Combined antiretroviral therapy reduces hyperimmunoglobulinemia in HIV-1 infected children

Objective: To evaluate the effect of combined antiretroviral therapy on serum immunoglobulin (Ig) levels in HIV-1 perinatally infected children. Methods: Data from 1250 children recorded by the Italian Register for HIV Infection in Children from 1985 to 2002 were analysed. Since Ig levels physiologically vary with age, differences at different age periods were evaluated as differences in z-scores calculated using means and standard deviations of normal population for each age period. Combined antiretroviral therapy has become widespread in Italy since 1996, thus differences in Ig z-scores between the periods 1985-1995 and 1996-2002 were analysed. Data according to type of therapeutic regimen were also analysed. Results: Between the two periods 1985-1995 and 1996-2002, significant (P < 0.0001) decreases in IgG (6.29 ± 4.72 versus 4.44 ± 4.33), IgM (9.25 ± 13.32 versus 5.61 ± 7.93), and IgA (10.25 ± 15.68 versus 6.48 ± 11.56) z-scores, together with a parallel significant (P < 0.0001) increase in CD4 T-lymphocyte percentages, were found. These decreases were confirmed regardless of whether the children were receiving intravenous Ig or not. Ig z-scores were significantly higher in children receiving mono-therapy than in those receiving double-combined therapy (IgC, P < 0.0001; IgM, P = 0.003; IgA, P = 0.031) and in the latter children than in those receiving three or more drugs (P < 0.0001 for all z-scores). Ig z-scores correlated inversely with CD4 T-lymphocyte percentages and, directly, with viral loads. Conclusions: Our data show that in HIV-1 infected children combined antiretroviral therapy leads to reduction of hyperimmunoglobulinemia which parallels restoration of CD4 T-lymphocyte percentage and viral load decrease, which it turn probably reflects improved B-lymphocyte functions. © 2004 Lippincott Williams & Wilkins

Private Security Companies and Shared Responsibility: The Turn to Multistakeholder Standard-Setting and Monitoring Through Self-Regulation-‘Plus'

The rapid and increasing outsourcing of security services by states to Private Security Companies (PSCs) in recent years and associated human rights violations have served as one of the catalysts for long overdue regulation of the global PSC industry. As part of an ‘empirical stocktaking’, this article focuses on current multistakeholder self-regulatory developments in relation to PSCs, in particular the International Code of Conduct for Private Security Providers and the PSC1 certification standard, and considers their likely impact on the responsibility of states in this area. What is clear is that the traditional conception of interna- tional responsibility is ineffectual when applied to PSCs because of its focus on the ex post facto responsibility of states for internationally wrongful acts. Furthermore, the fact that PSCs operate in high risk and complex environments and the fact that their clients are often non-state actors, means that an alternative prophylactic approach to responsibility for human rights violations by PSCs seems to be nec- essary. As it stands, however, the ‘self-regulation-plus’ approach adopted is not the definitive solution. While endeavouring to ensure that PSCs respect human rights, this approach may allow states to evade their own obligations to protect human rights