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Human immunodeficiency virus infection in hemophilic children
J M Jason1, J Stehr-Green, R C Holman
1Division of Host Factors, Centers for Disease Control, Atlanta, GA 30333.
Insights
Children with hemophilia-associated AIDS have similar poor outcomes as other pediatric AIDS cases, despite differing clinical manifestations. Further research is needed to understand HIV
Area of Science:
- Pediatric Infectious Diseases
- Hematology
- Immunology
Background:
- Acquired Immunodeficiency Syndrome (AIDS) in children with hemophilia presents unique challenges.
- Human Immunodeficiency Virus (HIV) infection impacts both pediatric and adult hemophiliac populations.
- Understanding clinical differences and outcomes in hemophilia-associated AIDS is crucial.
Purpose of the Study:
- To compare clinical manifestations and outcomes of hemophilia-associated AIDS in children versus other pediatric AIDS cases.
- To compare asymptomatic HIV-infected hemophilic children with asymptomatic HIV-infected hemophilic adults.
- To investigate demographic and clinical differences between pediatric and adult hemophilia-associated AIDS.
Main Methods:
- Comparative analysis of pediatric AIDS cases with hemophilia-associated AIDS.
- Comparison of asymptomatic HIV-infected hemophilic children and adults.
- Evaluation of clinical features such as lymphocytic interstitial pneumonitis and Pneumocystis carinii pneumonia.
- Analysis of demographic data including race and geographic residence.
Main Results:
- Children with hemophilia-associated AIDS were older than other pediatric AIDS cases and had less lymphocytic interstitial pneumonitis but similar Pneumocystis carinii pneumonia rates and fatality ratios.
- Hemophilic children with AIDS had lower rates of Pneumocystis carinii pneumonia than hemophilic adults with AIDS, with similar fatality ratios.
- Hemophilic children with AIDS were more likely to be nonwhite and reside in the New York/New Jersey/Pennsylvania tristate area.
- Immune effects of HIV on asymptomatic pediatric and adult hemophiliacs appeared similar, potentially more severe in adults.
Conclusions:
- Clinical manifestations of AIDS in children with hemophilia can differ from other pediatric AIDS cases, but outcomes are equally poor.
- Disease progression and clinical presentations in hemophilia-associated AIDS warrant further investigation.
- Differences between hemophilic children and adults with and without AIDS require deeper study.
Abstract:
The following groups were compared: (1) children less than 18 years old who have hemophilia-associated acquired immunodeficiency syndrome (AIDS) with other children with AIDS and with adults who have hemophilia-associated AIDS and (2) asymptomatic HIV-infected hemophilic children with asymptomatic HIV-infected hemophilic adults. Children with hemophilia-associated AIDS were older than other children with AIDS (medians 13 and 1 years, respectively) and less frequently had lymphocytic interstitial pneumonitis (5% v 48%) but had similar incidences of Pneumocystis carinii pneumonia (51% v 53%) and similar case to fatality ratios (59% v 61%). Children with hemophilia-associated AIDS had P carinii pneumonia significantly less often than did adults with hemophilia-associated AIDS, but both had similar case to fatality ratios (adults 72% with P carinii pneumonia, 68% dead). Significantly more hemophilic children than adults with AIDS were nonwhite (30% v 14%) and resided in the tristate area of New York/New Jersey/Pennsylvania (43% v 25%). The immune effects of human immunodeficiency virus (HIV) to date on asymptomatic pediatric and adult hemophiliacs are similar but may be more severe in adults. It is concluded that, although some of the clinical manifestations of AIDS (eg, lymphocytic interstitial pneumonitis) occurring or not occurring in older children infected through blood factor products differ from those of other children with AIDS, disease outcome to date is equally poor. The reasons for the differences between hemophilic children and hemophilic adults with and without AIDS warrant further investigation.