Percutaneous endoscopic gastrostomy placement in a human immunodeficiency virus-positive pediatric population leads to an increase in minor complications.

AIM: The development of effective multiple drug regimens for treating human immunodeficiency virus (HIV) are associated with nonadherence in children. HIV-positive children also have a higher incidence of malnutrition. Placement of a percutaneous endoscopic gastrostomy (PEG) is a potential solution. Primary outcome was to determine the complications of PEG placement in a pediatric HIV-positive population. MATERIALS AND METHODS: A 10 year retrospective data analysis was carried out on all HIV-positive children undergoing insertion of a PEG at two institutions. Parameters examined included infections, leakage, displacement, reasons for removal, total time in situ, HIV stage, CD4 count, and serological investigation. Data were compared against published data for PEG insertion in pediatric oncology patients and other comparable pediatric series using Fisher's exact test. RESULTS: Eighteen children were identified, with a median age 35 months and follow-up of 62 months. The majority of patients had advanced disease (Stage C; 65%). Fifty percent of PEGs were inserted for feeding supplementation and all were used for the administration of medications. Sixty-one percent experienced a minor complication; 5/18 (27.7%) experienced peristomal infection; 2/18 (11.1%) experienced either bleeding, leakage, or excessive granulation; and 1/18 (5.6%) experienced dislodgement. Stage of HIV did not affect the incidence of bleeding or infection: 5/11(Stage C) versus 2/7(Stage B) (P = .3). There was no significant difference for major complications when compared with any series though comparison with a large pediatric series revealed a significant difference for minor complications 11/18 versus 27/120 (P = .0003). CONCLUSIONS: There is a low rate of serious complications with PEG insertion in our patients, and the rate is comparable to that seen in pediatric oncology patients. The minor complication rate is, however, higher than a nonimmune compromised population; and careful follow-up for these patients is recommended so that the appropriate therapy can be promptly initiated.

Coping and psychological adjustment in adolescents with vertically acquired HIV.

Children with vertically acquired HIV face the challenges of adolescence in addition to the demands of coping with their illness. The relationship between coping and psychological adjustment has been widely studied in adults and children with chronic diseases but it is poorly understood in adolescents with HIV. This study aimed to identify whether a UK sample of adolescents with vertically acquired HIV had poor psychological adjustment and to clarify the relationship between coping and psychological adjustment in this sample. Thirty adolescents with vertically acquired HIV (aged 11-17) filled in questionnaires of coping and psychological adjustment and a correlational design was used to determine if specific coping styles were related to quality of psychological adjustment. Results showed that younger children had lower levels of psychological adjustment than older adolescents, although as a group the adolescents scored within normal ranges. Psychological adjustment was significantly related to two coping styles, Ventilating feelings and Being humorous. Exploratory analysis examined the extent of HIV disclosure in this sample and the degree of satisfaction felt about the nature of communication about the diagnosis. The results showed that participants had few confidants but were satisfied with the nature of communication about their status. The level of satisfaction was not related to adjustment. On the basis of the results, potential clinical implications for adolescents with vertically acquired HIV who might be struggling not only with the challenging demands of adolescence but also with their illness are discussed. The need to adopt a developmental approach to coping and psychological adjustment is emphasized.