Prevalence and predictors of undernutrition in HIV-infected children on antiretroviral therapy in Abakaliki, Southeast Nigeria

Background: The introduction of antiretroviral therapy (ART) to HIV medicine has dramatically improved the quality of care of HIV-infected children, translating to better nutritional status and general well-being. However, many HIV-infected children especially in sub-Saharan Africa, despite being on ART are malnourished. Objective: The study was done to determine the prevalence and predictors of undernutrition among HIV-infected children on ART in Abakaliki. Materials and Methods: It was a case–control study with a sample size of 220 (110 HIV infected and 110 HIV negative children as controls) aged 2–17 years. Anthropometric indicators expressed in Z scores were used to define malnutrition: Height for age (stunting) and weight for age (underweight) and weight for height (thinness). A structured questionnaire was used to obtain socio-demographic characteristics and drug adherence. Results: The prevalence rates of underweight and stunting were 24.5% and 20.0% in HIV-infected children as against the prevalence rates of 10.0% and 6.4% for underweight and stunting, respectively, found in HIV negative children. These prevalence rates were statistically significant (P = 0.002 and P = 0.001, respectively). Occupation of caregivers (P = 0.000, P = 0.000), drug adherence (P = 0.001, P = 0.000), and WHO clinical stages of disease (P = 0.002, P = 0.000) were statistically significant predicted the presence of underweight and stunting, respectively, in HIV-infected children on ART. Conclusion: The prevalence of undernutrition is high among children on ART. Nutritional support as well as strengthening adherence to ART is strongly advocated as part of routine care in HIV-infected children on ART.

The mediating effect of self-consciousness between peer relationship and social anxiety in HIV-infec-ted children / 中华行为医学与脑科学杂志

Objective To explore the relationship among peer relationship,self-consciousness and social anxiety in HIV-infected children. Methods Peer Relationship Scale,Piers-Harris Children's Self-con-cept Scale and Social Anxiety Scale for Children were applied to 126 HIV-infected children. Results The score of peer relationship was 53. 0(45. 0,62. 0),the score of self-concept was 52. 0(42. 0,60. 0),and the score of social anxiety was 6. 0(2. 0,9. 0). Peer relationship was positively correlated with social anxiety( r=0. 196,P=0. 029) and negatively correlated with self-consciousness(r=-0. 628,P<0. 01). Self-conscious-ness was negatively correlated with social anxiety(r=-0. 504,P<0. 01). Bootstrap analysis showed that self-consciousness played a complete mediating role between peer relationship and social anxiety,and the media-ting effect value was 0. 377. Conclusion Peer relationship,self-consciousness and social anxiety are closely related. Furthermore,self-consciousness plays a complete mediating role between peer relationship and social anxiety in HIV-infected children.

Viral suppression and adherence among HIV-infected children and adolescents on antiretroviral therapy: results of a multicenter study / Supressão viral e adesão entre crianças e adolescentes vivendo com HIV na terapia antirretroviral: resultados de um estudo multicêntrico

OBJECTIVE: To evaluate treatment adherence among perinatally-infected pediatric human immunodeficiency virus (HIV) patients followed in pediatric centers in Brazil. METHODS: This was a cross-sectional multicenter study. Medical records were reviewed and adherence scale, assessment of caregivers' quality of life (WHOQOL-BREF), anxiety, depression, and alcohol/substances use/abuse were assessed. Outcomes included self-reported 100% adherence in the last three days and HIV viral load (VL) < 50 copies/mL. Statistical analyses included contingency tables and respective statistics, and multivariable logistic regression. RESULTS: 260 subjects were enrolled: 78% children and 22% adolescents; 93% of caregivers for the children and 77% of adolescents reported 100% adherence; 57% of children and 49% of adolescents had VL < 50 copies/mL. In the univariate analyses, HIV diagnosis for screening due to maternal infection, lower caregiver scores for anxiety, and higher scores in physical and psychological domains of WHOQOL-BREF were associated with 100% adherence. Shorter intervals between pharmacy visits were associated with VL < 50 copies/mL (p ≤ 0.01). Multivariable regression demonstrated that caregivers who did not abuse alcohol/other drugs (OR = 0.49; 95% CI: 0.27-0.89) and median interval between pharmacy visits < 33 days (OR = 0.97; 95% CI: 0.95-0.98) were independently associated with VL < 50 copies/mL; whereas lower caregiver scores for anxiety (OR = 2.57; 95% CI: 1.27-5.19) and children's HIV diagnosis for screening due to maternal infection (OR = 2.25; 95% CI: 1.12-4.50) were found to be independently associated with 100% adherence. CONCLUSIONS: Pediatric HIV programs should perform routine assessment of caregivers' quality of life, and anxiety and depression symptoms. In this setting, pharmacy records are essential to help identify less-than-optimal adherence. .

OBJETIVO: Avaliar a adesão ao tratamento antirretroviral entre portadores de HIV acompanhados em centros pediátricos. MÉTODOS: Trata-se de estudo transversal multicêntrico. Os prontuários ambulatoriais foram revistos e aplicadas escala de adesão, avaliação de qualidade de vida (WHOQOL-BREF), ansiedade, depressão e uso indevido de álcool/substâncias entre cuidadores. Os desfechos incluíram autorrelato 100% de adesão nos últimos três dias e carga viral do HIV (CV) < 50 cópias/mL. RESULTADOS: 260 indivíduos foram incluídos, 79% crianças e 21% adolescentes; 93% das crianças e 77% dos adolescentes relataram 100% de adesão; 57% das crianças e 49% dos adolescentes tinham CV < 50 cópias /mL. Na análise univariada, diagnóstico do HIV por triagem devido à infecção materna, cuidador com pontuação menor para ansiedade e maior nos domínios físico e psicológico do WHOQOL-BREF se mostraram independentemente associados a 100% de adesão. Intervalos mais curtos entre visitas de farmácia foram associados com CV < 50 cópias /mL (p ≤ 0,01). Regressão multivariada mostrou que os cuidadores sem abuso de álcool/outras drogas (OR = 0,49; IC95% 0,27-0,89) e o intervalo médio entre visitas de farmácia < 33 dias (OR = 0,97; IC95% 0,95-0,98) foram associados com CV < 50 cópias/mL; cuidador com menores escores para ansiedade (OR = 2,57; IC95% 1,27-5,19) e diagnóstico de crianças por triagem devido à infecção materna (OR = 2,25; IC95% 1,12-4,50) foram associados com 100% de adesão. CONCLUSÕES: Programas de HIV pediátrico devem avaliar qualidade de vida e sintomas de ansiedade e depressão dos cuidadores. Registros de farmácia são essenciais na identificação de adesão ...

High Prevalence of Hypocholesterolaemia among Antiretroviral Therapy-naive HIV-infected Children in Makurdi, Nigeria: A Retrospective Study.

Aim: To determine the abnormalities in total cholesterol (TC) levels and the potential risk factors in ART–naive, HIV-infected Nigerian children. Study Design: A retrospective and cross-sectional study. Place and Duration of Study: Paediatric antiretroviral therapy (ART) clinic of the Federal Medical Centre, Makurdi, between June 2010 and June 2012. Methods: Electronic data of 429 HIV-infected ART-naive children, aged 1–15 years, including 223 males and 206 females, were analysed to get the relevant information for the study. Abnormal un-fasted TC levels and the association with potential risk factors were tested in bivariate regression analyses. Abnormal lipid level was defined as hypercholestrolaemia when the TC was>200mg/dL and hypocholesterolaemia when TC was ˂160mg/dl. Normal TC was value between 160 and 200mg/dl. P-value less than 0.05 was significant. Results: The median age was 5.00 years with an interquartile range of 3.0 to 8.0 years. The TC ranged from 32 to 196 mg/dl with a mean value of 116±34.98mg/dl. Hypocholesterolaemia was the prominent finding in 88.3% (379/429) of the children. Hypercholestrolaemia was not found (0%). In bivariate analyses, no factor was found to significantly impact on hypocholesterolaemia, although a greater proportion of hypocholesterolaemia was seen in children: within 2-15 years age group (92.1%, 349/379); male gender (52.0%): HIV/AIDS stages 1&2 (82.6%); CD4 count>200 cell/mm3(81.5%); viral load>10,000 copies/ml (69.1%); hemoglobin˂10g/dl (61.7%); stunting (55.4%, 102/207) and undernourishment with body mass index (BMI)˂18.5 (83.7%, 164/222). Multivariate analysis was not done. Conclusion: A high prevalence of hypocholesterolaemia was found among the ARTnaive, HIV-infected Children, in Makurdi. The study could serve as a stimulus for our centre and other paediatric ART programmes in Nigeria to undertake an elaborate lipid profile of HIV infected children at diagnosis and on follow-up on ART.

The Prevalence and the Predictors of Complementary and Alternative Medicine among Children on Highly Active Antiretroviral Therapy in Makurdi, Nigeria.

Aims: To determine the prevalence, the pattern of usage and the predictors of complementary and alternative medicine (CAM) among children on highly active antiretroviral therapy (HAART). Study Design: Prospective, Cross-sectional and quantitative. Place and Duration of Study: Paediatric antiretroviral clinic of the Federal Medical Centre, Makurdi, Benue State, Nigeria, February 2012 to December 2012. Methodology: Researchers administered structured questionnaire to 409 (102 men and 307 women) consecutively consented caregivers (CGs) whose children had been on HAART for not less than 6 months in order to fulfill the objectives of the study. Results: 79.2% (324/409) of children used CAM as reported by their CGs. The three most commonly used CAM products were herbal concoctions containing majorly Bitter leaves (317/324, 97.8%), Ugu leaves/roots (282, 87.0%) and Neem tree leaves/bark (270, 83.3%). CGs also largely administered CAM whose contents were unknown (250, 77.2%). The use of Anointed water (255, 78.7%) and Anointed Oil (245, 75.6%) were also common. Animal products including Elephant skin (12, 3.7%), Elephant bone (10, 3.1%) and Snake bone (8, 2.5%) were also acknowledged. Spiritual healing was the most sought-for practice, seen among 252 (77.8%) CGs. 3.7% (12/324) of the CGs had disclosed the use of CAM to their primary physicians. Multivariate logistic regression analyses showed that: the use of CAM by CGs (AOR; 33.79, 95%CI; 8.049-141.856, P=.000); when the child on HAART is of a male gender (AOR; 2.142, 95%CI; 1.230-3.730, P=.007); fathers as CGs compared to mothers (AOR; 1.698, 95%CI;1.180-2.443, P=.004); CGs with no formal education compared to when CG attained a post-secondary level of education (AOR; 1.498, 95%CI; 1.127-1.990, P=.005), remained independently associated with the use of CAM in children. Conclusions: CAM use is common in Nigerian children on HAART. Concerted efforts should be put in place to encourage disclosure among CGs. Identified harmful CAMs should be discouraged.

Nutritional Status and the Use of Protease Inhibitors Among Hiv-infected Children in Klang Valley, Malaysia

This study determined the association between nutritional status and the use of protease inhibitors (PI) containing regimen among HIV-infected children receiving treatment at the referral centres in Klang Valley. A total of 95 children currently on antiretroviral (ARV) therapy, aged one to eighteen years, were recruited using purposive sampling. Demographic data, anthropometric measurements, medical history, were collected using a structured questionnaire. Serum micronutrients levels and lipid profile were also examined using blood samples. Mean age was 8.8 3.9 years and 44.2% were on PI. Age ( 2 = 10.351, p = .006), weight-for-age ( 2 = 6.567, p = .010), serum selenium ( 2 = 4.225, p = .040) and HDL-C ( 2 = 7.539, p = .006) were significantly associated with the use of PI. Fewer children on PI were deficient in selenium as compared to those not on PI. On the contrary, more children on PI were underweight and had low HDL-C. The use of PI was found to have both positive and negative effects with better selenium level but poorer HDL-C level and weight status.

Plasma Efavirenz in HIV-Infected Children Treated with Generic Antiretroviral Drugs in India.

We measured plasma concentration of efavirenz (EFV) in 16 HIV-infected Indian children receiving antiretroviral treatment at Government ART centres. The mean 12-hour concentration was 2.39 μg/mL (range: 0.72- 7.82 μg/mL). The majority of children treated with generic EFV at currently recommended doses had blood levels within the therapeutic range.

Circadian cardiac autonomic function in perinatally HIV-infected preschool children

The 24-h heart rate variability and QT-interval adaptation was investigated in perinatally HIV-infected preschool children classified according to immunological status in order to assess autonomic function at early stages of infection. Thirty-five perinatally HIV-infected and clinically stable children (4.8 ± 0.3 years) were enrolled after approval of the study by the University Hospital Pedro Ernesto Ethics Committee and written informed parental consent was obtained. The children were classified according to peripheral CD4+ count (cells/µL) as follows: group 1, N = 11 (≥1000); group 2, N = 7 (≥500 and <1000); group 3, N = 17 (<500). Left ventricular ejection fraction (>55%), 24-h RR interval variability (RRV) indexes (NN, SDANN, SDNN index, r-MSSD) and 24-h QT and Bazett-corrected QT (QTc) were determined, and groups were matched for age, body surface area, and left ventricular ejection fraction, reducing biases in RRV. The peak differences (∆) between the highest and lowest RRV and QT indexes were extracted from nocturnal (1 am-6 am) and daytime (1 pm-6 pm) hourly assessed segments, respectively. Pearson’s correlation (r) and Kruskal-Wallis ANOVA were used to compare groups. CD4+ count correlated positively with ∆NN (r = 0.45; P = 0.003). There were no significant differences in daytime NN among groups. Nighttime SDNN index (P = 0.01), nighttime r-MSSD (P = 0.003), ∆NN (P = 0.01), ∆SDNN index (P = 0.03) and ∆r-MSSD (P = 0.004) were significantly lower in group 3 than in the other groups. Expected nighttime QTc-interval lengthening was not observed in all groups. In perinatally HIV-infected preschool children with preserved left ventricular systolic function, parasympathetic-mediated autonomic dysfunction parallels immune status, impairing both RRV and circadian QTc interval adaptation.

HIV-1: avaliação da resistência às drogas antiretrovirais em pacientes pediátricos / HIV-1: evaluation of resistance to antiretroviral drugs in pediatric patients

A utilização da terapia antiretroviral, atualmente mais amplamente acessível, implica na permanência da identificação da resistência viral e monitoramento da doença como itens importantes em adultos e pacientes pediátricos infectados pelo vírus da imunodeficiência humana tipo 1. Os principais marcadores da infecção por HIV-1, utilizados no monitoramento da infecção e curso da doença, são as contagens de células T CD4+ e a carga viral. Ambos são úteis como parâmetros indicadores para o início da terapia e na avaliação de sua eficácia. Além disto, a sua associação a testes de genotipagem para a identificação de mutações de resistência viral, pode auxiliar na indicação da conduta clínica mais adequada. No presente estudo, analisamos os valores da carga viral e taxas de linfócitos T CD4+ e CD8+ na avaliação do status imunológico de 25 crianças com indicação para a terapia antiretroviral, condicionando o regime terapêutico aos resultados do teste de genotipagem. A identificação dos subtipos virais foi feita por análise filogenética e a genotipagem incluiu a análise dos genes protease e transcriptase reversa do HIV-1. Dezoito amostras foram agrupadas no subtipo viral B e três no subtipo F1; cepas recobinantes também foram observadas, sendo uma BF, duas BD e uma DF. Dezoito crianças apresentaram mutações conferindo resistência viral aos inibidores da transcriptase reversa análogos de nucleosídeo e sete crianças apresentaram resistência aos inibidores não-análogos, com seis relatando resistência a nevirapina, delavirdina e efavirenz. Além disto, duas crianças, nas quais a terapia havia sido descontinuada dois a três anos antes da avaliação do teste de genotipagem, apresentaram as mutações K101E, K103N e G190A, conferindo resistência às três drogas. As mutações mais frequentes para o gene da transcriptase reversa foram observadas nos codons M41L, M184V e T215FY...

With antiretroviral therapy becoming more widely available nowadays. Human Immunodeficiency Virus type 1 resistance identification and monitoring of disease remains of great importance in adults and infected children. The major HIV-1 infection markers usually used for monitoring viral infection and disease course are CD4+ T cell counts or percentages and HIV viral load. Both of them are helpful indicating when to start therapy and evaluating its efficacy. Also, their association with genotyping tests to identify viral resistant mutations may help clinicians for the most adequate clinical conduct. In the present study, we assessed HIV-1 viral load and CD4+ and CD8+ T lymphocyte rates for the immunological status evaluation of 25 antiretroviral-treated children managing therapeutic regimens according to genotyping test results. Drug resistance evaluation was done using genotyping covering protease and reverse transcriptase genes. Additionally, all of the 25 vertically HIV-1 infected children were assessed for viral subtyping throughout phylogenetic analysis. Eighteen samples clustered at B subtype and three clustered at F1 subtype; one BF, two BD and one DF recobinant strains were also observed. Eighteen children presented, at least, one mutation conferring resistance to the nucleoside reverse transcriptase inhibitors, and seven children presented resistance to the non-nucleoside inhibitors, with six resistant to all three drugs, nevirapine, delavirdine, and efavirenz. In addition, two children in whom the therapy had been discontinued two to three years before testing presented K101E, K103N, and G190A mutations conferring resistance to the all three drugs. Reverse transcriptase gene mutations were more frequently observed at codons M41L, M184V, and T215FY. However, ten children presented and important number of viral resistance mutations, ranging from five to ten mutations, coferring resistance to at least four to up to eleven antiretroviral drugs...