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R J Simonds

Publications and source records attributed to R J Simonds.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1996

Lack of increased risk for perinatal human immunodeficiency virus transmission to subsequent children born to infected women.

BACKGROUND: Little is known about whether a woman's risk of transmitting HIV perinatally increases over time and whether the infection outcome of a previous child affects the risk of transmitting HIV to subsequent children. METHODS: We analyzed data from 114 prospectively followed women who gave birth to at least 2 children after becoming infected with HIV to determine the risk for perinatal HIV transmission to these sibling pairs. RESULTS: The median interval between sibling births was 19 months. HIV infection occurred in 19 (17%) older siblings and 20 (18%) younger siblings (P = 0.87). Two (11%) of the 19 children with infected older siblings were infected compared with 18 (19%) of the 95 children with uninfected older siblings (P = 0.86). The risk for transmission to younger siblings was not associated with the interval between deliveries of the two siblings. CONCLUSIONS: These data do not demonstrate that an HIV-infected woman's risk of transmitting HIV perinatally increases with time, although the observed interpregnancy interval was relatively short. The risk for perinatal transmission does not appear to be affected by the infection outcome of previous children. These findings may be useful for counseling HIV-infected women about their risk of transmitting HIV perinatally.

Child↗
PubMed1995

Prophylaxis against Pneumocystis carinii pneumonia among children with perinatally acquired human immunodeficiency virus infection in the United States. Pneumocystis carinii Pneumonia Prophylaxis Evaluation Working Group.

BACKGROUND: Pneumocystis carinii pneumonia (PCP) remains a common and often fatal opportunistic infection among children infected with the human immunodeficiency virus (HIV). HIV-infected infants between three and six months of age are particularly vulnerable. Current guidelines recommend prophylaxis in children from birth to 11 months old who have CD4+ counts below 1500 cells per cubic millimeter. METHODS: We used national surveillance data to estimate the annual incidence of PCP among children less than one year old. We reviewed the medical records of 300 children given a diagnosis of PCP between January 1991 and June 1993 to determine why treatment according to the 1991 guidelines for prophylaxis against PCP either was not given or failed to prevent the disease. RESULTS: In our study the incidence of PCP in the first year of life among infants born to HIV-infected mothers changed little between 1989 and 1992. Among 7080 children born to HIV-infected mothers in 1992, PCP developed in 2.4 percent. Of 300 children with PCP diagnosed from January 1991 through June 1993, 199 (66 percent) had never received prophylaxis, and for 118 of those children (59 percent) exposure to HIV was first identified 30 days or less before the diagnosis of PCP. Among 129 children less than one year old, the CD4+ count declined by an estimated 967 cells per cubic millimeter (95 percent confidence interval, 724 to 1210 cells per cubic millimeter) during the three months before the diagnosis of PCP. Among infants in whom CD4+ counts were determined within one month of the diagnosis of PCP, 18 percent (20 of 113) had at least 1500 cells per cubic millimeter, a level higher than the currently recommended threshold for prophylaxis. CONCLUSIONS: In the United States the incidence of PCP among HIV-infected infants has not declined. If this infection is to be prevented, infants exposed to HIV must be identified earlier, and prophylaxis must be offered to more children than the guidelines currently recommend.

AIDS-Related Opportunistic Infections↗
PubMed1995

Preventing Pneumocystis carinii pneumonia in persons infected with human immunodeficiency virus.

Although the incidence of Pneumocystis carinii pneumonia (PCP) among adults infected with human immunodeficiency virus (HIV) has declined, no decline in PCP incidence has been observed among HIV-infected children, and PCP remains the most common serious opportunistic infection among both adults and children in the United States. Some evidence of airborne transmission of P. carinii exists, and some clusters of cases of PCP have been reported; however, data are insufficient to recommend that persons with PCP be separated from immunosuppressed persons as a standard practice. The incidence of PCP can be reduced substantially if persons at risk for PCP are identified and receive adequate chemoprophylaxis. Several drugs and drug combinations are highly effective in preventing PCP. For both adults and children, oral trimethoprim-sulfamethoxazole (TMP-SMZ) is the preferred form of prophylaxis. Adverse effects are commonly associated with the use of TMP-SMZ and in some cases may necessitate withdrawal of the drug until the effects resolve. However, reintroduction at the same dose or at a lower and gradually increasing dose will often permit the continued use of TMP-SMZ. For persons intolerant of TMP-SMZ, dapsone alone and dapsone plus pyrimethamine are effective alternatives. A third alternative is aerosolized pentamidine. Additional drugs of unproven efficacy but of potential use in exceptional cases are available.

AIDS-Related Opportunistic Infections↗
PubMed1994

Epidemiology of pediatric human immunodeficiency virus infection in the United States.

Human Immunodeficiency Virus (HIV) infection is a growing problem for children worldwide. As of 31 December 1992, 4249 children with Acquired Immunodeficiency Syndrome (AIDS) under 13 years of age had been reported to the US Centers for Disease Control and Prevention (CDC). HIV is transmitted to children predominantly from their mothers. Nearly all cases of HIV infection acquired from blood transfusions in the United States occurred before donor-screening practices were implemented in March 1985. In 1991, approximately 7000 HIV-infected women gave birth to a liveborn infant in the United States, for a prevalence of 1.7 per 1000 women. Despite recent advances in prophylactic therapy for opportunistic infections, Pneumocystis carinii pneumonia remains the most common AIDS-defining illness in children in the United States. If these cases are to be prevented, children born to HIV-infected mothers will need to be identified early and monitored appropriately for CD4+ cell counts to determine the need for prophylaxis.

AIDS-Related Opportunistic Infections↗
PubMed1993

Epidemiology of pediatric human immunodeficiency virus infection in the United States.

HIV infection is an important cause of morbidity and mortality in the pediatric population. Providers of health care to children need to be aware of the problem and the characteristics of the most affected populations. Early diagnosis of HIV infection is critical for initiating appropriate antiviral therapy and prophylactic treatment for opportunistic infections. Attending to the myriad of social problems these families face is equally important for providing an optimal chance for prolonged survival and a reasonably high quality of life.

AIDS-Related Opportunistic Infections↗
PubMed1993

Pneumocystis carinii pneumonia among US children with perinatally acquired HIV infection.

OBJECTIVE: To describe epidemiologic characteristics of Pneumocystis carinii pneumonia (PCP) among children with perinatally acquired human immunodeficiency virus (HIV) infection to guide prevention efforts. DESIGN: National acquired immunodeficiency syndrome (AIDS) surveillance of children aged 0 through 12 years, a multisite surveillance study of HIV infection in children aged 0 through 12 years, and the national HIV serosurvey of childbearing women. SETTING: Surveillance conducted by state and local health departments and reported to the Centers for Disease Control and Prevention 1982 through 1992. RESULTS: Pneumocystis carinii pneumonia was reported in 1374 (37%) of 3665 perinatally acquired AIDS cases. Over half of these cases occurred between 3 and 6 months of age. In 183 (64%) of 275 PCP cases reported in the special surveillance study, PCP was the first or only AIDS-defining condition diagnosed, and in 44% of cases, the child had not been evaluated for HIV infection before diagnosis of PCP. The estimated median survival after diagnosis of PCP was 19 months. CONCLUSIONS: Pneumocystis carinii pneumonia is a common and serious opportunistic infection that affects young children with HIV infection. Effective efforts to prevent PCP in this population will require identification as early as possible of children who may be infected with HIV.

AIDS-Related Opportunistic Infections↗
PubMed1993

HIV transmission by organ and tissue transplantation.

PURPOSE: Published reports in English of HIV infection in organ and tissue recipients were reviewed to examine (1) the effect of donor screening, allograft type, and allograft processing on risk of HIV transmission by transplantation; (2) the antibody response to HIV infection in organ recipients taking antirejection therapy; and (3) survival following transplantation for HIV-infected organ recipients. DATA EXTRACTION: Date of transplant, timing of HIV infection in relation to transplant, type of allograft, type of antirejection therapy, duration of follow-up, time to death, and time to antigen and antibody appearance were recorded for each of 32 reports. RESULTS: HIV transmission associated with transplantation of kidney (n = 50), liver (n = 13), heart (n = 6), pancreas (n = 1), bone (n = 4), and skin (n = 1) has been reported. In all but 14 cases, transplantation occurred before routine donor screening for HIV antibody began. In addition, 24 cases of an organ transplant after the recipient became HIV-infected have been reported. Non-transmission of HIV from HIV-infected donors has also been reported in recipients of corneas (n = 9), bone (n = 26), other musculoskeletal tissue (n = 3), dura mater (n = 3), and kidneys (n = 2). Of 40 recipients with organ transplantation-associated infection who were tested for HIV antibody within 6 months of transplantation, 34 (85%) tested positive; only one recipient remained seronegative more than 6 months after transplantation. Estimated 1- and 5-year survival following transplantation for 61 HIV-infected kidney recipients was 90 and 50%, respectively. CONCLUSIONS: With current screening practices, HIV transmission by transplantation is rare. The transmission risk appears lower for recipients of processed or avascular tissues. The antibody response to HIV infection in organ recipients taking immunosuppressive therapy is similar to that reported in other infected people.

HIV Infections↗
PubMed1993

Epidemiology of disseminated nontuberculous mycobacterial disease in children with acquired immunodeficiency syndrome.

Between 1981 and 1991, disseminated nontuberculous mycobacterial infection (DNTM) was reported in 199 (5.7%) of 3472 children less than 13 years of age with acquired immunodeficiency syndrome (AIDS) in the United States. More than 85% of DNTM cases were caused by infection with Mycobacterium avium complex. The proportion of AIDS cases with DNTM was higher in those with hemophilia or transfusion-associated human immunodeficiency virus (HIV) infection than in those with perinatally acquired HIV infection (12.9% and 13.8% vs. 4.6%; P < 0.001). The proportion of AIDS cases with DNTM did not differ significantly by sex (6.1% in males and 5.3% in females) or race (7.4% in whites, 5.0% in blacks and 5.5% in Hispanics) when stratified by HIV transmission category. An active HIV infection surveillance project in 6 geographic areas revealed that the median age at diagnosis of DNTM was 3.3 years for perinatally acquired HIV infection but 8.7 years for DNTM in children with hemophilia or AIDS associated with transfusion, presumably because many of the latter acquired HIV at an older age. Among children with DNTM who had CD4 counts performed within 6 months of the date of DNTM, the median was 17 cells/mm3 and 70% of cases of DNTM occurred in children with fewer than 50 CD4 cells. We conclude that clinicians should have a high index of suspicion for DNTM in children with lower CD4 counts and a longer duration of HIV infection and that preventive strategies, such as prophylactic antimycobacterial therapy, should be focused on this group of children.

AIDS-Related Opportunistic Infections↗
PubMed1992

Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor.

BACKGROUND: Since 1985, donors of organs or tissues for transplantation in the United States have been screened for human immunodeficiency virus type 1 (HIV-1), and more than 60,000 organs and 1 million tissues have been transplanted. We describe a case of transmission of HIV-1 by transplantation of organs and tissues procured between the time the donor became infected and the appearance of antibodies. The donor was a 22-year-old man who died 32 hours after a gunshot wound; he had no known risk factors for HIV-1 infection and was seronegative. METHODS: We reviewed the processing and distribution of all the transplanted organs and tissues, reviewed the medical histories of the donor and HIV-1-infected recipients, tested stored donor lymphocytes for HIV-1 by viral culture and the polymerase chain reaction, and tested stored serum samples from four organ recipients for HIV-1 antigen and antibody. RESULTS: HIV-1 was detected in cultured lymphocytes from the donor. Of 58 tissues and organs obtained from the donor, 52 could be accounted for by the hospitals that received them. Of the 48 identified recipients, 41 were tested for HIV-1 antibody. All four recipients of organs and all three recipients of unprocessed fresh-frozen bone were infected with HIV-1. However, 34 recipients of other tissues--2 receiving corneas, 3 receiving lyophilized soft tissue, 25 receiving ethanol-treated bone, 3 receiving dura mater treated with gamma radiation, and 1 receiving marrow-evacuated, fresh-frozen bone--tested negative for HIV-1 antibody. Despite immunosuppressive chemotherapy, HIV-1 antibody appeared between 26 and 54 days after transplantation in the three organ recipients who survived more than four weeks. CONCLUSIONS: Although rare, transmission of HIV-1 by seronegative organ and tissue donors can occur. Improvements in the methods used to screen donors for HIV-1, advances in techniques of virus inactivation, prompt reporting of HIV infection in recipients, and accurate accounting of distributed allografts would help to reduce further this already exceedingly low risk.

Acquired Immunodeficiency Syndrome↗