TCD4+ Lymphocyte are Related to Muscle Strength Parameters in HIV-1 Positive Adolescents: A Preliminary Study

Introduction: Catabolism of muscle and loss of function are complications that can occur during the course of HIV infection, and are commonly seen in a majority of adolescents with vertically transmitted Human Immunodeficiency Virus-type 1 (HIV-1). The levels of CD4+ and CD8+ lymphocytes, reference markers for the treatment of vertically transmitted HIV-1, also decline as the disease progresses. Alterations on these reference markers may be associated with neuromuscular force parameters in sedentary adolescents that have potential as prognostic indicators for treatment administration. Objective: To investigate the relationship between maximal isometric muscular contraction force and levels of CD4+ and CD8+ lymphocytes in sedentary, vertically transmitted HIV-1 positive adolescents. Methods: The sample consisted of twenty individuals, adolescents (N= 9 males, 11 females, age 15-17 years), vertically transmitted HIV-1 patients from Institute of Infectious Diseases Emilio Ribas in São Paulo, Brazil, who were undergoing HAART therapy randomly selected to participate in the study. The number of CD4+ and CD8+ cells was determined by flow cytometry using BD FacsCalibur Multitest Equipment, and Multiset-BD software. Viral load was determined using b-DNA methodology, on Siemens System Versátil 440 equipment. All analyses followed standard procedures approved by the Brazilian Ministry of Health. Muscular strength measurements were completed in the morning after blood collection and weight and height measurements. Prior to starting, patients were familiarized with all testing procedures and strength exercises that were used for testing. After the warm up, maximum voluntary isometric muscular strength of the elbow flexors and knee extensors were assessed using an electric dynamometer (EMG210C, EMGLAB System of Brazil). Each patient made three attempts with a rest interval of two minutes between trials. The highest isometric force and torque value were recorded and used for analyses. Results: Upper body force (r=0.70, p=0.001) and maximal torque (r=0.69, p=0.001) were significant correlated with CD4+ count. Similar observations between CD4+ count and lower body muscular force (r=0.62, p=0.005) and maximum torque (r=0.61, p=0.007) were also observed. CD8+ was not associated with any strength measures. Conclusion: CD4+ lymphocytes showed a strong correlation with force parameters in sedentary HIV-1 positive adolescents. Given that those individuals with higher TCD4+ counts showed a tendency towards manifesting higher muscle strength, this may be used as a predictor to indicate the level of physical capacity of patients and consequently help optimize treatment. Further research is needed to explore the potential prognostic value of muscle strength parameters in HIV-1 positive adolescents

Lipid levels in the second year of life among HIV-infected and HIV-exposed uninfected Latin American children

Background: Dyslipidemia is observed among older children and adults with HIV. We examined nonfasting cholesterol and triglycerides in two groups of 12-23-month-old Latin American children - HIV-infected vs. HIV-exposed but uninfected (HEU). Methods: HIV-infected and HEU children in Latin America and Jamaica were enrolled in an observational cohort. Eligibility for this analysis required having cholesterol and triglyceride results available during the second year of life. Results: HIV-infected (n = 83) children were slightly older at the time of lipid testing than the HEU (n 681). Forty percent of the HIV-infected children were on protease inhibitor-based antiretroviral therapy (ART); 41% were not on ART. There was no statistically significant difference in mean cholesterol concentrations (mg/dl) by HIV status; however, the HIV-infected children had higher mean triglyceride concentrations. The prevalence of high cholesterol (>200 mg/dl) and high triglycerides (>110 mg/dl) was higher among the HIV-infected vs. HEU. Among the HIV-infected children, mean cholesterol and triglyceride concentrations varied by ART. Children receiving no ART had a significantly lower mean cholesterol concentration. Those receiving protease inhibitor-containing ART had a significantly higher mean triglyceride concentration compared to the other two antiretroviral regimen groups. Conclusion: A greater proportion of HIV-infected children at 12-23 months have hyperlipidemia when compared to HEU children, with the highest triglyceride concentrations observed among those receiving protease inhibitor-containing ART, and the lowest cholesterol levels among those not receiving ART. Implications of these findings will require continued follow-up of HIV-infected children who initiate therapy early in life. (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & WilkinsNICHDNICHD [N01-HD-3-3345, HHSN267200800001C, N01-HD-8-0001

Evaluation of Viral Load Thresholds for Predicting New World Health Organization Stage 3 and 4 Events in HIV-Infected Children Receiving Highly Active Antiretroviral Therapy

Background: This study evaluated a wide range of viral load (VL) thresholds to identify a cut-point that best predicts new clinical events in children on stable highly active antiretroviral therapy (HAART).Methods: Cox proportional hazards modeling was used to assess the adjusted risk for World Health Organization stage 3 or 4 clinical events (WHO events) as a function of time-varying CD4, VL, and hemoglobin values in a cohort study of Latin American children on HAART >= 6 months. Models were fit using different VL cut-points between 400 and 50,000 copies per milliliter, with model fit evaluated on the basis of the minimum Akaike information criterion value, a standard model fit statistic.Results: Models were based on 67 subjects with WHO events out of 550 subjects on study. the VL cut-points of >2600 and >32,000 copies per milliliter corresponded to the lowest Akaike information criterion values and were associated with the highest hazard ratios (2.0, P = 0.015; and 2.1, P = 0.0058, respectively) for WHO events.Conclusions: in HIV-infected Latin American children on stable HAART, 2 distinct VL thresholds (>2600 and >32,000 copies/mL) were identified for predicting children at significantly increased risk for HIV-related clinical illness, after accounting for CD4 level, hemoglobin level, and other significant factors.National Institute of Child Health and Human Development (NICHD)Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Pediat Adolescent & Maternal AIDS Brach, NIH, Bethesda, MD 20892 USAWestat Corp, Rockville, MD USAUniv Fed Rio de Janeiro, Inst Puericultura & Pediat Martagao Gesteira, Rio de Janeiro, BrazilUniv São Paulo, Fac Med Ribeirao Preto, São Paulo, BrazilUniv São Paulo, Fac Med São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilInst Infectol Emilio Ribas, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilNational Institute of Child Health and Human Development (NICHD): N01-HD-3-3345National Institute of Child Health and Human Development (NICHD): HHSN267200800001CNational Institute of Child Health and Human Development (NICHD): N01-HD-8-0001Web of Scienc

Viral Load Predicts New World Health Organization Stage 3 and 4 Events in HIV-Infected Children Receiving Highly Active Antiretroviral Therapy, Independent of CD4 T Lymphocyte Value

Background. Many resource-limited countries rely on clinical and immunological monitoring without routine virological monitoring for human immunodeficiency virus (HIV)-infected children receiving highly active antiretroviral therapy (HAART). We assessed whether HIV load had independent predictive value in the presence of immunological and clinical data for the occurrence of new World Health Organization (WHO) stage 3 or 4 events (hereafter, WHO events) among HIV-infected children receiving HAART in Latin America