[Evaluation of antibody response to HPV vaccination in HIV infected girls]. / Ocena skutecznosci szczepienia przeciwko HPV dziewczat zakazonych HIV na podstawie badania obecnosci przeciwcial poszczepiennych.

BACKGROUND: HIV-infected women have an increased prevalence of HPV infections and high risk of cervical cancer. HPV vaccines seem to be a successive method of prevention in immunocompetent women. AIM: To evaluate HPV vaccination effectiveness based on the presence of HPV antibodies in HIV infected girls and to establish factors, which influence vaccination effectiveness. PATIENTS AND METHODS: Post vaccination antibodies were evaluated in 17 HIV -infected girls who received 3 doses of quadrivalent (types 6/11/16/18) HPV vaccine at the mean age of 11,5 years (range 9-17 yr). HPV antibodies were checked 1 month to 2 years (mean 18 months) after the third vaccine dose by ELISA HPV IgG assay (Dia.Pro Diagnostic Bioprobes). All patients have been receiving combined antiretroviral treatment (cART). Analyzed factors included: age at HIV diagnosis, age at the first vaccine dose, Centers for Disease Control and Prevention (CDC) classification at diagnosis, at vaccination and at evaluation. RESULTS: HPV antibodies were present in all 17 (100%) patients. HIV-infection was diagnosed at the mean age of 3,5 years (range 1 month--10.5 years). Nadir clinical CDC category: 7/17 patients (41%)--A, 5/17 (29,5%)--B, 5/29 (29.5%)--C. Nadir CDC count pointed moderate immunosuppression in 8/17 (47%) children and severe in 9/17 (53%). At vaccination 15/17 girls had CDC classification N1/A1, 2/17 (11.7%) were classified N2. At evaluation all girls had CDC classification N1 or A1. CONCLUSIONS. HPV vaccination in HIV infected girls resulted in successful antibody response. Immune recovery due to cART resulted in a good vaccine response, even in children with prior severe immunodeficiency.

[20-years experiences of HIV infected children's care]. / 20-letnie doswiadczenie w opiece nad dziecmi zakazonymi HIV.

OBJECTIVE: The aim was to present the 20-years experiences of medical care of children borne to HIV(+) mothers and HIV infected children. METHODS: Between 1987 and 2006 year 305 children borne to HIV(+) mother were investigated. The risk of vertical transmission was estimated. We analyzed routs of HIV transmission, the reasons of HIV diagnosis, HIV staging at diagnosis, HBV and HCV coinfection, ART treatment and its efficacy. MAIN OBSERVATIONS AND RESULTS: HIV infection was confirmed: 75 cases of vertical HIV infection and 8 children infected in other ways. 260 children were borne after 1994 year (the date of introducing recommendation of the use of ART to reduce perinatal transmission of HIV). 158 of them received prophylaxis of vertical HIV infection. The risk of HIV vertical in children receiving prophylaxis was 5% comparing to 45.6% risk in children without prophylaxis regimens. 66 children receive ART regimen. The efficacy of treatment was: viral 85%, immunological: 89% and clinical: 85% improvement. CONCLUSIONS: HIV testing should be offered to every women in the child-bearing age. Current prophylaxis, which suppress maternal VL HIV below detection level, decrease the risk of vertical HIV transmission to 0-1%. The child born to HIV(+) mother requires early diagnostics of HIV, HBV, HCV infections. Because of rapid progression of the disease, the HIV infected child should be diagnosed and treated since the first year of life. Properly treated children reach to mature age.

Prevalence and predictors of liver disease in HIV-infected children and adolescents.

Liver disease in HIV-infected patients may result from the infection itself, antiretroviral treatment or comorbidities. In this study, we analysed liver disease in 79 HIV-infected children and adolescents aged 14.0 ± 5.1 years. All the patients were receiving combination antiretroviral therapy (cART), with a mean duration of 11.5 ± 4.7 years. Six patients (8%) had detectable HIV viral load, and 8/79 (10%) of the participants were coinfected with hepatitis B or C virus (HCV, 6/8 or HBV, 2/8). Liver disease was defined as an elevation of any of the following parameters: alanine or aspartate aminotransferase (ALT and AST), total bilirubin, and gamma glutamyl transferase (GGTP). For the noninvasive evaluation of liver fibrosis, the AST-to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) were calculated. Liver disease was diagnosed in 20/79 (25%) of the patients, including 13/71 (18%) of participants without coinfection and 7/8 (88%) with coinfection (p < 0.0001). All of the liver markers except bilirubin were significantly higher in the coinfected group. APRI scores indicated significant fibrosis in 5/8 (63%) of patients with coinfection. HBV or HCV coinfection and detectable HIV viral load were independently positively associated with APRI (p = 0.0001, and p = 0.0001) and FIB-4 (p = 0.001, and p = 0.002, respectively). In conclusion, liver disease in HIV-infected children and adolescents results mainly from HBV or HCV coinfection. Effective antiretroviral treatment is protective against hepatic abnormalities.

[Tuberculosis in HIV infected children]. / Gruzlica u dzieci zakazonych HIV.

UNLABELLED: Tuberculosis (TB) is important threat in HIV-infected people. Although there is slow but constant decline TB-infections among adults and children in Poland, about 30% HIV-(+) adults is coinfected with TB. There were 12 cases of TB in HIV(+) children diagnosed in Department of Pediatric Infectious Diseases in 1994-2005. The aim was analysis of reasons for TB diagnostic tests in HIV (+) children, coinfection HIV and TB and efficacy of anti TB treatment. TB diagnostics was performed in 23 children because of clinical indications (15/23) and conversion or excessive skin tests (8/23). There were bacteriological and radiological exams done in all cases of TB suspicion. When active TB was diagnosed there were 4 tuberculostatic drugs used (6-12 months). In latent or unlocalized TB-INH was used for 12 months. RESULTS: 12 cases of TB infection were diagnosed: active TB--4, BCG-itis--1, latent--1 and unlocalized TB--6. In 10 cases TB infection was excluded. All cases of tuberculostatic treatment was successful. 5/12 cases are presently treated. CONCLUSIONS: Skin test is lonely, generally used method of TB control in HIV (+) children without clinical manifestations of TB. There is a necessity of diagnosis and chemoprophylaxis in all cases of conversion or enlarged (above 10 mm, vesicularis) skin test. TB diagnosis is an indication for HIV diagnostics.

[Effectiveness of vaccination against hepatitis B in HIV infected children]. / Ocena skutecznosci szczepien przeciwko wzw B u dzieci zakazonych HIV.

OBJECTIVE: The aim of the study was to evaluate hepatitis B vaccination effectiveness in HIV infected children. METHODS: 45 children vertically infected with HIV who received hepatitis B vaccination were evaluated. Anti-HBs antibodies were assayed to established vaccination efficiency and were repeated every 6-12 months. No-responders received the next vaccination schedule with doubled dose. Children with antibody levels < 100 IU/ml were boostered. All the children have been receiving HAART. MAIN OBSERVATIONS AND RESULTS: 35/45 (77,8%) children had anti-HBs antibodies > 100 IU/ml, including 20 with anti-HBs antibodies > or = 1000 IU/ml (32 children without immunodeficiency, 2 with moderate and 1 with severe immunodeficiency). Anti-HBs level 8-100 IU/ml was observed in 6/46 (13,3%) children (5 children without immunodeficiency and 1 with severe immunodeficiency). 4/46 (8.9%) children had no anti-HBs antibodies (2 children without immunodeficiency, 1 with moderate and 1 with severe immunodeficiency). CONCLUSIONS: In HIV infected children anti-HBs antibodies should be assayed to establish hepatitis B vaccination efficiency and repeated every 6-12 months.

[HIV infection in children in Poland - clinical advancement at time of diagnosis]. / Zakazenie HIV u dzieci w polsce - zaawansowanie kliniczne choroby w momencie rozpoznania.

UNLABELLED: At the end of 2006, there were about 130 children with confirmed HIV infection in Poland, 90% of them being infected vertically. AIM: to present the causes, the diagnostic procedure of HIV infection and the assessment of clinical staging at diagnosis of vertical infection in a child. MATERIALS AND METHODS: between 1987-2006 there were 86 HIV infected children (45 male, 41 female) treated in our Department. 78 children had been infected vertically, 8 by other route. Reasons for HIV testing in children and clinical staging at diagnosis were analysed in vertically infected children. The patients were divided into two groups: I - diagnosed because of clinical signs and symptoms, II - because of knowledge of HIV positive status in family members. RESULTS: there were 22/79 children in group I and 56/79 in group II. Vertical HIV infection diagnosis was confirmed at the age from 1 month to 11 years, the mean age was: 26 months - in group I, 25 months - in group II. During the first year of life HIV infection was diagnosed in 36 children (33% of them having AIDS, 36% severe immunodeficiency), at the age of 12-35 months in 22 children (23% of them having AIDS, 32% severe immunodeficiency) and above 35 months in 20 children (15% of them having AIDS, 35% severe immunodeficiency), respectively. Children diagnosed because of clinical manifestations were more likely to have AIDS (p<0.01) and severe immunodeficiency (p<0.07). CONCLUSIONS: early diagnosis in children relies on the knowledge on the mother's HIV infection positive status. In Poland vertical HIV infection diagnosis is established late (mean: above 2 years), often at the advanced stage of the disease.

Diagnosis and management of children born to HIV infected mothers in Poland.

OBJECTIVE: The aim of this study was to describe the management of children born to HIV positive mothers in Poland. MATERIAL AND METHODS: Between 1987 to 2003, 218 children of HIV positive mothers were admitted to the Department of Children's Infectious Diseases of the Medical University in Warsaw. Currently recommended management of newborn infants and the routine schedule of diagnostic procedures of children born to HIV positive mothers were discussed. Children, who were in the programme of HIV mother to child transmission (MTCT) prophylaxis, are followed up from birth. Their psychosomatic development is evaluated. They also follow a modified vaccination schedule. RESULTS: From 1994 to 2003 the prevention programme of vertical transmission was carried out in 107 children. The risk of vertical transmission in this group was 2%. CONCLUSIONS: Children born to HIV infected mothers need to be diagnosed, to receive antiretroviral therapy initiated at the moment of diagnosis of HIV infection and to be under specialized care.