Prognostic factors and life expectancy in children with AIDS and pneumocystis carinii pneumonia

Article Abstract:

Pneumocystis carinii pneumonia (PCP) is a common lung infection in patients with the acquired immunodeficiency syndrome (AIDS). The fungal infection is present in half of all AIDS patients and present in 80 percent of patients with lung infections. PCP also occurs in children with AIDS. Clinical findings include fever, coughing, wheezing, reduced blood oxygen and high levels of lactate dehydrogenase, an enzyme released during when certain cells are destroyed. The extent of PCP as it relates to the prognosis of children with AIDS was studied. Out of 18 children, seven died (39 percent) during an acute PCP infection. Although lactate dehydrogenase was higher in children with PCP, it did not distinguish survivors from nonsurvivors. There was also no difference with respect to lung to blood oxygen gradients in the blood. There was difference in the number of lymphocytes (white blood cell) in survivors and nonsurvivors. The number of T4 cells, the specific type of lymphocyte that the AIDS virus destroys, was slightly higher in patients surviving the longest, but there was some overlap between the two groups. A response to the phytohemagglutinin test, a test that measures white blood cell protein, was measured in five out of seven patients who died initially. The response was markedly reduced in nonsurvivors and not in survivors. The patients with higher response to the phytohemagglutinin test died sooner than patients with lower responses. Only one child is alive five years after an illness with PCP. Phytohemagglutinin tests is useful in predicting which children with AIDS-related PCP will survive initial infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Complications and side effects, Prognosis, Pneumocystis carinii pneumonia

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Endocrine function in children with human immunodeficiency virus infection

Article Abstract:

The human immunodeficiency virus (HIV), the cause of AIDS, is thought to be dangerous primarily because of its impairment of the immune system, which allows the development of opportunistic infections and tumors. However, studies have shown that other body systems are affected as well. Few studies have addressed HIV-induced changes in endocrine function in children; it is also not known specifically why these children are often small at birth and grow poorly thereafter. The endocrine status was evaluated of 14 HIV-infected children who were aged 6 months to 10.5 years and who were shorter and had lower than normal growth rates. Although all patients had normal levels of thyroid hormone, five had abnormally high responses of thyrotropin, the pituitary hormone that stimulates thyroid hormone production. This type of response is suggestive of compensated hypothyroidism (adjustment for low thyroid function). These five subjects were shorter and had slower growth rates, although these differences were not significant. Of 12 patients tested, all had normal levels of growth hormone, but eight had low levels of somatomedin C, a protein produced by the liver in response to growth hormone. It is unclear whether this finding is related to altered effects of growth hormone, subtle malnutrition, or effects of chronic illness. Pituitary regulation of cortisol responses appeared normal. The study suggests that subtle changes in thyroid control may contribute to poor growth experienced by HIV-infected children. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, HIV infection in children, Pediatric HIV infections, Thyroid hormones

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Immune complexes in pediatric human immunodeficiency virus infection

Article Abstract:

Human immunodeficiency virus (HIV) infection in adults results in a deficiency of T-cells, a type of immune cell. In children with HIV infection, a deficiency of B-cells, another type of immune cell, may develop before the occurrence of T-cell defects. In the presence of a foreign substance referred to as an antigen, B-cells produce immune proteins called antibodies that act against that specific antigen. HIV infection in adults and children is associated with poor specific antibody responses and increased levels of circulating immune complexes (CIC), which consist of antigen bound to antibody. The structure of CIC in 30 HIV-infected children, aged one to nine years, was assessed. Increased levels of CIC were detected by a test called the C1q assay in 21 of 30 children, and by another test called the Raji cell assay in 28 of 30 children. Fewer than one-third of patients with elevated CIC had antibody against the Epstein-Barr virus (EBV), but 80 percent had antibodies to EBV associated with CIC. The CIC of HIV-infected children were found to have low levels of complement, a series of proteins that are capable of destroying bacteria and other cells. These findings show that CIC of HIV-infected children contain low levels of complement, and the tests that measure CIC based on levels of complement are likely to be inaccurate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, HIV infection, HIV infections, Immune complexes, Complement (Immunology)

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