Dissertations / Theses: 'HIV - infected childrens'

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Ripari, Valéria Rocha [UNESP]. "Níveis séricos de IgE total em crianças infectadas pelo vírus da imunodeficiência humana." Universidade Estadual Paulista (UNESP), 2001. http://hdl.handle.net/11449/104687.

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A progressão da doença na criança infectada pelo HIV associou-se à elevação do nível sérico de IgE total em alguns estudos. O mecanismo responsável por esta elevação ainda não foi claramente elucidado. O desbalanço na produção e liberação de citocinas de perfil Th1 e Th2, que ocorre após a infecção pelo HIV, tem sido proposto como um possível mecanismo para a elevação da IgE. Foram avaliadas neste estudo, 29 crianças de ambos os sexos, infectadas pelo HIV, acompanhadas no Ambulatório de Imunologia Pediátrica da Faculdade de Medicina de Botucatu-UNESP, com idade variando de 3 a 182 meses, com o objetivo de analisar os níveis séricos de IgE nessas crianças e sua correlação com presença de categorias clínicas e imunológicas mais graves, carga viral elevada e aumento da prevalência de alergia. A classificação clínica destes pacientes mostrou duas crianças (6,9%) na categoria N, sete (24,14%) na A, 12 (41,38%) na B e oito (27,58%) na C. Já a classificação imunológica mostrou três crianças (10,3%) na categoria 1, 16(55,2%) na 2 e 10 (34,5%) na 3. Após a aplicação do questionário alergológico, 11 crianças (37,93%) apresentaram história positiva de sintomas alérgicos, e quatro destes pacientes (13,79%) apresentaram teste cutâneo de hipersensibilidade imediata positivo a um ou mais dos aeroalérgenos testados. Os resultados mostraram níveis elevados de IgE em 17 crianças (58,62%), e estes foram numericamente maiores nos pacientes pertencentes à categoria clínica mais grave (C) em relação àqueles das outras categorias clínicas, mas sem diferença estatisticamente significante. Não foi encontrada diferença entre a freqüência de crianças com IgE elevada pertencentes às categorias clínicas e imunológicas mais graves e aquelas mais leves...
The progression of the disease in the infected child by HIV toke part in the elevation of the serum level of total IgE in some studies. The mechanism responsible for this elevation was still not clearly elucidated. The oscillation in the production and liquidation of Th1 and Th2 cytokines, that occur after the infection by HIV, have been proposed as a possible mechanism to the IgE elevation. In this study was evaluated 29 children of both sex, infected by HIV, accompanied in the Clinic of Pediatric Immunology of Botucatu Medical School - UNESP, with ages from 3 to 182 months, with the objective of analyze the serum levels of IgE in these children and the co-relation with the presence of the categories clinic and immunological more severe, high load viral and increase of the allergic diseases prevalence. The clinic classification of these patients showed two children (6,9%) in N category, seven (24,14%) in B and eight (27,58%) in C. While the immunologic classification showed three children (10,3%) in the category 1, sixteen (55,2%) in the 2 and ten (34,5%) in the 3. After the application of the allergologic questionnaire, eleven children (37,93%) presented positive history of allergic symptoms, and four of these patients (13,79%) presented positive immediate cutaneous hypersensitive test to one or more of the inhalant allergens tested. The outcomes showed high levels of IgE in 17 children (58,62%), and these were numerically greater in the patients in the more severe clinic category (C) in relation to those of the others clinic categories, but without significant statically difference. The difference between the frequency of children with high IgE in the clinic and immunologic categories more severe and that more soft was not founded. The load viral values were significantly lower in the group... (Complete abstract, click electronic access below)

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Ripari, Valéria Rocha. "Níveis séricos de IgE total em crianças infectadas pelo vírus da imunodeficiência humana /." Botucatu : [s.n.], 2001. http://hdl.handle.net/11449/104687.

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Orientador: Antonio Zuliani
Resumo: A progressão da doença na criança infectada pelo HIV associou-se à elevação do nível sérico de IgE total em alguns estudos. O mecanismo responsável por esta elevação ainda não foi claramente elucidado. O desbalanço na produção e liberação de citocinas de perfil Th1 e Th2, que ocorre após a infecção pelo HIV, tem sido proposto como um possível mecanismo para a elevação da IgE. Foram avaliadas neste estudo, 29 crianças de ambos os sexos, infectadas pelo HIV, acompanhadas no Ambulatório de Imunologia Pediátrica da Faculdade de Medicina de Botucatu-UNESP, com idade variando de 3 a 182 meses, com o objetivo de analisar os níveis séricos de IgE nessas crianças e sua correlação com presença de categorias clínicas e imunológicas mais graves, carga viral elevada e aumento da prevalência de alergia. A classificação clínica destes pacientes mostrou duas crianças (6,9%) na categoria N, sete (24,14%) na A, 12 (41,38%) na B e oito (27,58%) na C. Já a classificação imunológica mostrou três crianças (10,3%) na categoria 1, 16(55,2%) na 2 e 10 (34,5%) na 3. Após a aplicação do questionário alergológico, 11 crianças (37,93%) apresentaram história positiva de sintomas alérgicos, e quatro destes pacientes (13,79%) apresentaram teste cutâneo de hipersensibilidade imediata positivo a um ou mais dos aeroalérgenos testados. Os resultados mostraram níveis elevados de IgE em 17 crianças (58,62%), e estes foram numericamente maiores nos pacientes pertencentes à categoria clínica mais grave (C) em relação àqueles das outras categorias clínicas, mas sem diferença estatisticamente significante. Não foi encontrada diferença entre a freqüência de crianças com IgE elevada pertencentes às categorias clínicas e imunológicas mais graves e aquelas mais leves... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The progression of the disease in the infected child by HIV toke part in the elevation of the serum level of total IgE in some studies. The mechanism responsible for this elevation was still not clearly elucidated. The oscillation in the production and liquidation of Th1 and Th2 cytokines, that occur after the infection by HIV, have been proposed as a possible mechanism to the IgE elevation. In this study was evaluated 29 children of both sex, infected by HIV, accompanied in the Clinic of Pediatric Immunology of Botucatu Medical School - UNESP, with ages from 3 to 182 months, with the objective of analyze the serum levels of IgE in these children and the co-relation with the presence of the categories clinic and immunological more severe, high load viral and increase of the allergic diseases prevalence. The clinic classification of these patients showed two children (6,9%) in N category, seven (24,14%) in B and eight (27,58%) in C. While the immunologic classification showed three children (10,3%) in the category 1, sixteen (55,2%) in the 2 and ten (34,5%) in the 3. After the application of the allergologic questionnaire, eleven children (37,93%) presented positive history of allergic symptoms, and four of these patients (13,79%) presented positive immediate cutaneous hypersensitive test to one or more of the inhalant allergens tested. The outcomes showed high levels of IgE in 17 children (58,62%), and these were numerically greater in the patients in the more severe clinic category (C) in relation to those of the others clinic categories, but without significant statically difference. The difference between the frequency of children with high IgE in the clinic and immunologic categories more severe and that more soft was not founded. The load viral values were significantly lower in the group... (Complete abstract, click electronic access below)
Mestre

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Sefe, D. K. "T cell kinetics in HIV infected children." Thesis, University College London (University of London), 2011. http://discovery.ucl.ac.uk/1310446/.

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Infection with Human Immunodeficiency Virus, type 1 (HIV-1) is associated with a gradual progressive decline in the number of CD4+ T lymphocytes. Effective treatment suppresses viral replication and is accompanied by a concomitant increase in the number of CD4+ T cells. Immune reconstitution of CD4+ T cells in children following treatment is characterised by a sustained increase of naïve cells, a pattern that differs from that seen in adults. The aim of this thesis was to explore how these changes occur. CD4+ T cells in blood samples from HIV-1 infected children were identified, divided into sub-populations and analysed for apoptosis, proliferation, activation and differentiation by flow cytometry. Four CD4+ T cell sub-populations, with varying contributions to the total CD4+ T cell pool were thus identified: (i) recent thymic emigrants (RTEs) made up the largest population yet maintained very low levels of proliferation despite increased viral replication and cellular activation, and were consistently greater in children with undetectable viraemia; (ii) central naïve cells, which were fairly constant in HIV-1 infected children of all ages regardless of CD4 count; (iii) CD31- memory cells that increased as CD4 count fell and (iv) CD31+ memory cells that despite their high level of activation and proliferation remained a small population across age, viral load and CD4 count. Treatment interruption and the resulting increased viraemia and decreased CD4 count were associated with only transient changes to the percentage contribution of each subset, which supports the existence of a setpoint for each subpopulation. This thesis infers the importance of thymic output in maintaining the CD4 count and hence the potential for using RTEs in monitoring response to treatment and sheds light on the role and origin of CD31+ memory cells as a small but highly activated population that may be important in disease pathogenesis.

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Smith, Lara. "Neurocognitive outcome of HIV-infected children on antiretroviral therapy at Red Cross Children's Hospital." Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/11190.

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Includes bibliographical references (leaves 54-59).
Central nervous system involvement contributes significantly to the morbidity and mortality of paediatric HIV infection. The spectrum of CNS morbidity varies from minor developmental disabilities to severe, progressive encephalopathy. Therefore regular developmental evaluation should be regarded as an essential component of the overall care of HIV-infected children. Antiretroviral therapy may arrest or even reverse neurocognitive and motor deficits associated with HIV infection.

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Gerlach, Undine Ariane. "Interruption of antiretroviral treatment in HIV-infected children." Diss., lmu, 2004. http://nbn-resolving.de/urn:nbn:de:bvb:19-26945.

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Innes, Steven Eugene Vere. "Lipoatrophy in HIV-infected children on antiretroviral therapy." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/79864.

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Thesis (PhD)--Stellenbosch University, 2013.
Bibliography
ENGLISH ABSTRACT: Introduction: Lipoatrophy is a common adverse effect of stavudine and this effect is strongly dose-dependent. Stavudine remains the most commonly used paediatric antiretroviral drug in sub-Saharan Africa, yet when the current study began in 2009, the prevalence and severity of lipoatrophy in children on antiretroviral therapy in sub-Saharan Africa had never been studied. The development of lipoatrophy may have serious and far-reaching consequences for patients and their families. The off-label stavudine dosing method, prescribed to children whose caregivers do not have access to a refrigerator, in which the contents of an adult capsule is mixed into tap water, has potential for over-dosing or under-dosing. In addition, children on stavudine continue to be exposed to a disproportionately high dose out of line with the reduced adult dose. Aims: 1. a) To investigate the prevalence and risk factors for lipoatrophy in HIV-infected children in Southern Africa b) To identify a simple anthropometric screening tool to detect early lipoatrophy in children 2. To validate the off-label stavudine dosing method prescribed to children whose caregivers do not have access to a refrigerator, with a view to reducing the recommended dose and thereby the side-effects. Methods: 1. a) We recruited pre-pubertal children on antiretroviral therapy from a family HIV clinic in our facility. Lipoatrophy was identified by two experienced paediatric HIV clinicians using a standardized grading scale. A dietician performed dietary assessment and anthropometric measurements. Previous antiretroviral exposures were recorded. A subset of recruits received Dual-Energy X-ray Absorbtiometry scanning. b) Anthropometric measurements in children with and without lipoatrophy were compared using multivariate linear regression adjusting for age and gender. The most discerning anthropometric variables underwent Receiver Operating Characteristic curve analysis to identify the most appropriate diagnostic cut-off. 2. a) Accuracy of the standard off-label stavudine dosing method was investigated using high-performance liquid chromatography to recover active drug from solutions made up using the prescribed method. This was compared to the stated drug content of the capsules. b) Bioavailability was investigated by performing a randomized crossover pharmacokinetic study wherein healthy HIV-seronegative adult volunteers received one of two generic stavudine capsule formulations, either intact or mixed in water using the prescribed method. Plasma stavudine concentrations were assayed by liquid chromatography tandem mass spectrometry. Results: 1. a) Prevalence of lipoatrophy was 36%, and incidence was 12% per person-year. Adjusted odds ratio for developing lipoatrophy was 1.9 (CI: 1.3–2.9) for each additional year of accumulated exposure to standard-dose stavudine. b) Baseline biceps skin-fold thickness correlated well with maximum lipoatrophy grading score at any site, giving a partial correlation coefficient of 0.33 (p=0.0006), and a receiver operating characteristic area-under-curve value of 0.75 (CI: 0.64 – 0.84). Biceps skin-fold thickness <5mm at baseline had a sensitivity of 89% (CI: 67–100%) and a negative predictive value of 97% (CI: 91–100%) for predicting which children would go on to develop lipoatrophy by 15 month follow-up. Specificity was 60% (CI: 46–75%) and positive predictive value was 32% (CI: 14–50%). 2. a) Recovery of active drug from solution was 97.1%, 97.4% and 93.8% for the proprietary and two generic formulations respectively. b) Pharmacokinetic parameters of the off-label dosing method were well within the target range of intact capsule dosing for both generics. Conclusions: 1. a) The prevalence and incidence of lipoatrophy in pre-pubertal children on antiretroviral therapy in South Africa is high. Cumulative exposure to standard-dose stavudine was the greatest risk factor for lipoatrophy. b) Biceps skin-fold thickness provided reasonable sensitivity and specificity to detect and predict lipoatrophy in pre-pubertal children on antiretroviral therapy. 2. The off-label dosing method for stavudine prescribed to children whose caregivers do not have access to a refrigerator is reasonably accurate and is bioequivalent to intact capsule administration.
AFRIKAANSE OPSOMMING: Inleiding: Lipoatrofie is 'n algemene nadelige uitwerking van stavudien en hierdie effek is sterk dosis-afhanklike. Stavudien bly die mees algemeen gebruikte paediatriese antiretrovirale medikasie in sub-Sahara Afrika, maar toe ons studie begin het, was lipoatrofie in kinders op antiretrovirale terapie in sub-Sahara Afrika nog nooit voorheen bestudeer nie. Die ontwikkeling van lipoatrofie kan ernstige en verreikende gevolge vir die pasiënt en hul familie hê. Die af-etiket stavudien dosering metode voorgeskryf aan kinders wie se versorgers nie toegang tot 'n yskas het nie het 'n aansienlike potensiäal vir oor-dosering of onder-dosering. Daarbenewens, is kinders op stavudien blootgestel aan 'n disproporsionele hoë dosis uit-pas met die verminderde volwasse dosis. Doelwitte: 1. a) Om ondersoek in te stel na die voorkoms en risiko faktore vir lipoatrofie in MIV-geïnfekteerde kinders in Suid Afrika b) Om 'n eenvoudige antropometriese instrument te identifiseer om vroeë lipoatrofie op te spoor in kinders op antiretrovirale medikasie 2. Om die af-etiket stavudien dosering metode wat voorgeskryf is aan kinders wie se versorgers nie toegang tot 'n yskas het nie te valideer, met 'n oog op die vermindering van die aanbevole dosis Metodes: 1. a) Ons het 'n groep van onder-puberteitsjarige kinders op antiretrovirale terapie gewerf uit 'n familie MIV kliniek in ons fasiliteit. Lipoatrofie is geïdentifiseer deur twee ervare MIV pediaters deur gebruik van 'n gestandaardiseerde gradering skaal. 'n Diëetkundige het diëet assessering en antropometriese metings uitgevoer. Vorige antiretrovirale blootstellings is aangeteken. In 'n subset was Dual-energie X-straal Absorbtiometry (DXA) skandering uitgevoer. b) Antropometriese metings in kinders met en sonder lipoatrofie is vergelyk met behulp van meerveranderlike lineêre regressie aangepas vir ouderdom en geslag. Die mees kieskeurige antropometriese veranderlikes het Receiver Operating Curve analise ondergaan om die mees geskikte diagnostiese afgesnypunt te identifiseer. 2. a) Akkuraatheid is ondersoek deur gebruik te maak van hoë werkverrigting vloeistofchromatografie om aktiewe medikasie vanuit oplossings te herstel, wat gemeng is soos aangedui deur die voorgeskrewe af-etiket dosering metode. b) Biobeskikbaarheid is ondersoek deur die uitvoering van 'n ewekansige oorgesteekde farmakokinetiese studie waarin gesonde MIV- negatiewe volwasse vrywilligers een van twee generiese stavudien kapsule formulerings ontvang het, óf heel of in water gemeng soos aangedui deur die voorgeskrewe af-etiket dosering metode. Plasma stavudien konsentrasies is gemeet deur vloeistofchromatografie tandem massaspektrometrie. Uitslae: 1. a) Voorkoms van lipoatrofie was 36%, en insidensie was 12% per persoon-jaar. Aangepaste Odds ratio vir die ontwikkeling van lipoatrofie was 1,9 (CI: 1,3-2,9) vir elke addisionele jaar van opgehoopte blootstelling aan standaard dosis stavudien. b) Biceps vel-vou dikte <5mm het 'n sensitiwiteit van 89% (CI: 83-96%) en 'n negatiewe voorspellende waarde van 90% (CI: 84-96%) vir die opsporing en voorspelling van lipoatrofie. 2. a) Herwinning van aktiewe medikasie uit oplossings was 97,1%, 97,4% en 93,8% vir die oorspronklike en twee generiese formulerings onderskeidelik. b) Farmakokinetiese parameters van die af-etiket dosering metode was wel binne die teikenband van ongeskonde kapsule dosering vir beide generiese formulerings. Gevolgtrekkings: 1. a) Die voorkoms van lipoatrofie in onder-puberteitsjarige kinders op antiretrovirale terapie in Suid-Afrika is hoog. Die bedrag stavudien waaraan kinders blootgestel is moet hersien word. Die standaard stavudien dosis vir kinders moet herge-evalueer word. b) Biceps vel-vou dikte het redelike goeie sensitiwiteit en spesifisiteit om lipoatrofie op te spoor en te voorspel. 2. Die af-etiket dosering metode vir stavudien voorgeskryf aan kinders wie se versorgers nie toegang tot 'n yskas het nie is redelik akkuraat en is bio-ekwivalent aan ongeskonde kapsule administrasie.

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Smith, Allison Jayne. "Child care workers and HIV infected/affected children." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11167.

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Includes bibliographical references (leaves 73-77).
The objectives of this study are to explore stressors and challenges faced by child care workers working with HIV infected/affected children, their causes, what support is available to them and, finally, current and recommended coping strategies. The study explored the perceptions of 8 child care workers through 2 focus groups using a semi-structured interview schedule as the data collection tool. The findings reveal that the primary challenge experienced is working with traumatised children and working for long hours away from their children, who are often at home alone. It was also found that they not fear infection when working with HIV infected children. The primary recommendation was that child care workers receive regular counselling and that day care centres are established in low income areas to care for their own children.

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Morén, Núñez Constanza. "Mitochondrial functionalism in HIV-infected children receiving antiretroviral therapy." Doctoral thesis, Universitat de Barcelona, 2012. http://hdl.handle.net/10803/83490.

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It is widely known that HIV and ARV drugs trigger mitochondrial impairment in adults. However, their effects in perinatally-infected children have been poorly explored. For this reason, the main hypothesis of the present Thesis was to demonstrate that mitochondrial abnormalities are present in HIV-infected pediatric patients treated with ARV. It is expected to find mitochondrial alterations in asymptomatic perinatally HIV-infected children. This mitochondrial lesion, manifested in a depletion of the mitochondrial genome, would lead to a reduction of the mitochondrial protein synthesis or to a mitochondrial dysfunction and, as a last resort, compromising the cellular viability. However, it is also possible that the presence of homeostatic mechanisms in mitochondria entails a proper function of some complexes, even in the presence of mitochondrial genome depletion. Rather than a localized mitochondrial alteration in a specific enzymatic activity, it is possible that HIV and ARV cause a diffuse damage in the organelle which may be observed in a general assessment of the respiratory chain. In case of a mitochondrial alteration, either in asymptomatic or symptomatic patients, it would be expected a more evident presentation of mitochondrial toxicity in case of the latter. If our hypothesis of an evidence of mitochondrial toxicity derived from HIV and ARV in children is confirmed, we believe that, once the detrimental agent is withdrawn, a recover of the mitochondrial affectation is possible. Mitochondrial impairment may change depending on the type of HAART regimen, leading us to use mitochondrial parameters as a biomarker or a trail to find the best therapeutic options in the choice of different HAART schedules. In this context, the intensity of mitochondrial impairment over time would be higher in children receiving first generation NRTI which, in turn, have been demonstrated to present a higher mitochondrial toxicity in vitro, than those under second generation NRTI. In order to study and test our hypothesis, the main objectives of the present Thesis are: A) General Objective To test if HIV and ARV mechanisms of mitochondrial toxicity found in adults are present in perinatally HIV-infected children. B) Specific Objectives - Objective 1: To elucidate whether ARV treatment or HIV infection were exerting a mitochondrial toxic effect in asymptomatic perinatally HIV-infected pediatric patients receiving HAART. - Objective 2: To investigate if hypothetic alterations in the mitochondrial genome of asymptomatic HIV-infected children receiving ARV are downstream reflected at transcriptional, translational and functional levels. In case of mitochondrial dysfunction was present, to test whether MRC alterations are focalized or diffuse. - Objective 3: To determine mitochondrial status in lipodystrophic HIV-children and compare them to a group of asymptomatic children and to a group of uninfected controls. - Objective 4: To evaluate whether a 12-month interruption of ARV is able to improve or revert these hypothetic mitochondrial alterations at molecular and/or clinical level. - Objective 5: To compare mitochondrial toxicity derived from different HAART schedules in a longitudinal 2-year follow-up assessment of immunovirological and mitochondrial status under first or second generation NRTI. To elucidate whether those NRTI demonstrated to present high mitochondrial toxicity in vitro present a major toxicity in vivo as well.

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Chakraborty, Rana. "Correlates of protection among HIV-1-infected African children." Thesis, University of Oxford, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275512.

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Govender, Rajeshree. "Profile of specific neurological and neurobehavioural problems in children with HIV-1 infection attending dedicated clinics." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/14309.

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Includes bibliographical references (leaves 33-42).
Aim: Neurological involvement related to HIV-1 infection is well described in the paediatric population and causes significant morbidity and mortality. This study aimed to describe specific neurological and neurobehavioural complications in this population. Method: Children infected with HIV-1 attending infectious diseases clinics were recruited for general and neurological assessments, developmental history screening and categorization of behavioural phenotype using the Aberrant Behaviour Checklist (ABC). Results: Eighty patients were assessed (males - 44/80: females - 36/80) (median age 5 years 1 month; range: 3 months - 12 yrs). Eighteen patients (23%) were not on antiretroviral (ARV) therapy at the time of testing. The Centre for Disease Control (CDC) immune categories of the patients at the time of assessment were: Category 1- n=6/80, Category 2- n=15/80 and Category 3- n=59/80. Thirty-three percent had a history of chronic lung disease, 10% had a history of an opportunistic central nervous system infection and 12.5% had epilepsy. 5 5 Anthropometric measurements identified that 19% of the patients were microcephalic, 17% of the patients were < 60% of their expected weight, 49% were 60-80% of expected weight and 45% were stunted. On neurological assessment 41% of the patients had global pyramidal tract signs, 7% had a hemiparesis, 5% had peripheral neuropathy, 16% had visual impairment, and 6% were hearing impaired. Of those who were screened for developmental deficits (patients < 6years of age) 66% had gross motor delay, 75% had fine motor delay, 70% had language delay and 73% had cognitive delay. Forty one percent had HIV Encephalopathy, 81% of whom a CD4 count < 15% and 48% were < 1year old. On the aberrant behaviour checklist (ABC) scale 24/80 patients had features of hyperactivity and 22/80 patients scored in the mild-moderate range on the lethargy / social withdrawal sub-scale reflecting a correlation with the affective and adjustment disorders. Conclusion: Diverse neurological and neurobehavioural deficits are common in children with HIV-1 infection especially those with CD4 < 15%, not on ARVs, with growth impairment and < 1yr of age. This study demonstrated the extent and spectrum of neurobehavioural and neurological complications in a defined HIV population. It stresses the need for early initiation of ARVs in the planning for future regimens and guidelines.

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Nanyunja, Miriam. "Risk Factors for Measles among HIV-infected Children in Uganda." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2500.

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Measles remains a major global public health problem. Attainment of high population immunity to measles through vaccination is necessary to control this disease. Children infected with HIV infection often experience secondary measles vaccine failure by 2 years of age, making them susceptible to measles. It is not clear whether HIV-infected children on Highly Active Antiretroviral Treatment (HAART), older than 2 years, have a higher risk of measles than HIV-uninfected children. This retrospective cohort study, guided by the proximate determinants framework, was conducted to compare the risk of measles between HIV-infected children on HAART (exposed) and HIV-uninfected peers (unexposed). The age group with the highest measles susceptibility in the exposed children, which could inform timing for revaccination, was investigated. The role of age at initiation of HAART, low CD4+ count, and undernutrition as predictors of the risk of measles in the exposed children was examined. Univariate, bivariate, and binomial logistic regression analytical procedures were used in data analysis. Results showed no significant difference in the risk of measles between exposed and unexposed children. The age groups 5 to 9 years and 2 to 4 years were the first and second most affected by measles among the exposed children. Undernutrition (stunting) was a significant predictor of measles in exposed children (odds ratio of 4.14, p = 0.02), while age at initiation of HAART and CD4+ count prior to measles exposure were not. The study findings provide evidence to inform vaccination policy and nutrition care for HIV-infected children on HAART in Uganda, so as to reduce their risk of measles illness and mortality, thus contributing to positive social change for the children and the country.

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Ryan, Scott Douglas. "Caregivers of Children Infected and/or Affected by HIV/AIDS." Case Western Reserve University School of Graduate Studies / OhioLINK, 2001. http://rave.ohiolink.edu/etdc/view?acc_num=case1042053063.

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Kgomo, Gretta Tumelo. "Cognitive and motor development in HIV infected children : a systematic review." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/20089.

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Thesis (MCurr)--Stellenbosch University, 2012.
ENGLISH ABSTRACT: The global epidemic of HIV continues with an estimated 2.2 million children under 15 years of age worldwide living with HIV and 640 000 newly infected in 2004 (WHO, 2009). HIV crosses the blood–brain barrier which may lead to neuronal damage and death. There is controversial evidence within available research on effects of HIV on cognitive and motor development in children because of the limitations imposed by study designs, study populations and study methodological quality. The aims of the review were: - To conduct a systematic review of published research to establish the effects and the prevalence of HIV infection on cognitive and motor development in children. - To critically appraise the methodological quality of published research regarding cognitive and motor development of HIV infected children. The objectives of the review were: - To assess evidence on the cognitive and motor development of HIV-1 infected children - To describe anthropometric outcomes including: weight for age, weight for height, height for age and head circumference in children with a HIV infection. - To assess the methodological quality of studies on the cognitive and motor development of HIV infected children. The following databases were searched for identification of articles; MEDLINE, Google Scholar, AIDSTRIALS, AIDSLINE and CINHAL. The search time frame included published works from inception to July 2011 without language restrictions. Analytical observational trials that assessed at least one outcome (cognitive or motor development or 1 of the anthropometric outcomes) between HIV positive and HIV negative children aged 5 years and below or children with a mean age of less than 5 years were employed. Two review authors independently searched for eligible studies, evaluated methodological quality and extracted the data. Meta-analysis was carried out using Rev Man 5.1 using the risk ratio for categorical data and standard mean difference for continuous data. Fifteen studies with a total of 3 086 participants met the inclusion criteria. HIV infected children were 2.45 times at higher risk of developing cognitive developmental delay than HIV negative children (RR, 95% CI, 1.95, 3.07, P < 0.00001). Infected children scored - 0.54 less than HIV negative children (SMD 95% CI, -0.70, -0.39, 97, p < 0.00001) for cognitive development and -0.68 in motor development (SMD 95% CI, -0.82, -0.55, p< 0.00001). The risk of motor developmental delays was 2.95 times in HIV positive compared with HIV negative children (RR 95% CI, 2.19, 3.99, p < 0.00001). HIV infected children are slower in aspects of cognitive and motor development compared to their HIV negative counterparts. They also showed delays in anthropometric outcomes; weight for age and height for age. Study design influenced results of the studies with children scoring more on cross sectional than cohort studies. There is still need to develop culturally appropriate or standardise neurodevelopment tools as most African studies still rely on international tools. More evidence is needed on the effectiveness of HAART in reducing cognitive and motor delay.
AFRIKAANSE OPSOMMING: Die wêreldwye MIV epidemie duur voort met ongeveer 2.2 miljoen kinders onder 15 jarige ouderdom wat wêreldwyd met MIV leef en 640 000 onlangs in 2004 geïnfekteerd (WHO, 2009). MIV strek oor die bloed-brein grens wat kan lei tot neuronale skade en die dood. Daar is kontroversiële bewys binne beskikbare navorsing oor die effek wat MIV het op kognitiewe en motoriese ontwikkeling in kinders, vanweë die beperkinge wat geplaas word deur studie ontwerpe, studie bevolkings en studie metodologiese kwaliteit. Die doelwitte van die oorsig is om - ‘n sistematiese oorsig van gepubliseerde navorsing te doen om sodoende die effek en voorkoms van MIV infeksie op kognitiewe en motoriese ontwikkeling by kinders vas te stel - ’n kritiese waardering van die metodologiese kwaliteit van gepubliseerde navorsing te doen ten opsigte van die kognitiewe en motoriese ontwikkeling van MIV geïnfekteerde kinders. Die doelwitte van die oorsig is om - assessering te doen van die bewyse van kognitiewe en motoriese ontwikkeling by MIV-1 geïnfekteerde kinders - antropometriese uitkomste te beskryf, insluitend: gewig vir ouderdom, gewig vir hoogte, hoogte vir ouderdom en omtrek van die hoof by kinders met ’n MIV infeksie - die metodologiese kwaliteit te assesseer van studies op die kognitiewe en motoriese ontwikkeling van MIV geïnfekteerde kinders. Die volgende databasisse is nagevors vir die identifisering van artikels: MEDLINE, Google Scholar, AIDSTRIALS, AIDSLINE en CINHAL. Die tydraamwerk vir navorsing het gepubliseerde werk ingesluit vanaf aanvang tot Julie 2011 sonder taalbeperkings. Analitiese waarneembare toetse wat ten minste een uitkoms geassesseer het (kognitiewe of motoriese ontwikkeling of 1 van die antropometriese uitkomste) tussen MIV positiewe en MIV negatiewe kinders van 5 jarige ouderdom en jonger, of kinders met ’n gemiddelde ouderdom van minder as 5 jaar is betrek. Twee oorsig outeurs het onafhanklik vir geskikte studies gesoek, metodologies geëvalueer en data getrek. Meta-analise was uitgevoer deur gebruik te maak van Rev Man 5.1 met behulp van die risiko-ratio vir kategoriese data en die standaard gemiddelde verskil vir aaneenlopende data. Vyftien studies met ’n totaal van 3 086 deelnemers met die insluitingskriteria. MIV geïnfekteerde kinders het 2.45 keer ’n hoër risiko gehad om kognitiewe ontwikkelingsvertraging te ontwikkel as MIV negatiewe kinders (RR, 95% CI, 1.95, 3.07, P< 0.0000). Geïnfekteerde kinders het ’n -0.54 telling behaal, minder as MIV negatiewe kinders (SMD 95% CI, -0.70, -0.39,97 p < 0.00001) vir kognitiewe ontwikkeling en -0.68 vir motoriese ontwikkeling (SMD 95% CI, -0.82, -0.55, p< 0.00001). Die risiko van motoriese ontwikkelingsvertragings was 2.95 keer by MIV positiewe in vergelyking met MIV negatiewe kinders (RR 95% CI, 2.19, 3.99. p < 0.00001). MIV geïnfekteerde kinders is stadiger in aspekte van kognitiewe en motoriese ontwikkeling in vergeyking met hulle MIV negatiewe eweknieë. Hulle het ook vertragings getoon in antropometriese uitkomste; gewig vir ouderdom en hoogte vir ouderdom. Studie ontwerpe het uitslae beïnvloed van die kinders wat ’n hoër telling behaal het met deursnee as in kohort studies. Daar is nog ’n behoefte om kultureel geskikte of gestandaardiseerde neuro-ontwikkelingsinstrumente te ontwikkel, omdat die meeste Afrika-studies nog steeds staat maak op internasionale instrumente. Meer bewyse is nodig aangaande die effektiwiteit van HAART om kognitiewe en motoriese vertraging te verminder.

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Hattam, Michelle, Brenda Louw, and Salome Geertsema. "Communication Characteristics of Children Infected With HIV/AIDS in South Africa." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/2122.

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There is a dearth of locally relevant data in South Africa regarding the communication development of children infected with HIV/AIDS within the local context. The objective was to describe the characteristics of a group of children infected with HIV/AIDS being managed at a regional hospital in Gauteng, South Africa.

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Majonga, E. D. "Cardiac abnormalities in HIV infected older children and adolescents in Zimbabwe." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2018. http://researchonline.lshtm.ac.uk/4650757/.

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The global scale-up of antiretroviral therapy (ART) has resulted in a dramatic decline in mortality in HIV infected individuals. Longstanding HIV infection is associated with an increased risk of chronic co-morbidities. One of the most wellrecognised co-morbidities is cardiac disease. An increased risk of cardiac disease in HIV infected children was reported in the pre-ART era, but the burden and natural history in the ART-era, particularly in SSA is not known. Assessment of cardiac abnormalities is further complicated by the lack of regional (African) echocardiographic references ranges for healthy children. The main aims of this research were to establish echocardiographic reference ranges for older children in sub-Saharan Africa (SSA), and to determine the prevalence, incidence and progression of, and risk factors for cardiac abnormalities in children with HIV established on ART. A total of 282 healthy HIV-uninfected children aged 6-16 years with no known history of cardiac disease were enrolled to derive echocardiographic reference ranges. Standard M-mode and two-dimensional echocardiography was performed following the American Society of Echocardiography guidelines and a gamma-weighted model was used to calculate the z-scores for ventricular and atrial dimensions. The first echocardiographic references (z-scores) were established for older children in SSA and were normalised to body surface area. A total of 201 children with HIV aged between 6 and 16 years, taking ART for at least 6 months and clinically stable underwent transthoracic echocardiography, using a standard protocol at baseline and at 18 months. A total of 197 had echocardiograms at baseline and abnormalities were found in 83 (42%); left ventricular (LV) diastolic dysfunction was commonest in 45 (23%) and LV hypertrophy (LVH) in 22 (11%). Right ventricular (RV) dilatation and systolic dysfunction were found in 13 (7%) and 4 (2%) respectively, of whom 60% had concurrent left heart abnormalities. Current use of nevirapine and hypertension were associated with LVH and LV diastolic dysfunction respectively. A total of 175 (89%) participants were followed up for 283.9 person-years (pys). Ten participants developed left heart and 16 developed right heart abnormalities constituting an incidence of left and right heart abnormalities was 3.52 and 5.64 per 100 pys respectively. The risk of RV dilatation was highest, 12/163 (7%) Stunting was associated with development of any new cardiac abnormality (aOR 2.59 (95% CI, 1.03-6.49; p=0.043). Cardiac abnormalities persisted at follow up in majority of participants. Cardiac abnormalities present at baseline reverted to normal at 18 months in 11(6%). There was an overall increase in mean z-scores for LV, left atrial, LVH, interventricular septal and LV posterior wall diameters at 18 months (p < 0.001). Despite ART, children with HIV have a high prevalence and incidence of cardiac abnormalities, with only a minority being transient. The increase in mean zscores for LV, left atrial, LVH, interventricular septal and LV posterior wall diameters a short period of follow up suggests potential for progression of cardiac abnormalities. Longer follow up is recommended to understand the clinical implications of these abnormalities.

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Kenny, J. M. "The impact of HIV and antiretroviral therapy on the cardiovascular system of HIV-infected children." Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1476295/.

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Background Cardiovascular disease is increased in HIV-infected adults but the underlying aetiology is incompletely understood. Pre-clinical changes in cardiovascular structure and arterial stiffness in HIV-infected children are described in mainly middle to high-income countries with minimal longitudinal data available. Limited cross-sectional data is available from Africa in settings where 90% of HIV-infected children live. Methods ART-naïve and ART-experienced (on d4T+3TC+NNRTI for >2years, virologically suppressed at enrolment) HIV-infected children underwent serial assessment within the CHAPAS-3 trial (evaluating d4T vs ZDV vs ABC-based first line ART in Zambia/Uganda): extensive cardiovascular assessment of structure (carotid intimal medial thickness [cIMT] and arterial stiffness (pulse wave velocity [PWV]). Additionally markers of inflammation, disordered thrombogenesis, vascular damage and immune activation were measured. Age-matched HIV-uninfected controls had a single assessment. Baseline differences between ART-naïve/experienced children vs controls, and longitudinal changes in HIV-infected children were assessed. Results In 208 ART-naïve children with median age 2.9y (IQR 1.7–4.4), median CD4% 18% (11-23) and 209 HIV-uninfected controls median age 3.0y (2.1–4.1), mean(sd) cIMT was 0.46(0.04) v 0.44(0.04) mm respectively (p < 0.001); PWV was 5.85(0.8) vs 5.67(0.74)m/sec respectively (p=0.05). Among 74 ART-experienced children on ART for a mean of 3.7y with a median age of 6.9y (5.9–8.50), median CD4% 33% (27-39) and 75 uninfected controls with median age 6.7y (5.6-8.6), the mean(sd) cIMT was 0.46(0.05) vs 0.45(0.04)mm respectively (p=0.09); PWV was 5.63(0.61) vs 5.69(0.68)m/s respectively (p=0.57). In ART naïve children IMT and PWV significantly decreased from baseline (ART initiation) to week 96 mean(sd) cIMT -0.02(0.04)mm (p < 0.001), PWV -0.37(0.82)m/s (p < 0.001). In contrast whereas cIMT had significantly reduced by mean -0.2(0.06)mm (p=0.01) at week 96 in the ART experienced group PWV increased by 0.34(0.62)m/s (p < 0.001). There was no evidence that the changes in IMT or PWV over 96 weeks differed by randomisation ART in either ART naïve or ART experienced children (p≥0.27). Significant differences in a panel of 19 biomarkers and immunophenotyping (markers of activation and proliferation) were demonstrated between HIV infected ART naïve children and healthy age matched HIV uninfected children. No significant relationship between any of the biomarkers, immunophenotyping markers and IMT or PWV was demonstrated. Conclusion In this large study of arterial structural and stiffness in HIV-infected children in Africa, ART-naïve HIV-infected children had significantly poorer IMT and PWV than age-matched controls, with significant improvement seen after 96 weeks of ART. After a mean 3.7 years on ART, HIV-infected children had cIMT and PWV comparable to uninfected age-matched controls. IMT continued to improve after a further 96 weeks on ART. These findings illustrate that ART can reverse some of the structural/stiffness changes caused by HIV, strengthening the argument for early diagnosis and treatment of HIV-infected infants.

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Bates, Matthew Adam. "Betaherpesvirus genetic variation and infection in HIV-1 infected and 'HIV-1 exposed' Zambian children." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2010. http://researchonline.lshtm.ac.uk/4646542/.

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The betaherpesviruses human cytomegalovirus (HCMV) and human herpesvirus 6 (HHV-6) are investigated here as pathogens in Zambia, an HIV -1 endemic region where there was little previous data. In particular we assess the effects of these viruses on 'maternally HIV-l exposed' infants: HIV-l negative infants of HI V-I positive mothers. HCMV and HHV-6 are serious causes of morbidity and mortality in HIV / AIDS and are linked with AIDS progression, so in this thesis they are investigated in both HIV -1 infected and uninfected Zambian children, along with maternally HIV exposed infants, an under studied and growing group in Southern Africa. The aim ofthis thesis is to employ qualitative and quantitative PCR assays to determine betaherpesvirus prevalence, loads and genotypes in three independent Zambian paediatric cohorts: Two retrospective cohorts (141 infants hospitalized with fever and 36 childhood HIV-1 positive respiratory mortalities), and also one prospective cohort (812 infants taking part in a population-based study designed to test the efficacy of a micronutrient fortified feed supplement to improve growth and health) in which relationships between betaherpesvirus infection, duration of breast feeding, infant growth and morbidity were investigated. Prevalence and loads were highest within the symptomatic cohorts, although lower levels of both viruses were also detected in sera from healthy infants taking part in the prospective study. High load HCMV infections were shown here to be significantly more prevalent in maternally HIV -1 exposed infants. Genotyping analysis focused of two hypervariable glycoproteins (gO and gN), which in HCMV have been shown to form seven linked genotypes. Here we identified a new genotype (gN4d) and demonstrated linkage with g05, demonstrating now eight gO/gN linkages. Analyses of this data and that generated in other countries show these linkages are globally maintained. Conversely for HHV -6, whilst HHV-6B is the predominant strain for childhood infections in the V.S, Europe and Japan, in Zambia HHV-6A was identified in 84% ofinfant infections, suggesting emergence elsewhere. The prevalence of active betaherpesvirus infections through detection of viral sera-DNA was 34-40% for HCMV and 8-13% for HHV-6, showing that primary infection with HCMV occurs much earlier in this region than in European and North American countries. Active HCMV infections were associated with inhibitory effects on growth and a trend for increased morbidity in HIV -1 exposed infants as measured by an increased rate of hospital referrals. HCMV seroprevalence was associated with anaemia and stunting, and breast feeding increased HCMV transmission, particularly in HIV -1 exposed infants. A micronutrient supplement with iron reduced anaemia. In summary, genotypes of HCMV and HHV-6 were identified and characterised in infant infections in this region, and analyses shows association with morbidity and growth delays for HCMV infected children, particularly with maternal HIV -1, a newly identified potential hazard for this population.

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Mtimbiri, Siza. "The impact of HIV/AIDS on infected and affected rural primary school children in Zimbabwe : children's perspectives : a case study." Thesis, University of Cambridge, 2019. https://www.repository.cam.ac.uk/handle/1810/285424.

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Although there has been increasing research on HIV/AIDS and children, albeit mostly outside the school environment, most research in the area tends to view 'children as objects' (Christensen and James, 1999) in the research process whereby the change in the child is what is being observed. This view lessens the role of the child and as such means that the results are inadequate - mostly the researcher's perspective is represented. In Zimbabwe, with an estimated 1.1 million AIDS orphans and 115,000 children under 14 living with HIV/AIDS, not much empirical research has been conducted in school settings where they spend most of their time; the complexities of infected and affected students' experiences within the school-home-community spheres are mostly inferred due to lack of empirical research. Using Bronfenbrenner's Ecological System's Theory and the Capability Approach to adopt a holistic psychosocio-cultural lens, the research aims to understand the experiences of infected and affected students from their perspectives within their school, home and community environments. Added to observations, in-depth interviews based on data collected using photography, drawings, timelines, sociograms and student diaries were conducted with 65 boys and 27 girls aged 10 -13 years from a rural primary school during the months of August to December 2011. In-depth interviews were also conducted with 161 parents and caregivers. Also interviewed were 13 stakeholders comprising of a Senior Research Officer within the Ministry of Education, District Education Officer, 5 Teachers and their Principal, a District Councilor, the Chief, a village head, a local Baptist Minister and a research staff person from, FACT, a local NGO that works with AIDS orphans. Among children, findings point to dilapidating issues of stigma, abandonment, unaddressed emotional and physical needs; children relied on each other's advice more than that of teachers and caregivers. Among the adult community, the education authorities and community leaders who are custodians of their education, ignorance about infected and affected children is astounding. An ageing population of caregivers is barely able to deal with the complexities of infected children. Religion has a powerful negative influence on addressing HIV/AIDS issues. Teachers, citing taboo issues about sex and the fact that HIV/AIDS is not an exam at the school, refused to broach the subject. Education Officials at the time clearly pointed out that there has been no research nor any plans yet to address this population and their needs. Further research will need to be conducted for educational planning that will be most effective in implementing meaningful changes for this group and other rural primary school children.

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Palin, Frances L. "The Psychosocial Adjustment of Black South African Children of HIV-Infected Mothers." Digital Archive @ GSU, 2007. http://digitalarchive.gsu.edu/psych_diss/24.

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Research from the U.S. suggests that maternal HIV-infection negatively impacts children's psychosocial functioning and that resources (e.g., the parent-child relationship) positively influence their adjustment to maternal HIV-infection. Although HIV-infection in South Africa is most prevalent among Black South African women, there is limited research examining its impact on their children. In addition, as these children are exposed to numerous socio-cultural stressors beyond those associated with HIV-infection, they are at particular risk for psychosocial difficulties. This study had two aims: 1) to evaluate whether maternal HIV-infection confers risk for psychosocial difficulties (i.e., internalizing and externalizing behaviors) among Black South African children; and, 2) to examine potential protective resources for children of HIV-infected mothers that could ideally be addressed through appropriate community-level interventions. Three categories of resources were considered: material (familial economic stability); maternal (maternal psychological functioning; maternal social support); and, caregiving (the parent-child relationship; quality of the caregiver - co-caregiver relationship). Participants included women who self-identified as HIV-infected or non-infected and who were the biological mother of a child aged 11-16. Results indicated that there were no psychosocial adjustment differences between the two groups of children. The lack of differences suggests that in the context of the constellation of stressors Black South African children face, maternal HIV-infection may not serve as a unique stressor for psychosocial adjustment difficulties. However, the lack of differences should not be construed to mean that a child whose mother is HIV-infected is not affected his/her mother's diagnosis. Maternal HIV-infection is a complex phenomenon that warrants further study among Black South African children. The results did not illuminate any resources that were particularly salient to the children of HIV-infected mothers; rather, variables salient to all children were identified, notably economic stability, maternal depression, family social support, the parent-child relationship, and conflict in the mother- co-caregiver relationship. Given the overall risk present in the lives of Black South African children beyond maternal HIV-infection, it appears important to address the needs of all children. This study provides important information about individual and family-level variables that could be emphasized in family interventions with the population as a whole.

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Pitcher, Richard D. "Radiological progression of lung disease in Human Immunodeficiency Virus (HIV)-infected children." Doctoral thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20351.

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Introduction: There are limited data on the chest X-ray (CXR) abnormalities in human immunodeficiency virus (HIV)-infected children in low- and middle-income countries (LMIC's). Aim: To investigate the evolution of CXR abnormalities in HIV-infected children in LMIC's, to correlate this with the severity of HIV-disease, and to assess the impact of anti-retroviral therapy (ART). Method: A prospective longitudinal study evaluating clinical, immunological and radiographic parameters at regular intervals over a minimum of 24 months. CXR abnormalities were stratified by severity and deemed persistent if present for 6 consecutive months or longer. Univariate and multiple logistic regression analyses assessed associations between radiological and clinical/immunological parameters at enrolment. An ordinal multiple logistic regression model assessed the association of enrolment and time-dependent variables with CXR findings over time.

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Madzime, Joanah. "DTI-based tractographic analysis of white matter alterations in HIV infected children." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31464.

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Despite early combination antiretroviral therapy (cART) administration, children born with human immunodeficiency virus (HIV) continue to demonstrate neurodevelopmental abnormalities. Often, there is a link between structural and functional abnormalities. Previously, we found HIV-associated changes in white matter and functional networks in a cohort of 7-year-old HIV infected (HIV+) children who intiatied early cART compared to uninfected controls. To explore possible relationships between these alterations, we used tractography to identify HIV-related abnormalities within structural connections located in functional resting state networks. Within HIV+ children (n=61), we identified white matter (WM) tracts with lower mean fractional anisotropy (FA) and/or higher mean diffusivity (MD) located in several functional networks, including the somatosensory, auditory, salience, default mode network (DMN), motor and basal ganglia networks compared to uninfected controls (n=46). Among the uninfected controls, children born to HIV+ mothers (exposed uninfected, HEU) (n=19) showed WM alterations (higher FA) compared to HIV unexposed uninfected children (HUU) (n=27) within tracts in the posterior DMN, visual (occipital lobe and lingual gyrus), salience and motor networks. The observed WM alterations in HIV+ children point to demyelination/dysmyelination within six networks. Four of these networks – the basal ganglia, default mode, salience and somatosensory – were all found to have altered functional connectivity in a previous study; therefore, these results point to damage or developmental delay in white matter may be related to or responsible for the HIV-associated functional abnormalities. The observed WM alterations in the HEU children suggest that even exposure to HIV and/or antiretroviral therapy (ART) also has long-term effects on axonal integrity in the developing brain.

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Robertson-Dallas, Shannon. "The pharmacokinetic interaction between zidovudine and trimethoprim-sulfamethoxazole in HIV-1 infected children." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0027/MQ40854.pdf.

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Zar, Heather. "Pneumonia in HIV-infected children admitted to hospital in Cape Town, South Africa." Doctoral thesis, University of Cape Town, 2000. http://hdl.handle.net/11427/11105.

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Bibliography: leaves 129-163.
There is little information on the aetiology and outcome of HIV-associated pneumonia in African children and no comprehensive data from South Africa. Studies of HIV-infected adult in Africa reported that the spectrum of pulmonary disease differs from that of developed countries with tuberculosis and pyogenic pneumonia predominating and Pneumocystis carinii pneumonia (PCP) occurring uncommonly. Knowledge of the aetiology and outcome of pneumonia is important for the development of paediatric management guidelines and of policies for allocation of resources especially in South Africa, where the HIV pandemic has resulted in increasing numbers of HIV-positive children requiring admission to hospital or intensive care units for pneumonia. Furthermore in countries with limited resources, development of cost effective diagnostic procedures to investigate the aetiology of pneumonia is necessary.

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Hankin, Claire Dominique. "Exposure to antiretroviral therapy in uninfected children born to HIV infected women in Europe." Thesis, University College London (University of London), 2006. http://discovery.ucl.ac.uk/1444777/.

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This thesis aims to investigate possible adverse side effects of antiretroviral therapy (ART) exposure in uninfected children born to HIV infected women, and to explore potential strategies for monitoring the health of these children. Using data from the European Collaborative Study, an ongoing multi-centre cohort study of HIV infected women and their children, the association between ART exposure and health outcomes in uninfected children was investigated. ART exposure was not associated with congenital abnormalities, or serious clinical symptoms up to 18 months of age. Children exposed to combination therapy were more likely to be premature than unexposed children. There was a marginal but significant negative effect of combination therapy exposure on weight, height and head circumference up to 18 months of age, when compared to no or monotherapy exposure. The CHART study, a consented clinic-based follow-up of uninfected children born in the UK, was conducted for three years to explore the feasibility of individualised follow-up to monitor adverse health events. The study was based on reports to obstetric and paediatric HIV surveillance, the National Study of HIV in Pregnancy and Childhood (NSHPC). Of 2104 eligible children, 33% were enrolled, 25% lost to follow-up, parents of 5% declined and the remainder could not be enrolled mainly because of resources or family circumstances. To obtain details on deaths and cancers among ART-exposed children over the long term, nearly 2200 uninfected children reported to the NSHPC were identified on the National Health Service Central Register through an anonymous matching procedure. Three deaths and no cancers were notified by the end of 2005. A survey of 140 parents and carers of ART-exposed uninfected children was conducted to seek their views on the long-term follow-up of their children. Although most respondents were supportive of the rationale for follow-up, contradictory views were expressed on how contact should be maintained.

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Nwosu, Emmanuel Chukwubuikem. "Effects of HIV and different anti-retroviral therapy (ART) regimes on brain structure in HIV infected children at age 7." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16696.

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Includes bibliographical references
By 2013, more than 300, 000 children were living with HIV-infection in South Africa. The World Health Organization (WHO) recommended early aggressive antiretroviral therapy (ART) initiation to manage HIV in children, based on studies that reported this protocol as effective in reducing mortality and HIV progression. Early ART initiation in HIV-infected children generated new concern about the long-term effects on neurodevelopment. There is still much to understand about the outcome of HIV and early ART on children's brain structure and neurocognitive skills. This study therefore investigated the effects of HIV and early ART on brain morphometry in 7-year old children using magnetic resonance imaging (MRI). Participants were 99 Xhosa children (56 HIV-infected children 43 uninfected controls, 50 boys, mean age = 7.21 ± 0.14 years) from the neuroimaging follow-on study of the Children with HIV Early Antiretroviral (CHER) trial. T1-weighted structural MRI data were acquired on a 3T Allegra (Siemens, Erlangen, Germany) within 6 months of their 7th birthday. In the CHER trial, HIV-infected infants were randomized at 7 weeks of age into three arms, two of which received immediate ART for either 40 or96 weeks. The third arm received ART when clinically or immunologically indicated by WHO 2006criteria. At age 7 years, all children were stable on ART. Scans were performed in accordance with protocols approved by the human research ethics committees of Stellenbosch and Cape Town Universities; all parents provided written informed consent and children provided oral assent. MRI scans were analysed with FreeSurfer's automated processing stream (http://freesurfer.net/) to generate measures of cortical thickness, local gyrification index (LGI), and regional (corpus callosum, bilateral caudate, hippocampus, putamen, thalamus, and lateral ventricle) and global brain volumes. Vertex-wise and region of interest (ROI) comparisons were performed between and within HIV infected and uninfected children. Relationships between morphometric and clinical data were investigated. Our results showed no significant difference in cortical thickness between HIV-infected and uninfected children. Uninfected children had greater gyrification than HIV-infected children in a left medial parietal region while HIV-infected children had smaller volumes of the bilateral putamen (p=0.001)and right hippocampus (p=0.01), and smaller total white (p=0.001) and gray (p=0.02) matter volumes. There was no effect of duration of ART in HIV-infected children except in the left hippocampus where longer (96 weeks) duration was associated with greater volume. There was no significant relationship between cortical thickness at age 7 and immunological status at enrollment, but regional (caudal middle frontal, pars orbitalis, lateral occipital and superior parietal regions) gyrification showed a relationship with immune system parameters (CD4 count, CD4percentage and CD4/CD8 ratio) respectively. A healthier immune system at enrollment - CD4percentage and CD4/CD8 ratio - was associated with reduced volume in the caudate nucleus, while longer cumulative duration on ART was associated with increased volume of the bilateral thalamus at age 7. There was no difference in brain volume or cortical thickness measures between HIV-exposed but uninfected (HEU) children and HIV-unexposed uninfected (HUU), but HEU children had greater gyrification in the left precuneus region which may be abnormal due to HIV/ART exposure in utero. In conclusion, LGI and subcortical volumes were affected in HIV-infected children but their cortical thickness was not affected. This may likely have effects on neurodevelopmental skills and cortical folding development.

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Khobo, Isaac Lebogang. "Multimodal neuroimaging signatures of early cART-treated paediatric HIV - Distinguishing perinatally HIV-infected 7-year-old children from uninfected controls." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32731.

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Introduction: HIV-related brain alterations can be identified using neuroimaging modalities such as proton magnetic resonance spectroscopy (1H-MRS), structural magnetic resonance imaging (sMRI), diffusion tensor imaging (DTI), and functional MRI (fMRI). However, few studies have combined multiple MRI measures/features to identify a multivariate neuroimaging signature that typifies HIV infection. Elastic net (EN) regularisation uses penalised regression to perform variable selection, shrinking the weighting of unimportant variables to zero. We chose to use the embedded feature selection of EN logistic regression to identify a set of neuroimaging features characteristic of paediatric HIV infection. We aimed to determine 1) the most useful features across MRI modalities to separate HIV+ children from HIV- controls and 2) whether better classification performance is obtained by combining multimodal MRI features rather than using features from a single modality. Methods: The study sample comprised 72 HIV+ 7-year-old children from the Children with HIV Early Antiretroviral Therapy (CHER) trial in Cape Town, who initiated combination antiretroviral therapy (cART) in infancy and had their viral loads suppressed from a young age, and 55 HIV- control children. Neuroimaging features were extracted to generate 7 MRI-derived sets. For sMRI, 42 regional brain volumes (1st set), mean cortical thickness and gyrification in 68 brain regions (2nd and 3rd set) were used. For DTI data: radial (RD), axial (AD), mean (MD) diffusivities, and fractional anisotropy (FA) in each of 20 atlas regions were extracted for a total of 80 DTI features (4th set). For 1H-MRS, concentrations of 14 metabolites and their ratios to creatine in the basal ganglia, peritrigonal white matter, and midfrontal gray matter voxels (5th, 6th and 7th set) were considered. A logistic EN regression model with repeated 10-fold cross validation (CV) was implemented in R, initially on each feature set separately. Sex, age and total intracranial volume (TIV) were included as confounders with no shrinkage penalty. For each model, the classification performance for HIV+ vs HIV- was assessed by computing accuracy, specificity, sensitivity, and mean area under the receiver operator characteristic curve (AUC) across 10 CV folds and 100 iterations. To combine feature sets, the best performing set was concatenated with each of the other sets and further EN regressions were run. The combination giving the largest AUC was combined with each of the remaining sets until there was no further increase in AUC. Two concatenation techniques were explored: nested and non-nested modelling. All models were assessed for their goodness of fit using χ 2 likelihood ratio tests for non-nested models and Akaike information criterion (AIC) for nested models. To identify features most useful in distinguishing HIV infection, the EN model was retrained on all the data, to find features with non-zero weights. Finally, multivariate imputation using chained equations (MICE) was explored to investigate the effect of increased sample size on classification and feature selection. Results: The best performing modality in the single modality analysis was sMRI volumes

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Griffiths, Mikaela Ceridwen. "A profile of needs music therapy with HIV infected children in a South African institution /." Diss., Pretoria : [s.n.], 2003. http://upetd.up.ac.za/thesis/available/etd-02232005-104125/.

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Scott, Zachary Aaron. "T Cell Immunity and HIV-1 Replication in Vertically-Infected Infants and Children: A Dissertation." eScholarship@UMMS, 2003. https://escholarship.umassmed.edu/gsbs_diss/71.

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Virus-specific cellular immune responses have been shown to be important in the control of viral replication in several animal and human virus models. Cells of both the CD8+ and CD4+T cell lineages have been shown to play protective roles during viral infections by exerting effector functions that can kill infected host cells or inhibit the production and spread of infectious virions. The continued spread of HIV-1 infection throughout the world, as well as the lack of a prophylactic HIV-1 vaccine have generated much interest in HIV-specific cellular immune responses. Recent technical advances have yielded a tremendous increase in our understanding of HIV-1-specific immunity, as well as HIV-1 replication dynamics and host cell factors that shape the course of acute and chronic infection. Unfortunately, due to small sample volumes and technological limitations, the study of HIV-1-specific T cell immunity in infants and children has been difficult. An improved understanding of the timing, specificity, and intensity of pediatric HIV-specific T cell responses would contribute to the development of a HIV-1 vaccine for use in regions of the developing world without access to antiretroviral therapeutics. In the small number of published studies investigating pediatric HIV-specific immunity, T cell responses were uncommonly detected in infants. It remains unclear, however, whether the lack of HIV-specific T cells is an accurate reflection of the in vivoimmune state in vertically-infected infants, or rather is a consequence of reagents and assays ill-suited to the detection of low-level and/or diverse T cell responses in pediatric subjects. In the present dissertation, several methodologies were used to investigate HIV-specific T cell responses in vertically-infected infants and children. HIV-specific CD8+ T cell responses were infrequently detected in a cohort of young infants, but are commonly detected in older infants and children. Interestingly, CMV-specific CD8+ T cell responses were detected in several young infants that lacked HIV-specific responses, suggesting a specific defect in the ability of some infants to generate HIV-specific CD8+ T cell responses. Further experiments characterizing detectable HIV-1-specific CD8+ T cell responses found that the HIV-1 accessory proteins may be important targets of the immune response during early vertical infection. The role of HLA class I genotype and viral sequence are also explored in a pair of vertically-infected twins with discordant CD8+T cell responses. Finally, viral isolates from an infant with a marked shift in gag-specific epitope usage during infancy are analyzed for the presence of escape mutations. Gag-specific CD4+ T cell responses were commonly detected in a large cohort of vertically-infected children. A linear relationship between HIV-1 replication and the presence and intensity of HIV-specific CD4+ T cell responses was found, but ongoing HIV-1 replication appeared to blunt CD4+T cell proliferation. The data presented in this dissertation describe pediatric T cell immune responses and how they relate to HIV-1 replication. This information may be useful to the design of a prophylactic or therapeutic HIV-1 vaccine for vertically-infected infants and children.

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Davies, Mary-Ann. "Outcomes and effectiveness of antiretroviral therapy for HIV-infected children in South African treatment cohorts." Doctoral thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/9382.

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Includes abstract.
Includes bibliographical references.
Since 2004, increasing numbers of children in sub-Saharan Africa have commenced antiretroviral therapy (ART). This thesis reviews the outcomes of published studies of paediatric ART cohorts in Africa, describes outcomes for children receiving ART in South Africa and examines determinants of mortality and generalizability across the Southern African region. Temporal trends in characteristics at ART initiation are also examined. The measurement of treatment success in resource-limited settings is reviewed, by examining virological failure, and assessing the diagnostic accuracy of immunological criteria for identifying virological failure.The results chapter is presented in the form of published or submitted papers based on data from the International epidemiologic Databases to Evaluate AIDS-Southern Africa (IeDEASA) collaboration. The first paper reviews paediatric ART studies from Africa published before 2008. Together with the literature review in chapter 1, it provides the background to this thesis. The second paper reports on mortality (8%) and retention in care (81%) by 3 years after ART start for > 6,000 children who initiated ART in South Africa. The generalizable prognostic models in the third paper suggest that mortality during the first year on ART ranges from <2% to >45%, with the majority of children being in the group with the best prognosis. The fourth paper reports that 1 in 5 children meet criteria for confirmed virological failure by 3 years on ART. The risk is greater with triple ART containing nevirapine or unboosted ritonavir (in comparison with lopinavir/ritonavir or efavirenz). The fifth and sixth papers demonstrate that immunological criteria have low sensitivity and positive predictive value for virological failure. Targeted viral load measurement reduces the number of false positive virological failure diagnoses. The final paper shows that increasing numbers of children have initiated ART with a decline in disease severity at therapy start from 2005-2010. However, even in 2010 a substantial number of children started ART with advanced disease. The thesis concludes that access to ART for children has increased, with good outcomes. HIV cohort research is important in evaluating the safety and effectiveness of different models of care, treatment and monitoring strategies.

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Van, Biljon Noëlle. "Longitudinal analysis of Brain Metabolite levels for HIV infected Children from ages five to eleven." Master's thesis, Faculty of Science, 2020. http://hdl.handle.net/11427/32370.

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HIV infected (HIV+) children initiate antiretroviral therapy (ART) early in life and remain on it lifelong. However, the long-term impact of ART and HIV on the maturing brain is not well documented and longitudinal neuroimaging studies are rare, especially in developing countries most heavily impacted by HIV/AIDS where access to imaging resources are limited. We have examined HIV related changes in metabolite level trajectories from 5-11 years in three brain regions using Magnetic Resonance Spectroscopy (MRS). We used univariate linear mixed effect models to identify independent profiles of the metabolites measured in each region of the brain. To explore the metabolite trends in a multivariate setting we generated multilevel mixed effects models, and correlated response models. There was an element of confounding introduced through the change of MRI scanner during the follow-up period and we compare different methods to resolve this issue. Consequently, we did observe differences in metabolite profiles from HIV+ children compared to HIV uninfected (HIV-) controls. This suggests that while these children are on ART treatment, there is still some underlying effect on their neurochemistry which sets their development apart from the normal healthy profiles we expect.

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Nabukenya, Jennifer Maryann SSengooba. "Outcomes of late initiation of antiretroviral therapy in Ugandan-HIV -infected children treated at Mildmay Jajja home." Thesis, University of Limpopo (Medunsa Campus), 2011. http://hdl.handle.net/10386/463.

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Thesis (MPH)University of Limpopo (Medunsa Campus), 2011.
INTRODUCTION: Antiretroviral therapy (ART) has been proven to significantly improve the quality and quantity of lives of patients infected with HIV. However, several barriers exist that prevent children from being initiated on treatment on time. Studies in adults have shown that the timing of treatment influence outcomes of ART; but little is known about this in children. Hence, the need for this study. The purpose of this study was to characterize the outcomes of late initiation of ART in HIV- positive children seen at the Mildmay Jajja Home center. METHODOLOGY: The study was a cross-sectional survey involving all children who were initiated at the Mildmay Jajja Home in 2005 and had had been on ART for at least 18 months. Two sets of data were collected, for the children on ART: their age and sex were recorded. In addition, based on the Ugandan clinical guidelines for ART, children were grouped into two groups; those 6 six years and below; and those above 6 years. Clinical variables recorded were baseline and repeated measurements of bodyweights, and CD4 counts; weight and CD4 counts at the time of initiation of ART, at 12 months and at 18 months. For the care providers: their age, gender, education level, relationship to the child was recorded. Three outcomes of treatment were assessed, adherence level by the 12th month on treatment; hospitalisation by the 12th month (during the first 12 months of treatment); and survival or death at by the 12th and 18th month on treatment. RESULTS: In total, 114 children were included in the sample. Among them, 54.4% of children were initiated late. Based on age, children 6 years old and younger were more likely and significantly initiated late as compared to those over 6 years old as about 70% of them were actually initiated late. Based on sex, female children older than 6 years were significantly initiated late as compared to boys. The characteristics of care providers that were associated with children being initiated late were being male, less than 40 years old, with a primary school level of education, and not knowing their own HIV status. With regard to outcomes of the treatment, adherence, hospitalisation, and survival were assessed. Overall, 59.4% of children achieved an adherence level of 90% or more; 17.3% of children had been hospitalised at least once; and the mortality was 17.5% during the 2 year period covered by the study. Adherence was influenced slightly by the timing of the start of the treatment since less than half (46.34%) of those initiated late achieved an adherence level of 90% or more as compared to over 53% among those initiated timely. Though there was not statistically significant difference, adherence was slightly better in children whose care providers were biological parents, whose HIV status was known as positive, and female. With regard to hospitalisation, children less than 6 years were significantly more hospitalised than the older ones; their care providers were relatives, not educated, and of unknown HIV status. Those initiated late were significantly more hospitalised than those initiated timely (63.15% versus 36.84%, p=0.03). With regard to survival, the majority of children who died were over 6 years old, and female. The majority of their care providers were female, under 40 years old, and known HIV-positive. In children initiated late, the mortality was 50% (n=14) and 83.3% (n=6) respectively by the 12th and 18th month of treatment as compared to those initiated timely. In conclusion, 54.4% of children were initiated late. Late initiation was associated with negative outcomes such as low adherence to treatment as less than half of them achieved a adherence level of 90% or more; hospitalisation as those initiated late were significantly more hospitalised than those initiated timely; and high mortality since among those who died, 50% and 83.3% of deaths occurred respectively by the 12th and 18th month of treatment among those initiated late. In order to minimize the probability that the majority of children are initiated late, a general awareness campaign should be directed at the general public so that they can be sensitized to the need to bring children to medical attention as soon as possible

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Folefoc, Asongna Theresia. "Treatment outcome of HIV-1 infected children on antiretroviral therapy in the Limpopo Province of South Africa." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4006.

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Magister Public Health - MPH
Background:HIV is a worldwide pandemic with an estimated 2.5 million children under the age of 15 living with HIV in the world in 2009. Children account for approximately 14% of all HIV-related deaths around the world. Several studies have shown that the use of antiretroviral drugs greatly improve the lives of HIV-1 infected individuals, however, most of these studies report on outcomes of ART programmes in developed world and for adult patients. Very few settings have published outcomes of paediatric ART programmes.Objectives This research was aimed at describing the long term (at least one year) treatment outcome of HIV-1 infected children in the HIV/AIDS Prevention Group (HAPG) program in Bela-Bela in the Limpopo province of South Africa.Study design and methods: A quantitative approach involving a retrospective cohort design was used for the study. The study included all children under the age of 15 that were enrolled in the HATG treatment programme in Bela-Bela between February 2004 and December2009.Immunological, virological, clinical outcomes and loss to follow-up were determined for this cohort. Mortality and survival was also determined. Results: The median age of children in this study was 5 years (IQR: 2-7) with 14% (10/71) of them being less than 18 months. Median CD4 count at commencement of ART, viral load and weight were 358 cells/mm3 (IQR 203.5-, 125673 RNA copies/μL (IQR 58094-328424.5) and 14.5Kg (IQR: 11.0-18.35) respectively. CD4 counts and weight showed increase within the study period, and there was also a decline in viral load. Loss to follow-up was 7.04% while mortality was 19% with 21.43% of mortality cases being children who were ≤18months. Mortality occurred within the first year of ART initiation and occurred in cases that had advanced disease.Conclusion: This study shows that the ART program in Bela-Bela has a positive outcome on HIV positive children.The high mortality rate was due to children starting ART at an advanced disease stage. Despite the good outcome, it is recommended that a system be put into place that will aid in identifying children at an early stage of the disease and treatment initiated promptly.

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O'Callaghan, Erin Theresa. "Cognitive Functioning, Immune Functioning, and Disease Progression in Perinatally Infected HIV+ School-Aged Children on Highly Active Anti Retroviral Therapy." Scholarly Repository, 2007. http://scholarlyrepository.miami.edu/oa_dissertations/11.

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This study is one of the only investigations to examine the complex inter-relationships between immune status, cognitive functioning, and disease progression in school-aged, perinatally infected, HIV+ children on HAART over time and is the first to conduct long-term follow-up assessments beyond one year after initiating HAART. Previous research has shown that HIV+ children on HAART show stability in cognitive functioning for up to one year. The current study investigated cognitive functioning, as measured by the Wechsler Intelligence Scale for Children -III, as a function of immune functioning and disease progression over time in this sample. Overall, results showed that PIQ scores remained stable over the three time points. However, further analyses demonstrated that poorer immune status, as measured by CD4% <25, at the first time point significantly predicted lower Performance IQ (PIQ)scores and PIQ subtest scores at the third time point, even after controlling for covariates. Similarly, additional analyses revealed that PIQ scores significantly declined over time as a function of CD4% category at the first time point. Finally, scores on the PIQ, Verbal IQ (VIQ), Coding, Picture Arrangement, Symbol Search, and Arithmetic at the first time point were all significant predictors of more advanced disease progression, as measured by CDC C classification at follow-up. The clinical relevance of this study and recommendations for future research in this area are discussed

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Symonds, Gene. "Play to promote development and learning in children infected with Human Immune Virus (HIV): Case studies of three children." Thesis, University of the Western Cape, 2010. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_7428_1308638637.

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The aim of this study was to explore the use of play with toddlers who are HIV positive to facilitate play, playfulness and sensory-motor development. The objectives were to explore how the therapist facilitated play, to explore how the child responded to the intervention, to explore how playfulness manifested as a facilitatory strategy and to explore how playfulness manifested as a response. A qualitative approach framed the case study research method with three participants between the ages of twelve months and three years. The main source of data was a record of the play-based intervention with the three participants. Additional data was obtained from participant observation of the children&rsquo
s responses to the play-based intervention, and hospital and occupational therapy record notes. A theory analytical strategy was used by coding data using theoretic propositions inductively. Each case was first analyzed individually, and then an analysis was made across the cases. Qualitative analysis of the data was done manually by coding, seeking categories and eliciting emergent themes by using an analytical strategy of theoretical propositions and an analytical technique of explanation building. Coding was done inductively, using theoretical constructs from the occupation by design, namely the elements of appeal, intactness and accuracy. Signs of playfulness were coded according to evidence of the elements of playfulness, namely perception of control, intrinsic motivation, suspension of reality or framing were evident in the data. Findings of the study were reported under two themes: Playful enablement &ndash
the therapist and Engaging, playing and developing &ndash
the child.

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Milea, Simona Aostacioae. "The differences in environmental quality of care for HIV/AIDS-infected children in Romanian institutions and group homes." Theological Research Exchange Network (TREN), 1999. http://www.tren.com.

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Boyede, Ojombo Gbemisola. "The validation of a new development screening tool for developmental delays among HIV-Infected South African children." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15504.

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Background: Over 50% of HIV-infected children in South Africa have developmental delays. Early identification of affected children will lead to early intervention and favourable long-term outcome. Screening for developmental delay is not yet routine by many primary healthcare providers due to lack of locally available, rapid and sensitive screening tool s in busy Paediatric HIV clinics. A new screening tool was developed at the Red Cross War Memorial Children's Hospital (RCWMCH) for detecting moderate to severe global developmental delay among very young HIV infected children. The diagnostic accuracy and usefulness of the new tool was evaluated in this study. Objective: to validate the new RCWMCH developmental screening too l among HIV - infected South African children. Method: Forty-seven HIV-infected children in the age category 9-36 months attending the Infectious Disease Clinic (IDC) of the RCWMCH were screened using the new tool. Full developmental assessments of same children were performed using the Bayley Scale of Infant Development (BSID - III). Developmental Delay (global) was defined as composite scores 2 standard deviations below the mean in two or more developmental domains. Results: The sensitivity of the RCWMCH tool was 78.5%, specificity 54.6%, positive predictive value was 42.6%, and negative predictive value was 85. 7 %. Discussion: The RCWMCH screening tool was found to have sensitivity within the acceptable levels recommended for developmental screening tools. Its high negative predictive value will reduce unnecessary referrals for full developmental assessments in asymptomatic infants and toddlers. It is therefore recommended for screening for developmental delay among HIV-infected children from the age of 9 months to 3 years.

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Lewis, J. E. A. "Mathematical and statistical modelling of CD4 T-cell reconstitution in HIV-infected children starting antiretroviral therapy." Thesis, University College London (University of London), 2013. http://discovery.ucl.ac.uk/1388908/.

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Children's immune systems develop over the first 20 years of life and are fundamentally different to adults' in terms of lymphocyte numbers, turnover rates and population structure. Children perinatally infected with the human immunodeficiency virus (HIV) can expect their infection and any antiretroviral therapy (ART) administered to affect the developing population dynamics of the immune system and long-term immunological health in adulthood. Describing, understanding and predicting these effects is important for guiding individualised treatment regimes, public health policy and future research. The work described here develops an empirical model for CD4 T-cell reconstitution in HIV-infected children starting ART based on a monophasic, asymptotic recovery function and applied to data in a nonlinear mixed-effects framework. The model quantifies effects of age on both pre-ART and long-term CD4 count, and an association between poor pre-ART and poor long-term immune status. It allows prediction, by extrapolation, of CD4 counts in adulthood given ART initiation at different ages and CD4 levels. These predictions suggest that current ART initiation guidelines preserve potential for good long-term CD4 numbers in young children, but that this potential is progressively damaged as age increases. The model also identifies groups of children with qualitatively different CD4 trajectories and illustrates fundamental differences between recovery in children and adults probably due to children’s more active thymuses. Next, a mechanistic model of T-cell homeostasis is described, aiming to develop a biological understanding of some of the effects identified using the empirical model. A model of homeostasis in HIV proves a valid, useful tool for understanding pathogenesis and the reasons for incomplete recovery on ART, and illustrates the power of mixed-effects modelling for gleaning information about differences between children’s T-cell dynamics. In the future, more complex and complete models building on this foundation will help understanding of the interactions between development, HIV and ART.

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Thorne, Claire Nicola. "HIV-infected women and their children in Europe : an epidemiological study of health and social care." Thesis, University College London (University of London), 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285391.

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Vaz, Lara Maria Eng Eugenia. "Understanding the process of disclosure to HIV-infected children in Kinshasa, Democratic Republic of the Congo." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2008. http://dc.lib.unc.edu/u?/etd,1784.

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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2008.
Title from electronic title page (viewed Sep. 16, 2008). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Health Behavior and Health Education." Discipline: Health Behavior and Health Education; Department/School: Public Health.

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Stoltsz, Werner Heinrich. "Comparison of resting state functional networks in HIV infected and uninfected children at age 9 years." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29582.

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Over 2.5 million children are infected with HIV, the majority of whom reside in Sub-Saharan Africa. Treatment coverage is steadily gaining momentum, reducing mortality and morbidity. Yet little is known about brain development in HIV-infected (HIV+) children who are on highly-active antiretroviral therapy (ART), with viral load suppression from a young age. Here, we use resting state fMRI (rs-fMRI) to examine the impact of HIV and ART on the development of functional networks in 9-year-old vertically HIV-infected children compared to age-matched controls of similar socioeconomic status. We present analyses for a sample of 40 HIV+ (9.2 ± 0.20 years; 16 males) children from the Children with HIV Early Antiretroviral (CHER) clinical trial (Cotton et al. 2013; Violari et al. 2008) and 24 uninfected (12 exposed; 12 males; 9.6 ± 0.52 years) controls from an interlinking vaccine trial (Madhi et al. 2010). Scans were performed at the Cape Universities Body Imaging Centre (CUBIC) in Cape Town, South Africa. We investigated HIV-related differences in within- and between-network functional connectivity (FC) using independent component analysis(ICA) and seed-based correlation analysis (SCA). For SCA, seeds were placed in the structural core, in regions implicated in HIV-related between-group differences at age 7 years, and in regions associated with neuropsychological domains impaired in our cohort. In addition, we evaluated associations of past and present immune health measures with within-network connectivity using ICA. We found no HIV-related intra-network FC differences within any ICA-generated RSNs at age 9 years, perhaps as a result of within-network connectivity not being sufficiently robust at this age. We found a positive association of CD4%, both current and in infancy, with functional integration of left lobule 7 into the cerebellum network at age 9 years. Long-term impact of early immune health supports recently-revised policies of commencing ART immediately in HIV+ neonates. ii Compared to uninfected children, HIV+ children had increased FC to several seeds. Firstly, to seeds associated with the planning and visual perception neuropsychological domains. Secondly, to structural core seeds in the extrastriate visual cortex (of the medial visual network) and the right angular gyrus (of the temporoparietal network). Finally, to left paracentral (somatosensory network) and right precuneus (posterior DMN) seeds previously revealing between-group differences at age 7 years. The connections with greater FC in HIV+ children may variously indicate functional recruitment of additional brain capacity, immature excess of short-range connections, and/or immature excess of between-network connections. In conclusion, despite early ART and early virologic suppression, HIV+ children demonstrate instances of abnormal FC at age 9 years. Disruption to visual cortex is marked, consistent with indications from neuropsychological testing that visual perception is disrupted. The profile of HIV- and/or ART-related effects on FC differs considerably between the two ages of 7 and 9 years, but both show characteristics of immature functional organisation compared with age-matched controls.

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Tena-Coki, Nontobeko Gwendoline. "Investigations of mycobacteria-specific memoryy/effector T cell responses in HIV infected children receiving antiretroviral therapy." Doctoral thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11689.

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Includes abstract.
Includes bibliographical references (leaves 170-210).
Human immunodeficiency virus (HIV) infected children are at greater risk of developing tuberculosis disease, and might benefit from vaccination with novel TB vaccines. However, little is known about the effect of HIV-infection on function and phenotype of T cell responses to mycobacterial antigens in children. This study compares both CD4 and CD8 T cell cytokine expression and memory phenotype in children, following in vitro stimulation with mycobacterial antigens, also contained in novel anti-TB vaccines that are currently undergoing clinical trials.

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Toich, Jadrana. "Differences in resting state functional networks in HIV infected and uninfected children at age 7 years." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16653.

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Includes bibliographical references
Although early administration of highly active antiretroviral therapy (HAART) in infants provides the brain some protection against HIV damage, few studies have examined the long-term effects of HIV infection and HAART on neurodevelopment, and none have measured their impact on functional brain networks in young children. We use resting state functional magnetic resonance imaging (RS-fMRI) to explore differences in functional connectivity (FC) in HIV infected children stable on HAART and in HIV uninfected children. The 9 resting state networks (RSNs) identified using independent component analysis (ICA) included the visual lingual gyrus, visual occipital gyrus, salience, dorsal attention, auditory, motor, executive control, posterior default mode network (pDMN) and default mode network (DMN) . No significant group level differences were found in any RSNs using ICA. However, seed-based correlation analysis ( SCA ) revealed two regions where uninfected children had a higher FC compared to infected children (p < 0. 05 corrected for multiple comparison); specifically, between a seed in the left cingulate gyrus of the DMN and the left middle frontal gyrus, and between a seed in the right middle frontal gyrus of the executive control network and the right supramarginal gyrus. Consistent with our findings, previous RS-fMRI studies in HIV infected adults have reported reduced connectivity compared to uninfected adults in numerous DMN regions and executive control network. However, in contrast to the adult literature, in which a number of areas within the networks have been implicated, we only observed a focal effect in each of the two RSNs. Given that some of the RSNs are still undergoing major developments at age 7 years (i.e . time of scan for the children), the reduced FC may represent delayed network maturation within the infected cohort , with potential effects on cognitive functioning, information processing and memory recall abilities . Furthermore, positive associations were found between the clinical CD4/CD8 at time of enrollment and two regions within the dorsal attention and auditory networks. These results were independent of treatment arm and suggest that reduced FC in these networks at age 7 years are a result of poor immune function in early infancy (6-8 weeks of age), supporting the notion of in itiating ART immediately in HIV infected infants.

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Moos, Anbrenthia. "A qualitative feasability study to evaluate the use of a screening tool to detect neurocognitive deficits among perinatally HIV-infected children by primary health care workers." University of the Western Cape, 2020. http://hdl.handle.net/11394/8069.

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Magister Public Health - MPH
Despite the effectiveness and scale-up of antiretroviral treatment (ART), HIV-Associated neurocognitive disorders (HAND) still persist. Currently no gold standard tool exists to detect all forms of HAND, including major and minor cognitive impairments. In light of this, a newly developed screening tool was conceptualised, namely the Quick Paediatric Neurocognitive Screening tool (QPNST). The QPNST has been developed to detect HAND in perinatally HIV-infected children aged 5-10 years.

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Unuigbe, Oluwadamilola Hosen. "Naturally acquired and vaccine induced immune memory to Streptococcus pneumoniae in HIV-infected Malawian adults and children." Thesis, University of Bristol, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.535208.

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Punpanich, Warunee. "Development of a culturally appropriate health-related quality of life measure for HIV-infected children in Thailand." Diss., Restricted to subscribing institutions, 2009. http://proquest.umi.com/pqdweb?did=1835223241&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.

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Bienczak, Andrzej Marek. "Pharmacokinetics, pharmacogenetics and optimisation of treatment with non-nucleoside reverse transcriptase inhibitors in HIV-infected African children." Doctoral thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25063.

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Efavirenz and nevirapine are the most widely used agents for treatment of HIV in children. Sources of variability in their pharmacokinetics and its association with virological outcome and adverse events in African children are poorly characterised, thereby limiting treatment optimisation. To fill this gap we studied population pharmacokinetics (PK) of efavirenz and nevirapine in 478 children from CHAPAS-3 (aged 0.3-1.5 years) using non-linear mixed effects modelling and identified predictors of treatment outcome and PK thresholds most predictive of increased risk of nonsuppression using Cox proportional hazards regression models and likelihood profiling. Efavirenz PK was described by 2-compartment disposition model with 1st-order elimination and transit-compartment absorption and nevirapine by 1-compartment model with elimination through a well-stirred liver model and transit-compartment absorption. Combined effect of SNPs 516GT and 983TC was the strongest predictor of between-subject variability in clearance (89% and 68% decrease between fastest/slowest CYP2B6 metabolic subgroups for efavirenz and nevirapine, respectively). PK was affected by weight, described with allometric scaling. Nevirapine intrinsic clearance displayed diurnal variations (oscillations of amplitude 29%, maximum at 12 noon), while age affected pre-hepatic bioavailability (31.7% lower at birth and increasing exponentially). In antiretroviral treatment (ART)-naïve children (n=325) increased exposures were associated with decreased risk of non-suppression for both drugs. In efavirenz, risk further increased for children>8 years and for younger boys; in nevirapine for high pre-ART VL, low pre-ART CD4% and low adherence. Thresholds most predictive of non-suppression in efavirenz were: Cmid-dose=1.12 mg/L, Cmin=0.65 mg/L and AUC0-24=28 mg∙h/L, while nevirapine had no clear threshold. Adverse events were infrequent in efavirenz, whereas in nevirapine transient transaminase elevations >grade 1 were associated with Cmin>12.4 mg/L. Non-nucleoside reverse transcriptase inhibitors dosage guidelines for African children should take into consideration the combined effect of SNPs CYP2B6 516G>T and 983T>C, in particular for efavirenz where we observe 10-fold differences in exposures between metabolic subgroups. Moreover the target Cmin and AUC0-24 could be lowered in children for efavirenz. Treatment initiation at lower pre-ART VL and higher pre-ART CD4%, increased adherence, and maintaining average Cmin higher than current target could improve virological suppression of African children treated with nevirapine without increasing toxicity.

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47

Nassen, René. "Neuropsychiatric profile of a cohort of perinatally infected HIV positive children after one year of antiretroviral medication." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/12158.

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The Highly Active Antiretroviral Therapy (HAART) era in the mid-nineties signalled a dramatic change in the long-term outcome of Human Immunodeficiency Virus (HIV). Many children have shown significant neurologic benefit, and in particular, a decline in the incidence of HIV encephalopathy. As increasing numbers of children have survived into adolescence and early adulthood new challenges have arisen, such as the detection and characterization of milder forms of HIV-associated neurocognitive deficits in children previously thought to be asymptomatic...

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48

Le, Roux David Martin. "Incidence of bacteraemia in HIV-infected children in Africa, and the impact of highly active antiretroviral therapy." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/11483.

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From November 2002 to December 2006, a placebo-controlled, randomized trial investigated the incidence of tuberculosis and the overall mortality in a cohort of HIV-infected children in Cape Town, South Africa. They were randomized to receive either Isoniazid Preventive Therapy (IPT) or placebo. In addition, they were randomized to receive trimethoprim/sulfamethoxaxole prophylaxis on either a daily or a three-times-per-week schedule. The aim: To describe the incidence of bacteraemia, and the spectrum of organisms cultured. To determine if there was a difference in the incidence of bacteraemia between children using Isoniazid Preventive Therapy (IPT) versus placebo; and to determine if there was a difference in the incidence of bacteraemias between the groups using daily versus thrice-weekly trimethoprim/sulphamethoxazole prophylaxis.

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49

Shea, Robert F. "An exploration of disclosure and non-disclosure patterns in HIV-infected children in Cape Town, South Africa." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29479.

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A cross-sectional, descriptive study combining with open-ended (qualitative) interview questions with quantitative component was conducted to explore disclosure experiences of mothers and caregivers of HIV-infected children. The study was conducted with 102 parents and caregivers at a tertiary hospital in Cape Town delivering care to 303 HIV-infected paediatric patients. The study sample included 102 participants, ranging in age from 16 years to 71 years. The sample included 73 mothers (72%), six fathers (6%), 11 foster-mothers (11%), and 12 caregivers or grandmothers (12%). The median age of participants’ children was 4 (IQR 2-8) years and ranged from five months to 16 years. Only 48 (47%) were old enough for disclosure to be possible. Disclosure or disclosure delay was associated with several factors, including the child’s age or ability to understand, anxiety and guilt about being blamed for infecting the child, fear of exposing the child to stigma, discrimination and social exclusion related to the child disclosing to others, and the hope that the child would be adherent if they understood their illness and the way in which the medication could improve their health outcomes. Only 16 (33%) of 48 participants actually disclosed the child’s HIV status. The results indicate that HIV-disclosure remains a challenging, emotionally-charged experience for mothers and caregivers. The findings of this research, and similar studies, point to the value of integrating disclosure support and planning into routine care for children and adolescents, as well as their parents and caregivers.

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50

Nwosu, Emmanual Chukwubuikem. "Brain morphometry of HIV-infected children on early antiretroviral therapy (ART) from age 5 to 9 years." Doctoral thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32309.

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As of 2017, 1.8 – 2.1 million children vertically infected with HIV were living in sub-Saharan Africa, of whom an estimated 320, 000 were in South Africa. Since implementation of the prevention of mother to child transmission (PMTCT) strategy, the infection rate has reduced substantially. More recently, the World Health Organisation's (WHO) recommendation of early antiretroviral therapy (ART) initiation for children with perinatal HIV infection has considerably decreased the immediate effects of perinatal HIV infection, including mortality and morbidity. Despite this, not much is known about the long-term outcome of continued ART on early-treated, perinatally HIV-infected children. Early HIV invasion of the developing brain is associated with neurodevelopmental delays and neurocognitive deficits including encephalopathy, slower processing speed, language impairment, lack of concentration and attentiveness, and psychomotor slowing. Alterations in the neurodevelopmental trajectories of brain morphology, including cortical thickness and folding (gyrification) and sub-cortical volumes may be related to the observed neurocognitive deficits during a critical period of brain development spanning from mid-childhood into early adolescence (age 5 -13 years). The effects may be studied using structural magnetic resonance imaging (MRI) and automated segmentation software. FreeSurfer (https://surfer.nmr.mgh.harvard.edu/) is a valuable tool for investigating brain morphology but was not originally designed for segmenting pediatric brains. In this study we therefore first validate the latest FreeSurfer version 6.0.0 against manual segmentation for the study of pediatric HIV. We then assessed the long-term effects of perinatal HIV infection, early ART initiation as well as clinically designed ART interruption, HIV-related encephalopathy, disease severity at ART initiation and immune health measures on the developmental trajectories of cortical thickness and folding (gyrification) over the period from 5-9 years. Study participants were 141 children (75 HIV+, 66 uninfected controls; 72 male) from the Cape Town arm of the children with HIV early antiretroviral therapy (CHER) clinical trial. HIV+ children were randomized at age 6 -12 weeks to receive either immediate limited ART for 40 or 96 weeks, to be restarted when clinical and/or immunological criteria were met, or to start ART only when they developed HIV symptoms or CD4 percentage dropped below 20% (25% in the first year) as per guidelines at the time. Uninfected controls comprised children born to HIV+ mothers (HIV-exposed uninfected (HEU)) or uninfected mothers (HIV-unexposed (HU)) and were recruited from an interlinking vaccine trial. MRI scans were performed at time points around their 5th, 7th and 9th birthdays, in accordance with protocols approved by the human research ethics committees of the Universities of Stellenbosch and Cape Town and voluntary informed consent was received from either participants or their guardians. Both automated and manual methods were used to segment brain regions from high-resolution structural MRI scans. In addition, FreeSurfer was used to examine cross-sectional differences in cortical thickness and gyrification over the cortical surface at age 5. Linear mixed-effects models were used in conjunction with FreeSurfer's longitudinal processing stream to calculate and compare the annual rate of change in cortical thickness and gyrification between ages 5 and 9 in HIV+ children and controls. Results showed that automated FreeSurfer segmentation tended to overestimate volumes of all structures relative to manual segmentation, except the left caudate nucleus. Consistency and agreement between methods were highest for the putamen (Consistency: right ICC=0.89, left ICC=0.90; agreement: right ICC=0.84, left ICC=0.83) and lowest for the corpus callosum (consistency ICC=0.64, agreement ICC=0.26). There were no subcortical volume differences between HIV+ children and controls, except the globus pallidus which was smaller in HIV+ children using both manual and automated segmentation. Subsequent cross-sectional FreeSurfer analyses showed widespread regional increases in cortical thickness and decreases in gyrification at age 5 years, related to the effects of perinatal HIV-infection and early ART initiation. Clinically designed interruption led to thicker cortex in the left rostral middle frontal and right insula regions and, lower left precuneus and right superior frontal, as well as higher lateral occipital gyrification compared to HIV- controls. There were significant regional differences due to HIV severity based on CDC classification and viral burden at enrolment both in cortical thickness and gyrification compared to controls. Cortical thickness was not associated with immune health parameters, while gyrification was negatively associated with immune health measures. However, the linear rate of change of cortical thickness and gyrification from age 5 to 9 in the HIV+ children was not different from that of uninfected controls, nor was it different between controls and children on interrupted or continuous ART. Children with HIV-related encephalopathy showed a decrease in gyrification with age during this period, in contrast to controls who showed stable gyrification except in frontal regions where gyrification increased with age. Children with perinatal HIV infection display alterations in cortical development due to ART interruption and disease severity at age 5 years, despite starting ART early in life. Our results suggest that cortical gyrification is more sensitive than cortical thickness to effects of perinatal HIV infection. ART interruption and disease severity at ART initiation affect cortical morphometry development at age 5 years in a perinatally infected, early-treated pediatric cohort. However, on continued ART the cortical developmental trajectory is no different from that of uninfected controls. Any structural defects resulting from ART interruption appear to normalise by age 9, except in children with HIV-related encephalopathy, who show an altered trajectory of gyrification development.

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