Browsing by Author "Slogrove, Amy L."
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- ItemAcute extrapyramidal dysfunction in two HIV-infected children(2011) Solomons R.; Slogrove, Amy L.; Schoeman J.; Marais B.; van Zyl G.; Maritz J.; van Toorn R.Involvement of the basal ganglia is well documented in children with human immunodeficiency virus (HIV) encephalopathy, often with calcification. High concentrations of HIV protein have been detected in affected basal ganglia, although extrapyramidal dysfunction, in contrast to adults, is infrequently encountered in HIV-infected children. We describe the clinical course, magnetic resonance imaging appearance and outcome of two HIV-infected children who presented with acute debilitating extrapyramidal dysfunction. The cases highlight the importance of immune competence, co-existence of opportunistic infections, HIV testing of all children of HIV-infected mothers and magnetic resonance imaging when assessing the severity and anticipating outcomes of movement disorders in HIV-infected children. © The Author . Published by Oxford University Press. All rights reserved.
- ItemAntibody responses to vaccination among South African HIV-exposed and unexposed uninfected infants during the first 2 years of life(American Society for Microbiology, 2013-01) Reikie, Brian A.; Naidoo, Shalena; Ruck, Candice E.; Slogrove, Amy L.; De Beer, Corena; La Grange, Heleen; Adams, Rozanne C. M.; Ho, Kevin; Smolen, Kinga; Speert, David P.; Cotton, Mark F.; Preiser, Wolfgang; Esser, Monika; Kollmann, Tobias R.HIV-exposed but uninfected (HEU) infants born to HIV-infected mothers from areas in the world with a high burden of infectious disease suffer higher infectious morbidity and mortality than their HIV unexposed uninfected (HUU) peers. Vaccination provides protection from infection. The possibility exists that altered response to vaccination contributes to the higher rate of infection in HEU than in HUU infants. While short-term, cross-sectional studies support this notion, it is unclear whether or not HEU infants develop long-term protective immune responses following theWHOextended program on immunization (EPI). Vaccine-specific antibody responses were compared between HEU and HUU infants from 2 weeks until 2 years of age in a longitudinal South African cohort. Total IgG and antibodies specific for Bordetella pertussis, Haemophilus influenzae type b (Hib), tetanus toxoid, hepatitis B virus (HepB), and measles virus were measured at multiple time points throughout the first 2 years of life. Prevaccine antibodies (maternal antibodies passively acquired) specific for tetanus were lower in HEU than in HUU infants, while prevaccine antibodies to HepB were higher in HEU than in HUU infants. Both groups responded similarly to tetanus, Hib, and HepB vaccination. HEU demonstrated stronger pertussis vaccine responses, developing protective titers 1 year earlier than HUU patients, and maintained higher anti-tetanus titers at 24 months of age. Vaccine-induced antibodies to measles virus were similar in both groups at all time points. Our results suggest that the current EPI vaccination program as practiced in South Africa leads to the development of vaccine-specific antibody responses that are equivalent in HEU and HUU infants. However, our data also suggest that a large fraction of both HEU and HUU South African infants have antibody titers for several infectious threats that remain below the level of protection for much of their first 2 years of life.
- ItemAntiretroviral and Antituberculosis therapy in HIV-TB co-infected children(2011) Slogrove, Amy L.; Rabie H.; Cotton M.F.HIV-infected children experience a high burden of tuberculosis. With recent advances in international pediatric HIV treatment guidelines significant numbers of infants and children will require simultaneous treatment for both TB and HIV. This article attempts to concisely outline strategies for effective co-treatment of both infections. Rifamycins, an essential component of short course TB chemotherapy, alter the metabolism of a number of antiretroviral drugs. These interactions and their consequences are considered. Options for antiretroviral therapy and the optimal timing of its initiation in the presence of antituberculosis therapy are discussed. © 2011 Bentham Science Publishers Ltd.
- ItemBeing prepared to evaluate pregnancy PrEP(International AIDS Society, 2019-11-27) Slogrove, Amy L.Pregnant and breastfeeding women in high HIV-incidence set-tings are at great risk for HIV-acquisition and stand to benefit tremendously from HIV pre-exposure prophylaxis (PrEP)scale-up . The PrEP Implementation in Young women and Adolescents (PrIYA) programme is to be commended for addressing this challenge by integrating PrEP delivery into routine maternal child health and family planning services in16 clinics in Kisumu County, Kenya. Dettinger and colleagues used data from the PrIYA programme implementation to describe birth (weight and gestational age) and 6-week growth outcomes of infants born to women with and without pregnancy PrEP exposure, concluding that outcomes did not differ by PrEP exposure . However, methodologic limitations of this evaluation challenge interpretation of the comparisons in birth weight, gestational age and 6-week growth outcomes between PrEP-exposed and PrEP-unexposed pregnancies.
- ItemCOVID-19 in pregnancy in South Africa : tracking the epidemic and defining the natural history(Health & Medical Publishing Group, 2020-08) Fairlie, Lee; Sawry, Shobna; Patel, Faeezah; Balkus, Jennifer E.; Kalk, Emma; Mutevedzi, Portia; Technau, Karl-Gunter; Yates, Laura M.; Slogrove, Amy L.; Ballot, Daynia; Bandini, Rosella M.; Mehta, Ushma; Moodley, DhayendreENGLISH ABSTRACT: South Africa (SA) has seen a rapid increase in COVID-19 infections in recent weeks, with cases exceeding 40 000 in early June and anticipated to escalate rapidly as lockdown is eased. The country also has the largest HIV burden globally, and poor maternal and child health indices in many parts.
- ItemCurrent perspectives on paediatric HIV management from the Mexico International Aids Society Conference, 2019(AOSIS, 2019-10-31) Archary, Mohendran; Fairlie, Lee; Slogrove, Amy L.ENGLISH ABSTRACT: While acknowledging the great achievements in getting 23 million people living with HIV to access antiretroviral treatment (ART) globally, there is still more to do in order to close the HIV treatment gap between the paediatric and adult ART programmes, with only 54% of children accessing ART compared to 62% of adults. Furthermore, while tremendous global gains have been made in preventing perinatal and postnatal HIV acquisition, HIV-exposed and uninfected children are still not achieving early childhood developmental outcomes comparable to HIV-unexposed children. In this article, we present highlights from two preconference meetings (11th International Workshop on HIV Pediatrics and 5th Workshop on Children and Adolescents HIV Exposed and Uninfected) and the International Aids Society (IAS) meeting held in Mexico in July 2019.
- ItemHIV exposed uninfected (HEU) infants with excess infectious morbidity(2008) Esser M; Slogrove, Amy L.; Cotton MF
- ItemHIV sero-conversion during late pregnancy - when to retest(AOSIS, 2013) Kalk, E.; Slogrove, Amy L.; Speert, D.; Bettinger, J.; Cotton, M. F.; Esser, M.The South African National Prevention of Mother-to-Child Transmission of HIV programme has resulted in significant reductions in vertical transmission, but new infant HIV infections continue to occur. We present two cases of HIV seroconversion during late pregnancy, demonstrating the limitations of the current programme. These could be mitigated by expanding the programme to include maternal testing at delivery and at immunisation clinic visits as we pursue the elimination of mother-tochild transmission.
- ItemHIV-Exposed Uninfected Infants are at Increased Risk for Severe Infections in the First Year of Life.(OXFORD UNIV PRESS, GREAT CLARENDON ST, OXFORD, ENGLAND, OX2 6DP, 2012) Slogrove, Amy L.; Reikie B; Naidoo S; De Beer C; Ho K; Cotton MF; Bettinger J; Speert D; Esser M; Kollmann TR
- ItemLower birth weight-for-age and length-for-age z-scores in infants with in-utero HIV and ART exposure : a prospective study in Cape Town, South Africa(BMC (part of Springer Nature), 2021-05-04) Nyemba, Dorothy C.; Kalk, Emma; Madlala, Hlengiwe P.; Malaba, Thokozile R.; Slogrove, Amy L.; Davies, Mary-Ann; Boulle, Andrew; Myer, Landon; Powis, Kathleen MBackground: Successful scale-up of antiretroviral therapy (ART) during pregnancy has minimized infant HIV acquisition, and over 1 million infants are born HIV-exposed but uninfected (HEU), with an increasing proportion also exposed in utero to maternal ART. While benefits of ART in pregnancy outweigh risks, some studies have reported associations between in utero ART exposure and impaired fetal growth, highlighting the need to identify the safest ART regimens for use in pregnancy. Methods: We compared birth anthropometrics of infants who were HEU with those HIV-unexposed (HU) in Cape Town, South Africa. Pregnant women had gestational age assessed by ultrasound at enrolment. Women living with HIV were on ART (predominately tenofovir-emtricitabine-efavirenz) either prior to conception or initiated during pregnancy. Birth weights and lengths were converted to weight-for-age (WAZ) and length-for-age (LAZ) z-scores using Intergrowth-21st software. Linear regression was used to compare mean z-scores adjusting for maternal and pregnancy characteristics. Results: Among 888 infants, 49% (n = 431) were HEU and 51% (n = 457) HU. Of 431 HEU infants, 62% (n = 268) were exposed to HIV and antiretrovirals (ARVs) from conception and 38% (n = 163) were exposed to ARVs during gestation but after conception (median fetal ARV exposure of 21 weeks [IQR; 17–26]). In univariable analysis, infants who were HEU had lower mean WAZ compared with HU [β = − 0.15 (95% Confidence Interval (CI): − 0.28, − 0.020)]. After adjustment for maternal age, gravidity, alcohol use, marital and employment status the effect remained [adjusted β − 0.14 (95%CI: − 0.28, − 0.01]. Similar differences were noted for mean LAZ in univariable [β − 0.20 (95%CI: − 0.42, − 0.01] but not multivariable analyses [adjusted β − 0.18 (95%CI: − 0.41, + 0.04] after adjusting for the same variables. Mean WAZ and LAZ did not vary by in utero ARV exposure duration among infants who were HEU. Conclusion: In a cohort with high prevalence of ART exposure in pregnancy, infants who were HEU had lower birth WAZ compared with those HU. Studies designed to identify the mechanisms and clinical significance of these disparities, and to establish the safest ART for use in pregnancy are urgently needed.
- ItemMinimizing the risk of non-vertical, non-sexual HIV infection in children - beyond mother to child transmission(BIOMED CENTRAL LTD,, 2012) Cotton MF; Marais B.J; Andersson MI; Eley B; Rabie H; Slogrove, Amy L.; Dramowski, Angela; Schaaf H.S; Mehtar S
- ItemOptimizing research methods to understand HIV-exposed uninfected infant and child morbidity : report of the second HEU infant and child workshop(Frontiers Media, 2016) Slogrove, Amy L.; Archary, Moherndran; Cotton, Mark F.The first HIV Exposed Uninfected (HEU) Infant and Child Workshop was held in Vancouver in July 2015, hosted by the Child and Family Research Institute at the British Columbia Children’s Hospital and University of British Columbia. This event brought together 50 clinicians, epidemiologists, and basic scientists to review current knowledge of HEU infants, their clinical course, immunologic differences, and risk for neurodevelopmental and infectious morbidity. This Frontiers in Immunology Research Topic, “Immune mechanisms underlying the increased morbidity and mortality of HIVexposed uninfected (HEU) children,” is a product of the first HEU workshop synthesizing the evidence in the field. It was clear from the first workshop that there is a committed community of researchers who have identified the need to understand the mechanisms of increased morbidity and mortality in HEU infants and children, but evidence to intervene and mitigate these risks is lacking. In high HIV burden countries, all infants and children, irrespective of HIV exposure, are vulnerable to high rates of infant and child mortality (1). In this context, the essential question is whether HEU children are any different than HIV-unexposed uninfected (HUU) children experiencing similar nutritional, environmental, and social constraints to health. To this end, particular research methodological principles require reinforcing in future HEU research. It was these methodological challenges and possible solutions that formed the theme of the second HEU Infant and Child Workshop attended by 75 HEU researchers and hosted by the KwaZulu-Natal Research Institute for Tuberculosis and HIV at the University of KwaZulu-Natal in Durban, South Africa. We report on the specific methodological challenges tackled during the workshop and steps to move forward.
- ItemOutput from the CIHR Canadian HIV Trials Network international postdoctoral fellowship for capacity building in HIV clinical trials(Dove Medical Press, 2018) Mbuagbaw, L.; Slogrove, Amy L.; Sas, J.; Lengwe, Kunda J.; Morfaw, F.; Mukonzo, J. K.; Cao, W.; Ngomba-Kadima, G.; Zunza, Moleen; Ongolo-Zogo, P.; Nana, P. N.; Cockcroft, A.; Andersson, N.; Sewankambo, N; Cotton, M. F.; Li, T.; Young, T.; Singer, J.; Routy, J. P.; Ross, C. J. D.; Thin, K.; Thabane, L.; Anis, A. H.ENGLISH ABSTRACT: As a response to the human immunodeficiency virus (HIV) epidemic and part of Canadian Institutes for Health Research’s mandate to support international health research capacity building, the Canadian Institutes for Health Research Canadian HIV Trial Network (CTN) developed an international postdoctoral fellowship award under the CTN’s Postdoctoral Fellowship Awards Program to support and train young HIV researchers in resource-limited settings. Since 2010, the fellowship has been awarded to eight fellows in Cameroon, China, Lesotho, South Africa, Uganda and Zambia. These fellows have conducted research on a wide variety of topics and have built a strong network of collaboration and scientific productivity, with 40 peer-reviewed publications produced by six fellows during their fellowships. They delivered two workshops at international conferences and have continued to secure funding for their research, using the fellowship as a stepping stone. The CTN has been successful in building local HIV research capacity and forming a strong network of like-minded junior low- and middle-income country researchers with high levels of research productivity. They have developed into mentors, supervisors and faculty members, who, in turn, build local capacity. The sustainability of this international fellowship award relies on the recognition of its strengths and the involvement of other stakeholders for additional resources.
- ItemPaediatric antiretroviral drug targets(2011) Slogrove, Amy L.; Rabie H.; Cotton M.Introduction: HIV-1 infection is a major problem for children in lower income countries. The benefit of early antiretroviral (ARV) therapy started within 12 weeks of life is well documented. Although the development of new drug classes give alternative options for highly treatment experienced patients there is inadequate pharmacokinetic knowledge regarding the already established ARV classes in infants and children. Also, there are many practical challenges to administering these agents to children. Method and Results: The challenges of current widely available treatment regimens in the light of new vertical transmission prevention guidelines are discussed. The dynamic physiological changes affecting pharmacokinetics in infancy and childhood are reviewed. New antiretroviral drugs in the established drug classes are presented. The new drug classes of entry inhibitors (including co-receptor binding inhibitors and fusion inhibitors), integrase inhibitors and other novel drug classes under development are described and relevant pediatric studies are reviewed. Work on novel drug delivery systems with potential to enhance adherence, improve drug exposure and reduce side-effects are discussed. Conclusion: The established benefits of ARV therapy in children of all ages can be enhanced by appropriate pharmacokinetic data on established antiretroviral agents and child-friendly drug formulations. Besides new suppressive treatment options in treatment experienced patients with multi-class resistant virus the new drug classes provide potential for novel means of disease modification and reduction of vertical transmission. Novel drug classes and delivery systems in development provide potential for further reduction in vertical transmission of HIV, rapid virological suppression and improved neurological outcomes in children and adults. © 2011 Bentham Science Publishers Ltd.
- ItemPattern of infectious morbidity in HIV-exposed uninfected infants and children(Frontiers Media, 2016) Slogrove, Amy L.; Goetghebuer, Tessa; Cotton, Mark F.; Singer, Joel; Bettinger, Julie A.Background: Almost 30% of children in Southern Africa are HIV exposed but uninfected (HEU) and experience exposures that could increase vulnerability to infectious diseases compared to HIV unexposed (HU) children. The mechanisms of HEU infant vulnerability remain ill-defined. This review seeks to appraise the existing clinical evidence of the pattern of HEU infant infectious morbidity to aid understanding of the potential mechanism of susceptibility. Methods: A systematic search was conducted of scientific literature databases and conference proceedings up to December 2015 for studies comparing adequately defined HEU (in whom HIV-infection had been excluded through age-appropriate testing) and HU infants for all-cause mortality, all-cause hospitalization, or an infection-related morbidity. The systematic review was complemented by a narrative review of additional studies detailing the pattern of infectious morbidity experienced by HEU children without comparison to HU children or without conclusive exclusion of HIV-infection in HIV-exposed infants. Results: Only 3 of 22 eligible identified studies were designed to primarily compare HEU and HU infants for infectious morbidity. Fourteen were conducted prior to 2009 in the context of limited antiretroviral interventions. Three patterns emerge: (1) causes of morbidity and mortality in HEU infants are consistent with the common causes of childhood morbidity and mortality (pneumonia, diarrheal disease, and bacterial sepsis) but occur with greater severity in HEU infants resulting in higher mortality, more frequent hospitalization, and more severe manifestations of disease; (2) the greatest relative difference between HEU and HU infants in morbidity and mortality occurs beyond the neonatal period, during mid-infancy, having waned by the second year of life; and (3) HEU infants are at greater risk than HU infants for invasive streptococcal infections specifically Group B Streptococcus and Streptococcus pneumonia. Conclusion: To definitively understand HEU infant infectious morbidity risk, substantially larger prospective studies with appropriate HU infant comparison groups are necessary. HEU children would benefit from collaboration among researchers to achieve the quality of evidence required to improve HEU infant outcomes globally. HEU infant health and well-being, beyond avoiding HIV-infection, deserves a more prominent position in the local and international HIV research agendas.
- ItemSouth African healthcare workers and COVID-19 : a shared responsibility to protect a precious and limited resource(Health & Medical Publishing Group, 2020) Dramowski, Angela; Zunza, Moleen; Dube, Kopano; Parker, Mohammed; Slogrove, Amy L.Healthcare workers (HCWs) in African countries face high risks of occupational exposure to many pathogens, including tuberculosis, measles, HIV and Ebola.[1,2] The novel coronavirus SARSCoV- 2 poses an arguably greater threat to African HCWs than any other infectious agent to date. Data from countries with established epidemics show that HCWs experience high rates of COVID-19 infection, morbidity and mortality. In the USA, 19% of COVID-19 cases whose occupational status was known were HCWs (9 282/49 000), and >90 000 HCW COVID-19 infections were documented in 30 countries, with 260 deaths in nurses, by early May 2020. In South Africa (SA), on 6 May, Minister Zweli Mkhize reported that 511 HCWs had tested positive for SARS-CoV-2 (7% of the national total), with nurses accounting for 53% of total HCW cases. The unprecedented risk posed to HCWs by COVID-19 is clearly acknowledged by all levels of the SA government. Nationally there have been commitments, both financially and administratively, to ensure procurement and local production of personal protective equipment (PPE) and transparent reporting of HCW COVID-19 infections. To varying degrees, administrative and engineering interventions to prevent COVID-19 infections and outbreaks have been implemented in SA healthcare facilities (Table 1). Despite the early phase of the pandemic and general availability of PPE, SA is already facing high rates of HCW COVID-19 infections and exposure events. This is a concerning development reflecting both widespread community transmission (with HCW infections) and the need to strengthen ‘universal’ prevention measures in healthcare facilities, e.g. physical distancing, mask-wearing, hand hygiene, and increased cleaning/ disinfection of surfaces and equipment.
- ItemWidening the lens to ensure children who are Human Immunodeficiency Virus (HIV) exposed are alive, HIV free, and thriving(Oxford University Press, 2020-01) Slogrove, Amy L.; Powis, Kathleen M.The “Start Free” component of the “Start Free Stay Free AIDS Free” framework, launched in 2016 by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the US President’s Emergency Plan for AIDS Relief (PEPFAR), aims to secure a human immunodeficiency virus (HIV)–free beginning for every child by ending new HIV infections among children . Aligned with this, the Sustainable Development Goals challenge the global community to not only secure child survival, but ensure that children thrive and live transformative lives, contributing to societal transformation . For the 1.3 million children born each year to women with HIV (ie, HIV exposed), this means doing more than ensuring an HIV-free start .