ABSTRACT
Changes in bone mineral density (BMD) are common in adults infected with human immunodeficiency virus (HIV). There are few studies evaluating bone involvement in children infected. OBJECTIVE: To evaluate BMD in vertically HIV-infected children. METHODS: We studied 53 infected children (8-18 years) from five hospitals. Disease status, nutritional assessment, vitamin D (25-OHD) levels and immunological status were recorded. BMD was measured by densitometry. Descriptive analysis, comparison of means and simple and multiple linear regression were used. RESULTS: 88.7% children were in stage B and C, 57% were eutrophic and 18.9% had short stature. 33.3% had 25-OHD levels < 20 ng / ml. 11%, 6% and 4% of the children had BMD <-2DE in hip, spine and whole body respectively. BMD was correlated with BMI, height, disease stage and years of treatment. Only protease inhibitors (PIs) maintained their significance when adjusted for other variables. CONCLUSION: children infected with HIV had lower BMD by age compared to NHANES III data. The severity of the disease, height, zBMI, years of treatment with antiretrovirals, mainly IP, are related to the reduction of bone mass.
Subject(s)
Bone Density/physiology , HIV Infections/physiopathology , Adolescent , Antiretroviral Therapy, Highly Active , Bone Density/drug effects , Child , Diet Records , Female , HIV Infections/drug therapy , Humans , Infectious Disease Transmission, Vertical , Male , Risk Factors , Severity of Illness IndexABSTRACT
Resumen Los cambios en la densidad mineral ósea (DMO) son comunes en adultos infectados con virus de la inmunodeficiencia humana (VIH). Existen pocos estudios que evalúen el compromiso óseo en niños. Objetivo: Evaluar la DMO en niños infectados verticalmente por VIH. Métodos: Se estudiaron 53 niños infectados (8-18) de cinco hospitales. Se registró severidad de enfermedad, evaluación nutricional, vitamina D (25-OHD) y estado inmunológico. La DMO se midió mediante densitometría. Se utilizó análisis descriptivo, comparación de medias y regresión lineal simple y múltiple. Resultados: El 88,7% estaban en estadio B y C, 57% eran eutróficos y 18,9% tenían talla baja. El 33,3% presentaba niveles de 25-OHD < 20 ng/ml. El 11%, 6% y 4% de los niños tenían DMO < 2DE en cadera, columna y cuerpo entero, respectivamente. La DMO se correlacionó con IMC, talla, severidad de enfermedad y años de tratamiento. Sólo inhibidores de las proteasas (IP) mantuvieron su significancia al ajustar por otras variables. Conclusión: Los niños infectados con VIH tuvieron DMO más baja por edad comparados con datos de NHANES III. La severidad de la enfermedad, talla, zIMC, los años de tratamiento con anti-retrovirales, principalmente IP, están relacionados con la reducción de la masa ósea.
Changes in bone mineral density (BMD) are common in adults infected with human immunodeficiency virus (HIV). There are few studies evaluating bone involvement in children infected. Objective: To evaluate BMD in vertically HIV-infected children. Methods: We studied 53 infected children (8-18 years) from five hospitals. Disease status, nutritional assessment, vitamin D (25-OHD) levels and immunological status were recorded. BMD was measured by densitometry. Descriptive analysis, comparison of means and simple and multiple linear regression were used. Results: 88.7% children were in stage B and C, 57% were eutrophic and 18.9% had short stature. 33.3% had 25-OHD levels < 20 ng / ml. 11%, 6% and 4% of the children had BMD <-2DE in hip, spine and whole body respectively. BMD was correlated with BMI, height, disease stage and years of treatment. Only protease inhibitors (PIs) maintained their significance when adjusted for other variables. Conclusion: children infected with HIV had lower BMD by age compared to NHANES III data. The severity of the disease, height, zBMI, years of treatment with antiretrovirals, mainly IP, are related to the reduction of bone mass.
Subject(s)
Humans , Male , Female , Child , Adolescent , Bone Density/physiology , HIV Infections/physiopathology , Severity of Illness Index , Bone Density/radiation effects , Diet Records , HIV Infections/drug therapy , Risk Factors , Infectious Disease Transmission, Vertical , Antiretroviral Therapy, Highly ActiveABSTRACT
The present document describes the Cohort of HIV/AIDS children detected in Chile from 1987 to August 2014 and the effectiveness of the Protocol for Prevention of Vertical Transmission (PPVT) of HIV infection. Of the 375 HIV infected children enrolled since 1987 to August 2014, 245 of them are still in pediatric control. From the analysis of the Cohort is inferred that: a) it has observed an improvement in the detection of the HIV infected child, in number and precocious time; b) the majority of these children continue to be detected by clinic symptoms and signs (mainly unspecific and infectious manifestations); c) the ARVT use has meant a clinic and immunologic improvement with diminution of the infections, principally opportunistic infections, with a better life quality, a prolongation of survival and a diminution of lethality; d) as more survival has been produced, cancer has begun to be detected, a very infrequent complication observed in them before the ARVT use. The PPVT started in 1995, and was reinforced in 2005 with the "Joint Norm of HIV and Syphilis Vertical Transmission Prevention" (MINSAL), both have meant a diminution of the HIV vertical transmission from > 35% (before 1995) to < 2% nowadays in the mother-child binomial; also have permitted a second generation of HIV exposed children born without infection. In spite this PPVT, still HIV infected child continue to be detected which imply failures in some points of the health system.
Se presentan datos de la cohorte de niños con infección por VIH/SIDA detectados en Chile desde el año 1987 a agosto de 2014 y datos de la transmisión vertical (TV) del VIH con uso de protocolos de prevención de TV (PPTV). De los 375 niños infectados con VIH en este período, siguen en control pediátrico 245. Del análisis de la cohorte se desprende que: a) ha habido una mejoría en la pesquisa de los niños infectados con VIH, tanto en número como en precocidad; b) estos niños siguen detectándose, en su mayoría, por hechos clínicos (manifestaciones inespecíficas e infecciosas principalmente); c) el uso de TARV ha significado una mejoría clínica e inmunológica con disminución de las infecciones, principalmente las oportunistas, con una mejor calidad de vida, prolongación de la sobrevida, y disminución de la letalidad; d) por su mayor sobrevida, se ha observado el desarrollo de cánceres, muy infrecuentes en ellos antes del uso de terapia anti-retroviral. La aplicación de Protocolos de Prevención de la TV desde 1995, reforzada el 2005 con la Norma Conjunta de la Prevención de la Transmisión Vertical del VIH y Sífilis (MINSAL), ha significado una disminución de la TV del VIH desde más de 35% (antes de 1995) a < 2% actualmente en los binomios en prevención; además ha permitido que una segunda generación de niños expuestos al VIH nazca no infectada. A pesar de estos PPTV, aún siguen naciendo niños infectados con VIH, lo que implica fallas en algunos puntos del sistema de salud.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/epidemiology , Antiretroviral Therapy, Highly Active/statistics & numerical data , Time Factors , HIV Infections , Chile/epidemiology , Cohort Studies , Cause of Death , Age Factors , AIDS-Related Opportunistic Infections , Age Distribution , Infectious Disease Transmission, VerticalABSTRACT
The present document describes the Cohort of HIV/AIDS children detected in Chile from 1987 to August 2014 and the effectiveness of the Protocol for Prevention of Vertical Transmission (PPVT) of HIV infection. Of the 375 HIV infected children enrolled since 1987 to August 2014, 245 of them are still in pediatric control. From the analysis of the Cohort is inferred that: a) it has observed an improvement in the detection of the HIV infected child, in number and precocious time; b) the majority of these children continue to be detected by clinic symptoms and signs (mainly unspecific and infectious manifestations); c) the ARVT use has meant a clinic and immunologic improvement with diminution of the infections, principally opportunistic infections, with a better life quality, a prolongation of survival and a diminution of lethality; d) as more survival has been produced, cancer has begun to be detected, a very infrequent complication observed in them before the ARVT use. The PPVT started in 1995, and was reinforced in 2005 with the "Joint Norm of HIV and Syphilis Vertical Transmission Prevention" (MINSAL), both have meant a diminution of the HIV vertical transmission from > 35% (before 1995) to < 2% nowadays in the mother-child binomial; also have permitted a second generation of HIV exposed children born without infection. In spite this PPVT, still HIV infected child continue to be detected which imply failures in some points of the health system.
Subject(s)
Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/epidemiology , Antiretroviral Therapy, Highly Active/statistics & numerical data , AIDS-Related Opportunistic Infections , Adolescent , Age Distribution , Age Factors , Cause of Death , Child , Child, Preschool , Chile/epidemiology , Cohort Studies , Female , HIV Infections , Humans , Infant , Infant, Newborn , Infectious Disease Transmission, Vertical , Male , Time FactorsABSTRACT
Background: Pediatric HIV (+) patients have a 100 times greater risk of cancer than HIV (-) children. Objective: To describe in Chilean HIV (+) children, cancer types, its appearance in relation to the stages of HIV disease and mortality. Methods: A protocol was created to know some characteristics of these patients from the point of view of their HIV infection and cancer pathology. Results: Of 360 HIV (+) children confirmed by the Institute of Public Health to May 2014, 9 patients with neoplastic disease (2.5%) were diagnosed. All the children were on ART, had more than three years of evolution of HIV infection and were in moderate to severe clinical/immunological stages. Lymphoma was the most common cancer. Five children, has received therapy according to Programa Infantil Nacional de Drogas Antineoplásicas (PINDA). There was no interaction between cancer treatment and antiretroviral therapy. Mortality was 13.8 x 1000 (5 cases). Conclusions: The incidence and type of neoplasia is consistent with the international literature, with less survival than HIV (+) children without tumors. The occurrence of cancer was observed in children with moderate to severe clinical and immunological compromise.
Introducción: Los pacientes pediátricos con infección por VIH tienen un riesgo 100 veces mayor de presentar cáncer que los niños no infectados. Objetivos: Describir en niños chilenos con infección por VIH, los tipos de cáncer, su aparición en relación a las etapas de la enfermedad por VIH y la letalidad. Material y Métodos: Se creó un protocolo para conocer algunas características de estos pacientes desde el punto de vista de su infección por VIH y su patología oncológica. Resultados: De 360 niños infectados confirmados por el Instituto de Salud Pública a mayo de 2014, se diagnosticaron nueve casos con patología oncológica (2,5%).Todos los niños estaban con TARV, tenían una evolución de infección por VIH mayor a 3 años, en etapas clínicas/inmunológicas moderada a grave. Linfoma fue el cáncer más frecuente. Cinco niños, recibieron terapia de acuerdo al Programa Infantil Nacional de Drogas Antineoplásicas (PINDA). No hubo interacción entre tratamiento anti-neoplásico y terapia anti-retroviral. La mortalidad fue de 13,8 x 1.000 (5 casos). Conclusiones: La incidencia y tipo de neoplasias está de acuerdo con lo comunicado en la literatura científica internacional, con sobrevida inferior a los niños con infección por VIH sin neoplasias. La aparición de cáncer se observó en niños con larga evolución y compromiso clínico e inmunológico moderado a grave.
Subject(s)
Child, Preschool , Female , Humans , Infant , Male , HIV Infections/complications , Neoplasms/complications , Antiretroviral Therapy, Highly Active , Chile/epidemiology , HIV Infections/mortality , Incidence , Neoplasms/epidemiology , Neoplasms/mortality , Survival AnalysisABSTRACT
BACKGROUND: Pediatric HIV (+) patients have a 100 times greater risk of cancer than HIV (-) children. OBJECTIVE: To describe in Chilean HIV (+) children, cancer types, its appearance in relation to the stages of HIV disease and mortality. METHODS: A protocol was created to know some characteristics of these patients from the point of view of their HIV infection and cancer pathology. RESULTS: Of 360 HIV (+) children confirmed by the Institute of Public Health to May 2014, 9 patients with neoplastic disease (2.5%) were diagnosed. All the children were on ART, had more than three years of evolution of HIV infection and were in moderate to severe clinical/immunological stages. Lymphoma was the most common cancer. Five children, has received therapy according to Programa Infantil Nacional de Drogas Antineoplásicas (PINDA). There was no interaction between cancer treatment and antiretroviral therapy. Mortality was 13.8 x 1000 (5 cases). CONCLUSIONS: The incidence and type of neoplasia is consistent with the international literature, with less survival than HIV (+) children without tumors. The occurrence of cancer was observed in children with moderate to severe clinical and immunological compromise.
Subject(s)
HIV Infections/complications , Neoplasms/complications , Antiretroviral Therapy, Highly Active , Child, Preschool , Chile/epidemiology , Female , HIV Infections/mortality , Humans , Incidence , Infant , Male , Neoplasms/epidemiology , Neoplasms/mortality , Survival AnalysisABSTRACT
The worldwide reemergence of tuberculosis (TB) is related to different factors, being one of them HIV infection and its immune suppressive effect. This epidemiological pattern is also observed in pediatric population. We describe the clinical/immunological evolution, and treatment administered to six children under control by the Chilean Pediatric AIDS Committee with vertically transmitted HIV infection, who acquired tuberculosis. A review of the literature is carried out in addition.
Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , Tuberculosis, Pulmonary/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Adolescent , Anti-HIV Agents/therapeutic use , Antitubercular Agents/adverse effects , Antitubercular Agents/therapeutic use , Child , Child, Preschool , Female , HIV Infections/transmission , Humans , Infant , Infectious Disease Transmission, Vertical , Male , Tuberculosis, Pulmonary/drug therapyABSTRACT
BACKGROUND: Using adequate infection control measures, the rate of vertical transmission of human immunodeficiency virus (HIV) during pregnancy, has been reduced to 3% in Chile. AIM: To determine vertical transmission rate and risk factors associated to perinatal infection in pregnant women with known (KI) and unknown HIV infection (UI). PATIENTS AND METHODS: HIV infected pregnant women whose deliveries were attended at the San Borja Arriaran Hospital were included. Antiretroviral therapy (ART) has been used since 1995 (Zidovudine 13 patients, biOtherapy 4 and triple therapy 14 patients). Newborns have received ART since 1995. Premature labor without evident cause, premature rupture of membranes, and rupture of membranes over 4 h before delivery were evaluated. Delivery was by elective cesarean section since 1993. Breast feeding was avoided. Pregnant women with UI (suspected disease after delivery due to child or mother pathology) did not received ART. Delivery and breast feeding were managed with common obstetrical-neonatal criteria. RESULTS: Fifty three HIV infected pregnant women were studied (43 with KI and 10 with UI). Four children (36.4%) from the KI group and seven (63.6%) from the UI group became infected. The global rate of vertical transmission among KI group was significantly lower than UI group: 9.5% (4/42) vs 70.0% (7/10) p < 0.001. Using ART, this rate was further reduced to 6.5% (2/31) and with bitherapy or triple therapy to 0% (0/18). Breast feeding, vaginal delivery, premature delivery with no clinical cause, premature rupture of membranes, rupture of membranes longer than 4 h and lack of ART, were significantly more common in the UI group, compared with KI group. CONCLUSIONS: Vertical transmission in pregnant women with KI is significantly lower compared with UI. Risk factors increasing HIV perinatal infection are: breast feeding, lack of ART, vaginal delivery, premature rupture of membranes, rupture of membranes > 4 h and premature labor without a clinical cause.
Subject(s)
HIV Infections/transmission , Infectious Disease Transmission, Vertical/statistics & numerical data , Pregnancy Complications, Infectious/virology , Adult , Anti-HIV Agents/therapeutic use , Chile/epidemiology , Female , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Infant , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/epidemiology , Risk Factors , Zidovudine/therapeutic useABSTRACT
El objetivo de este trabajo fue estudiar las características clínicas del embarazo con infección por virus de inmunodeficiencia humana (VIH) y la transmisión vertical. Se analizaron embarazadas con esta infección, controladas en la Fundación Arriarán, cuya gestación y parto fueron atendidos en la Maternidad del Hospital San Borja Arriarán. Durante la gestación se hizo pesquisa de otras infecciones. La zidovudina (AZT) fue usada según protocolo ACTG 076 en 6 mujeres. En el parto se prefirió la cesárea electiva. Se impidió la lactancia. Se hizo seguimiento de los niños. Diecisiete mujeres tuvieron 19 partos. Presentaron infección genitourinaria 4 pacientes (21,1 por ciento); infecciones no ginecológicas 5 (26,3 por ciento); patología del embarazo 4 (21,1 por ciento); rotura prematura de membranas de término 1 (5,3 por ciento); parto prematuro 3 (15,8 por ciento). El parto fue por cesárea en 15 casos (78,9 por ciento). La transmisión vertical fue 26,3 por ciento (5/19), 33,3 por ciento (5/15) en la cesárea y 16,7 por ciento con tratamiento de AZT. Un niño presentó muerte fetal y trece (68,4 por ciento) están sanos. Ocho mujeres están asintomáticas, tres sintomáticas, cuatro abandonaron controles y dos fallecieron. Es conveniente que la embarazada con infección por VIH use AZT y sea controlada por especialistas para disminuir los factores de riesgo en la transmisión vertical. La cesárea facilita la administración de AZT durante el parto. La lactancia materna debe suprimiese
