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

Laboratory Diagnosis of HIV Infection

Live-attenuated Varicella Zoster Virus (VZV) Vaccine was first developed in Japan and tested for safety in children who were steroid treated. It proved safe and immunogenic. This led to its testing in the United States in a population of children with acute lymphoblastic leukemia who were in remission. This study too showed that the vaccine was safe and immunogenic in this population. After the vaccine was approved for healthy children, it was tested in a population of HIV-infected children and adolescents with minimal to moderate immunosuppression (i.e., CD4 percentage of >25 and a count of >350). It also proved safe and relatively immunogenic in this population. Finally, it has been evaluated in a more immunocompromised population of HIV-infected children and adolescents (i.e., CD4 percentage >15 and a count >200). VZV vaccine also proved safe and relatively immunogenic in this population. It is suggested that two immunizations, 12 weeks apart, be the vaccination strategy for these HIV populations.

Varicella Zoster Vaccine Experience in HIV-Infected Children and Adolescents

Our concept of the acquired immunodeficiency syndrome (AIDS) has evolved dramatically since it was first described in 1981 The syndrome, first termed the gay-related immunodeficiency syndrome, was soon renamed to describe the loss of immune function in adult life among certain individuals in defined risk groups These groups included homosexual men, intravenous drug abusers, and recipients of blood products Occasionally, a pediatric patient would be unfortunate enough to fall into the last risk group and would satisfy the CDC guidelines for the diagnosis of AIDS, but no one anticipated this group might represent a significant problem The description by Oleske et al in 1983 of a group of young children who died of pneumocystis carinii pneumonia (PCP) produced the first historic controversy about AIDS in children’ The pediatric victims he described did not fall into any previously described risk group for AIDS yet clearly died of opportunistic infections Congenital immunodeficiencies could certainly result in deaths due to PCP, but the clustering of so many congenital immunodeficiencies in Newark appeared to exceed the expected frequencies of congenital immunodeficiency In the accompanying editorial, Anthony Fauci wrote, “   we must be cautious in our acceptance of these infant cases as being truly AIDS However, the epidemiologic setting in which they occurred, the temporal appearance of the cases at this time, and the lack of their falling into any well recognized congenital immunodeficiency should at least alert us to the probability that we are truly dealing with AIDS in children’ The possibility of pediatric AIDS suggested the potential for vertical transmission, particularly since the mothers of these infants invariably admitted to intravenous drug abuse The true magnitude of the problem of defining pediatric AIDS was instigated by Rubinsteih et al in 1983 when he defined a new clinical entity characterized by recurrent infections with nonopportunistic agents, dysgammaglobulinemia, and cell-mediated immunodeficiency in infants of’drug-addicted mothers’ He speculated that perinatal or in utero transmission of Epstein-Barr virus (EBV) infection might induce an “infectious immunodeficiency” The intuitive link of this syndrome to that of AIDS was either accepted as a brilliant example of clinical acumen by some or rejected as pure speculation by others Additional support for the veracity of this novel

Controversies in pediatric aids

Effects of human dialyzable leukocyte extract on the leukocyte migration inhibition assay1

African-American Infants Human Immunodeficiency Virus Type 1 to Influences Perinatal Transmission of of the CC-Chemokine Receptor 5 Gene A Polymorphism in the Regulatory Region

William Borkowsky

Papers

Laboratory Diagnosis of HIV Infection

Varicella Zoster Vaccine Experience in HIV-Infected Children and Adolescents

Controversies in pediatric aids

Effects of human dialyzable leukocyte extract on the leukocyte migration inhibition assay1

African-American Infants Human Immunodeficiency Virus Type 1 to Influences Perinatal Transmission of of the CC-Chemokine Receptor 5 Gene A Polymorphism in the Regulatory Region