Viral phenotype, antiretroviral resistance and clinical evolution in human immunodeficiency virus-infected children.

BACKGROUND: The syncytium-inducing (SI) viral phenotype and the emergence of viral strains resistant to zidovudine have been described in persons infected with HIV, and in some cases they have been associated with poor prognosis. METHODS: HIV isolates obtained from 37 HIV-infected children were analyzed to determine whether the SI viral phenotype and the mutation on the 215 position of the reverse transcriptase (M215) could be used as markers of disease progression. We performed peripheral blood coculture mononuclear cells, and we analyzed the induction of syncytia using the MT-2 cell line. The emergence of mutations on the 215 position was determined by PCR. RESULTS: We found a statistically significant association (P < 0.05) between SI viral phenotype and (1) recurrent serious bacterial infections, (2) absolute CD4+ cell counts <2 SD, (3) progression to AIDS and (4) death. Sixty percent of the children treated with zidovudine developed 215 mutant viral strains without statistically significant association with clinical or immunologic findings. The SI viral phenotype was statistically associated with the presence of the 215 mutation (P < 0.05). CONCLUSIONS: SI viral phenotype is a marker associated with a poor clinical and immunologic progression of the disease and it may facilitate the emergence of mutant strains in children treated with zidovudine.

[Human immunodeficiency virus infection in children. Clinical and immunological markers of disease progression]. / Infección por el virus de la inmunodeficiencia humana en niños. Marcadores clínicos e inmunológicos de progresión de la enfermedad.

OBJECTIVE: The aim of this study was to analyze the prognostic value of the clinical manifestations and of the lymphocyte CD4 count in a cohort of HIV infected children. PATIENTS AND METHODS: We performed a prospective study in 37 HIV infected children during a 6 year period. We studied the statistical association between mortality and clinical and immunological parameters according to Fisher's test (p < 0.05). We performed a survival analysis according to Kaplan-Meier curves (p < 0.05). RESULTS: We have found that a high risk of mortality is associated with recurrent and severe bacterial infections (p = 0.0001), failure to thrive (p = 0.0057), opportunistic infections (p = 0.0008) and AIDS (p < 0.0001). The survival analysis has shown a low probability of survival in HIV-encephalopathy (p = 0.000053) and high in one case of lymphocytic interstitial pneumonia (p = 0.07). An age-related CD4 count less than 2 SD was associated significantly with a bad prognosis (p = 0 .0017). CONCLUSIONS: The clinical manifestations and age-matched CD4 count continue being good surrogate markers for the indication of prophylaxis, antiretroviral treatment and as prognostic values of the disease in HIV infected children until new techniques, especially plasma viremia, can be widely available.

[The halofantrine treatment of Plasmodium falciparum malaria. Clinical experience]. / Tratamiento con halofantrina del paludismo por el Plasmodium falciparum. Experiencia clínica.

UNLABELLED: The objective of this study was to evaluate the efficacy of halofantrine in the treatment of malaria caused by Plasmodium falciparum since the resistance of these plasmodium to chloroquine is increasing in countries of Western Africa. MATERIAL AND METHOD: Between January 1991 and June 1994 we studied 50 children from Equatorial Guinea. All of them were black and between the ages of 8 months and 13 years. They were treated with 3 doses of halofantrine (8 mg/kg every 6 hours). The definitive diagnosis was made by the demonstration of the parasites on thick and thin blood smears, stained by standard methods, repeated every 24-72 yours after therapy. We considered the disappearance of fever and the clearance of plasmodium from the red blood cells as signs of response to the treatment. We also monitored the tolerance and the adverse side effects of the drug. RESULTS: All of the patients responded favorably with the disappearance of the fever after 24 hours and after 72 hours no parasites were seen in red blood cells. Only one patient had a recurrence, which occurred on the 10th day. All patient satisfactorily tolerated the drug and only 3 children showed an increase of aminotransferases that was spontaneously cured. CONCLUSIONS: We conclude that halofantrine is a safe and efficient drug for the treatment of children diagnosed with malaria caused by Plasmodium falciparum.

[Malaria in childhood. Report of 26 cases]. / Paludismo en la edad pediátrica. Communicación de 26 casos.

It's known that there has been a resurgence of malaria in the world. Purpose of this article is to point out the increase in number of cases of imported malaria in children in Spain. Authors performed a clinical study and review up to date treatment and prophylaxis of the disease. They communicate cases of three children infected by Plasmodium falciparum resistant to chloroquine, proceeding from areas that up to one year ago were considered to be not resistant. Data published on prevention and selective primary health care of malaria in the world are revised.