Y. Bryson - Academia.edu (original) (raw)

Papers by Y. Bryson

Research paper thumbnail of Zidovudine for mother, fetus, and child

Research paper thumbnail of HIV clearance in an infant?

Research paper thumbnail of Perinatal transmission of HIV: Recognition and treatment interventions

Current Infectious Disease Reports, 2001

Great strides have been made in the fight against vertical transmission of HIV-1. Improved unders... more Great strides have been made in the fight against vertical transmission of HIV-1. Improved understanding of mechanisms and timing of transmission of HIV-1 from mother to child have led to the development of effective intervention strategies that have reduced transmission rates to unprecedented low levels, below 2% in developed countries. New reports using shortened, more affordable courses of antiretrovirals prenatally or at the time of delivery have also shown a significant reduction in transmission, over 50% in studies conducted in the developing world. These advances, combined with ongoing studies using simplified effective treatment regimens, have made possible the potential to significantly reduce perinatal transmission worldwide. Future challenges include reduction of breast feeding transmission and the development of an effective HIV-1 vaccine to produce long-lasting protection.

Research paper thumbnail of Hepatitis Viruses

Congenital and Perinatal Infections, 2006

The hepatitis viruses are a diverse group that has as their common feature the liver as their pri... more The hepatitis viruses are a diverse group that has as their common feature the liver as their primary target of infection. They come from several families of viruses, cause infection via different mechanisms, and have a variety of clinical manifestations. The differential diagnosis for hepatitis in pregnancy includes other viruses (cytomegalovirus, Epstein-Barr virus), toxic exposures (acetaminophen), autoimmune disease (e.g., systemic lupus erythematosus), and other entities unique to pregnancy (e.g., HELLP [hemolysis, elevated liver enzymes, and low platelet count]).

Research paper thumbnail of Population Pharmacokinetics of Lamivudine in Human Immunodeficiency Virus-Exposed and -Infected Infants

Antimicrobial Agents and Chemotherapy, 2007

This study aimed to determine lamivudine disposition in infants and to construct an appropriate d... more This study aimed to determine lamivudine disposition in infants and to construct an appropriate dose adjustment for age, given the widespread use of lamivudine for both the prevention of mother-to-child transmission of human immunodeficiency virus (HIV) and the treatment of HIV-infected infants. Using a pooled-population approach, the pharmacokinetics of lamivudine in HIV-exposed or -infected infants from four Pediatric AIDS Clinical Trials Group studies were assessed. Ninety-nine infants provided 559 plasma samples for measurement of lamivudine concentrations. All infants received combination antiretroviral therapy including lamivudine dosed at 2 mg/kg of body weight every 12 h (q12h) for the first 4 to 6 weeks of life and at 4 mg/kg q12h thereafter. Lamivudine's apparent clearance was 0.25 liter/h/kg at birth, doubling by 28 days. In the final model, age and weight were the only significant covariates for lamivudine clearance. While lamivudine is predominantly renally eliminat...

Research paper thumbnail of The pharmacokinetics and safety of zidovudine in the third trimester of pregnancy for women infected with human immunodeficiency virus and their infants: Phase I Acquired Immunodeficiency Syndrome Clinical Trials Group study (protocol 082)

American Journal of Obstetrics and Gynecology, 1993

Research paper thumbnail of Perinatal transmission of HIV: Recognition and treatment interventions

Current Infectious Disease Reports, 2001

Great strides have been made in the fight against vertical transmission of HIV-1. Improved unders... more Great strides have been made in the fight against vertical transmission of HIV-1. Improved understanding of mechanisms and timing of transmission of HIV-1 from mother to child have led to the development of effective intervention strategies that have reduced transmission rates to unprecedented low levels, below 2% in developed countries. New reports using shortened, more affordable courses of antiretrovirals prenatally or at the time of delivery have also shown a significant reduction in transmission, over 50% in studies conducted in the developing world. These advances, combined with ongoing studies using simplified effective treatment regimens, have made possible the potential to significantly reduce perinatal transmission worldwide. Future challenges include reduction of breast feeding transmission and the development of an effective HIV-1 vaccine to produce long-lasting protection.

Research paper thumbnail of LabMed21 ITUXH

Research paper thumbnail of Lymphoproliferative Response of Persons with Frequently Recurring HSV-2 Genital Infections

In a randomized double-blinded fashion, herpes simplex virus type 2 specific lymphocyte prolifera... more In a randomized double-blinded fashion, herpes simplex virus type 2 specific lymphocyte proliferation (HSV-2-LP) was studied in patients with frequently recurring genital HSV-2 who were administered daily suppressive oral acyclovir (S-ACV) or placebo and acyclovir for 5 d (PLC/ACV) with recurrences. The pretreatment HSV-2-LP of subjects was low compared with that of controls with infrequently recurring genital HSV-2(54,000vs. 110,000 cpm). The HSV-2-LP increased with both S-ACV and PLC/ACV (101,000 and 94,000 cpm, respectively).After treatment was stopped, the HSV-2-LP decreased in both groups (59,000 cpm). Similar data were seen in a subpopulation given a second year of S-ACV. HSV recurrences were reduced in the S-ACV but not in the PLC/ACV group. These data sug-gest that a low HSV-2-LP in untreated patients is associated with frequent recurrences of genital HSV; a reduction of viral antigens by suppression with ACV or early treatment of HSV recurrences augments the HSV-2-LP respon...

Research paper thumbnail of Congenital CMV and HIV Perinatal Transmission

The Pediatric infectious disease journal, Jan 9, 2018

Congenital cytomegalovirus (CMV) infection (cCMV) is an important cause of hearing loss and cogni... more Congenital cytomegalovirus (CMV) infection (cCMV) is an important cause of hearing loss and cognitive impairment. Prior studies suggest that HIV-exposed children are at higher risk of acquiring cCMV. We assessed the presence, magnitude, and risk factors associated with cCMV among infants born to HIV-infected women, who were not receiving antiretrovirals during pregnancy. cCMV and urinary CMV load were determined in a cohort of infants born to HIV-infected women not receiving antiretrovirals during pregnancy. Neonatal urines obtained at birth were tested for CMV DNA by qualitative and reflex quantitative real-time PCR. Urine specimens were available for 992 (58.9%) of 1684 infants; 64 (6.5%) were CMV-positive. Mean CMV load (VL) was 470,276 copies/ml (range: <200-2,000,000 copies/ml). Among 89 HIV-infected infants, 16 (18%) had cCMV versus 42 (4.9%) of 858 HIV-exposed, uninfected infants (p <0.0001). cCMV was present in 23.2% of infants with in utero and 9.1% infants with intra...

Research paper thumbnail of Syphilis in HIV-Infected Mothers and Infants

The Pediatric Infectious Disease Journal, 2014

Background-Untreated syphilis during pregnancy is associated with spontaneous abortion, stillbirt... more Background-Untreated syphilis during pregnancy is associated with spontaneous abortion, stillbirth, prematurity and infant mortality. Syphilis may facilitate HIV transmission, which is especially concerning in low and middle income countries where both diseases are common. Methods-We performed an analysis of data available from NICHD/HPTN 040 (P1043), a study focused on the prevention of intrapartum HIV transmission to 1684 infants born to 1664 untreated HIV-infected women. The present analysis evaluates risk factors and outcomes associated with a syphilis diagnosis in this cohort of HIV-infected women and their infants. Results-Approximately 10% (n=171) of women enrolled had serological evidence of syphilis without adequate treatment documented and 1.4% (n=24) infants were dually HIV and syphilis infected. Multivariate logistic analysis showed that compared to HIV-infected women, co-infected women were significantly more likely to self-identify as non-white (AOR 2.5, 95% CI 1.5-4.2), to consume alcohol during pregnancy (AOR 1.5, 95% CI 1.1-2.1) and to transmit HIV to their infants (AOR 2.1, 95% CI 1.3-3.4), with 88% of HIV infections being acquired in-utero. As compared to HIV infected or HIV exposed infants, co-infected infants were significantly more likely to be born to mothers with VDRL titers ≥1:16 (AOR 3, 95% CI 1.1-8.2) and higher viral loads (AOR 1.5 95% CI 1.1-1.9). Of 6 newborns with symptomatic syphilis, 2 expired shortly after birth, and 2 were HIV-infected. Conclusion-Syphilis continues to be a common co-infection in HIV-infected women and can facilitate in utero transmission of HIV to infants. Most infants are asymptomatic at birth, but those with symptoms have high mortality rates.

Research paper thumbnail of In Vitro Insulin-Like Growth Factor-I, Growth Hormone, and Insulin Resistance Occurs in Symptomatic Human Immunodeficiency Virus-1–Infected Children

Research paper thumbnail of Prednisone Improves Human Immunodeficiency Virus Encephalopathy in Children

The Pediatric Infectious Disease Journal, 1992

Research paper thumbnail of Ontogeny of phytohemagglutinin-induced gamma interferon by leukocytes of healthy infants and children: Evidence for decreased production in infants younger than 2 months of age

The Journal of Pediatrics, 1987

Research paper thumbnail of Pharmacokinetics and Safety of Nelfinavir When Used in Combination with Zidovudine and Lamivudine in HIV-Infected Pregnant Women: Pediatric AIDS Clinical Trials Group (PACTG) Protocol 353

HIV Clinical Trials, 2008

Research paper thumbnail of Pediatric HIV1???Specific Cytotoxic T-Lymphocyte Responses Suggesting Ongoing Viral Replication Despite Combination Antiretroviral Therapy

Research paper thumbnail of Cellular and humoral immune responses to a tetanus toxoid booster in perinatally HIV-1-infected children and adolescents receiving highly active antiretroviral therapy (HAART)

European Journal of Pediatrics, 2006

Human immunodeficiency virus type 1 (HIV-1) infected children treated with highly active antiretr... more Human immunodeficiency virus type 1 (HIV-1) infected children treated with highly active antiretroviral therapy (HAART) may develop a significant reduction of plasma viremia associated with an increase in CD4+ T-cell counts. Functional capacity of this reconstituted immune system in response to recall antigens is important to maintain protective immunity to vaccine-preventable diseases. We therefore determined cellular and humoral immune responses to tetanus toxoid (TT) booster in perinatally HIV-1-infected children and adolescents receiving HAART. Immune responses were prospectively evaluated pre- and post-tetanus booster using lymphocyte proliferation assay (LPA) stimulation index (SI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 3.0) and tetanus antibody (TAb &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 0.15) in 15 patients. The median interval from primary tetanus immunization series was 6 years (range 2-12 years). We compared patients by their virological response to HAART (complete responders, CR, n=7; incomplete responders, ICR, n=8). There were no significant differences in median age 12.6 years (CR: 12.9; ICR: 10.6) or median CD4 T-cell pre-booster (CR: 35%/819; ICR: 26%/429) between groups. Tetanus LPA responses were observed in one patient prior to booster and in seven patients post-booster. In contrast, 38% of patients had protective TAb pre-booster, but 92% developed protective TAb post-booster. All of the CR and 5/6 ICR patients developed protective TAb. HIV-1-infected children and adolescents had modest LPA responses to tetanus following booster, similar to HIV-1-infected adults. However, the majority of patients developed protective TAb levels after booster and maintained the response. Shorter intervals may need to be considered for TT immunization boosters in HIV-1-infected pediatric patients, as only 38% had protective TAb at baseline.

Research paper thumbnail of Recovery of Replication‐Competent Virus from CD4 T Cell Reservoirs and Change in Coreceptor Use in Human Immunodeficiency Virus Type 1–Infected Children Responding to Highly Active Antiretroviral Therapy

The Journal of Infectious Diseases, 2000

Highly active antiretroviral therapy (HAART) suppresses plasma viremia in most patients with huma... more Highly active antiretroviral therapy (HAART) suppresses plasma viremia in most patients with human immunodeficiency virus (HIV) infection. Prospective study of HIV-infected children () shows that, in 8 of 12 who responded to HAART (у0.5 log reduction in plasma n p 27 HIV RNA), HAART restricted the number of coreceptors used by the predominant HIV isolate (mean number of coreceptors used at baseline was 4, vs. 1 coreceptor used at 6 months after treatment). This decrease was most striking in 6 of 8 children whose HIV coreceptor tropism changed from X4-tropic at baseline to R5-tropic. In 6 of 10 children tested, with plasma HIV RNA levels of !50 copies/mL, R5-tropic virus was isolated from CD4 T cell reservoirs. All the responding children had a significant increase in naive CD4 T cells (P !). These results show that persistent HIV T cell reservoirs are present in children and that .05 HAART may influence the number and type of coreceptors used by the predominant virus isolate. Highly active antiretroviral therapy (HAART) has been shown to completely suppress human immunodeficiency virus (HIV) type 1 plasma viremia and to increase CD4 T cell counts in 40%-80% of infected children and adults [1-5]. Increases in CD4 T cell counts also have been observed in some patients with modest reductions in plasma virus load [6]. The reason for this discordance in response is unclear. In HIV-1-infected adults with sustained suppression of plasma virus, latent HIV can be recovered from their resting CD4 T cell reservoirs [7, 8]. The presence of inducible HIV T cell reservoirs currently is not known in children. HIV uses CC-chemokine receptors, as well as CD4, for entry

Research paper thumbnail of Immune complex-dissociated p24 antigenemia in the diagnosis of human immunodeficiency virus infection in vertically infected Brazilian children

The Pediatric Infectious Disease Journal, 1995

A retrospective cohort study evaluated the presence of immune complex-dissociated (ICD) p24 antig... more A retrospective cohort study evaluated the presence of immune complex-dissociated (ICD) p24 antigen in frozen plasma samples of 40 children born to HIV-seropositive mothers and followed in the outpatient clinic of Gaffree-Guinle University Hospital. ICD has been helpful in the early diagnosis of infants born of HIV-seropositive mothers within the first 2 months of life. After testing all charts were reviewed for evidence of HIV-related clinical findings and determination of HIV serology until the child reached 24 months of age. The children were all born to HIV-infected Brazilian women between 1984 and 1992. 17 boys (mean age at first evaluation for HIV infection, 17.3 months) and 23 girls (mean age at first evaluation, 16.8 months) were included. Of the 17 boys, 9 were Caucasian and 8 were African-Brazilian; 11 girls were Caucasian and 12 were African-Brazilian. An immune complex disruption procedure was performed at the Universidade do Rio de Janeiro on 100-mcl aliquots of serial ...

Research paper thumbnail of Chlamydia trachomatis and Neisseria gonorrhoeae Infections Among Men and Women Entering California Prisons

American Journal of Public Health, 2006

Objective. We estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infecti... more Objective. We estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection among newly arriving inmates at 6 California prisons. Methods. In this cross-sectional study in 1999, urine specimens collected from 698 men aged 18 to 25 years and 572 women aged 18 years or older were tested at intake for C trachomatis and N gonorrhoeae using ligase chain reaction. An analysis of demographic and arrest-related correlates of C trachomatis and N gonorrhoeae infection was performed. Results. The overall C trachomatis prevalence was 9.9% (95% CI = 7.8%, 12.3%) among men aged 18 to 25 years, 8.9% (95% CI = 2.9%, 22.1%) among women aged 18 to 25 years, and 3.3% (95% CI = 2.0%, 5.1%) among women overall. Three N gonorrhoeae cases were detected with an overall prevalence of 0.24% (95% CI = 0.05%, 0.69%). Conclusions. The prevalence of C trachomatis infection at entry to California prisons, especially among young female and male inmates, was high, which supports routine screening at entry into prison. In addition, screening in a jail setting where most detainees are incarcerated before entry into the prison setting may provide an excellent earlier opportunity to identify these infections and treat disease to prevent complications and burden of infection in this high-risk population.

Research paper thumbnail of Zidovudine for mother, fetus, and child

Research paper thumbnail of HIV clearance in an infant?

Research paper thumbnail of Perinatal transmission of HIV: Recognition and treatment interventions

Current Infectious Disease Reports, 2001

Great strides have been made in the fight against vertical transmission of HIV-1. Improved unders... more Great strides have been made in the fight against vertical transmission of HIV-1. Improved understanding of mechanisms and timing of transmission of HIV-1 from mother to child have led to the development of effective intervention strategies that have reduced transmission rates to unprecedented low levels, below 2% in developed countries. New reports using shortened, more affordable courses of antiretrovirals prenatally or at the time of delivery have also shown a significant reduction in transmission, over 50% in studies conducted in the developing world. These advances, combined with ongoing studies using simplified effective treatment regimens, have made possible the potential to significantly reduce perinatal transmission worldwide. Future challenges include reduction of breast feeding transmission and the development of an effective HIV-1 vaccine to produce long-lasting protection.

Research paper thumbnail of Hepatitis Viruses

Congenital and Perinatal Infections, 2006

The hepatitis viruses are a diverse group that has as their common feature the liver as their pri... more The hepatitis viruses are a diverse group that has as their common feature the liver as their primary target of infection. They come from several families of viruses, cause infection via different mechanisms, and have a variety of clinical manifestations. The differential diagnosis for hepatitis in pregnancy includes other viruses (cytomegalovirus, Epstein-Barr virus), toxic exposures (acetaminophen), autoimmune disease (e.g., systemic lupus erythematosus), and other entities unique to pregnancy (e.g., HELLP [hemolysis, elevated liver enzymes, and low platelet count]).

Research paper thumbnail of Population Pharmacokinetics of Lamivudine in Human Immunodeficiency Virus-Exposed and -Infected Infants

Antimicrobial Agents and Chemotherapy, 2007

This study aimed to determine lamivudine disposition in infants and to construct an appropriate d... more This study aimed to determine lamivudine disposition in infants and to construct an appropriate dose adjustment for age, given the widespread use of lamivudine for both the prevention of mother-to-child transmission of human immunodeficiency virus (HIV) and the treatment of HIV-infected infants. Using a pooled-population approach, the pharmacokinetics of lamivudine in HIV-exposed or -infected infants from four Pediatric AIDS Clinical Trials Group studies were assessed. Ninety-nine infants provided 559 plasma samples for measurement of lamivudine concentrations. All infants received combination antiretroviral therapy including lamivudine dosed at 2 mg/kg of body weight every 12 h (q12h) for the first 4 to 6 weeks of life and at 4 mg/kg q12h thereafter. Lamivudine's apparent clearance was 0.25 liter/h/kg at birth, doubling by 28 days. In the final model, age and weight were the only significant covariates for lamivudine clearance. While lamivudine is predominantly renally eliminat...

Research paper thumbnail of The pharmacokinetics and safety of zidovudine in the third trimester of pregnancy for women infected with human immunodeficiency virus and their infants: Phase I Acquired Immunodeficiency Syndrome Clinical Trials Group study (protocol 082)

American Journal of Obstetrics and Gynecology, 1993

Research paper thumbnail of Perinatal transmission of HIV: Recognition and treatment interventions

Current Infectious Disease Reports, 2001

Great strides have been made in the fight against vertical transmission of HIV-1. Improved unders... more Great strides have been made in the fight against vertical transmission of HIV-1. Improved understanding of mechanisms and timing of transmission of HIV-1 from mother to child have led to the development of effective intervention strategies that have reduced transmission rates to unprecedented low levels, below 2% in developed countries. New reports using shortened, more affordable courses of antiretrovirals prenatally or at the time of delivery have also shown a significant reduction in transmission, over 50% in studies conducted in the developing world. These advances, combined with ongoing studies using simplified effective treatment regimens, have made possible the potential to significantly reduce perinatal transmission worldwide. Future challenges include reduction of breast feeding transmission and the development of an effective HIV-1 vaccine to produce long-lasting protection.

Research paper thumbnail of LabMed21 ITUXH

Research paper thumbnail of Lymphoproliferative Response of Persons with Frequently Recurring HSV-2 Genital Infections

In a randomized double-blinded fashion, herpes simplex virus type 2 specific lymphocyte prolifera... more In a randomized double-blinded fashion, herpes simplex virus type 2 specific lymphocyte proliferation (HSV-2-LP) was studied in patients with frequently recurring genital HSV-2 who were administered daily suppressive oral acyclovir (S-ACV) or placebo and acyclovir for 5 d (PLC/ACV) with recurrences. The pretreatment HSV-2-LP of subjects was low compared with that of controls with infrequently recurring genital HSV-2(54,000vs. 110,000 cpm). The HSV-2-LP increased with both S-ACV and PLC/ACV (101,000 and 94,000 cpm, respectively).After treatment was stopped, the HSV-2-LP decreased in both groups (59,000 cpm). Similar data were seen in a subpopulation given a second year of S-ACV. HSV recurrences were reduced in the S-ACV but not in the PLC/ACV group. These data sug-gest that a low HSV-2-LP in untreated patients is associated with frequent recurrences of genital HSV; a reduction of viral antigens by suppression with ACV or early treatment of HSV recurrences augments the HSV-2-LP respon...

Research paper thumbnail of Congenital CMV and HIV Perinatal Transmission

The Pediatric infectious disease journal, Jan 9, 2018

Congenital cytomegalovirus (CMV) infection (cCMV) is an important cause of hearing loss and cogni... more Congenital cytomegalovirus (CMV) infection (cCMV) is an important cause of hearing loss and cognitive impairment. Prior studies suggest that HIV-exposed children are at higher risk of acquiring cCMV. We assessed the presence, magnitude, and risk factors associated with cCMV among infants born to HIV-infected women, who were not receiving antiretrovirals during pregnancy. cCMV and urinary CMV load were determined in a cohort of infants born to HIV-infected women not receiving antiretrovirals during pregnancy. Neonatal urines obtained at birth were tested for CMV DNA by qualitative and reflex quantitative real-time PCR. Urine specimens were available for 992 (58.9%) of 1684 infants; 64 (6.5%) were CMV-positive. Mean CMV load (VL) was 470,276 copies/ml (range: <200-2,000,000 copies/ml). Among 89 HIV-infected infants, 16 (18%) had cCMV versus 42 (4.9%) of 858 HIV-exposed, uninfected infants (p <0.0001). cCMV was present in 23.2% of infants with in utero and 9.1% infants with intra...

Research paper thumbnail of Syphilis in HIV-Infected Mothers and Infants

The Pediatric Infectious Disease Journal, 2014

Background-Untreated syphilis during pregnancy is associated with spontaneous abortion, stillbirt... more Background-Untreated syphilis during pregnancy is associated with spontaneous abortion, stillbirth, prematurity and infant mortality. Syphilis may facilitate HIV transmission, which is especially concerning in low and middle income countries where both diseases are common. Methods-We performed an analysis of data available from NICHD/HPTN 040 (P1043), a study focused on the prevention of intrapartum HIV transmission to 1684 infants born to 1664 untreated HIV-infected women. The present analysis evaluates risk factors and outcomes associated with a syphilis diagnosis in this cohort of HIV-infected women and their infants. Results-Approximately 10% (n=171) of women enrolled had serological evidence of syphilis without adequate treatment documented and 1.4% (n=24) infants were dually HIV and syphilis infected. Multivariate logistic analysis showed that compared to HIV-infected women, co-infected women were significantly more likely to self-identify as non-white (AOR 2.5, 95% CI 1.5-4.2), to consume alcohol during pregnancy (AOR 1.5, 95% CI 1.1-2.1) and to transmit HIV to their infants (AOR 2.1, 95% CI 1.3-3.4), with 88% of HIV infections being acquired in-utero. As compared to HIV infected or HIV exposed infants, co-infected infants were significantly more likely to be born to mothers with VDRL titers ≥1:16 (AOR 3, 95% CI 1.1-8.2) and higher viral loads (AOR 1.5 95% CI 1.1-1.9). Of 6 newborns with symptomatic syphilis, 2 expired shortly after birth, and 2 were HIV-infected. Conclusion-Syphilis continues to be a common co-infection in HIV-infected women and can facilitate in utero transmission of HIV to infants. Most infants are asymptomatic at birth, but those with symptoms have high mortality rates.

Research paper thumbnail of In Vitro Insulin-Like Growth Factor-I, Growth Hormone, and Insulin Resistance Occurs in Symptomatic Human Immunodeficiency Virus-1–Infected Children

Research paper thumbnail of Prednisone Improves Human Immunodeficiency Virus Encephalopathy in Children

The Pediatric Infectious Disease Journal, 1992

Research paper thumbnail of Ontogeny of phytohemagglutinin-induced gamma interferon by leukocytes of healthy infants and children: Evidence for decreased production in infants younger than 2 months of age

The Journal of Pediatrics, 1987

Research paper thumbnail of Pharmacokinetics and Safety of Nelfinavir When Used in Combination with Zidovudine and Lamivudine in HIV-Infected Pregnant Women: Pediatric AIDS Clinical Trials Group (PACTG) Protocol 353

HIV Clinical Trials, 2008

Research paper thumbnail of Pediatric HIV1???Specific Cytotoxic T-Lymphocyte Responses Suggesting Ongoing Viral Replication Despite Combination Antiretroviral Therapy

Research paper thumbnail of Cellular and humoral immune responses to a tetanus toxoid booster in perinatally HIV-1-infected children and adolescents receiving highly active antiretroviral therapy (HAART)

European Journal of Pediatrics, 2006

Human immunodeficiency virus type 1 (HIV-1) infected children treated with highly active antiretr... more Human immunodeficiency virus type 1 (HIV-1) infected children treated with highly active antiretroviral therapy (HAART) may develop a significant reduction of plasma viremia associated with an increase in CD4+ T-cell counts. Functional capacity of this reconstituted immune system in response to recall antigens is important to maintain protective immunity to vaccine-preventable diseases. We therefore determined cellular and humoral immune responses to tetanus toxoid (TT) booster in perinatally HIV-1-infected children and adolescents receiving HAART. Immune responses were prospectively evaluated pre- and post-tetanus booster using lymphocyte proliferation assay (LPA) stimulation index (SI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 3.0) and tetanus antibody (TAb &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 0.15) in 15 patients. The median interval from primary tetanus immunization series was 6 years (range 2-12 years). We compared patients by their virological response to HAART (complete responders, CR, n=7; incomplete responders, ICR, n=8). There were no significant differences in median age 12.6 years (CR: 12.9; ICR: 10.6) or median CD4 T-cell pre-booster (CR: 35%/819; ICR: 26%/429) between groups. Tetanus LPA responses were observed in one patient prior to booster and in seven patients post-booster. In contrast, 38% of patients had protective TAb pre-booster, but 92% developed protective TAb post-booster. All of the CR and 5/6 ICR patients developed protective TAb. HIV-1-infected children and adolescents had modest LPA responses to tetanus following booster, similar to HIV-1-infected adults. However, the majority of patients developed protective TAb levels after booster and maintained the response. Shorter intervals may need to be considered for TT immunization boosters in HIV-1-infected pediatric patients, as only 38% had protective TAb at baseline.

Research paper thumbnail of Recovery of Replication‐Competent Virus from CD4 T Cell Reservoirs and Change in Coreceptor Use in Human Immunodeficiency Virus Type 1–Infected Children Responding to Highly Active Antiretroviral Therapy

The Journal of Infectious Diseases, 2000

Highly active antiretroviral therapy (HAART) suppresses plasma viremia in most patients with huma... more Highly active antiretroviral therapy (HAART) suppresses plasma viremia in most patients with human immunodeficiency virus (HIV) infection. Prospective study of HIV-infected children () shows that, in 8 of 12 who responded to HAART (у0.5 log reduction in plasma n p 27 HIV RNA), HAART restricted the number of coreceptors used by the predominant HIV isolate (mean number of coreceptors used at baseline was 4, vs. 1 coreceptor used at 6 months after treatment). This decrease was most striking in 6 of 8 children whose HIV coreceptor tropism changed from X4-tropic at baseline to R5-tropic. In 6 of 10 children tested, with plasma HIV RNA levels of !50 copies/mL, R5-tropic virus was isolated from CD4 T cell reservoirs. All the responding children had a significant increase in naive CD4 T cells (P !). These results show that persistent HIV T cell reservoirs are present in children and that .05 HAART may influence the number and type of coreceptors used by the predominant virus isolate. Highly active antiretroviral therapy (HAART) has been shown to completely suppress human immunodeficiency virus (HIV) type 1 plasma viremia and to increase CD4 T cell counts in 40%-80% of infected children and adults [1-5]. Increases in CD4 T cell counts also have been observed in some patients with modest reductions in plasma virus load [6]. The reason for this discordance in response is unclear. In HIV-1-infected adults with sustained suppression of plasma virus, latent HIV can be recovered from their resting CD4 T cell reservoirs [7, 8]. The presence of inducible HIV T cell reservoirs currently is not known in children. HIV uses CC-chemokine receptors, as well as CD4, for entry

Research paper thumbnail of Immune complex-dissociated p24 antigenemia in the diagnosis of human immunodeficiency virus infection in vertically infected Brazilian children

The Pediatric Infectious Disease Journal, 1995

A retrospective cohort study evaluated the presence of immune complex-dissociated (ICD) p24 antig... more A retrospective cohort study evaluated the presence of immune complex-dissociated (ICD) p24 antigen in frozen plasma samples of 40 children born to HIV-seropositive mothers and followed in the outpatient clinic of Gaffree-Guinle University Hospital. ICD has been helpful in the early diagnosis of infants born of HIV-seropositive mothers within the first 2 months of life. After testing all charts were reviewed for evidence of HIV-related clinical findings and determination of HIV serology until the child reached 24 months of age. The children were all born to HIV-infected Brazilian women between 1984 and 1992. 17 boys (mean age at first evaluation for HIV infection, 17.3 months) and 23 girls (mean age at first evaluation, 16.8 months) were included. Of the 17 boys, 9 were Caucasian and 8 were African-Brazilian; 11 girls were Caucasian and 12 were African-Brazilian. An immune complex disruption procedure was performed at the Universidade do Rio de Janeiro on 100-mcl aliquots of serial ...

Research paper thumbnail of Chlamydia trachomatis and Neisseria gonorrhoeae Infections Among Men and Women Entering California Prisons

American Journal of Public Health, 2006

Objective. We estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infecti... more Objective. We estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection among newly arriving inmates at 6 California prisons. Methods. In this cross-sectional study in 1999, urine specimens collected from 698 men aged 18 to 25 years and 572 women aged 18 years or older were tested at intake for C trachomatis and N gonorrhoeae using ligase chain reaction. An analysis of demographic and arrest-related correlates of C trachomatis and N gonorrhoeae infection was performed. Results. The overall C trachomatis prevalence was 9.9% (95% CI = 7.8%, 12.3%) among men aged 18 to 25 years, 8.9% (95% CI = 2.9%, 22.1%) among women aged 18 to 25 years, and 3.3% (95% CI = 2.0%, 5.1%) among women overall. Three N gonorrhoeae cases were detected with an overall prevalence of 0.24% (95% CI = 0.05%, 0.69%). Conclusions. The prevalence of C trachomatis infection at entry to California prisons, especially among young female and male inmates, was high, which supports routine screening at entry into prison. In addition, screening in a jail setting where most detainees are incarcerated before entry into the prison setting may provide an excellent earlier opportunity to identify these infections and treat disease to prevent complications and burden of infection in this high-risk population.