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Biomedical subjects

J Bertolli

Publications and source records attributed to J Bertolli.

At least 19 recordsLinked to original sources
PubMed2001

Aging cohort of perinatally human immunodeficiency virus-infected children in New York City. New York City Pediatric Surveillance of Disease Consortium.

BACKGROUND: New York City (NYC) pediatricians are now caring for fewer HIV-infected infants and more school age children and adolescents than earlier in the epidemic. METHODS: Clinical, laboratory and demographic data were abstracted from medical records at 10 NYC centers participating in the CDC Pediatric Spectrum of HIV Disease project. Pediatric AIDS cases and HIV-related deaths reported to the NYC Department of Health were examined. RESULTS: Median age of HIV-infected children in care increased from 3 years in 1989 to 1991 to 6 years in 1995 to 1998. The number of HIV-infected women giving birth in NYC declined 50% from 1990 to 1997 (1630 to 831); increasing numbers were identified prenatally (14% in 1989; 78% after 1995); and most received prenatal zidovudine prophylaxis (73% in 1997). Estimated perinatal transmission decreased to 10% by 1997. Improved identification of seropositive status in infants was associated with an increased proportion of infected infants receiving Pneumocystis carinii pneumonia (PCP) prophylaxis, 84% in 1997. AIDS free survival was longer for children born 1995 to 1998 than for those born before 1995, P = 0.004. In 1998 among children with advanced immunosuppression (CDC category 3), 66% were prescribed 3 or more antiretroviral medicines and 88% received PCP prophylaxis. Citywide AIDS cases and HIV-related deaths fell precipitously beginning in 1996. CONCLUSIONS: Based on the observations of this study, the cohort of NYC HIV-infected children in care is aging, associated with a decline in new HIV infections, high rates of PCP prophylaxis and increased time to AIDS. Falling HIV-related deaths citywide support these observations.

Aging↗
PubMed2000

Survival in children with perinatal HIV infection and very low CD4 lymphocyte counts.

OBJECTIVES: To evaluate clinical conditions associated with mortality in HIV-infected children with CD4+ counts <100 cells/microl. METHODS: The Pediatric Spectrum of HIV Disease Project is a longitudinal medical record review study with eight study sites in the United States, which have been enrolling children since 1989. Survival time from baseline very low CD4 count (<100 cells/microl) to death was estimated using the Kaplan-Meier method. Cox proportional hazards models were used to evaluate the effect of clinical variables on mortality. RESULTS: Of 522 children (>/=1 year of age) with serial CD4+ T-lymphocyte measurements, the median age at the first very low CD4 count was 4.8 years. The estimated median survival following the first very low CD4 count was 36 months. The following factors present at the first very low CD4 count were independently associated with a higher risk of death: younger age, weight-for-age >2 standard deviations below the mean, and previously diagnosed AIDS. The subsequent development of cytomegalovirus (CMV)-associated disease, Mycobacterium avium intracellulare (MAI) infection, wasting syndrome, or esophageal candidiasis was also independently associated with a higher risk of death. CONCLUSION: Survival in HIV-infected children with very low CD4 counts before introduction of highly active antiretroviral therapy was highly variable. Poor nutritional status and the development of CMV disease or MAI infection were associated with the shortest survival times.

Age Factors↗
PubMed2000

Epidemiology of human immunodeficiency virus-associated opportunistic infections in the United States in the era of highly active antiretroviral therapy.

The incidence of nearly all AIDS-defining opportunistic infections (OIs) decreased significantly in the United States during 1992-1998; decreases in the most common OIs (Pneumocystis carinii pneumonia ¿PCP, esophageal candidiasis, and disseminated Mycobacterium avium complex ¿MAC disease) were more pronounced in 1996-1998, during which time highly active antiretroviral therapy (HAART) was introduced into medical care. Those OIs that continue to occur do so at low CD4+ T lymphocyte counts, and persons whose CD4+ counts have increased in response to HAART are at low risk for OIs, a circumstance that suggests a high degree of immune reconstitution associated with HAART. PCP, the most common serious OI, continues to occur primarily in persons not previously receiving medical care. The most profound effect on survival of patients with AIDS is conferred by HAART, but specific OI prevention measures (prophylaxis against PCP and MAC and vaccination against Streptococcus pneumoniae) are associated with a survival benefit, even when they coincide with the administration of HAART. Continued monitoring of incidence trends and detection of new syndromes associated with HAART are important priorities in the HAART era.

AIDS-Related Opportunistic Infections↗
PubMed2000

Human immunodeficiency virus-infected adolescents: a descriptive study of older children in New York City, Los Angeles County, Massachusetts and Washington, DC.

BACKGROUND: Children infected with HIV are entering adolescence with challenging and changing medical and social needs. Through chart review we describe certain medical and social characteristics of adolescents who acquired HIV as children. METHODS: HIV-infected children 12 years of age and older in 1995 were monitored through the Pediatric Spectrum of HIV Disease study from four US sites. In addition to standard 6-month medical chart reviews, a special chart abstraction in 1997 collected available psychosocial and sexual history information. RESULTS: A total of 131 adolescents HIV-infected as children were studied: 52 infected perinatally; 44 infected through a contaminated blood transfusion; 30 through receipt of contaminated blood products for hemophilia; and 5 with unknown transmission mode. Mean age at last medical contact was 15.5 years, 67% were Hispanic or African-American, 12% were employed, 66% attended regular school, 66% knew their HIV status and 48% (8% for the perinatally infected) lived with their biologic mother. Information on sexual activity showed that 18% had sexual relations, 28% did not and for 53% sexual activity was not recorded in the medical chart. Four percent used illicit drugs, which along with sexual activity showed a positive association with age. Forty-two percent had an AIDS-defining opportunistic infection, and 56% had a recent CD4+ lymphocyte count <200 cells/microl. CONCLUSIONS: Adolescents in this study represent a heterogeneous group of surviving HIV-infected children some of whom are sexually active and potential sources of HIV transmission. Clinicians who treat HIV-infected and high risk adolescents face the challenges of providing care and prevention services appropriate to adolescent development.

Adolescent↗
PubMed2000

Tuberculosis in human immunodeficiency virus-infected and human immunodeficiency virus-exposed children in New York City. The New York City Pediatric Spectrum of HIV Disease Consortium.

BACKGROUND: Tuberculosis disease incidence increased sharply in New York City (NYC) in the late 1980s in children and adults. The relationship of tuberculosis disease in adults with the coincident epidemic of immunosuppression caused by HIV disease has been well-documented. This paper examines the relationship of tuberculosis and HIV in children in NYC. METHODS: Information on tuberculosis was collected by retrospective chart abstraction in a cohort of HIV-exposed and infected children enrolled in a longitudinal study of HIV. Tuberculosis cases were ascertained by chart review or by matching HIV-infected and -exposed children to NYC Tuberculosis Registry cases. NYC Tuberculosis Registry data on children reported from 1989 to 1995, and not reported as HIV-infected, were used for comparison. RESULTS: Tuberculosis disease was found in 45 (3%) of 1426 HIV-infected children (0.61 per 100 child years of observation) and in 5 (0.5%) of 1085 HIV-exposed uninfected children (0.2 per 100 child years). 30% of children were evaluated for HIV only after presenting with tuberculosis. Children with tuberculosis and HIV were more likely than other age-matched HIV-infected children to have decreased CD4+ T lymphocyte counts (66% vs. 37%, P = 0.02) and more likely than other NYC children with tuberculosis to have culture-confirmed and extrapulmonary tuberculosis. In this series 8 of 21 deaths in HIV-infected children with tuberculosis appeared to be related to tuberculosis. CONCLUSIONS: During a period of high tuberculosis incidence in NYC, 3% of HIV-infected children in our cohort had tuberculosis, higher than the rate in uninfected children born to HIV-positive mothers in the same cohort. Because of this association, HIV-infected children with pulmonary illness should be tested for tuberculosis; and all children with tuberculosis should be tested for HIV.

AIDS-Related Opportunistic Infections↗
PubMed2000

Adherence to medication regimens among children with human immunodeficiency virus infection.

BACKGROUND: Rigorous adherence to antiretroviral medication regimens is necessary to achieve and maintain undetectable viral levels. This study describes adherence in a population of children with HIV infection. METHODS: Caregivers of HIV-infected children were interviewed about their experiences with administration of medications for treatment of HIV, opinions regarding medication-related issues and the potential usefulness of interventions to improve adherence. RESULTS: In the 90 caregiver interviews completed, 78% of the children were taking 3 or more medications, 17% missed a dose in the previous 24 h and 43% missed at least 1 dose in the previous week. Children whose caregivers reported no missed doses in the previous week (adherent) were more likely to have an HIV viral load <400 copies/ml (50% vs. 24%, P = 0.04). Nonadherent caregivers (who reported 1 or more missed doses in the previous week) were more likely than adherent caregivers to agree with a statement that full adherence is impossible (44% vs. 12%, P = 0.001) and express the need for more help with medication administration (26% vs. 6%, P = 0.02). They were less likely to have informed the school or day-care site about the child's HIV infection (42% vs. 67%, P = 0.05) and more concerned about the child's teachers and friends finding out (54% vs. 31%, P = 0.05). Of 10 potential interventions 6 were rated by a majority of respondents as "very helpful": better tasting medications (81%); longer dosing intervals (72%); medications that did not require refrigeration (63%); access to 24-h telephone advice (62%); a follow-up call from a health care provider (57%); and a pill organizer (56%). CONCLUSIONS: Caregivers' perceptions that adherence is too difficult or concerns about loss of privacy may affect their ability to adhere to complicated medication regimens. Caregivers felt that the most helpful interventions would be modifications to improve the convenience and palatability of medications and increased access to medical advice.

Adolescent↗
PubMed2000

Lack of definitive severe mitochondrial signs and symptoms among deceased HIV-uninfected and HIV-indeterminate children < or = 5 years of age, Pediatric Spectrum of HIV Disease project (PSD), USA.

BACKGROUND: In response to recent reports of mitochondrial dysfunction in HIV-uninfected infants exposed to antiretroviral (ARV) prophylaxis, the Perinatal Safety Review Working Group reviewed deaths in five large HIV-exposed perinatal cohorts in the United States to determine if similar cases of severe mitochondrial toxicity could be detected. We describe the results of this review for the PSD cohort. METHODS: Hospitalization, clinic and death records for deceased HIV-uninfected and HIV-indeterminate children who were less than 5 years of age were reviewed. Standard definitions were used to classify HIV infection status and the likelihood that signs and symptoms were related to mitochondrial dysfunction. Children were classified as having signs and symptoms that were considered (1) unrelated, (2) unlikely, (3) consistent with, or (4) likely related to mitochondrial disease. SIDS deaths were put into a separate category. RESULTS: 8,465 of 13,125 HIV-exposed children were either HIV-uninfected or HIV-indeterminate. Among the 84 deaths in the subgroup of 8,465 children, 9 were considered in Class 2 (unlikely), 4 were considered in Class 3 (consistent with), and none were considered in Class 4 (likely). 97% of those children who received ARV prophylaxis received zidovudine alone. None of the HIV-uninfected deaths were classified in 2, 3, or 4; and only one of these was exposed to ARV prophylaxis. Among the 3 HIV-indeterminate children who were classified in 3 (consistent with), 2 had no or unknown ARV exposure before 1994 when use of ZDV prophylaxis became the standard of care. Both HIV-uninfected and HIV-indeterminate children with ARV exposure or unknown exposure had lower mortality rates than children without ARV exposure. CONCLUSION: Monoprophylaxis with ZDV was not associated with higher death rates in the cohort of 8,465 children or with any findings likely consistent with mitochondrial dysfunction among the 85 deaths. Ongoing monitoring of drug safety in large multi-site prospective cohort studies of HIV-exposed children is essential in the era of highly active antiretroviral therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Adequacy of prenatal care and prescription of zidovudine to prevent perinatal HIV transmission.

In 1994, data were published on the effectiveness of zidovudine in preventing perinatal transmission of HIV infection. Using data from surveillance projects in San Antonio, Dallas, and Houston, Texas, U.S.A., we linked records of children born from 1987 through 1996 with records of their HIV-infected mothers. Prenatal care was measured by Kotelchuck's Adequacy of Prenatal Care Utilization (APNCU) Index. We examined the association between adequacy of prenatal care and four measures of zidovudine prescription: prenatal, intrapartum, neonatal, and the complete regimen. Inclusion criteria was that the mother's HIV infection was diagnosed before a live birth; 221 mother-infant pairs were included in the analysis. Overall, 68% received inadequate or no prenatal care. Over time, the proportion of mother-infant pairs with adequate prenatal care doubled (24%-48%; relative risk [RR], 2.0; 95% confidence interval [CI], 1.3-3.0), and the proportion prescribed prenatal zidovudine tripled (20%-67%; RR, 3.4; 95% CI, 2.4-4.9). In logistic regression, APNCU (adjusted odds ratio [aOR], 2.6; 95% CI, 1.1-6.2) and time period (aOR, 19.9; 95% CI, 8.1-48.7) were associated with prenatal prescription of zidovudine. The benefits of prenatal care, including HIV testing and zidovudine treatment, underscore the urgent need to improve access to and use of prenatal care services.

Adult↗
PubMed1999

Persistence and genetic stability of Ebola virus during the outbreak in Kikwit, Democratic Republic of the Congo, 1995.

Ebola virus persistence was examined in body fluids from 12 convalescent patients by virus isolation and reverse transcription-polymerase chain reaction (RT-PCR) during the 1995 Ebola hemorrhagic fever outbreak in Kikwit, Democratic Republic of the Congo. Virus RNA could be detected for up to 33 days in vaginal, rectal, and conjunctival swabs of 1 patient and up to 101 days in the seminal fluid of 4 patients. Infectious virus was detected in 1 seminal fluid sample obtained 82 days after disease onset. Sequence analysis of an RT-PCR fragment of the most variable region of the glycoprotein gene amplified from 9 patients revealed no nucleotide changes. The patient samples were selected so that they would include some from a suspected line of transmission with at least three human-to-human passages, some from 5 survivors and 4 deceased patients, and 2 from patients who provided multiple samples through convalescence. There was no evidence of different virus variants cocirculating during the outbreak or of genetic variation accumulating during human-to-human passage or during prolonged persistence in individual patients.

Adolescent↗
PubMed1999

Serologic survey among hospital and health center workers during the Ebola hemorrhagic fever outbreak in Kikwit, Democratic Republic of the Congo, 1995.

From May to July 1995, a serologic and interview survey was conducted to describe Ebola hemorrhagic fever (EHF) among personnel working in 5 hospitals and 26 health care centers in and around Kikwit, Democratic Republic of the Congo. Job-specific attack rates estimated for Kikwit General Hospital, the epicenter of the EHF epidemic, were 31% for physicians, 11% for technicians/room attendants, 10% for nurses, and 4% for other workers. Among 402 workers who did not meet the EHF case definition, 12 had borderline positive antibody test results; subsequent specimens from 4 of these tested negative. Although an old infection with persistent Ebola antibody production or a recent atypical or asymptomatic infection cannot be ruled out, if they occur at all, they appear to be rare. This survey demonstrated that opportunities for transmission of Ebola virus to personnel in health facilities existed in Kikwit because blood and body fluid precautions were not being universally followed.

Adult↗
PubMed1999

Clinical, virologic, and immunologic follow-up of convalescent Ebola hemorrhagic fever patients and their household contacts, Kikwit, Democratic Republic of the Congo. Commission de Lutte contre les Epidémies à Kikwit.

A cohort of convalescent Ebola hemorrhagic fever (EHF) patients and their household contacts (HHCs) were studied prospectively to determine if convalescent body fluids contain Ebola virus and if secondary transmission occurs during convalescence. Twenty-nine EHF convalescents and 152 HHCs were monitored for up to 21 months. Blood specimens were obtained and symptom information was collected from convalescents and their HHCs; other body fluid specimens were also obtained from convalescents. Arthralgias and myalgia were reported significantly more often by convalescents than HHCs. Evidence of Ebola virus was detected by reverse transcription-polymerase chain reaction in semen specimens up to 91 days after disease onset; however, these and all other non-blood body fluids tested negative by virus isolation. Among 81 initially antibody negative HHCs, none became antibody positive. Blood specimens of 5 HHCs not identified as EHF patients were initially antibody positive. No direct evidence of convalescent-to-HHC transmission of EHF was found, although the semen of convalescents may be infectious. The existence of initially antibody-positive HHCs suggests that mild cases of Ebola virus infection occurred and that the full extent of the EHF epidemic was probably underestimated.

Adolescent↗
PubMed1997

A case-control study of the effectiveness of BCG vaccine for preventing leprosy in Yangon, Myanmar.

BACKGROUND: Five randomized trials, a follow-up study, and six case-control investigations of BCG vaccine's effectiveness (VE) for preventing leprosy have been conducted internationally, with widely varying estimates of VE. Because of the difficulty of generalizing from disparate results, local estimates of VE are needed for health planning purposes and are currently particularly relevant, given the World Health Organization's (WHO) goal to eliminate leprosy by the year 2000. METHODS: We conducted a case-control study in Yangon, Myanmar. Residents of Yangon between the ages of 6 years and 24 years who were listed in the National Leprosy Registry as being on active treatment for leprosy between December 1992 and April 1993 were eligible to participate in the study as cases. Control subjects were matched to the cases on age, sex, and neighbourhood. RESULTS: One or more doses of BCG were associated with a VE of 66%. The results show a significant trend of increasing VE with increasing number of BCG doses (one dose, VE = 55%; two doses, VE = 68%; three doses, VE = 87%). One dose of BCG vaccine appeared to provide protection substantially higher than that found in an earlier vaccine trial in Myanmar, but consistent with results from case-control studies in other countries. CONCLUSIONS: These data suggest that BCG reduces the risk of leprosy in Myanmar, and that BCG vaccination of infants, along with early case-finding and treatment, should be considered an important part of the leprosy intervention strategy.

Adolescent↗
PubMed1996

A case-control study of reproductive variables, alcohol, and smoking in premenopausal bilateral breast cancer.

Premenopausal bilateral breast cancer is characterized by a strong family risk, and, consequently, a high probability that inherited susceptibility genes may be segregating in these families. Determining whether risk factors that affect other breast cancer cases have a similar effect in the etiology of bilateral breast cancer is of interest. Therefore, as part of an ongoing genetic-epidemiologic study of premenopausal bilateral breast cancer, we conducted a case-control analysis of reproductive variables, benign breast disease, alcohol, and smoking. Cases had premenopausal bilateral breast cancer, and their unaffected sisters served as controls. A set of reproductive variables--including earlier age at menarche, nulliparity, and late age at first full term pregnancy--appeared to increase the risk of breast cancer; the corresponding confidence limits, however, were wide and straddled the null. In addition, other variables associated with increased premenopausal bilateral breast cancer risk were: use of oral contraceptives, history of benign breast disease, and high alcohol consumption. We found no positive association for smoking. Nulliparity and late age at first full-term pregnancy appeared to have different effects in women with family histories of breast cancer than in women without such a history. We detected no substantial effect modification for the other risk factors. In general, risk factors previously identified for breast cancer (usually postmenopausal, unilateral cases) appear also to increase the risk for premenopausal, bilateral breast cancer.

Age Factors↗
PubMed1996

Estimating the timing of mother-to-child transmission of human immunodeficiency virus in a breast-feeding population in Kinshasa, Zaire.

Breast-fed infants born to human immunodeficiency virus (HIV)-infected mothers in Kinshasa, Zaire, were monitored a mean of 18 months. HIV infection in infants was determined by polymerase chain reaction (PCR), HIV culture, or ELISA. PCR test results for HIV DNA on venous blood drawn from children ages 0-2 days and 3-5 months were used to estimate proportions of mother-to-child transmission and transmission risks during the intrauterine, intrapartum/early postpartum, and late postpartum periods. Among 69 HIV-infected children (26% of the cohort), 23% (95% confidence interval [CI], 14%-35%) were estimated to have had intrauterine, 65% (CI, 53%-76%) intrapartum/early postpartum, and 12% (CI, 5%-22%) late postpartum transmission. The estimated risks for intrauterine, intrapartum/early postpartum, and late postpartum infection, respectively, were 6% (16/261; CI, 4%-10%), 18% (45/245; CI, 14%-24%), and 4% (8/189; CI, 2%-8%). These results support earlier studies indicating that most transmission occurs during labor and delivery or in the early postpartum period and that the risk of HIV transmission through breast-feeding during the postpartum period is substantial.

Breast Feeding↗
PubMed1995

Estimating the occurrence of child maltreatment and risk-factor effects: benefits of a mixed-design strategy in epidemiologic research.

Despite the large volume of literature on child abuse and neglect generated over the past two decades, there has been relatively little comprehensive discussion of the limitations of different study designs for achieving major epidemiologic research goals. Although some improvements have been made in conventional research designs, there have been few efforts to develop new approaches. This article discusses the methodologic limitations of four observational study designs--ecologic, case-control, cross-sectional, and cohort--that dominate the child abuse and neglect literature; identifies key features of an "ideal" study of child maltreatment; and proposes a new mixed-design research strategy. The major advantage of the proposed strategy is that it greatly improves the ability to identify cases of child maltreatment from a well-defined population at risk representing diverse segments of the US population.

Child↗
PubMed1994

T cell activation in pediatric AIDS pathogenesis: three-color immunophenotyping.

Immune activation is an important component of HIV disease in adults that may reflect a protective host response and/or be a component of immunopathogenesis. The goals of this study were to gain understanding of T cell activation in pediatric HIV disease, to assess the usefulness of T cell activation markers as surrogates for disease progression and/or early identification of infection in infants at risk, and to determine any advantages of three- compared to two-color flow cytometric immunophenotyping for the above assessments. We examined the expression of cell-surface activation antigens on the CD4 and CD8 T cells of 26 HIV-infected and 40 HIV-seronegative age-matched control children. Compared with controls, HIV-infected children showed a slight but not significant decrease in the proportion of CD4 cells that coexpressed CD45RA and L-selectin (mean of 83 vs 75% for < 2 years of age, 76 vs 62% for 2-3 years, 64 vs 56% for > or = 4 years). CD4 cells coexpressing CD38 and HLA-DR were significantly increased in HIV+ children (mean of 2 vs 6% for < 2 years of age, 3 vs 11% for 2-3 years, 2 vs 8% for > or = 4 years). There was a striking and significant increase in the proportion of CD8 cells coexpressing CD38 and HLA-DR (mean of 5 vs. 25% for < 2 years, 10 vs 41% for 2-3 years, 6 vs 31% for > or = 4 years); this double positive population of CD8 cells included cells that were approximately 1 log brighter for the expression of CD38 than for that of CD38 single-positive cells. There was a significant reduction in CD45RA+ CD8 cells (means of 92 vs 71% for < 2 years of age, 88 vs 50% for 2-3 years, 80 vs 57% for > or = 4 years) and an increase in CD57+ CD8 cells (mean of 4 vs 8% for < 2 years of age, 8 vs 22% for 2-3 years, 19 vs 31% for > or = 4 years) in HIV+ children. The inclusion of CD3 as an anchor marker for CD8 cell subsets to limit the analysis to CD3+ CD8 cells did not substantially alter the data nor enhance the differences between infected and control children compared with the analysis of all CD8 cells.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗