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      Preliminary study on HIV status disclosure to perinatal infected children: retrospective analysis of administrative records from a pediatric HIV clinic in the southern United States

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          Abstract

          Objective

          The World Health Organization recommends disclosing HIV-status between 6 and 12 years; American Academy of Pediatrics recommends that children are informed at “school age.” Neither suggests an optimal age when children should learn of their status to improve viral load suppression. Considering that virally suppressed people do not transmit HIV and that interrupting the transmission cycle is critical to ending the HIV epidemic, our objective is to examine the relationship between age of disclosure and viral load suppression by evaluating data from a pediatric HIV clinic in the southern United States. Records from perinatal infected patients seen between 2008 and 2018 were analyzed (N = 61).

          Results

          Longitudinal suppression was low across all groups when benchmarked against the UNAIDS 90% global target; black patients were less likely to achieve suppression compared to white patients (41% vs. 75%, p = 0.04). Adopted children were more likely to achieve suppression than children living with biological family (71% vs. 44%, p < 0.05). Children who learned of their status between 10 and 12 had the highest rate of suppression (65%) compared to peers who learned of their status younger (56%) or older (38%). Our preliminary study is designed to spark research on refining the current recommendations on HIV-status disclosure to perinatal infected children.

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          Most cited references4

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          Paediatric HIV/AIDS disclosure: towards a developmental and process-oriented approach.

          As antiretroviral therapy becomes more widely available in low-resource settings and children with HIV/AIDS live for longer periods, disclosure of HIV diagnosis to infected children is becoming increasingly important. This article reviews the current literature on HIV-related disclosure in light of theories of cognitive development, and argues for the adoption of a process-oriented approach to discussing HIV with infected children. Disclosure presents unique challenges to healthcare workers and caregivers of children with HIV/AIDS that include controlling the flow of information about the child's HIV status to him/her and deciding on what is in his/her best interest. Health care workers' and caregivers' views regarding disclosure to children may often be contradictory, with healthcare workers likely to support disclosing the diagnosis of HIV/AIDS to children and caregivers more reluctant to discuss the disease with them. There is a clear need for practical interventions to support paediatric HIV disclosure which provide children with age-appropriate information about the disease.
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            Disclosure of Illness Status to Children and Adolescents With HIV Infection

            (1999)
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              Advances and hope for perinatal HIV remission and cure in children and adolescents

              Purpose of review The known timing of HIV infection in perinatal transmission combined with the capacity for early antiretroviral therapy (ART) initiation and immune reconstitution can provide unique insights into HIV persistence. The scientific basis for a pediatric-specific research agenda aimed at HIV remission and cure is discussed. Recent findings Accumulating evidence supports a favorable biomarker profile for immunotherapeutic interventions in early treated, perinatally-infected individuals. HIV DNA concentrations in infected cells of early treated infants decrease over the first few years of life and, after >10 years of ART, the overwhelming majority of non-induced proviral genomes are replication-deficient. With early ART initiation, approximately half of perinatally-infected individuals become seronegative. Studies of untreated infants and vaccine trials indicate infected infants can generate HIV-specific humoral responses. Taken together, this evidence suggests early treatment results in low levels of replication-competent provirus, an absence of HIV-specific immunity, and the capacity to generate immune responses to potential immunotherapeutic interventions. Summary Perinatally HIV-infected individuals require lifelong ART due to the prompt establishment of viral latency in long-lived resting memory CD4+ T cells that rekindle viremia upon treatment cessation. However, intense research efforts are ongoing to perturb HIV latency towards reservoir clearance for virologic remission and cure in which perinatally-infected individuals can discontinue ART.
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                Author and article information

                Contributors
                budhwani@uab.edu
                Journal
                BMC Res Notes
                BMC Res Notes
                BMC Research Notes
                BioMed Central (London )
                1756-0500
                24 May 2020
                24 May 2020
                2020
                : 13
                : 253
                Affiliations
                [1 ]GRID grid.265892.2, ISNI 0000000106344187, Department of Health Care Organization and Policy, School of Public Health, , University of Alabama at Birmingham (UAB), ; Birmingham, AL 35294 USA
                [2 ]GRID grid.265892.2, ISNI 0000000106344187, Department of Pediatrics, School of Medicine, , University of Alabama at Birmingham (UAB), ; Birmingham, AL 35294 USA
                Author information
                http://orcid.org/0000-0002-6716-9754
                Article
                5097
                10.1186/s13104-020-05097-z
                7247121
                32448309
                a3061ea4-e33f-4b8d-94e5-e355da77ebba
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 16 January 2020
                : 19 May 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;
                Award ID: K01MH116737
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100000102, Health Resources and Services Administration;
                Award ID: H12HA24770
                Award Recipient :
                Categories
                Research Note
                Custom metadata
                © The Author(s) 2020

                Medicine
                hiv,disclosure,viral load,adolescents,children,people living with hiv
                Medicine
                hiv, disclosure, viral load, adolescents, children, people living with hiv

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