Impact of medications prescribed for treatment of attention-deficit hyperactivity disorder on physical growth in children and adolescents with HIV.

OBJECTIVE: To examine the relationships between physical growth and medications prescribed for symptoms of attention-deficit hyperactivity disorder in children with HIV. METHODS: Analysis of data from children with perinatally acquired HIV (N = 2251; age 3-19 years), with and without prescriptions for stimulant and nonstimulant medications used to treat attention-deficit hyperactivity disorder, in a long-term observational study. Height and weight measurements were transformed to z scores and compared across medication groups. Changes in z scores during a 2-year interval were compared using multiple linear regression models adjusting for selected covariates. RESULTS: Participants with (n = 215) and without (n = 2036) prescriptions were shorter than expected based on US age and gender norms (p \u3c .001). Children without prescriptions weighed less at baseline than children in the general population (p \u3c .001) but gained height and weight at a faster rate (p \u3c .001). Children prescribed stimulants were similar to population norms in baseline weight; their height and weight growth velocities were comparable with the general population and children without prescriptions (for weight, p = .511 and .100, respectively). Children prescribed nonstimulants had the lowest baseline height but were similar to population norms in baseline weight. Their height and weight growth velocities were comparable with the general population but significantly slower than children without prescriptions (p = .01 and .02, respectively). CONCLUSION: The use of stimulants to treat symptoms of attention-deficit hyperactivity disorder does not significantly exacerbate the potential for growth delay in children with HIV and may afford opportunities for interventions that promote physical growth. Prospective studies are needed to confirm these findings

Opioids exacerbate inflammation in people with well-controlled HIV

IntroductionPeople with HIV (PWH) are known to have underlying inflammation and immune activation despite virologic control. Substance use including opioid dependence is common in this population and is associated with increased morbidity and reduced lifespan. The primary objective of the present study termed opioid immunity study (OPIS), was to investigate the impact of chronic opioids in PWH.MethodsThe study recruited people with and without HIV who had opioid use disorder (OUD). Study participants (n=221) were categorized into four groups: HIV+OP+, n=34; HIV-OP+, n=66; HIV+OP-, n=55 and HIV-OP-, n=62 as controls. PWH were virally suppressed on ART and those with OUD were followed in a syringe exchange program with confirmation of OP use by urine drug screening. A composite cytokine score was developed for 20 plasma cytokines that are linked to inflammation. Cellular markers of immune activation (IA), exhaustion, and senescence were determined in CD4 and CD8 T cells. Regression models were constructed to examine the relationships of HIV status and opioid use, controlling for other confounding factors.ResultsHIV+OP+ participants exhibited highest inflammatory cytokines and cellular IA, followed by HIV-OP+ for inflammation and HIV+OP- for IA. Inflammation was found to be driven more by opioid use than HIV positivity while IA was driven more by HIV than opioid use. In people with OUD, expression of CD38 on CD28-CD57+ senescent-like T cells was elevated and correlated positively with inflammation.DiscussionGiven the association of inflammation with a multitude of adverse health outcomes, our findings merit further investigations to understand the mechanistic pathways involved

T-lymphocyte differentiation in severe combined immunodeficiency: Defects of the thymus

The thymus obtained at autopsy from two patients with severe combined immunodeficiency disease (SCID) were placed in culture to establish epithelial monolayers. These thymic epithelial monolayers and their supernatants were tested for their inductive influence on marrow cells from normal donors and, in addition, one monolayer was tested for its capacity to induce differentiation on marrow cells from another patient with SCID. The first thymic epithelial monolayer (B.H.) induced E-rosetting markers and mitogen responses in normal marrow cells but not in the marrow cells of the patient with SCID. These same SCID marrow cells were partially differentiated to E rosettes but responses to phytomitogens were not induced when these marrow cells were cultured on normal thymic epithelial monolayers. The epithelial monolayers from the second SCID patient (D.V.) induced the E-rosette markers but not HTLA markers on normal marrow cells. Evaluation of serum thymic hormone levels in patient D.V. had previously revealed absence of thymopoietin and low normal values of serum facteur thymique serique. These findings suggest that in SCID, a defect of the thymus may exist at the initial step of processing of cells which may be a prerequisite for subsequent differentiation events in the cell development. This defect appears to be related to impaired secretory activity for one or possibly more thymic hormones and seems to represent a functional defect of the thymic stroma

Heterogeneity of B Lymphocyte Differentiation in Severe Combined Immunodeficiency Disease

differentiation in vitro into antibody secreting plaque-forming cells (PFC) was investigated in nine patients with severe combined immunodeficiency having variable proportions of circulating B lymphocytes. When cultured by themselves, the peripheral blood mononuclear cells did not respond to stimulation with pokeweed mitogen in any patient. In the presence of irradiated allogeneic T cells as helpers, however, PFC responses were elicited in lymphocyte cultures from peripheral blood and/or bone marrow in some patients. In one of these patients, results of allogeneic co-culture experiments were suggestive of genetically restricted suppressor cells. In a single patient with deficiency of the enzyme adenosine deaminase, PFC were generated in bone marrow lymphocyte cultures only when they were supplemented with exogenous adenosine deaminase and allogeneic helper cells. A parallel study of T lymphocyte differentiation in vitro performed in fractionated bone marrow cells was suggestive of arrested differentiation at different steps along the differentiation pathway. In two patients with evidence of functional B cell precursors, deficiencies of helper T cell function could be attributed to differentiation defects at the level of the stem cells in one and the thymus in the other. The findings reported here further substantiate the heterogeneity of the severe combined immunodeficiency disease syndromes

Unusual features of scabies complicating human T-lymphotropic virus type III infection

Four cases of “exaggerated” scabies are described in patients who were immunodeficient secondary to human T-lymphotropic virus type III (HTLV-III) infection. As in classical scabies, these patients had a pruritic derrnatitis but lacked the usual distribution of the eruption. The rash was initially misdiagnosed in all four patients. Scabies should be considered in pruritic dermatitis in patients at risk for HTLV-III infection

Thrombocytopenia in an Infant With AIDS

Sir.—The clinical spectrum of the acquired immunodeficiency syndrome (AIDS) in children has continued to expand. Reported abnormalities include failure to thrive, chronic interstitial pneumonitis, hepatosplenomegaly, diffuse adenopathy, protracted diarrhea, recurrent otitis media, eczematoid rashes, and thrombocytopenia.1 Low platelet count has been shown to be due to increased destruction, although the pathogenesis remains unclear.2,3 We report a case of thrombocytopenia secondary to selective bone marrow failure in a child with AIDS.Patient Report.—The patient was the 1090-g male product of a 28-week gestation. He was born to a 31-year-old known intravenous drug abuser. The neonatal course was complicated by respiratory distress syndrome and moderate bronchopulmonary dysplasia, poor weight gain, hyperbilirubinemia, hypocalcemia, hypoglycemia, a moderate germinal matrix hemorrhage, and transient severe ischemia to the right lower extremity. Immunologic and serologic studies performed on the mother shortly after delivery revealed a T4/T8 ratio of 0.6 an