The purpose of this study was to determine selleck screening library the dosing regimen for ATV/r that produced adequate drug exposure during pregnancy compared with historical data in nonpregnant HIV-infected adults, and to assess the safety of ATV use in pregnancy. In this multicentre, open-label, prospective, single-arm Phase I study, patients were enrolled in South Africa, Puerto Rico and the USA from 12 June 2006 to 12 September 2008. The primary objective was to determine the dosing regimen of ATV/r that produces adequate drug exposure during pregnancy when compared with historical data in nonpregnant HIV-infected

adults. Secondary objectives included: (1) to measure the HIV RNA in mothers and the HIV DNA in infants born to women exposed to ATV/r during

pregnancy; (2) to assess the safety of ATV/r in pregnant women and their infants; (3) to compare ATV/r drug concentrations in cord blood with those in maternal plasma at the time of delivery; and (4) to explore ATV/r drug exposure during the second trimester of pregnancy. The mothers were followed until 8–12 weeks postpartum and the infants were followed until 6 months of age. The laws and regulatory requirements of all participating GSK126 countries were adhered to. This study was conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki, as defined by the International Conference on Harmonization and in accordance with the ethical

principles underlying the European Union Directive 2001/20/EC and the United States Code of Federal Regulations, Title 21 Part 50 (21CFR50). The research protocol was approved by institutional review boards for each research site. Written informed consent was obtained from every patient or their legally acceptable representative prior to clinical trial participation, including informed consent for any screening procedure conducted to establish eligibility for the trial. Patients who met the inclusion criteria were HIV-1-infected, pregnant women at ≥12 to ≤32 weeks of gestation with a CD4 cell count ≥200 cells/μL, with a singleton pregnancy, who agreed to formula-feed their infants throughout the study after delivery. Patients with the following ARV histories were included: (1) ARV-naïve patients with Thiamine-diphosphate kinase HIV RNA >400 copies/mL; (2) patients who were currently on HAART with HIV RNA <50 copies/mL and who switched to the study regimen for a reason other than virological failure of a protease inhibitor-based regimen; and (3) patients on HAART for ≤90 days with HIV RNA >50 copies/mL but ≥1 log10 copies/mL drop in HIV RNA within 90 days of screening. ATV-based HAART for ≥3 weeks was not allowed except for prior mother-to-child transmission prevention with documented HIV RNA <50 copies/mL at the time of discontinuation of ATV.

The median age at transition to adult HIV services in the UK is 17 years [3]; these pregnancies were reported both from paediatric settings and following transition to adult services, with the

median age at first pregnancy being 18 years. In three-quarters of the pregnancies women were reported to have detectable virus close to conception, with potential associated risk of transmission to partners; only half of the partners were reported by healthcare professionals to be aware of the woman’s status up to the time of delivery. While poor uptake of contraception and difficulties with partner disclosure are not limited to adolescence, professionals may need to reconsider their approach to educating this Cyclopamine purchase cohort about contraception and partner disclosure, and consider recommending

effective long-acting reversible contraception in this population. While GDC-0199 clinical trial barrier contraception is required to reduce the risk of HIV transmission to sexual partners, use is often inconsistent and concentrating on promoting condom use may detract from offering other more effective methods of contraception. Adherence to therapy was reported to be suboptimal at some stage in about half the pregnancies described, with at least one woman requiring hospital admission for directly observed therapy. Problems with attendance and adherence are common during adolescence for many chronic childhood conditions and result in increased disease-related morbidity and mortality [3, 11]. Adolescents living with HIV have poorer adherence to cART compared with children or older adult populations, and poor Cyclin-dependent kinase 3 adherence has also been associated with depression, alcohol and substance abuse, and lack of wider disclosure of HIV status [11, 12]. cART is effective in preventing first-generation MTCT of HIV with overall MTCT rates < 1% with optimal care [13]. In this cohort a single infant was infected, comparable to other reported adolescent cohorts in the USA (one of 30) [9] and a predominantly horizontally infected UK cohort (one

of 66) [10]. Five young women delivered with detectable virus, increasing the risk of transmission to their babies. Multidisciplinary care with the aim of improving adherence to cART during adolescence and particularly during pregnancy should remain a priority; complex social circumstances with frequent social service involvement and high rates of mental health illness should be considered when planning adherence interventions. The rate of preterm deliveries (14%) in this cohort was almost twice the overall European rate in adolescents [14, 15] but similar to the overall rate reported for HIV-positive women in the UK and Ireland [4]. Data are currently sparse on the prevalence of congenital abnormalities in the offspring of perinatally infected adolescents.

[11, 12] The Chinese study in this issue by Rong MU et al. has revealed poor awareness and deficiency in diagnostic skills amongst doctors including rheumatologists and is a must- read article for all. Some of the points discussed in the preceding paragraphs are realised in this paper. Many rheumatologists who considered themselves non-believers of this vague entity in the recent past, have now turned into believers in view of selleck chemical emerging evidences cited above. No rheumatologist can afford to make a mistake today in diagnosing or excluding these modern day illnesses. “
“A 72-year-old woman with slight pulmonary interstitial reticular

markings was initially diagnosed with microscopic polyangiitis (MPA). Two years 5-FU order later, cavitated pulmonary masses appeared, and a biopsy specimen revealed granulomas. Granulomatosis with polyangiitis (GPA) was diagnosed. The masses resolved with treatment. Ten years later, the usual interstitial pneumonia (UIP) pattern appeared on chest computed

tomography (CT). The diagnosis of lung toxicity from methotrexate (MTX) or cyclophosphamide (CYC) was precluded by the clinical course. Despite treatment with prednisolone (PSL), the UIP progressed. The change of pulmonary pathology from masses to UIP is rare in patients with GPA. “
“Polyarteritis nodosa in children is a rare necrotizing vasculitis affecting mainly small and medium-size arteries. To describe the different clinical patterns and laboratory profiles of polyarteritis nodosa patients nearly in a tertiary care hospital. This was a retrospective cohort study carried out in the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period January 2007 to December 2012. A total of 13 patients fulfilling the European League Against Rheumatism/Paediatric Rheumatology International Trial Organization/Paediatric Rheumatology European Society (EULAR/PRINTO/PRES) classification criteria were enrolled in this study. Data was collected

via a predesigned questionnaire. Age range was 3–12 years, male : female ratio was 9 : 4. The duration of symptoms was 2–16 weeks. All the children had fever, anorexia and generalized weakness. Subcutaneous nodules were present in 77% of cases followed by arthritis and rash (69%), muscle pain (54%) and abdominal pain (38%). Impaired peripheral pulses were present in 54%, ulceration and gangrene was present in 31% and auto-amputation was present in 15% of cases. All the patients had high erythrocyte sedimentation rates followed by neutrophilic leukocytosis and thrombocytosis (85% and 62%). Skin biopsy was positive in 77% of cases and angiographic abnormalities were present in 23% of cases.

Further studies using prospective long-term data are needed to confirm this benefit before this intervention should be introduced in other centres to help individuals self-manage their condition; however, we believe that our new service has been demonstrated to be helpful to people with type 1 diabetes. The authors would like to acknowledge the help and support of all their colleagues in the Poole Hospital Diabetes Centre. There are no conflicts of interest. “
“Pancreatic endocrine dysfunction in patients with cystic fibrosis heralds declining pulmonary function and a six-fold

rise in mortality. Insulin therapy increases weight and reduces decline in lung function. Optimal timing of initiation remains contentious but early intervention may maximise benefit. We http://www.selleckchem.com/products/epz015666.html explored the optimal timing of initiation of therapy and characterised the frequency and usual symptoms of hypoglycaemia. Fifty-four patients with cystic fibrosis treated with insulin were compared up to five years pre and post insulin initiation with respect to weight gain

and lung function. Frequency and usual symptoms of hypoglycaemia were assessed using the Hypoglycemia Symptoms Awareness Questionnaire. Mean age was 27.6(16–52) years. In the five years preceding insulin therapy, FEV1 declined from 2.6±0.14L to 1.78±0.12L INK 128 price (p<0.001). In the group as a whole, rate of decline was arrested with insulin initiation; the mean five-year post insulin FEV1 was 1.74±0.20L (p=0.15). When stratified according to oral glucose tolerance testing at initiation the rate of decline was significant in patients with impaired glucose tolerance

(p=0.02) but not normal glucose tolerance nor overt cystic fibrosis diabetes mellitus. Insulin therapy increased weight from 53.08±1.53kg to 56.22±2.08kg (p=0.05). Hypoglycaemia was common and 75% of respondents scored results indicative of hypoglycaemia unawareness. This study confirms that the favourable effect of insulin upon lung function in patients with cystic fibrosis correlates with the degree of glucose intolerance at baseline. Hypoglycaemia is an important clinical issue. Copyright © 2011 John Wiley & Sons. “
“Up to 50% of women diagnosed with gestational diabetes mellitus (GDM) Methane monooxygenase will be diagnosed with type 2 diabetes within five years. Attendance rates at postpartum screening are only 48-56%. As the barriers or facilitators to screening attendance among women diagnosed with GDM have not previously been determined, this study aimed to examine the barriers and facilitators to attendance at postpartum diabetes screening as reported by women following a recent history of GDM. This study was a cross-sectional telephone survey of Australian women diagnosed with GDM in a Queensland hospital during the period July 2006 to June 2007. Rates of attendance at postpartum diabetes screening were assessed, and reported barriers and facilitators to postpartum screening were grouped into themes.

Polyketide (PK) compounds constitute a major part of these metabolites and have long been recognized as a valuable source of diverse natural compounds of medical importance, for example lovastatin (cholesterol lowering) (Lai et al., 2005), griseofulvin selleck chemicals (antibiotic) (Chooi et al., 2010) and mycophenolic acid (immunosuppressant) (Bentley, 2000). However, polyketides also include many toxic compounds that pose a serious threat to human health, for example

patulin, ochratoxins, fumonisins and aflatoxin (Frisvad et al., 2004; Månsson et al., 2010). Polyketides are biosynthesized by large multidomain polyketide synthases (PKSs), which besides acyl transferase, β-ketoacyl synthase and acyl carrier domains may also contain keto reductase, dehydratase, cyclization and methyl-transferase domains (Cox, 2007; Smith & Tsai, 2007; Hertweck, 2009). In fungi, the different catalytic activities often work in an iterative manner (fungal type I) and it is generally difficult to predict the exact product formed by a given

PKS from its sequence alone (Keller et al., 2005). Product prediction is further complicated by the fact that the resulting polyketide structure may be decorated by tailoring enzymes. Such genes are often physically associated with the PKS gene Daporinad chemical structure in a gene cluster allowing for coordinated regulation (Schümann & Hertweck, 2006). The fact that natural products may be of mixed biosynthetic origin, combining elements such as polyketides with terpenes (meroterpenoids) and/or nonribosomal peptide units, adds to the complexity (Chang et al., 2009; Geris & Simpson, 2009; Hertweck, 2009; Scherlach et al., 2010). As a consequence of their bioactivity,

societal importance and also the prospect of reprogramming Silibinin the biosynthetic machinery for drug development (Cox, 2007), there is tremendous interest in the discovery and understanding of fungal polyketide biosynthesis. The availability of full genome sequences of a number of filamentous fungi has provided a means to address the discovery of polyketides because the PKS genes are large and contain several conserved protein domains. Importantly, analysis of the genomic sequences from filamentous fungi (including Aspergillus nidulans, teleomorph, Emericella nidulans) predict numbers of individual PKS genes that exceeds significantly the number of polyketides that these fungi are known to produce (Galagan et al., 2005). In fact, the genome of A. nidulans (Galagan et al., 2005) appears to contain as many as 32 individual PKS genes (Nierman et al., 2005; Szewczyk et al., 2008; von Döhren, 2009), but until now only nine genes have been linked to eight polyketides (Yamazaki & Maebayas, 1982; Bergmann et al., 2007; Chiang et al., 2008; Szewczyk et al., 2008; Bok et al., 2009; Chiang et al., 2009; Schroeckh et al., 2009) (see Supporting Information, Fig. S1).

Southern blot analysis of Dra I-digested genomic DNA of L. paraplantarum strains using LpF2 as a probe showed that LpF2 is distinctive of strain FBA1 among 16 L. paraplantarum strains. Because PI3K activation both ERIC- and RAPD-PCR are fast and technically simple methods, they are useful for the rapid discrimination of L. paraplantarum strains

and for the development of new strain-specific DNA markers for identifying industrially important strains. Lactobacillus paraplantarum, a species phenotypically close to Lactobacillus plantarum, was characterized in 1996 (Curk et al., 1996). Few phylogenetic studies of the species have been reported (Torriani et al., 2001a, b), and methods for discrimination between strains have yet to be developed. On the other hand, some L. paraplantarum strains have received

attention owing to their potential uses in food production or preservation (Lee et al., 2007; Chun et al., 2008). We evaluated the effects of 200 heat-killed lactic acid bacteria (LAB) strains on the production of hyaluronate and type I collagen when applied to normal human dermal fibroblast cells in vitro and found five strains with high efficacy (S. Miyata , K. Yamamoto, S. Sakata, C. Suzuki, H. Kimoto-Nira, K. Mizumachi & Y. Kitagawa, unpublished data). These strains (including one called FBA1) improved the skin integrity of HR-1 hairless mice fed a reduced-protein diet. These effects are strain dependent; hence, it is important to develop reliable methods to identify and discriminate strains of L. paraplantarum. BGB324 Enterobacterial repetitive intergenic consensus (ERIC) sequences are highly conserved DNA sequences that occur as multiple copies in the genomes of enteric bacteria and Vibrio species (Sharples & Lloyd, 1990; Mercier et al., 1996; Tcherneva et al., 1996; Wilson & Sharp, 2006). Methods using ERIC-PCR have been used to classify closely related strains of enterococci (Wei et al., 2004). The random amplified polymorphic DNA (RAPD) method has been used to classify various organisms

from bacteria to plants (Van Reenen & Dicks, 1996; Torriani et al., 2001a; Venkatachalam et al., 2004; Nomura et al., 2006; Walczak et al., 2007). RAPD entails PCR amplification with a single, short oligonucleotide primer that does not strongly match particular sites in target genomes, almost under low-stringency conditions, for annealing. In most cases, both ERIC- and RAPD-PCR generate several DNA bands that enable species-level or sometimes strain-level differentiation of bacteria. The aim of this study was to develop a fast and simple method to discriminate strains of L. paraplantarum using PCR and to develop a DNA marker to identify specifically the particular strain. We focused on an L. paraplantarum FBA1 strain, which improved the skin integrity of HR-1 hairless mice fed a reduced-protein diet, and developed a pair of FBA1-specific PCR primers and an FBA1-specific DNA fragment based on ERIC-PCR.

The diet of insects was prepared by the method described

previously (Hu et al., 2009). Different amounts (15–150 μL) of concentrated supernatant of BL (Bi) lysate were applied to 1-cm3 disks of artificial diet. Treated food blocks were allowed to dry for 20 min. Three first-instar larvae were placed on each food block before incubation at 25 °C for 7 days. The percent mortality of larvae and the weight ZVADFMK of surviving larvae were then recorded. Concentrated supernatants of BL21 (DE3) lysate were used as negative control. Solubilized Cry1Ac protein, which is highly toxic against H. armigera larva, was used as a positive control. The bioassay was performed three times on different days. The injectable toxicity of binary toxin was tested against S. exigua fourth-instar larvae. Different amounts (10, 25, 50 and 100 μL) of concentrated supernatant of untreated or heat-inactivated (incubated at 80 °C for PLX3397 30 min) BL (Bi) lysate were injected directly into the insect hemocoel from the third abdominal foot. Two repeats of 40 larvae for each amount were used. Concentrated supernatant of BL21 (DE3) lysate was used as a negative control. After injection, larvae

were incubated at 28 ± 1 °C on an artificial diet and monitored over 7 days for any deleterious effects. Bioassay was performed three times on different days. The cell line FPMI-CF-203/2.5 (CF-203), originated from the midgut of the spruce budworm (Choristoneura fumiferana; Lepidoptera, Torticididae), was kindly gifted by Prof. Guido F. Caputo (Natural Resource Canada). CF-203 Tolmetin was cultured in Insect-Xpress medium (BioWhittaker, Cambrex Bioscience, Walkersville, MD) supplemented

with 2.5% heat-inactivated fetal bovine serum (FBS; Sigma-Aldrich, Bornem, Belgium) at 27 °C (Vandenborre et al., 2008). 4T1 mouse breast tumor cells, Hep 3B human hepatoma cells, HeLa human cervical cancer cells, and HCT116 human colon cancer cells were purchased from the American Type Culture Collection (ATCC). B16 mouse melanoma cells were obtained from the Cell Bank of Type Culture Collection, Chinese Academy of Sciences. All mammalian cell lines were cultured in RPMI 1640 medium supplemented with L-glutamine (Gibco) and 10% heat-inactivated FBS, 100 U mL−1 penicillin, and 100 μg mL−1 Streptomycin at 37 °C. The effect of different concentrations of Plu1961 (0.5–3.0 μmol L−1) alone, Plu1962 (0.5–2.5 μmol L−1) alone, and their mixture (0.2–1.6 μmol L−1) on cell viability was determined against CF-203, 4T1, Hep 3B, HeLa, HCT116, B16 cell lines. Wells of a 96-well microtiter plate were loaded with 100 μL of cell suspension, containing 2.0 × 105 cells mL−1, and exposed to different concentrations of object proteins or deionized water in the control treatment. Cytotoxicity of lysate from BL (Bi) was also tested against 4T1, Hep 3B, HeLa, HCT116, B16 cell lines, and the lysate from BL21 (DE3) was used as a control. The plates were incubated for 2 days at 28 °C.

Only 45% of the IL-2 patients who experienced bacterial pneumonia received further dosing cycles of rIL-2 subsequently. The Kaplan–Meier table showing the time to bacterial pneumonia in the IL-2 and control arms

is shown in Figure 2. Overall, as shown in Table 3a, in the multivariate model, baseline risk factors for bacterial pneumonia were older age (HR per 10 years increase in age 1.34; 95% CI 1.14–1.59; P=<0.001), IDU (HR 1.78; 95% CI 1.09–2.90; P=0.02), VL ≥500 HIV-1 RNA copies/mL Trichostatin A cell line (HR 2.02; 95% CI 1.46–2.81; P=<0.001) and history of recurrent bacterial pneumonia as an ADI (HR 5.38; 95% CI 2.86–10.11; P=<0.001). Asian ethnicity was associated with a decreased risk of bacterial pneumonia (HR 0.17; 95% CI 0.05–0.56; P=0.003). In the multivariate analysis of bacterial pneumonia events in the IL-2 arm, the baseline associations were similar to the overall findings, Asian ethnicity was protective (HR 0.10; 95% CI 0.01–0.74; P=0.02);

being older (HR 1.46; 95% CI 1.15–1.85; P=0.002), having detectable plasma VL (HR 2.27; 95% CI 1.45–3.55; P=<0.001) and having a prior history of recurrent bacterial pneumonia (HR 4.46; 95% CI 1.72–11.54; P=0.002) were associated with increased pneumonia risk. However, IDU was not associated with an increased pneumonia risk (HR 1.46; 95% CI 0.72–2.96; P=0.30). Consistent with the overall findings, in control patients, IDU (HR 2.11; 95% CI 1.06–4.20; P=0.03), recurrent bacterial pneumonia (HR 5.61; 95% CI 2.38–13.24; P≤0.001) and detectable plasma VL (HR 1.85; 95% CI 1.13–3.03; BMS-354825 cost P=0.01) were associated with a

significantly increased hazard for pneumonia. In contrast to the overall findings, there was only a trend towards decreased risk with Asian ethnicity (HR 0.27; 95% CI 0.06–1.11; P=0.07) and a trend towards increased risk with older age (HR 1.26; 95% CI 0.99–1.61; P=0.06). As shown in Table 3b, higher proximal VL on study (HR for 1 log10 higher VL 1.28; 95% CI 1.11–1.47; P≤0.001) and receipt of rIL-2 within the last 180 days (HR 1.72; 95% CI 1.12–2.65; P=0.01) were predictors of increased risk for a bacterial pneumonia event; higher proximal CD4 cell count CYTH4 was associated with decreased risk (HR 0.94; 95% CI 0.89–1.00; P=0.04). When adjusted for baseline predictors (age, IDU, ethnicity and history of recurrent bacterial pneumonia) and time-updated CD4 cell count and VL, the hazards for IL-2 patients cycling within 180 days and ≥180 days of a bacterial pneumonia event were 1.66 (95% CI 1.07–2.60; P=0.02) and 0.98 (95% CI 0.70–1.37; P=0.90), respectively, compared with the control arm. In years 1 and 2 in the IL-2 group, the hazard for bacterial pneumonia when rIL-2 cycling was <30, 30–119 and 120–179 days, compared with receipt ≥180 days previously, was 2.59 (95% CI 0.88–7.62; P=0.08), 1.74 (95% CI 0.70–4.30; P=0.23) and 1.21 (95% CI 0.36–4.04; P=0.75), respectively.

Figure 1 shows proportions of children fully immunized with primary and booster doses of routine vaccines. Overall, 63% (186 of 297) of primary immunizations and only 41% (61 of 149) of booster immunizations were complete in children

eligible to receive selleck products the vaccine (P<0.001). Sixty-one per cent (162 of 267) of all immunizations were complete in UK-born children compared with 47% (85 of 179) in non-UK-born children (P=0.006). Even though rates of immunization in London are lower than in the UK overall [e.g. 83% vs. 93% completed primary diphtheria, tetanus and pertussis (DTP) by age 5 years (http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/immunisation; accessed 3 September 2009)], rates in HIV-infected children were surprisingly low. HIV-infected children may have other risk factors for incomplete immunization such as residence in disadvantaged areas, history of hospital admission [2] or coming from an immigrant family. Childhood vaccinations are free; however, specialist clinics incur costs if vaccinations are provided through them, and not all have the funding or resources to do so. Additionally, guidelines

are based on limited evidence in HIV-infected children, especially those with severe immune deficiency, causing uncertainty as to optimal practice. Approximately 20% of HIV-infected children nationally have a CD4% <20 (http://www.chipscohort.ac.uk/summary_data.asp; accessed 8 July Glutathione peroxidase 2010). This may contribute to the incomplete find more coverage observed for

MMR in our study. Few studies have assessed the immunization status of HIV-infected children in industrialized countries. Like ours, recent Swiss and Spanish studies found lower immunization coverage in this population than in the general public [3,4]. A study from Texas found no difference between HIV-infected patients and the general population for diphtheria, tetanus, acellular pertussis and inactivated polio vaccine (DTaP-IPV) and MMR, although vaccine coverage was low overall [5]. We conclude that immunization of HIV-infected children is suboptimal in this London population. Booster doses and nonroutine vaccines are most commonly omitted. Immigrant children are particularly likely to be under-immunized. As life expectancy and the proportion of immigrant HIV-infected children increase, appropriate routine and catch-up immunization becomes more important. Development of evidence-based recommendations and standards for immunization of HIV-infected children, improved accessibility of immunization records, and opportunistic immunization in clinics may all improve this situation.

Figure 1 shows proportions of children fully immunized with primary and booster doses of routine vaccines. Overall, 63% (186 of 297) of primary immunizations and only 41% (61 of 149) of booster immunizations were complete in children

eligible to receive Lumacaftor the vaccine (P<0.001). Sixty-one per cent (162 of 267) of all immunizations were complete in UK-born children compared with 47% (85 of 179) in non-UK-born children (P=0.006). Even though rates of immunization in London are lower than in the UK overall [e.g. 83% vs. 93% completed primary diphtheria, tetanus and pertussis (DTP) by age 5 years (http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/immunisation; accessed 3 September 2009)], rates in HIV-infected children were surprisingly low. HIV-infected children may have other risk factors for incomplete immunization such as residence in disadvantaged areas, history of hospital admission [2] or coming from an immigrant family. Childhood vaccinations are free; however, specialist clinics incur costs if vaccinations are provided through them, and not all have the funding or resources to do so. Additionally, guidelines

are based on limited evidence in HIV-infected children, especially those with severe immune deficiency, causing uncertainty as to optimal practice. Approximately 20% of HIV-infected children nationally have a CD4% <20 (http://www.chipscohort.ac.uk/summary_data.asp; accessed 8 July Coproporphyrinogen III oxidase 2010). This may contribute to the incomplete E7080 in vivo coverage observed for

MMR in our study. Few studies have assessed the immunization status of HIV-infected children in industrialized countries. Like ours, recent Swiss and Spanish studies found lower immunization coverage in this population than in the general public [3,4]. A study from Texas found no difference between HIV-infected patients and the general population for diphtheria, tetanus, acellular pertussis and inactivated polio vaccine (DTaP-IPV) and MMR, although vaccine coverage was low overall [5]. We conclude that immunization of HIV-infected children is suboptimal in this London population. Booster doses and nonroutine vaccines are most commonly omitted. Immigrant children are particularly likely to be under-immunized. As life expectancy and the proportion of immigrant HIV-infected children increase, appropriate routine and catch-up immunization becomes more important. Development of evidence-based recommendations and standards for immunization of HIV-infected children, improved accessibility of immunization records, and opportunistic immunization in clinics may all improve this situation.