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Brain Imaging in New-Onset Seizure of Children Living With Human Immunodeficiency Virus in Zambia
Sarah Mohajeri1, Michael Potchen1, Izukanji Sikazwe2
1Department of Imaging Sciences, University of Rochester, Rochester, New York.
Insights
Brain imaging in children with HIV (CLHIV) revealed atrophy is common and linked to neurocognitive impairment. Focal abnormalities were less frequent in children on antiretroviral therapy (ART).
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- 1.5 million children living with human immunodeficiency virus (CLHIV), predominantly in sub-Saharan Africa.
- New-onset seizures are a common presentation in CLHIV, often necessitating neuroimaging.
- Limited resources hinder routine neuroimaging for CLHIV in many regions.
Purpose of the Study:
- To investigate brain imaging findings in children with HIV presenting with new-onset seizures.
- To correlate imaging abnormalities with clinical risk factors and neurocognitive outcomes in this population.
Main Methods:
- Prospective cohort study at the University Teaching Hospital, Lusaka, Zambia.
- Clinical and demographic data collected; CT and/or MRI scans performed.
- Image interpretation using REDCap-based NeuroInterp; age-dependent neuropsychological assessments administered.
Main Results:
- 49% of children had brain MRI, 41% had CT.
- Advanced HIV disease was associated with higher odds of brain atrophy (OR 7.2).
- Children on antiretroviral therapy (ART) were less likely to have focal abnormalities (OR 0.22).
- Neurocognitive impairment correlated with atrophy (OR 8.4) and reduced focal abnormalities (OR 0.2).
Conclusions:
- Focal brain abnormalities are less common in CLHIV receiving ART.
- Brain atrophy is the most frequent imaging finding in this cohort.
- Brain atrophy is significantly associated with severe neurocognitive impairment in CLHIV.
Background:
There are an estimated 1.5 million children living with human immunodeficiency virus (CLHIV), most residing in sub-Saharan Africa. A common hospital presentation of CLHIV is new-onset seizure, for which imaging is helpful but not routinely performed due to scarce resources. We present imaging findings and their association with clinical risk factors and outcomes in a cohort of Zambian CLHIV presenting with new-onset seizure.
Methods:
In this prospective cohort study, participants were recruited at the University Teaching Hospital in Lusaka, Zambia. Various clinical and demographic characteristics were obtained. Computed tomography (CT), magnetic resonance imaging (MRI), or both were obtained during admission or shortly after discharge. If both studies were available, MRI data was used. Two neuroradiologists interpreted images using REDCap-based NeuroInterp, a tool that quantifies brain imaging findings. Age-dependent neuropsychologic assessments were administered.
Results:
Nineteen of 39 (49%) children had a brain MRI, 16 of 39 (41%) had CT, and four of 39 (10%) had both. Mean age was 6.8 years (S.D. = 4.8). Children with advanced HIV disease had higher odds of atrophy (odds ration [OR] 7.2, 95% confidence interval [CI] 1.1 to 48.3). Focal abnormalities were less likely in children receiving antiretroviral therapy (ART) (OR 0.22, 95% CI 0.05 to 1.0). Children with neurocognitive impairment were more likely to have atrophy (OR 8.4, 95% CI 1.3 to 55.4) and less likely to have focal abnormalities (OR 0.2, 95% CI 0.03 to 0.9).
Conclusions:
Focal brain abnormalities on MRI were less likely in CLHIV on ART. Brain atrophy was the most common imaging abnormality, which was linked to severe neurocognitive impairment.
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