Brain atrophy has been observed in perinatally HIV-infected patients (PHIV) despite initiation on... more Brain atrophy has been observed in perinatally HIV-infected patients (PHIV) despite initiation on combined antiretroviral treatment (cART), but neuroimaging studies are limited. We aimed to evaluate cortical thickness (CT) and subcortical gray matter (GM) volumes of PHIV youths with stable immunovirological situation and with a normal daily performance. A prospective cross-sectional study was conducted. A total of 25 PHIV patients on cART and 25 HIV-negative (HIV-) controls matched by age, sex, level of education, and socioeconomic status underwent a magnetic resonance imaging scan. CAT12 toolbox was used to extract CT values from T1w images using parcellations from Desikan–Killiany atlas (DK40). To measure regional brain volumes, native segmented images were parceled in regions of interest according to the Neuromorphometrics Atlas. Neuropsychological assessment and psychopathological symptoms were documented. Fifty participants were included (60% females, median age 20 years [interquartile range, IQR 19–23], 64% Whites). No differences regarding neuropsychological tests or psychopathological symptoms were found between groups (all P > .05). All participants presented an average performance in the Fluid Intelligence (FI) test (PHIV mean: −0.12, HIV- mean: 0.24), When comparing CT, PHIV-infected patients showed thinner cortices compared with their peers in fusiform gyrus (P = .000, P = .009), lateral-orbitofrontal gyrus (P = .006, P = .0024), and right parsobitalis gyrus (P = .047). Regarding subcortical GM volumes, PHIV patients showed lower right amygdala (P = .014) and left putamen (P = .016) volumes when compared with HIV- controls. Within the PHIV group, higher CD4 count was associated with higher volumes in right putamen (B = 0.00000038, P = .045). Moreover, increased age at cART initiation and lower nadir CD4 count was associated with larger volumes in left accumbens (B = 0.0000046, P = .033; B = −0.00000008, P = .045, respectively). PHIV patients showed thinner cortices of areas in temporal, orbito-frontal and occipital lobes and lower volumes of subcortical GM volumes when compared with the HIV- control group, suggesting cortical and subcortical brain alterations in otherwise neuroasymptomatic patients. Nevertheless, larger and longitudinal studies are required to determine the impact of HIV on brain structure in PHIV patients and to further identify risk and protective factors that could be implicated.
Purpose: We aimed to describe the outcomes, focusing on the hearing and neurological development,... more Purpose: We aimed to describe the outcomes, focusing on the hearing and neurological development, of children born to mothers with SARS-CoV-2 infection during pregnancy, and to evaluate the persistence of maternal antibodies in the rst months of life. Methods:An observational, prospective study at a tertiary hospital in Madrid (Spain) on infants born to mothers infected with SARS CoV-2 during pregnancy between March and September 2020. A follow-up visit at 1-3 months of age with a physical and neurological examination, cranial ultrasound (cUS), SARS-CoV-2 RT-PCR on NPS and SARS-CoV-2 serology were performed. Hearing was evaluated at birth through the automated auditory brainstem response and at six months of age through the auditory steady-state response. A neurodevelopmental examination using the Bayley-III scale was performed at 12 months of age. Results:Of 95 infants studied, neurological examination was normal in all of them at the follow-up visit, as was the cUS in 81/85 (95%) infants, with only mild abnormalities in four of them. Serology was positive in 47/95 (50%) infants, which was not associated with symptoms or severity of maternal infection. No hearing loss was detected and neurodevelopment was normal in 96% of the children (median Z score: 0). Conclusions: In this cohort, the majority of infants born to mothers with SARS-CoV-2 infection during pregnancy were healthy children with a normal cUS, no hearing loss and normal neurodevelopment in the rst year of life. Only half of the infants had a positive serological result during the follow-up. What Is Known Hearing loss and neurodevelopmental delay in infants born to mothers with SARS-CoV-2 infection during pregnancy has been suggested, although data is inconsistent. Maternal antibody transfer seems to be high, with a rapid decrease during the rst weeks of life. What is new: Most infants born to mothers with SARS-CoV-2 infection during pregnancy had normal hearing screening, cranial ultrasound and neurodevelopmental status at 12 months of life. Antibodies against SARS-CoV-2 were only detected in 50% of the infants at two months of life. Here we set out to describe the clinical outcomes of children born to mothers who were infected with SARS-CoV-2 during pregnancy, focusing particularly on the hearing and neurological development of the infants, and evaluating the persistence of maternal antibodies in these children in the rst months of life. Methods We carried out an observational prospective study at the Hospital Universitario 12 de Octubre, a tertiarycare center located in southern Madrid (Spain). This hospital covers an estimated population of 400,000 inhabitants and attends around 4,000 deliveries each year. Infants born from March to September 2020 to mothers with SARS-CoV-2 infection during pregnancy were included in this study. Mothers were considered to have had a SARS-CoV-2 infection during pregnancy if they had either a positive result in a SARS-CoV-2 Reverse-Transcription Polymerase Chain Reaction (RT-PCR) on a nasopharyngeal swab (NPS) sample and/or a positive SARS-CoV-2 serology test during pregnancy (no vaccine was available). During the whole study period, SARS-CoV-2 NPS RT-PCR was performed on pregnant women if they referred to any COVID-19 related symptom during their antenatal visits or at any other healthcare visit during their pregnancy. From April 2020, SARS-CoV-2 RT-PCR was performed on all pregnant women admitted to hospital, and from February 28th to May 10th 2020, SARS-CoV-2 serology was performed on all pregnant women as part of a seroprevalence study conducted by the Microbiology Department at our center[24]. All the serological samples from the pregnant women stored at the Microbiology Department biobank were evaluated for SARS-CoV-2 antibodies. The speci c IgG against SARS-CoV-2 Receptor Binding Domain and S proteins were studied, and SARS-CoV-2 seropositivity was de ned as the presence of anti-SARS-CoV-2 IgG antibodies in the serum (titer > 1:100). Pregnant women The clinical and microbiological data from pregnant women were recorded retrospectively from their electronic medical records. The date of maternal infection was de ned as the day of the rst positive RT-PCR, if available. If the mother's diagnosis was based only on a positive serology result, the date of maternal infection was established as the rst day of COVID-19 related symptoms, if indicated. In mothers with no positive RT-PCR result and no related symptoms, we were unable to establish the date of infection. The management of pregnant women documented with acute COVID-19 included a complete
Brain atrophy has been observed in perinatally HIV-infected patients (PHIV) despite initiation on... more Brain atrophy has been observed in perinatally HIV-infected patients (PHIV) despite initiation on combined antiretroviral treatment (cART), but neuroimaging studies are limited. We aimed to evaluate cortical thickness (CT) and subcortical gray matter (GM) volumes of PHIV youths with stable immunovirological situation and with a normal daily performance. A prospective cross-sectional study was conducted. A total of 25 PHIV patients on cART and 25 HIV-negative (HIV-) controls matched by age, sex, level of education, and socioeconomic status underwent a magnetic resonance imaging scan. CAT12 toolbox was used to extract CT values from T1w images using parcellations from Desikan–Killiany atlas (DK40). To measure regional brain volumes, native segmented images were parceled in regions of interest according to the Neuromorphometrics Atlas. Neuropsychological assessment and psychopathological symptoms were documented. Fifty participants were included (60% females, median age 20 years [inter...
Background Sleep quality (SQ) data in human immunodeficiency virus (HIV) pediatric population are... more Background Sleep quality (SQ) data in human immunodeficiency virus (HIV) pediatric population are scarce. Our main objective was to assess SQ in our cohort and to determine the impact of antiretroviral therapy (ART) on sleep in a cohort of HIV-infected adolescents on cART. Materials and Methods The SQ was assessed through the Pittsburgh Sleep Quality Index (PSQI). Neuropsychiatric symptoms (NS) were recorded using an auto-administered questionnaire. To determine the antiretroviral (ARV) impact of efavirenz (EFV) on SQ, patients on EFV versus protease inhibitors-based regimens were compared. Results Forty-six patients were evaluated (median age: 16 years, interquartile range [IQR]: 10.8, 17)). Age at the start of ART: 1.3 years (0.4, 5.2); 23.9% showed acquired immunodeficiency syndrome (AIDS) category. Median CD4 at baseline was 656 (550, 808) cells/mm3; 91.3% had viral load <50 copies/mL. Median time on cART was 11.3 years (7.5, 15.2). Fifty-two percent of the patients were on E...
Enfermedades infecciosas y microbiologia clinica, Jan 12, 2018
Sexual intercourse is currently the main route of HIV infection in Spain. Despite decreases in ne... more Sexual intercourse is currently the main route of HIV infection in Spain. Despite decreases in new infections among women and drug users, the rate remains stable in men. The aim of this study was to assess risk behaviour and HIV awareness in a sample of young adults in Spain. A cross-sectional, observational, descriptive study was performed on a non-HIV infected sample, using a questionnaire on sexual health and HIV awareness adapted from the Spanish National Institute of Statistics. A sexual risk variable was included (high and low), which was classified as high if subjects had had three or more sexual partners and did not always use a condom in all their sexual encounters. 243 subjects were included (65.6% women) aged between 16 and 36years (mean=25.7; SD=4.1) (16-24years: 134 subjects; 25-29years: 60 subjects; over 30years: 47 subjects). Approximately 40.9% said that they used a condom in all sexual relations and 61% did not perceive any risk of infection. There were no significa...
Objective: To analyze mid-term neurodevelopment outcome in children with isolated mild ventriculo... more Objective: To analyze mid-term neurodevelopment outcome in children with isolated mild ventriculomegaly (VM) ≤12 mm diagnosed in fetal life, using the Battelle Developmental Inventory Screening Test (BDIST). Methods: 86 cases of mild VM were identified. 68 were excluded due to: other cerebral anomalies (n = 40), extra-cerebral anomalies (n = 3), chromosomal defects (n = 4), dysmorphic syndromes (n = 4), congenital infections (n = 2), termination of pregnancy (n = 9), stillbirth (n = 2) and incomplete follow-up (n = 4). 18 cases (range 1-8 years) of isolated mild VM were included for analysis. Seven neurodevelopment domains were assessed by BDIST. Results: Routine neuropediatrical evaluation detected neurological disorders in five children (28%; 3 with language impairment, one left hemiparesis and one intellectual retardation). BDIST showed some degree of neurodevelopmental delay in higher proportions: 66% in social-personal skills, 56% in gross motor skills, 39% in adaptive behavior...
Brain atrophy has been observed in perinatally HIV-infected patients (PHIV) despite initiation on... more Brain atrophy has been observed in perinatally HIV-infected patients (PHIV) despite initiation on combined antiretroviral treatment (cART), but neuroimaging studies are limited. We aimed to evaluate cortical thickness (CT) and subcortical gray matter (GM) volumes of PHIV youths with stable immunovirological situation and with a normal daily performance. A prospective cross-sectional study was conducted. A total of 25 PHIV patients on cART and 25 HIV-negative (HIV-) controls matched by age, sex, level of education, and socioeconomic status underwent a magnetic resonance imaging scan. CAT12 toolbox was used to extract CT values from T1w images using parcellations from Desikan–Killiany atlas (DK40). To measure regional brain volumes, native segmented images were parceled in regions of interest according to the Neuromorphometrics Atlas. Neuropsychological assessment and psychopathological symptoms were documented. Fifty participants were included (60% females, median age 20 years [interquartile range, IQR 19–23], 64% Whites). No differences regarding neuropsychological tests or psychopathological symptoms were found between groups (all P &gt; .05). All participants presented an average performance in the Fluid Intelligence (FI) test (PHIV mean: −0.12, HIV- mean: 0.24), When comparing CT, PHIV-infected patients showed thinner cortices compared with their peers in fusiform gyrus (P = .000, P = .009), lateral-orbitofrontal gyrus (P = .006, P = .0024), and right parsobitalis gyrus (P = .047). Regarding subcortical GM volumes, PHIV patients showed lower right amygdala (P = .014) and left putamen (P = .016) volumes when compared with HIV- controls. Within the PHIV group, higher CD4 count was associated with higher volumes in right putamen (B = 0.00000038, P = .045). Moreover, increased age at cART initiation and lower nadir CD4 count was associated with larger volumes in left accumbens (B = 0.0000046, P = .033; B = −0.00000008, P = .045, respectively). PHIV patients showed thinner cortices of areas in temporal, orbito-frontal and occipital lobes and lower volumes of subcortical GM volumes when compared with the HIV- control group, suggesting cortical and subcortical brain alterations in otherwise neuroasymptomatic patients. Nevertheless, larger and longitudinal studies are required to determine the impact of HIV on brain structure in PHIV patients and to further identify risk and protective factors that could be implicated.
Purpose: We aimed to describe the outcomes, focusing on the hearing and neurological development,... more Purpose: We aimed to describe the outcomes, focusing on the hearing and neurological development, of children born to mothers with SARS-CoV-2 infection during pregnancy, and to evaluate the persistence of maternal antibodies in the rst months of life. Methods:An observational, prospective study at a tertiary hospital in Madrid (Spain) on infants born to mothers infected with SARS CoV-2 during pregnancy between March and September 2020. A follow-up visit at 1-3 months of age with a physical and neurological examination, cranial ultrasound (cUS), SARS-CoV-2 RT-PCR on NPS and SARS-CoV-2 serology were performed. Hearing was evaluated at birth through the automated auditory brainstem response and at six months of age through the auditory steady-state response. A neurodevelopmental examination using the Bayley-III scale was performed at 12 months of age. Results:Of 95 infants studied, neurological examination was normal in all of them at the follow-up visit, as was the cUS in 81/85 (95%) infants, with only mild abnormalities in four of them. Serology was positive in 47/95 (50%) infants, which was not associated with symptoms or severity of maternal infection. No hearing loss was detected and neurodevelopment was normal in 96% of the children (median Z score: 0). Conclusions: In this cohort, the majority of infants born to mothers with SARS-CoV-2 infection during pregnancy were healthy children with a normal cUS, no hearing loss and normal neurodevelopment in the rst year of life. Only half of the infants had a positive serological result during the follow-up. What Is Known Hearing loss and neurodevelopmental delay in infants born to mothers with SARS-CoV-2 infection during pregnancy has been suggested, although data is inconsistent. Maternal antibody transfer seems to be high, with a rapid decrease during the rst weeks of life. What is new: Most infants born to mothers with SARS-CoV-2 infection during pregnancy had normal hearing screening, cranial ultrasound and neurodevelopmental status at 12 months of life. Antibodies against SARS-CoV-2 were only detected in 50% of the infants at two months of life. Here we set out to describe the clinical outcomes of children born to mothers who were infected with SARS-CoV-2 during pregnancy, focusing particularly on the hearing and neurological development of the infants, and evaluating the persistence of maternal antibodies in these children in the rst months of life. Methods We carried out an observational prospective study at the Hospital Universitario 12 de Octubre, a tertiarycare center located in southern Madrid (Spain). This hospital covers an estimated population of 400,000 inhabitants and attends around 4,000 deliveries each year. Infants born from March to September 2020 to mothers with SARS-CoV-2 infection during pregnancy were included in this study. Mothers were considered to have had a SARS-CoV-2 infection during pregnancy if they had either a positive result in a SARS-CoV-2 Reverse-Transcription Polymerase Chain Reaction (RT-PCR) on a nasopharyngeal swab (NPS) sample and/or a positive SARS-CoV-2 serology test during pregnancy (no vaccine was available). During the whole study period, SARS-CoV-2 NPS RT-PCR was performed on pregnant women if they referred to any COVID-19 related symptom during their antenatal visits or at any other healthcare visit during their pregnancy. From April 2020, SARS-CoV-2 RT-PCR was performed on all pregnant women admitted to hospital, and from February 28th to May 10th 2020, SARS-CoV-2 serology was performed on all pregnant women as part of a seroprevalence study conducted by the Microbiology Department at our center[24]. All the serological samples from the pregnant women stored at the Microbiology Department biobank were evaluated for SARS-CoV-2 antibodies. The speci c IgG against SARS-CoV-2 Receptor Binding Domain and S proteins were studied, and SARS-CoV-2 seropositivity was de ned as the presence of anti-SARS-CoV-2 IgG antibodies in the serum (titer > 1:100). Pregnant women The clinical and microbiological data from pregnant women were recorded retrospectively from their electronic medical records. The date of maternal infection was de ned as the day of the rst positive RT-PCR, if available. If the mother's diagnosis was based only on a positive serology result, the date of maternal infection was established as the rst day of COVID-19 related symptoms, if indicated. In mothers with no positive RT-PCR result and no related symptoms, we were unable to establish the date of infection. The management of pregnant women documented with acute COVID-19 included a complete
Brain atrophy has been observed in perinatally HIV-infected patients (PHIV) despite initiation on... more Brain atrophy has been observed in perinatally HIV-infected patients (PHIV) despite initiation on combined antiretroviral treatment (cART), but neuroimaging studies are limited. We aimed to evaluate cortical thickness (CT) and subcortical gray matter (GM) volumes of PHIV youths with stable immunovirological situation and with a normal daily performance. A prospective cross-sectional study was conducted. A total of 25 PHIV patients on cART and 25 HIV-negative (HIV-) controls matched by age, sex, level of education, and socioeconomic status underwent a magnetic resonance imaging scan. CAT12 toolbox was used to extract CT values from T1w images using parcellations from Desikan–Killiany atlas (DK40). To measure regional brain volumes, native segmented images were parceled in regions of interest according to the Neuromorphometrics Atlas. Neuropsychological assessment and psychopathological symptoms were documented. Fifty participants were included (60% females, median age 20 years [inter...
Background Sleep quality (SQ) data in human immunodeficiency virus (HIV) pediatric population are... more Background Sleep quality (SQ) data in human immunodeficiency virus (HIV) pediatric population are scarce. Our main objective was to assess SQ in our cohort and to determine the impact of antiretroviral therapy (ART) on sleep in a cohort of HIV-infected adolescents on cART. Materials and Methods The SQ was assessed through the Pittsburgh Sleep Quality Index (PSQI). Neuropsychiatric symptoms (NS) were recorded using an auto-administered questionnaire. To determine the antiretroviral (ARV) impact of efavirenz (EFV) on SQ, patients on EFV versus protease inhibitors-based regimens were compared. Results Forty-six patients were evaluated (median age: 16 years, interquartile range [IQR]: 10.8, 17)). Age at the start of ART: 1.3 years (0.4, 5.2); 23.9% showed acquired immunodeficiency syndrome (AIDS) category. Median CD4 at baseline was 656 (550, 808) cells/mm3; 91.3% had viral load <50 copies/mL. Median time on cART was 11.3 years (7.5, 15.2). Fifty-two percent of the patients were on E...
Enfermedades infecciosas y microbiologia clinica, Jan 12, 2018
Sexual intercourse is currently the main route of HIV infection in Spain. Despite decreases in ne... more Sexual intercourse is currently the main route of HIV infection in Spain. Despite decreases in new infections among women and drug users, the rate remains stable in men. The aim of this study was to assess risk behaviour and HIV awareness in a sample of young adults in Spain. A cross-sectional, observational, descriptive study was performed on a non-HIV infected sample, using a questionnaire on sexual health and HIV awareness adapted from the Spanish National Institute of Statistics. A sexual risk variable was included (high and low), which was classified as high if subjects had had three or more sexual partners and did not always use a condom in all their sexual encounters. 243 subjects were included (65.6% women) aged between 16 and 36years (mean=25.7; SD=4.1) (16-24years: 134 subjects; 25-29years: 60 subjects; over 30years: 47 subjects). Approximately 40.9% said that they used a condom in all sexual relations and 61% did not perceive any risk of infection. There were no significa...
Objective: To analyze mid-term neurodevelopment outcome in children with isolated mild ventriculo... more Objective: To analyze mid-term neurodevelopment outcome in children with isolated mild ventriculomegaly (VM) ≤12 mm diagnosed in fetal life, using the Battelle Developmental Inventory Screening Test (BDIST). Methods: 86 cases of mild VM were identified. 68 were excluded due to: other cerebral anomalies (n = 40), extra-cerebral anomalies (n = 3), chromosomal defects (n = 4), dysmorphic syndromes (n = 4), congenital infections (n = 2), termination of pregnancy (n = 9), stillbirth (n = 2) and incomplete follow-up (n = 4). 18 cases (range 1-8 years) of isolated mild VM were included for analysis. Seven neurodevelopment domains were assessed by BDIST. Results: Routine neuropediatrical evaluation detected neurological disorders in five children (28%; 3 with language impairment, one left hemiparesis and one intellectual retardation). BDIST showed some degree of neurodevelopmental delay in higher proportions: 66% in social-personal skills, 56% in gross motor skills, 39% in adaptive behavior...
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