Infections in HIV-exposed Uninfected Children With Focus on Sub-Saharan Africa

2014 ◽  
Vol 33 (10) ◽  
pp. 1085-1086 ◽  
Author(s):  
Mark F. Cotton ◽  
Amy Slogrove ◽  
Helena Rabie
Keyword(s):  
Sub Saharan Africa ◽  
Sub Saharan ◽  
Hiv Exposed ◽  
Exposed Uninfected

scholarly journals Cytokine profile and clinical correlates in HIV-exposed infants with severe (hypoxic) pneumonia

2016 ◽  
Vol 22 (1) ◽  
pp. 3 ◽  
Author(s):  
Robin Green ◽  
A Terclanche ◽  
P Becker ◽  
P Rheeder ◽  
D F Wittenberg ◽  
...  
Keyword(s):  
Severe Pneumonia ◽  
Sub Saharan Africa ◽  
Control Group ◽  
Clinical Correlates ◽  
Sub Saharan ◽  
Paired Serum ◽  
Hiv Exposed ◽  
Host Inflammatory Response ◽  
Severe Lung Disease ◽  
Severe Lung

<p><strong>Introduction. </strong>Severe pneumonia in infants who are HIV-infected is a common problem in many parts of the developing world, especially sub-Saharan Africa. What has been missing from previous studies of severe pneumonia in HIV-infected infants, however, is a description of the host inflammatory response and cytokine/chemokine profile that accompanies this disease.</p><p><strong>Objective.</strong> To describe the cytokine profiles associated with severe hypoxic pneumonia in HIV-infected infants</p><p class="Body1"><strong>Methods. </strong>In a cohort of HIV-infected children diagnosed clinically with severe hypoxic pneumonia, paired serum and sputum cytokines were tested. A control group of HIV-infected children with bronchiectasis contributed matching controls.</p><p><strong>Results.</strong> A total of 100 infants (mean age 2.8 months) with a clinical diagnosis of severe hypoxic pneumonia were included in this study. IP-10 was markedly elevated in both sputum (mean 560.77pg/ml) and serum (mean 9091.14pg/ml), while IP-10 was elevated in serum (mean 39.55 pg/ml), with both these cytokines being significantly higher than in stable children with HIV-related bronchiectasis.</p><p><strong>Conclusion. </strong>This study of HIV-infected infants with severe hypoxic pneumonia suggests that IL-10 and IP-10 are associated with more severe lung disease. However, further investigation of this association is required.</p>

scholarly journals Defective monocyte enzymatic function and an inhibitory immune phenotype in HIV-exposed uninfected African infants in the era of highly active anti-retroviral therapy

2021 ◽  
Author(s):  
Louise Afran ◽  
Kondwani C Jambo ◽  
Wilfred Nedi ◽  
David J.C Miles ◽  
Anmol Kiran ◽  
...  
Keyword(s):  
B Cell ◽  
Sub Saharan Africa ◽  
Haemophilus Influenzae Type ◽  
Cell Phenotype ◽  
Bacterial Disease ◽  
Enzymatic Function ◽  
Increased Risk ◽  
Hiv Exposure ◽  
Hiv Exposed ◽  
Exposed Uninfected

HIV-Exposed Uninfected (HEU) infants are a rapidly expanding population in Sub Saharan Africa and are highly particularly susceptible to disease caused by encapsulated bacteria in the first year of life. The mechanism of this increased risk is still poorly understood and we therefore, investigated if HIV exposure dysregulates HEU infant immunity and if this is amplified by human herpes infection (HHV). Here, we compared monocyte enzymatic function, innate and adaptive immune cell phenotype, and vaccine-induced antibody responses between HEU and HUU infants. We demonstrate altered monocyte phagosomal function and B cell subset homeostasis, and lower vaccine-induced anti-Haemophilus influenzae type b (Hib) and anti-Tetanus Toxoid (TT) IgG titers in HEU compared to HUU infants. There was no difference in the prevalence of HHV infection between HEU and HUU infants. Our findings suggest that even in the era of ART-mediated viral suppression, HIV exposure dysregulates monocyte and B cell function during a vulnerable period of immune maturation in infancy. This may contribute to the high rates of bacterial disease and pneumonia in HEU infants.

scholarly journals Whole-Cell Pertussis Vaccine Induces Low Antibody Levels in Human Immunodeficiency Virus-Infected Children Living in Sub-Saharan Africa

2009 ◽  
Vol 16 (4) ◽  
pp. 479-483 ◽  
Author(s):  
Mathurin C. Tejiokem ◽  
Elisabeth Njamkepo ◽  
Ionela Gouandjika ◽  
Dominique Rousset ◽  
Lydie Béniguel ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Cross Sectional ◽  
Whole Cell ◽  
Immunodeficiency Virus ◽  
Severe Immunodeficiency ◽  
Sub Saharan ◽  
Hiv Exposed ◽  
Antibody Levels

ABSTRACT The WHO recommendations for the immunization of children infected with human immunodeficiency virus (HIV) differ slightly from the guidelines for uninfected children. The introduction of antiretroviral therapy for HIV-infected infants should considerably prolong their life expectancy. The question of the response to the whole-cell pertussis (wP) vaccine should now be addressed, particularly in countries in which pertussis remains endemic. To evaluate the persistence of antibodies to the wP vaccine in HIV-infected and uninfected children who had previously received this vaccine in routine clinical practice, we conducted a cross-sectional study of children aged 18 to 36 months, born to HIV-infected mothers and living in Cameroon or the Central African Republic. We tested blood samples for antibodies to the wP vaccine and for antibodies to diphtheria and tetanus toxoids (D and T, respectively) in the context of the use of a combined DTwP vaccine. We enrolled 50 HIV-infected children and 78 uninfected, HIV-exposed children in the study. A lower proportion of HIV-infected children than uninfected children had antibodies against the antigens tested for all valences of the DTwP vaccine. Agglutinin levels were substantially lower in HIV-infected than in HIV-exposed but uninfected children (30.0% versus 55.1%, respectively; P = 0.005). We also observed a high risk of low antibody levels in response to the DTwP vaccine in HIV-infected children with severe immunodeficiency (CD4 T-cell level, <25%). The concentrations of antibodies induced by the DTwP vaccine were lower in HIV-infected children than in uninfected children. This study supports the need for a booster dose of the DTwP vaccine in order to maintain high antibody levels in HIV-infected children.

scholarly journals Growth Trajectories of HIV Exposed and HIV Unexposed Infants. A Prospective Study in Gweru, Zimbabwe

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199033
Author(s):  
Lucy Mabaya ◽  
Hilda Tendisa Matarira ◽  
Donald Moshen Tanyanyiwa ◽  
Cuthbert Musarurwa ◽  
Johannes Mukwembi
Keyword(s):  
Transmission Rate ◽  
Growth Patterns ◽  
Sub Saharan Africa ◽  
Childbearing Age ◽  
Hiv Exposed Infants ◽  
Vertical Transmission Rate ◽  
Sub Saharan ◽  
Hiv Exposed ◽  
Nutritional Monitoring ◽  
A Prospective Study

Background: With the increasing HIV seroprevalence among women of childbearing age in sub-Saharan Africa, limited data on growth outcomes of HIV exposed infants under current policies of universal maternal antiretroviral therapy exist. Methods: The longitudinal growth patterns of 114 HIV exposed and unexposed infants were assessed and compared. The prevalence and factors associated with malnutrition were established. Infants under prevention of mother to child transmission care were recruited at 6 weeks post-delivery as were their HIV unexposed counterparts. Weight and length measurements were recorded at birth, 6 and 16 weeks postpartum. Results: HIV vertical transmission rate was 8.8%. HIV exposed infants had significantly lower mean birth weights compared to HIV unexposed infants (2.9 ± 0.3; 3.2 ± 0.5; P < .001) respectively. Mean weight/length-for-age z-scores for HIV exposed, uninfected (HEU) infants were significantly below those of the HIV unexposed infants during follow up. By 6 weeks of age, 28.5% of HEU infants were malnourished while no malnutrition was evident in HIV unexposed infants. A gestational age <37 weeks (OR: 3.83; 95% CI: 1.03-14.30; P = .045) and HIV exposure (OR: 1.62; 95% CI: 0.17-15.73; P = .017) substantially increased the risk of stunting. Conclusion: Growth deficits were witnessed in HIV exposed infants compared to HIV unexposed infants. There is need for early nutritional monitoring and support among HIV exposed infants.

scholarly journals Mortality, Human Immunodeficiency Virus (HIV) Transmission, and Growth in Children Exposed to HIV in Rural Zimbabwe

2020 ◽  
Author(s):  
Ceri Evans ◽  
Bernard Chasekwa ◽  
Robert Ntozini ◽  
Florence D Majo ◽  
Kuda Mutasa ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Transmission ◽  
Infant Nutrition ◽  
Sub Saharan Africa ◽  
Absolute Difference ◽  
Child Feeding ◽  
Young Child Feeding ◽  
Immunodeficiency Virus ◽  
Sub Saharan ◽  
Hiv Exposed

Abstract Background Clinical outcomes of children who are human immunodeficiency virus (HIV)–exposed in sub-Saharan Africa remain uncertain. Methods The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial evaluated improved infant and young child feeding (IYCF) and/or improved water, sanitation, and hygiene in 2 rural Zimbabwean districts with 15% antenatal HIV prevalence and &gt; 80% prevention of mother-to-child transmission (PMTCT) coverage. Children born between February 2013 and December 2015 had longitudinal HIV testing and anthropometry. We compared mortality and growth between children who were HIV-exposed and HIV-unexposed through 18 months. Children receiving IYCF were excluded from growth analyses. Results Fifty-one of 738 (7%) children who were HIV-exposed and 198 of 3989 (5%) children who were HIV-unexposed (CHU) died (hazard ratio, 1.41 [95% confidence interval {CI}, 1.02–1.93]). Twenty-five (3%) children who were HIV-exposed tested HIV positive, 596 (81%) were HIV-exposed uninfected (CHEU), and 117 (16%) had unknown HIV status by 18 months; overall transmission estimates were 4.3%–7.7%. Mean length-for-age z score at 18 months was 0.38 (95% CI, .24–.51) standard deviations lower among CHEU compared to CHU. Among 367 children exposed to HIV in non-IYCF arms, 147 (40%) were alive, HIV-free, and nonstunted at 18 months, compared to 1169 of 1956 (60%) CHU (absolute difference, 20% [95% CI, 15%–26%]). Conclusions In rural Zimbabwe, mortality remains 40% higher among children exposed to HIV, vertical transmission exceeds elimination targets, and half of CHEU are stunted. We propose the composite outcome of “alive, HIV free, and thriving” as the long-term goal of PMTCT programs. Clinical Trials Registration NCT01824940.

scholarly journals The burden of vaccine-preventable diseases among HIV-infected and HIV-exposed children in sub-Saharan Africa: a systematic review and meta-analysis

2019 ◽  
Vol 15 (11) ◽  
pp. 2590-2605 ◽  
Author(s):  
Olatunji O. Adetokunboh ◽  
Ajibola Awotiwon ◽  
Duduzile Ndwandwe ◽  
Olalekan A. Uthman ◽  
Charles S. Wiysonge
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Vaccine Preventable Diseases ◽  
Sub Saharan ◽  
Hiv Exposed

Breastfeeding and Complementary Feeding Practices among HIV-Exposed Infants in Coastal Tanzania

2015 ◽  
Vol 32 (1) ◽  
pp. 112-122 ◽  
Author(s):  
Anne M. Williams ◽  
Caroline Chantry ◽  
Eveline L. Geubbels ◽  
Astha K. Ramaiya ◽  
Aloisia I. Shemdoe ◽  
...  
Keyword(s):  
Infant Feeding ◽  
Exclusive Breastfeeding ◽  
Complementary Feeding ◽  
Hiv Disclosure ◽  
Sub Saharan Africa ◽  
High Prevalence ◽  
Breastfeeding Cessation ◽  
Sub Saharan ◽  
Hiv Exposed ◽  
Low Prevalence

Background: Appropriate infant feeding is a persistent challenge for human immunodeficiency virus (HIV)-infected mothers in sub-Saharan Africa. Objective: This study aimed to describe correlates of infant feeding among HIV-infected mothers in coastal Tanzania. Methods: HIV-infected women (n = 400) with infants younger than 18 months were enrolled from June to November 2011 from 3 public health facilities in Pwani, Tanzania: Tumbi Regional Hospital (TRH), Chalinze Health Center (CHC), and Bagamoyo District Hospital (BDH). Participants were surveyed about sociodemographics and infant feeding behavior at enrollment; infant feeding data were collected prospectively and retrospectively in the month of study follow-up. Results: Statistically significant correlates of exclusive breastfeeding (EBF) were infant age (months) (adjusted odds ratio [AOR] = 0.6; 95% confidence interval [CI], 0.5-0.9), enrollment facility (TRH: reference; CHC: AOR = 5.0, 95% CI, 1.2-20.8; BDH: AOR = 11.6, 95% CI, 2.3-59.9), and HIV disclosure to one’s mother (AOR = 0.2; 95% CI, 0.1-0.6). Exclusive breastfeeding prevalence among infants younger than 6 months was 77%, but 50% of infants older than 6 months no longer receiving breast milk did not receive animal source foods (ASF) daily. Enrollment facility (TRH: reference; CHC: AOR = 0.2, 95% CI, 0.1-1.0; BDH: AOR = 0.1, 95% CI, 0.01-0.4) and HIV disclosure (to mother-in-law: AOR = 0.2, 95% CI, 0.1-0.8; to brother: AOR = 0.3, 95% CI, 0.1-0.8) were negatively associated with ASF provision. Conclusion: High prevalence of EBF suggests that it is an attainable behavior, whereas low prevalence of daily ASF provision suggests that adequate diets are difficult to achieve after breastfeeding cessation. These findings support current recommendations for HIV-infected mothers in resource-poor regions to continue breastfeeding for at least 1 year and suggest the need for greater support with complementary feeding. Associations between HIV disclosure and infant feeding merit further exploration, and correlations between enrollment facility and infant feeding highlight the potential influence of clinics on achieving infant feeding recommendations.

Clinical outcomes of HIV-exposed, HIV-uninfected children in sub-Saharan Africa

2016 ◽  
Vol 21 (7) ◽  
pp. 829-845 ◽  
Author(s):  
Stanzi M. le Roux ◽  
Elaine J. Abrams ◽  
Kelly Nguyen ◽  
Landon Myer
Keyword(s):  
Clinical Outcomes ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
Hiv Exposed

RTS,S/AS01, a vaccine targeting pre-erythrocytic stages of Plasmodium falciparum

2017 ◽  
Vol 1 (6) ◽  
pp. 533-537
Author(s):  
Lorenz von Seidlein ◽  
Borimas Hanboonkunupakarn ◽  
Podjanee Jittmala ◽  
Sasithon Pukrittayakamee
Keyword(s):  
Protective Efficacy ◽  
Age Groups ◽  
Sub Saharan Africa ◽  
Phase Iii ◽  
European Medicines Agency ◽  
Older Children ◽  
Pivotal Phase ◽  
Malaria Epidemiology ◽  
Maximum Benefit ◽  
Sub Saharan

RTS,S/AS01 is the most advanced vaccine to prevent malaria. It is safe and moderately effective. A large pivotal phase III trial in over 15 000 young children in sub-Saharan Africa completed in 2014 showed that the vaccine could protect around one-third of children (aged 5–17 months) and one-fourth of infants (aged 6–12 weeks) from uncomplicated falciparum malaria. The European Medicines Agency approved licensing and programmatic roll-out of the RTSS vaccine in malaria endemic countries in sub-Saharan Africa. WHO is planning further studies in a large Malaria Vaccine Implementation Programme, in more than 400 000 young African children. With the changing malaria epidemiology in Africa resulting in older children at risk, alternative modes of employment are under evaluation, for example the use of RTS,S/AS01 in older children as part of seasonal malaria prophylaxis. Another strategy is combining mass drug administrations with mass vaccine campaigns for all age groups in regional malaria elimination campaigns. A phase II trial is ongoing to evaluate the safety and immunogenicity of the RTSS in combination with antimalarial drugs in Thailand. Such novel approaches aim to extract the maximum benefit from the well-documented, short-lasting protective efficacy of RTS,S/AS01.

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