Many PHIVYAs achieve adult milestones related to school, employment, sexual relationships, and starting families. However, they and PHEUYAs have high rates of psychiatric and substance use disorders and behavioral risks, which can jeopardize long-term health and adult functioning, particularly in the context of HIV. These findings underscore an urgent need to escalate interventions.

Background Varicella vaccine is now frequently administered to HIV-infected children who remain relatively healthy because it has been shown to be safe and immunogenic, but its effectiveness for this population remains unknown. Methods The effectiveness of varicella vaccine in preventing varicella and/or herpes zoster in HIVinfected children was assessed by chart review at two pediatric academic medical centers. These children had proven HIV infection, were receiving antiretroviral therapy, and were closely monitored between 1989 and 2007. Records were examined for immunologic data, antiretroviral therapy, varicella immunization, and the development of varicella or zoster. The vaccine's effectiveness for varicella and for zoster was calculated by subtracting from one, rate-ratios for the incidence rates of varicella or zoster in vaccinated vs. unvaccinated children. Results The effectiveness of varicella vaccine for preventing varicella was 82% (95% CI: 24%–99%; p = 0.01) and for preventing zoster was 100% (95% CI 67%–100%; p<0.001). When only those receiving highly active antiretroviral therapy (HAART) were included in this analysis (to assess effectiveness of vaccine independent of the effect of HAART), the vaccine's effectiveness against zoster was 100% (95% CI: 63%–100%; p=0.001). Conclusion Varicella vaccine is highly effective in preventing both varicella and zoster in HIV-infected children.

Antiretroviral therapy (ART) is associated with dyslipidemia and cardiovascular disease in adults infected with HIV. For children perinatally infected with HIV, ART exposure is lifelong and early-onset dyslipidemia could have significant long-term effects. We examined cholesterol levels in children during the first year after exposure to a new ART regimen (initiation or switch). In 52 children, total cholesterol increased by 30.5 and 43 mg/dL at 6 and 12 months, respectively (P < 0.001). Low-density lipoprotein cholesterol made the largest contribution, but high-density lipoprotein cholesterol also increased within months of therapy alteration. Early identification of these children and intervention could mediate potential increased risk for future cardiovascular disease.