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Background This study describes the incidence, clinical and demographic characteristics, and spectrum of chronic kidney disease (CKD) in youths with perinatal HIV-1 infection. Methods Retrospective analysis between May 1993 and December 2006 of subjects with renal disease followed in the Pediatric AIDS Clinical Trials Group 219/219C multi-center study examining the long-term consequences of perinatal HIV infection. Diagnosis confirmation was made utilizing a questionnaire mailed to research sites. Participants with CKD of other etiology than HIV were excluded. Outcome measures were biopsy-diagnosed CKD and, in the absence of biopsy, HIV-associated nephropathy (HIVAN) using established clinical criteria. Results Questionnaires on 191 out of 2,102 participants identified 27 cases of CKD: 14 biopsy-diagnosed and 6 clinical cases of HIVAN, and 7 biopsy-diagnosed cases of immune complex-mediated kidney disease (lupus-like nephritis, 3; IgA nephropathy, 2; membranous nephropathy, 2). Incidence rates for CKD associated with HIV in pre-highly active antiretroviral therapy (HAART) (1993-1997) and HAART (1998-2002, 2003-2006) eras were 0.43, 2.84, and 2.79 events per 1,000 person years respectively. In multivariate analysis, black race and viral load [greater than or equal to] 100,000 copies/mL (rate ratios 3.28 and 5.05, p [less than or equal to] 0.02) were associated with CKD. Conclusions A variety of immune complex-mediated glomerulonephritides and HIVAN occurs in this population. Black race and uncontrolled viral replication are risk factors for CKD associated with HIV. Keywords HIVAN * HIV immune complex kidney disease * FSGS * Renal * Youth * Proteinuria * Biopsy, Introduction Use of highly active antiretroviral therapy (HAART) in the United States (US), Europe, and increasingly worldwide, has contributed to a decline in mortality in HIV-1-infected adults and children [1-5]. [...]

Objectives. We sought to describe the reproductive health of adolescent girls perinatally infected with HIV. Methods. We estimated the incidence of first pregnancy, genital infections, and abnormal cervical cytology for 638 girls aged 13 years and older in the Pediatric AIDS Clinical Trials Group protocol 219C. Results. Thirty-eight girls became pregnant, for a first pregnancy rate of 18.8/ 1000 person-years; 7 of these girls had additional pregnancies (95% confidence interval [CI] = 13.3, 25.7). Thirty-two pregnancies resulted in live births. All girls received antiretroviral therapy during pregnancy. One infant was HIV infected, 29 were uninfected, and 2 had unknown infection status, for a rate of mother-to-child transmission of HIV in infants with known infection status of 3.3% (95% CI = 0.1, 18.6). Condylomata and trichomoniasis were the most frequent genital infections. Forty-eight (47.5%) of 101 girls with Papanicolaou test examinations had abnormal cervical cytology, including atypical cells of undetermined significance (n = 18), low-grade squamous intraepithelial lesions (SIL; n = 27), and high-grade SIL (n = 3). Many abnormalities persisted despite intervention. Conclusions. Pregnancy rates were lower and cervical abnormalities were higher than among non-HIV-infected adolescents. These findings underscore the importance of Papanicolaou tests and promotion of safer sexual practices in this population. doi:10.2105/AJPH.2005.071910

Development of an algorithm to selectively screen individuals suspected of having acute HIV-1 infection is described. Studying people during early and acute HIV-1 infection may allow scientists to investigate the impact of the intervention that is studied on early transmission or pathogenesis of HIV-1 infection.

The changes in the treatment of pediatric HIV infection in the US from 1987-2003 are described, an assessment of concordance of initial regimens with US pediatric guidelines is presented and predictors of the first regimen switch are identified. It is concluded that there was a short lag between the identification of novel antiretroviral therapy (ART) and its adoption in the pediatric community.

Research has been conducted on HIV vaccine efficacy trials. Results suggest that the prototype informed consent process should be used for vaccine efficacy trials in the future.

Research has been conducted on partner and situational characteristics associated with unprotected sex among women who are at risk for HIV infection. Results demonstrate that the study of these characteristics should help in developing interventions for women.

Research has been conducted on the primary HIV infection treatment strategies. The clinical outcome and life expectance projections for these strategies have been evaluated via the simulation model developed by the authors in order to assist decision makers in HIV infection treatment.

Preventable opportunistic infections have been found to cause not only short-term mortality in HIV-1 disease, but also seem to have a major impact on chronic mortality. The relationship of the opportunistic infections, HIV-1 RNA, and CD4 cell counts to chronic mortality was studied. Statistically significant effect modification was seen between preventable opportunistic infections and CD4 cell count.

Objectives. As the life expectancy of children with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) increases, quality-of-life outcomes are of increasing concern. The prevalence of pain in adults with AIDS ranges from 40% to 60%, depending on stage of illness. There is limited research concerning pain in HIV-infected children and youth. Design. The General Health Assessment for Children was administered to caregivers of HIV-infected children and youth enrolled in the Pediatric Late Outcomes Study (PACTG 219), a prospective cohort study. Pain is assessed over the previous month with 7 questions. For the purpose of this analysis, we defined pain as the presence of pain of at least moderate intensity. Participants were observed from January 1, 1996, to December 31, 1999. Results. A total of 985 HIV-positive participants had a baseline pain evaluation in 1995. The prevalence of pain remained relatively constant during each year of observation, averaging 20%. Lower CD[4.sup.+] T-lymphocyte percentage, female gender, and an HIV/AIDS-related diagnosis were highly associated with an increased risk of reported pain. Pain was also independently associated with increased risk of death. After adjusting for CD4 percentage, use of combination therapy including protease inhibitors, comorbid diagnoses, and other sociodemographic characteristics, individuals reporting pain were over 5 times more likely to die than those not reporting pain (hazard ratio = 5.07; 95% confidence interval = 3.23-7.95). Conclusions. Pain is a frequently encountered symptom in children and youth with HIV disease and is also associated with increased mortality. These findings emphasize the importance of pain management in this population. Pediatrics 2002;109:1144-1152; pain, HIV/ AIDS, pediatrics, protease inhibitors, generalized estimating equations, proportional hazards regression. ABBREVIATIONS. HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; PI, protease inhibitor; PACTG, Pediatric AIDS Clinical Trials Group; GHAC, General Health Assessment for Children; OR, odds ratio; CI, confidence interval., As new therapies dramatically extend the lives of people with human immunodeficiency virus (HIV), quality-of-life outcomes, such as pain and psychological distress have become increasingly important indicators Of disease manifestation. [...]

A combination of AIDS drugs that includes a protease inhibitor has caused annual mortality rates in HIV-infected children and teenagers to drop from 5.3% in 1996 to 0.7% in 1999. Only 7% of HIV-infected children and teenagers received combination therapy in 1996, compared to 73% in 1999.

One copy of a mutation in the gene for the CCR5 cell receptor can protect people from HIV infection as well as two copies, according to a study of 2,996 people. HIV uses this cell receptor to enter T cells.

Prophylactic treatment can be cost-effective for preventing many opportunistic infections in AIDS patients. Researchers used a mathematical simulation to determine the cost-effectiveness of preventing Pneumocystis carinii pneumonia (PCP), toxoplasmosis, Mycobacterium avium complex (MAC) infection, and cytomegalovirus (CMV) infections in AIDS patients. Patients with very low T cell counts who received no preventive treatment had a quality-adjusted life expectancy (QALY) of 39 months. Preventive treatment for PCP and toxoplasmosis increased QALY and appeared to be cost-effective but this was not true for CMV preventive treatment., Context.--Multiple options are now available for prophylaxis of opportunistic infections related to the acquired immunodeficiency syndrome (AIDS). However, because of differences in incidence rates as well as drug efficacy, toxicity, and costs, the role of different types of prophylaxis remains uncertain. Objective.--To determine the clinical impact, cost, and cost-effectiveness of strategies for preventing opportunistic infections in patients with advanced human immunodeficiency virus (HIV) disease. Design.--We developed a Markov simulation model to compare different strategies for prophylaxis of Pneumocystis carinii pneumonia (PCP), toxoplasmosis, Mycobacterium avium complex (MAC) infection, fungal infections, and cytomegalovirus (CMV) disease in HIV-infected patients. Data for the model were derived from the Multicenter AIDS Cohort Study, randomized controlled trials, and the national AIDS Cost and Services Utilization Survey. Main Outcome Measures.--Projected life expectancy, quality-adjusted life expectancy, total lifetime direct medical costs, and cost-effectiveness in dollars per quality-adjusted life-year (QALY) saved. Results.--For patients with CD4 cell counts of 0.200 to 0.300 x [10.sup.9]/L (200-300/ [micro] L) who receive no prophylaxis, we projected a quality-adjusted life expectancy of 39.08 months and average total lifetime costs of $40 288. Prophylaxis for PCP and toxoplasmosis with trimethoprim-sulfamethoxazole for patients with CD4 cell counts of 0.200 x [10.sup.9] /L (200/ [micro] L) or less increased quality-adjusted life expectancy to 42.56 months, implying an incremental cost of $16 000 per QALY saved. Prophylaxis for MAC for patients with CD4 cell counts of 0.050 x [10.sup.9]/L (50/ [micro] L) or less produced smaller gains in quality-adjusted life expectancy; incremental cost-effectiveness ratios were $35 000 per QALY saved for azithromycin and $74 000 per QALY saved for rifabutin. Oral ganciclovir for the prevention of CMV infection was the least cost-effective prophylaxis ($314 000 per QALY saved). Results were most sensitive to the risk of developing an opportunistic infection, the impact of opportunistic infection history on long-term survival, and the cost of prophylaxis. Conclusions.--The cost-effectiveness of prophylaxis against HIV-related opportunistic infections varies widely, but prophylaxis against PCP or toxoplasmosis and against MAC delivers the greatest comparative value. In an era of limited resources, these results can be used to set priorities and explore new alternatives for improving HIV patient care. JAMA 1998;279: 130-136

Objectives. This study developed a new acquired immunodeficiency syndrome (AIDS) severity system by including diagnostic, physiological, functional, and sociodemographic factors predictive of survival. Methods. Three-hundred five persons with AIDS in Boston were interviewed; their medical records were reviewed and vital status ascertained. Results. Overall median [plus or minus] SD) survival for the cohort from the first interview until death was 560 [plus or minus] 14.4 days. The best model for predicting survival, the Boston AIDS Survival Score, included die Justice score (stage 2 relative hazard [RH] = 1.25, 95% confidence interval [CI] = 0.80, 1.96; stage 3 RH = 1.76, 95% CI = 1.15, 2.70), a newly developed opportunistic disease score (Boston Opportunistic Disease Survival Score; stage 2 RH = 1.35, 95% CI = 0.90, 2.02; stage 3 RH = 2.10, 95% CI = 1.38, 3.18), and measures of activities of daily living (any intermediate limitations, RH = 1.84, 95% CI = 1.05, 3.21; any basic limitations, RH = 2.60, 95% CI = 1.44, 4.69). This model had substantially greater predictive power ([R.sup.2] = .17, C statistic = .68) than the Justice score alone ([R.sup.2] = .09, C statistic = .61). Conclusions. Incorporating data on clinically important events and functional status into a physiologically based system can improve the prediction of survival with AIDS. (Am J Public Health. 1997;87:567-573)

Objectives. To estimate the prevalence of and identify risk factors for human immunodeficiency virus type 1 (HIV-1) and hepatitis B virus (HBV) infections and unprotected anal intercourse among young homosexual […]

AIDS patients with mentally demanding jobs appear more likely to keep their jobs longer after diagnosis than those with physically demanding jobs. The employment status of 305 AIDS patients was evaluated for up to 16 months after initial diagnosis. Seventy-six percent of AIDS patients were employed at the time of their diagnosis, but only 53% were still holding jobs approximately 16 months later. However, 17% were on sick or disability leave. The study participants were mostly white males with some college education and in white-collar occupations. Hospitalization and physically challenging work were more likely to result in employment loss than mentally demanding job functions. Transitional programs could help AIDS patients continue working productively longer.

Medically insured AIDS patients may receive most but not all of the services they need. In a sample of 305 AIDS patients, 95% were insured, but 36% had changed insurance coverage since their diagnosis. Medicaid coverage increased from 14% to 41% and was associated with a longer history of AIDS. Preventive medication for Pneumocystis carinii pneumonia and zidovudine therapy were widely available to AIDS patients, but 15% reported unmet medical or dental needs. Poverty, homelessness, being female and being black seemed associated with difficulty obtaining services.

Objectives. The goal of the study was to determine survival time after diagnosis of acquired immunodeficiency syndrome (AIDS) and to identify predictors of survival. Methods. We conducted a population-based prospective survival analysis of all Massachusetts-resident adult AIDS patients diagnosed from January 1, 1979, through December 31, 1988. Results. Median survival was 406 days, with a 5-year survival rate of 3%. Age older than 40 years (P = .001), a diagnosis other than Kaposi's sarcoma (P = .001), and a history of intravenous drug use (P [is less than or equal to] .01) were associated with shorter survival after confounding was controlled. Survival increased as year of diagnosis became more recent (P < .0001). This temporal effect was strongest for patients with Pneumocystis carinii pneumonia. Individuals with Kaposi's sarcoma, Hispanics, homosexual men who were concurrent intravenous drug users, and residents of the greater Boston standard metropolitan statistical area, excluding the city of Boston, did not experience increases in survival over time. Conclusions. With the exception of cases initially defined by Kaposi's sarcoma, recently diagnosed AIDS case subjects survive longer than those diagnosed earlier in the epidemic. Further work is needed to determine whether this effect is due to lead-time bias or better treatment after diagnosis. (Am J Public Health. 1993;83:72-78), Recently diagnosed AIDS patients appear to be surviving longer. A Massachusetts study of 1,721 AIDS patients found that the average length of survival following AIDS diagnosis was 13.5 months. Average survival was shortest for patients over age 40 and was greatest among patients between the ages of 30 and 34. Whites survived significantly longer than blacks, and homosexual or bisexual men survived longer than intravenous drug users. Individuals diagnosed in 1987 had an average survival of 463 days compared with an average survival of 245 days among patients diagnosed in 1984 or earlier. The most dramatic increases in survival were seen among patients initially diagnosed with Pneumocystis carinii pneumonia alone or with Pneumocystis carinii pneumonia and any other opportunistic infection. Chances of survival among patients diagnosed with Kaposi's sarcoma alone did not change significantly over time.

AIDS patients treated at hospitals with less experience caring for such patients may be more likely to die in the hospital than those treated at more experienced hospitals. Among 300 AIDS patients, 806 hospitalizations at 40 Massachusetts hospitals took place over a two-year follow-up period. Overall, 13.2% of the patients died in the hospital. The in-hospital mortality rate was nearly twice as high among AIDS patients treated at low-experience hospitals than among those treated at hospitals with more experience (19% and 9.8%, respectively). Patients treated at a hospital with less experience spent more time in the hospital and in the intensive care unit than those treated in a hospital with more experience. With the growth of the AIDS epidemic, more AIDS patients are being admitted to local hospitals with less experience caring for individuals with AIDS.

HIV-infected men who have low CD4 T-cell counts, advanced disease or white blood cells in their semen are more likely to have the virus in their semen and would be more likely to transmit the virus through sexual intercourse. Semen samples taken from 95 HIV-positive men were tested for the presence of HIV. The virus was found in nine samples. Men who had CD4 counts less than 200, who were in an advanced stage of the infection or who were not taking zidovudine (AZT) were more likely to have the virus in their semen. Those who had white blood cells in their semen (seminal leukocytosis) were also more likely to have the virus in their semen. However, a separate study of 14 of the men whose CD4 counts were above 200 found that six had one semen sample that was positive for HIV at some time over a period of several months. All HIV-infected men should consider themselves potentially infective.

Sex trafficking may play a major role in spread of HIV across South Asia. We investigated co-infection with HIV and other sexually transmitted diseases among 246 sex-trafficked women and girls [...]

The centers for Disease Control (CDC) had been advised of more than 100,000 cases of acquired immunodeficiency syndrome (AIDS) as of December, 1989. It has further been estimated that as many as an additional 1.5 million persons have the human immunodeficiency virus (HIV), which causes AIDS. Furthermore, it is projected by CDC that the number of AIDS cases increase fourfold in the next three years. What are the costs of treating AIDS patients in view of the changes in the patterns of care and treatment, and in the duration of patient survival? These lifetime costs have been variously estimated at between $20,320 to $147,000 per patient. These estimated, however, do not take into account changes in treatment patterns or cost escalations. A two-year study was conducted to look at the effect of those changes. A group of 240 AIDS patients. 34 cases at the outset of the study and 206 added during the observation period, were identified from five major centers in Massachusetts. Seventeen cases were female, and 223 were male. All received primary care between March 1984 and February 1986. Reviews of patient records provided sociodemographic data and the clinical characheristics of each patient, including opportunistic infections at first diagnosis, the number of opportunistic infections developed later, and risk factors for AIDS. Hospital costs and the number of visits were obtained from outpatient billing records. The results showed that mulitple factors tempered the costs of care for AIDS patients. These included treatment patterns, length of patient survival and charachteristics of the related patient population. While the yearly cost of care may have decreased, the overall lifetime cost actually increased, a consequence of the longer survival of AIDS patients. There was no significant change in the population demographics in this group. Survival times increased among those admitted to the study later; earlier admissions were sick for a longer period of time. The annual cost of care, as determined in this study, was approximately $37,404 per patient. Using currently available data, life time cost per patient is almost $42,399 per patient. The direct cost burden of direct clinical care is enormous. These costs do not include the additional cost of special medications, such as azidothymidine (AZT), estimated at $8,00 per patient per year. Futhermore, the nonmedical economic costs, earnings losses and other cost-related components must be factored into the above costs. The patients numbers and their cost may be higher in other areas of the country. (Consumer Summary produced by Reliance Medical Information, Inc.)

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&apos;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.