To identify missed opportunities in HIV prevention, diagnosis, and linkage to care, we enrolled 183 hospitalized, HIV-infected, ART-naïve Kenyan children 0-12 years from four hospitals in Nairobi and Kisumu, and reviewed prevention of mother-to-child transmission of HIV (PMTCT), hospitalization, and HIV testing history. Median age was 1.8 years (IQR = 0.8, 4.5). Most mothers received HIV testing during pregnancy (77%). Among mothers tested, 60% and 40% reported HIV-negative and positive results, respectively; 33% of HIV-diagnosed mothers did not receive PMTCT antiretrovirals. First missed opportunities for pediatric diagnosis and linkage were due to failure to test mothers (23.1%), maternal HIV acquisition following initial negative test (45.7%), no early infant diagnosis (EID) or provider-initiated testing (PITC) (12.7%), late breastfeeding transmission (8.7%), failure to collect child HIV test results (1.2%), and no linkage to care following HIV diagnosis (8.7%). Among previously hospitalized children, 38% never received an HIV test. Strengthening initial and repeat maternal HIV testing and PITC are key interventions to prevent, detect, and treat pediatric HIV infections.

BackgroundInfant HIV infection is associated with delayed milestone attainment. The extent to which effective antiretroviral therapy (ART) prevents these delays is not well defined.MethodsAges at attainment of milestones were compared between HIV-infected (initiated ART by age <5 months), and HIV-unexposed uninfected (HUU) infants. Kaplan Meier analyses were used to estimate and compare (log-rank tests) ages at milestones between groups. Adjusted analyses were performed using Cox proportional hazards models.ResultsSeventy-three HIV-infected on ART (median enrollment age 3.7 months) and 92 HUU infants (median enrollment age 1.6 months) were followed prospectively. HIV-infected infants on ART had delays in developmental milestone attainment compared to HUU: median age at attainment of sitting with support, sitting unsupported, walking with support, walking unsupported, monosyllabic speech and throwing toys were each delayed (all p-values <0.0005). Compared with HUU, the subset of HIV-infected infants with both virologic suppression and immune recovery at 6 months had delays for speech (delay: 2.0 months; P = 0.0002) and trend to later walking unsupported. Among HIV-infected infants with poor 6-month post-ART responses (lacking viral suppression and immune recovery) there were greater delays versus HUU for: walking unsupported (delay: 4.0 months; P = 0.0001) and speech (delay: 5.0 months; P < 0.0001).ConclusionsHIV infected infants with viral suppression on ART had better recovery of developmental milestones than those without suppression, however, deficits persisted compared to uninfected infants. Earlier ART may be required for optimized cognitive outcomes in perinatally HIV-infected infants.Trial registration NCT00428116; January 22, 2007.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-017-0776-1) contains supplementary material, which is available to authorized users.

In early ART-treated HIV-infected infants, higher HIV RNA and wasting before ART were independent risk factors for pneumonia. Wood fuel use was associated with URI and pneumonia. Additional data on air pollution and respiratory outcomes in HIV-infected children may help optimize interventions to improve their lung health.

Children had significant neurodevelopmental gains during 6 months of ART, and children with better growth and immune recovery had greater improvement. Prompt commencement of ART may improve neurodevelopment in addition to immunity and growth.

Background: Few oral health studies have been conducted in HIV-exposed uninfected children, who, like their HIV-infected peers, have altered immunity and perinatal drug exposures. Aim: To compare caregiver' self-report of oral diseases, hygiene practices and utilization of routine dental care, between HIV-infected (HIV), HIV-exposed uninfected (HEU), and HIV-unexposed uninfected (HUU) children in Kenya.

Background Cytomegalovirus (CMV) viremia is common in HIV infection, and is associated with worse long-term outcomes. To date, no studies have assessed CMV viremia in children diagnosed with HIV in hospital. Methods We studied CMV viremia and clinical outcomes in 163 Kenyan children aged 2 months-12 years, diagnosed with HIV in hospital. CMV DNA levels in plasma were measured using quantitative PCR. Regression models were used to assess associations between CMV viremia &gt;1000 IU/mL and the risk of continued hospitalization or death at 15 days, duration of hospitalization, and 6-month mortality. Results At enrollment, 62/114 (54%) children had CMV viremia, and 20 (32%) were &gt;1000 IU/mL. Eleven CMV reactivations were observed after admission. The prevalence and level of CMV viremia were highest in children &lt;2 years and lowest in children &gt;5 years old. CMV viremia &gt;1000 IU/mL was independently associated with age &lt; 2 years (p=0.03), higher log10 HIV RNA level (p=0.01), and height-for-age z score &lt;-2 (p=0.02). Adjusting for age and log10 HIV RNA, the relative risk of death or continued hospitalization at 15 days was 1.74 (95%CI=1.04, 2.90), and the hazard ratio of 6-month mortality was 1.97 (95%CI=0.57, 5.07) for children with CMV DNA ≥1000 IU/ml compared to lower-level or undetectable CMV DNA. Children with CMV DNA ≥1000 IU/ml were hospitalized a median ~5 days longer than children with lower-level or undetectable CMV DNA (p=0.002). Conclusions In this nested observational study, CMV viremia was common in hospitalized children with HIV, and levels ≥1000 IU/mL were associated with increased risk of mortality and longer hospitalization.

Genus Eucalyptus belongs to the family Myrtaceae and consists of more than 900 species, various hybrids and varieties. The major species that are grown in Kenya are Eucalyptus grandis, E. globulus, E. saligna and E. camaldulensis. Most Eucalyptus species are highly dependent on rainfall and this is challenged by climatic changes owing to global warming making it difficult to effectively match the availability of mature trees and the market demand especially for use as power transmission poles. With the widespread availability of other naturally occurring Eucalyptus species such as E. camaldulensis and E. globulus, it becomes important to determine the genetic diversity and to analyze the phenotypic traits of these species for suitability as power transmission poles in order to counter the overdependence on E. grandis. Phenotypic traits investigated included measuring total tree height and diameter at breast height (DBH), while molecular data were obtained from sequencing MatK, rbcL and TrnL-F genes from selected species and evolutionary analyses such as nucleotide substitution rates, base composition disparity indices, evolutionary divergence, nucleotide diversity indices and phylogeny construction were conducted in MEGA 11. Significant differences in DBH and height among Eucalyptus species were observed when the phenotypic data were subjected to ANOVA. In this study, E. robusta, E. paniculata, E. maculata, E. dunnii, E. camaldulensis and E. citriodora are fit to be used as power transmission poles but they are limited by their short height. However, E. tereticornis and E. glaucina have the desired DBH and height and hence can be used as substitutes for E.grandis. Generally, the molecular phylogeny study has shown that the studied Eucalyptus species are closely related and form various monophyletic clades which can be attributed to the short genetic distances, low substitution rates, low nucleotide bias disparity indices and low diversity scores. Further phylogenetic and gene expression studies involving more Eucalyptus species are needed to better understand Eucalyptus phylogeny, and diversity and identify species with similar genetic make-up to that of E. grandis which has been used extensively for the provision of electricity transmission poles.