2006 July « InfectoNews – Jorge Omar Calabrese

Archive for July, 2006

Editorial – Antiretroviral Therapy for Children

JAMA 19 Jul 2006 Vol.296 N.3 p.330-331

Substantial Benefit But Limited Access

abstract
http://jama.ama-assn.org/cgi/content/extract/296/3/330

Add comment July 23, 2006

Incidence of Opportunistic and Other Infections in HIV-Infected Children in the HAART Era

JAMA 19 Jul 2006 Vol.296 N.3 p.292-300

Philimon Gona, PhD; Russell B. Van Dyke, MD; Paige L. Williams, PhD; Wayne M. Dankner, MD; Miriam C. Chernoff, PhD; Sharon A. Nachman, MD; George R. Seage III, DSc, MPH

Context Combination anti-retroviral therapy or highly active antiretroviral therapy (HAART) has resulted in a dramatic decline in the incidence of opportunistic and other infections in human immunodeficiency virus (HIV)–infected adults and children.

Objectives To estimate the incidence of 29 targeted opportunistic and other infections occurring in the era of HAART—between January 1, 2001, and December 31, 2004—in HIV-infected infants, children, and adolescents followed up in Pediatric AIDS Clinical Trials Group (PACTG) 219C; to compare incidence rates in the HAART era to those of the pre-HAART era; and to test for linear trends over time in the HAART era.

Design, Setting, and Participants Ongoing, multicenter, prospective cohort study designed to examine long-term outcomes in HIV-infected children. The study population included 2767 children enrolled between September 15, 2000, and December 31, 2004, with information entered in the database up to August 1, 2005, when data analysis was conducted. The pre-HAART era comparison population included 3331 children enrolled in 13 PACTG protocols from October 1988 to August 1998.

Main Outcome Measures First occurrence of each of the 29 targeted infections.

Results Seventy-five percent of the children were enrolled in 2000 and 2001, 90% acquired HIV perinatally, 52% were girls, and 59% were black. The median age was 8.2 years (range, 6-13 years). The median duration of follow-up was 3.4 years. Overall, 553 first episodes of a specific infection occurred among 395 (14%) of the study participants. The number of events for the 4 most common first-time infections and their incidence rates (IRs) per 100 person-years were 123 bacterial pneumonia (IR, 2.15; 95% confidence interval [CI], 1.79-2.56), 77 herpes zoster (IR, 1.11; 95% CI, 0.88-1.39), 57 dermatophyte infections (IR, 0.88; 0.67-1.14), and 52 oral candidiasis (IR, 0.93; 95% CI, 0.70-1.22). Incidence rates of first bacteremia, Pneumocystis jeroveci pneumonia, disseminated Mycobacterium avium complex, lymphoid interstitial pneumonitis, systemic fungal infection, cytomegalovirus retinitis, and tuberculosis were all less than 0.50 per 100 person-years. There were no statistically significant linear trends in incidence for any of the 29 infections over the 4 calendar years. However, infection rates were significantly lower than those reported in the PACTG in the pre-HAART era. The pre-HAART IRs were as follows: for bacterial pneumonia, IR, 11.1; 95% CI, 10.3-12.0; bacteremia, IR, 3.3; 95% CI, 2.9-3.8; herpes zoster, IR, 2.9; 95% CI, 2.6-3.3; disseminated M avium complex, IR, 1.8; 95% CI, 1.5-2.1; P jeroveci, IR, 1.3; 95% CI, 1.1-1.6; oral candidiasis, IR, 1.2; 95% CI, 1.0-1.5; cytomegalovirus retinitis, IR, 0.5; 95% CI, 0.3-0.6; and tuberculosis, IR, 0.2; 95% CI, 0.1-0.4.

Conclusions Opportunistic infections and other related infections are uncommon in children in the HAART era, and infection rates continue to be lower than those reported in the pre-HAART era. Continued surveillance is important to assess the long-term effect of HAART on the occurrence of opportunistic and other related infections in children.

Author Affiliations: Center for Biostatistics in AIDS Research (Drs Gona, Williams, Chernoff, Seage) and Departments of Biostatistics (Dr Williams) and Epidemiology (Dr Seage), Harvard School of Public Health, and Department of Mathematics and Statistics and Statistical Consulting Unit, Boston University (Dr Gona), Boston, Mass; Department of Pediatrics, Tulane University Health Sciences Center, New Orleans, La (Dr Van Dyke); Department of Pediatrics, Duke University, Durham, NC (Dr Dankner); and Department of Pediatrics, State University of New York Stony Brook (Dr Nachman).

abstract
http://jama.ama-assn.org/cgi/content/abstract/296/3/292

Add comment July 23, 2006

Review – Rotavirus vaccines: current prospects and future challenges

The Lancet July 22-28, 2006 Vol.368 N.9532 p.323-332

Glass RI, Parashar UD, Bresee JS, Turcios R, Fischer TK, Widdowson MA, Jiang B, Gentsch JR

Summary

Rotavirus is the most common cause of severe diarrhoea in children worldwide and diarrhoeal deaths in children in developing countries. Accelerated development and introduction of rotavirus vaccines into global immunisation programmes has been a high priority for many international agencies, including WHO and the Global Alliance for Vaccines and Immunizations. Vaccines have been developed that could prevent the enormous morbidity and mortality from rotavirus and their effect should be measurable within 2–3 years. Two live oral rotavirus vaccines have been licensed in many countries; one is derived from an attenuated human strain of rotavirus and the other combines five bovine-human reassortant strains. Each vaccine has proven highly effective in preventing severe rotavirus diarrhoea in children and safe from the possible complication of intussusception. In developed countries, these vaccines could substantially reduce the number and associated costs of child hospitalisations and clinical visits for acute diarrhoea. In developing countries, they could reduce deaths from diarrhoea and improve child survival through programmes for childhood immunisations and diarrhoeal disease control. Although many scientific, programmatic, and financial challenges face the global use of rotavirus vaccines, these vaccines—and new candidates in the pipeline—hold promise to make an immediate and measurable effect to improve child health and survival from this common burden affecting all children.

Affiliations
a. Viral Gastroenteritis Section, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA

Add comment July 23, 2006