Clinical and laboratory correlates of Pneumocystis carinii pneumonia in children infected with HIV

Article Abstract:

Infection with human immunodeficiency virus type I (HIV-I) is often complicated by Pneumocystis carinii pneumonia (PCP), which is associated with high rates of death and disability. PCP is often the initial sign of HIV disease in children who acquire HIV infection at birth. HIV-infected children may only survive for as little as one month after PCP diagnosis. Some factors that may predict the risk of developing PCP in adults include persistent thrush, or yeast infection of the mouth or throat; persistent elevated temperature; and decreased numbers of CD4 cells, a type of immune cell. Guidelines for use of PCP prophylaxis (preventive treatment) for HIV-infected adults have been developed by the United States Public Health Service. However, it remains unclear whether similar risk factors can be applied to HIV-infected children. Studies suggest that the numbers of lymphocytes, such as CD4 cells, are higher in infants as compared with adults. The characteristics of children who develop PCP, the associated clinical and laboratory findings, and the outcome of PCP in these children were assessed by reviewing 27 cases of pediatric AIDS-associated PCP. The mean (average) age at PCP diagnosis was 10.8 months, whereas the median (most frequent) age at diagnosis was 7.7 months. All infants had clinical evidence of HIV disease, which was detected before or during PCP diagnosis. Most cases were associated with acute illness, and 70 percent of infants developed complications of treatment. Seventy percent survived less than six months after PCP diagnosis. Most infants survived only two months after diagnosis, and the average life span of HIV-infected children with PCP was 14.4 months. Only 40 percent of children had CD4 lymphocyte counts that would be considered low enough to begin PCP prophylaxis in HIV-infected adults. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Pneumocystis carinii pneumonia

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Tumors of smooth-muscle origin in HIV-infected children

Article Abstract:

While many adults with AIDS (acquired immunodeficiency syndrome) develop tumors, it is rare in children with AIDS; fewer than 2 percent of affected children have tumors. Three cases involving rare tumors, multiple leiomyomata and leiomyosarcomata, are described in children with AIDS. This is the first report that links these tumors of the smooth muscle with AIDS or HIV (human immunodeficiency virus) infection. The patients, aged four, five and eight years, had all been infected with HIV during infancy. Two were infected through blood transfusions, and one was infected by his mother around the time of birth. The childrens' immune function was severely depressed, and they had a history of many infections before the tumors were found. The locations of these tumors were mainly in the digestive tract and the lungs. Because these tumors are so rare in childhood, the authors believe that the tumors were associated with AIDS in these three cases. From these findings, the authors conclude that HIV infection could play either a direct or indirect role in the growth of these smooth-muscle tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Leiomyoma, Tumors in children, Pediatric tumors

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Lymphocyte subsets in healthy children during the first 5 years of life

Article Abstract:

Children under the age of five have higher T-lymphocyte levels than adults, and this should be taken into consideration when HIV-infected children are treated. Analysis of blood samples from 208 healthy children from one month to five years old found that the youngest children had the highest levels of CD4 lymphocytes, a type of T-lymphocyte, and that the levels declined in the older children. While the average CD4 lymphocyte level in healthy adults is 760 per microliter (uL), the average CD4 lymphocyte level in the youngest children was 2,830 per uL. Children aged two through five years had average CD4 lymphocyte levels of 1,800 per uL. Zidovudine (AZT) treatment of HIV-infected adults is usually started when their CD4 lymphocyte levels drop to 500 per uL. Zidovudine treatment of HIV-infected children should be started when their CD4 lymphocyte levels drop to 1,500 per uL.

Measurement, Physiological aspects, Children, Lymphocytes

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