Introduction: Indonesia is stated as one of Asia's fastest growing HIV epidemics, yet to date, studies on the characteristics of human immunodeficiency virus (HIV) infection, especially on Indonesian children, are very limited. Opportunistic infections, such as oral candidiasis have been an integral part of the disease and related to important diagnostic and prognostic values of the infection. The aim of this study was to determine the candidiasis profile of the Indonesian HIV-infected pediatric patients, and to correlate the clinical types of candidiasis with highly active antiretroviral therapy (HAART) use and the level of immune suppression. Material and methods: HIV-infected pediatric patients attending the Intermediate Care and Infectious Disease Centre (UPIPI), Dr. Soetomo Hospital outpatient clinic between June-October 2017 were examined intraorally for the presence of oral candidiasis. Identification of Candida species was based on colony morphology on CHROM-Agar, hydrolysis of urea, carbohydrate fermentation tests, thermotolerance test, and microscopic morphology on slide culture from oral swab samples. Other relevant data regarding each patient were also obtained from medical records. Results: Oral candidiasis was found in 55.17% patients, with 3 different clinical types: pseudomembranous (21.43%), erythematous (14.29%), and angular cheilitis (46.3%). There was a significant relationship between HAART with erythematous type (p < 0.05) and even stronger with the pseudomembranous type of Candida (p < 0.01). There was significant relationship between the level of immune suppression and pseudomembranous type (p < 0.05) and even stronger with the erythematous type (p < 0.01). Conclusions: Concurrent pseudomembranous and erythematous candidiasis may indicate advanced progression of HIV-infected pediatric patients, therefore further studies are required to validate our findings.

Introduction: Strikingly, more than 95% pediatric HIV infections worldwide are in developing countries.Although ART can reduce significantly the risk of HIV transmission to children born from HIV-infected mothers, this can be effective only if the women know their HIV status. In many developing countries, such as Indonesia, the lack of access by pregnant mothers to laboratory facilities may deprive them of knowing their HIV status, thus the opportunity to transmit the disease to their children is high, knowing no preventive intervention is attempted. To date, it is estimated that the number of HIV infected children in Indonesia who are left undiagnosed is still high, therefore a study on clinical markers of HIV that can aid in the diagnosis and predict the severity of the disease among children is critical. In this study, Linear Gingival Erythema is assessed on its correlation to degree of immune suppression to be used as HIV clinical marker in laboratorypoor settings in Indonesia. Method: HIV-infected children admitted to Soetomo General Hospital between June -October 2017 were screened and examined intraorally for the presence of LGE. Other relevant data were obtained from questionnaire-guided interview to parents/guardians and from patient's medical record. Results:LGE was found in 21.43% children and statistical analysis shows significant correlation of LGE to degree of immune suppression. Conclusion: Further study with larger study population size is required to analyze the sensitivity and specificity of LGE to be used as HIV marker in predicting a particular degree of immune suppression, specific to Indonesian pediatric population.

Background and Objectives: HIV enteropathy may cause disruption of the intestinal barrier, leading to a loss of CD4+ T cells, increased intestinal permeability, and microbial translocation. Lactobacillus plantarum IS-10506 has the ability to improve gut barrier function. This study investigated the effect of L. plantarum IS-10506 on a number of biomarkers of en- teropathy-related damage in HIV-infected paediatric patients undergoing antiretroviral therapy (ARV). Materials and Methods: A randomized, double-blind, placebo-controlled study was conducted on 2-18 year-old children, diagnosed as HIV infected according to the WHO 2007 criteria who had received ARV for ≥ 6 months. Subjects were exclud- ed if ARV therapy was discontinued or the patients took probiotics ≥ 2 weeks prior to the study or during the study period. Subjects were randomized into a probiotic group and placebo group. The probiotic group received L. plantarum IS-10506 2.86 × 1010  cfu/day for 6 days. Blood lipopolysaccharide (LPS) level, serum CD4+ T cell count, serum CD8+ T cell count, CD4+/CD8+ T cell ratio, and faecal sIgA level were assessed as biomarkers. Results: Twenty-one subjects completed this study. The blood LPS level decreased significantly in the probiotic group (p = 0.001). There was no significant difference in absolute CD4+ T cell count, percent CD4+ cells, absolute CD8+ T cell count, CD4+/CD8+ T cell ratio, or faecal sIgA. No serious adverse events were reported. Conclusion: The probiotic L. plantarum IS-10506 reduced the blood LPS level but showed no effect on the humoral mucosa and systemic immune response in HIV-infected children undergoing ARV therapy.

Objective: To investigate the correlation Cluster of Differentiation 4 + (CD4 +) counts with a high prevalence of dental caries in Children Living with Perinatal Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (CLWPHA). Material and Methods: An analytical observational research with a cross-sectional design was conducted at Tertiary General Hospital, Surabaya, Indonesia. Randomized total sampling consisted of 29 CLWPHA 1-12 years old at outpatient ward Infectious Disease Intermediate Unit (UPIPI) Tertiary General Hospital Doctor Soetomo Surabaya. Demographic details and recent CD4 + counts obtained from medical records. Decayed, missing, filled teeth (dmft) in primary teeth and DMFT in permanent teeth index were used. Pearson's and Spearman's Correlation test (p<0.05) were performed. Results: Dental caries prevalence was 86.2%; meanwhile, the dmft/DMFT index score found were high (8.2 / 6.3). CD4 + count and caries showed significant correlation (r=-0.394, p<0.05). Tooth brushing frequency with caries showed a significant correlation (r=-0.419, p<0.05). Antiretroviral (ARV) therapy and caries showed an insignificant negative correlation (p<0.05). Conclusion: The high prevalence of dental caries in CLWPHA correlated with low CD4 + counts.

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