RESUMO -O envolvimento do sistema nervoso central SNC na infecção pelo HIV-1 em crianças pode estar evidente desde o início ou demorar muitos anos para se manifestar. Microcefalia, rebaixamento cognitivo, sinais piramidais, distúrbios do humor e do comportamento e complicações pelo uso da terapia antire t ro v i r a l são comuns. Este é um trabalho observacional, descritivo e seccional cuja finalidade é descrever as alterações do exame neurológico em um grupo de crianças e adolescentes expostos pelo HIV-1 durante o período perinatal. Foram avaliados 173 pacientes. Muitos pacientes tinham superposição de alterações de exame n e u rológico e/ou mais de um diagnóstico. As alterações mais comuns foram: re t a rdo do desenvolvimento n e u ro p s i c o m o t o r, atraso de linguagem, deficiência mental, síndrome piramidal, hiporreflexia. O exame n e u rológico foi alterado em 67% dos casos, mesmo naqueles pacientes soro -re v e rtidos. Sugerimos que e x i s t e alto risco para doença neurológica nesse grupo de pacientes e que a pro g ressão da infecção pelo HIV-1 a c e ntua o aparecimento de co-morbidades e comprometimento de seu prognóstico.PALAVRAS-CHAVE: HIV-1, sistema nervoso, exame neurológico.Neurological findings in a group of children and adolescents exposed and infected by HIV-1ABSTRACT -The CNS infection by HIV-1 in infancy could be present immediately after infection or became manifest later. Microcephalia, mental re t a rdation, pyramidal signs, humor and behavioral disorders and a n t i re t roviral therapy complications are common. This is an observational, sectional and descriptive study about findings on neurological examination of 173 patients in a group of children and adolescents infected and exposed to HIV-1 in perinatal period. Most of them had more than one neurological finding or diff e re n t diagnosis. The more common findings were: encephalopathy, mental re t a rdation, language d e l a y, pyramidal signs, hyporreflexia. The neurological examination was abnormal in 67% of all patients even in soro re v e rt e r s . We sugest that this group has a high risk to neurological disease and the development of co-morbidity is directly correlated to clinical deterioration by HIV-1 infection.KEY WORDS: HIV-1,nervous system, neurological examination.Durante os primeiros anos da epidemia de SIDA, a encefalopatia foi considerada uma das manifestações precoces da doença, acreditando-se que era mais comum na infância. Atualmente, após o estudo de duas grandes coortes, uma francesa 1 e outra a m e r i c a n a 2 , verificou-se que a pro g ressão dos sintomas definidores de SIDA no primeiro ano de vida era de 19% e 4,5% ao ano, respectivamente e, a posteriori, muito menor do que descrita no passado, p rovavelmente devido ao diagnóstico precoce da infecção e conseqüente intervenção terapêutica 3 , 4 . No lactente jovem, a encefalopatia pelo HIV-1 é, p rovavelmente, conseqüência direta da ação do víru s em um cére b ro em desenvolvimento, o que poderia justificar a diferença de evolução clínica entre adultos ...
This study explored the experiences of the first generation of adolescents who acquired HIV through vertical transmission when disclosing their diagnosis to friends and romantic partners. The study sample was selected by convenience, with 20 patients (13-20 years old) participating in a qualitative investigation using individual interviews (language: Portuguese; duration: 45 minutes). The participants were followed in specialized clinics for the treatment of pediatric AIDS in São Paulo, Brazil. The results suggest that families who live with HIV tend to keep it a secret, and such behavior is learned and accepted unquestioningly as natural. Respect for privacy and the fear of rejection, coupled with the belief that information about their disease will be spread, are the main beliefs with which participants justify their secrecy. In terms of romantic relationships, adolescents were aware that their HIV status should at some point be shared with current or future sexual partners. However, the decision to reveal an HIV diagnosis in romantic relationships is permeated by anxieties, uncertainties about the right time, and fear of abandonment. In any case, telling the truth requires trust, guarantees of the other's love, and, in some cases, probing romantic partners beforehand to learn their perceptions about the disease. Participants who had experiences disclosing their HIV status shared positive and negative results, including emotional support, acceptance, and understanding, along with ostracism, discrimination, and abandonment by family members. The findings of this paper reinforce the challenges of revealing an HIV diagnosis to third parties. It requires understanding the meaning and importance of the secret for each patient, along with the conflict between the right to confidentiality and the responsibility of treating others exposed to the disease. All these aspects should be discussed extensively with this population and incorporated into clinical practice.
Treatment of HIV-1 infection with highly active antiretroviral therapy has led to sustained viral suppression in the plasma in a large number of children. However, studies have suggested that the integrated provirus in resting CD4+ T lymphocytes could be a source of reactivatable virus and maintain drug-resistant virus. We evaluated the resistance-related mutations in children receiving antiretroviral therapy with prolonged viral suppression. Thirty-two peripheral blood mononuclear cell samples from 16 children with viral loads that had been below detection limits for at least 12 months were obtained at two different time points and the DNAs sequenced. The median CD4 cell count was 1,016 cells/mm³ (347-2,588) and 938 cells/mm³ (440-3,038) at the first and second time points, respectively. The median follow-up time was 15 months (9-27). Six (37.5%) and seven (43.75%) of the 16 patients showed at least one NRTI-associated mutation in the first and second samples, respectively. Two out of 16 (12.5%) had an NNRTI-associated mutation at the first time point and three out of 16 (18.75%) at the second. In addition, 14 out of 16 (87.5%) had at least one PI-associated mutation at both time points. Despite plasma HIV-1 RNA suppression for at least 12 months, resistance-related mutations from previous antiretroviral failures could still be detected in archival virus. Furthermore, viral evolution occurred at the reverse transcriptase region in spite of viral suppression to levels below 400 copies/mL. Persistence of archival resistant virus may be relevant when considering future treatment options.
Treatment of HIV-1 infection with highly active antiretroviral therapy has led to sustained viral suppression in the plasma in a large number of children. However, studies have suggested that the integrated provirus in resting CD4+ T lymphocytes could be a source of reactivatable virus and maintain drug-resistant virus. We evaluated the resistance-related mutations in children receiving antiretroviral therapy with prolonged viral suppression. Thirty-two peripheral blood mononuclear cell samples from 16 children with viral loads that had been below detection limits for at least 12 months were obtained at two different time points and the DNAs sequenced. The median CD4 cell count was 1,016 cells/ mm 3 (347-2,588) and 938 cells/mm 3 (440-3,038) at the fi rst and second time points, respectively. The median follow-up time was 15 months (9-27). Six (37.5%) and seven (43.75%) of the 16 patients showed at least one NRTI-associated mutation in the fi rst and second samples, respectively. Two out of 16 (12.5%) had an NNRTI-associated mutation at the fi rst time point and three out of 16 (18.75%) at the second. In addition, 14 out of 16 (87.5%) had at least one PI-associated mutation at both time points. Despite plasma HIV-1 RNA suppression for at least 12 months, resistance-related mutations from previous antiretroviral failures could still be detected in archival virus. Furthermore, viral evolution occurred at the reverse transcriptase region in spite of viral suppression to levels below 400 copies/ mL. Persistence of archival resistant virus may be relevant when considering future treatment options.
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