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[Neurological manifestations in HIV-infected child]
G Bossi1, A Maccabruni, D Caselli
1Clinica Pediatrica, Policlinico San Matteo IRCCS, Pavia.
Insights
HIV-related encephalopathy significantly impacts pediatric patients, with neurological impairment observed in 34%. Early antiretroviral therapy is crucial for better outcomes in children with human immunodeficiency virus (HIV).
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurodevelopmental Disorders
Background:
- This study examines the epidemiological, pathogenetic, and clinical aspects of HIV-related encephalopathy in pediatric patients.
- Investigated maternal, gestational, and perinatal factors influencing outcomes in vertically HIV-infected children.
Observation:
- A cohort of 50 pediatric patients (age 1 day-7 years) with HIV infection were evaluated between 1984 and 1994.
- A multidisciplinary team conducted comprehensive neurodevelopmental assessments with follow-up ranging from 6 months to 8.5 years.
- Seventeen patients (34%) exhibited HIV-related neurologic impairment, including 16 cases of encephalopathy and 1 of neurotoxoplasmosis.
Findings:
- HIV-related encephalopathy is frequent in pediatric patients, often showing a progressive or plateaued course.
- Neurological impairment in HIV-infected children is associated with worse disease evolution.
- Antiretroviral therapy demonstrated effectiveness only when initiated in the early stages of the disease.
Implications:
- Highlights the significant burden of neurological complications in pediatric HIV infection.
- Emphasizes the critical role of early intervention with antiretroviral therapy for improved neurodevelopmental outcomes.
- Suggests further investigation into pathogenetic covariates influencing neurological impairment in pediatric HIV.
Abstract:
The authors describe the main epidemiological, pathogenetic and clinical features of HIV-related encephalopathy in 50 pediatric patients (36 females, 24 males), born to HIV-seropositive mothers or infected by contaminated blood, observed in the Institute of Infectious Diseases of Pavia, between January 1984 and December 1994. All the patients (age 1 day-7 years) received a comprehensive evaluation, including subsequent neurodevelopmental assessments, by a multidisciplinary équipe of pediatric infectivologists and neuro-psychiatrists: the follow-up ranges from 6 months to 8.5 years. To evaluate the role of potentially covariates in HIV-vertically infected children, some maternal, gestational and perinatal factors were investigated. The neurodevelopmental assessment was carried out by a standardized protocol: tests were always conducted and evaluated by the same examiner. Seventeen pediatric patients with HIV-related neurologic impairment were observed (34%): 16 cases of encephalopathy (static-stable = 4, plateau = 6, subacute-progressive = 5, uncertain origin = 1) and 1 case of neurotoxoplasmosis. Findings of the current study demonstrate the high frequency of neurological impairment in HIV-infected infant/child, a worse evolution in this kind of patients and the effectiveness of an antiretroviral therapy only if administrated in the early phases of the disease. It was also emphasized the pathogenetic role of some covariates poorly evaluated in previously reported studies.