Coping Strategies in Liver Transplant Recipients and Caregivers According to Patient Posttraumatic Growth.

The purpose of this study was to analyze the differences in coping strategies employed by liver transplant recipients and their family members according to patient posttraumatic growth. Two matched groups of 214 liver transplant recipients and 214 family members were selected. The Posttraumatic Growth Inventory and Brief COPE were used. The most relevant results were: (1) Interactive effects in active coping, support (instrumental and emotional) and acceptance strategies, which were all used more by patients with higher growth levels, while their family members showed no differences in use of these strategies by patient growth level. Furthermore, while a low level of patient growth did not mark differences between them and their caregivers, a high level did, patients employing more active coping and support (instrumental and emotional), (2) In both groups a high level of patient growth was associated with more use of positive reframing and denial than a low one, and (3) Self-blame was employed by patients more than by their caregivers. It was concluded that a high level of posttraumatic growth in liver transplant recipients is associated with more use of healthy coping strategies, basically active coping, instrumental support, and emotional support.

High prevalence of X4/DM-tropic variants in children and adolescents infected with HIV-1 by vertical transmission.

BACKGROUND: We studied HIV coreceptor tropism in vertically HIV-infected children and adolescents with the objective of predicting the proportion of children and adolescents that could be treated with CCR5 (R5) antagonists. METHODS: One hundred eighteen multidrug-resistant pediatric patients (36 children and 82 adolescents) were enrolled in a cross-sectional study. Viral tropism was assessed using the new phenotypic HIV-1 tropism coreceptor assay information and Trofile. RESULTS: Of 118 antiretroviral-experienced HIV-infected children and adolescents, 49 (57.0%) had dual-tropic and 20 (23.3%) had X4-tropic viruses by tropism coreceptor assay information testing. Only 17 (19.7%) showed R5-tropic variants. HIV-1 coreceptor usage was not detectable in 32 of 118 (27%) patients. Among 24 children and 62 adolescents with tropism coreceptor assay information results, 17 (70.8%) children and 51 (82.2%) adolescents showed viruses with dual-tropic or X4-tropic variants. Additionally, Trofile (ES) was performed in 42 of 118 patients with HIV-1 RNA > 1000 copies/mL. No patient showed X4-tropic variants; dual-tropic viruses were observed in 12 (28.6%) patients. In 6 (14.3%) patients, HIV tropism could not be determined. X4-tropic variants were more common in children (P = 0.031). CD4 T cell percentage was significantly lower in children (P = 0.011) and adolescents (P = 0.027) with R5-tropic viruses than in those with X4-tropic viruses. CONCLUSIONS: The presence of X4-tropic variants in more than 80% of our cohort of antiretroviral-experienced children and adolescents with vertical HIV-1 infection indicates a very limited role for CCR5 antagonists as part of salvage regimens for highly treatment-experienced vertically HIV-1-infected patients with extensive antiretroviral drug resistance and limited treatment options.

Prevención de los trastornos de la conducta alimentaria (TCA) en chicas preadolescentes: eficacia de un programa multisesión e interactivo en el seguimiento a un año / Prevention of eating disorders in pre-adolescents girls: effectiveness of a multi-session interactive program at one year follow-up

El objetivo es determinar la eficacia de un programa de prevención (PP) para el desarrollo de TCA, aplicado en seis sesiones a 115 chicas de 1º y 2º de ESO (edad media= 12,71; DT= 0,72). Pre, post-programa y al año de seguimiento se aplicaron el EAT-40 y el BSQ. Post-programa, se administró una encuesta que evaluaba la capacidad para identificar la influencia de factores de riesgo. Los resultados al año de las chicas de 2º de ESO ya en 3º de ESO, se contrastaron con los obtenidos por un grupo de chicas (n= 69) del mismo curso (edad media= 14,36; DT= 0,54) no participantes en el PP. Las participantes mostraron puntuaciones muy bajas en ambos cuestionarios desde el pre-programa. Los efectos de la intervención fueron escasos, aunque se observó una alta capacidad adquirida en identificar la influencia de los factores de riesgo. En comparación con las no participantes, las participantes presentaban al año de seguimiento significativamente menos patología alimentaria y de la imagen corporal. En conclusión, el PP ha mostrado su eficacia a corto y largo plazo y el curso idóneo para su aplicación es 2º de ESO (AU)

The objective of this paper was to determine the efficacy of a program applied to 115 girls in 1st and 2nd grade in Secondary Obligatory Education (ESO) (average age=12.71; SD=0.72) in six sessions to prevent the onset of eating disorders. Pre-, post-program and after a one-year follow-up, the EAT-40 and BSQ were applied. Additionally, a questionnaire was created to assess the capability of identifying risk factors in ED development. The results were contrasted with those obtained from a group of girls (N= 69) in the same grades and of the same age (average age=14.36; SD=0.54) who did not participate in the prevention program (PP). Participants were already showing very low scores on both questionnaires from the pre-program. The effects of the intervention were scarce, although it was observed that a high capability of identifying risk factors had been acquired. When compared to the non-participants and after the one-year follow up, the participants showed significant lower eating and body image pathologies. The program has proven its efficacy both in short and long-term and the ideal school year to apply it is 2nd grade ESO

Long-term response to highly active antiretroviral therapy with lopinavir/ritonavir in pre-treated vertically HIV-infected children.

BACKGROUND: Immune recovery after prolonged highly active antiretroviral therapy (HAART) with lopinavir/ritonavir has been reported in adults but not in children. Our study aimed at evaluating the long-term use of lopinavir/ritonavir among children in a clinical setting. METHODS: We carried out a retrospective study on 69 protease inhibitor (PI)-experienced vertically HIV-infected children on HAART containing lopinavir/ritonavir. We analysed the changes in percentage CD4+ cell count (%CD4+) and viral load (VL) and identified prognostic factors to achieve CD4+ >25% and undetectable VL (uVL) ( 100,000 copies/mL. We found that %CD4+ at baseline had a strong positive association with achieving CD4+ >25% at 6, 12, 18, 24, 36 and 48 months of follow-up. We also found that length of PI use had a negative association with reaching CD4+ >25% at 24 and 48 months and achieving uVL at 12 and 24 months. VL at baseline had a negative association with achieving uVL at 18 and 24 months. CONCLUSIONS: Our study demonstrates ongoing immune recovery among children on HAART with lopinavir/ritonavir after 4 years of follow-up. Lopinavir/ritonavir, when given as part of a salvage regimen, is safe and well tolerated in HIV-infected children.

Long-term response to highly active antiretroviral therapy in human immunodeficiency virus and hepatitis C virus coinfected children: 6 years of follow-up.

We carried out a retrospective study to analyze the long-term response to highly active antiretroviral therapy of 19 vertically human immunodeficiency virus type 1/hepatitis C virus (HCV-1/HIV) coinfected children. The clinical, immunologic, viral, and biochemical variables were assayed at 0, 1, 2, 3, 4, 5, and 6 years of follow-up. Our data suggest that CD4 T-cell recovery and viral load control during long-term highly active antiretroviral therapy among HIV-1/HCV children were similar to those described in HIV-1 monoinfected children, but hepatic function was significantly altered in HIV-1/HCV children.

Salvage therapy with abacavir and other reverse transcriptase inhibitors for human immunodeficiency-associated encephalopathy.

BACKGROUND: HIV-associated encephalopathy (HIV-AE) is a severe neurologic condition that affects HIV-infected children. The potential benefit of antiretroviral (ARV) agents with good cerebrospinal fluid (CSF) penetration remains to be defined. Abacavir (ABC) achieves good CSF concentrations and studies of high-dose ABC showed benefit in adults with HIV dementia. The present study evaluated the safety and virologic, immunologic and neuropsychological responses of an ARV regimen including high-dose ABC in children with HIV-AE. METHODS: Children between 3 months and 18 years old and abacavir-naive with HIV-AE and virologic failure were eligible. RESULTS: : Seventeen children (16 ARV-experienced) were enrolled and 14 children completed 48 weeks of therapy. The overall tolerability was good; 2 children had a possible hypersensitivity reaction. At week 48, 53% and 59% of the children achieved HIV RNA levels below the limit of quantitation in plasma and CSF, respectively. The median (25%-75% range) change of HIV RNA from baseline to week 48 was -2.29 (-0.81 to -2.47) log10 copies/mL in plasma and -0.94 (0 to -1.13) log10 copies/mL in CSF. The mean increases in CD4 (+/-standard error of mean) cell count and CD4% were 427 (+/-169) cells/mm and 8% (+/-2), respectively. Concentrations of soluble tumor necrosis factor receptor II were reduced in plasma and CSF. Children less than 6 years of age demonstrated significant neuropsychological improvement at week 48. CONCLUSIONS: In the present study with a limited number of children, highly active ARV therapy including high-dose ABC showed a safety profile similar to standard dose ABC and provided clinical, immunologic and virologic response in children with HIV-AE at week 48. Children less than 6 years of age also demonstrated significant neuropsychological improvement.

Characterizing the immune system after long-term undetectable viral load in HIV-1-infected children.

Thirty two HIV-infected children, on highly active antiretroviral therapy (HAART) and > 500 CD4+ T cells/mm3, were rated according to the time-course of viral load (VL) during the whole follow-up period (> 18 months) in a longitudinal retrospective study. (a) uVL group: 15 children with VL below 400 copies/mL; (b) dVL group: 17 children with higher VL. The uVL group showed higher memory (CD4+CD45RO+) T cells than did dVL group, and higher number of memory activated CD4+CD45RO+HLA-DR+ than did control group (healthy age-matched uninfected children), whereas CD4+CD45RA(hi)+CD62L+ was similar. However, TCR rearrangement excision circles (TRECs) were higher in uVL group than in dVL group. uVL Group showed CD8+CD45RO+ and CD8+CD45RO+CD38- higher number than the control group, but lower than the dVL group. The percentage of CD8+CD45RA(hi)+CD62L+, CD8+CD45RA+, CD8+CD62L-, and CD8+CD28+ was higher in uVL group than in dVL group, and lower than in control group. The uVL group showed higher number of activated (HLA-DR+CD38+, HLA-DR+, HLA-DR+CD38-) CD4+ T cells and lower percentages of CD4+HLA-DR-CD38+ than dVL group. In activated CD8- T cell, the uVL group had lower CD8+HLA-DR+CD38+, CD8+HLA-DR+, and CD8+CD38+ than the dVL group. Preeffector (CD8+CD57-CD28- and CD8+CD45RA-CD62L-) T cells were lower in the uVL group than in dVL group. In the effector (CD8+CD57+, CD8+CD57+CD28-, and CD8+CD45RA+CD62L-) T cells, HIV-infected-children had higher values than control group. HIV-infected-children who respond to HAART had TRECs reconstitution, decreased immune activation, and lower effector CD8+ T cells. Moreover, successful HAART allow the increment of activated CD4+ T cells.

[Complete immune and clinical recovery after highly active antiretroviral therapy in advanced vertically HIV-1 infected children]. / Reconstitución clínica e inmunológica completa tras el tratamiento antirretroviral de gran actividad en un niño infectado verticalmente por el virus de la inmunodeficiencia humana tipo 1 con enfermedad avanzada.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the ability of long-term highly active antiretroviral therapy (HAART) to fully reconstitute the immune system in children with severe AIDS. PATIENT AND METHOD: Lymphoproliferative responses (LPR) were evaluated by incorporation of [3H]-thymidine. Cytokine production in culture (IFN- gamma, IL-5) was quantified using commercially available specific ELISA assays. T-cells subsets were determined by 3-color flow cytometry and thymic production of T-cells was assessed by quantification of TCR rearrangement excision circles (TRECs). RESULTS: We present a vertically HIV-1-infected child at clinical category C, with long-standing CD4+ T-cells below 50/l, who was monitored during 3-years after starting HAART by quantifying the viral load (VL), naïve, memory, and activated T-cell subsets, and thymical function as well as clinical events. VL was suppressed to undetectable levels since the beginning of HAART with d4T, 3TC, nelfinavir, and efavirenz resulting in a dramatic immune reconstitution, achieving normal CD4+ T-cells counts after 6 months (25%, 597 CD4+ T-cells/l) and perdurable undetectable VL levels. Naïve CD4 and CD8 T-cells increased in parallel to TCR rearrangement excision circles (TRECs) levels, with a concomitant decrease in T-cell activation markers. Interestingly, the patient showed an increase in the lymphoproliferative responses to PHA; the IFN-gamma production by PBMCs increased with HAART while the production of IL-5 diminished, thus indicating a switch of type 2 to type 1 response. He recovered clinically and immunologically (up to normal levels) and remains asymptomatic at present. CONCLUSION: This report demonstrates that at least in these children, an immune and clinical recovery from an advanced stage of HIV-disease can be possible throught HAART.

Reconstitución clínica e inmunológica completa tras el tratamiento antirretroviral de gran actividad en un niño infectado verticalmente por el virus de la inmunodeficiencia humana tipo 1 con enfermedad avanzada / Complete immune and clinical recovery after highly active antiretroviral therapy in advanced vertically HIV-1 infected children

FUNDAMENTO Y OBJETIVO: Evaluar la capacidad del tratamiento antirretroviral de gran actividad (TARGA) para reconstituir totalmente el sistema inmunológico en un niño infectado por el virus de la inmunodefiencia humana (VIH) con sida grave y profunda inmunodepresión. PACIENTE Y MÉTODO: La respuesta proliferativa y la producción de citocinas de las células mononucleares de sangre periférica (CMSP) frente a fitohemoglotinina (PHA) fueron evaluadas por incorporación de [3H]-timidina y enzimoinmunoanálisis, respectivamente. Las subpoblaciones linfocitarias T se cuantificaron por citometría de flujo y la producción tímica de células T, mediante la cuantificación de TCR rearrangement excision circles (TREC). RESULTADOS: En sus primeros años de vida, el niño presentó otitis recurrente por Pneumococcus. A los 2-3 años de edad, las células T CD4+ descendieron de 822 a 154 células ×× 106/l, iniciándose tratamiento con zidovudina (AZT), aunque nunca superó las 350 células T CD4+ ×× 106/l. A los 6 años de edad, la cifra de células T CD4+ era inferior a 15 ×× 106/l, y se administró estavudina (d4T) junto a lamivudina (3TC) sin recuperar las células T CD4+. A los 7 años de edad, la cifra de células T CD4+ era del 0,8 por ciento y la carga viral (CV) de 32.000 copias/ml. Este estado coincidió con un leiomioma plantar que fue extirpado y una neumonía por Pneumocystis carinii. Tras 6 meses de TARGA (con d4T, 3TC, viracept y efavirenz) alcanzó valores de células T CD4+ del 25 por ciento, células T CD4 de 597 ×× 106/l, y CV indetectable. Además se produjo un incremento del número absoluto de células vírgenes y valores de TREC. Tras el TARGA aumentaron la respuesta linfoproliferativa a PHA y la producción de interferón gamma (IFN). Actualmente el paciente está asintomático. CONCLUSIÓN: La recuperación inmunológica y clínica del niño infectado por el VIH en fases muy avanzadas de la enfermedad fue posible gracias al TARGA, lo que demuestra la plasticidad de su sistema inmunitario (AU)