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Neurologic manifestations of human immunodeficiency virus infection in children
Insights
Progressive encephalopathy is a significant neurologic complication in children with human immunodeficiency virus (HIV) infection, often worsening with immune decline. Its presence indicates a poor prognosis and active brain infection.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurovirology
Background:
- Human immunodeficiency virus (HIV) infection affects children, with potential for severe neurologic complications.
- Understanding the spectrum of neurologic manifestations in pediatric HIV is crucial for patient management.
Purpose of the Study:
- To describe the neurologic manifestations in a cohort of 36 children with HIV infection.
- To correlate neurologic signs with disease progression, immunodeficiency, and HIV-specific antibody presence.
- To investigate the role of primary HIV brain infection in pediatric encephalopathy.
Main Methods:
- Retrospective analysis of neurologic findings in 36 children with HIV.
- Assessment of immunodeficiency status and presence of HIV-specific antibodies (serum and intrathecal).
- Review of neuropathologic findings in deceased patients.
Main Results:
- Progressive encephalopathy developed in a significant proportion of children with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex.
- Neurologic signs worsened with advancing immunodeficiency and correlated with absence of neutralizing antibodies and poor outcomes.
- Evidence of intrathecal HIV-specific antibody synthesis indicated active brain infection in children with AIDS and AIDS-related complex.
- Neuropathologic findings supported primary HIV brain infection as the cause of encephalopathy.
Conclusions:
- Progressive encephalopathy is a key neurologic complication in pediatric HIV infection, linked to disease severity and poor prognosis.
- Active HIV replication within the brain, evidenced by intrathecal antibody synthesis, contributes to neurologic decline.
- These findings highlight the need for effective antiviral therapies targeting the central nervous system in pediatric HIV.
Abstract:
This report describes the neurologic manifestations of 36 children with human immunodeficiency virus (HIV) infection. In this cohort, in 16 of 21 children with acquired immunodeficiency syndrome (AIDS), three of 12 children with AIDS-related complex, and one of three asymptomatic seropositive children, a progressive encephalopathy developed. Neurologic signs were often detected early but tended to worsen coincident with progression of the immunodeficiency. The presence of progressive encephalopathy correlated with the absence of serum neutralizing antibodies to HIV and with a poor, usually fatal, outcome. The incubation period from initial HIV infection in the perinatal period to the onset of progressive encephalopathy varied from 2 months to 5 years. Intrablood-brain barrier synthesis of HIV-specific antibodies was demonstrated in eight of 14 children with AIDS and AIDS-related complex, indicating active brain infection with HIV. In three cases this was unassociated with progressive neurologic signs. Unique neuropathologic findings in children who died with HIV infection further suggest that the progressive encephalopathy is the result of primary and persistent infection of the brain with this retrovirus. These findings broaden the spectrum of HIV infection in children and have important implications for the development of antiviral therapy.