Aditya Kaul, M.D.

Hyper interleukin-10 in an HIV-positive child with t-cell lymphoma and candidal sepsis
Lighter, Jennifer; Tse, Doris B; Kaul, Aditya; Borkowsky, William
2008 Sep-Oct;7(5):228-231, Journal of the International Association of Physicians in AIDS Care : JIAPAC
We describe a case in which a human immunodeficiency virus (HIV)-positive child presented in severe metabolic acidosis secondary to his candidal sepsis and T-cell lymphoma, a rare finding in pediatric AIDS. Significantly elevated levels of Interleukin-10 (IL-10) were found in the patient's serum, which may have played a role in acute demise
— id: 92164, year: 2008, vol: 7, page: 228, stat: Journal Article,

Natural history of HIV infected pediatric long-term or slow progressor population after the first decade of life
Ofori-Mante, Juliana A; Kaul, Aditya; Rigaud, Mona; Fidelia, Andre; Rochford, Gemma; Krasinski, Keith; Chandwani, Sulachni; Borkowsky, William
2007 Mar;26(3):217-220, Pediatric infectious disease journal
BACKGROUND: Perinatally infected long-term nonprogressors/slow progressors represent a select group of individuals. There is very limited information on this group of children beyond the first decade of life. A group of HIV-infected long-term nonprogressor/slow progressor children was studied. METHODS: We enrolled 20 HIV-infected adolescents who were receiving no or minimal therapy (defined as single or dual nucleoside therapy) before the age of 10 years and who had maintained CD4 counts above 25% for the first decade of life. We analyzed immunologic and virologic characteristics. Thymic receptor excision circles (TREC) were measured on stored frozen peripheral blood mononuclear cells. CD4 count, viral load and other pertinent information including race and age were obtained from individual medical records. RESULTS: Nine of the 20 patients recruited were noted to have developed falling CD4 counts at or around puberty, whereas the other 11 remained stable. There was no difference in TREC values or HIV RNA values before or after puberty between the 2 groups of patients. Those who remained stable, in terms of maintaining CD4 T cells as a group had falling viral loads with age. Those whose CD4 values declined after puberty had viral loads that did not decrease with age. CONCLUSION: A select group of patients who never received HAART during their first decade of life will continue to maintain good CD4 associated with declining HIV RNA values. Thymic output is not predictive of those that don't maintain CD4 T cells
— id: 72125, year: 2007, vol: 26, page: 217, stat: Journal Article,

An appendiceal leiomyoma in a child with acquired immunodeficiency syndrome
Sambol, Elliot; Patterson, Danielle; Rivera, Rafael; Borys, Dariusz; Greco, M Alba; Kaul, Aditya; Nadler, Evan P
2006 Oct;22(10):865-868, Pediatric surgery international
Children with acquired immunodeficiency syndrome (AIDS) are at an increased risk for lymphoproliferative and neoplastic disorders. Included among these are smooth muscle neoplasms such as leiomyomas and leiomyosarcomas. There have been at least 15 reported cases of smooth muscle tumors in the approximately 8,000 children with AIDS, however the incidence in immunocompetent children is only two per ten million. The lesions in children with human immunodeficiency virus infection are usually found in the lung, liver, and gastrointestinal tract. Here, we present an unusual case of a 12-year-old African American girl with vertically acquired AIDS who presented to the pediatric emergency department with severe diffuse abdominal pain. She was ultimately found to have an appendiceal leiomyoma on abdominal exploration, the first reported case. Our report suggests that smooth muscle tumors of the appendix be included in the differential diagnosis of abdominal masses in children with AIDS
— id: 69689, year: 2006, vol: 22, page: 865, stat: Journal Article,

Correlation between HIV-Specific CD8 cell production of interferon- gamma and plasma levels of HIV RNA in perinatally infected pediatric populations
Borkowsky, William; Zhan, Ming-Xia; Chen, Song-He; Ilmet, Tiina; Kaul, Aditya; Chandwani, Sulachni; Rigaud, Mona; Essajee, Shaffiq; Gruber, Caroline; Freedman, Abigail; Krasinski, Keith
2004 Sep 15;190(4):722-726, Journal of infectious diseases
BACKGROUND: CD8 cell responses to human immunodeficiency virus (HIV) have been correlated with virus control in adults, and this study outcome has been controversial. Attempts to establish the same correlation in small numbers of children have also been made, with similar controversy resulting. METHODS: A total of 110 perinatally infected children were studied. Nine of the children (mean age, 1.9 years vs. 11.8 years for the remaining 101 children) received treatment with antiretrovirals within the first 3 months of life. CD4 cell and HIV RNA levels were measured. Production of interferon- gamma after exposure to recombinant vaccinia vectors was measured by enzyme-linked immunospot (ELISPOT) assay. RESULTS: Responses to Pol and Gag antigens exceeded those to Nef and Env antigens, with responses significantly approximated by a quadratic function for which peak responses occurred at plasma HIV RNA levels of 103-104 HIV RNA copies/mL. Children who are treated early in life with highly active antiretroviral therapy have fewer total responses of ELISPOT-forming cells to HIV antigens than do children who are treated later in life
— id: 46157, year: 2004, vol: 190, page: 722, stat: Journal Article,

Fever and rash in a 3-year-old girl: Rocky Mountain spotted fever
Kaufmann, Julie M; Zaenglein, Andrea L; Kaul, Aditya; Chang, Mary Wu
2002 Sep;70(3):165-168, Cutis
Initial symptoms of Rocky Mountain spotted fever (RMSF), a tick-borne illness caused by Rickettsia rickettsii, are nonspecific and include headache, gastrointestinal disturbances, malaise, and myalgias, followed by fever and rash. The classic triad of fever, rash, and history of tick exposure is uncommon at presentation. Clinical manifestations of RMSF range from virtually asymptomatic to severe. Because of the potentially fatal outcome of RMSF, presumptive clinical diagnosis and empiric antimicrobial therapy can be critical. We present the case of a 3-year-old girl from New York State who presented with fever and rash
— id: 95676, year: 2002, vol: 70, page: 165, stat: Journal Article,

Immunoreconstitution in children receiving highly active antiretroviral therapy depends on the CD4 cell percentage at baseline
Nikolic-Djokic, Divna; Essajee, Shaffiq; Rigaud, Mona; Kaul, Aditya; Chandwani, Sulachni; Hoover, William; Lawrence, Robert; Pollack, Henry; Sitnitskaya, Yekaterina; Hagmann, Stefan; Jean-Philippe, Patrick; Chen, Song He; Radding, Jayme; Krasinski, Keith; Borkowsky, William
2002 Feb 1;185(3):290-298, Journal of infectious diseases
The effect of highly active antiretroviral therapy (HAART) in 85 children infected with human immunodeficiency virus type 1 (HIV-1) was compared retrospectively among Centers for Disease Control and Prevention (CDC) immunologic groups 1-3. The duration of HAART did not vary significantly among the immunologic groups (median, 39.07 months). The CD4 cell percentage increased in 39.1%, 58.3%, and 90% of patients in CDC groups 1-3, respectively (P <.001). HAART resulted in the suppression of HIV-1 below detectable levels in 34.8%, 25%, and 32% of patients in the 3 CDC groups, respectively, and in a frequent switch from syncytium-inducing to nonsyncytium-inducing virus. Thymic excision circles increased in a subset of patients with increases in CD4 cell percentage independently of HIV RNA level. The results support the option of delaying HAART in early asymptomatic HIV-1 disease in children and the use of other markers of disease progression, in addition to virus load
— id: 42231, year: 2002, vol: 185, page: 290, stat: Journal Article,

Immunologic and virologic responses to HAART in severely immunocompromised HIV-1-infected children
Essajee SM; Kim M; Gonzalez C; Rigaud M; Kaul A; Chandwani S; Hoover W; Lawrence R; Spiegel H; Pollack H; Krasinski K; Borkowsky W
1999 Dec 24;13(18):2523-2532, AIDS
OBJECTIVE: To determine the long-term immunologic and virologic effects of highly active antiretroviral therapy (HAART) in children with AIDS. DESIGN: A prospective observational study. SETTING: Two pediatric HIV clinics. PARTICIPANTS: Twenty-five protease-inhibitor naive HIV-infected children (aged 2-18 years) with advanced disease (CD4 < or =6%). INTERVENTION: HAART (one protease inhibitor and one or more nucleoside analogs). Diphtheria and tetanus immunization in six patients after 18 months of therapy. MAIN OUTCOME MEASURES: Changes in percentage of CD4 cells and plasma HIV-1 RNA levels; post-treatment assays of lymphoproliferative responses to recall antigens; CD4 cell memory phenotype. RESULTS: Median duration of follow-up was 18.8 months (range, 7.5-28 months). At baseline the CD4 cell percentage was 2% (range, 0-6%), this increased significantly to 16% (range, 3-48%) above baseline at 12 months (P = 0.002). The mean maximum CD4 cell increase was 20.7% (range 4-48%) which corresponds to 657x10(6) cells/l (range, 30-2240x10(6) cells/l) above baseline. By contrast, the median viral load was not significantly lower at 12 months than at baseline (P = 0.34), and only 25% of the patients had sustained undetectable viral load. Of the reconstituted CD4 cells 70% were naive, and none of the subjects had lymphoproliferative responses to tetanus and diphtheria although 40% did develop responses to Candida, an environmental antigen. A single immunization with diphtheria and tetanus toxoid produced lymphoproliferative responses to tetanus in three out of six patients. CONCLUSIONS: HAART was associated with sustained increases in CD4 cell counts, despite a high incidence of 'virologic failure'. CD4 counts and the proportion of naive cells were higher than have been reported in adults, which may be a reflection of greater thymic activity in children. Memory cell clones for antigens encountered in the past which are not prevalent before therapy could not be expanded without additional antigenic exposure
— id: 8585, year: 1999, vol: 13, page: 2523, stat: Journal Article,

Cytomegalovirus infection in human immunodeficiency virus type 1-infected children
Chandwani S; Kaul A; Bebenroth D; Kim M; John DD; Fidelia A; Hassel A; Borkowsky W; Krasinski K
1996 Apr;15(4):310-314, Pediatric infectious disease journal
BACKGROUND: Cytomegalovirus (CMV) is a frequent opportunistic infection in human immunodeficiency virus type 1 (HIV-1)-infected children. The interactions of CMV and HIV-1 in coinfected children are not well-characterized. OBJECTIVE: To evaluate the prevalence of asymptomatic CMV infection and symptomatic CMV disease and to assess the influence of CMV on clinical and laboratory markers of HIV disease progression in CMV-coinfected children. METHODS: Serial urine CMV cultures were performed on 500 children (131 HIV-1-infected (HIV+), 129 seroreverters born to HIV-infected mothers, and 240 HIV-uninfected (HIV-)). The clinical, immunologic and virologic data of 131 HIV+ children were analyzed. RESULTS: CMV was recovered in 40 of 131 HIV+ (31%), 22 of 129 seroreverters (17%) and 30 of 240 HIV- (13%) children. Of the 40 HIV+ children with CMV coinfection, 7 developed symptomatic CMV disease (17.5%) including chorioretinitis (3), colitis (2) and pneumonitis (2). The HIV+ children with symptomatic CMV disease had significantly lower mean CD4+ T lymphocyte proportions (17% vs. 26%; age-adjusted P = 0.013) and greater HIV p24 antigen concentrations (329 pg/ml vs. 57 pg/ml; age-adjusted P = 0.13) than HIV+ children with asymptomatic CMV infection. In a subset of children coinfected with CMV before 6 months of age (n = 11), 5 (45%) developed symptomatic CMV disease, and 4 of these 5 children died within 10 months of diagnosis of CMV disease. At the time of the first positive CMV culture in these children, mean CD4+ T lymphocyte proportions did not differ according to the presence or absence of CMV-related symptoms (symptomatic CMV+, 21% vs. asymptomatic CMV = 38%; P = 0.14). In HIV+ children with symptomatic CMV disease, p24 antigen concentrations were greater than in those with asymptomatic CMV infection (461 vs. 190 pg/ml, P = 0.06). CONCLUSIONS: Symptomatic CMV disease occurred in young CMV-coinfected children with low CD4+ lymphocytes and elevated HIV p24 antigen concentrations. Whether progressive immunodeficiency allows the emergence of CMV disease or CMV infection causes more rapidly progressive HIV-1 disease or whether there is a more complex relationship remains to be determined
— id: 12620, year: 1996, vol: 15, page: 310, stat: Journal Article,

Dexamethasone in bacterial meningitis: to use or not to use?
Kaul A; Chandwani S
1996 Sep-Oct;63(5):583-589, Indian journal of pediatrics
Permanent neurologic disabilities are seen in up to a quarter of survivors of bacterial meningitis despite major improvements in therapy. Experimental studies have demonstrated that most of the pathology in meningitis is mediated by inflammatory cytokines such as tumor necrosis factor (TNF) and interleukin-1 (IL-1), which are produced by host cells in response to bacterial invasion of the meninges. Dexamethasone has been used in a number of clinical trials to moderate the host response and to improve neurologic outcome of meningitis. Results of six randomized, placebo controlled trials are summarized in this review. Dexamethasone treatment did not lower mortality. Only a moderate, but not a significant reduction in the neurologic and audiologic sequelae was seen in dexamethasone recipients when Haemophilus influenzae type b (Hib) was the causative agent of meningitis. Following routine use of Hib vaccine, meningitis caused by this agent has virtually disappeared in the USA. Hence, findings from these trials may no longer be applicable in countries with high rates of immunization against Hib. Presently, there is little or no evidence showing a benefit of dexamethasone therapy in meningitis caused by S. pneumoniae or N. meningitidis. Global emergence of penicillin and cephalosporin resistant S. pneumoniae has raised new concerns about the use of dexamethasone in pneumococcal meningitis. Since dexamethasone significantly decreases the penetration and concentration of vancomycin and ceftriaxone in the CSF and delays CSF sterilization, adjunctive dexamethasone therapy may increase the risk of treatment failure in meningitis caused by antibiotic resistant pneumococci. An antibiotic combination should be used in the treatment of meningitis caused by antibiotic resistant pneumococci, particularly if dexamethasone is also being administered concurrently
— id: 11677, year: 1996, vol: 63, page: 583, stat: Journal Article,

Rapid oral desensitization to trimethoprim-sulfamethoxazole in infants and children
Palusci VJ; Kaul A; Lawrence RM; Haines KA; Kwittken PL
1996 May;15(5):456-460, Pediatric infectious disease journal
BACKGROUND. Although trimethoprim-sulfamethoxazole is the preferred chemoprophylaxis against Pneumocystis carinii pneumonia, there are frequent IgE-mediated reactions among children infected with the human immunodeficiency virus (HIV). Oral desensitization allows more patients to receive chemoprophylaxis, but it has been studied in only a limited number of children. METHODS. We desensitized five children infected with the HIV using a rapid, 4-h oral protocol. RESULTS. Three children (including two infants) successfully completed desensitization and started maintenance therapy, but the other two experienced reactions that precluded further administration of trimethoprim-sulfamethoxazole. CONCLUSIONS. We conclude that a rapid, oral trimethoprim-sulfamethoxazole desensitization protocol is safe and, in some instances, effective among HIV-infected children and infants with a history of non-life-threatening, IgE-mediated reactions to trimethoprim-sulfamethoxazole
— id: 7086, year: 1996, vol: 15, page: 456, stat: Journal Article,

Recurrent pneumococcal bacteremia in HIV-1 infected children
Spiegel, H; Kaul, A; Chandwani, S; Desiderio, D; Lawrence, R; Pollack, H; Krasinski, K; Borkowsky, W
1996 OCT ;23(4):118-118, Clinical infectious diseases
— id: 52755, year: 1996, vol: 23, page: 118, stat: Journal Article,

Application of thin-section low-dose chest CT (TSCT) in the management of pediatric AIDS
Ambrosino MM; Roche KJ; Genieser NB; Kaul A; Lawrence RM
1995 ;25(5):393-400, Pediatric radiology
The aim of this study was to evaluate the usefulness of thin-section low-dose computed tomography (TSCT) in the management of children with AIDS, as chest radiographs (CXR) often fail to adequately explain the patients' clinical status. We performed 54 noncontrast TSCTs on 32 children. The patients aged from 3 months to 14.6 years, were diagnosed as having bacterial pneumonia, lumphocytic interstitial pneumonitis (LIP), Pneumocystis carinii pneumonia (PCP), or Mycobacterium avium-intracellulare infection (MAI). The scans were correlated with the clinical diagnosis, T-lymphocyte-subset percentages, and p24-antigen levels. Subsegmental consolidations were seen in patients with LIP, PCP, and MAI, and as an isolated finding in those with only bacterial pneumonia. Ground-glass haziness was seen exclusively with acute PCP. Reticulonodular thickening was identified only in patients with LIP. Mosaic perfusion was seen with MAI, LIP, and pneumonia. The presence of adenopathy correlated with CD4+ T-cell subset percentages. The greatest value of CT in this study was in detecting new disease when chest films failed to correlate with a patient's clinical state, and in demonstrating acute/subacute disease in patients with severe baseline chest-film changes. Recurrent pneumonias may represent progression of 'smoldering' disease, rather than true recurrent disease following complete clearing. Adenopathy with low CD4+ levels should suggest lymphoma or infection with MAI
— id: 6884, year: 1995, vol: 25, page: 393, stat: Journal Article,

Shortened survival in infants vertically infected with human immunodeficiency virus with elevated p24 antigenemia
Arlievsky NZ; Pollack H; Rigaud M; Kaul A; Krasinski K; Borkowsky W
1995 Oct;127(4):538-543, Journal of pediatrics
OBJECTIVE: To determine whether the amount of p24 antigenemia in the first 6 months of life is a predictor of survival in children infected vertically with human immunodeficiency virus type 1. METHODS: A retrospective study of vertically infected infants and children who were followed prospectively from early infancy and who had quantitation of plasma p24 antigen concentration in the first 6 months of life. Infants were first stratified by duration of survival as infants who died before 2 years of age (short-term survivors) and infants who survived to 2 years of age (intermediate-term survivors). The median p24 antigen concentration and the proportion of infants in each group with high concentrations of antigen were compared. Analyses with and excluding all p24 determinations made after the use of antiretroviral agents were compared Kaplan-Meier product limit analysis was used to compare survival in infants with low and high antigenemia during the first 6 months of life. RESULTS: The median p24 antigen concentration in 15 short-term survivors was 228 pg/ml, compared with 14 pg/ml in 26 intermediate-term survivors (p < 0.05). The proportion of children with > 100 pg/ml of p24 was higher in short-term than in intermediate-term survivors (p = 0.01). Survival to 2 years of age in infants in whom all p24 antigen values during the first 6 months of life were 100 pg/ml or less was 91%, in comparison with 39% in infants with values greater than 100 pg/ml (p = 0.0017). CONCLUSIONS: Elevated p24 antigenemia in the first 6 months of life is associated with shorter survival and may be a useful predictor of outcome
— id: 6802, year: 1995, vol: 127, page: 538, stat: Journal Article,

Molecular techniques in biomedical sciences: a new era in diagnosis of infectious diseases
Chandwani S; Kaul A
1995 Jan-Feb;62(1):41-53, Indian journal of pediatrics
— id: 11678, year: 1995, vol: 62, page: 41, stat: Journal Article,

Infants born to HIV-1 infected women: lessons from the past decade
Kaul A; Chandwani S
1995 Jan-Feb;62(1):17-24, Indian journal of pediatrics
— id: 11679, year: 1995, vol: 62, page: 17, stat: Journal Article,

Polymerase chain reaction is more sensitive than standard cytologic stains in detecting Pneumocystis carinii in bronchoalveolar lavages from human immunodeficiency virus type 1-infected infants and children with pneumonia
Leibovitz E; Pollack H; Rigaud M; Kaul A; Persaud D; Gallo L; Papellas J; Krasinski K; Borkowsky W
1995 Aug;14(8):714-716, Pediatric infectious disease journal
— id: 7910, year: 1995, vol: 14, page: 714, stat: Journal Article,

Comparison of methods of estimating the mother-to-child transmission rate of human immunodeficiency virus type 1 (HIV-1). New York City Perinatal HIV Transmission Collaborative Study Group
Matheson PB; Weedon J; Cappelli M; Abrams EJ; Shaffer N; Bamji M; Krasinski K; Lambert G; Kaul A; Grimm K; et al
1995 Oct 1;142(7):714-718, American journal of epidemiology
Four methods of estimating mother-to-child transmission rates of human immunodeficiency virus type 1 (HIV-1), based on the 1992 Ghent workshop, were compared in a multicenter New York City prospective cohort study in 1986-1992. Of 833 infants born to women at risk of HIV-1 infection, 388 were born HIV-1 seropositive and 445 were HIV-1 seronegative. The four methods, the Antibody Only, Indirect, Direct, and Virologic Methods, yielded transmission rate estimates of 19-25%, classifying 59-89% of the cohort. Estimation based on persistence of HIV-1 antibody and clinical assessment yielded transmission rates similar to those methods that incorporated virologic testing
— id: 15061, year: 1995, vol: 142, page: 714, stat: Journal Article,

Acute renal failure in a human immunodeficiency virus-infected child secondary to bilateral fungus ball formation
Papaevangelou V; Lawrence R; Kaul A; Lefluer R; Ambrosino M; Krasinski K; Borkowsky W
1995 May;14(5):401-403, Pediatric infectious disease journal
— id: 6856, year: 1995, vol: 14, page: 401, stat: Journal Article,

CORRELATION BETWEEN THE MAGNITUDE OF VIRAL LOAD IN EARLY INFANCY AND SURVIVAL AMONG PERINATALLY HIV-INFECTED CHILDREN
POLLACK, H; ARLIEVSKY, N; RIGAUD, M; KAUL, A; KRASINSKI, K; BORKOWSKY, W
1995 APR 2 ;54(3):242-242, Journal of cellular biochemistry
— id: 87326, year: 1995, vol: 54, page: 242, stat: Journal Article,

Feasibility of high-resolution, low-dose chest CT in evaluating the pediatric chest
Ambrosino MM; Genieser NB; Roche KJ; Kaul A; Lawrence RM
1994 ;24(1):6-10, Pediatric radiology
Thin-section, high-resolution (1.0/1.5 mm thick slices), low-dose chest CT scans were performed in 55 infants and children. The studies were carried out with 1- and 2-s scan (data acquisition) times using a high-resolution (bone) algorithm. Although there was some motion artifact, the studies provided valuable information for evaluating diffuse parenchymal lung disease. The thin slices provided finer detail and more diagnostic information than images representing thicker sections. Most studies were performed using between 40 and 80 mAs. It is estimated that the patients' radiation exposure was 20% that of conventional high-resolution CT (HRCT) and 57% that of routine chest CT. Diagnostic HRCT scans can be obtained in infants and young children without the need for suspended respiration or specialized ultrafast CT scanners
— id: 6307, year: 1994, vol: 24, page: 6, stat: Journal Article,

Streptococcus pneumoniae in human immunodeficiency virus type 1-infected children
Gesner M; Desiderio D; Kim M; Kaul A; Lawrence R; Chandwani S; Pollack H; Rigaud M; Krasinski K; Borkowsky W
1994 Aug;13(8):697-703, Pediatric infectious disease journal
The purpose of this study was to characterize systemic Streptococcus pneumoniae disease in human immunodeficiency virus type 1 (HIV-1)-infected children. All cases of bacteremia and meningitis caused by S. pneumoniae among children less than 18 years old were collected by review of the Microbiology Laboratory records at the Bellevue Hospital Center during the period August 1, 1978, through July 31, 1993. There were 31 bouts of systemic S. pneumoniae disease in 19 of 235 HIV-1-infected children cared for by the Pediatric Infectious Disease staff and 116 bouts in 113 children not known to be HIV-1-infected. Four of the 19 HIV-1-infected children had multiple episodes of S. pneumoniae bacteremia as compared with 3 of 113 in the general population (P = 0.008). The frequency of serotypes and distribution of infections by season of the year did not differ between the 2 groups. The median ages at the time of the S. pneumoniae infection were 1.8 and 1.1 years for the HIV-1-infected children and the general population of children, respectively, when those children with multiple episodes were included for their initial episode only (P = 0.06). In the HIV-1-infected patients, 10 episodes were associated with pneumonia, 5 with pneumonia and otitis media, 5 with otitis media only, 1 with pneumonia and meningitis, 1 with meningitis only and 1 with periorbital cellulitis; 5 had no apparent focus of infection. One episode of pneumonia was complicated by lung abscess and there were 2 deaths. Most HIV-1-infected patients recovered without significant sequelae, and the clinical course of their systemic infections did not appear to be markedly different than that of healthy children
— id: 12935, year: 1994, vol: 13, page: 697, stat: Journal Article,

HIV-1 infected children with severe immunodeficiency: survival and prognostic factors
Papaevangelou V; Pollack H; Kaul A; Lawrence R; Krasinski K; Borkowsky W
1994 Oct 4-7;:35-35, Program & abstracts (Interscience Conference on Antimicrobial Agents & Chemotherapy)
Objective: To study the survival and identify prognostic laboratory indicators for HIV-1 infected children with severe immunodeficiency (CD4 less than 15%). Methods: Kaplan-Meier product-limit analysis, from the time of severe immunodeficiency (i.e. presentation with CD4 less than 15% or persistent levels of CD4 less than 15%), was performed on HIV-1 infected children. Plasma p24 antigen and serial hemoglobin concentrations were reviewed as possible prognostic indicators of survival. Results: (Table: see text.) The presence of plasma p24 antigen at presentation did not appear to affect survival in children with CD4 between 10-15%, however the absence of detectable plasma p24 antigen was associated with increased survival in those with CD4 of less than 10% at presentation (50% survival 4.5y and 3.4y for children with CD4 5-9% and 0-4% respectively). A 15% reduction in serum hemoglobin concentration, was associated with decreased 50% survival only in children with CD4 less than 10% (6.2y vs 2.3y). Conclusions: Children with 9 greater than CD4% less than 15% are considered to be severely immunodeficient by the CDC, yet their 50% survival is significantly better than children who present with CD4 less than 10%. The absence of detectable p24 antigenemia at presentation appeared to be associated with improved survival only in children with CD4 T cells less than 10%, whereas a 15% decrease in serum hemoglobin concentration was associated with lower survival only in those with greater than 10% CD4 T cells
— id: 5994, year: 1994, vol: , page: 35, stat: Journal Article,

Efficacy of primary chemoprophylaxis against Pneumocystis carinii pneumonia during the first year of life in infants infected with human immunodeficiency virus type 1
Rigaud M; Pollack H; Leibovitz E; Kim M; Persaud D; Kaul A; Lawrence R; John DD; Borkowsky W; Krasinski K
1994 Sep;125(3):476-480, Journal of pediatrics
To evaluate the efficacy of primary chemoprophylaxis in preventing Pneumocystis carinii pneumonia (PCP) in infants with perinatal human immunodeficiency virus-1 infection during the first year of life, we conducted a retrospective chart review of infants with human immunodeficiency virus-1 infection born at New York University Medical Center-Bellevue Hospital Center, in New York. Between March 1989 and March 1993, 24 infants received primary chemoprophylaxis with trimethoprim-sulfamethoxazole in the first year of life and 24 infants did not receive primary prophylaxis. The CD4+ T-lymphocyte counts in the two groups did not differ during the first year of life. The median age at the time of initiation of prophylaxis was 3 months, and the average duration of prophylaxis was 5.5 months. Among the infants who had not received prophylaxis, five cases of PCP were diagnosed at a median age of 5 months; in contrast, no cases of PCP were observed in the infants receiving prophylaxis (log-rank test, p = 0.017). The probability of surviving after 1 year of age was 92% for the children who received prophylaxis and 74% for those who did not (log-rank test, p = 0.035). These data indicate that chemoprophylaxis is highly effective in preventing primary PCP and improving survival time in infants with human immunodeficiency virus-1 infection
— id: 12908, year: 1994, vol: 125, page: 476, stat: Journal Article,

Maternal predictors of perinatal human immunodeficiency virus transmission. The New York City Perinatal HIV Transmission Collaborative Study Group
Thomas PA; Weedon J; Krasinski K; Abrams E; Shaffer N; Matheson P; Bamji M; Kaul A; Hutson D; Grimm KT; et al
1994 Jun;13(6):489-495, Pediatric infectious disease journal
This analysis sought to identify characteristics of pregnant human immunodeficiency virus type 1 (HIV-1)-infected women that predict mother-to-child HIV-1 transmission. Pregnant and immediately postpartum women at risk for HIV were enrolled at obstetric and pediatric care settings in New York City from 1986 to 1992. Demographic and behavioral characteristics, clinical illness, T lymphocyte subsets, immunoglobulin concentration and syphilis serology were collected on the women. Infants were followed to determine HIV infection classification according to Centers for Disease Control and Prevention criteria for HIV-1 in children. Transmission rates were calculated for women who gave birth more than 15 months before the analysis. Of 172 HIV-1-infected women with known outcome 49 (28%) had infected infants. The transmission rate (TR) was significantly higher among women with < 280 CD4+ cells/microliters (lowest CD4+ quartile) than with CD4+ counts > 280 (48% vs. 22%; P = 0.004; odds ratio, 3.4; 95% confidence interval (1.5, 7.8)); a similar trend was seen by CD4+% quartile. No difference in TR was seen comparing women by CD8+ count quartile but marginally higher TR was seen among women with CD8+% > or = 51% than with CD8+% < 51% (TR = 41% vs. 24%; P = 0.076; odds ratio, 2.2; confidence interval (1.0, 5.1)). The highest TR, 62% was seen in women with both CD8+ count above the median and CD4+ count in the lowest quartile. No significant difference in TR was seen between women with and without HIV-related illness, although the TR was 53% among women hospitalized in the previous year for pneumonia compared with 25% in others (P = 0.03). TR was somewhat lower in women who delivered by cesarean section than vaginally (entire cohort: 18% vs. 32%, P = 0.11; prenatal enrollees only, 17% vs. 38%, P = 0.045). No factor or combination of factors was both highly sensitive and specific for predicting mother-to-child HIV transmission. A possible relationship between transmission and mode of delivery deserves further investigation
— id: 15064, year: 1994, vol: 13, page: 489, stat: Journal Article,

HIV-1 viremia in the first week of life in perinatal infection: effect on CD4% and survival
Zarudsky N; Rigaud M; Pollack H; Kaul A; Kim M; Krasinski K; Borkowsky W
1994 Oct 4-7;:33-33, Program & abstracts (Interscience Conference on Antimicrobial Agents & Chemotherapy)
Objective: To compare survival and CD4+ T cell % (CD4%) in infants with early versus late HIV viremia. Methods: HIV viremia was measured by HIV culture. PCR or P24 ag assay of peripheral blood. Three groups were identified: infants testing positive within the first week of life (X), infants testing negative in the first week and positive within two months (Y), infants tested after the first week but positive within two months (Z). Initial CD4% for all infants in the three groups were compared using the t test. CD4% attrition in the three groups was compared using linear regressions of the last CD4% measured in each infant. Survival times were evaluated by Kaplan-Meier product-limit analyses and compared by log-rank tests. Results: There were nine infants in group X, 12 in group Y, and 20 in group Z. There were no differences in CD4% at birth among these groups. Decline of CD4% in groups X, Y and Z was -0.30, -0.18 and -3.0% per month respectively. These were not significantly different. Survival in the three groups (X vs Y, log-rank p=0.24; Y vs Z, log-rank p=0.42; X vs Z, log-rank p=0.65) was not significantly different. Conclusions: The data suggest that early HIV-1 viremia in perinatal infection is not associated with more rapid decline of CD4% and decreased survival in this small sample. Further studies must be done to determine whether early HIV viremia in perinatal HIV-1 infection can serve as a prognostic indicator
— id: 5997, year: 1994, vol: , page: 33, stat: Journal Article,

Early diagnosis of human immunodeficiency virus type 1-infected infants by plasma p24 antigen assay after immune complex dissociation
Chandwani S; Moore T; Kaul A; Krasinski K; Borkowsky W
1993 Jan;12(1):96-97, Pediatric infectious disease journal
— id: 13308, year: 1993, vol: 12, page: 96, stat: Journal Article,

Cholestatic hepatitis in children infected with the human immunodeficiency virus
Persaud D; Bangaru B; Greco MA; Nachman S; Mittal K; Chandwani S; Krasinski K; Borkowsky W; Kaul A
1993 Jun;12(6):492-498, Pediatric infectious disease journal
A distinct clinical syndrome of cholestasis and hepatitis occurred during early infancy in seven infants with perinatally acquired human immunodeficiency virus 1 infection. In five infants hepatitis was the first manifestation of human immunodeficiency virus 1 infection. The median age of onset of hepatitis was 7 months (range, 5 to 10 months). The mean total bilirubin concentration at presentation was 7.4 mg/dl (range, 3.9 to 11 mg/dl), the mean aspartate aminotransferase was 1512 IU/liter (range, 782 to 2960 IU/liter) and the mean alanine amino-transferase 512 IU/liter (range, 92 to 1247 IU/liter). The absolute CD4 count at the time of onset of hepatitis ranged from 191 to 2298 cells/mm3 (mean, 766 cells/mm3). Six of the seven children died within 12 weeks of onset of hepatitis, three as a result of complications of Pneumocystis carinii pneumonia, and two died of complications secondary to cytomegalovirus. In only one infant was the cause of death the direct consequence of liver failure. The seventh infant died 17 months after the onset of hepatitis of dilated cardiomyopathy. No specific etiologic agent has been identified as the cause of cholestatic hepatitis in these infants. In situ hybridization studies to detect human immunodeficiency virus 1 messenger RNA was negative in the liver tissue obtained at biopsy and autopsy in five of the samples tested
— id: 6483, year: 1993, vol: 12, page: 492, stat: Journal Article,

Early diagnosis of human immunodeficiency virus infection in children less than 6 months of age: comparison of polymerase chain reaction, culture, and plasma antigen capture techniques
Borkowsky W; Krasinski K; Pollack H; Hoover W; Kaul A; Ilmet-Moore T
1992 Sep;166(3):616-619, Journal of infectious diseases
Three techniques were evaluated for their ability to detect human immunodeficiency virus (HIV) in infants from birth to 6 months of age. Polymerase chain reaction (PCR) and HIV cocultivation were of comparable sensitivity, detecting 90% of all positive specimens. Both techniques found positive results in approximately 5% of samples from seroreverting children. Both assays detected HIV in only half of infected newborns, suggesting that this fraction of children was infected during gestation. Plasma p24 antigen was detected in three-fourths of all samples tested but in only half of infected children during the first 2 months of life and 88% of samples from children during the next 4 months. The specificity of p24 antigen detection was 100%
— id: 13452, year: 1992, vol: 166, page: 616, stat: Journal Article,

PATHOLOGY OF THE PLACENTA IN MEASLES
CHANDWANI, S; NAGARAJ, A; KAUL, A; NUOVO, G; POLLACK, H; DEMOPOULOS, R; GRECO, MA
1992 ;66(Suppl 1):P2-P2, Laboratory investigation
— id: 52110, year: 1992, vol: 66, page: P2, stat: Journal Article,

Low risk of mother-to-child transmission of human T lymphotropic virus type II in non-breast-fed infants. The NYC Perinatal HIV Transmission Collaborative Study
Kaplan JE; Abrams E; Shaffer N; Cannon RO; Kaul A; Krasinski K; Bamji M; Hartley TM; Roberts B; Kilbourne B; et al
1992 Oct;166(4):892-895, Journal of infectious diseases
The transmissibility of human T lymphotropic virus (HTLV) type II from mother to child was investigated. Of 236 women enrolled during pregnancy in a study of mother-to-child transmission of human immunodeficiency virus in 1986-1988, 21 (8.9%) were seropositive for HTLV-I/II. All 21 mothers were infected with HTLV-II by synthetic peptide testing and polymerase chain reaction (PCR). HTLV-II-infected women were older (median age, 34 vs. 28 years), more likely to be black (70% vs. 38%), and more likely to report past or current intravenous drug use (85% vs. 56%) than HTLV-II-uninfected women. Of 20 non-breast-fed infants born to 19 of these HTLV-II-infected women, none had detectable HTLV-II by PCR done on peripheral blood mononuclear cells obtained at birth to 36 months of age. Serologic testing of these infants revealed gradual disappearance of HTLV-I/II antibody. While this study does not rule out the possibility of perinatal HTLV-II transmission, the data suggest that it occurs rarely in the absence of breast-feeding
— id: 15068, year: 1992, vol: 166, page: 892, stat: Journal Article,

Chronic varicella zoster in a child infected with human immunodeficiency virus: case report and review of the literature
Leibovitz E; Kaul A; Rigaud M; Bebenroth D; Krasinski K; Borkowsky W
1992 Jan;49(1):27-31, Cutis
Chronic zoster represents an infrequent presentation of varicella zoster virus infection. It is observed with increased frequency in patients infected with human immunodeficiency virus, especially when their lymphocyte counts are depressed. We report a child infected with human immunodeficiency virus who showed a long-standing cutaneous zoster lesion and was treated for a prolonged period of time with acyclovir. The occurrence of resistance to acyclovir by varicella zoster virus was suspected based on the clinical picture. The clinical and laboratory features of this case and a review of the literature are presented
— id: 13718, year: 1992, vol: 49, page: 27, stat: Journal Article,

Delayed recognition of human immunodeficiency virus infection in preadolescent children
Persaud D; Chandwani S; Rigaud M; Leibovitz E; Kaul A; Lawrence R; Pollack H; DiJohn D; Krasinski K; Borkowsky W
1992 Nov;90(5):688-691, Pediatrics
Thirty-two (18%) of 181 children cared for at our institution who were infected with the human immunodeficiency virus type 1 (HIV-1) were first seen, and HIV was diagnosed, when they were 4 years of age and older. Initial complaints or diagnoses for these children included the following: hematologic disorders (5) (3 idiopathic thrombocytopenic purpura, 1 neutropenia, 1 anemia); recurrent bacterial infections (10); Pneumocystis carinii pneumonia (3); developmental delay (1); skin disorders (2) (1 genital wart, 1 chronic zoster); weight loss (3); malignancy (1); and nephropathy (1). Eight children were referred for evaluation because of maternal HIV-1 infection. The risk factors for HIV-1 infection included maternal/perinatal exposure (22), perinatal blood transfusion (6), blood transfusion during infancy (2), and sexual abuse (2). Ten (31%) of the 32 children have subsequently died. The longest survival from perinatal infection was 12 years. HIV-1 infection in children can result in a prolonged clinical latency and can masquerade as other pathologic conditions. The absence of clinical symptoms in older children at risk for HIV-1 infection should not deter HIV testing
— id: 13381, year: 1992, vol: 90, page: 688, stat: Journal Article,

Thrombocytopenia in children infected with human immunodeficiency virus: long-term follow-up and therapeutic considerations
Rigaud M; Leibovitz E; Quee CS; Kaul A; Nardi M; Pollack H; Lawrence R; DiJohn D; Krasinski K; Karpatkin M; et al
1992 ;5(5):450-455, Journal of acquired immune deficiency syndrome
Among 180 children infected with human immunodeficiency virus (HIV-1), 14 (8%) developed thrombocytopenia during the course of the disease and have been followed for an average period of 18.8 months. Eight of 14 patients had clinical signs of bleeding. Increased levels of anti-platelet IgG antibodies were detected in 86% of patients tested and did not correlate with severity of disease. Eight patients were treated initially with intravenous immunoglobulins (IVIG) and responded with a transient increase in the platelet count of at least 30 x 10(9)/L. Sustained remission could not be achieved in the patients treated with IVIG alone. Corticosteroids were used in 6 patients who became refractory to IVIG and resulted in sustained remission in only one patient. Spontaneous remission of thrombocytopenia occurred in one patient. Ten patients were treated with zidovudine (ZVD) for a period of 3-20 months. Sustained improvement in the platelet counts occurred in only three of the children treated with ZVD
— id: 13750, year: 1992, vol: 5, page: 450, stat: Journal Article,

MEASLES INFECTION AND IMMUNOPROPHYLAXIS FAILURE IN HIV INFECTED CHILDREN
CHANDWANI, S; KAUL, A; DIJOHN, D; LEIBOVITZ, E; POLLACK, H; BORKOWSKY, W; KRASINSKI, K
1991 APR ;29(4):A168-A168, Pediatric research
— id: 51664, year: 1991, vol: 29, page: A168, stat: Journal Article,

LACK OF CYTOMEGALOVIRUS COFACTOR EFFECT ON PERINATAL HIV-INFECTION
KRASINSKI, K; KAUL, A; POLLACK, H; DIJOHN, D; BEBENROTH, D; KIM, M; BORKOWSKY, W
1991 APR ;29(4):A176-A176, Pediatric research
— id: 51666, year: 1991, vol: 29, page: A176, stat: Journal Article,

Disseminated fungal infections in children infected with human immunodeficiency virus
Leibovitz E; Rigaud M; Chandwani S; Kaul A; Greco MA; Pollack H; Lawrence R; Di John D; Hanna B; Krasinski K; et al
1991 Dec;10(12):888-894, Pediatric infectious disease journal
A retrospective review of charts of 156 human immunodeficiency virus-infected children cared for during a 7.5-year period revealed 11 episodes of disseminateed candidiasis (DC) occurring in 11 patients (7%). All 11 patients developed the fungal infection in the context of advanced human immunodeficiency virus infection. All but one were hospital-acquired, occurring at a mean of 2.3 months after admission. Ten patients had been febrile for more than 14 days before diagnosis. Previous oral thrush and central venous catheters (73 and 82% of patients) represented major predisposing factors for development of DC. Neutropenia (2 of 11 patients) did not represent a major risk factor for DC. Candida albicans was isolated in 9 patients, Rhodotorula minuta in 1 patient and 1 fungal isolate could not be identified. Sources of isolation were blood (8 of 11 patients), central venous catheters (3 of 11) and urine (2 of 11). Lungs (6 of 11 patients), esophagus (5 of 11) and brain, heart and kidneys (3 patients each) were the organs most often involved in DC. Antemortem diagnosis was achieved in only 7 (64%) patients; none of the 4 patients with DC diagnosed postmortem had been treated before death. Seven patients were treated with amphotericin B; 6 of them died but only 3 were treated for more than 7 days of therapy. The overall mortality was 90% (10 of 11 patients). In all 20% of the 50 human immunodeficiency virus-infected children who died at our hospital during the study period had an episode of DC in close proximity to their death. DC was considered the direct cause of death in 4 of 10 children
— id: 13828, year: 1991, vol: 10, page: 888, stat: Journal Article,

SYSTEMIC FUNGAL-INFECTIONS (SFI) IN CHILDREN INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS (HIV)
LEIBOVITZ, E; RIGAUD, M; CHANDWANI, S; KAUL, A; GRECO, MA; POLLACK, H; LAWRENCE, R; DIJOHN, D; KRASINSKI, K; BORKOWSKY, W
1991 APR ;29(4):A177-A177, Pediatric research
— id: 51667, year: 1991, vol: 29, page: A177, stat: Journal Article,

DELAYED RECOGNITION OF PEDIATRIC HIV-INFECTION IN PREADOLESCENT CHILDREN
PERSAUD, D; CHANDWANI, S; RIGAUD, M; LEIBOVITZ, E; KAUL, A; LAWRENCE, R; POLLACK, H; DIJOHN, D; KRASINSKI, K; BORKOWSKY, W
1991 APR ;29(4):A181-A181, Pediatric research
— id: 51668, year: 1991, vol: 29, page: A181, stat: Journal Article,

THROMBOCYTOPENIA IN CHILDREN INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS (HIV) - LONG-TERM FOLLOW-UP AND THERAPEUTIC CONSIDERATIONS
RIGAUD, M; LEIBOVITZ, E; SINQUEE, C; KAUL, A; NARDI, M; POLLACK, H; LAWRENCE, R; DIJOHN, D; KRASINSKI, K; KARPATKIN, M; BORKOWSKY, W
1991 APR ;29(4):A182-A182, Pediatric research
— id: 51670, year: 1991, vol: 29, page: A182, stat: Journal Article,

CYTOMEGALOVIRUS INFECTIONS IN CHILDREN AT RISK FOR HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION
KRASINSKI, K; BORKOWSKY, W; POLLACK, H; DIJOHN, D; KAUL, A; BEBENROTH, D; FIDELIA, A; MOORE, T
1990 APR ;27(4):A175-A175, Pediatric research
— id: 51498, year: 1990, vol: 27, page: A175, stat: Journal Article,

Use of the polymerase chain reaction for early detection of the proviral sequences of human immunodeficiency virus in infants born to seropositive mothers. New York City Collaborative Study of Maternal HIV Transmission and Montefiore Medical Center HIV Perinatal Transmission Study Group
Rogers MF; Ou CY; Rayfield M; Thomas PA; Schoenbaum EE; Abrams E; Krasinski K; Selwyn PA; Moore J; Kaul A; et al
1989 Jun 22;320(25):1649-1654, New England journal of medicine
The early diagnosis of infection with human immunodeficiency virus (HIV) in infants born to infected mothers is essential for early treatment, but current tests cannot detect HIV infection in newborns because of the presence of maternal antibodies. We used the polymerase chain reaction, a new technique that amplifies proviral sequences of HIV within DNA, to detect HIV infection in peripheral-blood mononuclear cells obtained from infants of seropositive women during the neonatal (age less than 28 days) and postneonatal periods. In blood obtained during the neonatal period, the polymerase chain reaction was positive in five of seven infants in whom the acquired immunodeficiency syndrome (AIDS) later developed (a mean of 9.8 months after the test). The test was also positive in one of eight newborns who later had nonspecific signs and symptoms suggestive of HIV infection (mean follow-up, 12 months). No proviral sequences were detected in neonatal samples from nine infants who remained well (mean follow-up, 16 months). HIV proviral sequences were detected in samples obtained during the postneonatal period (median age, five months) in all of 6 infants tested who later had AIDS and in 4 of 14 infants with nonspecific findings suggestive of HIV infection. No proviral sequences were detected in 25 infants who remained well (mean follow-up, 17 months) after being born to HIV-seropositive mothers, or in 15 infants born to HIV-seronegative mothers. We conclude that the polymerase chain reaction will be a useful technique to diagnose HIV infection in newborns and to predict the subsequent development of AIDS. However, larger studies will be required to determine the sensitivity and specificity of the test
— id: 15072, year: 1989, vol: 320, page: 1649, stat: Journal Article,

Liver cancer induction by 241Am and thorotrast in deer mice and grasshopper mice
Taylor, G N; Mays, C W; Lloyd, R D; Jones, C W; Rojas, J; Wrenn, M E; Ayoroa, G; Kaul, A; Riedel, W
1985 ;80:172-177, Sonderbande zur strahlentherapie
— id: 130714, year: 1985, vol: 80, page: 172, stat: Journal Article,