RESUMEN
OBJECTIVES: To determine the spectrum of serum immunoreactive erythropoietin (SIE) levels amongst HIV-infected children aged < 13 years in relation to the levels among healthy children as well as those with renal failure; to examine the relationship between clinical and laboratory parameters and SIE levels. DESIGN: A cross-sectional study with a descriptive non-interventional format. HIV-infected Canadian subjects were recruited through four tertiary Canadian and one Bahamian centre. Children with renal failure and healthy children were recruited from one of the Canadian centres. METHODS: Study subjects had clinical and laboratory profiles determined at baseline and at each of five follow-up periods over 1 year. SIE levels were measured by radioimmunoassay with a normal range of 12-28 IU/I. Data handling and statistical functions were performed by the Canadian HIV Trials Network. RESULTS: The study enrolled 133 HIV-infected subjects and 38 controls. Of these, 117 HIV-infected subjects, 24 healthy controls, and 11 controls with renal failure were eligible for analysis. The median age of infected subjects was 44 months, whereas that of healthy controls was 56 months, and 95 months for controls with renal failure. The median SIE levels were 14 and 11 IU/I for subjects with renal failure and healthy subjects, respectively. The median SIE level was 61 IU/I among zidovudine (ZDV)-treated subjects and 22 IU/I among ZDV-naive HIV-infected subjects. HIV-infected children almost invariably had SIE levels < 200 IU/I. The median SIE levels amongst HIV-infected subjects whose hemoglobin levels were < 100 g/l were 98 and 31 IU/I for ZDV-treated and ZDV-naive subjects, respectively (P = 0.002). This difference in median SIE levels between ZDV-treated subjects and ZDV-naive subjects was also observed among subjects whose hemoglobin levels were > 100 g/l (median, 58 and 15 IU/l, respectively; P < 0.001). Hemoglobin level was the most important predictor of log10 SIE (P < 0.01 for ZDV-treated and ZDV-naive subjects). CONCLUSIONS: SIE levels amongst HIV-infected children were affected by HIV infection, use of ZDV, and presence or absence of anemia. SIE levels amongst HIV-infected children were generally lower than 200 IU/I. This characterization of SIE levels will facilitate clinical trials of exogenous recombinant human erythropoietin in HIV-infected children with anemia.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Eritropoyetina/sangre , Infecciones por VIH/sangre , Zidovudina/uso terapéutico , Anemia/prevención & control , Bahamas , Canadá , Niño , Preescolar , Estudios Transversales , Femenino , Infecciones por VIH/tratamiento farmacológico , Hemoglobinas/análisis , Humanos , Lactante , Masculino , Insuficiencia Renal/sangreRESUMEN
OBJECTIVES: To determine the spectrum of serum immunoreactive erythropoietin (SIE) levels amongst HIV-infected children aged <13 years in relation to the levels among healthy children as well as those with renal failure; to examine the relationship between clinical and laboratory parameters and SIE levels. DESIGN: A cross-sectional study with a descriptive non-interventional format. HIV-infected Canadian subjects were recruited through four tertiary Canadian and one Bahamian centre. Children with renal failure and healthy children were recruited from one of the Canadian centres. METHODS: Study subjects had clinical and laboratory profiles determined at baseline and at each of five follow-up periods over 1 year. SIE levels were measured by radio-immunoassay with a normal range of 12-28 IU/I. Data handling and statistical functions were performed by the Canadian HIV Trials Network. RESULTS: Ths study enrolled 133 HIV-infected subjects and 38 controls. Of these, 117 HIV-infected subjects, 24 healthy controls, and 11 controls with renal failure were eligible for analysis. The median age of infected subjects was 44 months, whereas that of healthy controls was 56 months, and 95 months for controls with renal failure. The median SIE levels were 14 and 11 IU/I for subjects with renal failure and healthy subjects, respectively. The median SIE level was 61 IU/I among zidovudine (ZDV)-treated subjects and 22 IU/I among ZDV-naive HIV-infected subjects. HIV-infected children almost invariably had SIE levels < 200 IU/I. The median SIE levels amongst HIV-infected subjects whose hemoglobin levels were < 100 g/l were 98 and 31 IU/I for ZDV-treated and ZDV-naive subjects, respectively (P = 0.002). This difference in median SIE levels between ZDV-treated subjects and ZDV-naive subjects was also observed among subjects whose hemoglobin levels were > 100 g/l (median, 58 and 15 IU/I, respectively; P < 0.001). Hemoglobin level was the most important predictor of log10 SIE (P < 0.001 for ZDV-treated and ZDV-naive subjects). CONCLUSIONS: SIE levels amongst HIV-infected children were affected by HIV infection, use of ZDV, and presence or absence of anemia. SIE levels amongst HIV-infected children were generally lower than 200 IU/I. This characterization of SIE levels will facilitate clinical trials of exogenous recombinant human erythropoietin in HIV-infected children with anemia.(Au)
Asunto(s)
Niño , Preescolar , Estudio Comparativo , Femenino , Humanos , Masculino , Lactante , Fármacos Anti-VIH/uso terapéutico , Eritropoyetina/sangre , Zidovudina/uso terapéutico , Infecciones por VIH/sangre , Bahamas , Canadá , Estudios Transversales , Hemoglobinas/análisis , Infecciones por VIH/tratamiento farmacológico , Insuficiencia Renal/sangre , Anemia/prevención & controlRESUMEN
In the reversal of the thrombocytopenia of acute ITP in children, the traditional dose of prednisone (2mg/kg/day) has a low success rate. This study was conducted to examine the efficacy of high-dose prednisone (4mg/kg/day) in the above disease. A retrospective review was conducted for the time period 1983 to 1988 inclusive. Patients were included if they satisfied the usual criteria for diagnosis of acute ITP. A response to therapy was defined as a doubling of pre-treatment platelet count or a rise in platelet count to greater than 50 x 10(to the 9th power)/1. Sixteen patients were identified. All had pre-treatment platelet count to greater than 50 x 10(to the 9th power)/1 at 24 hour after the start of highdose prednisone. A response (as defined above) was obtained in 12.5 percent of patients at 48 hours. Similarly, 56.2 percent had a response at 72 hours, while 68.8 percent had a response at greater than 72 hours. Transient weight gain was the only complication noted. Oral high-dose (4km/kg/day) prednisone is efficacious in rapidly reversing the thrombocytopenia of acute ITP of childhood. This may prove to be a more cost-effective alternative to intravenous gamma globulin (AU)