Features of the course and therapy of HIV infection in children at different stages of the disease

Purpose of the study. Analysis of clinical and laboratory features of the course of HIV infection and antiviral therapy in children at different stages of the disease.

Materials and methods. Under supervision in the department of motherhood and childhood there were 90 children with HIV infection, which were divided into 3 groups: 1st group – 35 people. with a diagnosis of HIV infection in the first 2 months of life, group 2 – 25 people. with a diagnosis at the age of 6-12 months and the 3rd group (30 people) with a diagnosis of HIV infection over the age of 2 years. Statistical processing of the research results was carried out using the software package Statistica for Windows (version 8.0).

Research results. Early detection of HIV infection and the beginning of antiretroviral therapy (ARVT) led to the absence of clinical manifestations of the disease, low levels of HIV RNA in the blood and normal levels of CD4 lymphocytes, which persisted for 3 years of observation. The detection of HIV infection and the start of ART in the first 6–12 months of life of children was characterized by clinical symptoms up to CNS damage, high levels of HIV RNA in the blood, moderate decrease in CD4 lymphocytes, with normalization after 3–6 months of treatment and after 3 years of observation.
Late diagnosis of HIV infection in children – over 2 years of age is characterized by severe forms of the disease with secondary manifestations – AIDS in 20,0% of cases, low rates of CD4 lymphocytes, damage to the central nervous system with the formation of spastic diplegia, and slow recovery of immunity. The use of the drug Viferon, rectal suppositories in the combined treatment of EBV-mononucleosis and a generalized form of CMV infection allows the early treatment of the main symptoms of herpes virus infections and normalization of laboratory parameters.

Conclusion Our prospective study showed that mother-tochild  transmission of HIV was realized due to the absence of the first stage of chemoprophylaxis (during pregnancy), and was also aggravated in 9 cases (10,0%) by breastfeeding. The severity of the clinical manifestations of HIV infection, the levels of CD4-lymphocytes and HIV RNA in the blood directly depend on the period of detection and the initiation of ART  in children. The inclusion of human recombinant interferon alpha-2b with antioxidants (Viferon rectal suppositories) in the etiopathogenetic therapy of comorbid herpes virus diseases (EBV-mononucleosis, a generalized form of  CMV infection) is effective and safe.

1. Comorbid conditions in HIV infection. part III. Somatic diseases and disorders. N. A. Belyakov, V. V. Rassokhin.- St. Petersburg: Baltic medical educational center, 2019.-252 pp.

2. Latysheva I. B., Voronin E. E. Monitoring and evaluation of measures to prevent mother-to-child transmission of HIV in the Russian Federation in 2008-2017. Newsletter. 2018, 44p.

3. HIV infection in children» Clinical recommendations of the Ministry of health of the Russian Federation, 2017, M., 47p.

4. Voronin E. E., Latysheva I. B., Mussini K. Children with HIV infection are a special group of patients. Epidemiology and infectious diseases. Topical issue. 2018. No. 3. Pp. 71-75.

5. HIV infection and comorbid conditions in the NorthWestern Federal district of the Russian Federation in 2017: analytical review.-SPb.: Pasteur research Institute, 2018. 31p.

6. Yastrebova E. B., Samarin A.V., Fertig E. K., L. gutova V. Pediatric aspects of HIV and ways of their solution in SaintPetersburg. Journal of HIV infection and immunosuppression, 2019, vol. 11, no 1: 31-37.

7. Diagnosis of HIV infection and use of antiretroviral drugs in children, Clinical recommendations (treatment Protocol) of the Ministry of health of the Russian Federation, 2016, M., 65 p.

8. Department of Health and Human Services. Panel on antiretroviral therapy and medical management of HIV-infected children. Guidelines for the use of antiretroviral agents in pediatric HIV infection, 2016. http://aidsinfo.nih.gov/guidelines

9. HIV 2014/15. Under edition of C. Hoffman, J. Rockstroh Medizin Fokus, 2014. 924 p.

10. PENTA Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life. HIV Med 2015 Feb 3. – 42 p.

11. Timchenko V. N., Yastrebova E. B., Bulina O. V., Vyzhlova E. N. Modern etiotropic therapy of HIV infection and concomitant herpesvirus diseases in children. Infectious diseases, 2017, Vol. 15, No. 2. Pp. 25-32.

12. National clinical guidelines for HIV diagnosis and treatment- infections in children and adolescents / MOH of the Russian Federation and the national virological Association, 2013. – Moscow, 2013.