HIV infection in children: clinical features and management
Article Abstract:
It is estimated that 20 to 50 percent of children born to mothers who are infected with the human immunodeficiency virus (HIV, which causes AIDS) will become infected with the virus. The criteria for diagnosis of HIV infection in infants and young children include: detection of HIV in blood or tissue; detection of the p24 viral antigen; and the presence of antibody to the virus associated with symptoms of immunodeficiency. The spectrum of clinical symptoms of HIV infection in children is wide and includes: nonspecific symptoms of diseases, such as swelling of the lymph nodes, liver and spleen, chronic or recurrent diarrhea, and developmental delay; immunodeficiency states resulting in recurrent bacterial and viral infections as well as opportunistic infections, including infection with Pneumocystis carinii, Candida, Cytomegalovirus, Herpes simplex, and Toxoplasma; and various organ-specific diseases, such as abnormalities in the brain, heart, lungs, liver and kidneys. Laboratory studies show common abnormalities: low levels of red blood cells, white blood cells, and platelets; high levels of the liver enzymes protein transaminase and lactic acid dehydrogenase; and various immunological abnormalities, including high levels of immunoglobulin molecules but decreased function of the molecules, low numbers of T helper cells, and increased numbers of T suppressor cells. The management of HIV-infected infants includes the identification of those infected, routine clinical and laboratory evaluation every three months, and the treatment of other infections. Zidovudine is being used for treating HIV infection in children. The National Institutes of Health is conducting clinical trials in 13 centers across the United States for the treatment of children with HIV infection and associated infections. Various antiviral drugs, including zidovudine and dideoxycytidine, are being tested. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of Acquired Immune Deficiency Syndromes
Subject: Health
ISSN: 0894-9255
Year: 1991
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Decision making for clinical trials and prevention research: commentary on the model of Paltiel and Kaplan
Article Abstract:
A decision-making model that incorporates scientific knowledge, therapeutic effect and economic considerations may simplify clinical trials and the process of drug approval. Recognizing the inefficiency with which HIV drugs are brought to market and the lack of cooperation among various branches doing AIDS research, two researchers, Paltiel and Kaplan, start with a compartmental model in which transition rates from one stage of the disease to another are quantified using previously gathered data. The model takes into consideration mitigating factors such as the use of anti-HIV drugs, the cost of treatment, patterns of disease transmission and social behavior. Theoretically, the model can be used to judge how long a clinical trial should run or whether it should be abandoned or even attempted in the first place. Although the model makes some unrealistic assumptions, for example that HIV-positive individuals immediately begin counseling or therapy, it represents an important step toward a coordinated approach to drug evaluation and policy implementation.
Publication Name: Journal of Acquired Immune Deficiency Syndromes
Subject: Health
ISSN: 0894-9255
Year: 1993
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