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

Abstract

A B S T R A C TPurpose: Data relating to the role that Human immunodeficiency virus (HIV) contributes towards seizures in HIV-infected children is limited. The management of seizures in this group is complex due to potential interactions between antiseizure medication and antiretroviral therapies. This study explores the seizure semiology and course of a population of affected children based on questions raised from a previous epidemiological study. Methods: A retrospective case-control study of all patients presenting to an HIV neurology clinic between 2008-2015 was conducted. A multinomial logistic regression model was used to identify risk factors for seizure occurrence in HIV-infected children, as well as factors associated with seizure control. Results: Of 227 HIV-infected children (median 82 months, interquartile range 41-109), 52 (23%) reported a past or present history of seizures. Prior bacterial meningitis (p = 0.03, OR 12.5, 95% CI 1.2-136.1), cerebrovascular accident (CVA, p = 0. 005, OR 8.1, 95% CI 1.9-34.9) and or tuberculous meningitis (TBM, p = 0.0004) was associated with an increased risk of seizures in HIV-infected children. Generalised tonic-clonic seizures were the predominant seizure type (64%) with the majority caused by an infectious aetiology (62%). Thirty-two (62%) of these patients had epilepsy in-line with the latest diagnostic criteria. HIV-infected children with epilepsy who were treated with efavirenz were more likely to have poor seizure control (OR 23.1 95% CI 3.4-159.6, p = 0.0001). Conclusions:This study provides new data highlighting the complex clinical presentation and management challenges of HIV-infected children with seizures.

Current epidemiological and etiological characteristics and treatment of seizures or epilepsy in patients with HIV infection

“…As for the prevalence or incidence of epilepsy in the HIV+ population, most studies only reported the prevalence or incidence of seizures in detail, and only a few reported recurrent rates and followed up to the diagnosis of epilepsy. From the three studies reported so far, the proportion of HIV+ patients who had seizures and were subsequently diagnosed with epilepsy was very high (37/38, 21/27, and 32/52) [6,13,14]. It can be considered that the epidemiological characteristics of epilepsy in HIV+ patients may be similar to seizures.…”

“…According to the epilepsy definition by International League against Epilepsy (ILAE) in 2014 [22] and seizures classification in 2017 [23], most seizures in HIV-infected patients are generalized. The proportion of generalized seizures in patients with NOS ranged from 35.3% [12] to 67.3% [14].…”

“…According to the Centers for Disease Control and Prevention, HIVE cannot be diagnosed unless the patient meets at least one of its criteria for ≥2 months [73]. Only few studies stated that the diagnosis of HIVE strictly followed the standard [14]. Most literature merely attributed HIVE to seizures in patients with no obvious etiology.…”

“…Samia et al from South Africa reported both prevalence and incidence of seizures in the included HIV-infected children as 7.6% [ 13 ]. Another study from South Africa reported a 23% rate of history of seizure in 227 involved HIV+ children [ 14 ]. This situation may be due to the pandemic of AIDS in Africa, where many children were afflicted through the maternal-neonatal transmission.…”

“…The epilepsy type could not be demonstrated in HIV-infected patients because of a lack of studies. Some studies have reported the existence of status epilepticus (SE) in their HIV-infected participants, with a proportion from 0.175 to 4.34% [ 7 , 12 , 14 , 20 ], while in a meta-analysis published in 2017, status epilepticus had a prevalence of 12.6/100,000 among general populations [ 24 ]. This suggests that HIV may be an underlying risk factor for status epilepticus.…”