Diagnosis of human immunodeficiency virus 1 infection in infants: in vitro production of virus-specific antibody in lymphocytes

In children born to mothers infected with human immunodeficiency virus 1 (HIV-1), a diagnosis of HIV infection cannot be based on a positive antibody result until at least 18 months of age. There is therefore an urgent need for simple and reliable methods of diagnosing HIV infection in these infants. The sensitivity and specificity of a test using the in vitro antibody production of HIV-specific IgG was assessed in children whose infection status was known and compared with virus and antigen detection. In vitro antibody production sensitivity was 90 to 95%, at least as sensitive as virus culture in antibody-positive infected children. In the first 2 months there is a relatively high proportion of false positive results, possibly a result of contamination by maternal cells. However, after this period in vitro antibody production is a simple, inexpensive and reliable tool for early diagnosis.     

Epidemiology, clinical characteristics and natural history of vertically transmitted human immunodeficiency virus-1 infection in Japan

Abstract Background : According to the Ministry of Health and Welfare AIDS Surveillance Committee's report on vertically transmitted human immunodeficiency virus (HIV) infection, there have been eight children with acquired immune deficiency syndrome (AIDS) and 18 children with HIV infection in Japan, totalling 26 in all as of February 1997. A search of the literature fails to reveal any report that deals with many cases of vertically transmitted HIV infection in Japan. Methods: A primary questionnaire survey was taken of the main medical institutions across the country, followed by a secondary questionnaire survey of physicians and pediatricians who treated the disease. A clinical review was made of 19 children with vertically transmitted HIV infection (including eight AIDS children) according to the 1994 Revised Classification System for HIV Infection in Children. Results : The mean age at diagnosis was 14.5 months and the diagnosis was made at less than 18 months of life in approximately 70% of infected children. In the mean observation period of 16 months, six of eight AIDS children (75%), and one child of group B died. The mean period of observation for the seven dead children was 7 months, and six of seven children died by 36 months of life. The survival period after the diagnosis of AIDS was 15 months. The diagnosis of HIV infection was made based on the clinical symptoms of all children with AIDS. Of 11 children, six (45%) presented with symptoms of HIV infection by 6 months of life, and 10 of 11 children (91%) presented with symptoms by 26 months of life. The noteworthy clinical findings included hepatomegaly, splenomegaly, recurrent respiratory tract infection, lymph node swelling, oral candidiasis, hepatitis, wasting syndrome, HIV encephalopathy and severe pneumonia. The favored age for the start of complications and the magnitude of decrease in the HIV helper cell count varied with each case of complications of HIV infection (wasting syndrome, HIV encephalopathy) or opportunistic infections (cytomegalovirus infection, Mycobacterium avium complex infection). Anti-HIV drugs (mainly zidovudine) had been used in five of eight children with AIDS and were effective in two long survivors alone. Conclusions : Children who are diagnosed with HIV infection, based on their clinical symptoms, carry a poor prognosis. In this respect, early diagnosis and progress in anti-HIV therapy are necessary.     

艾滋病高发农村儿童人类免疫缺陷病毒感染与艾滋病发病的关系

目的了解艾滋病高发区儿童感染人类免疫缺陷病毒(HIV)情况.方法对某艾滋病高发农村高危育龄妇女及其年龄小于15岁的子女进行现场询问调查和采静脉血作HIV检测.结果 159名儿童中37例HIV阳性,其中33例为母婴途径感染,占89.2%,3例经输血感染,占8.1%,其他途径感染1例,占2.7%.HIV母婴传播率为38.4%(33/86).艾滋病状态母亲组母婴传播率(68.8%,22/32)显著高于HIV携带状态组(20.4%,11/54),P＜0.05.37名感染儿童中12例发展成艾滋病, 4例死亡,其中2例死于结核.33例中31例造成母婴传播的HIV阳性妇女在孕产前未作HIV检测,占93.9%.8名妊娠期HIV阳性妇女,1例艾滋病病情加重,2例自然流产,2例经规劝终止妊娠,3例继续妊娠.结论母婴传播是儿童感染HIV的主要途径.未对高危生育期妇女进行有效的HIV监测及咨询,未采取有效干预措施是造成儿童HIV/AIDS的主要原因.亟需采取相应的对策控制HIV进一步蔓延,保护AIDS高发区妇女及儿童的健康.     

中国儿童间质性肺疾病的临床研究

目的 了解中国儿童间质性肺疾病( ILD)的病因谱.方法 以2009年来自全国11家医院就诊的93例儿童ILD患者为研究对象,采用统一登记表格,详细记录其病史、症状、体征;所有病例均进行胸CT或高分辨率CT;住院期间常规检查项目包括血常规、血沉、C反应蛋白、血气分析,据病情轻重和年龄尽可能进行肺功能检查;具有诊断意义的项目包括呼吸道分泌物细菌培养、呼吸道病毒抗原检测、血清的病毒和支原体抗体检查,以及血清学的免疫抗体检查,痰、胃液、肺泡灌洗液涂片找含铁血黄素细胞等;对25例病例进行了支气管镜检,对14例病例进行了肺活检.由全国儿童弥漫性实质性肺疾病/间质性肺疾病协作组成员对每一病例进行集体讨论诊断.14例病例按临床-放射-病理(C-R-P)诊断模式达成诊断共识,79例病例根据临床及典型影像学改变、辅助检查做出最后诊断.结果 93例ILD患儿年龄8个月～14岁,平均年龄为4岁11个月,其中男53例,女40例.(1)93例ILD的病因谱为:闭塞性细支气管炎39例;特发性肺含铁血黄素沉着症39例;特发性间质性肺炎7例(其中非特异性间质性肺炎4例,急性间质性肺炎1例,淋巴细胞间质性肺炎1例,特发性肺纤维化1例);继发性的间质性肺炎2例(其中继发于系统性红斑狼疮的急性间质性肺炎1例,HIV感染引起的淋巴细胞间质性肺炎1例);外源性过敏性肺泡炎2例;闭塞性细支气管炎伴机化性肺炎1例,肺泡微石症1例,弥漫性泛细支气管炎1例,类脂性肺炎1例.(2)临床特点:72例有咳嗽,24例有气促,5例有三凹征,43例肺内可闻及湿啰音,8例有杵状指趾.(3)影像学特征:肺CT显示56例肺部有磨玻璃影;30例肺部有马赛克灌注征,其中11例伴有支气管扩张,8例伴有支气管壁增厚;1例弥漫性小叶中心性结节,伴小支气管和细支气管扩张;1例为弥漫性的细小结节影;1例为弥漫性网格影和泡性肺气肿.结论 儿童ILD是一组异质性疾病,本组共诊断出11种疾病,其中例数最多的前三位疾病为闭塞性细支气管炎、特发性肺含铁血黄素沉着症、特发性间质性肺炎.     

Cutaneous hypersensitivity reactions due to thiacetazone in the treatment of tuberculosis in Zambian children infected with HIV-I.

Tuberculosis is one of the most common infections in Zambian adults and children infected with HIV. In Africa, cutaneous hypersensitivity reactions attributed to thiacetazone during treatment of tuberculosis in adults infected with HIV-I have been well documented. This study monitored adverse drug reactions during treatment for tuberculosis over an 18 month period (1 April 1990 to 31 October 1991) in 237 children with a clinical diagnosis of tuberculosis (125 boys and 112 girls; 88/237 (37%) infected with HIV-I) and 242 control children (149 boys and 93 girls; 26/242 (11%) infected with HIV-I). Twenty two (9%) of the 237 children with tuberculosis developed hypersensitivity skin reactions during the course of treatment. Adverse skin reactions were seen more often in children infected with HIV than in those who were not (odds ratio 11.65, 95% confidence interval 3.07 to 34.88). These represented 19 (21%) of 88 children infected with HIV and three (2%) of 149 children not infected with HIV. These skin reactions occurred after a period of treatment ranging between two and four weeks among 14 children receiving the HST (isoniazid, streptomycin, thiacetazone) regimen and eight children receiving the HSTR (isoniazid, streptomycin, thiacetazone, rifampicin) regimen. Twelve (55%) of the 22 children who reacted adversely to treatment developed the Stevens-Johnson syndrome. All 12 of these children with the Stevens-Johnson syndrome were infected with HIV. The mortality among these children who developed the Stevens-Johnson syndrome was 91% (11 of 12 died within three days of the onset of the reaction). No further reactions were observed in the 11 children who recovered from the cutaneous hypersensitivity reactions after thiacetazone was discontinued over a period of six months of further treatment of tuberculosis. The results of this study were in part responsible for the recommendations put forward by the World Health Organization to avoid the use of thiacetazone in the treatment of tuberculosis in children infected with HIV.     

Malignancies in UK children with HIV infection acquired from mother to child transmission

By April 1995, 302 cases of vertically acquired HIV infection had been reported through the British Paediatric Association Surveillance Unit. Over 50% of these children had developed an AIDS indicator disease, including nine malignancies (seven cases of non-Hodgkin's lymphoma (NHL) and two of Kaposi's sarcoma). There were two other malignancies that were not AIDS indicator diseases. In children less than 5 years of age the incidence of NHL was approximately 2500 times greater than expected in the UK child population. Three children presented with NHL as their AIDS indicator disease and four developed NHL at a median of 14 (range 10-19) months after the initial diagnosis of AIDS. Six of the seven children died at a median of 6.5 (range 2-14) months after the diagnosis of NHL. The seventh child responded to treatment and is alive nearly four years later. Histology was available in five cases, of which four were of B cell and one of T cell origin. Epstein-Barr virus was detected in all three patients with NHL where it was sought; all had B cell lymphomas. Although comparatively rare, malignancies occur in children infected with HIV and may be the presenting illness. Paediatricians now need to consider HIV infection as a predisposing cause of childhood cancer, especially NHL.     

Energy balance in infants born from HIV seropositive mothers

OBJECTIVES: A nutritional evaluation of infants born from HIV seropositive mothers was carried out during their follow up and diagnostic investigation. The energy balance (EB) of infected and noninfected children were compared. METHODS: The energy balance (intake energy, fecal energy, and resting energy expenditure) was prospectively determined by indirect calorimetry, considering 13 infants (6 girls and 7 boys) between 1 and 6 months of age, born from HIV positive mothers. This was made in two opportunities: before and after the diagnosis of the disease. A full nutritional assessment, including clinical examination and anthropometric measures (weight, height and skinfold thickness), was also determined in these two opportunities. After the definite diagnosis, the infants were finally assembled in 2 different groups: infected (5 in 13) and noninfected (8 in 13). The children were monthly submitted to clinical evaluations and orientation, during all the study. RESULTS: By analyzing the anthropometric measures of the two groups, it was observed that the infected group had malnutritional manifestations since the first evaluation. The resting energy expenditure (kcal/kg/dia) of the infected group was higher than that of the noninfected group: 64.5-/+16.8 vs 48.0-/+5.7 (p<0.05) at the first evaluation and 68.0-/+11.7 vs 51.8-/+3.1 (p<0.05) at the second, respectively. CONCLUSION: The higher resting energy expenditure of the children in the infected group might be the cause of the protein energy malnutrition during the asymptomatic phase when the diagnosis was uncertain.     

Malignancies in UK children with HIV infection acquired from mother to child transmission

Accepted 19 November 1996By April 1995, 302 cases of vertically acquired HIV infection had been reported through the British Paediatric Association Surveillance Unit. Over 50% of these children had developed an AIDS indicator disease, including nine malignancies (seven cases of non-Hodgkin''s lymphoma (NHL) and two of Kaposi''s sarcoma). There were two other malignancies that were not AIDS indicator diseases. In children less than 5 years of age the incidence of NHL was approximately 2500 times greater than expected in the UK child population. Three children presented with NHL as their AIDS indicator disease and four developed NHL at a median of 14(range 10-19) months after the initial diagnosis of AIDS. Six of the seven children died at a median of 6.5 (range 2-14) months after the diagnosis of NHL. The seventh child responded to treatment and is alive nearly four years later. Histology was available in five cases, of which four were of B cell and one of T cell origin. Epstein-Barr virus was detected in all three patients with NHL where it was sought; all had B cell lymphomas. Although comparatively rare, malignancies occur in children infected with HIV and may be the presenting illness. Paediatricians now need to consider HIV infection as a predisposing cause of childhood cancer, especially NHL.     

Prognosis of human immunodeficiency virus infection in children and adolescents

The prognosis of 111 children and adolescents (from 2.5 months to 19.5 years of age) infected with human immunodeficiency virus (HIV) was assessed by survival analysis based on risk factors and clinical status. Risk factors included: maternal HIV infection 93; transfusion 12; both maternal HIV infection and transfusion 2; sexual abuse 1; and intravenous drug use and/or sexual activity 3. Children with perinatal infection survived from 2.5 months to 10.25 years (median, 1.87 years) and had inapparent infection from 6 weeks to 7.3 years (median, 0.75 years). Children who acquired HIV infection via transfusion had inapparent infection from 4 months to 5.7 years (median, 3.6 years). Actuarial survival following infection was not significantly different from maternally and transfusion-acquired infection; however, survival from infection was longer for children infected by transfusion beyond 2 years of age (mean, 7.5 years) than for children infected perinatally (mean, 5.6 years). The case-fatality ratio was 32%, with 25% of subjects succumbing within 1 year of developing an HIV-associated illness. Opportunistic infection was the most common acquired immunodeficiency syndrome-defining illness and the cause of death in 22 of the 35 children who died. Pneumocystis carinii and fungal pneumonias had the worst prognosis. Cryptosporidiosis and other opportunistic infections had a better prognosis. Because of difficulties in case finding, diagnosis of infection and variable survival of HIV-infected children, arge longitudinal studies and pooling of data among centers will be necessary to have an accurate understanding of the prognosis of individual clinical syndromes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Specific IgA detection can be used for perinatal diagnosis of HIV in children under protocol ACTG 076.

Detection of anti-HIV-1 IgA antibodies using a modified ELISA test for the early diagnosis of perinatally acquired HIV-1 infection in children treated with protocol ACTG 076 was evaluated. A total of 177 sera were obtained from 141 infants between 1 and 12 months of age (46 were treated and 95 were non-treated with protocol ACTG 076) and tested for HIV IgA antibodies by an ELISA test after removal of IgG with recombinant protein G. Infants were classified according to CDC's classification system after a follow-up until 20 months of age. Of the 46 treated children 22 turned out to be infected and in the group of 95 untreated children, 52 were infected. All 81 samples from uninfected children treated or untreated with protocol ACTG 076 were persistently IgA-negative. HIV IgA antibodies were detected in 14 of 25 plasma samples from infected children with treatment, and in 58 of 71 samples in infected children without treatment. Considering that the sensitivity of this test is lower in children younger than 6 months the population of children studied was divided into two groups; those under and those over 6 months of age. No significant differences were observed in the detection of IgA in treated or untreated children in both age groups. The overall specificity of the test was 100 per cent; sensitivity in children older than 6 months was 76.92 per cent in treated children and 93.10 per cent in untreated children. In spite of the small number of samples studied it could be demonstrated that treatment with zidovudine does not affect the detection of IgA antibodies. This is a simple and inexpensive method that could be used for diagnosis of treated and untreated children in developing countries.     

Transfusion-acquired human immunodeficiency virus infection in twelve neonates: epidemiologic, clinical and immunologic features

Twelve neonates in 3 cohorts received blood transfusions from two donors who were infected with human immunodeficiency virus (HIV). All 12 infants developed laboratory and/or clinical evidence of HIV infection, usually in the first year of life. Ten of 12 infants had serum antibody to HIV when tested between 9 and 42 months of age. The two seronegative infants were severely hypogammaglobulinemic when they were tested. Nine infants developed a variety of illnesses attributable to HIV infection, but only 2 fulfilled criteria for the diagnosis of acquired immunodeficiency syndrome. In follow-up ranging from 2 1/2 to 4 years 5 patients (42%) have died. Four patients had HIV-associated illnesses but recovered and now have few if any symptoms attributable to HIV infection. Three children have never had signs or symptoms attributable to HIV. Immunologic abnormalities were present in all patients; the most consistent finding was a decrease in the proportion of T helper cells. Three patients had severe panhypogammaglobulinemia. The hypogammaglobulinemic infants had significantly lower numbers and percentages of T helper cells compared to the remaining patients (P less than 0.01). We conclude that exposure to HIV via transfusion in the neonatal period results in an extremely high rate of infection with substantial mortality and morbidity, but clinical recovery occurs in some patients. Also hypogammaglobulinemia may be more common in infants with HIV infection than previously appreciated.     

Trends in survival for children reported with maternally transmitted acquired immunodeficiency syndrome in New York City, 1982 to 1989.

To better understand the natural history of severe pediatric human immunodeficiency virus infection, reported cases of perinatally acquired pediatric acquired immunodeficiency syndrome (AIDS) in New York City were examined for differences in survival and age at diagnosis before and after implementation of an expanded case definition in 1987. One hundred ninety-six children reported through August, 1987, and 333 children reported between September, 1987, and February, 1990, and diagnosed through 1989 were compared. Significant differences were not found in survival by either gender or race/ethnicity although Hispanics were slightly more likely to be diagnosed with Pneumocystis carinii pneumonia (PCP) and blacks with lymphocytic interstitial pneumonitis (LIP). The most striking differences were noted regardless of race between children whose earliest AIDS-specific diagnosis was PCP and those whose earliest diagnosis was LIP. In the group reported through August, 1987, median survival from birth was 10 months with PCP vs. 54 months with LIP, median age at diagnosis 5 months vs. 20 months, and median survival after diagnosis 2 months vs. 22 months, respectively. Twelve-month survival for PCP improved in the two time periods examined, but survival with LIP did not. After implementation of the 1987 case definition, bacterial infections replaced LIP as the second most common diagnosis. This study provides data on children diagnosed and reported with AIDS. Ongoing prospective studies of children who have a full spectrum of human immunodeficiency virus infection with and without reportable AIDS wil further elucidate survival in children infected with human immunodeficiency virus.     

Impact of HIV-1 status on the radiological presentation and clinical outcome of children with WHO defined community-acquired severe pneumonia.

AIMS: We compared the radiological features and outcome of WHO defined severe pneumonia among HIV infected and exposed uninfected children randomised to receive penicillin or oral amoxicillin in Durban, South Africa. METHODS: Of 425 children aged between 3 and 59 months with WHO defined severe pneumonia, 366 had anonymous HIV testing performed. Outcome was assessed by failure to improve at 48 h after enrolment or deterioration within 14 days. Chest radiographs were evaluated according to WHO defined radiological criteria for pneumonia and internationally standardised radiological criteria. Findings were stratified for HIV status. RESULTS: 82 (22.4%) children were HIV infected, 40 (10.9%) were HIV exposed and 244 (66.7%) were HIV uninfected. The day 14 outcome in children <12 months of age was significantly worse in HIV-1 infected than HIV uninfected children (OR 2.8 (95% CI 1.35 to 3.5), p = 0.002), while HIV-1 infected and uninfected children aged > or =12 months had equivalent outcomes. Parental penicillin and oral amoxicillin had equivalent response rates in all HIV groups. According to the WHO radiological classification, children who failed WHO standard antimicrobial treatment had significantly higher "other consolidates/infiltrates" than "endpoints for consolidation" in the HIV infected group (OR 5.45 (95% CI 1.58 to 21.38), p<0.002), while the reverse was true for HIV exposed uninfected children (OR 4.13 (95% CI 0.88 to 20.57), p<0.036). CONCLUSIONS: The WHO standard treatment guideline for severe pneumonia is inadequate for HIV-1 infected infants. The increased prevalence of "other consolidates/infiltrates" among HIV-1 infected children who failed standard treatment supports the addition of co-trimoxazole to WHO standard treatment.     

Broncho-alveolar lavage in HIV-1 seropositive children

Sixteen bronchoalveolar lavages (BAL) were performed in 15 children with HIV1 seropositivity, 12 of them being infected by HIV1. BAL was performed during episodes of acute pneumonitis with respiratory distress (group I: three cases) or without severity (group II: five cases), or in the presence of asymptomatic radiological pulmonary abnormalities (group III: seven cases). A specific diagnosis of infection was obtained in five cases of acute pneumonitis and 12 micro-organisms were identified by BAL: three cytomegaloviruses, three respiratory syncytial viruses, two Pneumocytis carinii, one Haemophilus influenzae, one Herpes simplex virus type 1, one Escherichia coli and one group A streptococcus. In three cases two micro-organisms were simultaneously identified. Cytological examination showed a high proportion of polymorphonuclear leukocytes in cases of acute pneumonitis (group II) and alveolar lymphocytosis in clinically asymptomatic children with radiological pulmonary abnormalities (group III). BAL appears to be a reliable tool for the investigation of pulmonary infections in children with HIV1 seropositivity. In addition it has the advantage of revealing latent cytological abnormalities in these patients.     

Favorable response of pediatric AIDS-related Burkitt's lymphoma treated by aggressive chemotherapy

We describe 4 male children infected by the human immunodeficiency virus (HIV) who developed Burkitt's lymphoma during their disease. The clinical picture was characterized by an insidious appearance of symptoms. All the children suffered for several months from abdominal discomfort and a gradual elevation of their blood lactic dehydrogenase (LDH) level prior to diagnosis. Bone marrow involvement was found in 2 of the patients and jaw involvement in the other 2. After confirming the diagnosis of Burkitt's lymphoma, they were treated according to conventional protocols, with no need to reduce the dose intensity. They all went into complete remission and did not suffer from major opportunistic infections during chemotherapy. None of them relapsed. Two patients died from opportunistic infections 1 and 3 years after diagnosis. The other 2 are alive, 7 years and 6 months after diagnosis. The various characteristics of this unique pediatric group are described and the comparison of the clinical picture in adults is made, together with a review of the relevant literature. © 1993 Wiley-Liss, Inc.     

Primary results of antiretroviral treatment among HIV/AIDS infected children in Lomé (Togo)]

Since 2004 in Togo HIV/AIDS infected children have, free of charge, access to antiretroviral drugs according to the national program. The aim of this study was to investigate the clinical, biological and prognosis aspects of anti-retroviral treatment on HIV/AIDS infected children. PATIENTS AND METHOD: We conducted a cross sectional study on 72 HIV/AIDS infected children with anti-retroviral treatment, under the supervision of clinicians within 3 associations specialized in the management of subjects infected by HIV/SIDA at Lomé (Togo). RESULTS: The average age of children was 6 years 9 months. The middle age to HIV screening was 4 years 2 months. The sex ratio was 1.05. The majority of these children (79.2%) were orphans of at least 1 of their parents. All the children were stemmed from families with modest income. The transmission mother to child was the way of HIV contamination found among all the children. To a certain extent, all the children were infected by the HIV 1. Most of the children (66.7%) receiving an antiretroviral treatment for at least 6 months were asymptomatic and had no more immunodeficiency. After 15 months, the children have gained 464 CD4/mm(3). The initial protocols antiretroviral prescribed among children were: zidovudine-lamivudine-abacavir (36.1%), lamivudine-didanosine-nevirapine (30.5%), lamivudine-stavudine-nevirapine (29.2%), zidovudine-lamivudine-didanosine (4.2%). The digestive disorders have been the first side effects (83.4%). The rate of good observance was middle (51%) and lowered with the increased age of children, and the period of the anti-retroviral treatment. CONCLUSIONS: Antiretroviral treatment among HIV/AIDS infected children is giving good results in Togo. But many efforts remain to increase the number of beneficiaries.     

Combined therapy in human immunodeficiency virus-infected children —a 4-year experience

From 1988 to 1991 the long-term efficacy of a combined therapy with a polyvalent immunoglobulin/cytomegalovirus (CMV) hyperimmunoglobulin, oral low dose zidovudine, oral cotrimoxazole or inhaled pentamidine was investigated in three groups of human immunodeficiency virus (HIV)-infected children. Group 1A consisted of three perinatally infected children with a CD4 cell decrease of >400, cells/l per year. Group 1B were 17 perinatally infected children with a CD4 cell decrease of <400 cells/l per year. Group 2 comprised eight haemophilic children infected by clotting factors. Despite combined therapy none of group 1A survived longer than 12 months showing a rapid loss of CD4 cell counts, progressive encephalopathy, wasting syndrome and severe bacterial, fungal and CMV reactivation. Under pure intravenous immunoglobulin (IVIG) therapy severe bacterial infections were seen in 1 of 12 children in group 1B. The majority of these patients showed increases or stabilisation of length and weight percentiles. In this group low dose zidovudine therapy was of benefit in HIV-associated neurological symptoms. Nevertheless combined therapy could not prevent further deterioration of CD4 cell counts. In group 2 severe bacterial infections were not seen under IVIG therapy. In this group a temporary increase (6 months) of CD4 cell counts under IVIG/zidovudine combined therapy occurred.Pneumocystis carinii pneumonia (PCP) prophylaxis with oral cotrimoxazole or inhaled pentamidine successfully prevented PCP in all three groups. Under CMV hyperimmunoglobulins (n=22), ten out of ten patients did not acquire primary CMV infection, whereas CMV reactivations mainly located in the CNS could not be prevented in 5 of 12 patients. Our findings indicate that this combined therapy showed remarkable differences in therapeutic efficacy in children with different modes of HIV progression. These modes must be considered for correct timing, dosage and evaluation of therapeutic measures.     

Strategy for preventing vertical transmisssion of HIV : Bombay experience

OBJECTIVE: To evaluate the efficacy of an interventional regime to reduce the perinatal mode of transmission of human immunodeficiency virus (HIV). DESIGN: Prospective. SETTING: Perinatal HIV clinic at a university affiliated maternity hospital. SUBJECT & METHODS: After adequate counseling, consenting HIV positive women were offered perinatal intervention: (i) administration of 400 mg of zidovudine (AZT) per day for the last 6 weeks of the antenatal period; (ii) delivery by elective Caesarian section before rupture of membrances; (iii) oral AZT powder in the dose of 8 mg per kilogram daily to the infant for the first 6 weeks of life; and (iv) avoidance of breast milk. The infants were scheduled for regular follow-up for at least 18 months. A definitive diagnosis of infectivity in the infant was ascertained by two positive enzyme-linked immunosorbent assays (ELISA) at the age of 9 months and between 15 to 18 months. RESULTS: Of the 107 mother-infant pairs enrolled, 22 infants were lost to follow-up, 15 were under 18 months of age at the time of this analysis and 2 infants died without a diagnosis. Of the remaining 68 infants followed up, 4 tested HIV positive at 18 months. Of the 229 women-infant pairs who did not receive perinatal intervention, 55 infants followed up to 15-18 months were found to be infected. CONCLUSION: This interventional strategy significantly reduced the mother to child transmission of HIV. However, the results need to be substantiated by larger studies.     

Pediatric HIV infection

Objective : The present cross sectional study was undertaken to study clinical profile of HIV infection in children in Northern India.Methods : 64 children from newborn to eighteen years, presenting for confirmation of diagnosis of HIV infection or monitoring of CD4-CD8 counts in confirmed cases, were evaluated. Children were categorized as per CDC classification of Pediatric HIV. The diagnosis was confirmed by serological tests or PCR assay. CD4-CD8 counts were done by FACS Count.Results : Majority of the children were between 18 months to 5 years. Adolescents comprised 24% of the case. 51.5% children were infected through the mode of mother to child transmission. 39% of the case was transfusion-mediated. Unsafe medical injections probably contributed to 6.2% and heterosexual promiscuity led to 3.1% cases. Clubbing, not described in Indian studies so far, was seen in 9.3% cases.Conclusions : HIV infection is a chronic childhood disease extending into adolescence, and contaminated blood and unsafe medical injections are still important routes of HIV transmission in India.     

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??Objective To better understand the spectrum of the disease and to explore the clinical significance of diagnostic procedures in clinical application.Method The medical records of 349 children with diffuse parenchymal lung disease /interstitial lung disease admitted to Beijing Children’s hospital from July 2001 to September 2011 were studied retrospectively. The diagnostic approaches were applied??including the history ?? physical examination ?? non-invasive examination and invasive examination. Result The 321 cases were made specific diagnosis through the diagnostic procedures and 28 cases were unclassified. The classification of the 349 cases were as follows:146 cases were with primary lung diseases??14 cases were with lung disease secondary to systemic disease?? 161 cases had the lung disease of known causes?? and the 28 cases were unclassified.The 160/349??45.85%?? cases were diagnosed based on the noninvasive examination?? including all 147 cases of bronchiolitis obliterans??3 cases of hypersensitive pneumonitis??2 cases secondary to aspiration??2 cases of systemic lupus erythematosus?? 2 cases of juvenile rheumatoid arthritis??1 case infected by CMV?? 1 case of Langerhans cell histocytosis??1 case of undifferentiated connective tissue disease and 1 case of Wegener's granulomatosis. The others were diagnosed by invasive examination?? including 2 cases of Langerhans cell histocytosis and 1 case of dermatomyositis by skin biopsies?? 1 case of Langerhans cell histocytosis by lymphaden biopsy ??all 113 cases of idiopathic pulmonary hemosiderosis?? 2 cases of eosinophilic pneumonia and 2 cases of hypersensitive pneumonitis by bronchoalveolar lavage fluid??40 cases were diagnosied by the lung biopsy?? including 23 cases of idiopathic interstitial pneumonia. Conclusion Diffuse parenchymal lung disease in children is a heterogeneous group of respiratory disorders . Bronchiolitis obliterans?? idiopathic pulmonary hemosiderosis and idiopathic interstitial pneumonia are the most common disease in the diffuse parenchymal lung disease of the children. The procedural diagnosis method could make specific diagnosis for 321/349??91.98%?? cases with parenchymal lung disease in this study. The 45.85% of whem are diagnosied by the noninvasive examination??and the other cases such as the idiopathic pulmonary hemosiderosis and the idiopathic interstitial pneumonia were confirmed by the invasive method.