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Although varicella vaccine is given to clinically stable human immunodeficiency virus (HIV)-infected children, its effectiveness is unknown. We assessed its effectiveness by reviewing the medical records of closely monitored HIV-infected children, including those receiving highly active antiretroviral therapy (HAART) between 1989 and 2007. Varicella immunization and development of varicella or herpes zoster were noted. Effectiveness was calculated by subtracting from 1 the rate ratios for the incidence rates of varicella or herpes zoster in vaccinated versus unvaccinated children. The effectiveness of the vaccine was 82% (95% confidence interval [CI], 24%-99%; P = .01) against varicella and was 100% (95% CI, 67%-100%; P.001) against herpes zoster. When the analysis was controlled for receipt of HAART, vaccination remained highly protective against herpes zoster.

Antiretroviral therapy (ART) is associated with dyslipidemia and cardiovascular disease in adults infected with HIV. For children perinatally infected with HIV, ART exposure is lifelong and early-onset dyslipidemia could have significant long-term effects. We examined cholesterol levels in children during the first year after exposure to a new ART regimen (initiation or switch). In 52 children, total cholesterol increased by 30.5 and 43 mg/dL at 6 and 12 months, respectively (P0.001). Low-density lipoprotein cholesterol made the largest contribution, but high-density lipoprotein cholesterol also increased within months of therapy alteration. Early identification of these children and intervention could mediate potential increased risk for future cardiovascular disease.

Factors influencing antiretroviral adherence for 42 HIV-positive children were elicited from primary caregivers, and the perspectives of families and clinicians regarding success with adherence were compared. Interviews in preferred language (Spanish or English), chart reviews, and visual analogue scales (VAS) were used. Adherence was high by traditional markers of prescriptions filled (100%), doses reported taken (97%), and appointments kept (88%). Clinicians estimated slightly but not significantly lower adherence than did families using the VAS. Sixty-four percent of families reported barriers to adherence, and 30% reported strategies that differ from those in the general adherence literature. Adherence strategies devised by families depended heavily on family support and resolution of disclosure issues in the household.