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The neuropathology of HIV-infected African children in Abidjan, Côte d'Ivoire
1Department of Neuropathology, University of Edinburgh, Western General Hospital.
Insights
Neuropathology in African children revealed low HIV encephalitis rates, possibly due to earlier mortality. Cerebral malaria was less frequent in HIV-positive children compared to HIV-negative children.
Area of Science:
- Neuropathology
- Infectious Diseases
- Pediatrics
Background:
- Autopsy studies are crucial for understanding disease impact in pediatric populations.
- HIV infection presents unique neuropathological challenges, particularly in resource-limited settings.
Purpose of the Study:
- To compare neuropathological findings in HIV-infected and HIV-negative children in Abidjan, Côte d'Ivoire.
- To investigate the prevalence of specific neuropathological conditions, including HIV encephalitis and opportunistic infections, in pediatric HIV cases.
Main Methods:
- Autopsy examination of 78 HIV-seropositive and 77 HIV-negative children.
- Confirmation of HIV infection using serology, IgA Western blots, and clinicopathological data.
- Comparative analysis of neuropathological abnormalities between the two groups.
Main Results:
- HIV encephalitis was diagnosed in 4% of HIV-positive children.
- Opportunistic infections like cytomegalovirus and toxoplasmosis were observed.
- Cerebral malaria was significantly less common in HIV-positive children (3%) compared to HIV-negative children (14%).
- Bacterial meningitis occurred with similar frequency in both groups.
Conclusions:
- The low prevalence of HIV encephalitis in this cohort may be linked to earlier mortality from HIV infection in Africa.
- HIV-positive children exhibited a different spectrum of neuropathological conditions compared to HIV-negative children, notably reduced cerebral malaria incidence.
Abstract:
In an autopsy study of HIV-infected children in Abidjan, Côte d'Ivoire, the neuropathology of 76 HIV-1- and 2 HIV-2-positive children was compared with that of 77 frequency-matched HIV-negative children, in whom the systemic pathology was also known. Seventy of the 78 HIV-seropositive children were confirmed as HIV-infected, as determined by combined serology, IgA Western blots and clinicopathological criteria. The HIV-negative children showed a high background level (n = 49, 64%) of neuropathological abnormalities, including nonspecific inflammatory infiltrates, micromineralization, and bacterial and lymphocytic meningitis. In the HIV-positive children, HIV encephalitis was found in 4 (6%), cytomegalovirus in 2 (3%), toxoplasmosis in 3 (4%) and measles encephalitis in one (1%). Bacterial meningitis was equally common in both groups, but cerebral malaria was less common (n = 2, 3%) in HIV-positive than in HIV-negative children (n = 11, 14%). The low prevalence of HIV encephalitis may reflect comparatively early death in HIV infection in Africa as compared with our experience in Europe and the US.