Objectives To evaluate whether maternal HIV disease severity during pregnancy is associated with an increased likelihood of lower respiratory tract infections (LRTIs) in HIV-exposed, uninfected infants. Methods HIV-exposed, uninfected, singleton, term infants enrolled in the NISDI Perinatal Study, with birth weight ≥ 2500 grams were followed from birth until six months of age. LRTI diagnoses, hospitalizations, and associated factors were assessed. Results Of 547 infants, 103 (18.8%) experienced 116 episodes of LRTIs (incidence=0.84 LRTIs/100 child-weeks). Most (81%) episodes were bronchiolitis. Forty-nine (9.0%) infants were hospitalized at least once with an LRTI. There were 53 hospitalizations (45.7%) for 116 LRTI episodes. None of these infants were breastfed. The odds of LRTI in infants whose mothers had CD4%<14 were 4.4 times than that of those whose mothers had CD4%≥29 (p=0.003). The odds of LRTI were 16.0 times that of infants with a CD4+ count [cells/mm3] < 750 at birth compared to those with CD4+≥750 (p=0.002). Maternal CD4+ decline and Infant hemoglobin at the 6-12 week visit were associated with infant LRTIs after 6-12 weeks and before six months of age. Conclusions Acute bronchiolitis is common and frequently severe among HIV-exposed, uninfected infants aged six months or less. Lower maternal and infant CD4+ values were associated with a higher risk of infant LRTIs. Further understanding of the immunological mechanisms of severe LRTIs is needed.

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Worldwide, the distribution of HIV-1 subtypes and intersubtype recombinants is not homogeneous. In Latin America and the Caribbean, HIV-1 subtype B predominates. However, in the south of Brazil and in countries of the Southern cone (Argentina, Chile, Paraguay, and Uruguay) there is a different distribution of viral subtypes and intersubtype recombinants. The aim of this work was to analyze HIV-1 diversity in a cohort of pregnant women (with primarily heterosexual acquisition of the infection) who were diagnosed with HIV-1 infection during their current pregnancy and who received ARVs during pregnancy for perinatal transmission prophylaxis. Analysis of 121 partial pol sequences from subjects enrolled in Argentina, Brazil, the Bahamas, and Mexico was performed by phylogenetic and recombinant characterization. Different prevalences of subtype B were observed (100% for specimens from Mexico and the Bahamas, 61% for Brazil, and 30% for Argentina). Subtypes C and F were found, along with BC, BF, FC, and CBF recombinants in specimens from Brazilians. A high prevalence of BF recombinants was found (70%) in specimens from Argentina. The different patterns of HIV- 1 subtypes and intersubtype recombinants in South America (Argentina and Brazil) compared to those in Central and North America should be considered in the design of future HIV-1 vaccine trials.

Background Many resource-limited countries rely on clinical and immunologic monitoring without routine virologic monitoring of HIV-infected children receiving highly active antiretroviral therapy (HAART). We assessed whether HIV viral load (VL) had independent predictive value in the presence of immunologic and clinical data for the occurrence of new World Health Organization (WHO) stage 3 or 4 events (WHO events) among HIV-infected children receiving HAART in Latin America. Methods The NICHD International Site Development Initiative (NISDI) Pediatric Protocol is an observational cohort study designed to describe HIV-related outcomes in infected children. Eligibility criteria for this analysis included perinatal infection, age <15 years, and continuous HAART for ≥6 months. Cox proportional hazards modeling was used to assess the time to new WHO events as a function of immunological status, VL, hemoglobin and potential confounding variables; laboratory tests repeated during the study were treated as time-varying predictors. Results The mean follow-up was 2.5 years; new WHO events occurred in 16% of 584 children. In proportional hazards modeling, most recent VL > 5000 copies/mL was associated with a nearly doubled risk of developing a WHO event (adjusted hazard ratio=1.81, 95% CI 1.05–3.11; p=0.033), even after adjustment for CD4-defined immunosuppression, hemoglobin level, age and body mass index. Conclusions Routine virologic monitoring, using the WHO virologic failure threshold of 5,000 copies/mL, adds independent predictive value to immunologic and clinical assessments for identification of children receiving HAART who are at risk for significant HIV-related illness. To provide optimal care, periodic virologic monitoring should be considered for all settings providing HAART to children.

SOUZA, Ricardo de. The social education in pedagogy experimentation spaces. f. 2010, 301 p. Thesis (Master's Degree).