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Evolution of HIV-1 encephalopathy in children
R Rigardetto1, P Vigliano, P Boffi
1Department of Pediatric and Adolescence Sciences, University of Turin, Italy.
Insights
Pediatric HIV-1 encephalopathy significantly increases mortality. Early onset is linked to worse prognosis, with pyramidal signs and cognitive decline being key features. Neuropsychological exams aid diagnosis and monitoring.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurodevelopmental Disorders
Background:
- Focuses on Human Immunodeficiency Virus type 1 (HIV-1) infected children.
- Aims to describe encephalopathy onset, progression, and impact on survival.
- Highlights diagnostic tools for pediatric HIV-1 encephalopathy.
Purpose of the Study:
- To illustrate features of encephalopathy onset and evolution in HIV-1 infected children.
- To determine the influence of encephalopathy on life expectancy.
- To identify useful diagnostic examinations for this condition.
Main Methods:
- A longitudinal study of 46 symptomatic HIV-1 infected children from 1989-1997.
- Included neuropsychiatric consultations, cognitive evaluations, EEG, Evoked Potentials, and CT scans.
- Survival analysis utilized the log-rank test.
Main Results:
- Encephalopathic patients exhibited significantly higher mortality rates.
- Early onset (first year of life) correlated with a poorer prognosis.
- Pyramidal signs and cognitive deterioration characterized encephalopathy; early onset plateau pattern showed greater severity and shorter survival.
Conclusions:
- Neuropsychological examinations are valuable for diagnosing and monitoring pediatric HIV-1 encephalopathy.
- Early detection and intervention may be crucial for improving outcomes.
Background:
This study has been conducted on a series of HIV-1 infected children, with the aim of illustrating the features of encephalopathy onset, its evolution and its influence on life expectancy. The most useful exams for diagnosis are also outlined.
Methods:
The perspective study lasted from January 1989 to June 1997. Forty six symptomatic patients, out of 142 seropositive children, were followed up in the Department of Paediatric and Adolescence Sciences of the University of Turin. The patients, now between 1 yr 2 mth and 13 yr 9 mth old, were born from HIV-1 seropositive mothers; seroreverters have been excluded. Scheduled neuropsychiatric consultations were used, consisting of a neurologic exam and an interview with parents, cognitive evaluations, EEGs, Evoked Potentials and CT scans. The results have been evaluated with log-rank test for the analysis of the survival curves.
Results:
We found a significantly higher mortality rate in encephalopathic versus non encephalopathic patients; encephalopathic patients, in whom neurologic signs began in the first year of life, have a worse prognosis than the other patients, in whom encephalopathy appeared later. We did not find a statistical correlation between clinical course and immunological deficit. The clinical features of encephalopathy are mainly characterized by pyramidal signs and cognitive deterioration. Clinical sign evolution is linked to the age of encephalopathy onset: plateau pattern encephalopathy, characterized by an early onset, severe motor signs and cognitive delay from the very beginning, shows a greater severity and a shorter survival than progressive encephalopathy, characterized by a slowly progressive evolution of pyramidal signs, to which a cognitive deterioration may be added.
Conclusions:
Neuropsychological exams can be helpful in the diagnosis and follow-up of encephalopathy.