UNLABELLED:This report examines the relationship between substance use, psychosocial stressors, and natural killer (NK) cell enumeration and function in HIV-infected and high-risk uninfected adolescents. We studied the association of demographic characteristics; self-report measures of alcohol, tobacco, and marijuana use; and self-report measures of psychosocial stressors (depressive symptoms, anxiety) with three immune outcomes: NK (CD3(-)CD16(+)CD56(+)) absolute counts, lytic units per peripheral blood mononuclear cells (PBMCs), and lytic units per NK cell. In addition, we determined the association of HIV disease stage, antiretroviral therapy (ART), CD4(+) T-cell count, and viral load with these outcomes in the subset of HIV-infected adolescents.METHODS:This cross-sectional analysis reports on data collected during a longitudinal observational study of adolescents (the REACH Study). A cross-sectional analysis was performed with data from the first visit for each subject that met criteria for concurrent (within 3 days) assessment of NK number and function, substance use, and psychosocial data. The data set represented 501 subjects. Analyses were performed separately for the HIV-seropositive and seronegative adolescents. In the HIV-seronegative population, there were no significant predictors of NK cell count and only female gender was significantly associated with CD3(-)CD16(+)CD56(+) NK lytic units per PBMC. Analysis of the HIV-seronegative cohort also showed that black race was significantly associated with higher lytic units per NK cell.RESULTS:In HIV-seropositive adolescents, we observed an association of female gender with lower NK cell number and lytic units per PBMC, but not with lytic units per NK cells. Current use of one or two antiretroviral drugs was predictive of lower NK numbers. This drug effect was also noted in the functional assay per PBMC but not per NK cell. Increasing worry scores and no marijuana use over the past 3 months were associated with lower functional NK measures per PBMC in HIV-seropositive youth. Laboratory-confirmed recent marijuana use was highly predictive of increased lytic activity calculated per NK cell. These effects were not observed in similar analyses of data from HIV-seronegative adolescents. Depressive symptoms, assessed with an epidemiologic screening tool, were not found to be predictive of NK cell number or function in either the HIV-seronegative or the HIV-seropositive subset. These findings document associations between substance abuse, psychosocial variables, and NK numbers and function in adolescents.

The roles of cytokines in the progression of human immunodeficiency virus (HIV)-associated disease are controversial. The patterns of innate cytokine production have been postulated to shift from TH1- to TH2-type cytokines with the progression of HIV-associated disease. Although there have been studies of cytokines in children and adults, no data are available on cytokine production in healthy or HIV-infected adolescents. We analyzed and characterized cytokine mRNA and protein levels for gamma interferon, interleukin 2 (IL-2), IL-4, and tumor necrosis factor alpha and protein levels of IL-6 in both stimulated and unstimulated peripheral blood mononuclear cells obtained from a large longitudinal, observational cohort study of HIV-seropositive and -seronegative adolescents. We correlated cytokine results with viral load and CD4(+)-T-cell counts as critical markers of disease progression in HIV-infected adolescents. These data were used to examine hypotheses related to the TH1-to-TH2 cytokine shift in a sample of HIV-infected adolescents. Five hundred twenty subjects participating in the REACH (Reaching for Excellence in Adolescent Care and Health) Project of the Adolescent Medicine HIV/AIDS Research Network contributed blood samples. Samples selected for the cross-sectional data set analyzed had to meet selection criteria developed to minimize the potential confounding effects of acute intercurrent illnesses or infections, recent vaccination for hepatitis, and altered hormone status and to optimize congruence of cytokine measurements with assays of viral load and CD4(+)-T-cell counts. Group differences in the proportions of subjects with detectable levels of each cytokine marker were compared. In the subset of subjects with detectable cytokine values, differences in detected values were compared across subgroups defined by HIV serostatus and among HIV-seropositive subjects by three viral load classifications. The study sample was 65% HIV seropositive, 71% African-American, and 75% female with a mean age of 17.4 years. HIV-seropositive subjects were relatively healthy with mean and median CD4(+)-T-cell counts of 534 and 499 cells/mm(3), respectively. Only 8.1% of subjects had CD4(+)-T-cell counts below 200 cells/mm(3), and 25% had viral loads that were below the threshold of detection (<400 copies/ml). Detailed analyses of these data indicate that there were no differences in cytokines detected in HIV-seropositive and HIV-seronegative adolescents, and there was no apparent relationship between the cytokine measurements and the viral load or CD4(+)-T-cell categorization, the parameters selected as markers of HIV-associated disease status. These adolescents, including the HIV-seropositive subjects, were relatively healthy, and the HIV-infected subjects were at an early stage in the course of their HIV-associated disease. On the basis of our data, we conclude that, early in the course of HIV-associated disease in adolescents, there are no detectable shifts from TH1 to TH2 cytokine production.

ABSTRACT Flow cytometry analysis of lymphocyte subset markers was performed for a group of sexually active, human immunodeficiency virus (HIV)-negative adolescents over a 2-year period to establish normative data. Data were collected in the REACH Project (Reaching for Excellence in Adolescent Care and Health), a multicenter, longitudinal study of HIV-positive and high-risk HIV-negative adolescents. Two- and three-color flow cytometry data were collected every 6 months for these subjects. We determined the effects of gender, race, and age on the following lymphocyte subset markers: total CD4+ cells, CD4+ naïve cells, CD4+ memory cells, all CD8+ cells, CD8+ naïve cells, CD8+ memory cells, CD16+ natural killer cells, and CD19+ B cells. Gender was the demographic characteristic most frequently associated with differences in lymphocyte subset measures. Females had higher total CD4+ cell and CD4+ memory cells counts and lower CD16+ cell counts than males. Age was associated with higher CD4+ memory cell counts as well as higher CD8+ memory cell counts. For CD19+ cells, there was an interaction between age and gender, with males having significantly lower CD19+ cell counts with increasing age, whereas there was no age effect for females. Race and/or ethnicity was associated with differences in total CD8+ cell counts and CD8+ memory cell counts, although both of these associations involved an interaction with gender.

Objective: To test the a priori hypothesis that longer duration of ruptured membranes is associated with increased risk of vertical transmission of HIV.Design: The relationship between duration of ruptured membranes and vertical transmission of HIV was evaluated in an individual patient data meta-analysis.Methods: Eligible studies were prospective cohort studies including at least 100 mother-child pairs, from regions where HIV-infected women are counselled not to breastfeed. Analyses were restricted to vaginal deliveries and non-elective Cesarean sections; elective Cesarean section deliveries (those performed before onset of labour and before rupture of membranes) were excluded.Results: The primary analysis included 4721 deliveries with duration of ruptured membranes less than or equal to 24 h. After adjusting for other factors known to be associated with vertical transmission using logistic regression analysis to assess the strength of the relationship, the risk of vertical HIV transmission increased approximately 2% with an increase of 1 h in the duration of ruptured membranes [adjusted odds ratio, 1.02; 95% confidence interval, 1.01-1.04; for each 1 h increment]. There were no significant interactions of duration of ruptured membranes with study cohort or with any of the covariates, except maternal AIDS. Among women diagnosed with AIDS, the estimated probability of transmission increased from 8% to 31% with duration of ruptured membranes of 2 h and 24 h respectively (P < 0.01).Conclusions: These results support the importance of duration of ruptured membranes as a risk factor for vertical transmission of HIV and suggest that a diagnosis of AIDS in the mother at the time of delivery may potentiate the effect of duration of ruptured membranes. (C) 2001 Lippincott Williams & Wilkins.

Dupin, Nicolas; Kellam, Paul; Fisher, Cyril; Alitalo, Kari; Weiss, Robin; Boshoff, Chris Author Information

OBJECTIVE:To determine the timing, extent, severity, and persistence of neurologic abnormalities in children with perinatally acquired human immunodeficiency virus 1 (HIV-1) infection compared with similar uninfected children of HIV-1-infected women and control children.METHODS:Serial neurologic examinations and head circumference measurements were performed on a cohort of HIV-1-infected children born to HIV-1-infected women, seroreverting children born to HIV-1-infected women, and control children born to uninfected women. Examination data from 32 HIV-1-infected children, 99 reverters, and 116 control children were summarized by eight neurologic domains. Data were analyzed by longitudinal analysis.RESULTS:Reverter children were not different from control children in neurologic function for any of the eight domains or head circumference. HIV-1-infected children had significantly more neurologic problems than the control and reverter children for seven of the eight domains. The HIV-1-infected children were further classified by whether they had acquired immunodeficiency syndrome (AIDS)-defining clinical conditions (other than lymphoid interstitial pneumonitis) in the first 24 months of life (the AIDS-opportunistic infection group) or did not (the infected-other group). Neurologic abnormalities were early, severe, pervasive, and persistent in the AIDS-opportunistic infection group, and nearly all in this group had head circumference measurements below the 10th percentile. The infected-other group had no statistically significant differences from the uninfected children, although individual children in the infected-other group had some abnormalities.CONCLUSIONS:In utero exposure to HIV-1 without infection seems to have no negative impact on neurologic function in children in the first 2 years of life. Among children with perinatally acquired HIV-1 infection, the most severe and pervasive neurologic problems occur in those children who have early serious HIV-1 clinical disease. Most children without serious AIDS-defining clinical conditions in the first 2 years of life are also free from serious neurologic problems during that period.

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Annals of the New York Academy of SciencesVolume 693, Issue 1 p. 35-51 Immunologic Targets of HIV Infection: T Cellsa WILLIAM T. SHEARER, Corresponding Author WILLIAM T. SHEARER Departments of Pediatrics, Microbiology, and Immunology, Baylor College of Medicine, Houston, Texas 77030. Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030.William T. Shearer, M.D., Ph.D., Department of Allergy & Immunology, Texas Children's Hospital, 6621 Fannin, MS 1-3291, Houston, TX 77030.Search for more papers by this authorHOWARD M. ROSENBLATT, Corresponding Author HOWARD M. ROSENBLATTWilliam T. Shearer, M.D., Ph.D., Department of Allergy & Immunology, Texas Children's Hospital, 6621 Fannin, MS 1-3291, Houston, TX 77030.Search for more papers by this authorMARK D. SCHLUCHTER, MARK D. SCHLUCHTER Department of Biostatistics/Epidemiology, Cleveland Clinic Foundation, Cleveland. Ohio 44195.Search for more papers by this authorLYNNE M. MOFENSON, LYNNE M. MOFENSON National Institute of Child Health and Human Development, Rockville, Maryland 20892.Search for more papers by this authorTHOMAS N. DENNY, THOMAS N. DENNY Department of Pediatrics, New Jersey Medical School and Children's Hospital of New Jersey, Newark, New Jersey 07103.Search for more papers by this authorTHE NICHD IVIG CLINICAL TRIAL GROUP, THE NICHD IVIG CLINICAL TRIAL GROUP National Institute of Child Health and Human Development, Rockville, Maryland 20892.Search for more papers by this authorTHE NHLBI P2C2 PEDIATRIC PULMONARY AND CARDIAC COMPLICATIONS OF HIV INFECTION STUDY GROUP, THE NHLBI P2C2 PEDIATRIC PULMONARY AND CARDIAC COMPLICATIONS OF HIV INFECTION STUDY GROUP National Heart, Lung and Blood Institute, Bethesda, Maryland 20892.Search for more papers by this author WILLIAM T. SHEARER, Corresponding Author WILLIAM T. SHEARER Departments of Pediatrics, Microbiology, and Immunology, Baylor College of Medicine, Houston, Texas 77030. Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030.William T. Shearer, M.D., Ph.D., Department of Allergy & Immunology, Texas Children's Hospital, 6621 Fannin, MS 1-3291, Houston, TX 77030.Search for more papers by this authorHOWARD M. ROSENBLATT, Corresponding Author HOWARD M. ROSENBLATTWilliam T. Shearer, M.D., Ph.D., Department of Allergy & Immunology, Texas Children's Hospital, 6621 Fannin, MS 1-3291, Houston, TX 77030.Search for more papers by this authorMARK D. SCHLUCHTER, MARK D. SCHLUCHTER Department of Biostatistics/Epidemiology, Cleveland Clinic Foundation, Cleveland. Ohio 44195.Search for more papers by this authorLYNNE M. MOFENSON, LYNNE M. MOFENSON National Institute of Child Health and Human Development, Rockville, Maryland 20892.Search for more papers by this authorTHOMAS N. DENNY, THOMAS N. DENNY Department of Pediatrics, New Jersey Medical School and Children's Hospital of New Jersey, Newark, New Jersey 07103.Search for more papers by this authorTHE NICHD IVIG CLINICAL TRIAL GROUP, THE NICHD IVIG CLINICAL TRIAL GROUP National Institute of Child Health and Human Development, Rockville, Maryland 20892.Search for more papers by this authorTHE NHLBI P2C2 PEDIATRIC PULMONARY AND CARDIAC COMPLICATIONS OF HIV INFECTION STUDY GROUP, THE NHLBI P2C2 PEDIATRIC PULMONARY AND CARDIAC COMPLICATIONS OF HIV INFECTION STUDY GROUP National Heart, Lung and Blood Institute, Bethesda, Maryland 20892.Search for more papers by this author First published: October 1993 https://doi.org/10.1111/j.1749-6632.1993.tb26255.xCitations: 16 a This work was supported by National Institutes of Health Grants HR-96040, AI-27551, HD-26603, AI-32466, and a contract from the National Institute of Child Health and Human Development, the Women and Infants HIV Transmision Study, and the Immunology Research Fund of Texas Children's Hospital. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume693, Issue1Pediatric AIDS: Clinical, Pathologic, and Basic Science PerspectivesOctober 1993Pages 35-51 RelatedInformation