Cerebrovascular disease in children with HIV‐1 infection

Abstract

An estimated 3.2 million children worldwide have human immunodeficiency virus (HIV) infection. Antiretroviral therapy (ART) has resulted in prolonged survival, leading to an increase in complications previously recognized in adults. Children with HIV infection have increased risk of cerebrovascular disease from multiple aetiologies including HIV‐associated vasculopathy, opportunistic vasculitis, cardioembolism or coagulopathy, all of which may be secondary to the infection. Prevalence of cerebrovascular disease in HIV‐infected children is underestimated because of limited neuroimaging in low and middle income countries, silent events without overt motor manifestations, and mislabeling as HIV encephalopathy for non‐motor manifestations such as behavioural and cognitive difficulties. No management guidelines for cerebrovascular disease in HIV‐infected children exist but common practices target risk factors for stroke in low and middle income countries. Where capacity permits, screening for opportunistic infections, vasculitis, coagulopathy and cardioembolism is important. Optimising virological suppression, correction of anaemia, control of seizures and aspirin prophylaxis are management priorities. Neurosurgical interventions may have a role.

Brain Magnetic Resonance Imaging Findings Associated With Cognitive Impairment in Children and Adolescents With Human Immunodeficiency Virus in Zambia

“…3 Previous studies estimate an incidence of approximately 1% to 6.4% of stroke in children with HIV, although studies following autopsy have shown much higher rates of up to 34%. 16,36,37 In both Malawian and Zambian populations, HIV infection has been associated with stroke in young adults, but most studies of HIV and stroke have not included subjects younger than 18 years. 38,39 HIV is known to cause cerebral vasculopathy, 40 angiitis, 41 aneurysmal dilatation 42 (particularly fusiform aneurysms in children 43 ), arterial stenosis complicated by ischemic infarction, 44 and secondary moyamoya syndrome.…”

“…7,8,12 Evidence of increased risk of cerebrovascular disease in children with HIV infection is also documented, with vasculopathy, opportunistic vasculitis, cardioembolism, and coagulopathy associated with HIV infection. 16 Magnetic resonance imaging (MRI) characteristics associated with cognitive outcomes in children and adolescents with HIV are more limited, although one study of HIV-infected adolescents in South Africa identified an association between global intelligence (intelligence quotient) and total gray and white matter volumes. 8 However, prior studies have been somewhat limited by inclusion of a mix of ART-treated and ART-naive subjects, lack of information on clinical characteristics of the studied population, and lack of an appropriate control group.…”

Higher subcortical and white matter cerebral blood flow in perinatally HIV-infected children

“…Chronic pediatric HIV infection and several components of cART have been associated with vasculopathy, coagulopathy, metabolic comorbidities, and an increased risk of cerebrovascular events, all potentially influencing cerebral blood flow (CBF). [ 6 , 7 ] A small positron emission tomography (PET) study reported decreased cortical and increased subcortical activity in HIV-infected children without cART, [ 8 ] but no studies have evaluated CBF in cART-treated HIV-infected children.…”

Seizures in Children with HIV infection in South Africa: A retrospective case control study

“…Moreover, in the seizure group there were more children with documented cerebrovascular disease in the absence other concurrent CNS infections. This is most probably as a direct consequence of an HIV-associated vasculopathy [4].…”

“…The neurological disease may be primarily caused via direct infection by the virus as observed in HIV encephalopathy (HIVE) [3]. In addition, HIV infection leads to increased risk of secondary insults to the nervous system in the form of cerebrovascular disease [4], peripheral neuropathy [5] and, most commonly, opportunistic infections such the acute bacterial meningitis [6] or tuberculous meningitis (TBM) [7,8].…”