This was seen in the case reported here and the other reported ca

This was seen in the case reported here and the other reported case of PML in an HIV-infected child associated with IRIS [10]. Reported in 2004, a 12-year-old African boy developed cerebellar dysfunction and hemiparesis 5 weeks after starting HAART. He was started on prednisone and continued on HAART. He subsequently had immunologic and virologic improvement with full method clinical recovery. Estimates from HIV-infected adults with PML associated IRIS range from 9�C19%, typically occurring 3�C5 weeks after initiation; this is purportedly much less common in children, as it is only sporadically mentioned in the literature [18, 23]. Therapy for PML associated IRIS has included glucocorticoids in addition to HAART interruption, which have been shown to be both beneficial and to be of no benefit in HIV-infected adults with PML [10, 22, 24�C26].

Our patient saw further clinical deterioration, despite a trial of these measures unlike the boy in Africa [10]. PML in HIV-infected adolescents has a wide distribution of ages and geography. Despite the cases presented here, there is limited information about this disease in children. Underdiagnosis is likely to both perpetuate this knowledge gap and discourage physicians from identifying this condition. Additionally, in developing countries, such as Thailand, lack of imaging and laboratory data may further hinder diagnosis. Clinicians should then be cognizant of both of this condition and sequelae after HAART, so that prompt diagnosis and treatment can be made. Clear guidelines would be beneficial to clinicians who face these complex patients.

Figure 5 Clinical manifestations and plasma HIV RNA and CD4 cell count levels. Acknowledgments The authors would like to thank Dr. Virat Sirisanthana who provided valuable advice. This work was supported by Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand (to P. Oberdorfer, K. Katanyuwong, and P. Jpttamala) and by a grant from the NIH/Fogarty Clinical Research Training Scholars Program (to C.H. Washington). Abbreviations 3TC: Lamivudine; AZT: Ziduvodine; d4T: Stavudine; ddC: Zalcitabine; ddI: Didanosine; EFV: Efavirenz; HAART: Highly active antiretroviral therapy; NLF: Nelfinavir; NVP: Nevirapine.
Allergic diseases are among the most common chronic diseases throughout the world [1] and the prevalence of atopic diseases in childhood has significantly increased during the past several decades [2, 3]. Although there is a general consensus on the importance of a genetic predisposition for atopic diseases, only changes in environmental factors can explain Drug_discovery this increase [4�C6]. There is a strong association between sensitisation and symptoms of allergic diseases although this association is not absolute.

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