Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil

Abstract INTRODUCTION: Achieving viral suppression (VS) in children is challenging despite the exponential increase in access to antiretroviral therapy (ART). We evaluated VS in children >1 year of age and adolescents 5 years after they had begun ART, in Manaus, Amazonas state, Brazil. METHODS: HIV-infected, ART-naive children >1 year of age between 1999 and 2016 were eligible. Analysis was stratified by age at ART initiation: 1-5 y, >5-10 y, and >10-19 y. CD4+ T-cell count and viral load were assessed on arrival at the clinic, on ART initiation, and at 6 months, 1 year, 2 years, and 5 years after ART initiation. The primary outcome was a viral load <50 copies/mL 5 years after ART initiation. RESULTS: Ultimately, 121 patients were included. The mean age at diagnosis was 4.8 years (SD 3.5), mean CD4% was 17.9 (SD 9.8), and mean viral load was 4.6 log10 copies/ml (SD 0.8). Five years after ART initiation, the overall VS rate was 46.9%. VS by patient age group was as follows: 36.6% for 1-5 y, 53.3% for >5-10 y, and 30% for >10-19 y. Almost all children (90,4%) showed an increase in CD4%+ T cell count. There were no statistically significant predictors for detecting children who do not achieve VS with treatment. VS remained below 65% in all the evaluated periods. CONCLUSIONS: Considerable immunological improvement is seen in children after ART initiation. Further efforts are needed to maintain adequate long-term VS levels and improve the survival of this vulnerable population.

Acute disseminated encephalomyelitis following inactivated influenza vaccination in the Brazilian Amazon: a case report

Here, we describe a case of acute disseminated encephalomyelitis (ADEM) that occurred during a plausible risk interval following inactivated influenza vaccination in a previously healthy 27-year-old man from Manaus, Brazil. He was treated with intravenous methylprednisolone and immunoglobulin. One-month follow-up revealed resolution of the brain lesions, but not of the spinal cord lesions. No recurrence or progression of the main neurological symptoms was observed. After two years of monitoring, the patient continues to experience weak lower limbs and urinary retention. Thus, we recommend that ADEM should be considered in a patient presenting with neurological symptoms after influenza vaccination.

Tratamento da malária com artesunate (retocaps©) em crianças da Amazônia brasileira / Malaria treatment with artesunate (retocaps©) in children of the Brazilian Amazon

Avaliamos a resposta clínica e parasitológica à terapêutica com o artesunate retocaps© em 32 crianças internadas na Fundaçäo de Medicina Tropical do Amazonas, que apresentavam malária com quadro clínico moderado e grave. Destas, 29 tinham a doença por P. falciparum e três, P. vivax. A melhora clínica foi observada após 24 horas do início da terapêutica, com 33,3 por cento de pacientes afebris e, 48 horas após o tratamento, 77,2 por cento das crianças näo apresentavam febre. O acompanhamento da parasitemia assexuada, mostrou que no D2 58,6 por cento das crianças com malária falciparum estavam negativas; em D4 todas haviam negativado, tanto na malária pelo P. falciparum como pelo P. vivax. No seguimento prolongado, na malária P. falciparum, encontramos 66,6 por cento de recrudescências. Os resultados nos permitem concluir pela eficácia e praticidade no uso do artesunate retocaps© com rápida reduçäo da parasitemia e melhora clínica. Entretanto, na malária P. falciparum a taxa de recrudescência foi elevada. Näo foi observado para-efeito que possa ser imputado ao uso da droga