent deterioration of CD4 z score was similar for children who initiated ART in different age groups (χ2 = 0.824; P = .82). Conclusions. We confirm the effectiveness of HAART with respect to the recovery of CD4 cell count and suggest a benefit of initiating ART before the age of 5 months. Age at initiation of the most-potent ART was not associated with the likelihood of sustaining the recovery of CD4 cell count
Age-related standards for total lymphocyte, CD4(+) and CD8(+) T cell counts in children born in Europe
No full textObjective: Currently used reference values for immunologic markers in children are largely derived from cross-sectional data from historic, small sample size studies in predominantly white children. There is a lack of reliable age-related standards for immunologic markers, such as CD4(+) cell counts, in particular in black children whose values according to recent reports may differ from those in white children. Standards are essential for diagnosing and monitoring childhood diseases such as pediatric human immunodeficiency virus (HIV) infection.
Design: Prospective cohort study with data on 1781 uninfected children born to HIV-infected mothers in the European Collaborative Study.
Methods: Age-related standards (centiles) for immunologic markers (CD4(+) and CD8(+) cell counts and total lymphocyte counts) up to 5 years in black and up to 10 years in white children were constructed using Generalized Additive Models for Location, Scale and Shape method, which allows for variability and skewness of the data. The optimal model was chosen according to the Akaike Information Criterion.
Results: Patterns and values of total lymphocyte, CD4(+) and CD8(+) cell counts varied with age, especially in the first 3 years of life, but less so thereafter. Values of all 3 immunologic markers were substantially and significantly lower in black than in white children of the same age.
Conclusions: We present age-related standards separately for black and white children to aid clinicians in the monitoring of childhood diseases. These standards may also contribute to the decision on an accurate cutoff for CD4(+) cell counts for initiating treatment of HIV-infected childre
Levels and patterns of neutrophil cell counts over the first 8 years of life in children of HIV-1-infected mothers
No full textBackground: Antiretroviral drugs (ARV) as prophylaxis to prevent mother-to-child transmission of HIV results in decreased haematological parameters during and shortly after exposure, with recent data suggesting a more prolonged inhibition of haematopoiesis until at least 18 months.
Design: Data on 156 HIV-infected and 1533 uninfected children in the European Collaborative Study followed from birth until at least 8 years of age.
Methods: Smoothers and splines were used to elucidate patterns over age; linear mixed effects allowed for repeated measurements. Covariates included the child's HIV-1 infection status, prematurity, gender, race, drug withdrawal symptoms at birth and ARV exposure; effects on neutrophil count were quantified in regression analyses using z-scores (SD from mean) of neutrophil counts obtained after modelling untransformed values using the LMS method. For HIV-infected children, progression to AIDS and ARV therapy were also included.
Results: After approximately 4 months of age, neutrophil counts were consistently and substantially lower in HIV-infected children than in uninfected children; in both groups, black children had significantly lower counts than white children across the whole age range. In uninfected children, male gender and ARV exposure were associated with reduced neutrophil count until at least 8 years of age. In HIV-infected children, advanced disease and ARV treatment were significantly associated with neutrophil count.
Conclusion: A considerably longer effect of exposure to ARV was shown in uninfected children than previously thought and significant associations were shown between race and gender and neutrophil count, as previously observed for lymphocyte counts. The clinical relevance of these reduced levels of neutrophils requires further investigation. (C) 2004 Lippincott Williams Wilkins
Level and pattern of HIV-1-RNA viral load over age: Differences between girls and boys?
No full textObjective: To estimate RNA viral load patterns over age in vertically infected children that account for between- and within-individual variation, treatment and assay cut-off detection level. To investigate possible sex-based differences. Design: A total of 118 infected children with 894 RNA viral load measurements enrolled in the European Collaborative Study were prospectively followed from birth for up to 15 years. Methods: Fractional polynomial and mixed effects models with censored data to assess the non-linear pattern of viral load over age, allowing for repeated measures. Results: The RNA viral load peaked at approximately 3 months of age, and gradually declined thereafter. The sex by age interaction was significant (X2 = 19.7, P < 0.001); viral load peaked higher for girls than boys, but after 4 years the RNA load was consistently 0.25-0.5 log10 lower for girls than boys. The effects of sex and treatment on viral load vary over age (X2 = 6.31, P = 0.043). Sex differences in RNA viral load relating to measurement without treatment were more pronounced than those under treatment. Disease progression was more rapid for girls than for boys up to the age of 4 years, and less rapid thereafter; the overall difference was not statistically significant. Conclusion: Differences in RNA viral load over age between untreated boys and girls may have implications for policies for the initiation of antiretroviral therapy, but do not seem to translate into differences in progression to serious disease. The findings would suggest underlying biological explanations, which need further investigation
A significant sex - but not elective cesarean section - Effect on mother-to-child transmission of hepatitis C virus infection
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