The Experts below are selected from a list of 111 Experts worldwide ranked by ideXlab platform
Donald P. Kotler - One of the best experts on this subject based on the ideXlab platform.
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Lipodystrophy in HIV-infected children is associated with high viral load and low CD4+ -Lymphocyte count and CD4+ -Lymphocyte Percentage at baseline and use of protease inhibitors and stavudine.
Journal of acquired immune deficiency syndromes (1999), 2001Co-Authors: Stephen M. Arpadi, Patricia A. Cuff, Mary Horlick, Jack Wang, Donald P. KotlerAbstract:Alterations in regional fat, often associated with abnormalities in lipid and insulin metabolism, have been reported in HIV-infected adults. To determine whether similar abnormalities occur in children with HIV, patterns of change in regional body fat distribution were determined by dual energy x-ray absorptiometry in 28 prepubertal HIV-infected children. Eight (29%) children experienced lipodystrophy (LD), defined as extremity lipoatrophy together with trunk fat accumulation. Despite a mean body weight increase of 2.9 +/- 2.4 kg, children with LD experienced a mean loss of total fat in contrast to children without LD who increased total fat (-0.151 +/- 0.324 versus 0.981 +/- 1.041 kg; p
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lipodystrophy in hiv infected children is associated with high viral load and low CD4 Lymphocyte count and CD4 Lymphocyte Percentage at baseline and use of protease inhibitors and stavudine
Journal of Acquired Immune Deficiency Syndromes, 2001Co-Authors: Stephen M. Arpadi, Patricia A. Cuff, Mary Horlick, Jack Wang, Donald P. KotlerAbstract:Alterations in regional fat, often associated with abnormalities in lipid and insulin metabolism, have been reported in HIV-infected adults. To determine whether similar abnormalities occur in children with HIV, patterns of change in regional body fat distribution were determined by dual energy x-ray absorptiometry in 28 prepubertal HIV-infected children. Eight (29%) children experienced lipodystrophy (LD), defined as extremity lipoatrophy together with trunk fat accumulation. Despite a mean body weight increase of 2.9 +/- 2.4 kg, children with LD experienced a mean loss of total fat in contrast to children without LD who increased total fat (-0.151 +/- 0.324 versus 0.981 +/- 1.041 kg; p <.01). Children with LD had significantly higher levels of HIV RNA and lower CD4 count and Percentage at baseline. LD was associated with use of protease inhibitors or stavudine, (odds ratio [OR], 7.0, 95% confidence interval [CI], 1.1-45.2, p =.04; OR, 9.0, 95% CI, 1.4-59.8, p =.03, respectively). This observational study suggests that during a time in childhood when accumulation of extremity and trunk fat is expected, some HIV-infected children experience changes in fat distribution that are similar to HIV-associated LD reported in adults. Studies to determine whether HIV-infected children with changes in regional fat also experience increases in "atherogenic" lipids and insulin resistance as described in adults with HIV-associated LD are warranted.
Kenneth D. Gadow - One of the best experts on this subject based on the ideXlab platform.
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Substance Use and its Association with Psychiatric Symptoms in Perinatally HIV-infected and HIV-Affected Adolescents
AIDS and Behavior, 2010Co-Authors: Paige L. Williams, Erin Leister, Miriam Chernoff, Sharon Nachman, Edward Morse, Vinnie Poalo, Kenneth D. GadowAbstract:Drug use in combination with psychiatric illness may lead to unsafe sexual risk behavior and increased risk for secondary HIV transmission among adolescents with HIV infection. We compared the prevalence of substance use for perinatally HIV-infected youth to uninfected adolescents living in families affected by HIV infection, and evaluated the association of psychiatric symptoms with risk of substance use. Among 299 adolescents (196 HIV+, 103 HIV−) aged 12–18 years enrolled in IMPAACT P1055, a multisite US cohort study, 14% reported substance use at enrollment (HIV+: 13%, HIV−: 16%). In adjusted logistic regression models, adolescents had significantly higher odds of substance use if they met symptom criteria for ADHD [adjusted odds ratio (aOR) = 2.7, Wald χ^2 = 5.18, P = 0.02], major depression or dysthymia (aOR = 4.0, Wald χ^2 = 7.36, P = 0.01), oppositional defiant disorder (aOR = 4.8, Wald χ^2 = 12.7, P = 0.001), or conduct disorder (aOR = 15.4, Wald χ^2 = 28.12, P = 0.001). Among HIV-infected youth, those with lower CD4 Lymphocyte Percentage (CD4%
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Substance Use and its Association with Psychiatric Symptoms in Perinatally HIV-infected and HIV-Affected Adolescents
AIDS and behavior, 2010Co-Authors: Paige L. Williams, Erin Leister, Miriam Chernoff, Sharon Nachman, Edward Morse, Vinnie Poalo, Kenneth D. GadowAbstract:Drug use in combination with psychiatric illness may lead to unsafe sexual risk behavior and increased risk for secondary HIV transmission among adolescents with HIV infection. We compared the prevalence of substance use for perinatally HIV-infected youth to uninfected adolescents living in families affected by HIV infection, and evaluated the association of psychiatric symptoms with risk of substance use. Among 299 adolescents (196 HIV+, 103 HIV−) aged 12–18 years enrolled in IMPAACT P1055, a multisite US cohort study, 14% reported substance use at enrollment (HIV+: 13%, HIV−: 16%). In adjusted logistic regression models, adolescents had significantly higher odds of substance use if they met symptom criteria for ADHD [adjusted odds ratio (aOR) = 2.7, Wald χ2 = 5.18, P = 0.02], major depression or dysthymia (aOR = 4.0, Wald χ2 = 7.36, P = 0.01), oppositional defiant disorder (aOR = 4.8, Wald χ2 = 12.7, P = 0.001), or conduct disorder (aOR = 15.4, Wald χ2 = 28.12, P = 0.001). Among HIV-infected youth, those with lower CD4 Lymphocyte Percentage (CD4% < 25%) had significantly increased risk of substance use (aOR = 2.7, Wald χ2 = 4.79, P = 0.03). However, there was no overall association of substance use with HIV infection status, and the association between psychiatric symptoms and substance use did not differ by HIV status. Programs to prevent substance use should target both HIV-infected and uninfected adolescents living in families affected by HIV infection, particularly those with psychiatric symptoms.
Ross E Mckinney - One of the best experts on this subject based on the ideXlab platform.
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evaluation of surrogate markers and clinical outcomes in two year follow up of eighty six human immunodeficiency virus infected pediatric patients
Pediatric Infectious Disease Journal, 1998Co-Authors: Megan E Valentine, Cynthia R Jackson, Cindy Vavro, Catherine M Wilfert, Daniel Mcclernon, Marty St Clair, Samuel L Katz, Ross E MckinneyAbstract:OBJECTIVES: To evaluate the prognostic value of surrogate markers (HIV RNA copy number, CD4 counts and CDC clinical and immunologic categories) in HIV-infected children through a 2-year period. METHODS: Eighty-six HIV-infected children followed by the Duke Pediatric HIV Clinic in the fall of 1994 were evaluated for plasma HIV RNA concentration (viral load), CD4 Lymphocyte Percentage, age, antiretroviral treatment status and CDC clinical and immunologic categories. Follow-up evaluations were performed for approximately 2 years, and the time to progression to a new CDC category C diagnosis or death was noted. RESULTS: Of 86 children 22 had progression to new Category C diagnosis or death. Seven children died, 17 had a new Category C diagnosis and 2 had both. Among children who progressed, the median CD4 Percentage at entry was 3% (absolute count, 75 cells/mm3), whereas children who had no disease progression entered with a median of 29% (868 cells/mm3). The overall median viral load at study entry was 4.58 log10 copies/ml (38,019 copies/ml, with a range of 1.7 to 6.78 logs). Children who had no disease progression had a median log copy number of 4.43, whereas 5.18 was the median for children whose disease progressed. Log copy number declined over time in children 5.08 log RNA copy/ml ( 120,226 copies/ml, respectively)]. Progression rates by quartile were 0 of 21, 4 of 22, 5 of 21 and 13 of 22. Kaplan-Meier survival curves defined by CD4% less than or greater than 15 and log RNA less than or greater than 5.0 (100,000) revealed that patients with CD4% less than 15 and plasma HIV RNA concentration > 5 log10 copies/ml did least well: 11 of 12 (92%) had a progression event at a median of 179 days. Patients with a high CD4 Percentage and high viral load, or a low CD4 Percentage and low viral load did similarly; 5 of 14 (36%) and 4 of 12 (33%) had progression events, respectively. Patients with high CD4 Percentage and low viral load did best: only 2 of 48 (4%) had a progression event. CONCLUSIONS: The two most significant prognostic indicators of disease progression were the initial CD4 Percentage and the plasma HIV RNA concentration, and a combination of CD4 Percentage and virus load best predicted which children had progression events. Progression was less common in children who had < 100,000 HIV RNA copies/ml initially (6 of 60 vs. 16 of 26; P < 0.001; relative risk 0.16). Therefore it seems reasonable that in a child for whom complete suppression is not possible, a threshold of 100,000 (5 log10 copies/ml) can be used to mandate a change in therapy.
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Growth as a prognostic indicator in children with human immunodeficiency virus infection treated with zidovudine
The Journal of pediatrics, 1994Co-Authors: Ross E Mckinney, Catherine M WilfertAbstract:Objective: To assess measures of growth as prognostic indicators in response to zidovudine treatment in children with symptomatic human immunodeficiency virus infection. Methods: We retrospectively assessed data from AIDS Clinical Trials Group Protocol 043, an open-label, phase II study of oral zidovudine therapy (180 mg/m 2 per dose every 6 hours) in children with human immunodeficiency virus who have severe symptoms. Several variables were evaluated for their prognostic significance: CD4+ Lymphocyte Percentage; rates of weight gain and linear growth; entry weight, height, and weight-for-height z scores for age; race; gender; age; and route of transmission. Results: The overall survival rate as of April 1, 1992 (4 years after study initiation), was 44%, with a median survival of 37.9 months. The risk of death was greatest in children with CD4+ Lymphocyte Percentages
Stephen M. Arpadi - One of the best experts on this subject based on the ideXlab platform.
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Lipodystrophy in HIV-infected children is associated with high viral load and low CD4+ -Lymphocyte count and CD4+ -Lymphocyte Percentage at baseline and use of protease inhibitors and stavudine.
Journal of acquired immune deficiency syndromes (1999), 2001Co-Authors: Stephen M. Arpadi, Patricia A. Cuff, Mary Horlick, Jack Wang, Donald P. KotlerAbstract:Alterations in regional fat, often associated with abnormalities in lipid and insulin metabolism, have been reported in HIV-infected adults. To determine whether similar abnormalities occur in children with HIV, patterns of change in regional body fat distribution were determined by dual energy x-ray absorptiometry in 28 prepubertal HIV-infected children. Eight (29%) children experienced lipodystrophy (LD), defined as extremity lipoatrophy together with trunk fat accumulation. Despite a mean body weight increase of 2.9 +/- 2.4 kg, children with LD experienced a mean loss of total fat in contrast to children without LD who increased total fat (-0.151 +/- 0.324 versus 0.981 +/- 1.041 kg; p
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lipodystrophy in hiv infected children is associated with high viral load and low CD4 Lymphocyte count and CD4 Lymphocyte Percentage at baseline and use of protease inhibitors and stavudine
Journal of Acquired Immune Deficiency Syndromes, 2001Co-Authors: Stephen M. Arpadi, Patricia A. Cuff, Mary Horlick, Jack Wang, Donald P. KotlerAbstract:Alterations in regional fat, often associated with abnormalities in lipid and insulin metabolism, have been reported in HIV-infected adults. To determine whether similar abnormalities occur in children with HIV, patterns of change in regional body fat distribution were determined by dual energy x-ray absorptiometry in 28 prepubertal HIV-infected children. Eight (29%) children experienced lipodystrophy (LD), defined as extremity lipoatrophy together with trunk fat accumulation. Despite a mean body weight increase of 2.9 +/- 2.4 kg, children with LD experienced a mean loss of total fat in contrast to children without LD who increased total fat (-0.151 +/- 0.324 versus 0.981 +/- 1.041 kg; p <.01). Children with LD had significantly higher levels of HIV RNA and lower CD4 count and Percentage at baseline. LD was associated with use of protease inhibitors or stavudine, (odds ratio [OR], 7.0, 95% confidence interval [CI], 1.1-45.2, p =.04; OR, 9.0, 95% CI, 1.4-59.8, p =.03, respectively). This observational study suggests that during a time in childhood when accumulation of extremity and trunk fat is expected, some HIV-infected children experience changes in fat distribution that are similar to HIV-associated LD reported in adults. Studies to determine whether HIV-infected children with changes in regional fat also experience increases in "atherogenic" lipids and insulin resistance as described in adults with HIV-associated LD are warranted.
Lynne M. Mofenson - One of the best experts on this subject based on the ideXlab platform.
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Immune parameters and morbidity in hard drug and human immunodeficiency virus-exposed but uninfected infants.
Pediatrics, 2004Co-Authors: Natalie Neu, Lynne M. Mofenson, Robert Leighty, Samuel Adeniyi-jones, Clemente Diaz, Edward Handelsman, Gary E. Kaufman, Mary E. Paul, Kenneth C. Rich, Jane PittAbstract:Objective. To examine the association of maternal hard drug use (injection drugs, cocaine, and opiates) on Lymphocyte subsets and clinical morbidity in uninfected infants who are born to human immunodeficiency virus-infected mothers who were enrolled in the Women and Infants Transmission Study (1990–2000). Methods. Maternal hard drug use was identified by self-report and/or urine toxicology. Infant evaluations occurred at birth and at 1, 2, 4, 6, 9, 12, 18, and 24 months of age. Results. A total of 401 (28%) of the 1436 uninfected infants were born to drug-using mothers. Maternal CD4 Lymphocyte Percentage and RNA at delivery were not significantly different between drug users and nonusers. Infants who were born to drug-using mothers had lower mean gestational age (37.8 vs 38.5 weeks) and birth weight (2.9 vs 3.1 kg). Infants with intrauterine drug exposure had lower CD4 Lymphocyte Percentage over the first 4 months of life after adjusting for covariates and higher natural killer Lymphocyte Percentage. When the analysis was stratified by time period of entry, the incidence of clinical events was not different between infants who were born to drug users versus nonusers. Conclusion. Maternal hard drug use is associated with immunologic changes in infants early in life, although these changes did not seem to be associated with increased risk of infections.
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Progression of HIV disease among women following delivery.
Journal of acquired immune deficiency syndromes (1999), 2003Co-Authors: D. Heather Watts, John S. Lambert, E. Richard Stiehm, D. Robert Harris, James Bethel, Lynne M. Mofenson, William A. Meyer, Bonnie J. Mathieson, Mary Glenn Fowler, George J. NemoAbstract:Objective: To assess patterns of HIV disease progression among HIV-1-infected women following delivery. Methods: Four hundred ninety-seven women enrolled in PACTG 185, a phase 3 trial of passive immunoprophylaxis in addition to zidovudine (ZDV) for the prevention of perinatal transmission, were included. Visits occurred twice during pregnancy; at delivery; and at 12, 26, 48, and 78 weeks postpartum. Repeated-measures linear regression and proportional hazards models were applied. Results: Trial treatment (HIV hyperimmune globulin vs. immune globulin) was not related to postpartum disease progression. Longitudinal analysis of HIV-1 RNA demonstrated stable levels during pregnancy, significantly increased HIV-1 RNA by 12 weeks postpartum even on stable therapy, and a gradual increase thereafter. Changes in CD4 + Lymphocyte Percentage over 18 months of follow-up were similar for women continuing or stopping ZDV postpartum. Compared with those receiving no therapy, the hazard ratio for AIDS or death among women who received monotherapy postpartum was 0.52 (95% confidence interval [CI]: 0.25-1.04), 0.17 (Cl: 0.06-0.49) for women who received combination therapy, and 0.24 (CI: 0.06-1.01) for women who received highly active antiretroviral therapy. Conclusions: RNA levels increased significantly from delivery to 12 weeks postpartum. Changes in HIV-1 RNA and CD4 + Lymphocyte Percentage were similar among women continuing or stopping therapy after delivery, and response to antiretroviral therapy was as expected postpartum.
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serum hiv 1 p24 antibody hiv 1 rna copy number and CD4 Lymphocyte Percentage are independently associated with risk of mortality in hiv 1 infected children
AIDS, 1999Co-Authors: Lynne M. Mofenson, James Bethel, Kenneth C. Rich, D R Harris, Jennifer S Read, J Moye, Robert P Nugent, James Korelitz, Savita PahwaAbstract:Objective: The role of HIV-1 antibody in modulating disease progression must be assessed in the context of other immune and viral load markers. We evaluated the association between HIV-1 p24 antibody, HIV-1 RNA, immune complex-dissociated (ICD) p24 antigen, CD4 cell Percentage, and mortality in a cohort of 218 HIV-infected children enrolled in a trial of intravenous immunoglobulin prophylaxis of bacterial infections. Methods: CD4 cell Percentage was measured and sera collected and stored at baseline and every 3 months on study (1988-1991). Stored sera were assayed for HIV-1 p24 antibody, HIV-1 RNA, and ICD p24 antigen. Mortality was recorded during the trial and updated through 1996 (mean total follow-up, 6.3 years). Results: Eighty-one (37%) children died; probability of mortality for children with baseline HIV-1 p24 antibody concentrations of undetectable ( 125 reciprocal titer units (RTU) was 61, 50, 24, and 10%, respectively. A 3.5-fold increase in the relative risk (RR) of death [95% confidence interval (Cl), 2.2-5.5] was observed among children with baseline HIV-1 p24 antibody concentration < 5 RTU compared with ≥5 RTU. In multivariate analyses, p24 antibody, HIV-1 RNA, and CD4 cell Percentage but not ICD p24 antigen were independently associated with mortality; the RR of death increased by 1.7 (95% Cl, 1.3-2.1) for each log 10 decrement in baseline HIV-1 p24 antibody. Conclusions: HIV-1 p24 antibody, HIV-1 RNA and CD4 cell Percentage independently predict mortality amongst infected children. Whereas CD4 cell Percentage provides an estimate of the general degree of immune suppression, HIV-1 p24 antibody could provide an easily obtained, inexpensive assessment of CD4 cell function and could augment prognostic information provided by CD4 cell count and viral load for clinical management of infected children.
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Association of maternal drug use during pregnancy with maternal HIV culture positivity and perinatal HIV transmission.
AIDS (London England), 1996Co-Authors: Evelyn M. Rodriguez, Lynne M. Mofenson, Mary Glenn Fowler, Clemente Diaz, Kenneth C. Rich, Sheldon Landesman, Bei-hung Chang, Vincent L. Smeriglio, Harold E. Fox, Karen GreenAbstract:Objective : To evaluate the relationship of drug use with maternal HIV culture positivity at delivery and perinatal HIV transmission. Design : Multicenter prospective cohort study. Setting : Obstetric and pediatric clinics in five cities in the United States. Participants : Five hundred and thirty HIV-infected pregnant women and their infants. Main outcome measures : Multivariate logistic regression was used to evaluate the association of 'hard drug' use (one or more of the following : cocaine, heroin/opiates, methadone, injecting drug use) assessed by self-report and urine toxicology with positive maternal HIV culture at delivery and perinatal HIV transmission. Results : Forty-two per cent of women used hard drugs during pregnancy. Increased probability of a positive maternal delivery HIV culture was significantly associated with prenatal hard drug use [odds ratio (OR), 3.08] and maternal cocaine use (OR, 2.98) among HIV-infected women with > 29% CD4+ Lymphocytes. After adjusting for maternal culture positivity at delivery, CD4+ Lymphocyte Percentage and gestational age, significantly greater transmission risk was observed with hard drug use among women with membrane rupture > 4 h. Conclusions : On the basis of self-report and urine toxicology, overall maternal hard drug use and cocaine use in the WITS cohort were associated with maternal HIV culture positivity at delivery, and maternal hard drug use was associated with perinatal transmission.