Faculty Bibliography

Laboratory diagnosis of human immunodeficiency virus (HIV) infection is complicated by absence of data on sensitivity, specificity and predictive value of the various tests as they apply to children. The presence of maternal anti-HIV passively transmitted across the placenta also confounds diagnosis. The authors review currently available data on the detection of HIV, HIV genome, and HIV gene products, as well as the diagnostic value of detecting serologic and cellular responses to HIV in infants and children

Children with human immunodeficiency virus (HIV) frequently have recurrent otitis media, chronic rhinorrhea, parotitis, cough and other common pediatric otolaryngologic problems. As these complaints often occur before more unusual opportunistic infections or pulmonary conditions prompt a diagnosis of acquired immunodeficiency syndrome (AIDS), members of our specialty are liable to see HIV-positive children before infection with the virus has been recognized. Children with HIV infection are also likely to be referred to us after diagnosis, as is any immunosuppressed child with otolaryngologic infections. These children may require procedures such as bronchoscopy, sinus irrigations or tympanocentesis. The subject of this review is the natural history of pediatric HIV infection with special emphasis on otolaryngologic manifestations and recommendations for safe techniques of examination and treatment

Lymphocytes derived from children and adults infected with the human immunodeficiency virus (HIV-1), as well as from seronegative children and adults, were tested for their ability to proliferate in response to recombinant HIV envelope (env) and core (cor) peptides. Proliferative responses to env were seen in 9% of control children compared with 27% of infected children (p less than 0.02). There was no difference in the response rates of seropositive and seronegative adults (17% and 16%, respectively). Proliferative responses to cor were seen more frequently in children and adults (22% and 28%, respectively) than their seronegative cohorts (11% and 12%, respectively). Also, the proliferative response to env and cor was seen in 27% and 37%, respectively, of seronegative children who were born to seropositive mothers and then subsequently seroreverted. These results suggest that sensitization to HIV recombinant antigens has resulted in a cell-mediated immune response in some HIV-infected individuals. Furthermore, the significant cell-mediated immune response to these antigens in seroreverting children raises the possibility that they may have been sensitized to this antigen by previous HIV infection