The following CDC staff members prepared this report: National Center for Infectious Diseases Division of HIV/AIDS Kenneth G. Castro, M.D. John W. Ward, M.D. Laurence Slutsker, M.D., M.P.H. James W. Buehler, M.D. Harold W. Jaffe, M.D. Ruth L. Berkelman, M.D. Office of the Director Associate Director for HIV/AIDS James W. Curran, M.D., M.P.H. 1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults Summary CDC has revised the classification system for HIV infection to emphasize the clinical importance of the CD4+ T-lymphocyte count in the categorization of HIV-related clinical conditions. This classification system replaces the system published by CDC in 1986 (1) and is primarily intended for use in public health practice. Consistent with the 1993 revised classification system, CDC has also expanded the AIDS surveillance case definition to include all HIV-infected persons who have less than 200 CD4+ T-lymphocytes/uL, or a CD4+ T-lymphocyte percentage of total lymphocytes of less than 14. This expansion includes the addition of three clinical conditions

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1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults

Evolution of Protein Molecules

Background and Methods Maternal-infant transmission is the primary means by which young children become infected with human immunodeficiency virus type 1 (HIV). We conducted a randomized, double-blind, placebo-controlled trial of the efficacy and safety of zidovudine in reducing the risk of maternal-infant HIV transmission. HIV-infected pregnant women (14 to 34 weeks' gestation) with CD4+ T-lymphocyte counts above 200 cells per cubic millimeter who had not received antiretroviral therapy during the current pregnancy were enrolled. The zidovudine regimen included antepartum zidovudine (100 mg orally five times daily), intrapartum zidovudine (2 mg per kilogram of body weight given intravenously over a one-hour period, then 1 mg per kilogram per hour until delivery), and zidovudine for the newborn (2 mg per kilogram orally every six hours for six weeks). Infants with at least one positive HIV culture of peripheral-blood mononuclear cells were classified as HIV-infected. Results From April 1991 through Decemb...

Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(05)71142-9.pdf

Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders.

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.29800

Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance

Transfer factor: recent developments in the pursuit of an idea.

Lithium, known best for its efficacy in the treatment of neuropsychiatric disorders, also is capable of influencing the function of a variety of non-neural cells. Shenkman et al. (1978), for example, demonstrated that lithium was capable of enhancing several functions of human peripheral blood mononuclear cells. Lithium chloride, in vitro, augmented thymidine incorporation by phytohemagglutinin-stimulated human lymphocytes and increased the ability oi these cells to form rosettes with sheep erythro-cytes. Lithium also stimulated phagocytosis of polystyrene latex particles by cultured human macrophages. Finally, lithium was found capable of reversing the inhibitory effects of prostaglandin E1 and theophylline on the response of human lymphocytes to phytohemagglutinin. Since these inhibitory effects were very likely mediated by increased cellular levels of cyclic 3′,5′-adenosine monophosphate (cAMP), the authors concluded that lithium acted by interfering in some fashion with adenylate cyclase activity. A similar conclusion was reached more recently by Gelfand et al. (1979). These authors found that theophylline, salbutamol, isoproterenol, and dibutyryl cAMP inhibited sheep erythrocyte rosette formation by human T lymphocytes as well as secretion of immunoglobulin M from plaque-forming B cells. Consistent with an ability to inhibit adenylate cyclase, lithium prevented the effects of all the drugs except dibutyryl cAMP.

Effects of Lithium on Polymorphonuclear Leukocyte Chemotaxis

The histopathology of cervical lymphadenitis caused by Mycobacterium avium-mycobacterium intracellulare complex in an immunocompromised host

Structured treatment interruptions (STIs) in HIV-1 infected pediatric populations increases interferon gamma production and reduces viremia.

CONTEXT
Although protease inhibitors are used routinely in adults with human immunodeficiency virus (HIV) infection, the role of these drugs in the treatment of clinically stable HIV-infected children is not clear.


OBJECTIVE
To evaluate the safety, tolerance, and virologic response produced by a change in antiretroviral therapy in HIV-infected children who were clinically and immunologically stable while receiving previous therapy.


DESIGN
The Pediatric AIDS Clinical Trials Group 338, a multicenter, phase 2, randomized, open-label controlled trial conducted from February 6 to April 30, 1997 (patient entry period); patients were followed up for 48 weeks.


SETTING
Pediatric HIV research clinics in the United States and Puerto Rico.


PATIENTS
Two hundred ninety-seven antiretroviral-experienced, protease inhibitor-naive, clinically stable HIV-infected children aged 2 to 17 years.


INTERVENTIONS
Children were randomized to receive zidovudine, 160 mg/m2 3 times per day, plus lamivudine, 4 mg/kg 2 times per day (n = 100); the same regimen plus ritonavir, 350 mg/m2 2 times per day (n = 100); or ritonavir, 350 mg/m2 2 times per day, and stavudine, 4 mg/kg 2 times per day (n = 97).


MAIN OUTCOME MEASURE
Plasma HIV-1 RNA levels at study weeks 12 and 48, compared among the 3 treatment groups.


RESULTS
At study week 12, 12% of patients in the zidovudine-lamivudine group had undetectable plasma HIV RNA levels (<400 copies/mL) compared with 52% and 54% of patients in the 2- and 3-drug ritonavir-containing groups, respectively (P<.001). Through study week 48, 70% of children continued receiving their ritonavir-containing regimen. At study week 48, 42% of children receiving ritonavir plus 2 nucleosides compared with 27% of those receiving ritonavir and a single nucleoside had undetectable HIV RNA levels (P = .04); however, similar proportions in each group continuing initial therapy had HIV RNA levels of less than 10000 copies/mL (58% vs 48%, respectively; P = .19).


CONCLUSIONS
In our study, change in antiretroviral therapy to a ritonavir-containing regimen was associated with superior virologic response at study week 12 compared with change to a dual nucleoside analog regimen. More children receiving ritonavir in combination with 2 compared with 1 nucleoside analog had undetectable HIV RNA levels at study week 48.

William Borkowsky

Papers

Transfer factor: recent developments in the pursuit of an idea.

Effects of Lithium on Polymorphonuclear Leukocyte Chemotaxis

The histopathology of cervical lymphadenitis caused by Mycobacterium avium-mycobacterium intracellulare complex in an immunocompromised host

Structured treatment interruptions (STIs) in HIV-1 infected pediatric populations increases interferon gamma production and reduces viremia.

Nucleoside Analogs Plus Ritonavir in Stable Antiretroviral Therapy-Experienced HIV-Infected Children