Rohan Hazra

Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maryland, United States

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Publications (69)256.58 Total impact

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    ABSTRACT: Most studies examining the association of prenatal antiretroviral (ARV) exposures with congenital anomalies (CAs) in children born to human immunodeficiency virus (HIV)-infected women have been reassuring, but some evidence suggests an increased risk with specific ARV agents.
    JAMA Pediatrics 11/2014; · 4.28 Impact Factor
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    ABSTRACT: 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.
    The Pediatric Infectious Disease Journal 11/2014; 33(11):1128-33. · 3.57 Impact Factor
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    ABSTRACT: Objective To evaluate the occurrence, clinical presentations and diagnostic methods for tuberculosis in a cohort of HIV-infected infants, children and adolescents from Latin America. Methods A retrospective analysis of children with tuberculosis and HIV was performed within a prospective observational cohort study conducted at multiple clinical sites in Latin America. Results Of 1114 HIV-infected infants, children, and adolescents followed from 2002 to 2011, 69 that could be classified as having confirmed or presumed tuberculosis were included in this case series; 52.2% (95% CI: 39.8–64.4%) had laboratory-confirmed tuberculosis, 15.9% (95% CI: 8.2–26.7%) had clinically confirmed disease and 31.9% (95% CI: 21.2–44.2%) had presumed tuberculosis. Sixty-six were perinatally HIV-infected. Thirty-two (61.5%) children had a history of contact with an adult tuberculosis case; however information on exposure to active tuberculosis was missing for 17 participants. At the time of tuberculosis diagnosis, 39 were receiving antiretroviral therapy. Sixteen of these cases may have represented immune reconstitution inflammatory syndrome. Conclusions Our study emphasizes the need for adequate contact tracing of adult tuberculosis cases and screening for HIV or tuberculosis in Latin American children diagnosed with either condition. Preventive strategies in tuberculosis-exposed, HIV-infected children should be optimized.
    The Brazilian Journal of Infectious Diseases. 10/2014;
  • Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 08/2014;
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    ABSTRACT: Renal toxicity is a concern in HIV-infected children receiving antiretrovirals. However, the prevalence (1.7%; 95% confidence interval [CI]: 1.0-2.6%) and incidence of kidney dysfunction (0.17 cases/100 person-years; 95% CI: 0.04-0.30) were rare in this multicenter cohort study of 1032 perinatally HIV-infected Latin American and Caribbean children, followed from 2002-2011.
    AIDS Research and Human Retroviruses 05/2014; · 2.71 Impact Factor
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    ABSTRACT: Tenofovir (TDF) is associated with phosphaturia and elevated 1,25 dihydroxy vitamin D (1,25-OH(2)D). Fibroblast growth factor 23 (FGF23) causes phosphaturia and increases in response to elevated 1,25-OH(2)D. Vitamin D binding protein (VDBP) binds to 1,25-OH(2)D, decreasing its biologic activity, and is elevated in persons with higher plasma tenofovir concentrations. We compared FGF23 and VDBP before and after vitamin D3 (VITD) supplementation in youth treated with combination antiretroviral therapy (cART) containing or not containing TDF. A randomized controlled trial in HIV+ youth ages 18-25 years enrolled participants based on cART treatment with TDF (TDF, N=118) or without TDF (no-TDF, N=85) and randomized within those groups to VITD (50,000 IU every four weeks) or placebo (PL). We measured FGF23 and VDBP and calculated free 1,25-OH(2)D at baseline and week 12, and compared changes by TDF treatment and VITD randomized group. At baseline, serum FGF23 concentration showed a quadratic relationship with 1,25-OH(2)D most pronounced in the TDF group. At week 12, total and free 1,25-OH(2)D increased in the VITD but not PL groups, independent of TDF use. FGF23 increased in the TDF group receiving VITD, but there was no FGF23 change in the no-TDF group receiving VITD or the PL groups. The adjusted mean change in FGF23 from baseline to week 12 was +7.7 pg/mL in the TDF/VITD group, compared to -1.7 (no-TDF/VITD, p=0.010); -1.3 (TDF/PL, p=0.006); and +1.1 (no-TDF/PL, p=0.035). These results suggest that TDF-containing cART may alter the FGF23 response to vitamin D supplementation in HIV-infected youth.
    Antiviral therapy 02/2014; · 3.07 Impact Factor
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    ABSTRACT: To examine the relationship between markers of vascular dysfunction and neurodevelopmental outcomes in perinatally HIV-infected (PHIV+) and perinatally HIV-exposed but uninfected (PHEU) youth. Cross-sectional design within a prospective, 15-site US-based cohort study. Neurodevelopmental outcomes were evaluated in relation to nine selected vascular biomarkers in 342 youth (212 PHIV+, 130 PHEU). Serum levels were assessed for adiponectin, C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), soluble vascular cell adhesion molecule-1 (sVCAM-1), E-selectin (sE-selectin), monocyte chemoattractant protein (sMCP-1), intercellular adhesion molecule-1 (sICAM-1), and P-selectin (sP-selectin). The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) was administered at entry, yielding a Full-Scale IQ score, and four index scores. Factor analysis was conducted to reduce the biomarkers to fewer factors with related biological roles. Structural equation models (SEMs) were used to measure associations between resulting factors and WISC-IV scores. Mean participant age was 11.4 years, 54% were female, 70% black. The nine biomarkers were clustered into three factor groups: F1 (fibrinogen, CRP, and IL-6); F2 (sICAM-1 and sVCAM-1); and F3 (MCP-1, sP-selectin, and sE-selectin). Adiponectin showed little correlation with any factor. SEMs revealed significant negative association of F1 with WISC-IV processing speed score in the total cohort. This effect remained significant after adjusting for HIV status and other potential confounders. A similar association was observed when restricted to PHIV+ participants in both unadjusted and adjusted SEMs. Aggregate measures of fibrinogen, CRP, and IL-6 may serve as a latent biomarker associated with relatively decreased processing speed in both PHIV+ and PHEU youth.
    AIDS (London, England) 01/2014; 28(3):355-64. · 4.91 Impact Factor
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    ABSTRACT: Background: P1093 is an ongoing Phase I/II multicenter open-label PK, safety, dose finding study of DTG plus optimized background regimen (OBR) in children and adolescents in age defined cohorts. The pediatric weight band dosing of ~1 mg/kg once a day achieved PK exposure in adolescents comparable to those observed at 50 mg once daily in adults. Methods: HIV infected treatment experienced children >12 to < 18 yrs on a failing antiretroviral (ARV) regimen with an HIV RNA of ≥1000 copies/mL (c/mL) were enrolled in Stage 1 (intensive PK) or Stage 2 (extended follow up). DTG was added to a stable, failing ARV regimen in Stage 1, with an OBR added after intensive PK (~Day5-10), or DTG was started with an OBR in Stage 2. Safety, tolerability, CD4 cell count and HIV-1 RNA were evaluated at Week 24. Virologic success was defined as achieving an HIV-1 RNA < 400 c/mL by Week 24 based on the FDA snapshot algorithm, with an additional secondary endpoint of HIV-1 RNA <50 c/mL. Results: Twenty three adolescents (Stage 1, n=10; Stage 2, n=13) were enrolled and completed the 24 week study visit. Demographics were as follows: 78% (18/23) female, 52% (12/23) African American, 35% (8/23) Caucasian, 26% (6/23) were of Hispanic ethnicity. Mean (SD) age 14 yrs (±1.8) and weight= 55.1 kg (±15.6). Median (IQR) baseline CD4+ cell count and % were 466 cells/µL (297, 771) and 22% (18.4, 29.2) respectively. Median (IQR) baseline HIV-1 RNA log10 was 4.3 log10 c/mL (3.9, 4.6). Virologic success with an HIV RNA < 400 c/mL was achieved in 82.6 % (19/23 ; 95% CI: 61.2 % to 95%) at Week 24. Additionally, 69.6% (16/23 ; 95% CI: 47.1% to 86.8%) had an HIV RNA load < 50 c/mL at Week 24. Median (IQR) gain in CD4 cell count and % at Week 24 was 63 cells/µL (-56, 180) and 4.9% (1, 8) respectively. DTG was well tolerated, with 2 subjects experiencing Grade 3 laboratory abnormalities; one developed unconjugated bilirubin elevation while on atazanavir as part of the OBR, and another subject developed asymptomatic lipase elevation, which was deemed treatment unrelated. There were no Grade 4 AEs, SAEs or discontinuations due to AEs. Conclusion: DTG plus OBR was safe and well tolerated in HIV infected adolescents. In addition, DTG treatment as part of an OBR provided high virologic efficacy through Week 24.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
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    ABSTRACT: Background:Tenofovir disoproxil fumarate (TDF) causes bone, endocrine and renal changes, by unknown mechanism(s). Data are limited on tenofovir pharmacokinetics and these effects.Methods:Using baseline data from a multicenter study in HIV-infected youth on stable treatment with regimens containing TDF (N=118) or no TDF (N=85), we measured cross-sectional associations of TDF use with markers of renal function, vitamin D-calcium-parathyroid hormone balance, phosphate metabolism (tubular reabsorption of phosphate and fibroblast growth factor 23 (FGF23)), and bone turnover. Pharmacokinetic-pharmacodynamic associations with plasma tenofovir and intracellular tenofovir diphosphate concentrations were explored among those receiving TDF.Results:Mean age was 20.9 (SD 2.0) years; 63% were male; and 52% African American. Compared to the noTDF group, the TDF group showed lower mean estimated glomerular filtration rate and tubular reabsorption of phosphate; and higher parathyroid hormone and 1,25-dihydroxy vitamin D (1,25-OH(2)D). The highest quintile of plasma tenofovir concentrations was associated with higher vitamin D binding protein, lower free 1,25-OH (2)D, higher 25-OH vitamin D and higher serum calcium. The highest quintile of intracellular tenofovir diphosphate concentration was associated with lower FGF23.Conclusion:Higher plasma tenofovir concentrations were associated with higher vitamin D binding protein and lower free 1,25-OH (2)D, suggesting a functional vitamin D deficiency possibly explaining TDF-associated increased parathyroid hormone. The finding of lower FGF-23 accompanying higher intracellular tenofovir diphosphate suggests different mechanisms mediate TDF-associated changes in phosphate handling. Separate pharmacokinetic properties may be associated with distinct TDF toxicities: tenofovir with parathyroid hormone and altered calcium balance, and tenofovir diphosphate with hypophosphatemia and FGF23 regulation.The clinical trials registration number for this study is NCT00490412, available online at http://clinicaltrials.gov/ct2/show/NCT00490412.
    Antimicrobial Agents and Chemotherapy 09/2013; · 4.57 Impact Factor
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    ABSTRACT: Perinatally HIV-infected (PHIV) children may be at risk of undervaccination. Vaccination coverage rates among PHIV and HIV-exposed uninfected (HEU) children in Latin America and the Caribbean were compared. All PHIV and HEU children born from 2002 to 2007 who were enrolled in a multisite observational study conducted in Latin America and the Caribbean were included in this analysis. Children were classified as up to date if they had received the recommended number of doses of each vaccine at the appropriate intervals by 12 and 24 months of age. Fisher's exact test was used to analyze the data. Covariates potentially associated with a child's HIV status were considered in multivariable logistic regression modeling. Of 1156 eligible children, 768 (66.4%) were HEU and 388 (33.6%) were PHIV. HEU children were significantly (P < 0.01) more likely to be up to date by 12 and 24 months of age for all vaccines examined. Statistically significant differences persisted when the analyses were limited to children enrolled before 12 months of age. Controlling for birth weight, sex, primary caregiver education and any use of tobacco, alcohol or illegal drugs during pregnancy did not contribute significantly to the logistic regression models. PHIV children were significantly less likely than HEU children to be up to date for their childhood vaccinations at 12 and 24 months of age, even when limited to children enrolled before 12 months of age. Strategies to increase vaccination rates in PHIV are needed.
    The Pediatric Infectious Disease Journal 08/2013; 32(8):845-850. · 3.57 Impact Factor
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    ABSTRACT: IMPORTANCE Prior to contemporary antiretroviral therapies (ARTs), children infected with human immunodeficiency virus (HIV) were more likely to have heart failure. This study suggests that highly active ART (HAART) does not appear to impair heart function. OBJECTIVE To determine the cardiac effects of prolonged exposure to HAART on HIV-infected children. DESIGN In the National Institutes of Health-funded Pediatric HIV/AIDS Cohort Study's Adolescent Master Protocol (AMP), we used linear regression models to compare echocardiographic measures. SETTING A total of 14 US pediatric HIV clinics. PARTICIPANTS Perinatally HIV-infected children receiving HAART (n = 325), HIV-exposed but uninfected children (n = 189), and HIV-infected (mostly HAART-unexposed) historical pediatric controls from the National Institutes of Health-funded Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection (P2C2-HIV) Study (n = 70). EXPOSURE Long-term HAART. MAIN OUTCOMES AND MEASURES Echocardiographic measures of left ventricular (LV) function and structure. RESULTS The 325 AMP HIV-infected children had lower viral loads, higher CD4 counts, and longer durations of ART than did the 70 HIV-infected children from the P2C2-HIV Study (all P < .001). The z scores for LV fractional shortening (a measure of cardiac function) were significantly lower among HIV-infected children from the P2C2-HIV Study than among the AMP HIV-infected group or the 189 AMP HIV-exposed but uninfected controls (P < .05). For HIV-infected children, a lower nadir CD4 percentage and a higher current viral load were associated with significantly lower cardiac function (LV contractility and LV fractional shortening z scores; all P = .001) and an increased LV end-systolic dimension z score (all P < .03). In an interaction analysis by HIV-infected cohort, the HIV-infected children from the P2C2-HIV Study with a longer ART exposure or a lower nadir CD4 percentage had lower mean LV fractional shortening z scores, whereas the mean z scores were relatively constant among AMP HIV-infected children (P < .05 for all interactions). CONCLUSIONS AND RELEVANCE Long-term HAART appears to be cardioprotective for HIV-infected children and adolescents.
    JAMA pediatrics. 04/2013;
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    ABSTRACT: Background: Perinatally HIV-infected children (PHIV) may be at risk of undervaccination. Vaccination coverage rates among PHIV and HIV-exposed uninfected children (HEU) in Latin America and the Caribbean were compared. Methods: All PHIV and HEU children born from 2002-2007 that were enrolled in a multi-site observational study conducted in Latin America and the Caribbean were included in this analysis. Children were classified as up to date (UTD) if they had received the recommended number of doses of each vaccine at the appropriate intervals by 12 and 24 months of age. Fisher's exact test was used to analyze the data. Covariates potentially associated with a child's HIV status were considered in multivariable logistic regression modeling. Results: Of 1156 eligible children, 768 (66.4%) were HEU and 388 (33.6%) were PHIV. HEU children were significantly (p<0.01) more likely to be UTD by 12 and 24 months of age for all vaccines examined. Statistically significant differences persisted when the analyses were limited to children enrolled prior to 12 months of age. Controlling for birth weight, sex, primary caregiver education and any use of tobacco, alcohol or illegal drugs during pregnancy did not contribute significantly to the logistic regression models. Conclusions: PHIV children were significantly less likely than HEU children to be UTD for their childhood vaccinations at 12 and 24 months of age, even when limited to children enrolled before 12 months of age. Strategies to increase vaccination rates in PHIV are needed.xs (C) 2013 Lippincott Williams & Wilkins, Inc.
    The Pediatric Infectious Disease Journal 02/2013; · 3.57 Impact Factor
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    ABSTRACT: We measured glucose, insulin, and lipids in 249 perinatally HIV-infected Latin American children. Only one subject had impaired fasting glucose; 6.8% had insulin resistance. Abnormalities in total, LDL and HDL cholesterol, and triglycerides were reported for 13%, 13%, 21%, and 34%, respectively. Continued follow up of this population is necessary to characterize the evolution and clinical consequences of these findings.
    The Pediatric Infectious Disease Journal 01/2013; · 3.57 Impact Factor
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    Journal of Cardiovascular Magnetic Resonance 01/2013; 15(1). · 4.44 Impact Factor
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    ABSTRACT: Serum 25-hydroxyvitamin D [25(OH)D] is often deficient (<12 ng/ml) or insufficient (<20 ng/ml) in youth living with human immunodeficiency virus type 1 infection (YLH). Based on evidence from multiple genome-wide association studies, we hypothesized that genetic factors associated with 25(OH)D deficiency should be readily detectable in YLH even when controlling for other known factors, including use of the antiretroviral drug efavirenz (EFV). Genotyping by bi-directional sequencing targeted 15 single nucleotide polymorphisms (SNPs) at the GC/DBP locus, with a focus on coding and regulatory variants, as well as those repeatedly reported in the literature. Three intronic SNPs (rs222016, rs222020, and rs222029) in a conserved haplotype block had unequivocal association signals (false discovery rate ≤ 0.006). In particular, the minor allele G for rs222020 was highly unfavorable among 192 YLH (99 African-Americans and 93 others), as gauged by relatively low likelihood for 25(OH)D sufficiency at enrollment (odds ratio = 0.31, p = 9.0 × 10(-4)). In a reduced multivariable model, race, season, latitude, body mass index, exposure to EFV, and rs222020-G were independent factors that collectively accounted for 38% of variance in the log10-transformed 25(OH)D concentration (p < 0.0001). Interaction terms were evident for rs222020-G × season (p < 0.001), latitude × season (especially fall and winter; p < 0.01), and race × EFV use (p = 0.024). Overall, variance in serum 25(OH)D is substantially attributable to multiple factors, but the exact contribution of genetic and non-genetic factors can be obscured by partial overlaps and frequent interactions.
    Frontiers in Genetics 01/2013; 4:234.
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    Annette H Sohn, Rohan Hazra
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    ABSTRACT: The global paediatric HIV epidemic is shifting into a new phase as children on antiretroviral therapy (ART) move into adolescence and adulthood, and face new challenges of living with HIV. UNAIDS reports that 3.4 million children aged below 15 years and 2 million adolescents aged between 10 and 19 years have HIV. Although the vast majority of children were perinatally infected, older children are combined with behaviourally infected adolescents and youth in global reporting, making it difficult to keep track of their outcomes. Perinatally HIV-infected adolescents (PHIVA) are a highly unique patient sub-population, having been infected before development of their immune systems, been subject to suboptimal ART options and formulations, and now face transition from complete dependence on adult caregivers to becoming their own caregivers. As we are unable to track long-term complications and survival of PHIVA through national and global reporting systems, local and regional cohorts are the main sources for surveillance and research among PHIVA. This global review will utilize those data to highlight the epidemiology of PHIVA infection, treatment challenges and chronic disease risks. Unless mechanisms are created to count and separate out PHIVA outcomes, we will have few opportunities to characterize the negative consequences of life-long HIV infection in order to find ways to prevent them.
    Journal of the International AIDS Society 01/2013; 16:18555. · 3.94 Impact Factor
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    ABSTRACT: A novel method for the simultaneous quantification of 16 antiretroviral (ARV) drugs and 4 metabolites in meconium was developed and validated. Quantification of 6 nucleoside/nucleotide reverse transcriptase inhibitors, 2 non-nucleoside reverse transcriptase inhibitors, 7 protease inhibitors and 1 integrase inhibitor was achieved in 0.25g of meconium. Specimen preparation included methanol homogenization and solid phase extraction. Separate positive and negative polarity multiple reaction monitoring mode injections were required to achieve sufficient sensitivity. Linearity ranged from 10-75ng/g up to 2500ng/g for most analytes and 100-500ng/g up to 25000ng/g for some; all correlation coefficients were ≥0.99. Extraction efficiencies from meconium were 32.8-119.5% with analytical recovery (bias) 80.3-108.3% and total imprecision 2.2-11.0% for all quantitative analytes. Two analytes with analytical recovery (70.0-138.5%) falling outside the 80-120% criteria range were considered semiquantitative. Matrix effects were -98.3-47.0% and -98.0-67.2% for analytes and internal standards, respectively. Analytes were stable (>75%) at room temperature for 24 h, 4°C for 3 days, -20°C for 3 freeze-thaw cycles over 3 days and on the autosampler. Method applicability was demonstrated by analyzing meconium from HIV-uninfected infants born to HIV-positive mothers on ARV therapy. This method can be used as a tool to investigate the potential effects of in utero ARV exposure on childhood health and neurodevelopmental outcomes.
    Analytical Chemistry 12/2012; · 5.82 Impact Factor
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    ABSTRACT: BACKGROUND:: Tenofovir is associated with renal proximal tubule injury. Such toxicity has not been extensively studied in HIV-1-infected children, in whom tenofovir is increasingly used. METHODS:: History, urine and blood were collected at regular intervals from 448 children and adolescents with perinatal HIV-1 infection followed in the Pediatric HIV/AIDS Cohort study. Relationships between tenofovir use and proteinuria and chronic kidney disease (CKD) outcomes were examined using multivariable logistic regression models. Proteinuria was defined as at least one urine protein/creatinine ratio (uPCR) ≥0.2, and CKD as ≥2 sequential uPCR ≥0.2 or estimated glomerular filtration rates (eGFR) <60 mL/min/1.73 m with no subsequent resolution, or a clinical diagnosis not contradicted by a normal uPCR. Subjects with ≥2 uPCR <0.2, and no abnormal uPCR and eGFR comprised the comparison group. RESULTS:: Subjects were 47% male, 72% black, 24% Hispanic, with entry mean age (±standard deviation) of 11.5 ±2.5 years. Proteinuria prevalence at entry, and annually during 3 years, ranged from 10.3%-13.7%. The cumulative prevalence of proteinuria was 22% (94/434, 95% CI: 18%-26%) and CKD 4.5% (20/448, 95% CI: 2.7%-6.8%). Duration of tenofovir use was an independent predictor of proteinuria, with >3 years of exposure having the highest risk compared with no exposure (OR: 2.53, 95% CI: 1.23- 5.22, overall p=0.01). Overall, duration of tenofovir use did not significantly predict the presence of CKD. CONCLUSIONS:: Rates of proteinuria and CKD were lower than those seen in the pre-HAART era. However, prolonged exposure to tenofovir increases risk of renal injury.
    The Pediatric Infectious Disease Journal 12/2012; · 3.57 Impact Factor
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    ABSTRACT: An alarming proportion of incident HIV infections worldwide occur in youth. In the U.S., 69% of all new infections among youth occurred in young men who have sex with men (YMSM). Recent studies show the promise of pre-exposure prophylaxis (PrEP) for preventing HIV infection, but research efforts suffer from disproportionately low representation of the most at-risk youth. Youth-focused research is critical and should include behavioral, community, and biomedical interventions to create a comprehensive HIV prevention package. The many ethical, legal and regulatory considerations in conducting HIV research among, and in providing care services to, youth must be addressed so that those at high risk and most likely to benefit can have unfettered access to safe and effective health-promoting interventions. YMSM and minority youth are at substantial HIV risk and urgently need effective HIV prevention tools for which the short and long-term benefits and risks have been carefully considered.
    Clinical Infectious Diseases 12/2012; · 9.37 Impact Factor
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    ABSTRACT: Background. Use of antiretroviral drugs (ARVs) during pregnancy has been associated with higher risk of preterm birth.Methods. The PHACS Surveillance Monitoring of ART Toxicities study is a US-based cohort of HIV-exposed uninfected children. We evaluated maternal ARV use during pregnancy and risk of total and spontaneous (occurring after preterm labor or membrane rupture without other complications) preterm birth (<37 weeks gestation), and small for gestational age (< 10(th) percentile) (SGA). Multivariable logistic regression models were used to evaluate association of ARVs and timing of exposure while adjusting for maternal characteristics.Results. Among 1869 singleton births, 18.6% were preterm, 10.2% were spontaneous preterm, and 7.3% were SGA. 89% used 3-drug combination ARV regimens during pregnancy. In adjusted models, both preterm and spontaneous preterm birth were increased with 1(st) trimester use of protease inhibitors (adjusted odds ratios [aOR's]=1.55 and 1.59 respectively) but not with non-nucleoside reverse transcriptase inhibitor or triple nucleoside regimens. Combination ARV exposure starting later in pregnancy was not associated with increased risk. No associations were observed between SGA and exposure to combination ARV regimens.Conclusions. Protease inhibitor use early in pregnancy may be associated with increased risk for prematurity.
    The Journal of Infectious Diseases 11/2012; · 5.85 Impact Factor

Publication Stats

743 Citations
256.58 Total Impact Points

Institutions

  • 2008–2014
    • Eunice Kennedy Shriver National Institute of Child Health and Human Development
      Maryland, United States
  • 2013
    • Children's Hospital of Wisconsin
      Madison, Wisconsin, United States
  • 2011–2013
    • National Institute of Child Health and Human Development
      Maryland, United States
    • Instituto de Medicina Legal y Ciencias Forenses (Perú)
      Λίμα, Provincia de Lima, Peru
  • 2012
    • University of Illinois at Chicago
      • Department of Pediatrics (Peoria)
      Chicago, Illinois, United States
    • Medical College of Wisconsin
      • Department of Pediatrics
      Milwaukee, WI, United States
  • 2005–2012
    • National Institutes of Health
      • Branch of HIV and AIDS Malignancy
      Maryland, United States
  • 2004–2011
    • National Cancer Institute (USA)
      • • Pediatric Oncology Branch
      • • HIV and AIDS Malignancy Branch
      Maryland, United States
  • 2010
    • Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
      Tlalpam, The Federal District, Mexico
  • 2009
    • University of São Paulo
      San Paulo, São Paulo, Brazil