An assessment of adverse effects of antiretroviral therapy on the development of HIV positive children by observation of dental mineralization chronology

J Oral Pathol Med (2010) 39 : 35–40
Background:  The difference between dental age (DA) and chronological age (CA) indicates an advance or delay in comparison with the normal standard. Considering that DA has a very close correlation with CA in a developing child, this study aimed to investigate the relationship between the effects of antiretroviral therapy on the development of HIV positive children, by observing the timing of dental mineralization.
Methods:  A retrospective examination was made of the medical records and dental panoramic radiographs of 50 HIV-positive pediatric patients, aged 37–168 months of age. Through these radiographs, their DA was estimated and compared with their CA.
Results:  The mean DA was significantly lower than the mean CA in the entire studied sample ( P  < 0.01). There was a statistical difference between children who received antiretroviral drugs and those who used no drugs ( P  = 0.02), i.e. the non-treated individuals presented practically no difference between CA and DA, while the treated patients showed a difference of 10.67 months.
Conclusion:  We conclude that the DA of HIV infected children was delayed when compared to the CA, and there was a positive association between the use of antiretroviral therapy and a delay in the chronology of dental mineralization in the sample.     

Evolution of the incidence and aetiology of fever of unknown origin (FUO), and survival in HIV-infected patients after HAART (Highly Active Antiretroviral Therapy)

BackgroundFever of unknown origin (FUO) is common among HIV-infected patients with a CD4+ T-lymphocyte cell count below 200 cells/ml. The use of HAART has transformed the evolution of AIDS and related diseases.Design and methodCase-control study, nested on a historical cohort of 3777 HIV-infected patients who were attended at “12 de Octubre” University Hospital in Madrid, Spain, between 1994 and 2000.Results276 FUO episodes were recorded, 58 of which occurred in patients receiving HAART. The significant decrease on the accumulated FUO incidence along the study period of 7.3 episodes per 100 HIV-infected patients after 1997 corresponded with the introduction of HAART. FUO was more frequent in patients who did not receive HAART. The aetiological spectrum of FUO was transformed by the introduction of HAART: the incidence of tuberculosis decreased while that of leishmaniasis increased. The four year survival in the non-FUO group increased when compared to that of patients who had had FUO. Similarly, this four year survival increased in patients who received HAART at the time of FUO versus those not receiving it.ConclusionsOur results confirm that the incidence of FUO has significantly decreased with the introduction of HAART. HAART has also transformed the aetiological spectrum related to FUO considerably. The most frequent cause of FUO in non-HAART patients on this study was the disseminated infection by Mycobacterium avium intracellulare (MAI), followed by tuberculosis, while leishmaniasis was its most common cause in patients receiving HAART. Survival decreased in patients who developed FUO; however, patients who received HAART at the time of FUO had longer survival than patients who did not.     

Evaluation of affordable screening markers to detect CD4+ T‐cell counts below 200 cells/μl among HIV‐1‐infected Ugandan adults

Objective To evaluate validity of WHO staging, low body mass index (BMI) and anaemia in detecting HIV‐infected adults with CD4+ T‐cell counts < 200 cells/μl. Methods Between October 1995 and April 2006, we screened Ugandans aged 16 or older at enrolment into an open cohort. We analysed highly active anti‐retroviral therapy (HAART)‐naïve HIV‐infected patients with WHO stages 1–3 and complete data in a secondary cross‐sectional study. Low BMI was a BMI < 18.5 kg/m². Anaemia was a haemoglobin level < 11 or 12 g/dl among women and men respectively. Results Among 2892 HAART‐naïve patients, the median age was 32 years. 71% were women, 54% had WHO stage 3 AIDS, 34% had anaemia, 16% had a low BMI and 43% had CD4+ T‐cell counts < 200 cells/μl. WHO stage 3 compared to combined WHO stages 1 and 2 had a sensitivity (95% CI) of 70% (67, 72) and a specificity of 57% (55, 60) respectively to detect CD4+ T‐cell counts < 200 cells/μl. Anaemia compared to normal haemoglobin had sensitivity (95% CI) of 47% (44, 50) and a specificity of 76% (74, 78). Low BMI compared to normal BMI had sensitivity (95% CI) of 23% (20, 25) and a specificity of 89% (87, 90) against CD4+ T‐cell counts < 200 cells/μl. Conclusion Only WHO stage 3 had reasonably high sensitivity in detecting CD4+ T‐cell counts below 200 cells/μl in this setting. Targeted low‐cost CD4 testing strategies are urgently needed to detect patients eligible for HAART in rural Africa and other resource‐limited settings.     

社区管理AIDS患者HAART治疗中的问题及对策探索

目的 探索基层HIV感染者经过检验符合高效逆转录抗病毒治疗(HAART)标准且进入治疗的病人,在实施HAART治疗过程中遇到的多种问题的有效措施.方法 采取社区管理等一系列措施.结果 治疗的依从性有较大的提高,在干预的一年内从72%达到95%,效果显著.结论 可在基层地区推行此模式进行艾滋病人的HAART治疗管理.     

Power spectral analysis of heart rate variability in HIV-infected and AIDS patients

Background: In HIV‐infected patients the risks for cardiovascular disease are multifactorial. Autonomic dysfunction has been detected in the early phase of HIV infection as well as in AIDS patients with advanced cardiomyopathy. Methods: Forty AIDS patients receiving highly active antiretroviral therapy (HAART), 40 HIV+ naïve of HAART, and 40 control subjects were studied. Computerized analysis of heart rate variability was performed using an analog to digital converter. R‐R intervals were obtained from a standard ECG, recorded in DII lead in supine rest and after the cold‐face and tilt tests. The series of R‐R intervals were assessed in time and frequency domains using an autoregressive algorithm. Results: There was no difference regarding to mean values of R‐R intervals and variance in baseline. The normalized power of the low‐frequency (LF) component and the low‐frequency/high‐frequency (HF) ratio (LF/HF) was significantly decreased in the HIV group. Responses of normalized HF and LF/HF ratio during the cold‐face test were significantly decreased in the HIV group, as compared to the control. During the tilt test, a higher augmentation of normalized LF and the LF/HF ratio was observed in the HIV group compared with the control. The AIDS group was similar to the control in baseline and after cold‐face and tilt tests. Conclusion: The HIV group presented in baseline conditions, a shift of cardiac sympathovagal balance, an exacerbated response of the LF component during the tilt test, and an ineffective cardiac vagal response to the cold‐face test suggesting sympathetic and parasympathetic dysfunction. AIDS patients receiving HAART did not present these autonomic alterations.     

中医药配合HAART对HIV/AIDS患者CD4+T细胞及病毒载量影响的研究

目的:观察中医药配合HAART对HIV/AIDS患者CD4+T细胞及病毒载量的影响。方法:将180例HIV/AIDS患者随机分成2组,治疗组予以芩花解毒胶囊,艾可清颗粒以及HAART治疗,对照组予以HAART治疗,分别于治疗前后检测患者CD4+T细胞、病毒载量变化以及安全性指标。结果:治疗前后CD4+T细胞绝对计数治疗组与对照组比较均能显著提高(P0.05),治疗组与对照组CD4+T细胞计数与CD4+T细胞上升幅度无显著性差异(P0.05)。安全性方面治疗组并未出现血常规、肝功能以及肾功能,相反,血常规和肝肾功能方面有改善的趋势。结论:艾可清颗粒与芩花解毒胶囊没有影响HAART的免疫学疗效,同时可以改善HIV/AIDS患者血常规、肝肾功能方面的问题以及尿黄、盗汗和便秘等症状。