Vertical transmission of HIV in Belgium: a 1986-2002 retrospective analysis.

Prophylactic interventions have lead to the reduction of the mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) to less than 2% in industrialized countries. The aim of this study was to evaluate the changes over time in vertical transmission according to the standard care of prophylaxis in the practice of a single large reference center and to identify the risk factors for failure. The rate of MTCT decreased progressively from 10% in 1986-1993 to 4.7% in 1999-2002, reflecting the progressive implementation of newly available means of prevention. During the last period evaluated (1999-2002), where highly active antiretroviral therapy (HAART) prophylaxis was the standard of care, 17% of women had a viral load between 400 and 20,000 copies/ml around delivery and 5% had a viral load above 20,000 copies/ml. High viral load and low CD4 lymphocyte count were strongly associated with vertical transmission. The rate of MTCT in women who received HAART for more than one month during pregnancy was 1.7%, compared to 13.3% in women treated with HAART for less than one month. The risk of vertical transmission in the absence of therapy was four times higher than before the era of antiretroviral therapy (ART; p=0.05). In conclusion, since the prevention of MTCT of HIV with HAART is the standard of care, a short duration or absence of ART during pregnancy linked to late or absent prenatal care is associated with a high risk of transmission. The early detection of HIV-1 infection in pregnant women, and close follow up and support during pregnancy are crucial to the success of the prevention of transmission.

Long-term efficacy of the interleukin-1 receptor antagonist anakinra in ten patients with neonatal-onset multisystem inflammatory disease/chronic infantile neurologic, cutaneous, articular syndrome.

OBJECTIVE: Cryopyrin-associated periodic syndromes (CAPS) are a group of rare autoinflammatory diseases. Neonatal-onset multisystem inflammatory disease (NOMID)/chronic infantile neurologic, cutaneous, articular syndrome (CINCA syndrome) is the most severe phenotype, with fever, rash, articular manifestations, and neurologic and neurosensory involvement. CAPS are caused by mutations in CIAS1, the gene encoding NLRP3, which plays a critical role in interleukin-1 (IL-1) processing. Anakinra, an IL-1 receptor antagonist, has been shown to be an effective treatment; however, data on long-term efficacy and safety have been sparse. This study was undertaken to assess the long-term efficacy and safety of anakinra treatment in patients with NOMID/CINCA syndrome. METHODS: We retrospectively analyzed the medical records of NOMID/CINCA syndrome patients referred to 2 centers, who had started anakinra treatment before June 2007. RESULTS: There were 10 patients with NOMID/CINCA syndrome who had been treated with anakinra. The patients' ages at the time anakinra treatment was initiated ranged from 3 months to 20 years. They had been followed up for 26-42 months. Sustained efficacy in the treatment of systemic inflammation and, in some cases, neurologic involvement and growth parameters, was achieved. The dosage of anakinra required for efficacy ranged from 1 to 3 mg/kg/day in the 8 oldest patients and from 6 to 10 mg/kg/day in the 2 youngest. Residual central nervous system inflammation and deafness persisted in some patients, especially if there had been a delay in diagnosis and treatment. Secondary amyloidosis persisted in cases in which it was present at treatment initiation, but no new lesions developed. No effect on overgrowth arthropathy was observed. Adverse events consisted of mild injection-site reactions. CONCLUSION: The present results indicate that anakinra treatment is effective over the long term in NOMID/CINCA syndrome. However, treatment has to be initiated before irreversible lesions develop, and, particularly in very young patients, dosage adjustment is required.

Ocular threat in juvenile idiopathic arthritis.

OBJECTIVES: Uveitis is the most severe complication of juvenile idiopathic arthritis (JIA). The diagnosis may be delayed, as visual symptoms are usually absent, which provides time for insidious complications. The course is chronic and long-term treatment is therefore required. METHODS: We retrospectively reviewed the medical records of 75 children with uveitis who accounted for 10.5% of all patients with JIA seen at our pediatric rheumatology outpatient clinic between July 1997 and July 2007. RESULTS: Uveitis occurred chiefly in patients with pauciarticular JIA. At last follow-up, in 69 patients in whom the files could be satisfactorily reviewed, only the anterior compartment was involved in 59.4% and both the anterior and the posterior compartments in the remainder. Mean age at the uveitis diagnosis was 4.5 years. In 9 (13.0%) patients, uveitis antedated joint manifestations; in 17 (24.7%) both were diagnosed simultaneously; and in 43 (62.3%) arthritis antedated uveitis. In 42 (61%) patients, complications occurred (synechiae, papillary block, cataract, hyalitis, papilledema, glaucoma, macular edema, elevated intraocular pressure, vision loss, and hypotonia). Topical medications were used in all patients for at least 3 months. Severe ocular involvement required systemic glucocorticoid therapy in 29 (42.0%) patients. Among immunomodulating agents, methotrexate and cyclosporine were used in 41 patients and TNFalpha antagonists in 15 patients. Surgery was performed in 21 (30.4%) patients. Uveitis completely resolved in 12 (17.4%) patients, a relapsing course occurred in 14 (20.3%), and became chronic with relapses as soon as the topical treatment was decreased in 23 (33.3%). A severe course was observed in 21 (30.4%) patients of whom 3 became blind and 4 lost vision in one eye. CONCLUSION: Uveitis is a severe complication of JIA. Patients with JIA should receive routine ophthalmological follow-up at regular intervals, even is their joint disease is quiescent.