Susan King

Cognitive development in school-age children with vertically transmitted HIV infection.

We examined a broad range of neuropsychological functioning in school-age children with vertically transmitted HIV infection and a control group made up of siblings of children with HIV infection. Fourteen children with HIV (2 asymptomatic, 8 mildly symptomatic, and 4 with AIDS) and 11 control children were administered a battery of neuropsychological tests assessing intelligence, receptive language, expressive language, visual and verbal memory, visual-motor speed and coordination, visual-motor and visual-spatial processing, fine motor skill, and academic achievement. Results revealed that school-age children with vertically transmitted HIV infection show many areas of cognitive function within the normal range. Despite normal cognitive development, subtle motor impairments were documented in children with vertically transmitted HIV infection. Our results are the first report of fine motor and motor strength deficits in school-age children with vertically transmitted HIV. Lastly, computed tomography (CT) results suggest that children with HIV who have documented structural anomalies in the brain may be at risk for deficits in visual-motor and visual-spatial processing. This finding should be explored with larger samples and other measures to determine its generalizability.

Cognitive and motor development in children with vertically transmitted HIV infection

This study was designed to examine mental and motor development in infants with vertically transmitted human immunodeficiency virus (HIV) infection. Early neurodevelopment was examined in 25 young children with HIV infection acquired through vertical transmission. Compared with 25 children born to HIV-positive mothers but not infected with the virus, and after controlling for developmental risk factors, the HIV-infected group showed impairments in mental and motor development. Mental and motor development were assessed using the Bayley Scales of Infant Development. On the mental scale (MDI), the HIV-infected infants obtained significantly lower scores than the uninfected infants. On the performace scale (PDI), the HIV-infected infants obtained significantly lower standard scores than the uninfected infants. CT scan results were available for 20 of the HIV-infected children. CT abnormalities were associated with developmental delays, particularly for motor development. The results point to the importance of early abnormalities in myelination and of subcortical lesions of cognitive and motor development.

Hepatitis B and human immunodeficiency virus infection in street youths in Toronto, Canada.

Hepatitis B and human immunodeficiency virus are transmitted by veneral contact or by the sharing of used needles during drug use. A questionnaire was administered to street youths admitting to prostitution and to a group denying prostitution, as well as to sexually active adolescents who lived with their family and were attending an adolescent medical clinic. The age, gender, race, number of sexual partners, condom use, illicit drug use, anal intercourse and admission to prostitution were recorded for each of the subjects. Serology was obtained for hepatitis B markers and human immunodeficiency virus antibody. Multiple regression analysis was performed to determine the factors which might predict hepatitis B serologic status. A single subject, who admitted to prostitution, was found to be human immunodeficiency virus.

Epstein-Barr virus infection in transplant recipients: Summary of a workshop on surveillance, prevention and treatment.

Diseases caused by the Epstein-Barr virus are of great significance among organ transplant recipients. One of these diseases, post-transplant lymphoproliferative disease, is a major complication among organ transplant recipients. Management of this entity is problematic due to the difficulties with laboratory surveillance, diagnosis, prevention and treatment. A group of Canadian and American experts was assembled to discuss these aspects of Epstein-Barr virus diseases in Canadian organ transplant recipients. This report summarizes the relevant background literature and levels of evidence in relation to the outcomes of the deliberations and recommendations by the expert panel.

Pharmacokinetic interaction between zidovudine and trimethoprim/sulphamethoxazole in HIV-1 infected children

OBJECTIVE To evaluate the effect of the antimicrobial agent trimethoprim/sulphamethoxazole (TMP/SMX) on the pharmacokinetic properties of the antiretroviral drug zidovudine (ZDV). DESIGN This single dose, open label, crossover study involved the oral administration of ZDV (150 mg/m²) alone and in combination with oral TMP/SMX (2.5 mg/kg) on two separate occasions. Serial blood samples (0 to 8 h) were collected, and concentrations of ZDV and its glucuronide metabolite were quantified using a radioimmunoassay. ZDV pharmacokinetics were determined by noncompartmental analysis. PATIENTS AND SETTING Six HIV-1 infected children aged four months to five years were recruited from the HIV clinic at The Hospital for Sick Children, Toronto, Ontario. Only three patients completed both study phases and were included in the pharmacokinetic analysis. MAIN RESULTS With TMP/SMX therapy, no statistically significant changes were observed in ZDV pharmacokinetic parameters. However, there was a trend towards increased ZDV half-life and area under the concentration versus time curve, as well as decreased apparent oral clearance. Similarly, a trend towards an increased half-life of the ZDV-glucuronide metabolite was also observed. CONCLUSION The changes in ZDV pharmacokinetics in the presence of TMP/SMX did not reach statistical significance, most likely due to the limited number of patients involved. Despite the limited data, a possible interaction between ZDV and TMP/SMX in young HIV-1 infected children should be considered, and patients may require close clinical monitoring.

High Prevalence of HIV-1 Reverse Transcriptase Mutations Conferring Zidovudine (ZDV) Resistance among HIV-Infected Canadian Children. • 685

Objectives: To assess the prevalence of mutations conferring ZDV resistance (genotypic resistance) among HIV-1 strains obtained from HIV-infected Canadian children.

Viral load analysis in a cohort of Canadian pediatric HIV infected patients. 763

HIV viral load testing has recently become available to HIV infected patients outside of research protocols. The interpretation of viral load measurements, the best laboratory technique for their determination and the frequency with which the test should be performed is the focus of active research in the pediatric population. We report our initial experience with viral load measurements in a cohort of HIV infected children.