22 results on '"Cooper ER"'
Search Results
2. Central nervous system disease with JC virus infection in adults with congenital HIV.
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McEntire CRS, Fong KT, Jia DT, Cooper ER, Cervantes-Arslanian AM, Mateen FJ, Anand P, and Thakur KT
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- Adolescent, Adult, DNA, Viral, Female, Humans, Male, Retrospective Studies, Central Nervous System Diseases, HIV Infections complications, JC Virus, Leukoencephalopathy, Progressive Multifocal
- Abstract
Objective: The aim of this study was to describe the natural history of individuals with congenital HIV who develop JC virus (JCV) infection of the central nervous system (CNS)., Methods: We retrospectively evaluated individuals with congenital HIV who met criteria for progressive multifocal leukoencephalopathy (PML) or JCV granule cell neuronopathy (JCV GCN) at three major healthcare centres in the northeast USA. Data on adherence to combined antiretroviral therapy (cART), neurologic symptoms, serum markers of immunity and HIV infection, cerebrospinal fluid (CSF) analyses, radiographic features, modified Rankin Scale (mRS) scores and survival were collected from the electronic medical record up to a censoring date of 1 August 2020., Results: Among 10 adults with congenitally acquired HIV, nine were diagnosed with definitive PML and one was diagnosed with probable JCV GCN. Individuals presented at the time of their PML or JCV GCN diagnosis with a mean mRS of 2.0 (standard deviation 1.0). A premorbid mRS was documented for six patients and was zero in all cases. The most common risk factor was confirmed cART nonadherence in nine individuals. Five individuals with PML and one with JCV GCN died, with a latency from symptom onset to death of approximately 3 months for three individuals, and approximately 2 years for the remaining two., Conclusion: Youth-adulthood transition is a high-risk point for dropping off from medical care. The study of this timepoint in people living with HIV could help inform effective care in these individuals., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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3. Rapid Initiation of Antiretrovirals in Two Newly Diagnosed HIV-infected Infants.
- Author
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Clarke DF, Yildirim I, and Cooper ER
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- Female, HIV Infections immunology, HIV-1 genetics, Humans, Infant, Male, RNA, Viral blood, Time-to-Treatment, Viral Load, Anti-Retroviral Agents administration & dosage, Anti-Retroviral Agents therapeutic use, HIV Infections drug therapy, HIV Infections virology
- Abstract
We report our experience with 2 infants with in utero HIV-1 infection who began very early combination antiretroviral therapy within 4 hours of birth. Further neonatal studies of antiretroviral pharmacokinetics (PKs), safety, efficacy and treatment strategies are critically needed for the development of more potent regimens for use in HIV-infected infants.
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- 2017
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4. Potential confounding of the association between exposure to nucleoside analogues and mitochondrial dysfunction in HIV-uninfected and indeterminate infants.
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Brogly SB, Foca M, Deville JG, Mirochnick M, Scott GB, Mofenson LM, Read JS, Viani RM, Burchett SK, Cooper ER, Browning R, and Shapiro DE
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- Anti-HIV Agents therapeutic use, Clinical Trials as Topic, Dideoxynucleosides therapeutic use, Female, Follow-Up Studies, Humans, Infant, Newborn, Mitochondrial Diseases chemically induced, Mothers, Viral Load, Anti-HIV Agents adverse effects, Dideoxynucleosides adverse effects, HIV, HIV Infections drug therapy, Mitochondrial Diseases epidemiology
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- 2010
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5. Routine offering of HIV testing to hospitalized pediatric patients at university teaching hospital, Lusaka, Zambia: acceptability and feasibility.
- Author
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Kankasa C, Carter RJ, Briggs N, Bulterys M, Chama E, Cooper ER, Costa C, Spielman E, Katepa-Bwalya M, M'soka T, Ou CY, and Abrams EJ
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- Caregivers, Child, Preschool, Counseling, DNA, Viral blood, Female, HIV Antibodies blood, HIV Infections epidemiology, Humans, Infant, Infant, Newborn, Informed Consent, Male, Parents, Polymerase Chain Reaction, Zambia epidemiology, HIV Infections diagnosis
- Abstract
Objectives: The difficulties diagnosing infants and children with HIV infection have been cited as barriers to increasing the number of children receiving antiretroviral therapy worldwide., Design: We implemented routine HIV antibody counseling and testing for pediatric patients hospitalized at the University Teaching Hospital, a national reference center, in Lusaka, Zambia. We also introduced HIV DNA polymerase chain reaction (PCR) testing for early infant diagnosis., Methods: Caregivers/parents of children admitted to the hospital wards were routinely offered HIV counseling and testing for their children. HIV antibody positive (HIV+) children <18 months of age were tested with PCR for HIV DNA., Results: From January 1, 2006, to June 30, 2007, among 15,670 children with unknown HIV status, 13,239 (84.5%) received counseling and 11,571 (87.4%) of those counseled were tested. Overall, 3373 (29.2%) of those tested were seropositive. Seropositivity was associated with younger age: 69.6% of those testing HIV antibody positive were <18 months of age. The proportion of counseled children who were tested increased each quarter from 76.0% in January to March 2006 to 88.2% in April to June 2007 (P < 0.001). From April 2006 to June 2007, 1276 PCR tests were done; 806 (63.2%) were positive. The rate of PCR positivity increased with age from 22% in children <6 weeks of age to 61% at 3-6 months and to 85% at 12-18 months (P < 0.001)., Conclusions: Routine counseling and antibody testing of pediatric inpatients can identify large numbers of HIV-seropositive children in high prevalence settings. The high rate of HIV infection in hospitalized infants and young children also underscores the urgent need for early infant diagnostic capacity in high prevalence settings.
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- 2009
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6. Endocrine abnormalities and impaired growth in human immunodeficiency virus-infected children.
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Chantry CJ, Frederick MM, Meyer WA 3rd, Handelsman E, Rich K, Paul ME, Diaz C, Cooper ER, Foca M, Adeniyi-Jones SK, and Moye J
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- Body Height, Body Weight, Case-Control Studies, Child, Child, Preschool, Dehydroepiandrosterone metabolism, Female, Humans, Insulin-Like Growth Factor Binding Protein 3 metabolism, Male, Thyroid Gland physiopathology, Triiodothyronine metabolism, HIV Infections metabolism, HIV Infections physiopathology
- Abstract
Objectives: Identify endocrine differences between human immunodeficiency virus- (HIV) infected versus uninfected children and evaluate associations of growth and body composition with endocrine measures., Study Design: Nested case-control study in 21 HIV-infected and 46 age- and sex-matched uninfected children in the Women and Infant Transmission Study. Plasma specimens from children between 2.5 to 7.0 years of age, taken during 3-4 visits, were tested for insulin-like growth factor binding protein-3 (IGFBP-3), cortisol, dehydroepiandrosterone (DHEA), growth hormone and thyroid studies. Longitudinal mixed and generalized estimating equation models compared group means and examined effects of endocrine measures on growth and body composition, respectively., Results: HIV-infected children had lower IGFBP-3 than uninfected children (1.96 +/- 0.09 mg/L versus 2.34 +/- 0.06 mg/L, P < 0.001). In infected but not in uninfected children, IGFBP-3 values and DHEA:cortisol ratios were associated with weight- and body mass index-for-age z scores ([WAZ] P = 0.019, <.001 respectively, and [BMZ] P = 0.029, 0.038). DHEA concentration was associated with height-for-age z score (P = 0.049)., Conclusions: In these HIV-infected children compared with their uninfected counterparts, IGFBP-3 concentration was different between groups. Infected children had multiple endocrine associations with growth and body composition not found in their uninfected peers. We hypothesize that in HIV-infected children, growth hormone resistance and shunting of precursors from adrenal androgen to cortisol production contributes to altered body composition and stunting.
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- 2007
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7. HIV type 1 zidovudine (ZDV) resistance in blood and uterine cervical secretions of pregnant women.
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Frenkel LM, McKernan J, Dinh PV, Goldman D, Hitti J, Watts DH, Cooper ER, Dragavon J, and Coombs RW
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- Biomarkers blood, Cervix Mucus virology, Drug Resistance, Viral physiology, Female, Genitalia, Female virology, HIV Infections drug therapy, HIV-1 genetics, Humans, Infectious Disease Transmission, Vertical prevention & control, Plasma virology, Pregnancy, RNA-Directed DNA Polymerase genetics, Anti-HIV Agents pharmacology, Drug Resistance, Viral genetics, HIV Infections prevention & control, HIV-1 drug effects, Pregnancy Complications, Infectious virology, Zidovudine pharmacology
- Abstract
To determine if HIV-1 resistance testing of the blood predicts mutants in the genital secretions of ZDV-treated pregnant women, ZDV resistance mutations were assessed by an oligonucleotide ligation assay. ZDV resistance was detected in viral sequences from blood (16/48; 33%) and cervical secretions (6/24; 25%) collected during 57 pregnancies. The genotype of 11/69 (16%) resistance codons was discordant between blood and cervical virus of pregnant women near term. However, in only 1 (1.8%) of 57 pregnancies evaluated was resistant virus limited to the cervical secretions. ZDV-resistant virus is rarely limited to the female genital tract.
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- 2006
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8. Morbidity and mortality during the first two years of life among uninfected children born to human immunodeficiency virus type 1-infected women: the women and infants transmission study.
- Author
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Paul ME, Chantry CJ, Read JS, Frederick MM, Lu M, Pitt J, Turpin DB, Cooper ER, and Handelsman EL
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- Adult, Child, Preschool, Drug Therapy, Combination, Female, Growth, HIV Infections drug therapy, HIV Infections physiopathology, HIV Infections transmission, Hospitalization, Humans, Incidence, Infant, Infant, Newborn, Infant, Premature, Morbidity trends, Pregnancy, Pregnancy Complications, Infectious virology, Prenatal Exposure Delayed Effects, Substance-Related Disorders complications, Anti-HIV Agents therapeutic use, HIV Infections mortality, Infectious Disease Transmission, Vertical, Pregnancy Complications, Infectious drug therapy, Reverse Transcriptase Inhibitors therapeutic use
- Abstract
Objective: We evaluated morbidity and mortality during the first 2 years of life among children born to human immunodeficiency virus-(HIV) type 1-infected women enrolled in the Women and Infants Transmission Study (WITS) during an 11-year period (1990-2001)., Design and Methods: As part of WITS, evaluations were performed at birth and at 1, 2, 4, 6, 9, 12, 18 and 24 months of age. Growth, hospitalization and the incidence of clinical disease were assessed regularly., Results: Data regarding 1118 children born to HIV-infected women (955 HIV-uninfected children and 163 HIV-infected children) were analyzed. Fewer changes in the caretaker of the child and fewer in utero exposures to drugs, tobacco and alcohol occurred in the latter periods of the study (all P values for time trend analyses <0.01). The percentages of HIV-uninfected children with poor weight gain (44 of 767; 5.7%), short stature (32 of 703; 4.5%) and wasting (27 of 792; 3.4%) were higher than expected for the general population. Two or more changes in caretaker were associated with all growth deficiencies except wasting, and fetal exposure to tobacco was associated with height abnormalities. Anemia was common and was associated with receipt of zidovudine prophylaxis. Morbidity and mortality decreased during the study period. For the uninfected children, a decrease in class A events (Kaplan-Meier rates: group 1, 22.3%; group 2, 6.8%; group 3, 4.2%; P < 0.001) and class C events and death (Kaplan- Meier event rates: group 1, 2.0%; group 2, 1.7%; group 3, 0.2%; P = 0.062) during the first 2 years of life account for the differences in the curves over time., Conclusions: During an 11-year period, morbidity and mortality during the first 24 months of life decreased substantially for children born to HIV-infected women.
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- 2005
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9. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission.
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Cooper ER, Charurat M, Mofenson L, Hanson IC, Pitt J, Diaz C, Hayani K, Handelsman E, Smeriglio V, Hoff R, and Blattner W
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- Adult, CD4 Lymphocyte Count, Cohort Studies, Drug Therapy, Combination, Female, HIV Infections prevention & control, HIV Infections transmission, HIV-1 isolation & purification, HIV-1 physiology, Humans, Infant, Newborn, Pregnancy, Pregnancy Complications, Infectious virology, Prospective Studies, RNA, Viral blood, Risk Factors, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, Infectious Disease Transmission, Vertical prevention & control, Pregnancy Complications, Infectious drug therapy, Reverse Transcriptase Inhibitors therapeutic use
- Abstract
Context: The Women and Infants Transmission Study is a prospective natural history study that has been enrolling HIV-1-infected pregnant women and their infants since 1989., Objective: To evaluate the impact of different antiretroviral regimens on perinatal HIV-1 transmission at the population level., Design: Prospective cohort study. Plasma HIV-1 RNA levels were serially measured in 1542 HIV-1-infected women with singleton live births between January 1990 and June 2000., Main Outcome Measure: HIV-1 status of the infant., Results: HIV-1 transmission was 20.0% (95% confidence interval [CI], 16.1%-23.9%) for 396 women who not receiving prenatal antiretroviral therapy; 10.4% (95% CI, 8.2%-12.6%) for 710 receiving zidovudine monotherapy; 3.8% (95% CI, 1.1%-6.5%) for 186 receiving dual antiretroviral therapy with no or one highly active drug (Multi-ART); and 1.2% (95% CI, 0-2.5%) for 250 receiving highly active antiretroviral therapy (HAART). Transmission also varied by maternal delivery HIV RNA level: 1.0% for <400; 5.3% for 400 to 3499; 9.3% for 3500 to 9999; 14.7% for 10,000 to 29,999; and 23.4% for >30,000 copies/mL (p =.0001 for trend). The odds of transmission increased 2.4-fold (95% CI, 1.7-3.5) for every log10 increase in delivery viral load. In multivariate analyses adjusting for maternal viral load, duration of therapy, and other factors, the odds ratio for transmission for women receiving Multi-ART and HAART compared with those receiving ZDV monotherapy was 0.30 (95% CI, 0.09-1.02) and 0.27 (95% CI, 0.08-0.94), respectively., Conclusion: Levels of HIV-1 RNA at delivery and prenatal antiretroviral therapy were independently associated with transmission. The protective effect of therapy increased with the complexity and duration of the regimen. HAART was associated with the lowest rates of transmission.
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- 2002
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10. Thymic size on chest radiograph and rapid disease progression in human immunodeficiency virus 1-infected children.
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Meyers A, Shah A, Cleveland RH, Cranley WR, Wood B, Sunkle S, Husak S, and Cooper ER
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- Adolescent, Child, Child, Preschool, Disease Progression, HIV Infections diagnostic imaging, HIV Infections pathology, HIV-1 pathogenicity, Humans, Infant, Infectious Disease Transmission, Vertical, Prospective Studies, Radiography, Thoracic, HIV Infections physiopathology, Thymus Gland diagnostic imaging, Thymus Gland pathology
- Abstract
Background: Early infection of the thymus, an organ central to the ontogeny of the immune system, has been proposed as a cause of rapid progression in pediatric HIV disease., Objective: To test the hypothesis that small thymic volume is associated with rapid disease progression in HIV-infected children., Design: Three pediatric radiologists established criteria for rating the size of the thymic profile on chest radiographs. All available baseline chest radiographs were reviewed in a random sequence, with radiologists blinded to study subjects' clinical status. A consensus was reached on whether the thymus was normal or small for age., Setting: A prospective multicenter study of the natural history of HIV-1 infection in children, the Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted Human Immunodeficiency Virus Infection (P2C2) Study., Patients: Fifty-eight HIV-infected children and 38 control children (uninfected but born to HIV-infected women) for whom chest radiographs in the first year of life were available., Main Outcome Measure: Rapid progression of HIV disease, defined as CDC Clinical Category C (severely symptomatic) or Immunologic Category 3 (severe immunosuppression) by 1 year of age., Results: The mean age at the time of chest radiography was 3.5 months. Ten (17%) HIV-infected children had reduced thymic profile size, whereas no controls did (P = 0.006). Of the 58 (59%) HIV-infected children 34 were classified as rapid progressors, and 9 (26%) of them had reduced thymus size, compared with 1 (4%) of the non-rapid progressor children [odds ratio, 8.28; 95% confidence interval (CI), 1.0, 70.5; P = 0.035]. Baseline mean CD4+ count was 1642 (95% CI 1322 to 2009) cells/microl for those with normal thymus and 740 (95% CI 380 to 1275) cells/microl for those with reduced thymus (P = 0.007)., Conclusion: Early thymic involution is associated with rapidly progressive disease in HIV-infected children.
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- 2001
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11. Prophylaxis against possible human immunodeficiency virus exposure after nonoccupational needlestick injuries or sexual assaults in children and adolescents.
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Babl FE, Cooper ER, Kastner B, and Kharasch S
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- Adolescent, Chi-Square Distribution, Child, Child, Preschool, Female, HIV Infections transmission, Humans, Male, Surveys and Questionnaires, Anti-HIV Agents therapeutic use, Child Abuse, Sexual, HIV Infections prevention & control, HIV-1, Needlestick Injuries, Practice Patterns, Physicians'
- Abstract
Background: Nonoccupational human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) for adults has been described, although the Centers for Disease Control and Prevention, Atlanta, Ga, offer no specific recommendations. There is limited information about its use in children and adolescents., Objective: To describe the current practices of physicians in pediatric infectious disease (PID) and pediatric emergency medicine (PEM) departments regarding nonoccupational HIV PEP for children and adolescents., Design: Survey., Participants: Directors of all PID and PEM departments with fellowship programs in the United States and Canada between July and November 1998., Main Outcome Measures: General questions regarding HIV PEP and questions concerning 2 scenarios (5-year-old with a needlestick injury and a 15-year-old after sexual assault)., Results: The return rate was 67 (78%) of 86 for PID and 36 (75%) of 48 for PEM physicians. Fewer than 20% of physicians reported institutional policies for nonoccupational HIV PEP; 33% had ever initiated nonoccupational HIV PEP. In both scenarios, PID physicians were more likely than PEM physicians to recommend or offer HIV PEP in the first 24 hours after the incident (55 [83%] of 66 vs 20 [56%] of 36 for needlestick injuries [odds ratio, 4.0; 95% confidence interval, 1.6-10.1] and 47 [72%] of 65 vs 16 [50%] of 32 for sexual assault [odds ratio, 2.6; 95% confidence interval, 1.1-6.3]). Seven different antiretroviral agents in single, dual, or triple drug regimens administered for 2 to 12 weeks were suggested., Conclusions: Although few physicians reported institutional policies, and only one third had ever initiated HIV PEP, many would offer or recommend HIV PEP for children and adolescents within 24 hours after possible HIV exposure. A wide variation of regimens have been suggested. There is a need for a national consensus for nonoccupational HIV PEP.
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- 2001
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12. Human immunodeficiency virus-related mortality in infants and children: data from the pediatric pulmonary and cardiovascular complications of vertically transmitted HIV (P(2)C(2)) Study.
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Langston C, Cooper ER, Goldfarb J, Easley KA, Husak S, Sunkle S, Starc TJ, and Colin AA
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- AIDS Dementia Complex mortality, AIDS-Related Opportunistic Infections mortality, Age Factors, Child, Child, Preschool, Female, Fetal Death, HIV Infections transmission, HIV Wasting Syndrome mortality, Heart Diseases mortality, Humans, Infant, Infant, Newborn, Infectious Disease Transmission, Vertical, Longitudinal Studies, Lung Diseases mortality, Male, Mortality trends, Cause of Death, HIV Infections mortality
- Abstract
Objectives: To identify the causes of mortality in children with vertically transmitted human immunodeficiency virus (HIV) infection and to study age-related mortality trends., Methods: In the multicenter P(2)C(2) HIV Study, 816 children born to HIV-infected mothers were followed for a median of 3.6 years. Two hundred five study participants with HIV infection were enrolled at a median age of 23 months; 611 were enrolled either prenatally or in the neonatal period before their HIV infection status was known. There were 121 deaths in study patients. The cause of death for all patients, its relationship to HIV infection, and pulmonary or cardiac involvement were determined. Age trends in disease-specific mortality were summarized for the HIV-related deaths., Results: Ninety-three children died of HIV-related conditions. Infection was the most prevalent cause of death for children under 6 years of age with 32.3% caused by pulmonary infection and another 16.9% caused by nonpulmonary infection. The frequency of pulmonary disease as the underlying cause of death decreased significantly with increasing age: 5/9 (55.6%) by age 1, 1/12 (8.3%) after age 10 years. The frequency of chronic cardiac disease as the underlying cause increased with age-0% by age 1 year, 3/12 (25.0%) after age 10 years, as did the frequency of wasting syndrome with disseminated Mycobacterium avium complex-0% by age 1 year, 6/12 (50.0%) after age 10 years., Conclusions: Children with HIV who survive longer are less likely to die of pulmonary disease or infection and more likely to die of cardiac causes or with wasting syndrome.pediatric acquired immunodeficiency syndrome, mortality, human immunodeficiency virus.
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- 2001
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13. Trends in antiretroviral therapy and mother-infant transmission of HIV. The Women and Infants Transmission Study Group.
- Author
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Cooper ER, Charurat M, Burns DN, Blattner W, and Hoff R
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- Drug Therapy, Combination, Female, HIV Infections drug therapy, Humans, Mothers, Pregnancy, Prospective Studies, Anti-HIV Agents therapeutic use, HIV Infections transmission, HIV Protease Inhibitors therapeutic use, HIV-1 genetics, Infectious Disease Transmission, Vertical prevention & control, Pregnancy Complications, Infectious drug therapy, Zidovudine therapeutic use
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Trends in the vertical transmission rate of HIV and evolving antiretroviral usage between 1990 and 1998 within the Women and Infants Transmission Study were evaluated. A decline in mother-infant transmission was temporally associated with advances in therapy, especially when regimens including a protease inhibitor were included in the analysis.
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- 2000
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14. HIV postexposure prophylaxis for children and adolescents.
- Author
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Babl FE, Cooper ER, Damon B, Louie T, Kharasch S, and Harris JA
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- Academic Medical Centers, Adolescent, Adult, Age Factors, Boston, Child, Child, Preschool, Drug Utilization, Female, HIV Infections transmission, Humans, Male, Needlestick Injuries complications, Practice Guidelines as Topic, Rape, Retrospective Studies, Risk Factors, Anti-HIV Agents therapeutic use, Emergency Treatment methods, Emergency Treatment statistics & numerical data, HIV Infections etiology, HIV Infections prevention & control, Practice Patterns, Physicians' statistics & numerical data
- Abstract
HIV postexposure prophylaxis (PEP) is now a well-established part of the management of health care workers after occupational exposures to HIV. Use of PEP for adults exposed to HIV after sexual contact or injection drug use in nonoccupational settings remains controversial with limited data available. There is even less information available concerning HIV PEP for children and adolescents after accidental needlestick injuries or sexual assault. The objective was to describe the current practice of and associated problems with HIV PEP for children and adolescents at an urban academic pediatric emergency department. A retrospective review of all children and adolescents offered HIV PEP between June 1997-June 1998 was conducted. Ten pediatric and adolescent patients were offered HIV PEP, six patients after sexual assault, four patients after needle stick injuries. There were two small children 2 and 3 years of age and eight adolescents. Of these 10 patients, eight were started on HIV PEP. The regimens used for PEP varied; zidovudine, lamivudine, and indinavir were prescribed for in seven patients and zidovudine, lamivudine, and nelfinavir for one other. All 10 patients were HIV negative by serology at baseline testing and all available for follow-up testing (5 of 10) remained HIV negative at 4 to 28 weeks. Only two patients completed the full course of 4 weeks of antiretroviral therapy. Financial concerns, side effects, additional psychiatric and substance abuse issues as well as the degree of parental involvement influenced whether PEP and clinical follow-up was completed. HIV PEP in the nonoccupational setting for children and adolescents presents a medical and management challenge, and requires a coordinated effort at the initial presentation to the health care system and at follow-up. The difficulties encountered in the patients in our series need to be considered before initiating prophylaxis. A provisional management approach to HIV PEP in children and adolescents is proposed.
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- 2000
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15. Vitamin A deficiency and other nutritional indices during pregnancy in human immunodeficiency virus infection: prevalence, clinical correlates, and outcome. Women and Infants Transmission Study Group.
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Burns DN, FitzGerald G, Semba R, Hershow R, Zorrilla C, Pitt J, Hammill H, Cooper ER, Fowler MG, and Landesman S
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- Adult, Cohort Studies, Female, HIV Infections epidemiology, HIV Infections physiopathology, Humans, Nutritional Status, Pregnancy, Prevalence, Vitamin A Deficiency epidemiology, Vitamin A Deficiency physiopathology, HIV Infections complications, HIV-1, Pregnancy Complications epidemiology, Pregnancy Complications physiopathology, Pregnancy Complications, Infectious epidemiology, Pregnancy Complications, Infectious physiopathology, Pregnancy Outcome, Vitamin A Deficiency complications
- Abstract
Vitamin A levels in plasma and other nutritional indices were measured during pregnancy for 449 women enrolled in a multicenter cohort study of mother-to-infant transmission of human immunodeficiency virus type 1 (HIV-1). During the third trimester, 29.6% of the women had low (20 to <30 microg/dL) and 11.1% had very low (<20 microg/dL) vitamin A levels. Vitamin A and body mass index, serum albumin levels, and hemoglobin levels were weakly correlated. After adjustment for other covariates, women with low and very low vitamin A levels before the third trimester were more likely to deliver infants with low birth weight (<2500 g) than were those with higher levels (odds ratio [OR], 4.58; 95% confidence interval [CI], 1.57-13.4; and OR, 6.99; 95% CI, 1.09-45.0, respectively). However, there was no statistically significant association between vitamin A level and mother-to-infant transmission of HIV-1. Anemia and low body mass index before the third trimester were associated with an increased risk of transmission in univariate analyses but not in multivariate analyses.
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- 1999
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16. Unexpected non-HIV causes of death in children born to HIV-infected mothers. Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection Study Group.
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Starc TJ, Langston C, Goldfarb J, Colin AA, Cooper ER, Easley KA, Sunkle S, and Schluchter MD
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- Child, Preschool, Female, Humans, Infant, Infectious Disease Transmission, Vertical, Male, Prospective Studies, Risk Factors, Sudden Infant Death, Wounds and Injuries mortality, Cause of Death, HIV Infections transmission
- Abstract
Introduction: A high incidence of sudden, unexplained deaths in infants born to HIV-infected mothers has been noted in several epidemiologic studies. During the course of a prospective study of heart and lung disease in children born to HIV-infected mothers, we noted that of 5 unexpected non-HIV-related deaths, 4 were attributed to traumatic events., Methods: The Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection (P2C2) study is a multicenter, prospective investigation of the incidence of heart and lung disease in HIV-infected children. A total of 805 children were enrolled and followed for 5 to 7 years with serial immunologic, pulmonary and cardiac function studies. During the study, a multidisciplinary committee was formed to review the cause of death for those patients who died. The committee used results of pulmonary, cardiac, and laboratory tests, hospital summaries, as well as autopsy and coroners' reports. The committee formed a consensus about the underlying and contributing causes of death for each subject using the definitions from the 1989 US Standard Certificate of Death., Results: A total of 121 deaths occurred during the course of the P2C2 study. Of the 121 deaths, 5 were traumatic or sudden and unexpected and judged by the Mortality Review Committee to be unrelated to HIV infection. The median age at the time of death was 1.3 months and ranged from 1.2 to 37.8 months. Two infants died of trauma: a skull fracture and subdural hematoma in 1 infant and multiple skeletal fractures consistent with battered child syndrome in the other infant. The third infant died of accidental suffocation at home at 1.2 months of age. The fourth infant died suddenly and unexpectedly at home at 1.3 months of age. The autopsy showed no sign of HIV or other infection and was consistent with sudden unexpected death or SIDS. One non-HIV-related death occurred when a 38-month-old child died together with the mother in an unwitnessed drowning. The cumulative mortality rate attributable to trauma and sudden death at 4 months of age was 0.95% (95% CI: 0.02-1. 87%) and the infant mortality rate was 9.5/1000 live births. Three children were born prematurely at 30, 33, and 36 weeks' gestational age, respectively, and 3 mothers admitted using recreational drugs before or during pregnancy., Discussion: These traumatic and sudden non-HIV-related deaths accounted for 4.1% (5/121) of the deaths during the entire P2C2 study period and for 20% (4/20) of the deaths in the first year of life. Four deaths were attributable to accidental and nonaccidental trauma rather than to other common causes of infant death. One death was a sudden unexpected death, similar to SIDS, a leading cause of infant death in the United States. The majority of previously reported non-HIV-related deaths in infants born to HIV-infected mothers have been attributed to SIDS or to unexplained sudden death. In contrast with other reports, 4 of the 5 children in our series died of accidental or nonaccidental trauma and only 1 was a sudden unexplained death. It is unlikely that HIV exposure is related directly to the deaths described in this report; however, maternal HIV infection may be a marker for factors that place the child at risk for sudden or traumatic death., Summary: This report suggests that children born to HIV-infected mothers may be at increased risk for traumatic or sudden, unexplained, non-HIV-related death. These children seem to be at risk regardless of their own HIV infection status. Furthermore, 4 of the deaths in our study occurred within the first few months of life, suggesting that this is a period of increased vulnerability. Studies to identify associated risk factors for non-HIV-related deaths are needed to identify these high-risk infants. Children born to HIV-infected mothers may be more vulnerable than was recognized previously and may be in need of increased social services, especially in early infancy.
- Published
- 1999
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17. Disease progression in a cohort of infants with vertically acquired HIV infection observed from birth: the Women and Infants Transmission Study (WITS).
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Diaz C, Hanson C, Cooper ER, Read JS, Watson J, Mendez HA, Pitt J, Rich K, Smeriglio V, and Lew JF
- Subjects
- Cohort Studies, Disease Progression, Female, Follow-Up Studies, HIV Infections mortality, HIV Infections transmission, Humans, Infant, Newborn, Male, Pregnancy, Probability, Prognosis, Proportional Hazards Models, Prospective Studies, Risk Factors, Time Factors, HIV Infections immunology, Infectious Disease Transmission, Vertical
- Abstract
Background: The Women and Infants Transmission Study is an ongoing prospective cohort study of HIV-infected pregnant women and their infants. We used the 1994 U.S. Centers for Disease Control and Prevention (CDC) classification system for HIV infection in children to describe HIV disease progression in 128 HIV-infected children, and examined maternal and infant characteristics associated with disease course., Methods: The Kaplan-Meier method was used to calculate probabilities of entry into CDC clinical classes A, B, and C (mild, moderate, and severe HIV disease); CDC immunologic stages 2 and 3; and death. Relative risks of progression for selected predictor events were estimated using the Cox proportional hazards model., Results: With a median 24 months of follow-up, the median ages at entry into clinical classes A, B and C were 5, 11, and 48 months, respectively. Increased risk of progression to class C was seen in infants who had: onset of class B events (p < .001); progression to immunologic stage 2 (p < .001) or 3 (p < .001); early culture positivity (in first 48 hours, p < .01; in first 7 days, p = .03); and early appearance (within the first 3 months of life) of lymphadenopathy, hepatomegaly, or splenomegaly (p < .001)., Conclusions: Reaching specific clinical or immunologic stages were strong predictors of progression to AIDS or death. Early onset of clinical signs (onset of lymphadenopathy, hepatomegaly, or splenomegaly < or =3 months of age), and early culture positivity (within the first 48 hours or within the first week of life), defined the infant with highest risk of disease progression.
- Published
- 1998
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18. Encephalopathy and progression of human immunodeficiency virus disease in a cohort of children with perinatally acquired human immunodeficiency virus infection. Women and Infants Transmission Study Group.
- Author
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Cooper ER, Hanson C, Diaz C, Mendez H, Abboud R, Nugent R, Pitt J, Rich K, Rodriguez EM, and Smeriglio V
- Subjects
- AIDS Dementia Complex epidemiology, AIDS Dementia Complex immunology, Cohort Studies, Disease Progression, Female, HIV Infections complications, HIV Infections mortality, Humans, Incidence, Infant, Infant, Newborn, Probability, Retrospective Studies, Survival Analysis, AIDS Dementia Complex mortality, HIV Infections transmission, Infectious Disease Transmission, Vertical
- Abstract
Objective: To describe the incidence, predictors, and survival of children with human immunodeficiency virus (HIV) encephalopathy followed in the Women and Infants Transmission Study cohort., Study Design: Retrospective review of clinical and immunologic staging of perinatally HIV-infected infants, based on the 1994 Centers for Disease Control and Prevention Classification System., Results: Data were available for 128 HIV-infected children, with a median follow-up of 24 months. HIV encephalopathy was diagnosed in 27 (21%) of children. Median survival after diagnosis was 14 months. Of children with encephalopathy, 74% had at least moderate immunosuppression by the time of diagnosis. Encephalopathy represented the first acquired immunodeficiency syndrome-defining condition in 67%, and the only one in 26% of children. Hepatosplenomegaly or lymphadenopathy during the first 3 months of life was diagnosed in 63%, in contrast to 29% of those without encephalopathy (p value = 0.001). Cardiomyopathy was present in 30% of the children with encephalopathy versus 2% of those without encephalopathy. High viral load in infancy was associated with increased risk of encephalopathy but was not predictive of age at onset., Conclusions: Encephalopathy in children with HIV is common and is associated with high viral load, immunodeficiency, and shortened survival. Encephalopathy was more likely to develop in infants with early signs and symptoms of HIV, although age at onset could not be predicted.
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- 1998
- Full Text
- View/download PDF
19. After AIDS clinical trial 076: the changing pattern of zidovudine use during pregnancy, and the subsequent reduction in the vertical transmission of human immunodeficiency virus in a cohort of infected women and their infants. Women and Infants Transmission Study Group.
- Author
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Cooper ER, Nugent RP, Diaz C, Pitt J, Hanson C, Kalish LA, Mendez H, Zorrilla C, Hershow R, Moye J, Smeriglio V, and Fowler MG
- Subjects
- Adult, CD4 Lymphocyte Count, CD8-Positive T-Lymphocytes immunology, Cesarean Section, Female, Fetal Membranes, Premature Rupture, Follow-Up Studies, Gestational Age, HIV Infections epidemiology, Humans, Infant, Infant, Newborn, Infectious Disease Transmission, Vertical, Pregnancy, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious virology, Retrospective Studies, Substance-Related Disorders, Time Factors, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, HIV Infections transmission, Zidovudine therapeutic use
- Abstract
To determine the impact of the AIDS Clinical Trials Group (ACTG) Protocol 076 results on the subsequent use of zidovudine during pregnancy and the transmission rate of human immunodeficiency virus (HIV) in a cohort of mother-infant pairs (Women and Infants Transmission Study), a retrospective analysis was done. Transmission rates were calculated by simple proportion for infants with at least 6 months of follow-up, stratified by date of birth (n = 453 born on or before 1 March 1994; n = 103 born after 1 March 1994). Transmission rates decreased from 19% to 8% (P = .005, Fisher's exact test). Zidovudine use increased during pregnancy (22% vs. 89%) and in newborns (1% vs. 79%). Both cohorts were similar with respect to maternal immunosuppression, mode of delivery, and demographics. In summary, in a perinatal HIV observational study, the release of results of ACTG Protocol 076 was associated with an increase in zidovudine use during pregnancy and a concomitant decline in HIV transmission from mothers to infants.
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- 1996
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20. Natural history of somatic growth in infants born to women infected by human immunodeficiency virus. Women and Infants Transmission Study Group.
- Author
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Moye J Jr, Rich KC, Kalish LA, Sheon AR, Diaz C, Cooper ER, Pitt J, and Handelsman E
- Subjects
- Body Height physiology, Body Weight physiology, Female, HIV Infections congenital, HIV Infections drug therapy, HIV Infections transmission, Head growth & development, Humans, Infant, Infant, Newborn, Infectious Disease Transmission, Vertical, Male, Multivariate Analysis, Pregnancy, Prospective Studies, Zidovudine therapeutic use, Growth physiology, HIV Infections physiopathology, Pregnancy Complications, Infectious
- Abstract
Objective: To evaluate the nature and magnitude of the effect of congenitally or perinatally acquired human immunodeficiency virus (HIV) infection on somatic growth from birth through 18 months of age., Study Design: Anthropometry was performed serially in 282 term infants born to HIV-infected women in a multicenter prospective natural history cohort study. Repeated measures analysis was used to compare z-score anthropometric indexes of weight-for-age, length-for-age, weight-for-length, and head circumference-for-age between infected and uninfected infants, with adjustment for covariates including infant gender; maternal education; prenatal alcohol, tobacco, and/or illicit drug exposure; and mean prenatal CD4+ T-lymphocyte count. A separate repeated measures model was used to assess the effect of infant zidovudine treatment on growth., Results: Infants infected with HIV were an estimated average 0.28 kg lighter and 1.64 cm shorter than uninfected infants at birth, were 0.71 kg lighter and 2.25 cm shorter by 18 months of age, and had a sustained estimated average decrement of 0.70 to 0.75 cm in head circumference. Patterns of growth were similar in male and female infants. Infected infants had a progressive decrement in body mass index from birth through 6 months of age. Infection with HIV was associated with significant decrements across all standardized growth outcome measures after adjustment for covariates. Mean z scores were lower for weight by 0.612 (p < 0.001), for length by 0.735 (p < 0.001), for weight-for-length by 0.255 (p = 0.02), and for head circumference by 0.563 (p < 0.001) SD units compared with uninfected infants. Zidovudine treatment was not associated with improved growth., Conclusion: The effect of congenitally or perinatally acquired HIV infection on infant growth is one of early and progressive decrements in attained linear growth and growth in mass, early and sustained decrements in head growth, and marked early decrements in body mass index.
- Published
- 1996
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21. Seroreversion in human immunodeficiency virus-exposed but uninfected infants.
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Chantry CJ, Cooper ER, Pelton SI, Zorilla C, Hillyer GV, and Diaz C
- Subjects
- Blotting, Western, Catchment Area, Health, Cohort Studies, Enzyme-Linked Immunosorbent Assay, Female, HIV Infections diagnosis, HIV Infections transmission, HIV Seropositivity immunology, Humans, Infant, Newborn, Pregnancy, Prospective Studies, AIDS Serodiagnosis, HIV Infections immunology, HIV Seronegativity, Infectious Disease Transmission, Vertical, Pregnancy Complications, Infectious immunology
- Abstract
The goal of this study was to describe seroreversion (SR) in a cohort of human immunodeficiency virus-exposed but uninfected infants. Groups of patients who seroreverted very early or late were examined for salient clinical and immunologic characteristics of the mother or infant. The mean time (+/- s.d.) to seroreversion by enzyme-linked immunoabsorbent assay (ELISA) was 50.1 +/- 14.8 weeks, or 11.6 months (n = 84); the range of times to antibody loss by ELISA was 17.9 to 82.0 weeks. The mean time to seroreversion by Western blot was 68.3 +/- 12.6 weeks, or 15.8 months (n = 51), with a range of 44.9 to 94.1 weeks. Initial anti-human immunodeficiency virus titer as measured by cord blood ELISA optical density (OD) was found to relate significantly to mean time to seroreversion. No relationship to time to seroreversion was demonstrated for gestational age, maternal or neonatal serum immunoglobulin concentrations, maternal CD4 cell counts, maternal alcohol consumption, infantile diarrhea or failure to thrive. The lengthy time to seroreversion seen here demonstrates the 1994 revised Centers for Disease Control and Prevention definition of human immunodeficiency virus infection (based on seropositivity by both ELISA and confirmatory tests persisting beyond 18 months of age) to be accurate in our population. We recommend Western blot testing be used as confirmation for positive ELISAs only after 18 months of age.
- Published
- 1995
- Full Text
- View/download PDF
22. Antibody response to measles and rubella vaccine by children with HIV infection.
- Author
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Breña AE, Cooper ER, Cabral HJ, and Pelton SI
- Subjects
- Child, Preschool, Cohort Studies, Drug Combinations, Enzyme-Linked Immunosorbent Assay, Humans, Immunoglobulin G biosynthesis, Infant, Measles Vaccine administration & dosage, Measles-Mumps-Rubella Vaccine, Mumps Vaccine administration & dosage, Regression Analysis, Retrospective Studies, Rubella Vaccine administration & dosage, Time Factors, Vaccination, Antibodies, Viral biosynthesis, HIV Infections immunology, Measles Vaccine immunology, Rubella Vaccine immunology
- Abstract
To determine the immunogenicity of the measles and rubella components of the measles, mumps, and rubella virus (MMR) vaccine in human immunodeficiency virus (HIV)-infected children, we compared their response to that of uninfected controls. Sera were collected from HIV-infected patients and HIV seroreverters followed in our clinic and tested as close to 2 months post-MMR vaccination as possible. Specific IgG to both rubella and measles were measured by enzyme-linked immunosorbent assay. Of 20 children with HIV, 11 responded with adequate levels of antibody to measles. In the seroreverters, 12 of 13 responded. Of the measles responders, the median antibody level was significantly lower in the HIV-infected group than in the seroreverter group. In addition, HIV-infected responders tested at 9-15 months after vaccination demonstrated a significant decline in measles antibody levels. Although there was not a difference between the two cohorts in the proportion of patients who responded to the rubella component of the vaccine, there was a significant difference in the median antibody level of the responders of the two groups. We did not find a statistical difference in CD4 counts between responders and nonresponders. Alternate strategies will need to be established to prevent measles in HIV-infected children.
- Published
- 1993
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