Antibody response to inactivated polio vaccine (E-IPV) in children born to HIV positive mothers

In order to evaluate the response to immunization of HIV-infected children we studied the humoral response to an enhanced potency inactivated poliovaccine (E-IPV) of 43 children born of HIV seropositive mothers. All these subjects have been followed for 32 (15-48) months in order to ascertain their infection status. After a course of 2 doses of E-IPV, 88% of children had neutralizing antibody (n.a.) titers greater than 1:4 to the 3 poliovirus serotypes and 100% to at least 2 polio strains. No statistically significant differences both as rates of n.a. positive subjects and as antibody levels were found between HIV infected children and those who lost HIV antibodies. The poorest response was observed in subjects with full-blown immunodeficiency (CD4 less than 1000/mm3, reduced response to PWM). Sixteen children also received a booster dose of vaccine one year after the completion of the primary cycle. Infected and non-infected subjects responded to the same extent with high levels of n.a. to this immunization. Interestingly, the recall dose was also able to induce high n.a. titers in those HIV infected children who showed significant decreases of n.a. titers in the months following the end of the primary cycle

Granulocyte-colony stimulating factor and erythropoietin therapy in children with human immunodeficiency virus infection

To determine whether granulocyte-colony stimulating factor and erythropoietin are effective in the therapy of neutropenia and anaemia related to human immunodeficiency virus (HIV) infection and to anti-retroviral agents, we recruited 11 HIV-infected children (mean age 4 years 10 months). All the children were given granulocyte-colony stimulating factor at a dosage of 5 μg/kg twice or three times a week while erythropoietin was administered additionally to three patients at a dosage of 50 U/kg twice a week. Both agents were administered subcutaneously for at least 4 months. Leukocyte and neutrophil counts significantly increased during the treatment (after 1 month, P = 0.003 and P = 0.009, respectively). Erythropoietin prevented blood transfusions and increased haemoglobin levels in the three children treated. No side-effects were recorded during the administration of either agent. Granulocyte-colony stimulating factor and erythropoietin appear to be safe and useful agents in the management of HIV-infected childre

Incidence of Chlamydia pneumoniae infection in vertically HIV-1 infected children

The rate of seroconversion for antibody to Chlamydia pneumoniae was analysed in blood samples of 26 vertically HIV-1 infected children and 14 seroreverter children (HIV-negative children born to HIV-positive mothers) during a 3-year study period. Seroconversion for Chlamydia pneumoniae was found in 13 of 26 HIV-1 infected children and in 1 of 14 in the seroreverter group (P = 0.013). A lower mean CD4+ cell count and p24 antigen positivity at enrolment were significantly associated with seroconversion for Chlamydia pneumoniae. Signs and symptoms of acute respiratory infection were recorded in the 30 to 40 days preceding collection of the blood samples showing seroconversion for Chlamydia pneumoniae in 8 of 13 HIV-1 infected children and in the single seroreverter. This study confirms the potential role of Chlamydia pneumoniae in the pathogenesis of respiratory tract infections in HIV-1 infected subjects

Immunization in children with HIV seropositivity at birth: Antibody response to polio vaccine and tetanus toxoid

Objective: To evaluate the humoral response to routine childhood immunization of HIV-infected children. Design: Response rate, antibody titres and persistence after polio and tetanus vaccination were compared in 72 children with HIV seropositivity at birth and divided according to HIV infection status as determined by clinical and laboratory tests. Methods: Polio antibodies were titred in a microneutralization test (positive titres, 651:4), and antibody to tetanus toxoid with a passive haemagglutination method (protective titres, 651:1024). Results: The response rates to polio and tetanus vaccination (>80 and >75%) were similar in the HIV-infected and non-infected children, as were antibody levels. In the subgroup with sera obtained some months after the last dose of vaccine, polio antibody levels decreased in all four HIV-infected and in three of the seven non-infected children; protective tetanus antitoxin levels were detected in three of the six infected and in all three non-infected children. Conclusions: This study demonstrates the ability of children with HIV infection to respond adequately to the two vaccines considered, although tetanus antitoxin levels were inferior, compared with those in the seroreverted children. The unsatisfactory antibody levels observed in the admittedly few HIV-positive children studied some months after the last vaccination could be the result of a lower initial protective level and not necessarily an expression of severely impaired immunocompetence. The administration of booster doses in addition to the traditional immunization schedule could be useful in children with HIV infection

Features of children perinatally infected with HIV-1 surviving longer than 5 years. Italian Register for HIV Infection in Children.

Children infected with HIV do not necessarily develop AIDS to a set pattern but can be divided into long-term and short-term survivors. We examined long-term survival in children perinatally infected with HIV-1. Out of a total of 624, we studied 182 children who survived longer than 5 years (long-term survivors [LTS]) and 120 children who died of HIV-1-related disease before 5 years (defined as short-term survivors [STS]). 28 (15%) LTS were symptomless (Centers for Disease Control [CDC] P-1 children). 154 (85%) had symptoms (CDC P-2). The proportion of LTS with less than 0.2 x 10(9)/CD4 cells per L was 24/116 (21%) at 61-72 months, rising to 11/26 (41%) at more than 96 months. On at least one occasion, p24 antigenaemia was observed in 112 (62%) LTS. Annual rate of CD4 cell loss was lower in LTS (25% [95% CI: 21-29]) than in STS (53% [45-60]) and in LTS symptomless or with solitary P-2A signs (17%; [13-21]) than in LTS with severe manifestations (30% [25-35]). A new outlook emerges. A substantial number of children do survive after early childhood; severe diseases; low CD4 cell numbers, and p24 antigenaemia do not necessarily preclude long-term survival. The study shows that a CD4 cell decrease early in life can be predictive of outcome

HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 INFECTION AND BREAST-MILK

Major questions are whether mothers infected with the Human Immunodeficiency Virus type 1 (HIV-1) transmit the virus through breast milk and the magnitude of the additional transmission risk. The demonstration of a dose-response effect is an epidemiological method to demonstrate causality. Thus, a study was carried out by the Italian Register for HIV Infection in Children on 961 children of known infection status. Duration of breast-feeding was considered as the level of exposure in 168 ever breastfed children. Results showed that duration of practice significantly increased the risk of transmission. The adjusted infection odds ratio for one day of breast- versus exclusive formula-feeding was 1.19 with narrow confidence limits (1.10-1.28). In a second study by the Register on 556 children of known infection status and derived prospectively, an infection odds ratio of 2.55 (confidence interval: 1.03-6.37) was calculated in breast- versus exclusively formula-fed children. Several lines of evidence, including the above-mentioned data from the Italian Register for HIV Infection in Children, showed a contribution of breast-feeding to mother-to-child HIV-1 transmission. Thus, this practice is now discouraged in HIV-1 infected mothers living in industrialized societies where formula feeding is practical and attainable. Mode of feeding was known in 2183 children enrolled in the Register and born to HIV-1 infected mothers since 1981. It could be observed that feeding habits of at-risk infants changed in Italy in the middle 1980s, when a large majority of subjects was identified at birth. However, women infected exclusively by the sexual route are often unconscious of being infected or even being at risk from infection and consequently their children are less frequently identified at birth than are children of women with a history of intravenous drug use. In industrialized areas, the former children remain at risk from milk-borne HIV-1 infection