Human immunodeficiency virus-related cerebral white matter disease in children

Area of Science:

• Neurology
• Radiology
• Pediatrics

Background:

• The human immunodeficiency virus (HIV) epidemic is increasingly managed with long-term anti-retroviral therapy, leading to a growing population of children living with HIV.
• Children on long-term HIV treatment are at higher risk for HIV-related brain injury, cognitive impairment, and neurological complications.
• Cerebral white matter abnormalities are common in HIV infection, presenting with diverse appearances and overlapping pathologies.

Purpose of the Study:

• To provide guidance for radiologists facing the diagnostic challenge of nonspecific cerebral white matter lesions in children with HIV.
• To discuss the common etiologies of HIV-related cerebral white matter disease in pediatric populations.
• To highlight the role of neuroimaging in managing children with HIV and associated white matter changes.

Main Methods:

• This is a review article.
• The authors synthesize current knowledge on HIV-related white matter disease in children.
• Guidance is provided based on understanding the varied pathophysiology and neuroimaging findings.

Main Results:

• HIV-related cerebral white matter disease encompasses primary HIV effects, opportunistic infections, vascular issues, and neoplasms.
• Pathophysiology can manifest as diffuse or focal white matter lesions.
• White matter changes in children may differ from those observed in adults.

Conclusions:

• Radiologists require specific guidance to interpret nonspecific white matter lesions in pediatric HIV.
• Understanding the differential diagnoses, including primary HIV effects and secondary complications, is crucial.
• Neuroimaging plays a vital role in the diagnosis and management of neurological complications in children with HIV.