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Myelomeningocele in a child with intrauterine exposure to efavirenz

AIDS (Impact Factor: 6.56). 02/2002; 16(2):299-300. DOI: 10.1097/00002030-200201250-00025
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    ABSTRACT: Background: Long-term effects of in utero and neonatal antiretroviral (ARV) exposure on cognitive and academic development in HIV-exposed, uninfected school-age children are unknown. Methods: HIV-exposed, uninfected children, ages 5-13 years, in Pediatric HIV/AIDS Cohort Study Surveillance Monitoring for Antiretroviral Treatment Toxicities, a US-based multisite cohort study, completed age-appropriate Wechsler intelligence and academic scales (WPPSI-III, WASI, WIAT-II-A). Associations between cognitive and academic outcomes and in utero ARV exposure by regimen, class and individual ARVs were evaluated, adjusting for potential confounders. Results: Children completing WPPSI-IIIs (n = 350) were 49% male, 74% Black, 25% Hispanic; WASI (n = 337) and WIAT-II-A (n = 415) cohorts were similar. The percentage exposed to combination ARV (cARV) was 84% (WPPSI-III), 64% (WASI) and 67% (WIAT-II-A). Among ARV-exposed children, there were no significant associations between any ARV regimen or class and any cognitive or academic outcome. In addition, in both unadjusted models and after adjustment for caregiver IQ, sociodemographic factors and maternal health and substance use during pregnancy, no individual ARV drug was associated with significantly lower cognitive or academic scores. Factors typically associated with lower cognitive and academic scores in the general population, such as prematurity, small for gestational age, maternal alcohol use and lower maternal cognitive status, were also associated with lower scores in this study. Conclusions: Overall, the safety of prenatal and neonatal ARV use was supported.
    The Pediatric Infectious Disease Journal 11/2014; 33(11):1128-33. DOI:10.1097/INF.0000000000000410 · 3.14 Impact Factor
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    ABSTRACT: R SpecialIssue ecently, a report suggested that the epidemic of human immune deficiency virus (HIV) infection may have reached its peak. Although the number of new cases is reducing, the number of people living with HIV has not decreased as the patients survive in this era in which effective antiretroviral therapy has been widely accessible. The knowledge about HIV disease has never been this immense. The challenges facing us have changed from treating the dying diseased cases complicated with opportunistic infections to dealing with the problems related to long-term treatment including life-long adhe-rence, drug adverse effects, drug resistance, and the need for a newer generation with less toxic drugs. In children, additional challenges are related to adolescent problems. This review summarizes the challenging issues of this era in treating HIV-infected children. The overview disease burden In 2009, there were 33.3 million people living with HIV worldwide, of which 5-10% were children. 1 The majority of them are living in Sub-Saharan Africa. In Thailand, an estimated 400,000 infected people with HIV were reported in 2009, of which approximately 15,000-20,000 were children. Nearly all of them were acquired perinatally. The prevalence of HIV infection among pregnant women in Thailand has declined from 1.74% in 1999 to 0.64% in 2009. After the implementation of a nation-wide prevention-of-mother-to-child-transmission (PMTCT) program, the rate of perinatal transmission has decreased from 25% to 2-4%. 2 Diagnosis of HIV infection in perinatally HIV-exposed infants Virologic assay, either HIV DNA-PCR or RNA-PCR assay, can be used for diagnosis of HIV infection in infants. Because of the maternally transferred anti-HIV antibody, the serologic test causes a false positive in uninfected young infants. The PCR is recommended to be performed at least 2 times at age 1-2 months and 4-6 months. At age 12-18 months of age, the HIV antibody test should always be performed to confirm the diagnosis regardless of the results of prior virologic tests. HIV infection can be definitely diagnosed by the presence of HIV antibody in children aged ≥ 18 months. Definitive exclusion of HIV infection can be made by no clinical or virologic evidence of HIV infection plus one of the fol-lowing criteria: 1) at least two negative HIV PCR assays which are performed at age ≥ 1 month and ≥ 4 months, 2) at least two negative HIV antibody tests at ≥ 6 months of age, 3) one negative HIV PCR at age ≥ 4 months and absence of HIV antibody after 6 months of age. 3 Management of HIV-infected children: the current Thai guidelines HIV-infected children require routine care and an-ticipatory guidance similar to normal children. All HIV-infected children should be immunized with the same schedule as uninfected children except that children with severe immune suppression (CD4 percentage < 15% or CD4 count < 200 cells/mm 3) or severely symptomatic disease status should not receive live-attenuated vaccine such as mumps-measles-rubella or varicella vaccine. Moreover, all HIV-exposed infants with unknown infection status from 4-6 weeks of age, should receive chemoprophylaxis against Pneumocystis jiroveci pneumonia (PCP) until HIV infection can be excluded. Cotrimoxazole is the drug of choice. Likewise, infected children younger than 12 months or those with CD4 < 15%; or < 200 cells/mm 3 in children older than 5 years, should also receive PCP prophylaxis. This is because the risk of PCP development is quite high in HIV-infected infants < 12 months regardless of their CD4 levels. Highly active antiretroviral therapy (HAART) has been the principle of treatment of HIV infection. HAART normalizes immunologic function, prevents opportunistic infection and mortality. With HAART, HIV has been changed from a deadly disease to a chronic disease in which patients can live a very normal life. HAART is generally composed of three drugs from at least two classes. The aims of antiretroviral therapy are to minimize viral load, maintain viral suppression, preserve immune function, maintain normal growth and development, and improve the quality of life.
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