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[The parameters of the immune function in the evolution of HIV-1 infection in institutionalized children in Romania]
F Zugun1, S Sfartz, C Dragomir
1Universitatea de Medicină şi Farmacie Gr. T. Popa, Iaşi.
Insights
This study tracked HIV-1 infected children in an orphanage, identifying three distinct disease stages based on immunological markers. These stages differ from current CDC and WHO classifications, highlighting a unique disease progression in this population.
Area of Science:
- Pediatric Immunology
- Virology
- Epidemiology
Background:
- Human Immunodeficiency Virus type 1 (HIV-1) infection in children presents unique challenges, particularly in institutionalized settings.
- Understanding the natural history and progression of HIV-1 in vertically infected children is crucial for effective management.
Purpose of the Study:
- To describe the clinical and immunological evolution of horizontally infected children with HIV-1.
- To characterize distinct disease stages in HIV-1 positive children within a closed community setting.
Main Methods:
- Longitudinal assessment of biological status in 26 HIV-1 positive children aged 1 month to 3 years.
- Dynamic monitoring of immunological parameters including CD4+ and CD8+ lymphocytes, CD4/CD8 ratio, and beta-2-microglobulin.
- Flow cytometry analysis to identify lymphocyte subpopulations and marker expression.
Main Results:
- Three progressive stages of HIV-1 infection were identified: oligosymptomatic, multiform symptomatology, and severe immunodepression.
- Specific thresholds for CD4% lymphocytes, absolute CD4+ counts, CD4/CD8 ratio, and beta-2-microglobulin differentiated these stages.
- Abnormal lymphocyte populations and surface marker expression (CD4, CD8, CD19, CD3, CD2) were observed, suggesting unique immunological responses or immaturity.
Conclusions:
- The identified immunological features and disease stages in this cohort of HIV-1 positive children do not align with current CDC or WHO classification systems.
- This distinct epidemiological group necessitates further investigation and potentially tailored management strategies for HIV-1 infected children in similar settings.
Objective:
To describe the evolution of HIV-1 + horizontal infected children nursed in closed community.
Method:
The biological status of 26 HIV-1 + children nursed in Iaşi Orphanage was assessed in dynamic during April. 1993-Feb. 1994. The income age ranged among 1 month-3 years.
Results:
The following progressive stages could be drawn accordingly to the biological status parameters dynamic: stage 1 ("oligosymptomatic"), stage 2 ("multiform, medium or severe symptomatology"), and stage 3 ("severe immunodepression, with predominant infectious symptomatology, waves evolution"). These stages could not be assimilated to the currently CDC or WHO classifications. The following thresholds of the immunologically parameters separate the stages 1 and 2, and respective stages 2 and 3: CD4% lymphocytes (27% respective 20%); absolute CD4+ lymphocytes (1150/microliter respective 700 + 750/microliter), CD4/CD8 ratio (0.75 respective 0.45), beta 2-microglobulin (1.5 mg/1000 respective 2.5 mg/ 1000). Lymphocytes lacking the markers CD4, CD8, CD19, CD3, ranging between 15 + 20% were also detected by flow-cytometry; these cells could be attributed to the immature subpopulations (typically for dystrophy) or to down-regulation of membrane expression of some markers. Also, a dichotomy in the distribution of the CD2/CD3 surface markers was recorded in the case of lymphocytes.
Conclusions:
Immunological features demarcate this epidemiological group versus the current described models for the HIV-1 + child.