Neurologic and Neurobehavioral Sequelae in Children With Human Immunodeficiency Virus (HIV-1) Infection

Abstract

The range and extent of neurologic and neurobehavioral complications of human immunodeficiency virus (HIV-1) infection in children are under-described. Seventy-eight children with HIV-1 infection (32 females) were assessed for neurologic complications. Forty-six children had abnormal neurology examinations. Thirty-three children had global pyramidal tract signs, 5 had a hemiparesis, 4 had peripheral neuropathy, 18 had visual impairment, and 5 had hearing impairment. Thirty-nine of 63 children over 1 year of age had neurobehavioral problems. Of 24 children with HIV encephalopathy, 74% had severe immunosuppression and 45% were not receiving antiretroviral therapy. Twelve children had prior opportunistic central nervous system infections, and 9 had epilepsy. Diverse neurologic and neurobehavioral deficits are common in children with HIV-1 infection. Children with severe immunosuppression, who were not receiving antiretroviral therapy, were growth impaired and less than 1 year of age, were at greatest risk for developing neurologic complications.

Prevalence of Seizures in Children Infected With Human Immunodeficiency Virus

“…Priorities under such circumstances are focused toward monitoring adherence with treatment protocols, disease complications, and medication side effects. 3 As previously reported, most children with seizures had generalized tonic-clonic seizures (67%). 4 On the basis of the multiple underlying pathologies, a greater proportion of focal seizures with or without loss of consciousness would be expected.…”

“…28,29 In this study, the reported prevalence of 7.6% (95% confidence interval: 5.1-10.9%) of seizures in children with HIV is within the ranges reported in previous studies. [2][3][4][5][6] However, this figure may be an underestimate for a hospital-based population as the information was collated from retrospective data recorded by pediatricians in a busy outpatient setting. Priorities under such circumstances are focused toward monitoring adherence with treatment protocols, disease complications, and medication side effects.…”

“…23,24 However, large studies in children with concomitant seizures and HIV are lacking. 3,5,6 Materials and Methods Aim Methodology In a retrospective study, a sequential folder review of patients attending the general pediatric HIV clinics was undertaken from January 2008 to January 2009. A total of 354 records were reviewed from 2 sites: at the Red Cross War Memorial Children's Hospital and the Kidz-positive clinic at Groote Schuur Hospital, located in Cape Town, South Africa.…”

Clinical associations of white matter damage in cART-treated HIV-positive children in South Africa

“…HIV-associated neurological complications are common in South African children and include a wide spectrum of disorders (Govender et al 2011). The specific consequences of HIV infection in the central nervous system (CNS) of vertically infected children could be associated with multiple factors.…”

Efavirenz as a cause of ataxia in children

“…[4] An SA study found the prevalence of neurological complications to be 59%, the most common being HIV encephalopathy and long-tract motor signs; however, no cases of cerebellar dysfunction were documented in that study. [4] The occurrence of ataxia in an HIV-positive individual is rare, with the chronic sequelae being neurocognitive impairment and polyneuropathy. [5] Ataxia in the setting of HIV is generally secondary to an infectious, vascular or neoplastic cerebellar lesion.…”