Sorin Petrea

Vaccination of HIV positive children... a genuine challenge.

Methods During 01 January 2012 – 01 September 2013, in the Pediatric and Adolescents Immunosuppression Department of the National Institute for Infectious Diseases “Prof. Dr. Matei Bals” we performed an analysis of the immunizations in children perinatally exposed to HIV, aged 0-18 months. Data from medical records and vaccination history refer to the vaccination share and track, namely from the maternity to the general practitioner. A major setback is parents’ reluctance in accessing medical services. Most of them expose various reasons for avoiding contact with the medical staff, so that most children do not benefit from prevention through vaccination.

Postpartum evolution of newborns to mothers addicted to “new drugs” and recently diagnosed with HIV infection

Background In 2011 and 2012 Romania registered a significant increase in the number of intravenous drug users (IVDUs) along with a change in the use pattern, namely the replacement of heroin with the so called “new drugs”. These are mostly synthetic cannabinoids and cathiones. Within this context, the share of new IVDU-HIV cases expanded from 3% in 2010 to 29% in 2012. Our objective was to observe the evolution of 30 newborns to mothers recently diagnosed with HIV infection, who were also “new drugs” consumers.

Adherence to antiretroviral treatment in 2013 between myth and reality

Case report We present the case of a 9 year, 6 month old girl, diagnosed with HIV at the age of 2, right after the death of her HIV seropositive father (later the mother was also diagnosed with HIV). For more than 7 years the mother did not administer the child the antiretroviral treatment that she was supplied with. In January 2013, after the mother’s death, the patient’s health worsened. She was admitted for multiple opportunistic associated infections, but, despite the complex therapeutic treatment administered, the evolution was not favorable.

ART management in children perinatally infected with HIV from mothers who experience behavioural changes in Romania

During the recent years the rate of HIV perinatally exposed children in Romania has increased as a consequence of the expanding number of HIV‐infected women. These women belong to Romanias long‐terms survivors, aged between 20 and 24 years and to the group of new HIV infection cases (20–24 years), acquired through unsafe sexual contact and use of new psychoactive substance (IV).

Immunizations in children exposed perinatally to HIV – from theory to practice

Increased vulnerability of HIV infected children to numerous infections argues vaccination to protect them. Lately we faced diseases preventable by vaccination in children perinatally exposed to HIV infection and, prematurity, abandonment, social condition, lack of understanding, drug mothers are among the causes that prevent children from immunization HIV-positive women. During 01.01.2011-31.12.2013, in the department of immunocompromised children at the National Institute for Infectious Diseases “Prof. Dr. Matei Bals” we conducted an analysis of immunizations to 198 children exposed perinatally to HIV infection aged 0-18 months. Data from medical records and history refers to the share of vaccinations starting maternity and continuing thereafter through family physicians or pediatricians within hospital units caring for these children. A major role is parents’ avoidance to health services. Most of them rely on various reasons to avoid contact with health workers, so that most children do not benefit from prevention through vaccination. A percentage of 79.29% were vaccinated in hospital. Only 63.13% were BCG vaccinated, prematurity and knowing immunological status (CD4) representing key factors for deprivation of BCG vaccination. Optional vaccinations are hard supported by parents, such as 5.94% children were vaccinated for flu, RSV, 3.96%, 1.98% and Prevenar Rotarix. We found an increased incidence of RSV, rotavirus enterocolitis, pneumococcal pneumonia and otitis, and measles, often evolving severely. HIV perinatally exposed infants need protection against vaccine-preventable diseases. Immunization does not influence disease progression, but the lack of vaccination can lead to severe infection, potentially fatal.

OC-8 Use of new psychoactive drugs by hiv-infected women and its’ impact on mother-to-child hiv transmission in romania

Background and aims The national antenatal HIV screening process in Romania revealed an increase in the number of HIV infected women-IDUs since 2011, due to the use of synthetic cannabinoids and cathinones, or “legal highs”. Moreover, the percentage of new IDU/HIV cases increased from 2.8% in 2010 to 20% in 2015, most of them living in or around Bucharest. The aim of the surveillance was to have a more accurate view on the drug-using HIV infected mothers and the effect of this phenomenon on their babies. Methods Between January 2012 and December 2016, the Paediatric Immunosuppression Unit of INBI “Prof. Dr. Matei Bals” surveyed 468 HIV-exposed newborns. 13,46% (63/468) were perinatally exposed to “new drugs”. However, at the end of 2015 the rate of HIV mother-to-child transmission in Romania remained stable- below 2.3%. The following parameters were evaluated for mothers: time of HIV screening, time of HIV diagnosis, age, prenatal care, time when taken into active surveillance, treatment/prophylaxis, type of birth, drugs taken and screening for co-infections (HBV, HCV, STIs). For children we focused on: sex, age, time of diagnosis, ART prophylaxis, type of birth, feeding, neurological assessment, CD4 count, HIV-RNA, ultrasound evaluation. Results During the 4 year monitoring period, the following results of HIV time of detection in IDU/HIV mothers were obtained: 41.26% (26/63 mothers tested) were found with HIV before pregnancy, 11.1% (7/63) during pregnancy, 41.26% (26/63) during delivery and 6.34 % (4/63) in the first 24 hours after birth. Although all newborns perinatally exposed to HIV/IDU benefitted from post partum prophylaxis and received artificial nutrition, 14.2 % (9/63) exposed to drug use were HIV infected. All children had poor neonatal adaption, mainly severe withdrawal syndrome – 63.49% (40/63) of newborns monitored and more than 50% had neurological lesions. Conclusions Most drug-using HIV infected pregnant women have little access to antenatal care, which leads to late detection of HIV. The use of synthetic cannabinoids and cathinones by these women has significant effects on newborns and their subsequent development which is a challenge for the post-?partum surveillance system. These women come from poor families who don’t ensure them a proper support. Furthermore, due to issues associated to risky behaviour it is difficult to include them in HIV screening or prevention programmes, which need to be adapted to their needs.

Tuberculosis in children perinatally exposed to HIV in the current epidemiological TB context

Method During 01.01.2011 -01.07.2014 in the Immunocompromised Children Department from the National Institute for Infectious Diseases “Prof. Dr. Matei Bals” we analyzed the dynamical evolution of 214 perinatally HIV exposed children, aged 0-4 years. Lack of vaccination due to prematurity and the degree of immunosuppression in maternity contributed considerably to the increased incidence of TB in the family’s epidemiological context (at least one family member is diagnosed with tuberculosis). A troubling aspect is that these children come from families with resistant forms of tuberculosis (TB MDR) due to their parents’ poor adherence to treatment, mainly those pertaining to the 1989-1993 HIV cohort in Romania.

The National Registry of pregnant women infected with HIV and of perinatally exposed children – a need for Romania?

Background The recent years’ experience made us face a new typology of HIV cases (the outbreak within the people who inject drugs) as well as the necessity to adapt specific cares to the needs of the patients coming from the 1987-1990 cohort. The latter presents a complex pathology: they are therapeutically multi experienced, have adherence and ART resistance problems and experience advanced stages of disease. Furthermore, most of them have reached a fertile age, giving birth to a new generation of HIV children, which makes us update our approach to HIV infection. The National Registry of pregnant womeninfected with HIV and of perinatally exposed children represents an operational tool that collects data on the item “mother-child”, whose main role is to clearly display a national overview on the phenomenon of mother to child transmission. The registry sides with a prospective observational study launched at 1 January 2014 that focuses on pregnant women and HIV exposed children from all the regions in Romania.

Disclosure of diagnosis – Adherence – Couple or future of the past

Background HIV infection causes in the patient the development of specific attitudes toward diagnosis, leading even to a psychological change in the patient’s personality expressed by a certain type of mental, emotional and behavioral participation, variable time depending on the stage of infection. The children of the Romanian cohort have an emotional and behavioral baggage marked by depression, anxiety, adjustment disorder, acquired a pronounced psychological fragility, with major impact in medical condition, which means non-adherence, suicide attempts etc. The disclosure of diagnosis (DD), adherence and desire of a family are defining notes describing these patients.

Is functional cure achievable in children perinatally exposed to HIV

Background A successful therapeutic course in children infected with HIV relies heavily on their adherence to antiretroviral treatment (ART). The adherence is influenced by every child’s particularities, his family or caregivers and, last but not least, by the selected therapeutic regimen. In newborns and toddlers, who depend completely on their family or caregivers, issues affecting adherence are essential. Methods We analyzed a lot of 43 children infected with HIV through mother to child transmission – newborns and toddlers – born between 2008 and 2013, focusing on specific factors of the caregivers that affected adherence to ART. From the patients’ files we collected data about the prescribed regimen, the last prescription date, the syrup quantity prescribed per day, the number of days prescribed in conjunction with regular assessment of the viral load. Caregivers may include the child’s parents, grandparents, other relatives, or guardians who directly influenced the child’s medication dosing. Results 84% of children were born to mothers recently infected with HIV, either through unsafe sex or injecting drug use. Adherence in this group of children maintained a value of 50% compared with the value of 58% in children born to mothers who belong to the 1988-1990s cohort. Assessment of adherence from the viewpoint of socioeconomic status emphasized a 54% value in families with precarious economic status and a6 0% value for families with high economic and social levels. Children from mothers with low levels of education were 42% adherent to treatment, compared with 63% adherence in children whose mothers accessed basic or academic education. One of the most significant differences was registered in institutionalized children - 80% compared to children in biological families - 47%. Conclusion Despite of the latest progress in the treatment destined to children with HIV infection – from the discovery of new drugs to formulas tailored to children of various ages (syrup, chewable tablets) – ART options for newborns and toddlers continue to be limited. Given this, adherence to treatment of this pediatric category depends fully on their family or caregivers. In order to make this a reality it is essential to encourage families to access medical services and help them understand the evolution of the diseases and the benefits of treatment.