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Objective. To examine beneficial or detrimental effects of protease inhibitor (PI)-containing antiretroviral regimens on height and weight growth in children with human immunodeficiency virus (HIV) infection. Methods. A prospective cohort study was conducted of 906 HIV-infected children, from pediatric research clinics in the United States, who were between 3 months and 18 years of age and who had height and weight assessed in 1995 (before introduction of PIs in this population) and at least once more through 1999. Changes in age- and gender-adjusted height and weight growth associated with PI use were assessed. Results. Compared with a healthy reference population, children were more affected in height (mean z score: -0.90 [18th percentile]) than in weight (mean z score: -0.42 [34th percentile]) at baseline (1995). Two thirds of children received at least 1 PI during 1996 to 1999. In the multivariate mixed effects regression models adjusted for baseline [log.sub.10] CD4 cell count, baseline age, gender, and race/ethnicity, the use of PIs was associated with per-year gains of 0.13 z scores in height and 0.05 z scores in weight relative to the expected growth with non-PI-containing regimens (eg, after 1 year of PI use, a representative 6-year-old boy in our study would be approximately 0.7 cm taller and 0.1 kg heavier than if he had not received PIs). No significant differential effects of PIs on height or weight growth according to specific agents or children's sociodemographic or clinical characteristics were found. Conclusions. Although the use of PI-containing regimens was not associated with growth retardation, it was associated with only small annual increments in height and weight growth in HIV-infected children. Pediatrics 2001;107(4). URL: http://www.pediatrics.org/cgi/content/ full/107/4/e72; HIV-1, protease inhibitor, growth, children.

This study investigated why some homosexual and bisexual men who are infected with the human immunodeficiency virus (HIV, which causes AIDS) infect their partners while others do not. Laboratory tests were performed to determine whether seropositive (a positive blood test for HIV) men who transmitted the virus differed from seropositive men who did not transmit it. If both partners in a pair were seropositive, the researchers attempted to determine which partner was more likely to have transmitted the virus to the other, based on history of high-risk sexual contacts and fidelity. Researchers also studied pairs which included one man who tested positive and one who tested negative for HIV; these were cases in which the virus had not been transmitted despite exposure on at least six occasions. Seven probable transmitters of HIV and 11 nontransmitters, all of whom were seropositive, were compared on blood immunity tests. Transmitters had increased suppressor T cells. This may indicate that transmitters were recently infected with HIV, because suppressor T-cells reportedly increase during the initial phase of acute HIV infection. Alternately, transmitters may have had another infection at the same time, which could raise suppressor cells and possibly allow HIV to reproduce at a faster rate. This research supports the theory that HIV-positive individuals who do not have symptoms of infection can transmit the virus and not all transmitters have advanced HIV infection. Other blood parameters did not differ between transmitters and nontransmitters. In the larger group of 155 partner-pairs, sexual behavior was assessed in terms of risk for transmission. High-risk behaviors were identified as receptive anal intercourse, receptive fisting, nitrite use, history of syphilis or gonorrhea, and sexual contact with men from areas with a high incidence of AIDS. Some of these behaviors involve rectal trauma for the receptive partner, which may allow the virus to enter the body more easily.

Objective. Osteonecrosis of the hip has been reported in human immunodeficiency virus (HIV)-infected adults; whether this is related to HIV infection or its treatment is unknown. There has been 1 report of osteonecrosis among HIV-infected children. Specifically, avascular necrosis of the hip consistent with Legg-Calve-Perthes disease (LCPD) was reported in 3 HIV-infected children with AIDS from Spain in 1992. We evaluated the prevalence and incidence of LCPD, the pediatric equivalent of adult osteonecrosis of the hip, in HIV-infected children participating in a prospective cohort study of long-term outcomes in HIV-infected and HIV-exposed children--Pediatric AIDS Clinical Trials Group (PACTG) protocol 219. Methods. PACTG 219 enrolled 2014 HIV-infected and 849 HIV-exposed, uninfected children between April 1993 and September 2000. Children had periodic examinations with collection of clinical and laboratory data. The database was reviewed for reports of LCPD and other bone disorders. A prevalent case was defined as LCPD diagnosis preceding PACTG 219 enrollment and an incident case had to have occurred between enrollment and September 2000. A case-control study (matching on age, gender, and race/ethnicity, which are known to be associated with risk of LCPD and HIV infection status) was performed to investigate factors possibly associated with LCPD. Results. Six cases of LCPD (4 prevalent cases reported at study entry; 2 diagnosed during 5837 person-years of follow-up) were observed; LCPD was seen only in children with perinatal HIV infection. LCPD prevalence was 199 per 100 000 compared with an estimated general pediatric population prevalence of 23 per 100 000. Based on age-adjusted general population rates, the expected number of prevalent cases at PACTG 219 study entry would have been 0.44; the age-adjusted LCPD prevalence rate ratio was 9.0 (95% confidence interval [CI]: 8.3-9.7) for HIV-infected children compared with the general population. LCPD incidence was 34 per 100 000 person-years (95% CI: 0.42-124) compared with the estimated general population incidence of 6 per 100 000 person-years (95% CI: 5-7). Based on age-adjusted general population rates, the expected incidence of LCPD in PACTG 219 would have been 0.42; the age-adjusted relative risk of LCPD in HIV-infected PACTG 219 children was 4.8 (95% CI: 0.56-10.4). No cases were observed in uninfected children during 1919 person-years of follow-up on PACTG 219; the age-adjusted expected number of cases was 0.09. Median onset age was 7 years; 67% were of Hispanic or black race/ethnicity and 33% were female. Four of the 6 LCPD cases had received antiretroviral therapy before diagnosis; treatment was primarily with nucleoside reverse transcriptase inhibitors, and 2 had received protease inhibitors. Three of the LCPD cases had corticosteroid exposure before the diagnosis, but only 1 child had systemic exposure and the remaining 2 had topical exposure exclusively. In the case-control study, antiretroviral and corticosteroid therapy, CD4 cell percentage, birth weight, height for age and gender percentile, and triglyceride levels were not significantly associated with LCPD. However, the case-control study had limited power to evaluate possible associations. Conclusion. Similar to HIV-infected adults, children with perinatal HIV infection have an increased risk for osteonecrosis of the hip, and clinicians should be alert to this diagnosis when HIV-infected children present with limp or hip pain. Whether LCPD is attributable to HIV infection itself, HIV-associated complications that could predispose to hypercoagulopathy, HIV-related therapies, or to the growth abnormalities in HIV-infected children is unknown and deserves additional evaluation. Pediatrics 2002;109(5). URL: http://www.pediatrics.org/ cgi/content/full/109/5/e74; osteonecrosis, Legg-Calve-Perthes disease, perinatal human immunodeficiency virus infection.