Independent predictors of forecasting the course of congenital HIV infection in children

The purpose is to characterize the clinical and laboratory parameters in children with different rates of congenital HIV infection progression and, based on the data obtained, to develop independent predictors of forecasting the course of the disease.Research methods. The comparison of clinical, immunological and virological parameters in 91 children with HIV infection with rapid (26%) and slow progression of the disease (74%) was carried out. The criterion for the rapid progression of HIV infection was considered the development of the AIDS clinic in the first two years of life.Results. Testing of clinical, immunological and virological parameters in a multivariate logistic regression model revealed independent predictors of rapid progression in children aged 6 months — HIV blood viral load more than 1 00 000 cop./ml (odds ratio OR 23.9; 95% confidence interval 95% CI 4.6—71.8; P < 0.001) and a decrease of blood CD4-lymphocytes less than 25% (OR 6.3; 95% CI 1.2—33.4; P = 0.029). The predictor «HIV blood viral load more than 100 000 cop./ml» was characterized by a higher sensitivity (91.3%), specificity (97.1 %) compared to the indicator «CD4 lymphocyte count less than 25%» (88.2% and 86.9%).Conclusion. In 26% of children with HIV infection, there is a rapid progression of the disease with the development of AIDS clinic during the first two years of life. The independent predictors of forecasting an unfavorable course of the disease are HIV blood viral load of more than 1 00 000 cop./ml and a decrease in CD4 lymphocytes in the blood of less than 25% at the age of 6 months. The level of viremia seems to be more preferable for predicting the course of HIV infection in children due to its high sensitivity and specificity.

Adenovirus viremia may predict adenovirus pneumonia severity in immunocompetent children

Background Previous studies have demonstrated an association between adenovirus viremia and disease severity in immunocompromised children. However, few studies have focused on this association in immunocompetent children. This study explored the association between adenovirus viremia and adenovirus pneumonia severity in immunocompetent children. Methods We performed a retrospective, observational study of immunocompetent children with adenovirus pneumonia admitted to Shenzhen Children’s Hospital in Shenzhen, China. Pneumonia was classified as severe or mild based on the Chinese guideline for the classification of pneumonia severity. Serum samples from all the children included in the study were tested for adenovirus DNA with a quantitative polymerase chain reaction. Clinical manifestations, laboratory examinations, and disease severity were compared between children with severe and mild pneumonia. Results A total of 111 immunocompetent children with adenovirus pneumonia (60 severe, 51 mild) were included. The median age was 40 months, and 64 patients were male. Five patients were admitted to the intensive care unit, and two underwent endotracheal intubation. All patients were discharged after recovery or improvement. Univariate analysis and binary logistic regression analysis showed that leukocytosis (OR = 1.1; 95% CI: 1.0 to 1.2; P = 0.033), co-infection with Mycoplasma pneumoniae (OR = 5.0; 95% CI: 2.1 to 12.3; P < 0.001), and high blood viral load (OR = 1.5; 95% CI: 1.2 to 2.0; P = 0.001) may be risk factors for severe adenovirus pneumonia. Conclusions Leukocytosis, co-infection with Mycoplasma pneumoniae, and high blood viral load may be risk factors for severe adenovirus pneumonia in immunocompetent children. Blood viral load may predict pneumonia severity.

Adenovirus Viremia Predicts Adenovirus Pneumonia Severity in Immunocompetent Children

Background: Previous studies have demonstrated an association between adenovirus viremia and disease severity in immunocompromised children. However, few studies focused on the use of this approach in immunocompetent children. This study explored the association between adenovirus viremia and adenovirus pneumonia severity in immunocompetent children. Methods: We did a retrospective, observational study of immunocompetent children with adenovirus pneumonia admitted in Shenzhen Children’s hospital in Shenzhen, China. Pneumonia was classified as severe or mild, based on the Chinese guideline of pneumonia severity classification. The serum of all the children in the study was tested for adenovirus DNA with quantitative polymerase chain reaction (PCR). Clinical manifestations, laboratory examinations, and disease severity were compared between these two groups. Results: A total of 111 immunocompetent children with adenovirus pneumonia (60 severe, 51 mild) were included. The median age was 40 months and 64 patients were male. Five patients were admitted to intensive care unit and two were endotracheal intubated. All the patients were discharged with recovery or improvement. Univariate analysis and binary logistic regression analysis showed leukocytosis (OR = 1.1; 95% CI: 1.0 to 1.2; P = 0.033), co-infection of mycoplasma pneumoniae (OR = 5.0; 95% CI: 2.1 to 12.3; P < 0.001), and high blood viral load (OR = 1.5; 95% CI: 1.2 to 2.0; P = 0.001) were risk factors for severe adenovirus pneumonia. Conclusions: Leukocytosis, co-infection of mycoplasma pneumoniae, and high blood viral load are risk factors for severe adenovirus pneumonia in immunocompetent children. Blood viral load predicts pneumonia severity.

Adenovirus Viremia Predicts Adenovirus Pneumonia Severity in Immunocompetent Children

Background: Previous studies have demonstrated an association between adenovirus viremia and disease severity in immunocompromised children. However, few studies focused on the use of this approach in immunocompetent children. This study explored the association between adenovirus viremia and adenovirus pneumonia severity in immunocompetent children. Methods: We did a retrospective, observational study of immunocompetent children with adenovirus pneumonia admitted in Shenzhen Children’s hospital in Shenzhen, China. Pneumonia was classified as severe or mild, based on the Chinese guideline of pneumonia severity classification. The serum of all the children in the study was tested for adenovirus DNA with quantitative polymerase chain reaction (PCR). Clinical manifestations, laboratory examinations, and disease severity were compared between these two groups. Results: A total of 111 immunocompetent children with adenovirus pneumonia (60 severe, 51 mild) were included. The median age was 40 months and 64 patients were male. Five patients were admitted to intensive care unit and two were endotracheal intubated. All the patients were discharged with recovery or improvement. Univariate analysis and binary logistic regression analysis showed leukocytosis (OR = 1.1; 95% CI: 1.0 to 1.2; P = 0.033), co-infection of mycoplasma pneumoniae (OR = 5.0; 95% CI: 2.1 to 12.3; P < 0.001), and high blood viral load (OR = 1.5; 95% CI: 1.2 to 2.0; P = 0.001) were risk factors for severe adenovirus pneumonia. Conclusions: Leukocytosis, co-infection of mycoplasma pneumoniae, and high blood viral load are risk factors for severe adenovirus pneumonia in immunocompetent children. Blood viral load predicts pneumonia severity.

Impaired type I interferon activity and inflammatory responses in severe COVID-19 patients

Coronavirus disease 2019 (COVID-19) is characterized by distinct patterns of disease progression that suggest diverse host immune responses. We performed an integrated immune analysis on a cohort of 50 COVID-19 patients with various disease severity. A distinct phenotype was observed in severe and critical patients, consisting of a highly impaired interferon (IFN) type I response (characterized by no IFN-β and low IFN-α production and activity), which was associated with a persistent blood viral load and an exacerbated inflammatory response. Inflammation was partially driven by the transcriptional factor nuclear factor–κB and characterized by increased tumor necrosis factor–α and interleukin-6 production and signaling. These data suggest that type I IFN deficiency in the blood could be a hallmark of severe COVID-19 and provide a rationale for combined therapeutic approaches.