HIV Mother-to-Child Transmission, Mode of Delivery, and Duration of Rupture of Membranes: Experience in the Current Era

Objective. To evaluate whether the length of time of rupture of membranes (ROM) in optimally managed HIV-positive women on highly active antiretroviral therapy (HAART) with low viral loads (VL) is predictive of the risk of mother to child transmission (MTCT) of the human immunodeficiency virus (HIV). Study Methods. A retrospective case series of all HIV-positive women who delivered at two academic tertiary centers in Toronto, Canada from January 2000 to November 2010 was completed. Results. Two hundred and ten HIV-positive women with viral loads <1,000 copies/ml delivered during the study period. VL was undetectable (<50 copies/mL) for the majority of the women (167, 80%), and <1,000 copies/mL for all women. Mode of delivery was vaginal in 107 (51%) and cesarean in 103 (49%). The median length of time of ROM was 0.63 hours (range 0 to 77.87 hours) for the entire group and 2.56 hours (range 0 to 53.90 hours) for those who had a vaginal birth. Among women with undetectable VL, 90 (54%) had a vaginal birth and 77 (46%) had a cesarean birth. Among the women in this cohort there were no cases of MTCT of HIV. Conclusions. There was no association between duration of ROM or mode of delivery and MTCT in this cohort of 210 virally suppressed HIV-positive pregnant women

Structural brain differences in school-aged children who are HIV-exposed uninfected

Background: Antiretroviral therapy (ART) has dramatically reduced perinatal HIV transmission, leading to a growing population of children who are HIV-exposed but uninfected (CHEU). While the neuroanatomic developmental impacts of in utero HIV and ART exposure have been studied in young children, long-term effects on school-aged children are poorly understood, prompting this investigation. Methods: Fifty-eight CHEU and 38 children who are HIV-unexposed, uninfected (CHUU), 6–12 years old, were recruited through hospitals and community groups in Ontario, Canada. From T1-weighted magnetic resonance images, volume, cortical thickness, and gray-/white-matter tissue volume were extracted. Multiple linear regression models controlling for sex, age, household income, and total brain volume were fit to assess differences by in utero HIV exposure, with additional sex-stratified analyses to uncover sex-specific effects. Results: Compared with CHUU, CHEU showed total brain volumes that were significantly smaller by 49.7cm3 (95% CI [− 95.66, − 3.67]) and cortices thinner by 0.08 mm (95% CI [− 0.13, − 0.02]). In male CHEU, three regions displayed volumetric age-exposure interactions: the bilateral pars opercularis at 0.36 cm3/year (95% CI [0.10, 0.62]), left rolandic operculum at 0.22 cm3/year (95% CI [0.04, 0.39]) and left precentral gyrus at 0.71 cm3/year (95% CI [0.22, 1.21]), suggesting delayed maturation in those regions. Bilateral frontal lobe cortical thickness was reduced by 0.07 mm in CHEU (95% CI [− 0.14, − 0.006]), most pronounced in the left orbital middle frontal gyrus with a reduction of 0.20 mm among male CHEU (95% CI [− 0.32, − 0.07]). An age-exposure interaction of 0.06 cm3/year in bilateral amygdala volume (95% CI [− 0.11, − 0.01]) suggested reduced growth or altered developmental trajectory among CHEU, whereas male CHEU showed bilateral hippocampal volumes diminished by 0.21 cm3 (95% CI [− 0.40, − 0.01]). Conclusions: These findings suggest that in utero HIV and ART exposure have broad neuroanatomic developmental impacts, particularly in boys, with significant differences in brain regions critical for motor function, expressive language, memory, and emotion. These structural differences align with previously reported motor and language deficits and highlight the importance of early intervention and tailored support strategies for CHEU

Effect of wearing a face mask on hand-to-face contact by children in a simulated school environment: the Back-to-School COVID-19 Simulation Randomized Clinical Trial

Importance Wearing a face mask in school can reduce SARS-CoV-2 transmission but it may also lead to increased hand-to-face contact, which in turn could increase infection risk through self-inoculation. Objective To evaluate the effect of wearing a face mask on hand-to-face contact by children while at school. Design, Setting, and Participants This prospective randomized clinical trial randomized students from junior kindergarten to grade 12 at 2 schools in Toronto, Ontario, Canada, during August 2020 in a 1:1 ratio to either a mask or control class during a 2-day school simulation. Classes were video recorded from 4 angles to accurately capture outcomes. Interventions Participants in the mask arm were instructed to bring their own mask and wear it at all times. Students assigned to control classes were not required to mask at any time (grade 4 and lower) or in the classroom where physical distancing could be maintained (grade 5 and up). Main Outcomes and Measures The primary outcome was the number of hand-to-face contacts per student per hour on day 2 of the simulation. Secondary outcomes included hand-to-mucosa contacts and hand-to-nonmucosa contacts. A mixed Poisson regression model was used to derive rate ratios (RRs), adjusted for age and sex with a random intercept for class with bootstrapped 95% CIs. Results A total of 174 students underwent randomization and 171 students (mask group, 50.6% male; control group, 52.4% male) attended school on day 2. The rate of hand-to-face contacts did not differ significantly between the mask and the control groups (88.2 vs 88.7 events per student per hour; RR, 1.00; 95% CI, 0.78-1.28; P = >.99). When compared with the control group, the rate of hand-to-mucosa contacts was significantly lower in the mask group (RR, 0.12; 95% CI, 0.07-0.21), while the rate of hand-to-nonmucosa contacts was higher (RR, 1.40; 95% CI, 1.08-1.82). Conclusions and Relevance In this clinical trial of simulated school attendance, hand-to-face contacts did not differ among students required to wear face masks vs students not required to wear face masks; however, hand-to-mucosa contracts were lower in the face mask group. This suggests that mask wearing is unlikely to increase infection risk through self-inoculation. Trial Registration ClinicalTrials.gov Identifier: NCT0453125

La prise en charge des nourrissons, des enfants et des adolescents vulnérables à l’infection par le virus de l’hépatite C

Abstract L’infection par le virus de l’hépatite C touche de 0,5 % à 1,0 % de la population canadienne. La plupart des infections pédiatriques découlent d’une transmission verticale ou, chez les adolescents et les jeunes adultes, de comportements à haut risque comme l’utilisation de drogues injectables et les activités sexuelles non protégées. Il est désormais recommandé que tous les nourrissons, les enfants et les adolescents qui présentent au moins un facteur de risque soient soumis au dépistage de l’infection par le virus de l’hépatite C. Il est démontré que le traitement de la forme chronique de cette infection au moyen d’antiviraux à action directe provoque une suppression virologique soutenue chez 97 % à 100 % des enfants dès l’âge de trois ans. Les pédiatres et les médecins de famille ont un rôle important à jouer pour informer les adolescents des risques et des modes de prévention de l’infection par le virus de l’hépatite C, ainsi que pour revendiquer, auprès du gouvernement et des autorités sanitaires, l’adoption de stratégies d’intervention globales de réduction des méfaits ciblant les jeunes à risque, des traitements accessibles et le dépistage prénatal systématique de ce virus.</jats:p

The management of infants, children, and youth at risk for hepatitis C virus infection

Abstract Hepatitis C virus (HCV) infection affects 0.5% to 1.0% of the Canadian population. Most paediatric HCV infections are a consequence of vertical transmission or, among youth and young adults, the result of engaging in high-risk behaviours, such as injection drug use and unprotected sexual activity. It is now recommended that all infants, children, and youth with one or more risk factors be screened for HCV infection. Treating chronic HCV infection with direct-acting antivirals has been shown to achieve sustained virologic suppression in 97% to 100% of children as young as 3 years old. Paediatricians and family physicians have an important role in educating youth regarding HCV infection risks and prevention, and in advocating to government and public health authorities for comprehensive harm reduction interventions targeting at-risk youth, accessible treatments, and routine prenatal screening for HCV.</jats:p

Metabolic abnormalities associated with protease inhibitor therapy in HIV-infected children

Objectives. To investigate the extent and severity of reduced insulin sensitivity (IS) and associated metabolic abnormalities in HIV-infected children and determine if protease inhibitor (PI) therapy is associated with the development of these abnormalities. Methods. The study was cross sectional in design. Insulin sensitivity was determined using the insulin-modified frequent sampling intravenous glucose tolerance test. Serum lipids, glucose, insulin, proinsulin and C-peptide were measured in the fasting state. Abdominal fat distribution was assessed by computed tomography. Results. After adjusting for other explanatory variables, the IS of PI-treated children was significantly lower than that of PI-naïve children (p = 0.0333). PI therapy was a significant correlate of IS in pubertal (p = 0.0163), but not in prepubertal children (p = 0.41). Total cholesterol, LDL cholesterol and triglycerides, but not visceral to subcutaneous adipose tissue ratio were significantly higher in PI-treated than PI-naïve subjects. Conclusions. In HIV-infected children, PI therapy is associated with reduced IS, hypercholesterolemia and hypertriglyceridemia.M.Sc

Childhood Encephalitis in Canada in 2015

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