Pediatric HIV infection. An update.

Human immunodeficiency virus infection is a leading cause of immunodeficiency in children. The epidemic in children parallels that in women since most infected women are in the child-bearing age groups. The risk of vertical transmission of HIV from an infected mother to her infant ranges from 13% to 39%. Diagnosis of infection in the infant is complicated by the passive transfer of antibody across the placenta, making the use of standard serologic tests to confirm infection difficult. In children less than 15 months of age, a positive p24 core antigen test, a positive viral culture or AIDS defining criteria with immune abnormalities are required for diagnosis. HIV infection in children is chronic and multisystem characterized by immunologic and clinical deterioration with a higher incidence of serious bacterial infections, neurologic disease, and lymphoid interstitial pneumonitis. The cornerstones of management include close medical follow-up, good nutrition, and prompt diagnosis and treatment of infections. Certain children will benefit from therapeutic modalities such as Pneumocystis carinii pneumonia prophylaxis and/or intravenous gamma globulin. The antiretroviral drugs have improved the quality of life and increased survival. Several newer antiviral agents are presently in clinical trials.     

丙型肝炎病毒感染献血者8年追踪观察

献血者发生丙型肝炎病毒(HCV)感染后大多数要向慢性肝炎发展,其中一部分要发展为肝硬化和肝癌,这已有许多文献报告。上世纪90年代我国献血者中发生了严重的HCV感染传播。据季阳、任勤惠、朱志义等人报告,1993年～1994年调查我国四川,广东,新疆三省区20280名献血者首次检测抗-HCV的流行率达13.5％,估计当时我国全     

Hepatitis C and steatosis

Hepatitis C infection and non-alcohol-related hepatic steatosis are the most common liver diseases worldwide, and both conditions often co-exist in the same patient. Hepatitis C virus (HCV) genotype 3 directly induces development of steatosis, whereas in patients with non-genotype 3 chronic hepatitis C infection, insulin resistance plays a key role in the pathophysiology of steatosis. Insulin resistance and its clinical components including obesity, hyperglycemia, hypertriglyceridemia, increased blood pressure, and low HDL-cholesterol levels are often seen in patients with chronic hepatitis C infection. Both increased adipocity and presence of steatosis may increase the risk of fibrosis progression, and both have been associated with a decreased rate of response to antiviral treatment. Hence, liver steatosis in the setting of HCV infection is a distinct condition with specific clinical and prognostic implications. Accumulating evidence suggests that weight management may lead not only to a decrease in steatosis but also improvement in fibrosis severity. However, further studies are necessary to determine whether weight reduction improves response to antiviral therapy.     

Women in medical specialty societies. An update

The question of whether women are joining medical specialty societies at the same rate as their male counterparts has not been studied. A questionnaire was mailed to 48 medical specialty societies representing the 37 specialties listed in the Physician Characteristics and Distribution in the U.S., 1986 Edition. The response rate was 79%. Twenty organizations were able to identify the sex of their members, including the 7 specialty societies that represent the 6 most frequently chosen specialties of women physicians. Only in the American Psychiatric Association and the American Academy of Family Physicians was the enrollment of potential female members equivalent to that of male members. If the medical specialty societies do not address the issue of women being underrepresented in their societies, they will lose a large potential resource of leadership, participation, and financial support. More important, the societies will not be truly representative of their specialties.     

Hepatitis C in childhood

The prevalence of hepatitis C virus (HCV) infection is relatively low in childhood. Blood transfusion has been the principal route of acquisition in children but vertical transmission is gradually occupying primacy in the developed world. The risk of vertical transmission increases with higher maternal viraemia and human immuno-deficiency virus (HIV) co-infection but current international guidelines do not suggest avoidance of vaginal delivery and breastfeeding to minimise the risk of vertical transmission. The diagnosis of perinatal transmission is different from that in older child or adult and detection of HCV-RNA is essential. Although the natural history of HCV infection in children is not well characterised, almost 50-80% will progress to chronic hepatitis among vertically infected and blood transfusion acquired hepatitis C cases. Children have a lower viral load, lower ALT values and milder histological derangement as compared to adults with chronic hepatitis C cases. Experience of treatment of chronic hepatitis C in children is limited and still evolving. Few patients achieve spontaneous remission and progression to a more severe liver disease might occur in adult life. Here, the natural history, diagnosis and management of HCV infection in children are discussed with special emphasis on features which are different from adults.