Effect of Structured Physical Activity on Inflammation and Immune Activation Profile of Antiretroviral Therapy-Experienced Children Living With HIV.

AIM: To compare the markers of inflammation and immune activation in virally suppressed HIV-infected children on antiretroviral therapy, who practiced regular structured exercise comprising running and yoga to those who did not over a 2-year period. METHODS: This retrospective cohort study included 72 children aged 8 to 16 years divided into 2 groups, exercisers (n = 36) and the nonexercisers (n = 36) based on their intentional physical activity. The analyses were carried out at baseline and after 2 years (Y2) for the soluble biomarkers of inflammation and immune activation (tumor necrosis factor alpha, interleukin-6, interleukin-10, interferon gamma, sCD14, and sCD163). In addition, cell-associated biomarker (CD38), lipopolysaccharides, and the gene expression of interleukin-2 and brain-derived neurotrophic factor were also measured at Y2. RESULTS: Reduction in levels of sCD14 (effect size [ES], -0.6; 95% confidence interval [CI], -1.08 to -0.14), tumor necrosis factor alpha (ES, -0.7; 95% CI, -1.18 to -0.23), interferon gamma (ES, -0.7; 95% CI, -1.17 to -0.22), and interleukin-10 (ES, -0.6; 95% CI, -1.08 to -0.14) was observed among exercisers as compared with nonexercisers at Y2. In addition, CD38+ expressing CD4+ T cells were found to be lower among exercisers (P = .01) at Y2. However, the differences in levels of interleukin-6, sCD163, lipopolysaccharides, interleukin-2, and brain-derived neurotrophic factor were not significantly different among the 2 groups. CONCLUSION: The study result suggests that regular structured physical activity improves the inflammatory profile of antiretroviral therapy-treated HIV-infected children.

Quality of life and psychosocial well-being among children living with HIV at a care home in Southern India.

This study was designed to evaluate the quality of life (QOL) of children living with HIV at an institutional care home in Bangalore, India. The Sneha Care Home is a unique residence that provides educational and community support with a focus on physical, nutritional, medical, and psychological care for orphans and vulnerable children. Cross-sectional health measures and interview data were collected from 97 residents including 52 boys and 45 girls between 5 and 12 years of age (mean age = 9). QOL was measured with the Pediatric Quality of Life 4.0 (PedsQL) Inventory. Caregivers perceived children to have an overall higher QOL than was self-reported by children (total score 83 vs. 78). Our findings indicated self-reported QOL decreased with age of the child, while caregiver-reported QOL increased with age, suggesting a need to ensure greater psychological support for older children. Physical measures showed the children's clinical severity of disease remained well controlled living in this residential, values-based care home.

Growth patterns and anaemia status of HIV-infected children living in an institutional facility in India.

OBJECTIVE: To understand the health status of HIV orphans in a well-structured institutional facility in India. METHOD: Prospective longitudinal analysis of growth and anaemia prevalence among these children, between June 2008 and May 2011. RESULTS: A total of 85 HIV-infected orphan children residing at Sneha Care Home, Bangalore, for at least 1 year, were included in the analysis. Prevalence of anaemia at entry into the home was 40%, with the cumulative incidence of anaemia during the study period being 85%. At baseline, 79% were underweight and 72% were stunted. All children, irrespective of their antiretroviral therapy (ART) status, showed an improvement in nutritional status over time as demonstrated by a significant increase in weight (median weight-for-age Z-score: -2.75 to -1.74, P < 0.001) and height Z-scores (median height-for-age Z-score: -2.69 to -1.63, P < 0.001). CONCLUSION: These findings suggest that good nutrition even in the absence of ART can bring about improvement in growth. The Sneha Care Home model indicates that the holistic approach used in the Home may have been helpful in combating HIV and poor nutritional status in severely malnourished orphaned children.

Morbidity Profiles of People Living With HIV/AIDS in Urban and Rural Inpatient and Outpatient Settings in Karnataka, South India.

We examined the morbidity profiles associated with people living with HIV infection in an urban HIV inpatient treatment site near the city of Bangalore, in southern Karnataka state, south India, and in a rural outpatient site in northern Karnataka. Data from March 2007 until July 2008 were analyzed. The urban cohort comprised 432 patients, and the most common comorbid conditions were unexplained prolonged fever (50.2%) and oral candidiasis (42.6%). The rural cohort comprised 2374 patients, and the most common comorbid conditions were unexplained prolonged fever (58.8%), minor mucocutaneous infections (58.4%), and recurrent upper respiratory tract infections (52.3%). With less than 1% of patients in rural areas on treatment for tuberculosis (vs over one third in the urban cohort), tuberculosis is likely significantly underdiagnosed in rural areas. In addition, only 2.6% of rural outpatients who were eligible for antiretroviral treatment (ART), per Government of India guidelines, were actually on ART, compared to 31.6% of the urban population.