Effects and safety of delayed versus early umbilical cord clamping in newborns of HIV-infected mothers

Objective: To investigate the effect of a 2 minutes-delayed cord clamp (DCC) versus early cord clamp (ECC) on neonate haemoglobin concentration 24 hours and 1 month after birth, and assess the safety of DCC concerning the risk of HIV infection. Design: Sixty-four mother-infant peers were enrolled. All mothers were on stable ARV therapy. Viral load, CD4+count and blood haemoglobin (Hb) concentrations 24 hours before delivery were collected from all mothers and their infants. Methods: All patients were enrolled at the Department of Paediatrics, AO FBF Sacco Hospital in Milan, and were followed until 18 months after birth. Women with haematological diseases and obstetrical complications were excluded. All of 64 mother and infants couples (32 ECC group and 32 DCC group) completed the study. ECC and DCC are defined as application of umbilical clamp within 30 seconds and 120 seconds after birth, respectively. Results: Mean birth weight was significantly higher in the DCC compared with ECC group. Mean Hb levels at birth were significantly higher in DCC than in ECC group (p\ue2\u80\u89=\ue2\u80\u89.05): this difference persisted at 1 month of life. All newborns showed negative viral load. Conclusions: DCC 2 minutes after birth is proven to be a safe procedure, particularly beneficial in newborns from HIV mothers. The risk of anemia is significantly decreased at 24 hours after birth and persists at age of 1 month without any increased risk of neonatal jaundice or polycitemia

Acute Inflammation and Elevated Cardiac Markers in a Two-Month-Old Infant with Severe Acute Respiratory Syndrome Coronavirus 2 Infection Presenting with Cardiac Symptoms

Severe acute respiratory syndrome coronavirus 2 infection in children mainly shows a milder course. In complicated cases, it is unknown whether inflammation is predictive of disease severity, as in adults. Moreover, cardiac involvement is anecdotally described. We report the case of a 2-month-old infant with severe acute respiratory syndrome coronavirus 2 infection presenting with fever, tachycardia and elevated interleukin-6, who was diagnosed with myocarditis and treated with immunoglobulins

Sexually transmissible infections among young adolescents in Milan areas: a multicentre study

Objective: Sexually transmitted infections (STIs) are a major health problem affecting mostly young people, the exact magnitude of STIs is frequently unknown due to lack of country surveillance systems. Aim of this study was to determine the prevalence of STIs and relative risk factors among and adolescents in Milan areas, Italy. Methods: From May to October 2011, 117 adolescents (63 female, 54%), median age 15 years, attending hospitals from the north-western areas of Milan, Italy, were enrolled. All subjects completed a questionnaire and provided a urine sample, which was tested for Neisseria gonorrhea, Chlamidia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum/parvum, Trichomonas vaginalis, Treponema pallidum, Streptococcus agalatiae, Haemophylus ducrey, Citomegalovirus (CMV), Herpes Simplex Virus 1(HSV1) and Lymphogranuloma venereum by a multiplex PCR assay: Seeplex\uae STI Master ACE Detection (Seegene, Seoul, Korea). Forty tree out of 117 adolescents (36%) were HIV-1 positive, 63% (74/117) were without any underlying infectious disease. Results: Fifty seven (48,7%) out of 117 adolescent were sexually active (SA), 20 out of 57 (35%) had STIs as follow: 24.5% (14 cases) U.urealyticum/parvum, 7% (4cases) C.trachomatis, 1.7% (one case each) M. genitalium and N.gonorrhoea. Thirty-two (56%) out of 57 SA adolescents were HIV-1 positive and infected with U. urealyticum/parvum (37.5%, 12 cases) and C.trachomatis (6.2% 2 cases). A single case (3.1%) of mixed infection due to C.trachomatis, N.gonorrhoea and U.urealyticum/parvum was observed. Six out of 60 (10%) sexually inactive (SI) adolescents resulted positive for U.urealyticum/parvum (3 cases), C.trachomatis (2 cases) and N.gonorrhoea (1 case). Eleven out of 60 were HIV-1 positive and among this group one case of C.trachomatis and U.urealyticum/parvum infection was reported. For T.vaginalis, T. pallidum, S. agalatiae, H.ducrey, CMV, HSV1 and Lymphogranuloma venereum any infection was reported. Conclusion: STIs as expected were higher in SA adolescent than in SI and in HIV-1 positive patients (P <0.025).Twenty-two percent of SA adolescents resulted positive for at least one STIs. A prevalence of 14.5% (17/117) for U. urealyticum/parvum, was detected in the adolescents studied, even if its clinical significance has yet to be assessed. Findings suggest that surveillance and screening programs should be implemented to prevent sequels on this vulnerable population

Longitudinal changes of bone mineral density and metabolism in antiretroviral-treated human immunodeficiency virus-infected children

Highly active antiretroviral therapy (HAART) may be a contributory factor for a decreased bone mass and altered bone metabolism in HIV-infected children. However, the evolution of bone mineral density (BMD) and bone metabolism during HAART has not been studied yet. In the current longitudinal study we monitored the changes of BMD and bone metabolism over a period of 12 months. Thirty-two HIV-infected children (15 girls and 17 boys), aged from 6.3 to 17.7 yr, with a long duration of HAART exposure (40.0 months at baseline) were enrolled in the study. As a control group, 381 healthy volunteers of comparable age were assessed. BMD was measured at the lumbar spine and whole skeleton by dual-energy x-ray absorptiometry. Bone-specific alkaline phosphatase (BALP, as bone formation index) and N-terminal telopeptide of type I collagen (as bone resorption index) were measured in serum and urine, respectively. BMD values at baseline were significantly lower at all skeletal sites than those of control subjects. The annual increment of spine BMD was comparable to normal, whereas that of the whole skeleton was significantly lower (P &lt; 0.04). BALP and N-terminal telopeptide of type I collagen concentrations were significantly higher compared with controls at baseline and at follow-up. BALP annual changes of HIV patients were significantly different from normal. Our data confirm the presence of low BMD and bone metabolism derangement in HIV-infected children treated with HAART. The role of possible therapeutic approach to restore bone mass and metabolism should be assessed in pediatrics

Preparing for an influenza pandemic in Italy: resourses and procedures in paediatric hospital units

The World Health Organization (WHO) has stated that preparedness for effectively facing a major influenza epidemic should involve the training of physicians in the management of contagious diseases and upgrading hospital resources and procedures [1]. Children would be particularly vulnerable during an influenza pandemic and specific measures are needed to face the threat to them effectively. We performed a national survey to obtain information about the preparedness in facing a major influenza outbreak in Italian paediatric units. In Italy, paediatrics clinics are found in both paediatric wards and paediatric departments. Departments are more complex structures, containing several units with different specialisations and facilities. For this study, we interviewed heads of both departments and units. A structured questionnaire, including 30 items, was submitted to the heads of 150 paediatric hospital departments across the country. Responses were obtained from 123 units; 10% of these had rooms dedicated to infectious diseases, and 4% had experts in infectious diseases available and routinely applied procedures for preventing the spreading of acute infectious diseases. Only 8% of departments have paediatric intensive care facilities. Few paediatric units, usually located in large children's hospitals or in academic paediatric departments, have a sufficient degree of preparedness to face severe influenza pandemics. A structural improvement of the paediatric units and the use specific procedures are essential for effectively care for children hospitalised because of contagious diseases

Humoral and cell-mediated immune responses after a booster dose of HBV vaccine in HIV-infected children, adolescents and young adults

OBJECTIVE: HBV vaccine induces protective antibodies only in 23-56% of HIV-infected children. The aim of our study is to evaluate the immunologic effects of a booster dose of HBV vaccine in HIV-infected youth. DESIGN: 53 young HIV-infected patients in whom HBV vaccination did not elicit protective Ab titers were enrolled. All patients were on ART with optimal immunological and viral response. METHOD: All patients received a booster dose of HBV vaccine (HBVAXPRO 10 \u3bcg i.m.). HBV-specific Ab titer, viral load and CD4+ T cells were measured at baseline (T0), T1, T6 and T12 months. In a subgroup of 16 patients HBV-specific cell mediated immune responses were evaluated at baseline, at T1 and T6. RESULTS: The booster dose induced seroconversion in 51% of patients at T1, 57% at T6, and49% at T12; seroconversion rate was significantly correlated with CD4+T cells at T0 and to the CD4 nadir. The booster dose induced HBV-specific cell mediated immunity at T6 mainly in Responders (Rs): Effector Memory CD8+T cells, HBV-specific TNF\u3b1-, IFN\u3b3-, granzyme secreting CD8+ T cells and IL2-secreting CD4+ T cells were significantly increased in Rs compared to T0. In Non Responders (NRs), HBV-specific IL2-secreting CD4+ T cells, Central and Effector Memory CD8+ T cells were the only parameters modified at T6. CONCLUSIONS: Seroconversion induced by a booster dose of vaccine correlates with the development of T cell immunological memory in HIV-infected patients who did not respond to the standard immunization. Alternate immunization schedules need to be considered in NRs

Proteinuria in paediatric patients with human immunodeficiency virus infection

In human immunodeficiency virus (HIV)-infected people kidney disease is as an important cause of morbidity and mortality. Clinical features of kidney damage in HIV-infected patients range from asymptomatic microalbuminuria to nephrotic syndrome. The lack of specific clinical features despite the presence of heavy proteinuria may mask the renal involvement. Indeed, it is important in HIV patients to monitor renal function to early discover a possible kidney injury. After the introduction of antiretroviral therapy, mortality and morbidity associated to HIV-infection have shown a substantial reduction, although a variety of side effects for long-term use of highly active antiretroviral therapy, including renal toxicity, has emerged. Among more than 20 currently available antiretroviral agents, many of them can occasionally cause reversible or irreversible nephrotoxicity. At now, three antiretroviral agents, i.e., indinavir, atazanavir and tenofovir disoproxil fumarate have a well established association with direct nephrotoxicity. This review focuses on major causes of proteinuria and other pathological findings related to kidney disease in HIV-infected children and adolescents

Antiretroviral therapy and pregnancy,: effect on cortical bone status of HIV-infected women

Antiretroviral therapy and pregnancy: effect on cortical bone status of HIV-infected wome

Efficacy and tolerability of multiple drug therapy in HIV-infected children

Objectives To characterize the efficacy and tolerability of multiple drug therapy (MDT) among heavily pre-treated HIV-infected children. Methods An observational study of seven children treated with 4\u20137 antiretroviral agents. MDT regimens were chosen with regard to past antiretroviral exposure and genotypic resistance data. Five children received MDT once, one child twice and one child four times. All patients had AIDS and severe CD4+ depletion and failed >2 PI-based HAART regimens. Results Virologic response, defined as a 65log10 decrease in plasma HIV-1 RNA at week 24, was achieved in 7/11 MDT. Successful MDT kept a sustained viral suppression (<50 copies/ml) at longest follow-up (72\u201396 weeks). Successful MDT obtained a great immune recovery: the median rise in absolute and percentage of CD4+ cells was 261 and 4 at week 24 and it reached 480 and 16 at 72\u201396 weeks. Adverse events were common but generally manageable. Mild/moderate gastrointestinal complaints and laboratory abnormalities were detected in 5/11 and 8/11 MDT. Grade 2 severity pancreatitis occurred in one case with chronic active hepatitis C. Pancreatitis resolved within 30 days of MDT interruption. Conclusions MDT may be a therapeutic option in children who failed to respond to most standard HAART regimens