The reduced risk of mother-to-child transmission due to improved HIV treatment has resulted in an increasing number of healthy children born to mothers living with HIV. The study's objective was to identify the number of parents or caregivers in a sample of persons living with HIV in Flanders, the number of HIV-affected children as well as specific family-related characteristics. Using a structured survey quantitative data were assessed on a total of 628 patients at three Flemish Aids reference centres. Qualitative data were collected in a small sub-sample of African caregivers living in Flanders. Twenty-seven per cent of the overall sample had children younger than 18 years, totalling 165 HIV-affected families with 279 children. Parents from developing countries had significantly more children than European parents. One hundred and eighty-two (68%) of all children were HIV-negative, while the HIV status of 75 (28%) was unknown. Disclosure rate was low: 26 (10%) children were aware of the parental HIV disease. The study shows that HIV-affected families have to deal with complex psychosocial issues such as migration, family illness, family secrecy around HIV and disclosure. Service implications are discussed.
Background
Meningitis can be caused by several viruses and bacteria. Identifying the causative pathogen as quickly as possible is crucial to initiate the most optimal therapy, as acute bacterial meningitis is associated with a significant morbidity and mortality. Bacterial meningitis requires antibiotics, as opposed to enteroviral meningitis, which only requires supportive therapy. Clinical presentation is usually not sufficient to differentiate between viral and bacterial meningitis, thereby necessitating cerebrospinal fluid (CSF) analysis by PCR and/or time-consuming bacterial cultures. However, collecting CSF in children is not always feasible and a rather invasive procedure.
Methods
In 12 Belgian hospitals, we obtained acute blood samples from children with signs of meningitis (49 viral and 7 bacterial cases) (aged between 3 months and 16 years). After pathogen confirmation on CSF, the patient was asked to give a convalescent sample after recovery. 3′ mRNA sequencing was performed to determine differentially expressed genes (DEGs) to create a host transcriptomic profile.
Results
Enteroviral meningitis cases displayed the largest upregulated fold change enrichment in type I interferon production, response and signaling pathways. Patients with bacterial meningitis showed a significant upregulation of genes related to macrophage and neutrophil activation. We found several significantly DEGs between enteroviral and bacterial meningitis. Random forest classification showed that we were able to differentiate enteroviral from bacterial meningitis with an AUC of 0.982 on held-out samples.
Conclusions
Enteroviral meningitis has an innate immunity signature with type 1 interferons as key players. Our classifier, based on blood host transcriptomic profiles of different meningitis cases, is a possible strong alternative for diagnosing enteroviral meningitis.
Two postal questionnaires were sent to Belgian gynaecologists in order to have information on their current policy of antenatal HIV screening. Of the 815 contacted, 446 (54.7%) completed the first questionnaire. 91.0% offers HIV testing in pregnancy; 49.1% to all pregnant women and 41.9% only to those with behavioural risks. Only 6.5% never offers HIV testing during pregnancy. The majority of these gynaecologists (79.8%) never had to deal with the problem of HIV-seropositivity in a pregnant woman. A second questionnaire with more detailed questions about HIV testing was sent to the identified respondents of the first survey. 237 of 340 (69.7%) responded. Of those, 48.9% perform HIV testing without informing the patient, whereas 43.4% always inform their patients before HIV testing. The majority performs the test at the first antenatal consultation (73.5%; 14.9% offers the test twice. These findings let us conclude that there is a need for recommendations concerning the policy of antenatal screening and information of patients.
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