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Unaccompanied and separated children (UASC) are a high-risk group for infectious diseases and information on their vaccination status is scarce. Different approaches are used to screen newly arrived minors in Europe. The aim of this study was to describe the health status and serological protection against different vaccine-preventable diseases among UASC to inform public health decision-making.Retrospective study of all UASC seen at an international health reference center in Barcelona (Spain) between January 2017 and February 2020. Screening results were analyzed using binary logistic regression with adjustment for symptoms, geographic origin, and time since arrival.We studied 289 UASC (88.9% males; median age, 17 years). At least one infection was diagnosed in 136 minors (47.1%). There was a high prevalence of intestinal parasites (22.8%), latent tuberculosis infection (22.5%), and hepatitis B (5.2%), even in asymptomatic individuals, and especially among UASC from sub-Saharan Africa (odds ratio, 2.5; 95% confidence interval, 1.5-4.0, Plt; 0.001). We did not observe a significant association between clinical symptoms and the presence of infection or differences in the prevalence of different infections according to number of months since arrival. Protection against hepatitis B virus (36%), measles (80%), and varicella (83%) was suboptimal.Our results highlight the importance of screening and vaccination programs for UASC arriving in Europe, especially border countries. Protocols should be adjusted according to geographic origin. Absence of symptoms does not necessarily rule out infection, highlighting the importance of screening in asymptomatic minors. These programs are a public health priority and should not be neglected during the current COVID-19 pandemic.

We investigated the impact of baseline tuberculin skin tests (TSTs) and preventive isoniazid chemoprophylaxis on subsequent QuantiFERON-TB Gold In-Tube (QFT-GIT) assays performed after a 10- to 12-week window period in 114 children

Severe imported pediatric malaria is of concern in non-endemic settings. We aimed to determine the features of pediatric severe cases in order to design a model able to stratify patients at presentation.We conducted a retrospective cross-sectional study including all imported P. falciparum malaria infection in patients ≤14 years of age, treated from January 2008 to February 2019 in two tertiary hospitals: Brescia, Italy and Barcelona, Spain. Severe malaria was defined according to World Health Organization criteria. Mortality rate, pediatric intensive care unit (PICU) stay and blood transfusion were analysed as adverse outcomes.Out of 139 children included, 30.9% were severe malaria. Twenty-seven (19.4%) were admitted to PICU, and transfusion was required in 14 cases (10.1%). Predictors for severe malaria were: young age, low hemoglobin, high white blood cells (WBC) and high C-reactive protein. Platelet130,000/μl correlated with severe malaria (without statistical significance). A model that includes age, WBC and C-reactive protein shows a high specificity to classify patients without severe malaria (92.3%) with 70% PPV and 75% NPV.A score based on patient's age, WBC and C-reactive protein easily available at emergency room can help to identify children with higher risk of adverse outcomes.

In this cross-sectional study of 284 children and adolescents with clinically or radiologically suspected tuberculosis in a low-endemic country, the QuantiFERON-TB Gold Plus assay specificity, sensitivity, positive predictive value and negative predictive value were 91.5%, 87.3%, 86.4%, and 91.2%, respectively. The specificity was higher than that observed in tuberculin skin tests performed simultaneously, but similar to previous-generation interferon-gamma release assays. Sin financiación 3.806 JCR (2021) Q3, 105/161 Inmunology 1.104 SJR (2021) Q1, 29/320 Pediatrics, Perinatology and Child Health No data IDR 2021 UEM

Background: Zika virus (ZIKV) infection has been associated with congenital microcephaly and other neurodevelopmental abnormalities. There is little published research on the effect of maternal ZIKV infection in a non-endemic European region. We aimed to describe the outcomes of pregnant travelers diagnosed as ZIKV-infected in Spain, and their exposed children. Methods: This prospective observational cohort study of nine referral hospitals enrolled pregnant women (PW) who travelled to endemic areas during their pregnancy or the two previous months, or those whose sexual partners visited endemic areas in the previous 6 months. Infants of ZIKV-infected mothers were followed for about two years. Results: ZIKV infection was diagnosed in 163 PW, 112 (70%) were asymptomatic and 24 (14.7%) were confirmed cases. Among 143 infants, 14 (9.8%) had adverse outcomes during follow-up, three had a congenital Zika syndrome (CZS), and 11 other potential Zika-related outcomes. The overall incidence of CZS was 2.1% (95%CI: 0.4&ndash, 6.0%), but among infants born to ZIKV-confirmed mothers, this increased to 15.8% (95%CI: 3.4&ndash, 39.6%). Conclusions: A nearly 10% overall risk of neurologic and hearing adverse outcomes was found in ZIKV-exposed children born to a ZIKV-infected traveler PW. Longer-term follow-up of these children is needed to assess whether there are any later-onset manifestations.

Introduction: Tuberculosis (TB) is a global infectious disease. In low-incidence countries, paediatric TB affects mostly immigrant children and children of immigrants. We hypothesize that these children are at risk of exposure to Mycobacterium tuberculosis when they travel to the country of origin of their parents to visit friends and relatives (VFR). In this study, we aim to estimate the incidence rate and risk factors associated to latent tuberculosis infection (LTBI) and TB in VFR children. Methods and analysis: A prospective study will be carried out in collaboration with 21 primary health care centres (PCC) and 5 hospitals in Catalonia, Spain. The study participants are children under 15 years of age, either immigrant themselves or born to immigrant parents, who travel to countries with high incidence of TB (≥ 40 cases/100,000 inhabitants). A sample size of 492 children was calculated. Participants will be recruited before traveling, either during a visit to a travel clinic or to their PCC, where a questionnaire including sociodemographic, epidemiological and clinical data will be completed, and a tuberculin skin test (TST) will be performed and read after 48 to 72 hours; patients with a positive TST at baseline will be excluded. A visit will be scheduled eight to twelve-weeks after their return to perform a TST and a QuantiFERON-TB Gold Plus test. The incidence rate of LTBI will be estimated per individual/month and person/year per country visited, and also by age-group. Ethics and dissemination: The study protocol was approved by the Clinical Research Ethics Committee of the Hospital Universitari Mútua Terrassa (code 02/16) and the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (code P16/094). Articles will be published in indexed scientific journals. Trial registration: Clinical-Trials.gov: NCT04236765

Zika virus (ZIKV) infection has caused the most challenging worldwide infectious epidemic outbreak in recent months. ZIKV causes microcephaly and other congenital malformations. There is a need to perform updated systematic reviews on ZIKV infection periodically because this epidemic is bringing up new evidence with extraordinary speed. Areas covered: Evidence related to ZIKV infection in the gestational, perinatal, and early infant periods covering epidemiology, virology, pathogenesis, risk factors, time of infection during pregnancy, newborn symptoms, treatment, and vaccines. To this end, a search was performed using terms ['Zika'] AND ['Perinatal Infection'] OR ['Congenital Infection'] in the PubMed® international electronic database. Out of a total of 1,538 articles published until 30 November 2017, we finally assessed 106 articles articles that were relevant to the research areas included in this study. Expert commentary: ZIKV is a new teratogenic/neurotropic virus affecting fetuses. Many challenges are still far from being solved regarding the epidemiology, case definition, clinical and laboratory diagnosis, and preventive measures. An approach using 'omics' and new biomarkers for diagnosis, and a ZIKV-vaccine for treatment, might finally give us the tools to solve these challenges.

Background: There is no consensus for the best treatment of complex cutaneous leishmaniasis (CL). We aimed to describe a cohort of CL, focusing on liposomal amphotericin B (L-AmB) treatment outcome. Methods: We performed a retrospective study in Vall d’Hebron University Hospital (Barcelona, Spain). All patients with parasitologically proven CL diagnosed from 2012 to 2018 were included. Results: The analysis included 41 patients with CL. The median age was 39 years (IQR 12- 66), 12 (29%) were children, and 29 (71%) were men. Regarding treatment, 24 (59%) received local treatment, whereas 17 (41%) had complex CL and were offered intravenous systemic treatment. Sixteen patients received L-AmB, eight (50%) had adverse events, and three (19%) discontinued treatment for safety reasons. All cases were considered cured within the first year post-treatment. Conclusions: L-AmB for complex CL showed no treatment failures, offering an alternative treatment option for patients with complex CL. Clinicians should pay close attention to the potential adverse events of L-AmB and adopt an active drug safety surveillance scheme to rapidly detect reversible side effects.

We describe the case of a Russian child with persistent mild eosinophilia in whom intestinal parasitism by Dibothriocephalus latus is finally diagnosed. This cestode is prevalent in circumpolar regions and, therefore, an uncommon finding in International Health units, where care for patients from tropical and subtropical areas is usually provided.

Zika virus; Diagnosis; Infection in utero Virus Zika; Diagnòstic; Infecció uterina Virus Zika; Diagnóstico; Infección uterina INTRODUCTION: Zika virus (ZIKV) has caused one of the most challenging global infectious epidemics in recent years because of its causal association with severe microcephaly and other congenital malformations. The diagnosis of viral infections usually relies on the detection of virus proteins or genetic material in clinical samples as well as on the infected host immune responses. Serial serologic testing is required for the diagnosis of congenital infection when diagnostic molecular biology is not possible. PATIENT CONCERNS: A 2-year-old girl, born to a mother with confirmed ZIKV infection during pregnancy, with a confirmed ZIKV infection in utero, showed at birth a severe microcephaly and clinical characteristics of fetal brain disruption sequence compatible with a congenital ZIKV syndrome (CZS). DIAGNOSIS: ZIKV-RNA and ZIKV-IgM serological response performed at birth and during the follow-up time tested always negative. Serial serologic ZIKV-IgG tests were performed to assess the laboratory ZIKV diagnosis, ZIKV-IgG seroreversion was observed at 21 months of age. ZIKV diagnosis of this baby had to be relied on her clinical and radiological characteristics that were compatible with a CZS. INTERVENTIONS: The patient was followed-up as per protocol at approximately 1, 4, 9, 12, 18-21, and 24 months of age. Neurological, radiological, audiological, and ophthalmological assessment were performed during this period of time. Prompt rehabilitation was initiated to prevent potential adverse long-term neurological outcomes. OUTCOMES: The growth of this girl showed a great restriction at 24 months of age with a weight of 8.5 kg (-2.5 z-score) and a head circumference of 40.5 cm (-4.8 z-score). She also had a great neurodevelopmental delay at the time of this report. CONCLUSION: We presume that as a consequence of prenatal ZIKV infection, the fetal brain and other organs are damaged before birth through direct injury. Following this, active infection ends during intrauterine life, and as a consequence the immune system of the infant is unable to build up a consistent immune response thereafter. Further understanding of the mechanisms taking part in the pathogenesis of ZIKV congenital infection is needed. This finding might change our paradigm regarding serological response in the ZIKV congenital infection.

Spanish Pediatric TB Research Network (pTBred) and the European NontuberculouS MycoBacterial Lymphadenitis in childrEn (ENSeMBLE) Study., [Objectives] To assess the performance of interferon-gamma release assays (IGRAs) in the differential diagnosis between Mycobacterium avium complex (MAC) and tuberculosis (TB) in children affected with subacute/chronic submandibular/cervical lymphadenitis., [Study design] Multicenter observational study comparing children with microbiologically confirmed MAC lymphadenitis from the European NontuberculouS MycoBacterial Lymphadenitis in childrEn study with children with TB lymphadenitis from the Spanish Network for the Study of Pediatric TB database., [Results] Overall, 78 patients with MAC and 34 with TB lymphadenitis were included. Among MAC cases, 44 out of 74 (59.5%) had positive tuberculin skin test (TST) results at the 5-mm cut-off, compared with 32 out of 33 (97%) TB cases (P < .001); at the 10-mm cut-off TST results were positive in 23 out of 74 (31.1%) vs 26 out of 31 (83.9%), respectively (P < .001). IGRA results were positive in only 1 out of 32 (3.1%) patients with MAC who had undergone IGRA testing, compared with 21 out of 23 (91.3%) TB cases (P < .001). Agreement between TST and IGRA results was poor in MAC (23.3%; κ = 0.017), but good in TB cases (95.6%; κ = 0.646). IGRAs had a specificity of 96.9% (95% CI 84.3%-99.8%), positive predictive value of 95.4% (95% CI 78.2%-99.8%), and negative predictive value of 93.9% (95% CI 80.4%-98.9%) for TB lymphadenitis., [Conclusions] In contrast to TST, IGRAs have high specificity, negative predictive value, and positive predictive value for TB lymphadenitis in children with subacute/chronic lymphadenopathy, and consequently can help to discriminate between TB and MAC disease. Therefore, IGRAs are useful tools in the diagnostic work-up of children with lymphadenopathy, particularly when culture and polymerase chain reaction results are negative.

In 2016, a new interferon-gamma release assay, QuantiFERON-TB Gold Plus, was introduced. We conducted a cross-sectional multicenter study, involving 158 children and adolescents with tuberculosis disease. The overall sensitivity of the assay was 82.9% (IQR 77.0%-88.8%), indicating that in children this test does not have higher sensitivity than previous generation interferon-gamma release assays.

Resumen: Introducción objetivos: La enfermedad meningocócica invasiva (EMI) constituye un grave problema de salud pública. A pesar de que el cultivo es la técnica de referencia para su diagnóstico, la administración previa de antibiótico altera su sensibilidad. Los objetivos de este estudio son el análisis epidemiológico de la EMI en nuestro medio, evaluar la utilidad de la reacción en cadena de la polimerasa (PCR) para incrementar el diagnóstico de confirmación de la EMI y valorar la asociación de la administración de antibiótico con el resultado negativo del cultivo. Pacientes y métodos: Estudio retrospectivo de los pacientes menores de 16 años diagnosticados de EMI mediante cultivo, PCR o ambos, que ingresaron en nuestro centro en el periodo 2004-2012. Resultados: Se incluyó a 75 pacientes, de los cuales el 52% presentó sepsis, el 30,7% meningitis y el 17,3% sepsis con meningitis. La PCR fue positiva en todas las muestras de sangre y líquido cefalorraquídeo analizadas, mientras que el cultivo tuvo una positividad muy inferior (50,7%). Recibieron antibiótico antes de la extracción de las muestras 40 pacientes (53,3%) y el 40% de ellos fueron confirmados por la PCR. Conclusiones: Gracias a la PCR se obtuvo un diagnóstico de confirmación de EMI en el 38,7% de los casos y del serogrupo, hecho relevante para la vigilancia epidemiológica y el estudio de la efectividad vacunal. Abstract: Introduction and objectives and aims: Invasive meningococcal disease (IMD) remains a serious public health problem. Although culture is the gold standard, previous antibiotic therapy reduces its sensibility. The aim of this study is the epidemiological analysis of IMD in our area, to assess the usefulness of polymerase chain reaction (PCR) to increase its diagnostic accuracy,and to show the association of antibiotic administration with the negative result of the culture. Patients and methods: A retrospective study was conducted on all children younger than 16 years with microbiologically (positive culture and/or PCR) confirmed IMD, admitted to our hospital between 2004-2012. Results: Seventy-five patients were included, of whom 52% had sepsis, 30.7% meningitis, and 17.3% with both of them. PCR was positive in all samples, whereas a positive was seen 50.7% of the cultures. Previously administered antibiotic was documented in 40 patients (53.3%), and 40% of them were confirmed by PCR only. Conclusions: PCR was the only test providing evidence for IMD diagnosis and serogroup determination in almost 39% of cases.

Resumen Introduccion Desde la descripcion de la infeccion por el virus de la inmunodeficiencia humana (VIH) se han producido muchos avances en su diagnostico, seguimiento y tratamiento. Sin embargo, son escasas las aportaciones relacionadas con el area de calidad asistencial. En este sentido, el Grupo de Estudio de Sida (GESIDA) ha elaborado un documento con 66 indicadores de calidad asistencial para la atencion de los adultos que viven con el VIH —de los que 22 se consideran relevantes— que recoge con sus estandares de cumplimiento requeridos correspondientes. No disponemos de un documento de estas caracteristicas para el paciente pediatrico. Metodos Elaboracion de indicadores de calidad aplicables a la edad pediatrica a partir del documento de GESIDA y las Guias Espanolas para el seguimiento del paciente pediatrico infectado por el VIH. Se analizo cada uno de los indicadores respecto a los estandares requeridos en todos los pacientes Resultados Se obtuvo un total de 61 indicadores, 51 adaptados del documento GESIDA para la poblacion adulta y 10 adecuados segun las guias pediatricas, de los cuales 30 se consideraron relevantes. Se obtuvo un cumplimiento global del 81%, y del 83% en los indicadores relevantes. Conclusion La creacion y el cumplimiento de unos estandares de calidad asistencial es imprescindible en la atencion del paciente pediatrico infectado por el VIH. La evaluacion del seguimiento de nuestros pacientes a partir de estos indicadores ofrecio resultados satisfactorios.

[Objective] To characterize children, adolescents and young adults infected with HIV/hepatitis C virus (HCV) vertically or before age of 18 years and living in Europe regarding mode of acquisition, HCV genotype, clinical status and treatment., [Design] Retrospective, cross-sectional study using pooled data from 11 European paediatric HIV cohorts., [Methods] Patients aged more than 18 months and less than 25 years, with HIV/HCV acquired vertically or in childhood, were included. Anonymized individual patient data were collected using a standard protocol and modified HIV Cohorts Data Exchange Protocol., [Results] Of 229 patients included, 142 (62%) had vertically acquired infection. Median age at last follow-up was 16.2 years. Most children had HCV genotype 1 (101/184, 55%) or 3 (57/184, 31%). One-fifth (46/214) had a previous AIDS diagnosis (data missing on prior AIDS diagnoses for 15). At their last clinic visit, 70% (145/208) had no/mild immunosuppression (Centers for Disease Control and Prevention stage 1), and 131 of 179 on antiretroviral therapy had undetectable HIV RNA (assay thresholds varied from, [Conclusion] The high proportion of patients with progressive liver disease underscores the need for close monitoring and earlier and more effective HCV treatment., This work was supported by funding from the EU Seventh Framework Programme (FP7/2007–2013) under EuroCoord grant agreement [no. 260694] and additional funding from Janssen.

Metabolic syndrome (MetS) is more common in HIV-infected adults and children than in the general population. Adipocytokines and inflammatory markers may contribute to the pathophysiology of this condition and could be useful indices for monitoring MetS. The objective of this study was to provide information on the prevalence of MetS and investigate the role of adipocytokines and other biomarkers in this syndrome in HIV-infected pediatric patients. A cross-sectional study was conducted between October 2013 and March 2014 in the outpatient clinics of 2 tertiary pediatric referral hospitals. Fifty-four HIV-infected children and adolescents were included. MetS was defined according to the International Diabetes Federation and modified National Cholesterol Education Program Adult Treatment Panel III criteria. Measurements included anthropometry, waist circumference, blood pressure, fasting lipids, glucose and insulin, adiponectin, leptin, interleukin-6, vitamin D and C-reactive protein and clinical lipodystrophy assessment. Among the total, 3.7% of patients met the International Diabetes Federation criteria for MetS and 7.4% met the National Cholesterol Education Program Adult Treatment Panel III criteria. C-reactive protein and leptin levels were significantly higher and adiponectin level significantly lower in patients with MetS, regardless of the criteria used. Insulin resistance was observed in 40.7% of patients; abnormal quantitative insulin sensitivity check index values were found in 88.9%. Eighteen patients (33.3%) had vitamin D deficiency. The prevalence of MetS was similar to that observed in larger cohorts of HIV-infected patients in our setting. Adipocytokine dysregulation seems to be related to MetS in HIV-infected children. A high percentage of patients showed insulin resistance, which should be strictly monitored.

Metabolic syndrome (MetS) is considered an independent risk factor for developing cardiovascular disease. It is well known that the prevalence of metabolic disorders have increased in pediatric HIV-infected children. The objective of this study is to assess the prevalence and characteristics of MetS in HIV-infected children and adolescents in Spain.A cross-sectional multicenter study in 152 patients from the pediatric cohort of the Spanish AIDS Research Network (CoRISpe) was performed. MetS was defined according to the new International Diabetes Federation (IDF) diagnostic criteria and the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Measurements included anthropometry, waist circumference, blood pressure, fasting lipids, glucose and insulin and lipodystrophy assessment. Demographic, clinical, immunological, virological and antiretroviral therapy data were obtained from the Network database.An abnormally low high-density lipoprotein-cholesterol level was the most prevalent disturbance (21.05%) found. Three patients met IDF criteria for MetS (1.97%), and MetS was significantly associated with lipohypertrophy (P=0.029) in the analysis. When the modified NCEP-ATP III criteria were used, the prevalence of MetS was 5.92% (9 patients), and MetS was significantly associated with Tanner stage ≥2 (P=0.041), lipohypertrophy (P=0.001) and higher Z scores for weight and body mass index (P=0.002 and P0.001). Insulin resistance was observed in 17 patients (11.18%) and was associated with MetS (as per the modified NCEP-ATP III criteria) (P=0.03) and lower high-density lipoprotein-cholesterol values (P=0.036).The prevalence of MetS in our cohort was 1.97% or 5.92%, depending on the diagnostic criteria used. MetS should be actively assessed, particularly in children who show lipohypertrophy.

The impact of Chagas disease is no longer restricted to endemic areas. The aim of this study is to evaluate a 2-year period of a vertical transmission screening program of Trypanosoma cruzi infection in a tertiary care hospital in Barcelona (Spain). Two enzyme-linked immunosorbent assays (recombinant and crude antigen) were performed in parallel to pregnant women at risk of T. cruzi infection. Discordant results were confirmed by a third diagnostic test. In the case of a positive result, the newborn was tested at birth and after 8 months of life. A total of 1,473 women met the inclusion criteria for the screening program with a resulting seroprevalence for T. cruzi of 3.5% (2.2-5.2% 95% confi- dence interval (95% CI)). One case of congenital infection was identified. Screening programs for vertically transmitted T. cruzi acute infection are beneficial in non-endemic areas for early detection and treatment of acute infection.

Resumen: Introducción: La bacteriemia asociada a catéter venoso central (BACVC) es una infección nosocomial frecuente. Su incidencia es mayor en los pacientes pediátricos que en los adultos y en aquellos ingresados en unidades de cuidados intensivos (UCI). La morbimortalidad asociada a esta entidad hace de la BACVC un problema de salud importante frente al que es imprescindible desarrollar estrategias de prevención. Pacientes y métodos: Se ha realizado un estudio de intervención en una UCI pediátrica (UCIP) para valorar el impacto de la implantación, en diciembre de 2007, del programa «Bacteriemia zero», que tiene como objetivo la prevención de la BACVC. Se han recogido datos demográficos y variables relacionadas con la hospitalización y la infección de los pacientes desde enero a diciembre de 2007 (antes de la intervención) y desde enero a diciembre de 2008 (después de la intervención), estudiándose 497 pacientes en el primer periodo y 495 en el segundo, y se han comparado los resultados entre ambos periodos. Resultados: Se ha observado una reducción del 30,4% en la tasa de incidencia de BACVC (p = 0,49) en el segundo año de estudio (de 5,5 a 3,8 episodios por 1.000 catéter-días). La ratio de utilización de CVC ha sido de 0,59 y de 0,64, respectivamente. El microorganismo más frecuentemente aislado ha sido Staphylococcus spp. coagulasa negativo. Conclusiones: La implantación de un programa de «bacteriemia 0» que implica tanto a los profesionales de la UCIP como a los de control de la infección nosocomial consigue reducir la incidencia de BACV. Abstract: Background: Central line-associated bloodstream infection (CLABSI) is one of the most common nosocomial infections. The incidence is higher in paediatric patients than in adults, especially in those admitted to Intensive Care Units (ICU). CLABSI-related morbidity makes it a major health problem; therefore it is necessary to develop prevention strategies against it. Patients and methods: An intervention study in a paediatric ICU (PICU) was performed, in order to assess the impact of the introduction of the program «Bacteraemia zero» in December 2007. This program aims to prevent CLABSI. Demographic data and variables related to hospitalisation and infection were collected from January to December 2007 (before the intervention) and from January to December 2008 (after the intervention), and were compared. In the first period, 497 patients were studied, and 495 in the second. Results: A reduction of 30.4% in the incidence of CLABSI (P = 0.49) in the second year was observed (5.5 to 3.8 episodes per 1000 catheter-days). The CVC use ratio was 0.59 and 0.64, respectively. The most frequently isolated organism was coagulase-negative Staphylococcus spp. Conclusions: The implementation of a «no bacteraemia» program, involving all staff in the PICU as well as the professionals in infection control, reduces the incidence of CLABSI.

Maraviroc (MVC) is not approved for HIV-1-infected paediatric patients. This is the first assessment of the use of MVC-based salvage therapy in vertically HIV-1-infected paediatric patients in clinical settings. The results suggest that MVC-based salvage therapy is useful in children and adolescents with extensive resistance profile leading to maintained virological suppression in up to 88% of the patients with CCR5-tropic virus. The likelihood of treatment success might increase when MVC is combined with other active drugs.

No data are available on 2009 H1N1 influenza in human immunodeficiency virus (HIV)-infected children, a highly susceptible and vulnerable population. We report 13 cases of pandemic influenza among a cohort of HIV-infected pediatric patients. Clinical features of H1N1 influenza were similar to those described in the general population. Most patients received antivirals on an outpatient basis. An uneventful evolution was observed in all patients, only 2 of whom required hospitalization. Influenza had no effect on the evolution of HIV infection.

El paciente infectado por VIH presenta, en nuestro entorno, una mayor esperanza de vida con practicamente ausencia de episodios definitorios de SIDA. La cuestion es si esta mayor esperanza de vida esta libre de enfermedades concomitantes o si van a aparecer otras nuevas. La enfermedad hepatica es un buen ejemplo de este cambio epidemiologico. El paciente infectado por VIH presenta un riesgo de afectacion hepatica a traves, tanto de la accion directa del virus como del efecto de los farmacos antirretrovirales. Por otra parte, las tasas de infeccion de VHB y VHC son considerablemente mas altas en estos pacientes, al compartir la mayor parte de las vias de transmision. Los pacientes infectados por el VIH pueden presentar coinfecciones por virus hepatotropos serologicamente silentes: la infeccion VHB oculta y la infeccion por VHC seronegativa, que no se diagnostican con los metodos habituales. Estas entidades suponen un aumento del riesgo de reactivacion de la enfermedad, progresion y evolucion a dano hepatico cronico y grave, sobre todo en los ninos que adquieren el virus precozmente. La inclusion rutinaria del cribado de hepatitis ocultas seria una herramienta util para identificar a los pacientes con riesgo de descompensacion hepatica, de especial interes en los ninos que viven con el VIH, ya que se enfrentan a una perspectiva de coinfeccion, y riesgo de dano hepatico, de por vida. A traves de este estudio transversal en la cohorte nacional de pacientes VIH pediatricos (CoRISPe) se abordo la prevalencia de coinfeccion por VHB y VHC, asi como la coinfeccion por hepatitis ocultas. De forma secundaria, se realizo una valoracion no invasiva de la fibrosis hepatica a traves de marcadores bioquimicos (ALT/AST ratio, APRI index, FIB-4 score). Se incluyo un total de 254 pacientes. Tres (1.2%) presentaron una VHB cronica y 13 (5%) una infeccion cronica por VHC. Seis ninos se consideraron probables casos de infeccion VHB oculta, 2 con anti-HBc aislado y 4 con un patron serologico anti-HBc+/anti-HBs+, a pesar de la negatividad de la PCR a VHB en plasma. Dos pacientes (0.8%) presentaron infeccion VHC seronegativa. No se realizaron biopsias hepaticas en este estudio por razones eticas. La evaluacion no invasiva de la fibrosis hepatica fue patologica en los 3 y en 7 de los 13 con infecciones por VHB y VHC, respectivamente, advirtiendo de una posible fibrosis subyacente. Una paciente infectado por VHC mostro alteracion simultanea de los tres marcadores incluidos en el estudio. Cinco de los 6 casos de probable VHB oculta mostraron ALT/AST ratios alteradas pero con normalidad en el APRI y FIB-4 score. Los dos casos de infeccion VHC seronegativa presentaron valores anormales. En los ninos infectados por VIH sin coinfeccion por virus hepatotropos, el 77% mostro ALT/AST ratios elevadas mientras que el 5.7% presento valores anormales de APRI. Solo un paciente mostro un FIB-4 score elevado. En ausencia de datos mas amplios sobre coinfeccion en poblacion pediatrica infectada por el VIH, la prevalencia de VHB y VHC en CoRISPe es similar a lo descrito previamente. Aunque la tasa de coinfeccion por hepatitis ocultas en esta cohorte fue baja (3.1%) parece razonable la inclusion de tecnicas de diagnostico molecular que aumenten la sensibilidad en el diagnostico de las hepatitis ocultas. Se necesitan mas datos para evaluar la idoneidad del uso de los scores bioquimicos para valoracion de fibrosis hepatica en esta poblacion pediatrica, con el objetivo de aumentar la sensibilidad y especificidad, y correlacionar los resultados con la biopsia hepatica, que sigue siendo la tecnica de referencia. HIV-infected patients can now enjoy a longer life expectancy with almost no AIDS defining episodes if diagnosed promptly, as is the case for most vertically infected children in our setting. The question is whether this longer life expectancy is free of comorbidities or whether other medical conditions will appear. Liver disease is a good example of this epidemiological change. A worse outcome of liver disease is expected through both the direct action of the virus and the effect of the antiretroviral drugs. Moreover, HIV itself is considered a risk factor that contributes to increased MTCT of the hepatitis virus. Furthermore, the infection rates of HBV and HCV are considerably higher in patients living with HIV, as they share most of the transmission routes. HIV-infected patients prone to uncommon variations of hepatotropic coinfections which are serologically silent, namely, occult hepatitis B infection and seronegative HCV infection. These entities bring an increased risk of disease reactivation, progression and evolution to chronic and severe liver damage, especially in children who acquire the virus early in life. Current regular screening methods may miss the diagnosis of these coinfections in immunocompromised patients. The inclusion of screening for OBI and seronegative hepatitis C in routine HIV patient monitoring would be a useful tool to identify those patients at risk of hepatic decompensation. In HIV-infected children who face the prospect of a lifetime coinfection, this possibility would be of particular interest, and highly beneficial, as it would become possible to anticipate secondary clinical conditions and future complications. This is a cross-sectional study among the Spanish cohort of HIV-infected children (CoRISPe) in order to assess the prevalence of HBV and HCV infection and occult hepatitis as well. Secondarily noninvasive liver fibrosis assessment through biochemical serum markers was made. A total of 254 patients were included in this study. Three (1.2%) and 13 (5%) patients respectively had serological markers compatible with overt cHBV and cHCV infection. Two patients showed spontaneous clearance of HCV infection. Six children were considered probable OBI cases, 2 presenting with anti-HBc alone and 4 with an anti-HBc+/anti-HBs+ serological pattern, although blood HBV DNA testing was negative in all cases. Two patients (0.8%) had seronegative HCV infection. Noninvasive assessment of liver fibrosis was pathological in all 3 with overt cHBV and in 7 out of 13 with overt cHCV, warning of a possible underlying fibrosis. One HCV-infected patient showed simultaneous alteration of the three scores included in the study. Five out of 6 probable OBI cases appeared to have altered ALT/AST ratio but APRI index and FIB-4 scores were normal in all patients with occult hepatitis. Both cases of seronegative HCV infection showed abnormal scores values. Among HIV-monoinfected children, 77% showed raised ALT/AST ratios, while 5.7% presented APRI abnormal values. Just one patient showed FIB-4 score abnormality. The HBV and HCV prevalence coinfection rates in this cohort appear to be in keeping with previously published data, in the absence of wider prevalence coinfection data for the HIV-infected pediatric population. The global rate of occult hepatitis coinfection cases detected in this cohort was low (3.1%). However, molecular diagnosis assays are indicated to increase the sensitivity of detection and minimize the risk of under-diagnosis and its clinical implications in adulthood. Further research is needed to assess the suitability of using biochemical scores in these populations in order to approach good levels of sensitivity and specificity, and to correlate this method to liver fibrosis assessed by imaging and/or biopsy.

Perinatal antiretroviral (ARV) exposure has been related to hyperlactatemia and lactic acidosis in infants born to HIV-infected mothers. Our objective was to determine the incidence of these conditions during the first year of life in uninfected infants born to HIV-infected mothers and compare the data with infants born to mothers with hepatitis C virus (HCV) infection. We investigated the relationships between hyperlactatemia and neurological and neurodevelopmental disorders by conducting a prospective, comparative cohort study (October 2004 to October 2007) consecutively including children of HIV- and HCV-infected mothers. Liver enzymes, pH, lactic acid, and plasma amino acids were determined at 1.5, 3, 6, and 12 months of life. Pathological hyperlactatemia was defined as lactate2.1 mmol/liter together with alanine475 μmol/liter. Seventy-nine patients (39 HIV-exposed patients and 40 unexposed patients) were included. Baseline maternal characteristics in the two groups were similar. Almost 90% of HIV-infected mothers received HAART during gestation, while 10.3% were given AZT monotherapy. Eight newborns received combined therapy and 31 received AZT-based monotherapy. Twelve patients (five exposed and seven nonexposed) had some neurological disorder, and four other patients (one vs. three) showed signs of neurodevelopmental delay, with no significant differences between the groups (p=0.34). Pathological hyperlactatemia was detected in 56.4% (95% CI 39.6-72.2) and 57.5% (95% CI 40.9-73.0) of patients, respectively (p=0.92), and this condition was more frequent in preterm children (p0.05). ARV use during pregnancy and the neonatal period was not associated with pathological hyperlactatemia. The presence of hyperlactatemia was not associated with neurological or neurodevelopmental disorders. No association was established between the use of ARV agents and the development of hyperlactatemia or neurological disorders in HIV-exposed children during their first year of life.

There are approximately from 1,100 to 1,200 HIV-infected children in a follow-up in Spain. In 2008 an open, multicentral, retrospective and prospective Cohort of the Spanish Paediatric HIV Network (CoRISpe) was founded. The CoRISpe is divided into the node 1 and node 2 representing geographically almost the whole territory of Spain. Since 2008 seventy-five hospitals have been participating in the CoRISpe. All the retrospective data of the HIV-infected children have been kept in the CoRISpe since 1995 and prospective data since 2008. In this article we are going to present the notion of CoRISpe, its role, the structure, how the CoRISpe works and the process how a child is transferred from Paediatric to Adults Units. The main objective of the CoRISpe is to contribute to furthering scientific knowledge on paediatric HIV infection by providing demographic, sociopsychological, clinical and laboratory data from HIV-infected paediatric patients. Its aim is to enable high-quality research studies on HIV-infected children.