This is the second study from Tamil Nadu that deals with epidemiology of brain tumors. Multimodality management including surgery, chemotherapy, and radiation therapy remains the cornerstone in the management of pediatric brain tumors.

The benefit of daily over thrice-weekly antituberculosis therapy among HIV-positive patients with pulmonary tuberculosis (TB) who are receiving antiretroviral therapy remains unproven. OBJECTIVE To compare the efficacy and safety of daily, part-daily, and intermittent antituberculosis therapy regimens in the treatment of HIV-associated pulmonary TB. DESIGN, SETTING, AND PARTICIPANTS This open-label, randomized clinical trial was conducted by the National Institute for Research in Tuberculosis, south India. Adults infected with HIV with newly diagnosed, culture-positive, pulmonary TB were enrolled between September 14, 2009, and January 18, 2016. INTERVENTIONS Patients were randomized to daily, part-daily, and intermittent antituberculosis therapy regimens, stratified by baseline CD4 lymphocyte count and sputum smear grade. Antiretroviral therapy was initiated as per national guidelines. Clinical and sputum microbiological examinations of patients were performed monthly until 18 months after randomization. Adverse events were recorded using standard criteria. MAIN OUTCOMES AND MEASURES The primary outcome was favorable response, defined as treatment completion with all available sputum cultures negative for Mycobacterium tuberculosis during the last 2 months of treatment. Unfavorable responses included treatment failures, dropouts, deaths, and toxic effects among regimens. RESULTS Of 331 patients (251 [76%] male; mean [SD] age, 39 [9] years; mean [SD] HIV viral load, 4.9 [1.2] log 10 copies/mL; and median [interquartile range] CD4 lymphocyte count, 138 [69-248] cells/μL), favorable responses were experienced by 91% (89 of 98), 80% (77 of 96), and 77% (75 of 98) in the daily, part-daily, and intermittent regimens, respectively. With the difference in outcome between daily and intermittent regimens crossing the O'Brien-Fleming group sequential boundaries and acquired rifampicin resistance emergence (n = 4) confined to the intermittent group, the data safety monitoring committee halted the study. A total of 18 patients died and 18 patients dropped out during the treatment period in the 3 regimens. Six, 4, and 6 patients in the daily, part-daily, and intermittent regimens, respectively, had TB recurrence. CONCLUSIONS AND RELEVANCE Among HIV-positive patients with pulmonary TB receiving antiretroviral therapy, a daily anti-TB regimen proved superior to a thrice-weekly regimen in terms of efficacy and emergence of rifampicin resistance. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00933790

Nevirapine blood concentrations are affected by many factors, most notably age ≤ 3 years; a combination of young age, stunting and CYP2B6 GG or GT genotype could potentially result in sub-therapeutic nevirapine concentrations. Dosing recommendations for children should be reviewed in the light of these findings.

Background Antiretroviral therapy (ART) associated dyslipidaemia has been reported among children living with HIV (CLHIV) in both developed and developing countries. Not much data is available on changes in blood lipid profile among CLHIV on first-line ART in India. Aims: To study the changes in the Lipid profile among CLHIVs, 12 months after initiating a non-nucleoside reverse transcriptase inhibitor-based (NNRTI) ARTMethods A prospective multicentric study enrolled HIV infected children, between 2-12 years of age, initiating NNRTI-based ART in south India. Clinical details, anthropometry and fasting blood for estimating serum total cholesterol (TC), triglyceride (TGL), high-density cholesterol (HDL-c), low-density cholesterol (LDL-c), plasma viral load and CD4 cell counts was collected. These measurements were repeated at 6th and 12th month after ART initiation. Proportion of children with abnormal lipid profile at baseline and 12 months after ART were compared using McNemar test. Generalized linear model was applied to predict factors associated with changes in serum lipid levels 12 months post-ART.ResultsOf the 393 HIV-infected children, 66 % received Zidovudine and 14 % Stavudine in their ART regimen. After 12 months of ART, TC, LDL-c and HDL-c increased from baseline by a mean of 31mg/dL, 13.7 mg/dL and 19mg/dl, respectively. TC/HDL-c ratio decreased from a mean of 5.1 to 3.5 (all changes, P <0.000). At baseline and 12 months, respectively, TC was >200 mg/dL for 3% and 13% of patients, LDL-c was >130 mg/dL for 5% and 8%, HDL-c was <35 mg/dL for 70% and 16%, and TG were >150 mg/dL for 38% and 24%. Baseline HIV viral load >400 copies/mL (P, 0.01) was associated with increase in HDL-c and lower TG levels (P, 0.008). Baseline CD4 % <15 and younger age group were significantly associated with increase in TC (P, 0.02) and decrease in TGL (P,0.02) after 12-months of ART.Conclusion Significant changes in serum lipid profile occurs early in children started on first-line ART. Increase in the cardio protective HDL-c was proportionally greater than increases in TC or TGL. Regular monitoring of lipid levels will help in early identification of metabolic complications of ARTDisclosures All authors: No reported disclosures.