Bennedsenmaclean7075

Median follow-up was 72 weeks. Fewer women than men had HIV-1 RNA ≤200copies/mLat week 48 39% vs 49% in cohort A and 83% vs 89% in CohortsB, C and D combined. More women experienced VF, Grade ≥3 signs and symptoms, but similar Grade ≥3 diagnoses or laboratory abnormalities. CONCLUSION More women than men entered the study with a resistance profile suggesting that their second-line regimen could have been effective in maintaining virologic suppression. The more frequent occurrence of Grade≥3 signs and symptoms in women suggests that tolerability issues were under recognized in women on PI based therapy.BACKGROUND Disclosing HIV status to HIV-positive children is a major challenge facing families and healthcare providers. Despite recommendations for disclosure, rates remain low. We tested whether a pediatric HIV disclosure intervention delivered as an integral component of routine HIV healthcare in Ghana would improve disclosure to children. METHODS Dyads of HIV-infected children aged 7 to 18 years and their caregivers were enrolled from two HIV clinics in Accra and Kumasi, Ghana. The sites were randomly assigned to one of the two intervention arms to avoid treatment contamination between intervention and control participants. Trained interventionist employed theory-guided therapeutic communication and personalized interaction to promote disclosure. Disclosure outcomes were measured at 12-week intervals. All analyses were completed using a modified intention-to-treat approach. RESULTS We enrolled 446 child-caregiver dyads (N=240 intervention group; N=206 control group); 52% of the children were male, mean age 9.78 (±2.27) years. For disclosure at 1 year, a better overall treatment effect was observed (p less then 0.001). Children in the treatment group had greater disclosure at each time point (p less then 0.001) and a higher proportion of them had been disclosed to by 1 year (51.4% vs 16.2%; p less then 0.001; un-adjusted HR=3.98 95% CI, 2.63, 6.03) and 3 years (71.3% vs 34.0%; unadjusted HR=4.21 95% CI, 3.09, 5.72). Phlorizin In the multivariate Cox model, factors associated with disclosure were treatment group (p less then 0.001), children less then 11 years of age (p less then 0.001), HIV-infected caregivers (p=0.015), and caregiver's with greater education (p=0.022). CONCLUSIONS This practical clinic-based disclosure intervention shows excellent promise as a means of improving HIV pediatric disclosure outcomes.BACKGROUND Exposure to incarceration is associated with increased risk of mortality, and HIV is cited as a leading cause of death. Yet, few studies have examined the association between incarceration and mortality among people with HIV (PWH), specifically whether and how increasing exposure to incarceration increases risk of mortality. We compared mortality by different incarceration exposures and HIV status. METHODS We conducted a prospective cohort study of participants in the Veterans Aging Cohort Study (VACS) from January 2011 to August 2017 (N=5,367). The primary exposure was incarceration by three measures 1) any (ever/never); 2) frequency; and 3) cumulative duration. Stratifying by HIV status and controlling for age, race, and gender, we used Cox Proportional Hazard models to estimate adjusted hazard ratios (AHRs) and 95% confidence intervals (CIs). RESULTS Incarceration was associated with increased risk of mortality compared with those never incarcerated for PWH (AHR 1.37; 95% CI, 1.13-1.66) and those uninfected (AHR 1.24; 95% CI, 0.99-1.54), but the association was only statistically significant among PWH. Increasing frequency of incarceration was associated with higher risk of mortality in both groups for PWH, AHRs 1.13, 1.45, and 1.64 for 1, 2-5; 6+ times, respectively; for uninfected, AHRs 0.98, 1.35, and 1.70 for 1, 2-5, and 6+ times, respectively. CONCLUSIONS PWH were at increased risk for mortality following incarceration and repeated exposure to incarceration was associated with mortality in both groups in a dose-response fashion. This increased risk for mortality may be mitigated by improving transitional healthcare, especially HIV care, and reducing incarceration.BACKGROUND The frequency of neutropenia in pediatric primary immunodeficiency disorders (PIDDs) is unknown and potentially underappreciated. Our study aimed to determine the overall frequency and severity of neutropenia in children diagnosed with a PIDD entered in the United States Immunodeficiency Network (USIDNET) patient registry. PROCEDURE Neutropenia data and demographic/clinical information from 1145 patients younger than 21 years of age was obtained from the USIDNET registry. RESULTS Neutropenia is more common in PIDD patients entered within the USIDNET registry than previously appreciated. There was a >10% occurrence rate of neutropenia in all broad primary immunodeficiency categories as well as in nearly all individual PIDDs. Neutropenia frequency was greater in African American pediatric PIDD patients than in white or Asian patients. The degree of neutropenia did not associate with mortality in pediatric patients with a PIDD. CONCLUSION Although our study did not assess the frequency of PIDD in patients presenting with neutropenia, the possibility of a primary immune disorder should be considered in patients with idiopathic neutropenia.We present the case of a 7-year-old boy who fulfilled the diagnostic criteria for hemophagocytic lymphohistiocytosis (HLH). Prompt visualization of his bone marrow confirmed the diagnosis of visceral leishmaniasis (VL). He responded well to treatment with liposomal amphotericin-B. The patient had a false-negative enzyme-linked immunosorbent assay for Leishmania infantum and a false-positive immunoglobulin M test for Epstein Barr virus (EBV). Because age at presentation is similar in children with VL and familial HLH for whom EBV is the usual trigger, ruling out VL is extremely important because nonspecific serologic tests for EBV can lead to the inappropriate diagnosis of EBV-driven primary HLH and to the administration of unnecessary immunochemotherapy.We report an 18-year-old female individual with septic arthritis due to Mycobacterium kansasii. Three years and 6 months before arthritis, the patient underwent bone marrow transplantation and developed severe chronic graft-versus-host disease. The arthritis was refractory to medication, and she underwent joint lavage of the right foot, hip joint, and elbow joint. After surgery, her joint symptoms were relieved, and chronic graft-versus-host disease remitted more easily. It is important that we maintain a high index of suspicion for mycobacterial arthritis and diagnose it early when immunosuppressed patients experience chronic pain and joint swelling.