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[Aids neurologic manifestations in childhood]
Insights
Vertical transmission of HIV in children has significantly decreased due to prophylactic treatments. Neurologic complications remain a concern, but combination antiretroviral therapy shows promise for managing HIV-related neurological issues.
Area of Science:
- Pediatric infectious diseases
- Neurovirology
- Public health
Context:
- Vertical transmission is the primary route of HIV infection in children.
- Neurologic complications affect nearly half of vertically infected children.
- Advances in antiretroviral therapy have reduced transmission rates.
Purpose:
- To analyze the incidence and spectrum of neurologic complications in vertically HIV-infected children.
- To evaluate the effectiveness of current treatment strategies for pediatric HIV/AIDS with neurological involvement.
Summary:
- A study of 340 HIV+ children revealed a 49% incidence of neurologic complications, including encephalopathy, developmental delay, and CNS infections.
- Central nervous system infections were common, with bacterial infections and cytomegalovirus being most frequent.
- Cerebrospinal fluid and neuroimaging studies frequently showed abnormalities.
- Treatment focused on controlling viral replication, with combined AZT and other neuroprotective antiretrovirals showing the best response.
Impact:
- Demonstrates the significant burden of neurologic complications in pediatric HIV/AIDS.
- Highlights the success of prophylactic measures in reducing mother-to-child HIV transmission.
- Provides evidence for the efficacy of combination antiretroviral therapy in managing neurological manifestations of pediatric HIV.
Introduction:
Children with AIDS get infected mainly by vertical transmission.
Development:
That was what happened in 90% of the cases in a series of 340 HIV+ children followed at Hospital de Clínicas de Porto Alegre, Brazil. Currently, after the use of prophylactic treatment during pregnancy and the six first weeks of life, our transmission rate is 3% to 4%. The incidence of neurologic complications in the vertical transmission group was 49% in our prospective series, and due either to immunosuppression or primary neurological disease. Neurologic changes secondary to HIV constitute a complex syndrome, manifested by various degrees of cognitive, motor and behavioral delay. Encephalopathy can be either progressive or static. In our series, encephalopathy occurred in 32.5% of cases, developmental delay in 42.5%, seizures in 6%, speech delay in 5%, headaches in 2.5% and behavioral disorders in 2%. Central nervous system infections happened in 33.8% of our cases: acute bacterial infections in 11%, cytomegalovirus in 6.8%, toxoplasmosis in 5.9%, cryptococcal in 5%, tuberculous in 3.8% and syphilis in 1.3%. Hemorrhagic cerebrovascular accidents were seen in 2.5% of our cases, and peripheral neuropathy in 5%. Seventy percent of our cases had abnormalities in the CSF, 75% in brain CT scans and 45% in EEGs.
Conclusions:
Treatment of children with AIDS and neurologic manifestations was based on specific drugs aimed at controlling viral replication. Best response was obtained with combined use of AZT and other anti-retroviral neuro-protective.