9 research outputs found
Pediatric HIV infection: the state of antiretroviral therapy
No full textPediatric HIV/AIDS has become less of a problem in resource-rich countries as the number of perinatal infections has reduced dramatically since the advent of antiretrovirals, resulting in the effective prevention of mother-to-child transmission. In resource-limited settings, however, pediatric HIV infection remains a colossal problem; a separate review in this same issue of Expert Review of Anti-Infective Therapy examines the international aspects of pediatric HIV/AIDS. Treatment of HIV infection in children differs from that in adults in the use of immunologic markers and owing to drug pharmacokinetics and age-related adherence issues. This review, geared for the general pediatrician or family practitioner who may see the HIV-positive child in the clinic or the hospital, summarizes the most recent pediatric data and guidelines for the testing and treatment of HIV, including the US NIH guidelines released in February 2008. Treatment-experienced patients, who should be cared for by pediatric HIV specialists, are not addressed here specifically. Adolescents, infected either perinatally or sexually, with their own unique issues, deserve a separate review
HIV care and treatment for children in resource-limited settings
No full textAlthough efforts to combat the HIV epidemic have focused on the perinatal reduction of HIV transmission, many children are still being infected with HIV in resource-limited settings. Access to HIV care, cotrimoxazole and antiretroviral therapy (ART) for HIV-infected children has greatly improved in recent years, and has proven to be very effective in reducing mortality in all age categories. Many challenges remain to be resolved, such as the retention in care of children born to HIV-infected mothers, the lack of pharmacokinetic data on ART in malnourished children, optimum timing of ART, treatment and diagnosis of concomitant tuberculosis, and the effects of ART and HIV on the child's development. In the long term, treatment success might be negated due to lower rates of viral suppression in children and the accumulation of resistance mutations. Evidenced-based comprehensive care models should allow for decentralizing care up to the level of the community, allowing larger numbers of children to receive HIV care
Computed CD4 percentage as a low-cost method for determining pediatric antiretroviral treatment eligibility
No full textAbstract Background The performance of the WHO recommendations for pediatric antiretroviral treatment (ART) in resource poor settings is insufficiently documented in routine care. Methods We compared clinical and immunological criteria in 366 children aged 0 to 12 years in Kinshasa and evaluated a simple computation to estimate CD4 percent, based on CD4 count, total white blood cell count and percentage lymphocytes. Kappa (κ) statistic was used to evaluate eligibility criteria and linear regression to determine trends of CD4 percent, count and total lymphocyte count (TLC). Results Agreement between clinical and immunological eligibility criteria was poor (κ = 0.26). One third of children clinically eligible for ART were ineligible using immunological criteria; one third of children immunologically eligible were ineligible using clinical criteria. Among children presenting in WHO stage I or II, 54 (32%) were eligible according to immunological criteria. Agreement with CD4 percent was poor for TLC (κ = 0.04), fair for total CD4 count (κ = 0.39) and substantial for CD4 percent computational estimate (κ = 0.71). Among 5 to 12 years old children, total CD4 count was higher in younger age groups (-32 cells/mm3 per year older), CD4 percent was similar across age groups. Conclusion Age-specific thresholds for CD4 percent optimally determine pediatric ART eligibility. The use of CD4 percent computational estimate may increase ART access in settings with limited access to CD4 percent assays.</p
Antiretrovirals for HIV prevention: when should they be recommended?
No full textSince the introduction of the first antiretroviral agent for HIV treatment, information on antiretroviral therapy (ART) effectiveness has grown continuously. In recent years, there has also been a growth of interest in use of ART for the prevention of HIV transmission, either by reducing the infectivity of the infected person or by protecting the uninfected individuals from HIV acquisition. The purpose of this review is to summarize the body of evidence available for treatment as prevention and pre-exposure prophylaxis and their effectiveness in prevention of infection. In addition, our aim is to discuss the operational aspects of both prevention strategies and to provide commentary for future HIV prevention programs
CD4 percent obtained by flow cytometryandcomputational estimate are stable with increasing age (p 0
No full text05). Linear prediction (and 95%CI) of CD4 percent obtained by flow cytometry (solid line), CD4 percent computational estimate (dashed line), total CD4 count (long dash line) and TLC (long dash – dotted line) in children aged 5 to 12 years.<p><b>Copyright information:</b></p><p>Taken from "Computed CD4 percentage as a low-cost method for determining pediatric antiretroviral treatment eligibility"</p><p>http://www.biomedcentral.com/1471-2334/8/31</p><p>BMC Infectious Diseases 2008;8():31-31.</p><p>Published online 6 Mar 2008</p><p>PMCID:PMC2292192.</p><p></p
Grey areas indicate children misclassified using CD4 percent computational estimate compared to CD4 percent obtained by flow cytometry
No full text<p><b>Copyright information:</b></p><p>Taken from "Computed CD4 percentage as a low-cost method for determining pediatric antiretroviral treatment eligibility"</p><p>http://www.biomedcentral.com/1471-2334/8/31</p><p>BMC Infectious Diseases 2008;8():31-31.</p><p>Published online 6 Mar 2008</p><p>PMCID:PMC2292192.</p><p></p
Pulmonary cystic disease in HIV positive individuals in the Democratic Republic of Congo: three case reports
No full textAbstract Pulmonary emphysema and bronchiectasis in HIV seropositive patients has been described in the presence of injection drug use, malnutrition, repeated opportunistic infections, such as Pneumocytis jirovici pneumonia and Mycobacterium tuberculosis infection, and has been linked to the presence of HIV virus in lung tissue. Given the high burden of pulmonary infections and malnutrition among people living with HIV in resource poor settings, these individuals may be at increased risk of developing pulmonary emphysema, potentially reducing the long term benefit of antiretroviral therapy (ART) if initiated late in the course of HIV infection. In this report, we describe three HIV-infected individuals (one woman and two children) presenting with extensive pulmonary cystic disease.</p
Case 3: Alveo-interstitial infiltrate in right lower filed with multiple bullae spread throughout right lung field
No full text<p><b>Copyright information:</b></p><p>Taken from "Pulmonary cystic disease in HIV positive individuals in the Democratic Republic of Congo: three case reports"</p><p>http://www.jmedicalcasereports.com/content/1/1/101</p><p>Journal of Medical Case Reports 2007;1():101-101.</p><p>Published online 22 Sep 2007</p><p>PMCID:PMC2082036.</p><p></p
Case 1: Surinfected dystrophic bullous emphysema with pleurisy on the right side
No full text<p><b>Copyright information:</b></p><p>Taken from "Pulmonary cystic disease in HIV positive individuals in the Democratic Republic of Congo: three case reports"</p><p>http://www.jmedicalcasereports.com/content/1/1/101</p><p>Journal of Medical Case Reports 2007;1():101-101.</p><p>Published online 22 Sep 2007</p><p>PMCID:PMC2082036.</p><p></p
