ABSTRACT
BACKGROUND: Inflammatory bowel disease (IBD) present in childhood in 15% to 25% of cases. The aim of therapy in children is not only to guarantee normal growth but also to prevent relapse and to maintain remission. Steroids are effective to induce remission; however, resistance, dependency, and irreversible side effects can develop. The aim of this study was to determine whether treatment with repeated infusions of autologous red blood cells (RBCs) loaded with dexamethasone 21-phosphate (Dex 21-P) is safe and allows maintenance of long-term remission in children with steroid-dependent Crohn disease (CD). PATIENTS AND METHODS: Eighteen consecutive pediatric patients who met the inclusion criteria were admitted to the study. Infusions of autologous RBCs loaded with Dex 21-P were performed every 4 weeks; the mean duration of treatment was 24 months. At the beginning of treatment and after 6, 12, and 24 months, we performed clinical evaluation according to the Pediatric Crohn Disease Activity Index (pCDAI). Assessment of body mass in dexamethasone and bone mineral density by means of computerized bone mineralometry-dual energy x-ray absorptiometry, endoscopic evaluation, and hematic morning cortisol determination were also performed. RESULTS: During treatment, the mean pCDAI significantly decreased (P < 0.05); 78% of patients discontinued steroids. Determination of morning cortisol showed suppression only on the first day after infusion, followed by normalization of values. Endoscopic findings showed remission in 44% of patients. None of the patients experienced serious side effects. CONCLUSIONS: These data suggest that repeated infusions of RBCs loaded with Dex 21-P can be safe and useful to maintain long-term remission in pediatric patients with moderately active CD.
Subject(s)
Anti-Inflammatory Agents/administration & dosage , Crohn Disease/therapy , Dexamethasone/analogs & derivatives , Erythrocyte Transfusion/methods , Adolescent , Blood Transfusion, Autologous , Child , Child, Preschool , Dexamethasone/administration & dosage , Female , Humans , Male , Pilot Projects , Remission InductionSubject(s)
Intestinal Diseases/etiology , Child , Chronic Disease , Humans , Intestinal Diseases/mortality , Intestinal Diseases/therapy , Intestinal Pseudo-Obstruction/etiology , Intestinal Pseudo-Obstruction/therapy , Parenteral Nutrition , Retrospective Studies , Short Bowel Syndrome/mortality , Short Bowel Syndrome/surgery , Time Factors , Treatment Failure , Treatment OutcomeSubject(s)
Intestines/transplantation , Liver Diseases/complications , Short Bowel Syndrome/surgery , Analysis of Variance , Child , Colon/surgery , Enterocolitis, Necrotizing/surgery , Female , Follow-Up Studies , Humans , Intestinal Atresia/surgery , Intestinal Obstruction/surgery , Male , Patient Selection , Reoperation , Time FactorsSubject(s)
Intestinal Diseases/therapy , Intestine, Small/transplantation , Parenteral Nutrition , Short Bowel Syndrome/therapy , Child , HIV Infections/complications , HIV Infections/mortality , Humans , Intestinal Diseases/classification , Intestinal Diseases/surgery , Retrospective Studies , Short Bowel Syndrome/surgery , Transplantation, HomologousABSTRACT
The prevalence and the clinical course of hepatitis C virus (HCV) infections were studied in 23 HIV-1-infected children, who were born to 22 mothers with HIV-1/HCV coinfection. During the follow-up only two children (8.7%) showed persistent anti-HCV antibodies and circulating HCV RNA. Both children, who were aged 10 and 10.6 years respectively at the end of follow-up, had chronically-evolving liver disease and autoimmune thrombocytopenia but no signs of progressive HIV disease. Based on our experience, vertically-acquired HIV-1/HCV coinfection is less frequent than is generally reported and may be associated with the development of chronic thrombocytopenia in addition to liver disease. Moreover, perinatal HIV-1/HCV coinfection appears to be associated with a slow progression of HIV disease.
Subject(s)
AIDS-Related Opportunistic Infections/transmission , HIV-1 , Hepatitis C/transmission , Infectious Disease Transmission, Vertical , AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/physiopathology , Child , Female , Follow-Up Studies , Hepatitis C/complications , Hepatitis C/epidemiology , Hepatitis C/physiopathology , Humans , Infant , Male , Prevalence , Prospective StudiesABSTRACT
The prevalence of human herpesvirus 6 (HHV-6) infection and the course of human immunodeficiency virus (HIV) disease were investigated in 25 Romanian children with nosocomial HIV-1 infection. HHV-6 IgM and IgG antibodies were detected by enzyme immunoassay (EIA) and immunofluorescence assay (IFA) at the beginning of the study and after 18 months, concomitantly with collection of virologic, immunologic and clinical data. The initial HHV-6 seropositivity was 92% by EIA and 76% by IFA, whereas final testing showed 100% positivity by EIA and 84% by IFA. Positive HHV-6 IgM antibodies were detected in 10 children (40%) by EIA and IFA. Of these 9 children (36%) by EIA and 6 (24%) by IFA had both initial and final IgM antibodies. Children with HHV-6 IgM antibodies had a higher prevalence of pneumonitis than those without (100% vs. 53.3%; P < 0.01). In addition they more frequently showed positive p24 antigen detection (67% vs. 40%) and positive HIV-1 culture (80% vs. 69%). Nevertheless the patients with HHV-6 IgM antibodies showed a slight increase in the final mean CD4+ T cell count (from 1.140 to 1.185 x 10(6)/liter), whereas those with HHV-6 IgG alone showed a statistically significant (P = 0.01) decrease (from 1.395 to 968 CD4+ T-cells x 10(6)/liter). Therefore current or recent HHV-6 infection, as revealed by positive HHV-6 IgM antibodies, appeared to be associated with the development of pneumonitis but not with progression of HIV disease. A possible competitive inhibition of HIV-1 by HHV-6 or a stimulating effect of HHV-6 on CD4+ T-cell production may be suggested.
