Neuroimaging Findings in Children Perinatally Infected With the Human Immunodeficiency Virus

Johann-Liang, Rosemary; Lin, Karen; Cervia, Joseph S.; Stavola, Joseph J.; Noel, Gary J.

doi:10.1097/00006454-199808000-00019

Cited by 25 publications

(20 citation statements)

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“…Las alteraciones más frecuentemente encontradas incluyen la atrofia cerebral, las alteraciones de la sustancia blanca y las calcificaciones de los ganglios basales (20)(21)(22). Se ha encontrado una asociación importante entre estos hallazgos imaginológicos con cargas virales altas y un estado inmunológico y clínico deficiente (23).…”

Section: Alteraciones Imaginológicas Y Electroencefalográficasunclassified

“…Se ha encontrado una mayor frecuencia y gravedad de atrofia cerebral en los pacientes pediátricos positivos para VIH-1 con encefalopatía de inicio temprano, quienes presentan simultáneamente un retardo significativo de la mielinización encefálica (21).…”

Section: Alteraciones Imaginológicas Y Electroencefalográficasunclassified

“…Lo anterior sugiere que la alteración en el balance de estas últimas, en etapas tempranas del desarrollo, podría generar alteraciones en la mielinización del SNC. Las manifestaciones clínicas observadas en infantes con encefalopatía temprana sugieren una alteración importante del proceso de mielinización, lo cual se ha comprobado imaginológicamente con la RM (21,25,31).…”

Section: La Mielinización Un Evento Fundamental En El Desarrollo Delunclassified

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El virus de la inmunodeficiencia humana tipo 1 y el sistema nervioso central en desarrollo.

et al. 2005

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Actualmente, hay más de 42 millones de infectados con el virus de la inmunodeficiencia humana tipo 1 (VIH-1), de los cuales, 3,2 millones son niños y, de éstos, el 90% con transmisión vertical de la infección. Se considera que en Colombia más de 200.000 personas se han infectado desde el inicio de la pandemia y los estudios muestran una tendencia constante al aumento en las cifras de seroprevalencia en mujeres embarazadas y, por ende, en el número de recién nacidos infectados. El VIH-1 es primordialmente linfotrópico, pero su tropismo por el sistema nervioso central (SNC) es bien conocido, lo que genera múltiples alteraciones neurológicas, particularmente prominentes en niños, de las cuales la más prevalerte es la encefalopatía. Clásicamente, se reconocen dos tipos de encefalopatía en esta población: encefalopatía temprana y tardía, ambas con diferentes características clínicas e inmunológicas. La infección por el VIH-1 en el SNC está limitada a los macrófagos, la microglía y los astrocitos en menor escala. Las neuronas, células principalmente afectadas en los pacientes con sida, raras veces son infectadas, por lo que se postula que factores solubles, provenientes tanto del huésped como del virus, son los principales causantes del daño neuronal. Los hallazgos presentados en esta revisión sugieren la posibilidad de que el SNC, en etapas tempranas del desarrollo, sea especialmente susceptible a la infección por el VIH-1. Las cifras epidemiológicas sugieren que este tipo de alteraciones clínicas serán cada vez más frecuentes; de ahí, la importancia de conocer la neuropatogénesis de la infección por el VIH-1.Palabras clave: encefalitis, VIH-1, neuropatogénesis, neurogénesis, citocinas, embriología. The human immunodeficiency virus type 1 and the developing central nervous systemCurrently, at least 42 million people are infected worldwide with the human immunodeficiency virus type 1 (HIV-1). Of these, 3.2 million are children infected, in 90% of the cases, through vertical transmission. In Colombia, approximately 200,000 persons have been infected since the beginning of the pandemic, with an increasing trend in the seroprevalence among pregnant women. Although HIV-1 is basically lymphotropic, its capacity to invade the central nervous system (CNS) is well known, generating multiple neurological alterations, especially prominent in children, with encephalopathy being the most prevalent. Classically, two types of neurological disorders are recognized in children, consisting of early and late encephalopathies, each with differing clinical and immunological characteristics. HIV-1 infection of the CNS is limited to macrophages, microglia and astrocytes in a restricted manner. In patients with acquired immunodeficiency virus (AIDS), neurons are rarely infected, suggesting that cellular and viral soluble factors, are responsible for the neuronal damage. The conclusion is that the CNS in earlier stages of development is especially susceptible to HIV-1 infection. The epidemiological trends predict that these types of clinical...

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Section: Alteraciones Imaginológicas Y Electroencefalográficasunclassified

Section: La Mielinización Un Evento Fundamental En El Desarrollo Delunclassified

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El virus de la inmunodeficiencia humana tipo 1 y el sistema nervioso central en desarrollo.

et al. 2005

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“…Cerebral atrophy and ventriculomegaly are the commonest neuroimaging findings in HIV-infected children, being present in 68 and 78% of children with symptomatic disease, respectively [8, 73, 75]. However, progressive encephalopathy can be associated with normal imaging studies [74].…”

Section: Brain Imaging For Hiv Diseasementioning

confidence: 99%

“…The presence of calcification correlates with progressive encephalopathy [73, 74]. Children with the highest HIV viral load have the most marked calcification on neuroimaging [75]. Unlike cerebral calcification seen in other congenital infections, HIV calcification is not seen before 2 months of age.…”

Section: Brain Imaging For Hiv Diseasementioning

confidence: 99%

Central Nervous System Abnormalities in Pediatric Human Immunodeficiency Virus Infection

Gavin¹,

Yogev²

1999

Pediatr Neurosurg

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Neurological and developmental effects of HIV and AIDS in children and adolescents

Mitchell

2001

Ment. Retard. Dev. Disabil. Res. Rev.

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HIV-related encephalopathy is an important problem in vertically infected children with HIV. Infected infants may manifest early, catastrophic encephalopathy, with loss of brain growth, motor abnormalities, and cognitive dysfunction. Even without evidence of AIDS, infected infants score lower than serorevertors on developmental measures, particularly language acquisition. Children with perinatal or later transfusion-related infection generally are roughly comparable developmentally to their peers until late in their course. Symptoms similar to adult AIDS dementia complex are occasionally seen in adolescents with advanced AIDS, including dementia, bradykinesia, and spasticity. Opportunistic CNS infections such as toxoplasmosis and progressive multifocal leukoencephalopathy are less common in children and adolescents than in adults. Increasing evidence suggests that aggressive antiretroviral treatment may halt or even reverse encephalopathy. Neuroimaging changes may precede or follow clinical manifestations, and include early lenticulostriate vessel echogenicity on cranial ultrasound, calcifying microangiopathy on CT scan, and/or white matter lesions and central atrophy on MRI. Differential diagnosis of neurological dysfunction in an HIV-infected infant includes the effects of maternal substance abuse, other CNS congenital infections, and other causes of early static encephalopathy. Initial entry of HIV into the nervous system occurs very early in infection. The risk of clinical HIV encephalopathy increases with very early age of infection and with high viral loads. Virus is found in microglia and brain derived macrophages, not neurons. The neuronal effect of HIV is probably indirect, with various cytokines implicated. Apoptosis is the presumed mechanism of damage to neurons by HIV.

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Neuroimaging Findings in Children Perinatally Infected With the Human Immunodeficiency Virus

Cited by 25 publications

References 10 publications

El virus de la inmunodeficiencia humana tipo 1 y el sistema nervioso central en desarrollo.

El virus de la inmunodeficiencia humana tipo 1 y el sistema nervioso central en desarrollo.

Central Nervous System Abnormalities in Pediatric Human Immunodeficiency Virus Infection

Neurological and developmental effects of HIV and AIDS in children and adolescents

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