Pediatric acquired immunodeficiency syndrome-related complex: clinical and immunologic features
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N Kamani1, H Lightman, I Leiderman
1Department of Pediatrics, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, New York.
Insights
Pediatric acquired immunodeficiency syndrome-related complex (PAIDS-RC) in children may represent a prolonged plateau in HIV infection. Most patients showed stable or improved immune status and physical growth over time.
Area of Science:
- Pediatric Immunology
- Infectious Diseases
- Clinical Outcomes
Background:
- The long-term clinical outcome for children with pediatric acquired immunodeficiency syndrome-related complex (PAIDS-RC) remains largely unknown.
- This study focuses on the clinical course and immunological status of 14 children diagnosed with PAIDS-RC.
Purpose of the Study:
- To describe the clinical and immunological outcomes of children with PAIDS-RC.
- To evaluate the potential for PAIDS-RC to represent a stable phase in pediatric HIV infection.
Main Methods:
- Longitudinal follow-up of 14 pediatric patients with PAIDS-RC for 11-71 months.
- Assessment of clinical features, including lymphadenopathy and hepatosplenomegaly.
- Immunological evaluation including T4/T8 ratios and in vitro responses.
Main Results:
- Frequent initial symptoms included persistent generalized lymphadenopathy and hepatosplenomegaly.
- Most patients exhibited hypergammaglobulinemia and reversed T4/T8 ratios at presentation.
- No serious or opportunistic infections were observed; 12/14 showed catch-up growth.
- T4/T8 ratios remained stable or improved in most patients, with gradual regression of lymphadenopathy and hepatosplenomegaly.
Conclusions:
- PAIDS-RC may represent a prolonged plateau in pediatric HIV infection.
- Further long-term studies are needed to confirm these findings.
- Immunological evaluation could identify children benefiting from specific therapies like gamma-globulin or antibiotics.
Abstract:
The long term clinical outcome for infants and children with the pediatric acquired immunodeficiency syndrome-related complex is unknown. This report describes our experience with 14 patients with acquired immunodeficiency syndrome-related complex who have been followed for 11 to 71 months since the onset of their symptoms. The most frequent clinical features at presentation were persistent generalized lymphadenopathy (14 of 14), hepatosplenomegaly (11 of 14) and a history of recurrent otitis media (7 of 14). Except for hypergammaglobulinemia (14 of 14) and reversed T4/T8 ratios (9 of 14), immunologic analyses, including in vitro responses to mitogens and antibody responses following immunization, revealed no consistent abnormalities. Over the course of follow-up, none of the patients have developed serious or opportunistic infections and 12 of 14 have shown catch up or age-appropriate growth. The T4/T8 ratios have remained stable in 8 of 11 and improved in 2 of 11 patients. Gradual regression of hepatosplenomegaly and lymphadenopathy has been noted patients. Although follow-up studies over a longer period are needed to confirm our observations to date, acquired immunodeficiency syndrome-related complex may represent a prolonged plateau in the course of human immunodeficiency virus infection in many infected children. Detailed immunologic evaluation of these patients may help to identify a subset of children that could benefit from periodic gamma-globulin or chronic antibiotic therapy.