Maraisa Centeville

Abnormalities in body composition and nutritional status in HIV-infected children and adolescents on antiretroviral therapy.

This cross-sectional study aimed to compare growth, nutritional status and body composition outcomes between a group of 94 HIV-infected children and adolescents on antiretroviral therapy (ART) and 364 healthy controls, and to evaluate their association with clinical and lifestyle variables within the HIV-infected group. When compared with the control group, HIV patients had higher risk of stunting (odds ratio [OR] 5.33, 95% confidence interval [CI]: 2.83–10.04) and thinness (OR 4.7, 95% CI: 2.44–9.06), higher waist-to-hip ratios (medians 0.89 versus 0.82 for boys and 0.90 versus 0.77 for girls, P < 0.001), and lower prevalence of overweight or obesity (OR 0.33, 95% CI: 0.14–0.78). Protease inhibitor usage was associated with thinness (OR 3.51, 95% CI 1.07–11.44) and lipoatrophy (OR 3.5, 95% CI 1.37–8.95). HIV-infected children on ART showed significant nutritional status and body composition abnormalities, consistent with the severity of vertical HIV infection and the consequences of prolonged ART.

Lack of association between nutritional status and change in clinical category among HIV-infected children in Brazil

CONTEXT AND OBJECTIVE Malnutrition is common among HIV-infected children. Our objective was to study the occurrence of malnutrition and its relationship with changes in clinical category among HIV-infected children. DESIGN AND SETTING Longitudinal study, at the Pediatrics Department and Pediatrics Investigation Center (CIPED), Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp). METHODS We reviewed the hospital records of 127 vertically HIV-infected children. Anthropometric measurements were obtained at the beginning of follow-up, at clinical category change and five months later. These were converted to z-scores of weight/age, height/age and weight/height. Data were presented as means, standard deviations, frequency counts and percentages. The Wilcoxon and Kruskal-Wallis tests and odds ratios were used in the analysis. RESULTS We found that 51 (40.2%) were undernourished and 40 (31.5%) were stunted, with higher risk of being included in clinical category C. There was an association between nutritional condition and the clinical categories of the Centers for Disease Control classification (1994), and with age at symptom onset (except for height z-score). During follow-up, 36 patients (28.4%) changed their clinical category, which occurred early among the undernourished patients. The group that changed its clinical category maintained the same z-score distribution for weight, height and weight/height throughout follow-up. CONCLUSION Aids manifestation severity was associated with nutritional status and with age at symptom onset, but change in clinical category was not followed by worsening of nutritional status.

Initial Benchmarking of the Quality of Medical Care in Childhood-Onset Systemic Lupus Erythematosus.

To assess the quality of medical care in childhood‐onset systemic lupus erythematosus (SLE) at tertiary pediatric rheumatology centers as measured by observance of SLE quality indicators (SLE‐QIs).

Primary Sjögren's syndrome in children: Is a family approach indicated?

Sjo¨grens syndrome (SS) is a chronic autoimmune diseaseprimarily affecting the lachrymal and salivary glands withvarying degrees of systemic involvement. SS can be isolated(primary SS or pSS) or associated with other autoimmunediseases, such as rheumatoid arthritis, systemic lupuserythematosus, or scleroderma (secondary SS). pSS pre-dominantly affects middle-aged women and is uncommonin childhood.

Koebner’s phenomenon in systemic lupus erythematosus

Koebner phenomenon is defined as a nonspecific skin stimulus eliciting a disease skin reaction. The nature of the skin trauma varies greatly and includes areas of thermal injury, excoriations, surgical incisions, and scars. We report a patient with recent onset of systemic lupus erythematosus who developed Herpes zoster on immunosuppressant medication. Two weeks after resolution of the vesicles, the patient presented with new ulcerative reddish lesions over the herpes zoster scare and worsening of her malar rash without evidence of worsening of any other organ. Koebner phenomenon was suspected. We review the literature on Koebner phenomenon in SLE.

Quality of sleep and quality of life in adolescents infected with human immunodeficiency virus

OBJECTIVES To assess sleep characteristics of adolescents infected by HIV, and to ascertain whether psychosocial aspects are associated to the quality of sleep. METHODS A cross-sectional study assessing 102 HIV-infected adolescents of both genders, aged between 10 and 20 years-old and 120 Controls. Data collection was performed by applying the Sleep Disturbance Scale for Children, the Epworth Sleepiness Scale, and the Pediatric Quality of Life Inventory. RESULTS A sleep disturbance prevalence of 77.4% was found in patients, and a 75% prevalence in controls, and there was correlation between quality of sleep and of life. HIV-infected adolescents scored higher for sleep breathing disorders and had higher prevalence of excessive daytime sleepiness. CONCLUSIONS HIV-infected adolescents had similar quality of sleep compared to healthy adolescents. This may be explained by the steady improvements in daily living as a result of successful anti-retroviral therapy, and by the vulnerability that affects Brazilian adolescents living in major urban centers.

Serum immunoglobulins in children perinatally exposed to human immunodeficiency virus

OBJECTIVE: Hypergammaglobulinemia is an early manifestation of perinatal HIV infection. Our objective was to analyze the differences in serum immunoglobulin levels between infected and seroreverting children and their association with clinical outcome. METHODS: We carried out a historical prospective study with 107 infected and 90 seroreverting children. We compared the IgA, IgG, and IgM levels between infected and seroreverting patients within the first 18 months of life; IgA, IgG, and IgM as surrogate markers of infection; and IgA, IgG, and IgM levels within the first 5 years in infected children, according to clinical outcome. The Mann-Whitney test was used for comparison between groups. Surrogate markers were assessed according to sensitivity, specificity, positive and negative predictive values, and Youdens index. RESULTS: Infected children, when compared to seroreverters, showed significantly higher levels of IgM between the 1st and 5th trimesters; IgA and IgG between the 2nd and 6th trimesters (P less than or equal to 0.05). Levels of IgA greater than or equal to 90 mg/dl in the 2nd trimester and IgG greater than or equal to 1,700 mg/dl or 1,200 mg/dl in the 2nd and 3rd trimesters were associated with HIV infection, with Youdens indexes of 0.97, 0.92, and 0.93, respectively. Infected children in the B and C categories, compared to those in the N and A, showed higher levels of IgM between the 2nd and 4th years, and IgA between the 3rd and 5th year (P > 0.05). CONCLUSIONS: The temporal progression of IgA, IgG, and IgM levels showed an early and intense stimulation to the synthesis of immunoglobulin in infected children. Clinical and epidemiological indicators showed that such levels may be surrogate markers of infection. Higher IgM and IgA levels between the 2nd and 5th years in more severely infected children suggest a dysfunction in immune regulation secondary to persistent antigenic stimulation.