Pathology in children of HIV women.

OBJECTIVE: To assess the frequency of perinatal pathology in children exposed to antiretrovirals in perinatal period. DESIGN: Retrospective observational cohort study. METHODS: Retrospective observational cohort study. Data collected among uninfected children born to HIV-infected women followed up from 1994 to 2006 in a tertiary Hospital. 220 uninfected children were studied. Factors studied included maternal, obstetrical and pediatric variables. RESULTS: The most common disorder found among children exposed to antiretroviral drugs was anemia (84%); 6,4% of children had neutropenia and more than 24% had thrombocytosis, a finding never described before. Prematurity (24%) and low birth weight (23.6%) rates were high. Several congenital malformations were found: Poland syndrome, angiomas, hypospadias, Pierre-Robin sequence, trisomy 8, craniostosis and others. Long-term follow-up revealed neurological, cardiological and ophthalmological pathologies. CONCLUSION: Some pathologies are frequent among children exposed to antiretroviral agents during perinatal life. It is crucial to carry out long-term studies to assess the safety of this therapy.

Pneumococcal disease in sub-Saharan African children: what is the effectiveness of the pneumococcal conjugate vaccine?

Streptococcus pneumoniae is still a leading cause of morbidity and mortality among children in developing countries. Young children represent a high-risk group for severe pneumococcal disease; not only because of their physio-logical susceptibility but also because polysaccharide vaccines are not effective for them. Pneumococcal conjugate vaccines have shown a high protection against pneumococcal diseases all over the world. Therefore; the expanded use of this vaccine must be considered as a major world health priority

La terapia combinada puede ser tan efectiva como la terapia antirretroviral de alta eficacia en el control de la carga viral en niños con un sistema inmunitario conservado / Combination therapy can be as effective as highly active antiretroviral therapy in controlling viral load in children with a preserved immune system

Objetivo: Comparar la efectividad de la terapia combinada (TC) y del tratamiento antirretroviral de alta eficacia (TARGA) en el control de la replicación viral en una cohorte de niños infectados por el virus de la inmunodeficiencia humana tipo 1 (VIH-1) con un sistema inmunitario relativamente conservado. Material y métodos: Realizamos un estudio observacional en 21 niños infectados verticalmente por el VIH-1 con terapia antirretroviral(TAR), comparando la efectividad de la TC y del TARGA, en el control de la carga viral (CV) plasmática. Principales variables evaluadas: Las principales variables medidas fueron la presencia de carga viral indetectable (400 copias/ml) y el desarrollo de fracasos virológicos tras alcanzaruna CV indetectable con rebotes de CV (>400 y/o >5.000 copias/ml). Resultados: Los niños con TARGA alcanzaban CV indetectables más precozmente. La media de tiempo para alcanzar CV indetectable fue de 8,1 +/- 3,7 meses en el grupo de TC y de 2,9 +/- 0,2 meses en el grupo con TARGA (p 400 copias/mL. El tiempo mediopara el aumento de CV >400 y CV >5.000 copias/mL fue similaren ambos grupos (p >0,05). Ocho niños del grupo de la TC y6 del grupo con TARGA presentaron un rebote de CV >5.000 copias/mL. En ninguno de los dos grupos hubo reducción en el porcentaje de CD4+, que se mantuvo elevado durante todo el seguimiento. El porcentaje de niños con CV <5.000 copias/mL fue similar en ambos grupos. Conclusiones: Nuestro estudio muestra que la TC puedes ertan efectiva como el TARGA en niños infectados por el VIH con un sistema inmunitario relativamente conservado

Objective: To compare the effectiveness of combination therapy (CTI and highly active antiretroviral therapy (HAART} in the control of viral replication in a group of HIV-1-infected children with a relatively preserved immune system. Design and setting: For this purpose, we carried out an observational study in 21 vertically HIV-1-infected children on ART, comparing the effectiveness of CT and HAART regimens in the control of plasma viral load (VL). Main outcome measures: The outcome variables were undetectable VL (uVL; VL 400 copies/mL; VL >5.000 copies/mL). Results: The children on HAART achieved u VL at earlier timepoints. The median time required to achieve uVL was 8.1 +/- 3.7 months in the CT group and 2.9 +/- 0.2 months in the HAART group (p 400 copies/mL. The median time to a rebound of VL >400 and VL>5.000 copies/mL were similar in the two groups of children(p >0.05). Eight children in the CT group and 6 children in the HAART group presented a rebound of VL over 5.000 copies/mL. In the CT group and HAART group, there was no reduction of the mean %CD4+, which remained high throughout the follow uperiod. The percentage of HIV children with VL <5.000copies/mL was similar in the two groups. Conclusions: The present study suggests that CT may be justs a effective as HAART in children with a relatively preservedimmune system