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Fourteen patients with sexually transmitted human immunodeficiency virus (HIV)-related immune thrombocytopenia were treated with intravenous gammaglobulin (IVIG). The patients were treated with a uniform program consisting of 1 g/kg of IVIG on day 1 and day 2, followed by 1 g/kg on day 15. Most patients had pretreatment bleeding symptoms, which included petechiae, spontaneous and traumatic ecchymoses, gum bleeding, and epistaxis. Median baseline platelet count was 17,000/mm3 (range 3-61,000/mm3). After the infusion of the IGIV, all patients had a resolution of their bleeding by day 8. The median maximum platelet count achieved with the IGIV was 220,000/mm3 (range 76-426,000/mm3). No patient achieved either a sustained complete or partial remission after the conclusion of the IVIG therapy. Toxicities were minimal with the majority being headache and nausea. In conclusion, patients with sexually transmitted HIV infection and immune thrombocytopenia respond favorably to IVIG. This treatment should be considered as first-line therapy for patients with HIV-related immune thrombocytopenia who require immediate but temporary increase in their platelet count, attributable to symptoms or signs of clinical bleeding or because of the need for an invasive procedure.

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The purpose of this statement is to provide a progress report concerning the activities and accomplishments of the Committee on Indian Health. The Committee was established in late 1964 with the following objectives defined by the Executive Board: 1. To encourage experienced pediatricians to consider careers within the Indian Health Service. 2. To conduct or sponsor studies of special pediatric problems in Indian and Alaskan natives. 3. To provide leadership in the review and development of methods and procedures to improve the provision of pediatric services to the Indian and Alaskan native population. 4. To stimulate continuing individual and organizational interest in the Indian Health Program by pediatricians, particularly those in practice in areas with a large Indian population. 5. To establish a continuing liaison and professional relationship between the Academy and pediatricians assigned to the Indian Health Program. COMMITTEE ACTIVITIES Meetings Since its inception, the Committee has held formal meetings in Phoenix, Anchorage, Billings, Chicago, Washington, Albuquerque, Tucson, and Oklahoma City. Members of the Committee are physicians who are informed and interested in Indian health and who reside near Indian or Alaskan native populations. The Committee has seen the problems of American Indians and Alaskan natives firsthand during field trips to reservations and other locations with concentrations of Indian populations. Shortly after its establishment, the Committee saw the need to maintain continuing liaison with other committees and agencies. Therefore, a consultant from the National Institute of Child Health and Human Development was named to the Committee, and a liaison representative from the Committee on School Health of the Academy was added as a consultant.

Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system and a leading cause of neurological disability in young adults. Clinical presentation and disease course are highly heterogeneous. Typically, disease progression occurs over time and is characterized by the gradual accumulation of disability. The risk of developing MS is driven by complex interactions between genetic and environmental factors, including the gut microbiome. How the commensal gut microbiota impacts disease severity and progression over time remains unknown. Methods: In a longitudinal study, disability status and associated clinical features in 60 MS patients were tracked over 4.2 +/- 0.97 years, and the baseline fecal gut microbiome was characterized via 16S amplicon sequencing. Progressor status, defined as patients with an increase in Expanded Disability Status Scale (EDSS), were correlated with features of the gut microbiome to determine candidate microbiota associated with risk of MS disease progression. Results: We found no overt differences in microbial community diversity and overall structure between MS patients exhibiting disease progression and non-progressors. However, a total of 45 bacterial species were associated with worsening disease, including a marked depletion in Akkermansia, Lachnospiraceae, and Oscillospiraceae, with an expansion of Alloprevotella, Prevotella-9, and Rhodospirillales. Analysis of the metabolic potential of the inferred metagenome from taxa associated with progression revealed a significant enrichment in oxidative stress-inducing aerobic respiration at the expense of microbial vitamin K2 production (linked to Akkermansia), and a depletion in SCFA metabolism (linked to Lachnospiraceae and Oscillospiraceae). Further, statistical modeling demonstrated that microbiota composition and clinical features were sufficient to robustly predict disease progression. Additionally, we found that constipation, a frequent gastrointestinal comorbidity among MS patients, exhibited a divergent microbial signature compared with progressor status. Conclusions: These results demonstrate the utility of the gut microbiome for predicting disease progression in MS. Further, analysis of the inferred metagenome revealed that oxidative stress, vitamin K2 and SCFAs are associated with progression.