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School performance in a longitudinal cohort of children at risk of maltreatment.

OBJECTIVE: Previous research has suggested that child maltreatment is associated with poor school performance. However, previous studies have largely been cross-sectional or, if longitudinal, have had small sample sizes, short follow-up periods, or have not adequately controlled for confounders. The objective of this study is to determine the relationship between child maltreatment and school performance in a cohort of children at risk of maltreatment and followed since birth. METHOD: This prospective study followed children born at risk for maltreatment with semi-annual reviews of the North Carolina Central Registry of Child Abuse and Neglect. At ages six and eight years, children's teachers were surveyed using the Achenbach Teacher Report Form and project-developed questions regarding peer status. This information, along with control variables from maternal interviews, was used in logistic regression models to determine the impact of maltreatment on academic performance, peer status, and adaptive functioning. The generalized estimating equations (GEE) method was applied to adjust variance estimates for within-person correlations of school performance measures at two points in time. RESULTS: A substantiated maltreatment report is significantly associated with poorer academic performance (p < 0.01) and poorer adaptive functioning (p < 0.001) but not with peer status. CONCLUSIONS: Understanding the consequences of maltreatment, including poor academic performance and adaptive functioning, is important in planning educational, health, and social service interventions that may help abused or neglected children succeed in school and later in life. Longitudinal analysis is the best way to establish a causal relationship between maltreatment and subsequent school problems.

Achievement↗

[Criminality in a birth cohort].

Beginning with a group of approximately 10,000 boys born in 1945 who lived in Philadelphia from at least ages ten through seventeen, the Center for Studies in Criminology and Criminal Law, University of Pennsylvania has engaged in a longitudinal analysis of the delinquency of the birth cohort. The first publication which examines the dynamic flow of delinquency committed by 3500 of the boys was published by the University of Chicago Press in 1972 and is entitled Delinquency in a Birth Cohort. This study is the first in the United States to establish a base line of delinquency probabilities and to analyze the types of delinquency committed over time, with the recording of the seriousness of each of the 10,000 acts committed by the 3500 boys. The seriousness scores were derived from the earlier work by Sellin and Wolfgang, entitle The Measurement of Delinquency. A stochastic model was used to analyze the delinquent patterns and one of the major conclusions, at least up to age eighteen, was that there was no specific delinquency specialization by type of offense. Moreover, after the third offense, the probabilities of desistence, or refraining from further delinquent acts, remained stable, thus indicating that the most propitious point for social intervention would be after the third offense rather than at some time prior to the onset of delinquency or even after the first or second offense-offenses which are usually of a very minor character. The Center for Studies in Criminology and Criminal Law has continued to follow up a ten per cent sample of the original birth cohort by interviewing them to obtain additional social psychological dynamic features of their background, of the situations involving their first and last delinquencies, and of their adult careers. The follow-up indicates thus far that approximately 12 per cent new cases of criminality appeared, thus adding to the original 35 per cent of the birth cohort who had a delinquency record. The study will pursue data analysis of the elaborate interview schedule and a continued examination of recidivism, particularly chronic, among the chronic offenders who have committed five or more offenses.

Adolescent↗

[Food consumption, habits, and nutritional status of the population of Reus (VIII). Evolution of energy and nutrient intake from 1983 to 1993].

BACKGROUND: Nutritional characteristics of the mediterranean diet, with a high intake of complex carbohydrates, fibre, monounsatured fatty acids and vegetables, are related to a lower prevalence of some nutritional associated diseases. The aim of our study was to perform a longitudinal analysis of the evolution of food intake in a mediterranean population in order to observe its influence on the energy and nutritional intake and their balance. The latter could have some effects on health status. METHODS: Dietary intake was evaluated using the 24 hours recall method in a representative sample (n = 941, age range = 10-69) of a Reus population. This longitudinal study consisted of 70% of the samples studied in 1983 using identical methodology. RESULTS: During this decade (1983-1993), energy intake decreased significantly 180 kcal/day for men and 158 kcal/day for women, carbohydrates being the main cause for this drop (132 and 84 kcal/day less for men and women, respectively). Protein intake decreased significantly in both sexes, 5.6% for men and 8.0% for women. However, the evolution of fat intake was different for men (no changes) and for women (a significant decrease of 5.7%). Saturated and monounsatured fatty acids did not show significant changes in this decade. Cholesterol intake decreased significantly in both sexes. Energy percents obtained from lipids, saturated and monounsaturated fatty acids significantly increased. However, in absolute values very little changes in fat intake in both sexes were observed. CONCLUSIONS: The dietary pattern evolved to a lower energy intake with an increment of the percentage of dietary lipids, but this feature was did not reflect a greater fat intake in absolute values. Moreover, the main characteristics of the typical mediterranean diet (which is basically different to the usual diet of other non mediterranean european countries mainly due to its richness in monounsaturated fatty acids) did not change in the period analyzed.

Adolescent↗

Spousal communication and family planning behavior in Navrongo: a longitudinal assessment.

The poor performance of most family planning programs in the 1980s, especially in sub-Saharan Africa, generated concern among researchers and led to a quest for explanations. In most countries, the alienation of men from participation in these programs was subsequently identified as one of the major causes, a finding that led researchers to redirect their attention to couples instead of individuals as the focus of such programs. Lack of spousal communication about family planning was identified as one reason for the low level of contraceptive use among women. Subsequent research has persistently demonstrated a positive relationship between spousal communication and contraceptive use. Most prior studies on this topic have been based on cross-sectional data, so that whether the identified relationships are causal remains unclear. Does communication, in fact, predict contraceptive use, or does the use of contraceptives generate communication among couples? This study addresses the question of causality by using longitudinal data from the Navrongo Health Research Centre panel survey. Results from both cross-sectional and longitudinal analysis demonstrate that spousal communication does, indeed, predict contraceptive behavior, even when other factors are controlled.

Adolescent↗

Sensitivity of quantitative (1)H magnetic resonance spectroscopy of the brain in detecting early neuronal damage in systemic lupus erythematosus.

OBJECTIVE: To quantify N-acetylaspartate (NAA), total creatines (tCr), total cholines (tCho), and myo-inositol (mI) levels in normal and abnormal appearing white matter of patients with neuropsychiatric systemic lupus erythematosus (NPSLE) in order to determine the specific changes in metabolite concentrations. METHODS: Axial proton density and T(2) weighted magnetic resonance images, and short echo time (TE 30 ms) (1)H spectra were acquired with a GE SIGNA 1.5 T magnetic resonance system. Concentrations of NAA, tCr, tCho, and mI were determined, using brain tissue water as a reference, from nine patients (seven female, mean age 40.3 years, range 16-65) with NPSLE and eight healthy women (mean age 43 years, range 31-65). RESULTS: A significant rise of tCho (12.4%, p<0.05) and mI (31.4%, p<0.005) and a significant reduction in NAA (-12%, p<0.05) was found in normal appearing white matter compared with controls. Analysis according to severity of the clinical NPSLE features (subgrouped as major or minor) showed that SLE major had reduced NAA compared with SLE minor (-18.4%, p<0.05) and controls (-20%, p<0.005). The SLE major group showed a significant rise of mI (32%, p<0.01) and the SLE minor group a significant increase in tCho (18.6%, p<0.05) compared with controls. Longitudinal analysis of brain metabolites in normal appearing white matter showed consistent abnormalities in NAA, tCho, and mI in a patient with stable clinical features and a constant rise of tCho, but transient rise of mI was seen during a flare of disease in another patient. CONCLUSION: Quantitative (1)H magnetic resonance spectroscopy (MRS) suggests a particular course of neurometabolite changes that precedes irreversible reductions in NAA and permanent neuronal loss. Initially, in patients with SLE minor, there is a significant rise in tCho and a trend (reversible) for mI also to be raised. In patients with SLE major the NAA is significantly and permanently reduced and mI is significantly raised, whereas the tCho levels are near normal. Further investigations are needed to determine how specific MRS is as a clinical marker for brain disturbance in SLE.

Adolescent↗

Physiological dysregulation and changes in health in an older population.

We investigate whether a multi-system measure of physiological dysregulation based on 16 biological measures is associated with deterioration in physical and mental health over a 3-year period. The data come from a national survey of persons 54 and older in Taiwan that collected standard clinical markers related to cardiovascular and metabolic function and "non-clinical" measures pertaining to the immune, neuroendocrine and sympathetic nervous systems. The dysregulation score counts the number of biomarkers for which values are in the lowest or highest decile. Statistical models examine whether dysregulation predicts four health outcomes (survival, physical functioning, cognitive functioning and depressive symptoms), in the presence of extensive controls for baseline health. The estimates reveal significant associations between dysregulation and health for each outcome, although there is variability across outcomes. The associations are often attenuated in the presence of health controls, underscoring the importance of longitudinal analysis. This study extends previous research on the health consequences of physiological dysregulation by considering a broader range of outcomes and biomarkers in a non-Western population-based sample. Our analysis suggests that such dysregulation provides early warning signs of a broad range of comorbidities.

Aged↗

The impact of illness disclosure and custody plans on adolescents whose parents live with AIDS.

OBJECTIVES: To describe the disclosure and custody planning of parents living with AIDS and the impact of these on their adolescents' adjustment. METHODS: An examination of the association of multiple behaviour problems in children and the illness disclosure and custody plans of their parents living with AIDS. RESULTS: Both mothers (87%) and fathers were significantly more likely to disclose their HIV serostatus to adolescents (73%), compared with younger children (23%); only 44% disclosed their illness to all their children; 11% disclosed to none. Most parents (80%) living with AIDS had discussed their custody plans. However, only 30% initiated legal plans, typically for younger children. Adolescents who were informed of their parents' serostatus engaged in more sexual risk acts, smoked more cigarettes, and reported more severe substance use and greater emotional distress than uninformed adolescents. Legal custody arrangements were not associated with adolescent adjustment at recruitment or follow-up. CONCLUSIONS: A longitudinal analysis of the impact on adolescents of the behaviours of parents living with AIDS is needed.

Acquired Immunodeficiency Syndrome↗

Functional correlation between a novel amino acid insertion at codon 19 in the protease of human immunodeficiency virus type 1 and polymorphism in the p1/p6 Gag cleavage site in drug resistance and replication fitness.

Population-based sequence analysis revealed the presence of a variant of human immunodeficiency virus type 1 (HIV-1) containing an insertion of amino acid Ile in the protease gene at codon 19 (19I) and amino acid substitutions in the protease at codons 21 (E21D) and 22 (A22V) along with multiple mutations associated with drug resistance, M46I/P63L/A71V/I84V/I93L, in a patient who had failed protease inhibitor (PI) therapy. Longitudinal analysis revealed that the P63L/A71V/I93L changes were present prior to PI therapy. Polymorphisms in the Gag sequence were only seen in the p1/p6 cleavage site at the P1' position (Leu to Pro) and the P5' position (Pro to Leu). To characterize the role of these mutations in drug susceptibility and replication capacity, a chimeric HIV-1 strain containing the 19I/E21D/A22V mutations with the M46I/P63L/A71V/I84V/I93L and p1/p6 mutations was constructed. The chimera displayed high-level resistance to multiple PIs, but not to lopinavir, and grew to 30% of that of the wild type. To determine the relative contribution of each mutation to the phenotypic characteristic of the virus, a series of mutants was constructed using site-directed mutagenesis. A high level of resistance was only seen in mutants containing the 19I/A22V and p1/p6 mutations. The E21D mutation enhanced viral replication. These results suggest that the combination of the 19I/E21D/A22V mutations may emerge and lead to high-level resistance to multiple PIs. The combination of the 19I/A22V mutations may be associated with PI resistance; however, the drug resistance may be caused by the presence of a unique set of mutations in the p1/p6 mutations. The E21D mutation contributes to replication fitness rather than drug resistance.

Codon↗

Analysis of the human antibody response to thrombospondin-related anonymous protein of Plasmodium falciparum.

Thrombospondin-related anonymous protein (TRAP) of the malaria parasite Plasmodium falciparum shares two sequence motifs with other proteins which possess adhesive properties. Recently, findings indicate that TRAP is an antigen which contributes to antisporozoite immunity. We have cloned and expressed the TRAP coding sequences in Escherichia coli to investigate the human humoral immune response against this protein in a region of malaria endemicity of West Africa characterized by a seasonal transmission. Our results show that antibodies against TRAP are present in infected individuals. The anti-TRAP antibodies were analyzed in both a longitudinal and a prospective study. The longitudinal analysis shows seasonal fluctuations of the levels of specific antibodies as well as age-dependent quantitative differences. The immune response is long-lived in most of the adults and some of the older children but short-lived in young children. More importantly, the prospective analysis suggests that the presence of anti-TRAP antibodies in older children before the beginning of malaria transmission correlates with the subsequent control of parasite densities.

Adolescent↗

High-dose melphalan and autologous stem-cell transplantation in patients with AL amyloidosis: an 8-year study.

BACKGROUND: AL amyloidosis is a fatal disease resulting from tissue deposition of amyloid fibrils derived from monoclonal immunoglobulin light chains. Treatment with oral chemotherapy is minimally effective. OBJECTIVE: To test survival and organ response in a large sample of patients treated with high-dose intravenous melphalan (100 to 200 mg/m2) and autologous blood stem-cell transplantation. DESIGN: 8-year longitudinal analysis of clinical effectiveness. SETTING: University-affiliated specialty referral clinic. PATIENTS: 701 consecutive new patients with AL amyloidosis. INTERVENTION: High-dose chemotherapy and autologous stem-cell transplantation for patients who met eligibility requirements based on organ involvement and clinical status. MEASUREMENTS: Survival analysis of all patients evaluated and a detailed analysis of treatment outcome in the subgroup that received high-dose melphalan and stem-cell transplantation. RESULTS: Among 701 patients with AL amyloidosis, 394 (56%) were eligible for high-dose melphalan and stem-cell transplantation; 82 did not proceed with treatment because of patient choice or disease progression. Median survival of the 312 patients who initiated treatment was 4.6 years. A complete hematologic response, defined as no evidence of an underlying plasma cell dyscrasia 1 year after treatment, was achieved in 40% of patients and was associated with prolonged survival. Statistically significant improvements occurred in end-organ disease and were greater in patients with a complete hematologic response. Mortality rate within 100 days of treatment with high-dose melphalan and stem-cell transplantation was 13%; patients with cardiomyopathy had the highest mortality rates. CONCLUSIONS: Treatment of selected patients with AL amyloidosis by using high-dose melphalan and stem-cell transplantation resulted in hematologic remission, improved 5-year survival, and reversal of amyloid-related disease in a substantial proportion.

Aged↗

In multiple myeloma, t(4;14)(p16;q32) is an adverse prognostic factor irrespective of FGFR3 expression.

This study analyzed the frequency and clinical significance of t(4;14)(p16;q32) in multiple myeloma (MM) among 208 patients with MM and 52 patients with monoclonal gammopathy of undetermined significance (MGUS); diagnosed between 1994 and 2001. Patients with the translocation were identified using reverse transcription-polymerase chain reaction (RT-PCR) to detect hybrid immunoglobulin heavy chain (IgH)-MMSET transcripts from the der(4) chromosome. We found 31 (14.9%) t(4;14)(+) MM patients and 1 (1.9%) t(4;14)(+) MGUS patient. IgH-MMSET hybrid transcripts were detected in bone marrow (BM) and blood. Breakpoint analysis revealed that 67.7% of t(4;14)(+) patients expressed hybrid transcripts potentially encoding full-length MMSET, whereas the remainder lacked one or more amino terminal exons. Expression of fibroblast growth factor receptor 3 (FGFR3), presumptively dysregulated on der(14), was detected by RT-PCR in only 23 of 31 (74%) patients with t(4;14)(+) MM. Patients lacking FGFR3 expression also lacked detectable der(14) products. Longitudinal analysis of 53 MM patients with multiple BM and blood samples showed that, over time, BM from t(4;14)(+) patients remained positive and that t(4;14)(-) patients did not acquire the translocation. IgH-MMSET hybrid transcripts and FGFR3 transcripts disappeared from blood during response to therapy. No correlation was observed between the occurrence of t(4;14) and known prognostic indicators. However, we find the t(4;14) translocation predicts for poor survival (P =.006; median, 644 days vs 1288 days; hazard ratio [HR], 2.0), even in FGFR3 nonexpressors (P =.003). The presence of t(4;14) is also predictive of poor response to first-line chemotherapy (P =.05). These results indicate a significant clinical impact of the t(4;14) translocation in MM that is independent of FGFR3 expression.

Adult↗

Quantitative analysis for human glucocorticoid receptor alpha/beta mRNA in IBD.

We have previously reported that in peripheral blood mononuclear cells (PBMC), the augmented expression of the beta isoform of the human glucocorticoid receptor (hGRbeta), as a putative dominant negative regulator of glucocorticoid action, is associated with glucocorticoid (GC) unresponsiveness of UC patients. In this study, we quantified the levels and serial changes of hGR transcripts in PBMC of IBD patients by a real-time fluorescence monitoring of PCR. As results, relative hGRbeta mRNA expression was significantly higher in the active stage of UC than in inactive periods of UC or CD patients. Longitudinal analysis revealed that hGRbeta mRNA expression in UC was increased after the relapse of inflammation, suggesting that the overproduction of cytokines during inflammation may be responsible. In in vitro culture experiments of human lymphoid cell (CEM) and human PBMC, IL-7, and IL-18 increased hGRbeta mRNA expression in these cells but GC itself did not. Through these analyses, it is indicated that the inflammatory cytokines altered the splicing condition of the primary transcript of hGR gene in IBD patients.

Adult↗

Natural T-helper immunity against human papillomavirus type 16 (HPV16) E7-derived peptide epitopes in patients with HPV16-positive cervical lesions: identification of 3 human leukocyte antigen class II-restricted epitopes.

Tumor-specific T-helper (Th) immunity was found to play a pivotal role in the natural and vaccine-induced immune defense against tumors. Since the majority of cervical cancers express human papillomavirus type 16 (HPV16) E7 oncoprotein, it is important to investigate the Th response against this target antigen in detail. By means of PBMC cultures from HLA-typed healthy donors, we identified the central part of HPV16 E7 (E7(41-72)) as the major immunogenic region within this antigen. Furthermore, we mapped 3 distinct Th epitopes within this region (DR15/E7(50-62), DR3/E7(43-77), DQ2/E7(35-50)). In a parallel approach, employing IFN-gamma ELISPOT analysis, we detected Th immunity against HPV16 E7 in subjects with HPV16+ lesions. Several of these responses matched with the 3 Th epitopes defined in our study. A number of other HPV16+ subjects did not display any E7-specific type 1 cytokine-producing T-cell immunity, indicating failure of the immune response. Our combined data argue for more extensive as well as longitudinal analysis of HPV16-specific T-cell immunity using the ELISPOT assay described, as well as for HPV-specific vaccination of individuals with HPV+ lesions.

Cancer Vaccines↗

Evidence of radiation-induced reduction of height and body weight from repeated measurements of adults exposed in childhood to the atomic bombs.

Reduction of growth from exposure to atomic bomb radiation has been examined using individuals under 10 years old at the time of the bombing (ATB) and a growth curve analysis based on measurements of height and weight made in the course of the 4th-7th cycles of the Adult Health Study examinations (1964-1972). As expected, the largest difference in growth to emerge is between males and females. However, a highly significant reduction of growth associated with dose (DS86) was observed among those survivors for whom four repeated measurements of height and weight were available. Longitudinal analysis of a more extended data set (n = 821), using expected values based on simple linear regression models fitted to the three available sets of measurements of height and weight on the 254 individuals with a missing measurement, also indicates a significant radiation-related growth reduction. The possible contribution of such factors as poor nutrition and disruption of normal family life in the years immediately after the war is difficult to evaluate, but the effects of socioeconomic factors on the analysis of these data are discussed.

Adult↗

Clinical and laboratory parameters in dapsone acute intoxication.

OBJECTIVE: To determine the severity of dapsone (DDS) acute intoxication - an uncommon medical event - using clinical and laboratory parameters. METHODS: Two hundred and seventy four patients with acute DDS intoxication, aged 1 month to 50 years old, were studied and classified into four age groups. Clinical evaluation was assessed through a protocol and correlated with laboratory parameters. Spectrophotometric methods were used to analyze methemoglobinemia (MHbp) and dapsonemia (DDSp). RESULTS: The most prevalent clinical sign of intoxication was cyanosis, seen in 65.7% of the patients and in 100% of children less than 5 years of age. According to laboratory criteria, MHbp-related severe clinical intoxication was seen in 56.2% and DDSp-related occurred in 58% of the patients. Regarding DDSp, intoxication was considered severe when 20 tablets (100 mg each) were ingested, a median of 29 microg/ml. Regarding MHbp, intoxication was severe when 7.5 tablets were ingested, a median of 38% of the total Hb. The correlation between MHbp and DDSp was statistically significant (n=144, r=0.32, p<0.05). Negative correlation was observed between MHbp and the time elapsed since DDS intake (n=124, r=-0.34, p<0.001). There was also a negative correlation between DDSp and the time elapsed since DDS intake (n=63, r=-0.35, p<0.0001). CONCLUSIONS: Longitudinal analysis showed a significant association between methemoglobinemia and the time elapsed after the intake (t), according to the equation: Dapsonemia = 12.9256 - 0.0682t + 0.234 methemoglobinemia

Adolescent↗

Geometry of coronary capillaries in hyperthyroid and hypothyroid rat heart.

Coronary capillary geometry was studied in male rats treated with 3,3',5-triiodo-L-thyronine (T3; Hyper), 6-N-propyl-2-thiouracil (PTU; Hypo), or a sequence of PTU and T3 (Hypo/Hyper). Ventricular mass and heart-to-body mass ratios revealed myocardial hypertrophy in Hyper, atrophy in Hypo, and a return of ventricular mass to control (Con) values in Hypo/Hyper rats. From cross-sectional analysis, capillary densities for Hyper and Hypo/Hyper were comparable with Con, despite increased left ventricular mass. Hypo rats demonstrated increased capillary density. In Hyper and Hypo rats, tissue area surrounding individual capillaries (capillary domain) decreased, compared with Con, for capillaries close to the feeding arteriole. In Hyper and Hypo/Hyper, capillaries distal to the feeding arteriole had similar domain areas as Con; in Hypo, this area was smaller. From longitudinal analysis, capillary segment lengths were significantly shorter in all groups compared with Con. Our data suggest that while hypothyroidism induced myocardial atrophy and hyperthyroidism induced myocardial hypertrophy, both thyroid states stimulated capillary proliferation.

Alkaline Phosphatase↗

Psychiatric comorbidity measures as predictors of retention in drug abuse treatment programs.

OBJECTIVE: To examine lifetime and current psychiatric comorbidity measures as predictors of drug abuse treatment retention, and to test the generalizability of results across treatment agencies in diverse settings and with varying practices. DATA SOURCES/STUDY SETTING: The national Drug Abuse Treatment Outcome Studies (DATOS), a longitudinal study of clients from 96 treatment agencies in 11 U.S. cities. STUDY DESIGN: The design is naturalistic and uses longitudinal analysis of treatment retention in long-term residential, outpatient drug-free, and outpatient methadone treatment modalities; client background (including psychiatric comorbidity) and program service provision are predictors. Clinical thresholds for adequate treatment retention were 90 days for long-term residential and outpatient drug-free, and 360 days for outpatient methadone. Psychiatric indicators included lifetime DSM-III-R diagnoses of depression/anxiety and antisocial personality, and dimensional measures of current symptoms for depression and hostility. DATA COLLECTION/EXTRACTION METHODS: Data include structured interviews with clients, a survey of treatment program administrators, and program discharge records. PRINCIPAL FINDINGS: Dimensional measures of current psychiatric symptoms emerged as better predictors than lifetime DSM-III-R diagnoses. In addition, the predictive association of hostility with retention varied significantly across treatment agencies, both in the long-term residential and outpatient drug-free modalities. Other notable findings were that on-site mental health services in long-term residential programs were associated with better retention for clients with symptoms of hostility. CONCLUSIONS: Assessment issues and stability of results across programs are important considerations for treatment research and practice.

Adult↗

Human papillomavirus type 16 E2-specific T-helper lymphocyte responses in patients with cervical intraepithelial neoplasia.

T-cell-mediated immune responses against mucosal oncogenic types of human papillomaviruses (HPV) are thought to play a role in the control of the virus infection and its associated cervical lesions. The in vitro production of interleukin-2 by T-helper (Th) cells in response to the C-terminal and N-terminal domains of the HPV-16 E2 protein was determined in 74 women with cytological evidence of premalignant cervical epithelial neoplasia who participated in a non-intervention follow-up (FU) study. Cross-sectional analysis at the end of FU showed that Th cell responses against the C-terminal domain were associated with evidence of previous or present HPV-16 infection as compared to patients with no evidence of any HPV infection (18.9% versus 0%, P = 0.039). Th cell responses against the N-terminal domain were not associated with evidence of HPV-16 infection. No association with disease outcome was observed with Th cell responses against either of the E2 protein domains. However, longitudinal analysis revealed that Th cell responses against the C-terminal domain frequently occur at the time of virus clearance. Whether these responses are responsible for the clearance of the virus is not known.

Adult↗