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OBJECTIVES: Several single-tablet regimens (STRs) are now available and are recommended for first-line antiretroviral therapy (ART); however, STR use for youth with HIV (YHIV) has not been systematically studied. We examined the characteristics associated with initiation of STRs versus multi-tablet regimens (MTRs) and the virological outcomes for youth with nonperinatally acquired HIV (nPHIV). METHODS: A retrospective cohort study of nPHIV youth aged 13-24 years initiating ART between 2006 and 2014 at 18 US HIV clinical sites in the HIV Research Network was performed. The outcomes measured were initiation of STRs versus MTRs, virological suppression (VS) at 12 months, and time to VS. Demographic and clinical factors associated with initiation of STR versus MTR ART and VS (< 400 HIV-1 RNA copies/mL) at 12 months after initiation were assessed using multivariable logistic regression. Cox proportional hazards regression was used to assess VS within the first year. RESULTS: Of 987 youth, 67% initiated STRs. Of the 589 who had viral load data at 1 year, 84% of those on STRs versus 67% of those on MTRs achieved VS (P < 0.01). VS was associated with STR use [adjusted odds ratio (AOR) 1.61; 95% confidence interval (CI) 1.01-2.58], white (AOR 2.41; 95% CI 1.13-5.13) or Hispanic (AOR 2.38; 95% CI 1.32-4.27) race/ethnicity, and baseline CD4 count 351-500 cells/µL (AOR 1.94; 95% CI 1.18-3.19) and > 500 cells/µL (AOR 1.76; 95% CI 1.0-3.10). STR use was not associated with a shorter time to VS compared with MTR use [hazard ratio (HR) 1.07; 95% CI 0.90-1.28]. CONCLUSIONS: Use of STR was associated with a greater likelihood of sustained VS 12 months after ART initiation in YHIV.
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Antirretrovirales/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , VIH-1/efectos de los fármacos , Adolescente , Antirretrovirales/farmacología , Femenino , Infecciones por VIH/virología , VIH-1/genética , Humanos , Modelos Logísticos , Masculino , Estudios Retrospectivos , Comprimidos , Cumplimiento y Adherencia al Tratamiento , Carga Viral/efectos de los fármacos , Adulto JovenRESUMEN
It is unknown whether vitamin D supplementation positively impacts body composition and bone outcomes in children and young adults with HIV. This RCT found that despite increasing 25(OH)D concentrations, high dose vitamin D3 supplementation did not impact bone or body composition in children and young adults with HIV infection. INTRODUCTION: The objective of this paper was to determine the impact of high-dose daily cholecalciferol (vitamin D3) supplementation on body composition and bone density, structure, and strength in children and young adults with perinatally acquired (PHIV) or behaviorally acquired (BHIV) HIV infection. METHODS: Participants were randomized to receive vitamin D3 supplementation (7000 IU/day) or placebo for 12 months. Serum 25-hydroxyvitamin D [25(OH)D] concentrations, dual energy X-ray absorptiometry (DXA) of the whole body and lumbar spine, and peripheral quantitative computed tomography (pQCT) of tibia sites were acquired at 0, 6, and 12 months. DXA and pQCT outcomes were expressed as sex- and population-ancestry specific Z-scores relative to age and adjusted for height or tibia length, as appropriate. RESULTS: Fifty-eight participants (5.0 to 24.9 years) received vitamin D3 supplements (n = 30) or placebo (n = 28). At enrollment, groups were similar in age, sex, population ancestry, growth status, serum 25(OH)D concentrations, body composition, and size-adjusted bone measures. Median 25(OH)D concentrations were similar (17.3 ng/mL in the vitamin D3 supplementation group vs 15.6 ng/mL in the placebo group), and both groups had mild bone deficits. At 12 months, 25(OH)D rose significantly in the vitamin D supplementation group but not in the placebo group (26.4 vs 14.8 ng/mL, respectively, p < 0.008). After adjusting for population ancestry, sex, antiretroviral therapy use, and season, there were no significant treatment group differences in bone or body composition outcomes. CONCLUSIONS: Despite increasing 25(OH)D concentrations, 12 months of high-dose vitamin D3 supplementation did not impact bone or body composition in children and young adults with HIV infection.
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Composición Corporal/efectos de los fármacos , Densidad Ósea/efectos de los fármacos , Colecalciferol/administración & dosificación , Infecciones por VIH/complicaciones , Deficiencia de Vitamina D/tratamiento farmacológico , Absorciometría de Fotón , Adolescente , Niño , Preescolar , Colecalciferol/farmacología , Colecalciferol/uso terapéutico , Suplementos Dietéticos , Método Doble Ciego , Esquema de Medicación , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/fisiopatología , Humanos , Estudios Longitudinales , Masculino , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/fisiopatología , Deficiencia de Vitamina D/virología , Adulto JovenRESUMEN
OBJECTIVES: We tested the hypothesis that daily vitD3 supplementation increases neuromuscular motor skills, jump power, jump energy, muscular force, and muscular strength. METHODS: This was a secondary analysis of a randomized controlled trial of 12-months of oral 7,000 IU/day vitD3 supplementation or placebo among 56 persons living with HIV aged 9-25 years. Neuromuscular motor skills were quantified using the Bruininks-Oseretsky Test of Motor Proficiency. Power was quantified using peak jump power, and energy was quantified using peak jump height. Muscular force was quantified using isometric ankle plantar- and dorsiflexion, isokinetic knee flexion and extension. Muscular strength was quantified using isometric handgrip strength. RESULTS: After 12-months, serum 25-hydroxyvitamin D [25(OH)D] was higher with supplementation versus placebo (ß=12.1 ng/mL; P<0.001). In intention-to-treat analyses, supplementation improved neuromuscular motor skills versus placebo (ß=1.14; P=0.041). We observed no effect of supplementation on jump power, jump energy, muscular force, or muscular strength outcomes versus placebo. CONCLUSIONS: Among HIV-infected children and young adults supplementation with daily high-dose vitD3 increased concentration of serum 25(OH)D and improved neuromuscular motor skills versus placebo.
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Colecalciferol/uso terapéutico , Suplementos Dietéticos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/fisiopatología , Músculo Esquelético/fisiopatología , Vitaminas/uso terapéutico , Adolescente , Niño , Preescolar , Metabolismo Energético , Femenino , Fuerza de la Mano , Humanos , Contracción Isométrica , Masculino , Destreza Motora , Fuerza Muscular , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVES: Although cognitive outcomes among perinatally infected youth have improved with highly active antiretroviral therapy (HAART), the impact of the age of initiation of treatment and the central nervous system (CNS) penetration effectiveness (CPE) of the regimen on cognitive outcomes is unknown. We aimed to describe the association between initiation age/regimen CPE score and cognitive outcomes in perinatally HIV-infected youth. METHODS: Linear regression was used to retrospectively assess the association between full-scale IQ score (FSIQ) and age of initiation of HAART, regimen CPE, and the presence/absence of an AIDS diagnosis before initiation of HAART in an urban US cohort. RESULTS: A total of 88 of 181 subjects (48.6%) had an AIDS diagnosis. In 69, AIDS preceded the start of HAART. Mean FSIQ (mean age 155.4 months) was 86.3 [standard deviation (SD) 15.6]. Neither age of initiation of HAART (P = 0.45) nor regimen CPE score (P = 0.33) was associated with FSIQ. Mean FSIQ for patients with an AIDS diagnosis before HAART initiation [82 (SD 17.0)] was significantly lower than for patients initiating HAART before an AIDS diagnosis [90 (SD 13)] (P = 0.001). Of the 129 subjects without AIDS by age 5 years, 41 (31.8%) initiated HAART before age 5 years; four of 41 later developed AIDS, compared with 32 of 88 of those who did not initiate HAART before age 5 years. The relative risk of AIDS if HAART was initiated before age 5 years was 0.19 (95% confidence interval 0.05-0.60). CONCLUSIONS: Earlier age at HAART initiation and higher CPE score of a regimen did not improve cognitive outcomes. However, initiating HAART prior to AIDS protected against AIDS and was associated with a significantly higher FSIQ.
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Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Trastornos del Conocimiento/prevención & control , Infecciones por VIH , Transmisión Vertical de Enfermedad Infecciosa , Inteligencia/efectos de los fármacos , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Factores de Edad , Recuento de Linfocito CD4 , Niño , Preescolar , Trastornos del Conocimiento/etiología , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Modelos Lineales , Masculino , Análisis de Regresión , Estudios RetrospectivosRESUMEN
BACKGROUND: Natural killer (NK) cells and plasmacytoid and myeloid dendritic cells (DCs) are depleted, and their function impaired, in advanced adult human immunodeficiency virus (HIV)-1 infection. Studies in perinatally infected children are lacking. METHODS: Percentages of NK cells and plasmacytoid and myeloid DCs were evaluated by flow cytometry. Forty children with perinatal HIV-1 infection were compared with 11 age-matched, uninfected children. Plasmacytoid and myeloid DC function was evaluated by activation-induced cytokine secretion. RESULTS: Virally suppressed children had normal levels of circulating plasmacytoid and myeloid DCs and total NK cells but had sustained depletion of a mature (CD3-/161+/56+/16+) NK cell subset and decreased interferon- alpha secretion by plasmacytoid DCs. Despite similar viral loads, percentages of myeloid and plasmacytoid DCs and mature NK cells were significantly lower in viremic children with a history of decreasing CD4+ cell percentages, compared with children with stable CD4+ cell counts. CONCLUSIONS: Children achieve partial reconstitution of myeloid and plasmacytoid DCs and NK cells during viral suppression; irrespective of viral load, a clinical history of decreasing CD4+ cell percentage is associated with greater depletion of these subsets. We hypothesize that the evaluation of selected innate-immunity effector cells may serve as a marker of CD4+ cell loss in pediatric HIV-1 infection.
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Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/inmunología , Recuento de Linfocito CD4 , Células Dendríticas/inmunología , Células Asesinas Naturales/inmunología , Síndrome de Inmunodeficiencia Adquirida/sangre , Niño , Citocinas/sangre , Femenino , Citometría de Flujo , VIH-1 , Antígenos HLA-DR/sangre , Humanos , Interferón-alfa/sangre , Subgrupos Linfocitarios/inmunología , Masculino , Valores de ReferenciaRESUMEN
OBJECTIVE: To investigate the effects of the home environment, socioeconomic status (SES), and health status on cognitive functioning in a sample of children with HIV-1 infection in a cross-sectional study. METHODS: Forty-three caregivers and their children (2.5 to 12 years) participated. Caregivers completed two self-report measures of the home environment that included questions regarding the organization of the environment, play materials, parental involvement, variety of stimulation, and parental attitudes toward the provision of a cognitively stimulating environment. Cognitive functioning was assessed using a standardized intelligence (IQ) test. Children's medical charts were reviewed for HIV-1 classification status (CDC, 1994), CD4 cell counts, and current medication. RESULTS: This study revealed two primary findings. First, measures of the home environment mediated the association between SES and child IQ. Second, measures of the home environment had a stronger association with child IQ during the advanced stages of disease than earlier stages of disease. CONCLUSIONS: The home environment is associated with cognitive functioning among children with HIV-1 infection. Moreover, interventions aimed at enhancing the quality of the home environment may have a positive impact on these children's cognitive development.
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Infecciones por VIH/congénito , VIH-1 , Estado de Salud , Inteligencia , Medio Social , Factores Socioeconómicos , Niño , Preescolar , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Humanos , Masculino , PronósticoRESUMEN
BACKGROUND: Accommodative spasm (AS) has been reported to be a rare cause of an acquired unilateral visual loss. We describe a unique case of acquired visual loss due to an apparent unilateral AS triggered by occlusion of the contralateral eye. Clinical examination and photorefraction techniques were performed during the acute phase of the disorder and in the follow-up evaluations. CASE REPORT: An otherwise healthy 27-year-old woman presented with a 2-month decrease of vision in her left eye. Unaided visual acuity in the right eye was 20/20 and in the left eye was finger counting. Orthophoria existed at distance and near. The decrease in vision in the left eye was attributed to an apparent unilateral AS of 5 D, which occurred only when the right eye was occluded. Under the occluder, the right eye also manifested an AS. With the left eye occluded or with binocular viewing, the right eye and left eye accommodated normally. With a 5 D convex lens before the right eye, the visual acuity in the left eye was 20/20. Refractive error with cycloplegia revealed low hyperopia in each eye. CONCLUSION: AS can be the cause of acquired unilateral visual loss. To our knowledge, this is the first documented report of an apparent unilateral AS triggered by occlusion of the contralateral eye.
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Acomodación Ocular , Músculos Oculomotores/patología , Espasmo/complicaciones , Trastornos de la Visión/etiología , Adulto , Femenino , Humanos , Privación Sensorial , Agudeza VisualRESUMEN
OBJECTIVE: To examine the prevalence of steatorrhea and exocrine pancreatic insufficiency (EPI) and their association with growth and immune status variables in children with perinatally acquired human immunodeficiency virus (HIV) infection. DESIGN: Cross-sectional study. SETTING: Tertiary care HIV subspecialty practice. PARTICIPANTS: Children with perinatally acquired HIV infection. Exclusion criteria included being younger than 1 year and receiving mineral oil as a medication. METHODS: Weight, height, and upper arm anthropometric variables were measured. Spot stool samples were analyzed for steatorrhea using the Sudan III qualitative test and for EPI using fecal elastase-1 enzyme assay. Hormone-stimulated pancreatic function testing and 72-hour stool and dietary fat sample collection were performed when fecal elastase-1 enzyme was in the range of EPI, defined as less than 200 microgram/g. HIV RNA viral load, CD4 status, type of antiretroviral therapy, and biochemical evidence of hepatobiliary disease were measured within 3 months of stool sample collection. z Scores were computed for height, weight, triceps skinfold, and upper arm muscle area. RESULTS: We enrolled 44 patients (23 girls [52%]) with a mean +/- SD age of 7.4 +/- 3.1 years. None had hepatobiliary disease. The prevalence of steatorrhea was 39% (95% confidence interval, 23%-56%). The prevalence of EPI was 0% (95% confidence interval, 0%-9%). There were no associations between steatorrhea and EPI, growth, HIV RNA viral load, CD4 status, or type of antiretroviral therapy. Older children had decreased z scores for height (r = -0.42; P =.006). CONCLUSIONS: The clinical significance of steatorrhea in children with HIV infection is unclear. Furthermore, its evaluation should focus on nonpancreas-based conditions. Continual close monitoring of growth is essential in children with HIV infection.
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Enfermedad Celíaca/complicaciones , Crecimiento , Infecciones por VIH/complicaciones , Enfermedad Celíaca/inmunología , Niño , Desarrollo Infantil/fisiología , Estudios Transversales , Insuficiencia Pancreática Exocrina/complicaciones , Femenino , Crecimiento/inmunología , Infecciones por VIH/inmunología , Infecciones por VIH/fisiopatología , Humanos , Masculino , Páncreas/fisiología , Elastasa Pancreática/sangre , Perinatología , PrevalenciaRESUMEN
In the 20 years since the first description of the clinical manifestations of HIV infection, more than 32 million people have been infected worldwide. In untreated HIV-infected pregnant women, the risk of maternal-child transmission varies from 16 to 40%. In developed countries, utilizing combinations of available medications and elective cesarean sections, it is possible to lower the transmission rates to less than 2 to 4%. Effective programs use universal screening of pregnant women, perinatal antiretroviral therapy, and, at times, delivery via elective cesarean section. In resource-poor areas, major barriers remain to the control of maternal-child transmission.
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Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Lactancia Materna , Parto Obstétrico , Femenino , Humanos , Embarazo , Factores de Riesgo , Zidovudina/uso terapéuticoRESUMEN
With the advent of highly active antiretroviral therapy (HAART), children with perinatally acquired human immunodeficiency virus (HIV) are living into their school-age years and adolescence. This study was designed to explore some of the medical, educational, and psychosocial aspects of these older children's lives. A retrospective chart review of 85 HIV-infected, school-age patients was conducted to obtain demographic and clinical data. Fifty-four of these patients and their caregivers were interviewed regarding school-related issues. Although 50% of the children had experienced severe symptoms (Centers for Disease Control [CDC] class C) related to their HIV infection, their mean CD4 count at the time of the study was 722 cells per microliter, and 40% had an undetectable (<40 copies per milliliter) viral load. More than two thirds of the patients were not hospitalized over the course of the year. The mean developmental quotient (DQ) for the group was 85; 12% of the children had a DQ below 70. Nearly all (85%) of the children were attending public school, and 76.5% were in the appropriate grade level for their age. More than half (53%) required some special services while in school. Forty-three percent of the children had been told their HIV status, and the average age at disclosure was 9 years. School employees had been told the child's diagnosis in 23% of the cases. As the perinatally acquired HIV-infected population ages, health care providers must be cognizant of the range of issues, both medical and social, confronting these children.
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Desarrollo Infantil , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa , Carencia Psicosocial , Adolescente , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/uso terapéutico , Niño , Preescolar , Escolaridad , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Humanos , Masculino , Philadelphia , Sistema de Registros , Estudios RetrospectivosAsunto(s)
Neumonía por Pneumocystis/terapia , Adolescente , Antiinfecciosos/uso terapéutico , Candidiasis Bucal/etiología , Técnicas de Laboratorio Clínico , Diagnóstico Diferencial , Ensayo de Inmunoadsorción Enzimática , Seropositividad para VIH , Humanos , Inmunoglobulina G/análisis , Pruebas de Función Hepática , Masculino , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/microbiología , Esputo/microbiología , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
PURPOSE: Although there have been studies in the past of the difference between distance and near stereopsis in intermittent exotropia, no such comparisons have been studied and/or reported for other forms of strabismus, nor for strabismic functional amblyopia, or for refractive functional amblyopia. METHODS: The study was prospective: Sixty-eight consecutive patients, ages 6-76 years, with either childhood onset strabismus and no amblyopia, childhood onset strabismus and amblyopia, or refractive amblyopia and no strabismus, had their stereopsis measured. Distance stereopsis was determined on the Mentor BVAT with Random Dot E Test (global stereopsis) and the Circle Test (contour stereopsis). Near stereopsis was determined with the Circle Test of the Randot Stereotest. The data were tabulated and analyzed statistically. RESULTS: Of the 26 strabismus/no amblyopia cases, 14 (54%) appreciated distance stereopsis. Of these, 12/14 were intermittent, and other 2 who were constant had deviations of 8 PD or less. Only 4 of the 14 appreciated global stereopsis at distance (mean = 90 sec. of arc), but all 14 appreciated contour stereopsis at distance (mean = 125 sec. of arc). Of all 26, 21 (81%) had near stereopsis (mean = 137 sec. of arc). For the 21 strabismic amblyopes, only one appreciated global stereopsis at distance (120 sec of arc), and 2 (10%) contour stereopsis at distance (mean = 210 sec. of arc). These two and 4 others (total 29%) had near stereopsis (mean = 162 sec. of arc). For the 21 refractive amblyopes, 3 appreciated global stereopsis at distance (mean = 220 sec. of arc), 11 in all, (52%) contour stereopsis at distance (mean = 121 sec. of arc) and 20 (95%) had near stereopsis (mean = 78 sec. of arc). The percentages of patients in all categories capable of appreciating distance stereopsis were "statistically significantly" (P<.05) or clinically/medically significantly different from (less than) the percentages having near stereopsis. CONCLUSIONS: distance stereopsis is more likely to be reduced or absent than near stereopsis in strabismus, strabismic amblyopia and refractive amblyopia and thus appears to be more sensitive to, and better screening for, binocular vision disorders and a stronger and better outcome standard for treatment of binocular vision disorders than near stereopsis.
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Ambliopía/diagnóstico , Errores de Refracción/diagnóstico , Estrabismo/diagnóstico , Selección Visual/métodos , Visión Binocular , Agudeza Visual , Adolescente , Adulto , Anciano , Niño , Percepción de Profundidad , Diagnóstico Diferencial , Humanos , Persona de Mediana Edad , Pronóstico , Estudios ProspectivosRESUMEN
PURPOSE: To describe a patient with accommodative esotropia who developed spasm of the near reflex. CASE REPORT: A 6-year-old girl with a history of successfully treated refractive, accommodative esotropia suddenly developed spasm of the near reflex after the death of a relative. The condition resolved after 2 months. CONCLUSION: Spasm of the near reflex should be considered in children with accommodative esotropia who seem to deteriorate and become esotropic once again while wearing their hyperopic glasses.
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Acomodación Ocular , Esotropía/complicaciones , Hiperopía/complicaciones , Espasmo , Niño , Diagnóstico Diferencial , Esotropía/diagnóstico , Movimientos Oculares , Femenino , Humanos , Hiperopía/diagnóstico , Hiperopía/fisiopatología , Agudeza VisualRESUMEN
Pneumococcal antibody levels surrounding systemic pneumococcal illness (SPI) were measured in children infected with human immunodeficiency virus (HIV). Archived serum samples were collected from 28 HIV-infected children who had 34 cases of SPI, caused by pneumococcal groups 4, 6, 9, 14, 19, and 23. Serum samples collected within 23 weeks before and 13 weeks after the SPI were assayed by ELISA for antipneumococcal polysaccharide (PnPs) IgG antibody to 6 representative pneumococcal serotypes. There was a wide range (0. 16-30.80 microg/mL) of pre-SPI anti-PnPs antibody levels to the presumed infecting serotypes, with a geometric mean level of 0.83 microg/mL (n=34). Seventy-six percent of the antibody values were <2.0 microg/mL, and 95% were <5.0 microg/mL. Homologous seroresponses (>/=4-fold rise in anti-PnPs antibody) were detected in only 4 (27%) of 15 paired serum samples. Heterologous, noninfecting group seroresponses were detected frequently (72%) in the paired serum samples from these 4 homologous group seroresponders.
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Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Anticuerpos Antibacterianos/sangre , Infecciones por VIH/inmunología , Inmunoglobulina G/sangre , Infecciones Neumocócicas/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/sangre , Bacteriemia/sangre , Bacteriemia/inmunología , Niño , Ensayo de Inmunoadsorción Enzimática , Infecciones por VIH/sangre , Humanos , Registros Médicos , Infecciones Neumocócicas/sangre , Polisacáridos Bacterianos/inmunologíaRESUMEN
Orphenadrine (N,N-dimethyl-2(o-methyl-alpha-phenylbenzyloxy)ethylamine) is an analog of diphenhydramine with central and peripheral anticholinergic properties. It is commonly prescribed both as a muscle relaxant and as an adjunct to antipsychotic medications to prevent parkinsonism. We report a case of orphenadrine poisoning in a 3-year-old boy following ingestion of no more than two 100-mg tablets. Central anticholinergic toxicity was prominent, manifested by hallucinations and severe agitation. Orphenadrine can cause profound toxicity in children after ingestion of small doses, and should be considered as a potential cause for acute delirium in childhood.
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Antagonistas Colinérgicos/envenenamiento , Delirio/inducido químicamente , Alucinaciones/inducido químicamente , Relajantes Musculares Centrales/envenenamiento , Orfenadrina/envenenamiento , Preescolar , Urgencias Médicas , Humanos , Masculino , SíndromeRESUMEN
PURPOSE: To determine the efficacy of distance stereotesting as a screening device. METHODS: Distance stereoacuity using the global Random Dot and contour Circle test of the Mentor BVAT II-SG computerized testing system was measured for 216 patients, ages 6 to 18 years, before the clinical examination. Patients were classified into pass/fail groups in the areas of refractive error change (REC), ocular deviation (DEV), visual acuity (VA), and all three together (EXAM). Legitimate cutoff scores were obtained when patients were classified as 'pass' as follows: REC if the change was 0.50 D or less in sphere or cylinder relative to the habitual correction or to emmetropia if no habitual correction; DEV if there was no heterophoria or strabismus at distance (criteria of heterophoria of < 6 prism diopters and heterophorias of any magnitude were also tested); VA if the acuity at distance was better than or equal to 20/25 in the poorer eye and better than or equal to 20/20 in the better eye; EXAM if they were pass in REC, DEV, and VA. Optimal pass/fail cutoff values for the stereopsis measurements were determined by finding the maximum chi2 value from contingency tables constructed using pass/fail levels for the screening test at each of the observed levels. RESULTS: The pass rates for REC, DEV, VA, and EXAM were 45%, 72%, 42%, and 24%, respectively. Patients passed the BVAT at the analytically determined optimal cutoff values of less than or equal to 120 sec arc for global and less than or equal to 30 sec arc for contour stereopsis. The sensitivity and specificity for global stereopsis were 0.90 and 0.40 for REC, 0.89 and 0.30 for DEV, 0.93 and 0.51 for VA, and 0.87 and 0.63 for EXAM. For contour stereopsis, the corresponding values were 0.85 and 0.42, 0.89 and 0.34, 0.91 and 0.53, and 0.84 and 0.62. CONCLUSION: Distance stereotesting is highly sensitive to small refractive error changes, heterophorias and strabismus, visual acuities < 20/25, or any of the three. Global stereopsis is only slightly better than contour stereopsis at classifying patients. Distance stereotesting has potential as an effective screening test.
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Percepción de Profundidad , Errores de Refracción/diagnóstico , Trastornos de la Visión/diagnóstico , Selección Visual/métodos , Visión Binocular , Adolescente , Niño , Reacciones Falso Negativas , Humanos , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Selección Visual/instrumentación , Agudeza VisualRESUMEN
We reviewed the short-term response to and safety of protease inhibitor (PI) therapy in HIV-infected children by performing a retrospective chart review of open-label PI containing combination therapy at two urban pediatric HIV centers. Seventy HIV-infected children received 101 PI containing antiretroviral therapy (ART) combinations. Main outcome measures were follow-up CD4 counts, viral loads, and patient or caregiver reported compliance. During follow-up, treatment with PI ART was associated with a mean maximal increase in CD4+ lymphocyte count of 454 x 10(6)/L and a mean maximal decrease in viral load of 1.76 log units. Of the 32 patients who achieved undetectable viral loads, 28 (87.5%) remained undetectable through a mean follow-up of 8.9 months. Patients who reported good compliance achieved a higher rate of response (92.6%) than those who reported poor compliance (61.5%). Of 14 changes made to a second PI because of treatment failure, 11 (78.6%) resulted in a positive response to the second regimen. Nineteen of 101 courses of PI therapy resulted in significant side effects, including renal complications in 8 of 21 patients treated with indinavir. PI ART was associated with substantial short-term improvement in immunological and virological parameters in this heavily pretreated cohort, with 40% of patients maintaining an undetectable viral load after 9 months of therapy. Patients who failed one PI regimen usually responded to a second regimen. There was a significant rate of side effects from PI treatment.
Asunto(s)
Didanosina/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/uso terapéutico , Lamivudine/uso terapéutico , Nelfinavir/uso terapéutico , Estavudina/uso terapéutico , Zidovudina/uso terapéutico , Adolescente , Factores de Edad , Terapia Antirretroviral Altamente Activa/métodos , Recuento de Linfocito CD4 , Niño , Preescolar , Femenino , Infecciones por VIH/inmunología , Infecciones por VIH/psicología , Infecciones por VIH/virología , Humanos , Lactante , Masculino , Cooperación del Paciente/psicología , Cooperación del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Carga ViralRESUMEN
Peripheral blood mononuclear cells (PBMC) of human immunodeficiency virus (HIV)-infected children, age-matched HIV-seronegative controls, and HIV-infected asymptomatic and symptomatic adults were compared for their ability to mediate antibody-dependent cellular cytotoxicity (ADCC) and natural killer (NK) cell-mediated cytotoxicity against target cells expressing HIV or herpes simplex virus (HSV) antigens. Target cells consisted of CD4 lymphocytes purified from PBMC of HIV-seronegative adults and incubated with the IIIB strain of HIV, HUT78 cells chronically infected with IIIB, and HSV-infected human fibroblasts. PBMC of asymptomatic HIV-infected adults were generally able to lyse CD4 cells expressing HIV antigens. Direct correlation was found between the magnitude of lysis and absolute CD4 cell counts in these individuals. In contrast to these results, PBMC from HIV-infected children were generally unable to lyse IIIB-expressing CD4 cells, regardless of the children's clinical status, age, or absolute CD4 cell counts. Cells from HIV-seronegative adults and children did not directly lyse these target cells either but, in contrast to cells of HIV-seropositive children, were able to mediate cell lysis when serum from an HIV-seropositive adult was added. However, effector cells from these HIV-infected children were able to mediate both ADCC against HSV-infected fibroblasts and NK cell-mediated cytotoxicity against IIIB-infected HUT78 cells. Reduced ability of PBMC from vertically HIV-infected children to mediate ADCC against HIV antigen-expressing CD4 cells may contribute to rapid progression to AIDS.
Asunto(s)
Linfocitos T CD4-Positivos/inmunología , Infecciones por VIH/inmunología , VIH-1 , Adulto , Factores de Edad , Recuento de Linfocito CD4 , Linfocitos T CD4-Positivos/citología , Linfocitos T CD4-Positivos/virología , Células Cultivadas , Niño , Preescolar , Pruebas Inmunológicas de Citotoxicidad , Epítopos , Anticuerpos Anti-VIH/análisis , Anticuerpos Anti-VIH/sangre , Infecciones por VIH/transmisión , Seronegatividad para VIH , Seropositividad para VIH , Humanos , Inmunidad Celular/inmunología , Lactante , Transmisión Vertical de Enfermedad Infecciosa , Células Asesinas Naturales/citología , Células Asesinas Naturales/inmunología , Células Asesinas Naturales/virologíaRESUMEN
PURPOSE: To determine if higher degrees of anisometropia cause deeper amblyopia and poorer binocularity than lower degrees of anisometropia in children and adults. METHODS: The clinical records for 60 patients with untreated anisometropic amblyopia without strabismus, ranging in age from 3 to 39 years, were reviewed. The refractive error, the initial best corrected visual acuities in the amblyopic and nonamblyopic eyes, and the level of binocularity were recorded from each chart. The degree of anisometropia was determined by: (1) calculating the difference between spherical equivalents for each eye; (2) calculating the difference in the vertical meridians for each eye; (3) calculating the difference in the horizontal meridians for each eye; and (4) calculating the root mean square difference which also takes into account differences in astigmatic axis. The depth of amblyopia was determined by converting the visual acuity score to its logarithmic value, logarithm of the minimum angle of resolution (logMAR), and calculating the difference between the amblyopic and nonamblyopic eye. The level of binocularity was determined from stereopsis testing. RESULTS: For all patients, there was a significant relationship between the four measures of anisometropia, the depth of amblyopia, and the level of binocularity (median correlations 0.61 and 0.61, respectively). For the myopes (N = 10), there was no significant relationship between the 4 measures of anisometropia, the depth of amblyopia, and the level of binocularity (median correlations 0.34 and 0.61, respectively). For the hyperopes (N = 50), the relationship was significant for all 4 measures of anisometropia (median correlations 0.72 and 0.62, respectively). CONCLUSION: As the degree of anisometropia increases, the depth of amblyopia becomes greater and the level of binocularity becomes poorer, at least for hyperopic patients.
Asunto(s)
Ambliopía/etiología , Anisometropía/complicaciones , Visión Binocular , Adolescente , Adulto , Ambliopía/diagnóstico , Ambliopía/fisiopatología , Anisometropía/diagnóstico , Anisometropía/fisiopatología , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Pronóstico , Refracción Ocular , Estudios RetrospectivosRESUMEN
To examine the protective role of cellular immunity in the vertical transmission of HIV, we analyzed HIV-specific IL-2 and CTL responses, as well as beta-chemokine expression in HIV-infected and uninfected infants of HIV+ mothers. Our results showed that HIV envelope (env) peptide-specific IL-2 responses associated with beta-chemokine production were detectable at birth in the majority of uninfected infants of HIV+ mothers. The responses falling to background before the infants were 1 yr old were rarely associated with HIV-specific CTL activity. Conversely, HIV-specific Th and CTL cellular responses were absent at birth in HIV-infected infants. Infants with AIDS-related symptoms exhibited undetectable or very low levels of HIV-specific cellular immunity during the first year of life, whereas those with a slowly progressive disease showed evidence of such immunity between their second and ninth month. The latter group of infected infants tested negative for plasma HIV RNA levels shortly after birth, suggesting lack of intrauterine exposure to HIV. The presence of HIV-specific Th responses at birth in uninfected newborns of HIV+ mothers, but absence of such activities in HIV-infected infants without evidence of intrauterine HIV infection, suggests that in utero development of HIV-specific Th responses associated with beta-chemokines could mediate nonlytic inhibition of infection during vertical transmission of HIV.