Sustained Virologic Suppression Reduces HIV-1 DNA Proviral Levels and HIV Antibodies in Perinatally HIV-Infected Children Followed from Birth.

The extent to which perinatally HIV-infected children, following cART initiation, develop a low proviral reservoir burden over time, as measured by HIV DNA droplet-digital polymerase chain reaction (ddPCR) and the effect on HIV antibody is not well characterized. We measured proviral HIV DNA and plasma RNA virus load (VL) in 37 perinatally HIV-infected children at 6 months of age who initiated stable cART. At 6-11 years of age, HIV proviral DNA, HIV VL (RNA), and HIV antibody by Western Blot (WB) were assessed. CART was initiated before 6 months of age in 13 children and after 6 months in 24. At school age, the HIV DNA levels did not differ by the timing of cART, and the HIV DNA levels were lower in children with negative/indeterminate WB (p = 0.0256). Children with undetectable HIV RNA VL > 50% of the time since cART initiation had lower median DNA VL than children with undetectable VL < 50% of the time (p = 0.07). Long-term viral suppression in perinatally HIV-infected children is associated with a decrease in HIV antibodies and reduced HIV reservoirs.

Retrospective analysis of risk factors and gaps in prevention strategies for mother-to-child HIV transmission in Rio de Janeiro, Brazil.

BACKGROUND: Despite great progress made in methods to prevent mother-to-child transmission of HIV (MTCT), delivery and uptake of these measures remains a challenge in many countries. Although the Brazilian Ministry of Health aimed to eliminate MTCT by 2015, infection still occured in 15-24% of infants born to HIV-infected mothers. We sought to identify remaining factors that constrain MTCT elimination. METHODS: We conducted a retrospective, matched case-control study by reviewing hospital charts of infants born to HIV-infected mothers between 1997 and 2014 at three MTCT reference hospitals in the Rio de Janeiro metropolitan area. Cases were defined as HIV-exposed children with two positive HIV tests before 18 months of age; controls were defined as HIV-exposed children with two negative HIV tests before 18 months of age. We performed bivariate and MTCT cascade analyses to identify risk factors for MTCT and gaps in prevention services. RESULTS: We included 435 infants and their mothers (145 cases, 290 controls). Bivariate analyses of MTCT preventative care (PMTCT) indicated that cases were less likely to complete all individual measures in the antenatal, delivery, and postnatal period (p < 0.05). Assessing completion of the PMTCT cascade, the sequential steps of PMTCT interventions, we found inadequate retention in care among both cases and controls, and cases were significantly less likely than controls to continue receiving care throughout the cascade (p < 0.05). Motives for incompletion of PMTCT measures included infrastructural issues, such as HIV test results not being returned, but were most often due to lack of care-seeking. Over the course of the study period, PMTCT completion improved, although it remained below the 95% target for antenatal care, HIV testing, and antenatal ART set by the WHO. Adding concern, evaluation of co-infections indicated that case infants were also more likely to have congenital syphilis (OR: 4.29; 95% CI: 1.66 to 11.11). CONCLUSIONS: While PMTCT coverage has improved over the years, completion of services remains insufficient. Along with interventions to promote care-seeking behaviour, increased infrastructural support for PMTCT services is needed to meet the HIV MTCT elimination goal in Brazil as well as address rising national rates of congenital syphilis.

Neurologic Outcomes in HIV-Exposed/Uninfected Infants Exposed to Antiretroviral Drugs During Pregnancy in Latin America and the Caribbean.

To evaluate antiretroviral (ARV) drug exposure and other factors during pregnancy that may increase the risk of neurologic conditions (NCs) in HIV-exposed/uninfected (HEU) infants. A prospective cohort study was conducted at 24 clinical sites in Latin America and the Caribbean. Data on maternal demographics, health, HIV disease status, and ARV use during pregnancy were collected. Infant data included measurement of head circumference after birth and reported medical diagnoses at birth, 6-12 weeks, and 6 months. Only infants with maternal exposure to combination ARV therapy (cART) (≥3 drugs from ≥2 drug classes) during pregnancy were included. Microcephaly, defined as head circumference for age z-score less than -2, and NC were evaluated for their association with covariates, including individual ARVs, using bivariable and logistic regression analyses. From 2002 to 2009, 1,400 HEU infants met study inclusion criteria. At least one NC was reported in 134 (9.6%; 95% confidence interval [CI]: 8.1-11.2), microcephaly in 105 (7.5%; 95% CI: 6.2-9.0), and specific neurologic diagnoses in 33 (2.4%; 95% CI: 1.6-3.3) HEU infants. Microcephaly and NC were not significantly associated with any specific ARV analyzed (p > 0.05). Covariates associated with increased odds of NC included male sex (odds ratio [OR] = 1.9; 95% CI: 1.3-2.8), birth weight <2.5 kg (OR = 3.1; 95% CI: 2.1-4.8), 1-min Apgar score <7 (OR = 2.5; 95% CI: 1.4-4.4), and infant infections (OR = 2.5; 95% CI: 1.5-4.1). No ARV investigated was associated with adverse neurologic outcomes. Continued investigation of such associations may be warranted as new ARVs are used during pregnancy and cART exposure during the first trimester becomes increasingly common.

Draft Genome Sequence of a Community-Associated Methicillin-Resistant Panton-Valentine Leukocidin-Positive Staphylococcus aureus Sequence Type 30 Isolate from a Pediatric Patient with a Lung Infection in Brazil.

The sequence of methicillin-resistant Staphylococcus aureus strain B6 (sequence type 30 [ST30], spa type t433, staphylococcal chromosomal cassette mec element [SCCmec] type IVc, Panton-Valentine leukocidin [PVL] positive), isolated from a pediatric patient with a lung infection in Niterói, Rio de Janeiro, Brazil, is described here. The draft genome sequence includes a 2.8-Mb chromosome, accompanied by a 20-kb plasmid containing blaZ and two small cryptic plasmids.

Risk factors for Staphylococcus aureus and methicillin-resistant S aureus colonization among health care workers in pediatrics departments.

Risk factors for Staphylococcus aureus and methicillin-resistant S aureus (MRSA) were evaluated for 178 health care workers from a public hospital pediatrics department in Brazil. Colonization rates were 33.1% for S aureus and 5.1% for MRSA. Risk factors for S aureus colonization differed from those for MRSA. Results suggest nurses with prolonged pediatric patient contact in inpatient units are at higher risk for MRSA colonization.

Abuso sexual crônico: estudo de uma série de casos ocorridos na Infância e na adolescência / Chronic abuse: study of a series of cases occurring in childhood and adolescence

A Organização Mundial de Saúde considera o abuso sexual um dos maiores problemas de saúde pública. Tal agravo atinge crianças e adolescentes muitas vezes silenciosamente e são praticados, usualmente, por pessoas ligadas diretamente às vítimas. Objetivo: descrever as características do abuso crônico em crianças e adolescentes, identificar os fatores de vulnerabilidade associados e avaliar o desfecho dos casos. Métodos: trata-se de uma série de 264 casos em 260 pacientes de 0 a 18 anos, vítimas de violência sexual, sendo 104 casos de abuso crônico, acompanhados no ambulatório de Atendimento a Crianças e Adolescentes Vítimas de Violência (ACAVV), do Hospital Universitário Antônio Pedro, da Universidade Federal Fluminense.Modelos de regressão logística, simples e múltiplos foram utilizados na análise estatística, considerando abuso crônico a variável dependente. Resultados:variáveis relacionadas com os 104 casos de abuso sexual crônico foram crianças (46), residência das vítimas (68) e ambiente intrafamiliar (75). Apesar dosexo feminino prevalente (91/104 casos), meninos tiveram três vezes mais chance de sofrer abuso crônico, tendo as vítimas de outros tipos de maus-tratos duas vezes mais chance de sofrer esse tipo de abuso, e manipulação de genitália, quatro vezes mais chance de acontecer quando comparado com o abuso sexual agudo. Conclusão: características das vítimas de abuso crônico foram crianças entre 6 e 10 anos e as adolescentes, abusadas dentro do ambientefamiliar, ocorrendo a maioria absoluta na residência das vítimas; metade das vítimas teve sexo vaginal com seus agressores. Observou-se que a violência foi cometida por pais e padrastos, sendo associada a outros maus-tratos.

World Health Organization considers sexual abuse one of the greatest health problems publishes. Such grievance reaches children and adolescents many times silently, and are practiced, usually by people linked directly to victims. Objective: to describe the characteristics of chronic abusein children and adolescents, identify vulnerability factors associated with the same and evaluate the outcome of cases attended. Methods it is studying aseries of 264 cases in 260 patients from zero to 18 years, victims of sexual violence, including 104 cases of chronic abuse, as outpatients Care for Children and Adolescents Victims of Violence (ACAVV), of Antonio Pedro University Hospital, at Universidade Federal Fluminense. Logistic regression models,single and multiple, were used in the statistical analysis, considering chronic abuse, the dependent variable. Results: variables related to 104 cases of sexualabuse chronic were kids (46), residence of the victims (68) and family environment (75 cases). Although the prevalent female sex (91/104 cases), boys were three times more likely to suffer chronic abuse, and victims of other types of maltreatment twice as likely to suffer this kind of abuse, and manipulation of genitals four times more likely to happen compared to acute sexual abuse. Conclusion: characteristics of victims of chronic abuse were children, agedbetween six and 10 years and adolescents. The victims were abused within the family environment, where the majority occurred in the victim's residence committed by fathers and step fathers, associated with other types of maltreatment. Importantly, half of the victims had vaginal sex with their aggressors.

Toxoplasma gondii antibody profile in HIV-1-infected and uninfected pregnant women and the impact on congenital toxoplasmosis diagnosis in Rio de Janeiro, Brazil.

OBJECTIVE: Compare the anti-T. gondii IgG titer between HIV-1 infected and non HIV-1 infected pregnant women and report three cases of congenital toxoplasmosis resulting from reactivation of infection during pregnancy of HIV-1 infected women. METHODS: This study was conducted among 2,270 pregnant women with chronic Toxoplasma gondii infection (absence of IgM and presence of IgG), including 82 HIV-1 infected and 2,188 non-infected women. RESULTS: The average anti-T. gondii IgG titer was 127 for the 2,188 non-HIV-1 infected women, and 227 for the 82 HIV-1-infected women (p = 0,007). These results suggested that higher anti-T. gondii IgG titers in HIV-1-infected pregnant women may not be indicative of an elevated risk for fetal infection. In this study three cases of congenital toxoplasmosis that resulted from infection reactivation during pregnancy of HIV-1-infected women were manifested by fetal death, symptomatic infection, and infant without symptoms, respectively. In two of these women, a ten-fold increase in IgG levels above used cutoff was observed (2,320 UI/mL and 3,613 UI/mL, respectively). In the third pregnant women anti-T. gondii IgG titers during pregnancy did not rise despite the occurrence of congenital toxoplasmosis (204; 198; 172 UI/mL). CONCLUSIONS: Congenital toxoplasmosis resulting reactivation of infection during pregnancy in the studied group leads us to believe that it is a public health problem, especially in our population, in which seroprevalence of T. gondii infections is high. These findings also suggest that special attention is necessary during pregnancy, because the serologic diagnosis may not be indicative of toxoplasmosis reactivation.

Toxoplasma gondii antibody profile in HIV-1-infected and uninfected pregnant women and the impact on congenital toxoplasmosis diagnosis in Rio de Janeiro, Brazil

OBJECTIVE: Compare the anti-T. gondii IgG titer between HIV-1 infected and non HIV-1 infected pregnant women and report three cases of congenital toxoplasmosis resulting from reactivation of infection during pregnancy of HIV-1 infected women. METHODS: This study was conducted among 2,270 pregnant women with chronic Toxoplasma gondii infection (absence of IgM and presence of IgG), including 82 HIV-1 infected and 2,188 non-infected women. RESULTS: The average anti-T. gondii IgG titer was 127 for the 2,188 non-HIV-1 infected women, and 227 for the 82 HIV-1-infected women (p = 0,007). These results suggested that higher anti-T. gondii IgG titers in HIV-1-infected pregnant women may not be indicative of an elevated risk for fetal infection. In this study three cases of congenital toxoplasmosis that resulted from infection reactivation during pregnancy of HIV-1-infected women were manifested by fetal death, symptomatic infection, and infant without symptoms, respectively. In two of these women, a ten-fold increase in IgG levels above used cutoff was observed (2,320 UI/mL and 3,613 UI/mL, respectively). In the third pregnant women anti-T. gondii IgG titers during pregnancy did not rise despite the occurrence of congenital toxoplasmosis (204; 198; 172 UI/mL). CONCLUSIONS: Congenital toxoplasmosis resulting reactivation of infection during pregnancy in the studied group leads us to believe that it is a public health problem, especially in our population, in which seroprevalence of T. gondii infections is high. These findings also suggest that special attention is necessary during pregnancy, because the serologic diagnosis may not be indicative of toxoplasmosis reactivation.

Pregnancy in HIV vertically infected adolescents and young women: a new generation of HIV-exposed infants.

BACKGROUND: Vertically infected individuals are reaching childbearing age and the new generation of HIV-exposed infants is coming to pediatric care. METHODS: Chart review of pregnancies among HIV vertically infected adolescents and young women. RESULTS: Fifteen pregnancies were reviewed. Girls had HIV diagnosis at median age 10.1 years (range 1.3-20). They started sexual life at median age 15 years (range 13-19); median age at pregnancy was 16.9 years (range 14-21.5); 36.4% had presented an AIDS-defining clinical event; have been followed for median 8.5 years (range 2.9-15.8) and had used median two antiretroviral regimens (range 0-7). Fourteen (93.3%) received antiretroviral drugs during pregnancy; median CD4 cell count during pregnancy was 394 (range 117-651) cells/µl and median viral load was 4800 copies/ml (range 50-100 000); 54% had undetectable viral load near delivery. All patients delivered by elective c-section. Median birth weight was 2650 g (range 2085-3595), median length was 47.3 cm (range 42-51) and median gestational age 38 weeks (range 37-39). All newborn received zidovudine for 6 weeks of life and none was breastfed. Fourteen (93%) infants were considered HIV-uninfected; one was lost to follow-up. CONCLUSIONS: This group of adolescents seems to have sexual behavior similar to that of HIV-uninfected. Since this is an experimented antiretroviral population, new drugs may be necessary for adequate viral suppression to avoid HIV mother-to-child transmission. Follow-up of this third generation of HIV-exposed infants needs to be addressed within HIV adolescent care.

O banho no leito em unidade de terapia intensiva: uma visão de quem percebe / Bathing on bed at the intensive care unit: perceptions of whom receives it

Estudo realizado com 12 clientes internados na Unidade de Terapia Intensiva, de dois hospitais públicos, no ano de 2001 em Goiânia - GO, com o objetivo de verificar a visão do cliente sobre o banho no leito...

Study of the cardiac alterations in HIV-infected children consequent to the antiretroviral therapy. Prospective study of 47 cases.

OBJECTIVE: Detect of cardiac alterations in children with AIDS and compare their evolution with the administration of only one anti-retroviral and the recent cases who received drugs in combination. METHODS: We prospectively studied 47 children in 3 groups: group 1, 20 cases treated only with zidovudine; group 2, 10 patients treated initially with zidovudine and later with a combination of drugs and in group 3, 17 patients, who receiced two or three since the beginning. In all patients it was done chest X-ray, EKG and echocardiography every 6 months and after death complete pathological study. RESULTS: Among the 45 patients cases 26 (57%) were index cases. Malnutrition, diarrhea tachycardia, signs of congestive heart failure, pericardial effusion, abnormal ventricular repolarization and arrhythmias were more frequent in group 1. Echocardiographic abnormalities were present in 10 (50%) children of group 1. They were less frequent in the others two groups. In regard to the outcome in group 1, two patients had worsening of sings of cardiomyopaty and 4 died. Cardiac dysfunction in all cases of group 2 and 3 improved with the medication. CONCLUSION: The children who received combination and their cardiac alterations had more favorable outcome than those who received only one drug.

Estudo das alterações cardíacas em crianças com SIDA em relação à terapêutica com anti-retrovirais. Estudo prospectivo de 47 casos / Study of the cardiac alterations in HIV-infected children consequent to the antiretroviral therapy. Prospective study of 47 cases

OBJECTIVE: Detect of cardiac alterations in children with AIDS and compare their evolution with the administration of only one anti-retroviral and the recent cases who received drugs in combination. METHODS: We prospectively studied 47 children in 3 groups: group 1, 20 cases treated only with zidovudine; group 2, 10 patients treated initially with zidovudine and later with a combination of drugs and in group 3, 17 patients, who receiced two or three since the beginning. In all patients it was done chest X-ray, EKG and echocardiography every 6 months and after death complete pathological study. RESULTS: Among the 45 patients cases 26 (57 percent) were index cases. Malnutrition, diarrhea tachycardia, signs of congestive heart failure, pericardial effusion, abnormal ventricular repolarization and arrhythmias were more frequent in group 1. Echocardiographic abnormalities were present in 10 (50 percent) children of group 1. They were less frequent in the others two groups. In regard to the outcome in group 1, two patients had worsening of sings of cardiomyopaty and 4 died. Cardiac dysfunction in all cases of group 2 and 3 improved with the medication. CONCLUSION:- The children who received combination and their cardiac alterations had more favorable outcome than those who received only one drug

Avaliaçäo do programa de treinamento para o controle das infecçöes hospitalares em Goiás - 1985 a 1992 / Evaluation of the training program to control hospital infections in Goiás- 1985-1992

Desde 1985 o Hospital de Doenças Tropicais de Goiânia é o centro de treinamento, ligado ao Ministério da Saúde, responsável pela ccapacitaçåo profissional na área de controle de infecçåo hospitalar em Goiás. O objetivo deste trabalho é o de avaliar o programa de treinamento desenvolvido no período do 1985 a 1992. Nos últimos 8 anos foram treinados 913 profissionais de nível superior sendo 509 médicos, 286 enfermeiros, 78 farmacêuticos/bioquímicos e 40 de outras áreas da saúde; 84,6 pôr cento dos treinados trabalhavam em Goiânia e 15,4 pôr cento em cidades do interior de Goiás e Tocantins. Para que ema mudança efetiva no C.I.H. ocorra em nosso meio, såo necessários: seleçåo criteriosa da clientela dos cursos; inclusåo de estágios práticos complementares à parte teórica; desenvolvimento de programas de prevençåo; fiscalizaçåo efetiva pela Vigilância Sanitária Estadual