Neorological abnormalities and their association with immunological status in HIV-infected children: 20 years of experience

Abstract

Introduction. The neurological manifestations observed in human immunodeficiency virus (HIV)-infected patients are directly related to the activity of the virus on the central nervous system (CNS) or to the development of opportunistic infections as a result of immunosuppression.
Objective. To describe the prevalence and type of neurological manifestations and the association with the immunological and virological status in a pediatric population infected with HIV.
Materials and methods. Medical records of HIV-positive children followed at Dr. Pedro de Elizalde Children’s Hospital, Buenos Aires, Argentina, during the last 20 years were analyzed. CD4 + T- lymphocyte levels and HIV viral load at the time of appearance of neurological manifestations were evaluated.
Results. A total of 487 medical records were analyzed. Nineteen (3.9 %) of the patients had neurological abnormalities, twelve (63 %) developed HIV encephalopathy, and three (15.8 %) presented Cryptococcus neoformans infection. In five patients, the appearance of neurological signs was the first clinical finding that led to the suspicion of HIV infection. At the time of neurological manifestation, seventeen children (89 %) had moderate or severe immunosuppression, according to the Pediatric Classification of Center for Disease Control and Prevention. The common characteristic in all patients who presented different types of neurological manifestations was the lack of appropriate adherence to antiretroviral treatment.
Conclusion. The neurological disorder with the highest prevalence in the pediatric population studied was HIV encephalopathy. Its presence, together with other entities with different degrees of CNS involvement, would be associated with CD4 + T cell depletion and deficient