Natural history of HIV infected pediatric long-term or slow progressor population after the first decade of life
ABSTRACT Perinatally infected long-term nonprogressors/slow progressors represent a select group of individuals. There is very limited information on this group of children beyond the first decade of life. A group of HIV-infected long-term nonprogressor/slow progressor children was studied.
We enrolled 20 HIV-infected adolescents who were receiving no or minimal therapy (defined as single or dual nucleoside therapy) before the age of 10 years and who had maintained CD4 counts above 25% for the first decade of life. We analyzed immunologic and virologic characteristics. Thymic receptor excision circles (TREC) were measured on stored frozen peripheral blood mononuclear cells. CD4 count, viral load and other pertinent information including race and age were obtained from individual medical records.
Nine of the 20 patients recruited were noted to have developed falling CD4 counts at or around puberty, whereas the other 11 remained stable. There was no difference in TREC values or HIV RNA values before or after puberty between the 2 groups of patients. Those who remained stable, in terms of maintaining CD4 T cells as a group had falling viral loads with age. Those whose CD4 values declined after puberty had viral loads that did not decrease with age.
A select group of patients who never received HAART during their first decade of life will continue to maintain good CD4 associated with declining HIV RNA values. Thymic output is not predictive of those that don't maintain CD4 T cells.
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ABSTRACT: Ein 17-jähriger Jugendlicher wurde mit einer schweren Dysphagie und einer progressiven Peroneuslähmung aufgenommen. Bei dem Patienten bestanden seit 4Jahren eine unklare Neutropenie und wiederholte Infektionen, trotz umfangreicher Diagnostik war keine Diagnose gestellt worden. Schließlich wurde eine HIV-assoziierte CMV-Ösophagitis und Polyneuropathie bei HIV-Infektion im Stadium AIDS diagnostiziert. Die CMV-Ösophagitis wurde antiviral behandelt und eine antiretrovirale HIV-Kombinationstherapie eingeleitet. Der Infektionsweg der HIV-Infektion blieb zunächst völlig unklar. Im Verlauf konnte eine nosokomiale Infektion im 1.Lebensjahr in Rumänien als wahrscheinliche Ursache identifiziert werden. A 17-year-old German adolescent with a four year history of neutropenia and repeated infections presented with severe dysphagia and progressive right-sided peroneus palsy. In the past four years, extensive medical workup had been performed, and despite conspicuous findings, no diagnosis was made. Finally we diagnosed HIV related CMV esophagitis and HIV associated polyneuropathy. The CMV oesphagitis was treated antivirally, and highly active antiretroviral HIV therapy was initiated. The mode of HIV transmission remained obscure until further research revealed a probable nosocomial infection during early childhood in Romania.Der Internist 08/2009; 50(8):1018-1021. DOI:10.1007/s00108-009-2422-y · 0.27 Impact Factor
Article: The pathology of AIDS.Modern Pathology 03/1995; 8(2):199-217. · 6.36 Impact Factor
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ABSTRACT: Background: In adults, an increase in CD8(+)CD38(+) T cell levels is a strong indicator of disease progression in HIV infection. However, in children, data are conflicting. Slow-progressing children (SPC) provide an exceptional resource for the investigation and clarification of the immunological and virological mechanisms of natural control of HIV infection and can be used to investigate prognostic indicators of disease progression. Objectives: To investigate the immune activation status and T regulatory (Treg) cell levels in SPC. Study design: A cross-sectional study was carried out on 28 children 8 years old and older who were vertically infected with HIV. The children were stratified into 3 groups according to their clinical outcome: SPC (anti-retroviral-therapy-naïve; ≥8 years-old; CD4 ≥20%; viral load <25,000 copies), IF/VF (anti-retroviral-therapy but with no therapeutic response), and IS/VS (anti-retroviral therapy with good therapeutic response). Uninfected children (NI) were assessed as healthy control group. RESULTS: A higher percentage of activated CD8(+) T cells were found in all HIV infected children, regardless of the evolution of disease. The activation of CD8(+) T cells was not associated with either viral load or the percentage of CD4(+) T cells. In addition, Treg cell levels did not show any correlation with the clinical outcome or the activation status of CD8(+) T cells. Conclusions: HIV-1-infected children presented an increased percentage of activated CD8(+) T cells and an unaltered percentage of Treg cells, regardless of their clinical evolution. Thus, these immunological parameters should not be used for prognostic evaluation.Journal of the International Association of Physicians in AIDS Care (JIAPAC) 10/2011; 11(3):164-8. DOI:10.1177/1545109711421642