Cryptosporidium, Enterocytozoon, and Cyclospora Infections in Pediatric and Adult Patients with Diarrhea in Tanzania.

Cryptosporidiosis, microsporidiosis, and cyclosporiasis were studied in four groups of Tanzanian inpatients: adults with AIDS-associated diarrhea, children with chronic diarrhea (of whom 23 of 59 were positive [+] for human immunodeficiency virus [HIV]), children with acute diarrhea (of whom 15 of 55 were HIV+), and HIV control children without diarrhea. Cryptosporidium was identified in specimens from 6/86 adults, 5/59 children with chronic diarrhea (3/5, HIV+), 7/55 children with acute diarrhea (0/7, HIV+), and 0/20 control children. Among children with acute diarrhea, 7/7 with cryptosporidiosis were malnourished, compared with 10/48 without cryptosporidiosis (P < .01). Enterocytozoon was identified in specimens from 3/86 adults, 2/59 children with chronic diarrhea (1 HIV+), 0/55 children with acute diarrhea, and 4/20 control children. All four controls were underweight (P < .01). Cyclospora was identified in specimens from one adult and one child with acute diarrhea (HIV-). Thus, Cryptosporidium was the most frequent and Cyclospora the least frequent pathogen identified. Cryptosporidium and Enterocytozoon were associated with malnutrition. Asymptomatic fecal shedding of Enterocytozoon in otherwise healthy, HIV children has not been described previously

Low Peripheral T Follicular Helper Cells in Perinatally HIV-Infected Children Correlate With Advancing HIV Disease.

Background: T follicular helper (Tfh) cells are crucial for B cell differentiation and antigen-specific antibody production. Dysregulation of Tfh-mediated B cell help weakens B cell responses in HIV infection. Moreover, Tfh cells in the lymph node and peripheral blood comprise a significant portion of the latent HIV reservoir. There is limited data on the effects of perinatal HIV infection on Tfh cells in children. We examined peripheral Tfh (pTfh) cell frequencies and phenotype in HIV-infected children and their associations with disease progression, immune activation, and B cell differentiation. Methods: In a Kenyan cohort of 76 perinatally HIV-infected children, comprised of 43 treatment-naïve (ART-) and 33 on antiretroviral therapy (ART+), and 42 healthy controls (HIV-), we identified memory pTfh cells, T cell activation markers, and B cell differentiation states using multi-parameter flow cytometry. Soluble CD163 and intestinal fatty acid-binding protein plasma levels were quantified by ELISA. Results: ART- children had reduced levels of pTfh cells compared with HIV- children that increased with antiretroviral therapy. HIV+ children had higher programmed cell death protein 1 (PD-1) expression on pTfh cells, regardless of treatment status. Low memory pTfh cells with elevated PD-1 levels correlated with advancing HIV disease status, indicated by increasing HIV viral loads and T cell and monocyte activation, and decreasing %CD4 and CD4:CD8 ratios. Antiretroviral treatment, particularly when started at younger ages, restored pTfh cell frequency and eliminated correlations with disease progression, but failed to lower PD-1 levels on pTfh cells and their associations with CD4 T cell percentages and activation. Altered B cell subsets, with decreased naïve and resting memory B cells and increased activated and tissue-like memory B cells in HIV+ children, correlated with low memory pTfh cell frequencies. Last, HIV+ children had decreased proportions of CXCR5+ CD8 T cells that associated with low %CD4 and CD4:CD8 ratios. Conclusion: Low memory pTfh cell frequencies with high PD-1 expression in HIV+ children correlate with worsening disease status and an activated and differentiated B cell profile. This perturbed memory pTfh cell population may contribute to weak vaccine and HIV-specific antibody responses in HIV+ children. Restoring Tfh cell capacity may be important for novel pediatric HIV cure and vaccine strategies

Comparison of Magnetic Resonance Spectroscopy (MRS) data in children with and without HIV at 11-12 years

Although HIV and antiretroviral drugs have been shown to cause damage in the brain, the long-term impacts of perinatal infection, early treatment and exposure in children at 11 years, remain unclear. The effects of HIV and antiretroviral therapy (ART), whilst indistinguishable, can be investigated at a chemical level through proton magnetic resonance spectroscopy (1H-MRS). Previous studies in children have largely focused on individual metabolite changes. However, several adult studies have now advanced beyond this to address patterns of metabolic activity that are altered with HIV infection. Using a 3T Skyra scanner, 136 children (76 HIV+, 30 HEU, 30 HU; 71 males) between the ages of 11.0- 12.5 years, and from a similar socioeconomic background, were scanned. In this study metabolite concentrations were quantified within the basal ganglia (BG), midfrontal gray matter (MFGM) and peritrigonal white matter (PWM). We utilised linear regression to investigate individual metabolite differences, comparing HIV-infected (HIV+) children from the Children with HIV Early Antiretroviral Therapy (CHER) trial, and HIV-exposed-uninfected (HEU) children, to HIV-unexposed (HU) children. Pearson's correlation analysis, factor analysis and logistic regression were then used to study alterations in metabolic patterns between HIV+ and HIV-uninfected (HIV-) children. Analysis of the data was carried out in R. We found elevated total choline in the BG (p = 0.03) and MFGM (p < 0.001) of HIV+ children, as well as reduced PWM total NAA (p = 0.03) and total creatine (p = 0.01). Altered metabolite concentrations were further observed in HEU children. Additionally, we identified a cross-regional coupling of choline which distinguishes HIV+ from HIV- children (p < 0.001). These findings indicate that multiregional inflammation and PWM axonal damage are occurring in HIV+ children at 11 years. Ultimately, the consequences of perinatal HIV acquisition, in spite of early treatment, continue to be seen at 11 years, as do the impacts of exposure

Accelerated aging in perinatally HIV-infected children: clinical manifestations and pathogenetic mechanisms

BACKGROUND: Premature aging and related diseases have been documented in HIV-infected adults. Data are now emerging also regarding accelerated aging process in HIV-infected children. METHODS: A narrative review was performed searching studies on PubMed published in English language in 2004-2017, using appropriate key words, including "aging", "children", "HIV", "AIDS", "immunosenescence", "pathogenesis", "clinical conditions". RESULTS: Premature immunosenescence phenotype of B and T cells in HIV-infected children is mediated through immune system activation and chronic inflammation. Ongoing inflammation processes have been documented by increased levels of pathogen-associated molecular patterns (PAMPS), increased mitochondrial damage, higher levels of pro-inflammatory cytokines, and a positive correlation between sCD14 levels and percentages of activated CD8+ cells. Other reported features of premature aging include cellular replicative senescence, linked to an accelerated telomeres shortening. Finally, acceleration of age-associated methylation pattern and other epigenetic modifications have been described in HIV-infected children. All these features may favor the clinical manifestations related to premature aging. Lipid and bone metabolism, cancers, cardiovascular, renal, and neurological systems should be carefully monitored, particularly in children with detectable viremia and/or with CD4/CD8 ratio inversion. CONCLUSION: Aging processes in children with HIV infection impact their quality and length of life. Further studies regarding the mechanisms involved in premature aging are needed to search for potential targets of treatment

ANALYSIS OF AFFECTING FACTORS OF FAMILY RESILIENCE IN FAMILY WITH POSITIVE HIV CHILDREN IN SURABAYA ANALYTIC DESCRIPTIVE RESEARCH

PLWHA are increasing in Surabaya every year. Number of PLWHA in Surabaya on 2014 was 2028. Total of children with low resilience suffered positive HIV excessively increase and have the impact in family that affecting their life in social, economy and psychology. 80% of five families with positive HIV children in Surabaya have low resilience. The objective of this research was to analyze the factor that influence the resilience of families who have children with HIV positive. This research used analytic descriptive design with cross sectional approachment. Population in this research was family with positive HIV children in Surabaya. Total samples were 20 respondents with purposive sampling. Independent variables were social support, cognitive, and psychological resources. Dependent variable was family resilience. This research used questionnaire and analyzed with spearman’s rho statistic test (p< 0, 05). The outcome of this research showed correlation coefficient related factor in social support with resilience (p=0,041), cognitive related factor with resilience (p=0,037), and psychological resources with family resilience (p=0,021). Social support, cognitive, and psychological resources factor have significance relation in family resilience. Further research should find the other factors that affecting family with positive HIV children resilience in Surabaya, such as spirituality. Keywords : resilience, social support, cognitive, psychological resources

The Baby AIDS Bill

Assemblywoman Mayersohn first explains the reasons behind her support for the so-called “Baby AIDS” bill; namely, that over one thousand babies in New York State tested positive for AIDS or HIV antibodies every year but medical professions were not allowed to reveal the results to anyone, including the mother. After the introduction of the bill, the author details how she received criticism and opposition from activist organizations that she had previously supported. In conclusion, the “Baby AIDS” bill is a success because it no longer treated infected infants as some sort of statistical tool and ensures the infants receive the care they need

The Baby AIDS Bill

Assemblywoman Mayersohn first explains the reasons behind her support for the so-called “Baby AIDS” bill; namely, that over one thousand babies in New York State tested positive for AIDS or HIV antibodies every year but medical professions were not allowed to reveal the results to anyone, including the mother. After the introduction of the bill, the author details how she received criticism and opposition from activist organizations that she had previously supported. In conclusion, the “Baby AIDS” bill is a success because it no longer treated infected infants as some sort of statistical tool and ensures the infants receive the care they need

High soluble CD163 levels correlate with disease progression and inflammation in Kenyan children with perinatal HIV-infection

Objectives: CD163 is a hemoglobin scavenger receptor on monocytes and macrophages, cleaved to soluble CD163 (sCD163) in the plasma following activation. In HIV+ adults, sCD163 is linked to non-AIDS morbidity and predicts mortality, but there is limited data in children. We investigated sCD163 levels in HIV+ children and their correlations with disease progression, immune activation and gut mucosal damage. Design and methods: We quantified sCD163 levels in Kenyan children aged 0–20 years with perinatal HIV infection, including 74 antiretroviral treatment (ART)-naïve (ART−) and 64 virally suppressed on ART (ART+), and 79 HIV unexposed-uninfected controls (HIV−). The cohort was divided into age groups 0–5 (younger) and 5–20 (older) years. Correlations between sCD163 and HIV viral load, %CD8+, CD4+ : CD8+ ratio, markers of T-cell activation and proliferation, and gut mucosal damage were also assessed. Results: ART− children have higher sCD163 levels compared with HIV− and ART+ children (P ≤ 0.01); ART+ have equivalent sCD163 levels to HIV− children. In a prospective analysis, sCD163 levels decreased in older ART− children after 12 months of treatment (P < 0.0001). Regardless of age, sCD163 levels correlate with clinical disease progression measured by %CD4+ T cells, CD4+ : CD8+ T-cell ratios and HIV viral load. sCD163 levels directly correlate with T-cell activation markers CD38, human leukocyte antigen-DR isotype, and Ki67 (P ≤ 0.01). Conclusion: High plasma sCD163 levels in HIV+ children correlate with advancing disease and T-cell activation. ART initiation normalizes sCD163 levels and may alleviate HIV-related morbidities and improve long-term pediatric outcomes

COVID-19 and Prophylactic Measures for HIV Children of Ratodero, Larkana

Ratodero is Taluka of population 224,000 in the district Larkana of Sindh, Pakistan. In the HIV outbreak (2019), 1132 HIV patients were reported in the Ratodero, amongst them, 901 (80%) were children, and the majority (735) below the age of 5 years.1 Larkana district is included among the cities where eight (8) COVID-19 carrier pilgrims from Iran were first confirmed as virus positive.2 Followed by community transmission in the area with the confirmation of the virus in the two individuals.3 There was reported shortage of the personnel protection equipment (PPEs) for the Medical Professional engaged in the tests of the COVID-19 as well as the shortage of Kits, so less number of COVID-19 tests were conducted, therefore the actual number of COVID-19 positive can abruptly raise with the availability of Kits and PPEs.4 There is a complete lockdown in the area since last week of March 2020. There is one medical University with an affiliated hospital. Collaborative efforts of the University teaching hospital and the district administration have constituted a team of experts for necessary actions to combat with expected Corona-19 outbreak. In such circumstances of the existence of HIV in Ratodero as an alarm of threats for another health risk for the poor HIV children of Ratodero Larkana. Dated 09 April 2020. there was a random selection of 20 such HIV children of Ratodero below the age 5,&nbsp; to have look on their physical health and to confirm the quantity/availability of ART (antiretroviral treatment) at their home. It was found that 30% of children were found physically weak. The confirmed average availability of remaining ART drugs was found available for use in the next 14 days. Generally, the children are the population of developing immunity (vulnerable age group) hence there can be increased risk if Co-Infection of COVID-19 if hits the Ratodero Taluika. Therefore the District of Larkana in general but the Taluka Ratodero, in particular, need special attention from the health administration. Following preventive measures can be useful to prevent the spread of COVID-19 among the HIV children of Ratodero, Larkana. Better compliance of prophylactic SOPs verses COVID-19 through proper surveillance at the rural level in Ratodero. Availability of Rashan on priority for the families of registered HIV children of Ratodero, taking into account the inclusion of all requirements of good nutrients in the daily intake. COVID-19 screening of registered HIV children. HIV Screening of any COVID-19 career of Ratodero if the individual is not amongst already registered HIV patients. Establishment of a dedicated isolation ward in case of Co-Infection in these children along with the provision of special care to prevent the onset of COVID-19 symptoms in these patients. Advance Supply of 03 to 06 month ART at home as per instructions of the World Health Organization (WHO) for such HIV patients.