COVID-19 and HIV viral load suppression in children andadolescents in Durban, South Africa

Background: The coronavirus disease 2019 (COVID-19) pandemic poses challenges to paediatric and adolescent HIV treatment programme. Modelling exercises raised concerns over potential impact of disruptions. Objectives: To describe the impact of the COVID-19 pandemic on viral load (VL) testing among infants, children and adolescents on antiretroviral treatment (ART) in Durban, South Africa. Method: Routinely collected, aggregated data of monthly VL counts done on all those less than 19 years old from January 2018 to January 2022 was analysed. An interrupted time series analysis using a Prais-Winsten linear regression model, including terms for lockdowns and excess mortality determined VL trends. Results: The unadjusted mean VL was 2166 (confidence interval [CI]: 252.2) and 2016 (CI: 241.9), P = 0.039, and percentage VL suppression rates (72.9%, CI: 2.4% vs 73.6%, CI: 1.8%) across COVID and pre-COVID periods, showing no significant difference, P = 0.262. In the interrupted time series analysis, modelled monthly VL counts did not differ significantly by lockdown level (e.g., level 5 lockdown: ­210.5 VLs, 95% CI: ­483.0 to +62.1, P = 0.138) or excess mortality (­0.1, 95% CI: ­6.3 to 6.1, P = 0.969). A significant downward trend in VL testing over time, including during the pre-COVID-19 period (­6.6 VL per month, 95% CI: ­10.4 to ­2.7, P = 0.002), was identified. Conclusion: Viral load suppression for children and adolescents were not negatively affected by COVID-19. A trend of decrease in VL testing predated COVID-19. What this study adds: Evidence presented that HIV VL testing and suppression rates in children and adolescents in a high burden setting were sustained through the COVID pandemic.

Pattern of paediatric HIV status disclosure in coastal Karnataka

Background & objectives: Karnataka is a high HIV prevalent State in India. Although benefits have been shown by disclosing the HIV status to the child, information regarding HIV status disclosure in Karnataka is limited. Hence, this study was conducted to estimate the proportion of children who had been disclosed of their HIV status and its pattern among those who visited the district antiretroviral therapy (ART) centre in coastal Karnataka. Methods: A cross-sectional study was conducted in an ART centre in a district hospital in coastal Karnataka between October 2014 and July 2015. Caregivers of paediatric HIV patients were approached and willing participants were administered a pre-formed, pre-tested semi-structured questionnaire developed for the study. Results: A total of 185 caregivers of the HIV-positive children were interviewed. Mean age of the children was 11�years. Only 107 (57.8%) children were aware of their HIV status. Of these, 95 were disclosed fully. Counsellors in rehabilitation centres were the most probable person to disclose and planned events. Children were told of their HIV status for their knowledge and were more likely to be disclosed if they were around 11-15 yr of age and staying in rehabilitation centres. Interpretation & conclusions: Older children were more likely to be disclosed of their HIV status by counsellors. Steps need to be taken to counsel and encourage caregivers to fully disclose the HIV status to the children at least when they attain the age more than 11 years.

Relación entre adherencia al tratamiento antirretroviral y subpoblaciones linfocitarias en niños con HIV/Sida / Antiretroviral treatment adherence and its association with TCD4+ lymphocyte subsets in children with HIV/Aids

El curso de la infección por HIV se caracteriza principalmente por una depleción grave de los linfocitos TCD4+ y una activación inmune marcada, hallazgos centrales que conducen a variaciones numéricas y fenotípicas de las poblaciones linfocitarias TCD4+. El tratamiento antirretroviral (TARV) combinado ha modificado sustancialmente el curso de la infección por HIV, y la correcta adherencia al mismo resulta en una disminución de la carga viral a niveles indetectables, y a un incremento significativo en la repoblación de los linfocitos T periféricos. En este trabajo se evaluó en 28 niños HIV (+) la relación entre los cambios en los niveles de las poblaciones linfocitarias y la adherencia al TARV, luego de 9 meses en promedio de iniciado el mismo. El grupo de 18 niños con buena adherencia, superior al 95%, presentó un aumento significativo en los porcentajes de células naive CD4+CD45RA+CD62L+ y un descenso en las células de memoria central CD4+CD45RA-CD62L+, entre ambos momentos del seguimiento. Por el contrario, los 10 niños con fallas en la adherencia no mostraron diferencias significativas en los niveles de tales poblaciones. La buena adherencia al TARV produce el rápido y significativo descenso de la replicación viral lo cual se asocia a la progresiva reconstitución cuantitativa y funcional del sistema inmune.

Human immunodeficiency virus infection causes a severe depletion of TCD4+ lymphocytes and a sustained immune activation state, hallmarks findings that led to numerical and phenotypic changes in the TCD4+ subsets. Highly active anti-retroviral therapy has substantially modified the course of HIV infection. Correct adherence to the treatment results in a decrease in viral load at undetectable levels and a significant increase in the number of peripheral T cell lymphocytes. In the present study association between changes in T cell subsets and treatment adherence was evaluated in 28 HIV (+) infected children, before and after 9 months on average, from starting anti-retroviral therapy. The group of 18 patients with good adherence, above 95%, showed a significant increase in CD4+CD45RA+CD62L+ naive cells percentual levels and a decrease in the CD4+CD45RA-CD62L+ central memory subset, between the two points of the follow-up period. Conversely, 10 children with failure in the adherence did not show significant differences in the percentual levels of both subsets. Improvement in the percentage of adherence among paediatric population, optimizing antiretroviral treatment, allows a quick and significant reduction of viral replication. This feature is associated with the progressive reconstitution of the immune system.

Características sócio-demográficas de uma coorte de crianças nigerianas hiv positivas / Socio-demographic characteristics of a cohort of hiv positive nigerian children

Objetivo: Descrever as características sócio-demográficas e identificar fatores de risco em pacientes pediátricos HIV positivos atendidos no Hospital de Ensino da Universidade de Lagos, Nigéria. Métodos: Estudo transversal no qual foi aplicado um questionário para avaliar as características sócio-demográficas de pacientes infantis HIV durante um período de 12 meses. Os dados foram analisados com o software Epi-Info 2002. Resultados: A maioria dos pais tinha abaixo do nível terciário de educação (mães, 72,7% e pais, 69,1%). Setenta por cento das mães HIV positiva, assim, a transmissão vertical parece ser o fator de risco mais prevalente. A maioria das crianças (68,1%) nasceu em hospitais privados e 78,2% oriundas de parto normal. Histórias de hospitalizações anteriores foram relatadas em 58,2% com a transfusão de sangue prévia em 30,9%. Mais de um terço das crianças (40,0%) pesava entre 2,5 e 2,9 kg ao nascimento. Conclusão: O nível de alfabetização, baixo nível socioeconômico e status de HIV familiar foram os principais fatores que contribuíram entre as crianças estudadas. Intervenções orientadas sobre as barreiras à assistência e conhecimento da infecção pelo HIV deve ser uma parte integrante do programa de prevenção do HIV.

Objective: To describe the socio-demographic characteristics of and identify risk factors in HIV positive paediatric patients presenting at the Lagos University Teaching Hospital.Methods: A descriptive questionnaire based cross-sectional study to assess socio-demographic characteristics of patients presenting to the Paediatric HIV clinic of the Lagos University Teaching Hospital over a 12 month period. The data were analyzed using the Epi-Info 2002 statistical software for windows. Results: Majority of parents had below tertiary level of education; mothers, 72.7 % and fathers, 69.1 %. Seventy percent of the mothers were HIV positive thus mother to child transmission seems to be the most prevalent risk factor. Majority of the children, 68.1% were delivered at private hospitals and 78.2% through normal vagina delivery. History of previous hospitalizations reported in 58.2% with previous blood transfusion in 30.9%. Over one-third of the children, 40.0% weighed between 2.5 and 2.9kg at birth. Conclusions: The literacy level, poor socioeconomic background and parental HIV status were major contributory factors in the children studied. Targeted interventions on barriers to care and knowledge of HIV infection should be an integral part of the HIV prevention program.

Paediatric HIV - trends & challenges.

With the availability of antiretroviral therapy (ART), HIV infection, which was once considered a progressively fatal illness, has now become a chronic treatable condition in children, as in adults. However, the challenges these children are forced to face are far more daunting. The most significant shortcoming in the response to paediatric HIV remains the woefully inadequate prevention of motherto- child transmission (PMTCT), allowing a large number of children to be born with HIV in the first place, in spite of it being largely preventable. In the west, mother-to-child transmission has been virtually eliminated; however, in resource-limited settings where >95 per cent of all vertical transmissions take place, still an infected infants continue to be born. There are several barriers to efficient management: delayed infant diagnosis, lack of appropriate paediatric formulations, lack of skilled health personnel, etc. Poorly developed immunity allows greater dissemination throughout various organs. There is an increased frequency of malnutrition and infections that may be more persistent, severe and less responsive to treatment. In addition, these growing children are left with inescapable challenges of facing not only lifelong adherence with complex treatment regimens, but also enormous psychosocial, mental and neuro-cognitive issues. These unique challenges must be recognized and understood in order to provide appropriate holistic management enabling them to become productive citizens of tomorrow. To address these multi-factorial issues, there is an urgent need for a concerted, sustainable and multipronged national and global response.

Vertical Transmission of HIV-An Update.

One of the greatest successes in AIDS research to date has by far been the discovery of successful interventions that interrupt the transmission of HIV from mother to child. It is however important to note that these successes have occurred largely in countries with great resources and the least burden of perinatal transmission of HIV. In the developing world wherein currently 95% of vertical transmission of HIV occurs, it is highly condemnable that still every minute an infected infant is said to be born in spite of the fact that vertical transmission is largely preventable, mainly because translating knowledge into practice is not always possible or feasible; This has led to a continuous growing numbers of children with HIV, thereby making pediatric HIV a looming problem rapidly draining the already burdened health care system of these countries. It is the need of the hour to appropriately address the challenges to achieve zero percent transmission of HIV from an infected mother to her child thereby giving a hope for an AIDS-free new generation worldwide.

Antibiotic resistance among pathogens causing disease in Jamaican children with HIV/AIDS / Resistencia antibiótica entre los patógenos que causan enfermedades en los niños jamaicanos con VIH/SIDA

OBJECTIVE: There are limited data regarding the antimicrobial resistance patterns of pathogens in children with HIV/AIDS from developing countries. We aimed to determine the prevalence and antibiotic susceptibility patterns of bacterial pathogens causing urinary tract infections (UTIs) and sepsis in a cohort of 219 HIV-infected Jamaican children. METHODS: This cross-sectional study examined clinical and microbiological data for children enrolled in the Kingston Paediatric/Perinatal HIV/AIDS programme from September 1, 2002 to May 31, 2007. Cases were defined as physician-diagnosed, laboratory confirmed UTIs and sepsis based on Centers for Disease Control and Prevention (CDC) criteria. Only isolates from urine, blood and sterile sites were considered. RESULTS: Forty-four patients (20.1%) accounted for 74 episodes of UTIs and sepsis. Mean number of infections was 1.7 ± 1.3 per patient. There were 31 males (70.5%) and mean age at time of infection was 5.6 ± 4.7 years. Bacterial infections comprised cystitis (n = 52, 70.3%), bacterial pneumonia (n = 15, 20.3%), meningitis (n = 4, 5.4%), septicaemia (n = 2, 2.7%) and bone infection (n = 1, 1.4%). Among 52 UTIs, 39 were caused by a single organism. The most common UTI isolates included Escherichia coli (n = 21, 53.8%) and Enterobacter spp (n = 5, 12.8%). Among 22 cases of sepsis, isolates included Streptococcus pneumoniae (n = 8, 36.4%) and coagulase negative Staphylococcus (n = 6, 27.3%). All E coli isolates at two of three clinical sites were resistant to cotrimoxazole. There were 79.7% (n = 51) of infectious episodes with a cotrimoxazole-resistant organism occurring among those on cotrimoxazole prophylaxis. CONCLUSIONS: Escherichia coli was the most frequent bacterial isolate. Cotrimoxazole is a poor choice for empiric treatment of sepsis and UTIs in this clinical setting.

OBJETIVO: Los datos existentes en relación con los patrones de resistencia antimicrobiana en los ninos con VIH/SIDA de los países en vías de desarrollo, son limitados. Nuestro objetivo fue determinar la prevalencia y los patrones de susceptibilidad antibiótica de los patógenos bacterianos que causan infecciones de las vías urinarias (IVU) y sepsis en una cohorte de 219 ninos jamaicanos infectados con VIH. MÉTODOS: Este estudio transversal examinó datos clínicos y microbiológicos de ninos enrolados en el programa KPAIDS del 1ero. de septiembre de 2002 al 31 de mayo de 2007. Los casos se definieron como IVU y sepsis de diagnóstico médico, confirmada en el laboratorio, a partir de criterios de los Centros de Control y Prevención de Enfermedades (CCE). Solamente se tuvieron en cuenta aislados de orina, sangre y sitios estériles. RESULTADOS: Cuarenta y cuatro pacientes (20.1%) dieron lugar a 74 episodios de IVU y sepsis. El número promedio de infecciones fue 1.7 ± 1.3 por paciente. Hubo 31 varones (70.5%) y la edad promedio en el momento de la infección fue 5.6 ± 4.7 anos. Las infecciones bacterianas abarcaron: cistitis (n = 52, 70.3%), pulmonía bacteriana (n = 15, 20.3%), meningitis (n = 4, 5.4%), septicemia (n = 2, 2.7%) e infección ósea (n = 1, 1.4%). De las 52 IVU, 39 fueron causadas por un solo microorganismo. Los aislados más comunes de IVU incluyeron Escherichia coli (n = 21, 53.8%) y Enterobacter spp (n = 5, 12.8%). De los 22 casos de sepsis, los aislados incluyeron Streptococcus pneumoniae (n = 8, 36.4%) y Staphylococcus coagulasa negativo (n = 6, 27.3%). Todos los aislados de E coli en dos o tres sitios clínicos eran resistentes al cotrimoxazol. Se produjeron 79.7% (n = 51) episodios infecciosos con un organismo resistente al cotrimoxazol entre los pacientes que se hallaban bajo profilaxis con cotrimoxazol. CONCLUSIONES: Escherichia coli fue el aislado bacteriano más frecuente. El cotrimoxazol es una opción pobre para el tratamiento empírico de sepsis e IVU en esta situación clínica.