Quality Of Sleep And Quality Of Life In Adolescents Infected With Human Immunodeficiency Virus [qualidade Do Sono E Qualidade De Vida Em Adolescentes Infectados Pelo Vírus Da Imunodeficiência Humana]

Objectives: To assess sleep characteristics of adolescents infected by HIV, and to ascertain whether psychosocial aspects are associated to the quality of sleep. Methods: A cross-sectional study assessing 102 HIV-infected adolescents of both genders, aged between 10 and 20 years-old and 120 Controls. Data collection was performed by applying the Sleep Disturbance Scale for Children, the Epworth Sleepiness Scale, and the Pediatric Quality of Life Inventory. Results: A sleep disturbance prevalence of 77.4% was found in patients, and a 75% prevalence in controls, and there was correlation between quality of sleep and of life. HIV-infected adolescents scored higher for sleep breathing disorders and had higher prevalence of excessive daytime sleepiness. Conclusions: HIV-infected adolescents had similar quality of sleep compared to healthy adolescents. 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Brasília: Ministério da SaúdeBruni, O., Salvatori, O., Guidetti, V., The sleep disturbance scale for children (SDSC) Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence (1996) J Sleep Res, 5, pp. 251-261Johns, M.W., A new method for measuring daytime sleepiness: The Epworth sleepiness scale (1991) Sleep, 14, pp. 540-545Ferreira, V.R., Carvalho, L.B.C., Ruotolo, F., Morais, J.F., Prado, L.B.F., Prado, G.F., Sleep disturbance scale for children: Translation, cultural adaptation and validation (2009) Sleep Med, 10, pp. 457-463Bertolazi, N.A., Fagondes, S.C., Hoff, L.S., Pedro, V.D., Barreto, S.S.M., Johns, M.W., Validação da escala de sonolência de Epworth em português para uso no Brasil (2009) J Bras Pneumol, 35, pp. 877-883Klatchoian, D.A., Len, C.A., Terreri, M.T., Quality of life of children and adolescents from São Paulo: Reliability and validity of the Brazilian version of the Pediatric Quality of Life Inventory TM version 4.0 Generic Core Scales (2008) J Pediatr (Rio J), 84, pp. 308-315Potasz, C., Juliano, M.L., Varela, M.J., Prevalence of sleep disorders in children of a public hospital in São Paulo (2010) Arq Neuropsiquiatr, 68, pp. 235-241Carotenuto, M., Bruni, O., Santoro, N., Giudice, E.M., Perrone, L., Pascotto, A., Waist circumference predicts the occurrence of sleep-disordered breathing in obese children and adolescents: A questionnaire-based study (2006) Sleep Med, 7, pp. 357-361Ramalho, L.C.B., Gonçalves, E.M., Carvalho, W.R.G., Abnormalities in body composition and nutritional status in HIV-infected children and adolescents on antiretroviral therapy (2011) Int J STD AIDS, 22, pp. 453-456Chan, E.Y., Ng, D.K., Chan, C.H., Modified Epworth Sleepiness Scale in Chinese children with obstructive sleep apnea: A retrospective study (2009) Sleep Breath, 13, pp. 59-63Melendres, M.C., Lutz, J.M., Rubin, E.D., Marcus, C.L., Daytime sleepiness and hyperactivity in children with suspected sleep-disordered breathing (2004) Pediatrics, 114, pp. 768-775van Litsenburg, R.R., Huisman, J., Hoogerbrugge, P.M., Egeler, R.M., Kaspers, G.J., Gemke, R.J., Impaired sleep affects quality of life in children during maintenance treatment for acute lymphoblastic leukemia: An exploratory study (2011) Health Qual Life Outcomes, 18, pp. 9-25Erickson, J.M., Beck, S.L., Christian, B.R., Fatigue, sleep-wake disturbances, and quality of life in adolescents receiving chemotherapy (2011) J Pediatr Hematol Oncol, 33, pp. 17-25Mitchell, R.B., Boss, E.F., Pediatric obstructive sleep apnea in obese and normal-weight children: Impact of adenotonsillectomy on quality-of-life and behavior (2009) Dev Neuropsychol, 34, pp. 650-661Crabtree, V.M., Varni, J.W., Gozal, D., Health-related quality of life and depressive symptoms in children with suspected sleep-disordered breathing (2004) Sleep, 27, pp. 1131-1138Ong, L.C., Yang, W.W., Wong, S.W., Alsissiq, F., Khu, Y.S., Sleep habits and disturbances in Malaysian children with epilepsy (2010) J Paediatr Child Health, 46, pp. 80-8

Serum immunoglobulins in children perinatally exposed to human immunodeficiency virus

OBJECTIVE: Hypergammaglobulinemia is an early manifestation of perinatal HIV infection. Our objective was to analyze the differences in serum immunoglobulin levels between infected and seroreverting children and their association with clinical outcome. METHODS: We carried out a historical prospective study with 107 infected and 90 seroreverting children. We compared the IgA, IgG, and IgM levels between infected and seroreverting patients within the first 18 months of life; IgA, IgG, and IgM as surrogate markers of infection; and IgA, IgG, and IgM levels within the first 5 years in infected children, according to clinical outcome. The Mann-Whitney test was used for comparison between groups. Surrogate markers were assessed according to sensitivity, specificity, positive and negative predictive values, and Youden's index. RESULTS: Infected children, when compared to seroreverters, showed significantly higher levels of IgM between the 1st and 5th trimesters; IgA and IgG between the 2nd and 6th trimesters (P less than or equal to 0.05). Levels of IgA greater than or equal to 90 mg/dl in the 2nd trimester and IgG greater than or equal to 1,700 mg/dl or 1,200 mg/dl in the 2nd and 3rd trimesters were associated with HIV infection, with Youden's indexes of 0.97, 0.92, and 0.93, respectively. Infected children in the B and C categories, compared to those in the N and A, showed higher levels of IgM between the 2nd and 4th years, and IgA between the 3rd and 5th year (P > 0.05). CONCLUSIONS: The temporal progression of IgA, IgG, and IgM levels showed an early and intense stimulation to the synthesis of immunoglobulin in infected children. Clinical and epidemiological indicators showed that such levels may be surrogate markers of infection. Higher IgM and IgA levels between the 2nd and 5th years in more severely infected children suggest a dysfunction in immune regulation secondary to persistent antigenic stimulation.OBJETIVO: a hipergamaglobulinemia é uma manifestação precoce da infecção perinatal por HIV. O objetivo foi analisar as diferenças nos níveis séricos de imunoglobulinas entre crianças infectadas e sororreversoras, e sua associação com a evolução clínica. MÉTODOS: Em um estudo prospectivo histórico, avaliaram-se 107 crianças infectadas e 90 sororreversoras. Compararam-se: IgA, IgG e IgM entre infectados e sororreversores nos primeiros 18 meses de vida; IgA, IgG e IgM como marcadores indiretos de infecção; IgA, IgG e IgM nos 5 primeiros anos em infectados, de acordo com a evolução clínica. Utilizou-se o teste de Mann-Whitney para a comparação entre grupos. Na avaliação de marcadores indiretos, analisaram-se Sensibilidade, Especificidade, Valores Preditivos Positivo e Negativo, e índice J. RESULTADOS: Infectados, em relação a sororreversores, apresentaram níveis significativamente superiores de IgM, do 1o ao 5o trimestre; IgA e IgG, do 2o ao 6o trimestre (P 90 mg/dl no 2o trimestre e IgG > 1.700 mg/dl ou 1.200 mg/dl no 2o e 3o trimestres associaram-se à infecção por HIV com índices J de 0,97, 0,92 e 0,93, respectivamente. Crianças infectadas nas categorias B e C, comparadas àquelas nas categorias N e A, apresentaram níveis superiores de IgM, do 2o ao 4o ano e IgA, do 3o ao 5o ano (P £.0,05). CONCLUSÕES: A evolução temporal dos níveis de IgA, IgG e IgM demonstra um estímulo intenso e precoce à síntese de imunoglobulinas em infectados. Indicadores clínico-epidemiológicos demonstram que tais níveis podem ser marcadores indiretos de infecção. Níveis superiores de IgM e IgA do 2o ao 5o ano em crianças infectadas com maior gravidade sugerem disfunção na regulação imune secundária ao estímulo antigênico persistente.20921

XLA PATIENTS DISPLAY REDUCED EXPANSION FOR BCG CELLULAR IMMUNE RESPONSE AND A LOWER IFN-Gamma PRODUCTION

15th Biennial Meeting European-Society-for-Immunodeficiency (ESID)3227127

Abnormalities in body composition and nutritional status in HIV-infected children and adolescents on antiretroviral therapy

This cross-sectional study aimed to compare growth, nutritional status and body composition outcomes between a group of 94 HIV-infected children and adolescents on antiretroviral therapy (ART) and 364 healthy controls, and to evaluate their association with clinical and lifestyle variables within the HIV-infected group. When compared with the control group, HIV patients had higher risk of stunting (odds ratio [OR] 5.33, 95% confidence interval [CI]: 2.83-10.04) and thinness (OR 4.7, 95% CI: 2.44-9.06), higher waist-to-hip ratios (medians 0.89 versus 0.82 for boys and 0.90 versus 0.77 for girls, P < 0.001), and lower prevalence of overweight or obesity (OR 0.33, 95% CI: 0.14-0.78). Protease inhibitor usage was associated with thinness (OR 3.51, 95% CI 1.07-11.44) and lipoatrophy (OR 3.5, 95% CI 1.37-8.95). HIV-infected children on ART showed significant nutritional status and body composition abnormalities, consistent with the severity of vertical HIV infection and the consequences of prolonged ART.22845345

Satisfação corporal e características de lipodistrofia em crianças e adolescentes com HIV/AIDS em uso de terapia antirretroviral de alta potência Body satisfaction and lipodystrophy characteristics in HIV/AIDS children and teenagers undergoing highly active antiretroviral therapy

OBJETIVO: Verificar a presença de alterações metabólicas e corporais e satisfação corporal em crianças e adolescentes em uso de terapia antirretroviral. MÉTODOS: Estudo transversal de 38 jovens entre seis e 18 anos infectados por HIV e atendidos entre dezembro de 2009 e maio de 2010. A satisfação corporal foi avaliada por escala de silhuetas, composta por 11 figuras. O estado nutricional foi avaliado por meio de mensurações de peso, altura, circunferências e pregas cutâneas. A presença de características de lipodistrofia foi avaliada pelo exame físico e o perfil lipídico e glicêmico foi solicitado no dia da consulta. Na análise estatística, aplicou-se o teste t e do qui-quadrado, sendo significante p<0,05. RESULTADOS: A maioria dos 38 jovens era eutrófica, com estatura adequada para idade, e 26% apresentavam sobrepeso/obesidade. O colesterol total esteve adequado em 29% dos pacientes. As mudanças corporais mais expressivas foram a lipo-hipertrofia na face e na região abdominal. A prevalência de insatisfação corporal foi de 84%. Crianças e adolescentes apresentaram níveis de insatisfação semelhantes; no entanto, as insatisfeitas com o excesso de peso mostravam valores médios mais elevados de índice de massa corporal e prega cutânea tricipital do que os satisfeitos, porém sem relação com a presença de lipodistrofia. CONCLUSÕES: A prevalência de insatisfação corporal nesta amostra não se associou com a lipodistrofia e foi semelhante à de indivíduos saudáveis. No entanto, as alterações morfológicas e bioquímicas requerem atenção das equipes multiprofissionais, de modo que se possam diminuir os riscos de novas enfermidades nos pacientes avaliados.<br>OBJECTIVE: To verify the presence of body and metabolic alterations as well as body satisfaction in children and teenagers undergoing antiretroviral therapy. METHODS: This cross-sectional study enrolled 38 HIV infected young individuals (aged six to 18 years old) treated from December 2009 to May 2010). The body satisfaction was assessed by the silhouette rating scale with 11 figures. The nutritional status was assessed by weight, height, circumferences and skinfolds. The presence of lipodystrophy characteristics was determined by the physical exam, and lipid profile and glycemia were requested during consultation. The statistical analysis used t-test and chi-square test, being significant p<0.05. RESULTS: Most of the 38 patients were eutrophic with length adequate for age; 26% of them presented overweight/obesity. The total cholesterol was within the normal range in 29% of the sample. The most expressive changes were cheek and abdominal lipohypertrophy. The body dissatisfaction prevalence was 84%. Children and teenagers had similar dissatisfaction levels; however, those dissatisfied by an excessive body weight had higher mean body mass index and tricipital skinfold thickness than the satisfied ones. The dissatisfaction was not associated with the presence of lipodystrophy. CONCLUSIONS: The prevalence of body dissatisfaction in these patients was not associated with lipodystrophy and was similar to the reported by healthy individuals. However, the morphological and biochemical alterations need multi-professional attention in order to decrease the risk of new diseases in HIV patients