Introduction
Neurodevelopmental abnormalities have been a well-known and frequent complication of pediatric HIV infection, causing significant morbidity and mortality [1]. However, significant progress has been made in the treatment of pediatric HIV disease, changing the prevalence and natural history of neurological complications.
Central nervous system (CNS) manifestations of HIV disease can be subdivided into two main groups: (a) those indirectly related to the effects of HIV on the brain, such as CNS opportunistic infections (OIs), malignancies, and cerebrovascular disease, and (b) those directly related to HIV brain infection.
Peripheral nervous system (PNS) abnormalities occur relatively frequently in adult HIV-infected patients and are usually related to antiretroviral therapy, HIV disease, or OIs [2]. Although much less common in infants and children, neuropathies and myopathies occur, with similar etiologies [3].
Secondary CNS disorders
Opportunistic infections of the CNS
Children with HIV disease have fewer problems with CNS OIs compared with adults, probably because OIs represent reactivation of previous, relatively asymptomatic infections. CNS OIs can present significant problems in children; their incidence may increase because children with HIV disease are living longer. Generally, OIs are seen in patients with severe immunocompromise (age-corrected CD4+ lymphocyte counts less than 200 cells/μl), and in infants and younger children due to congenital infection.
The most common CNS OI in chlidren is cytomegalovirus (CMV) infection, which may present as a subacute or chronic encephalitis/ventriculitis, an acute ascending radiculomyelitis, or as an acute or subacute neuritis [4, 5] (see also Chapter 34).