Neurologic problems

doi:10.1017/CBO9780511544798.029

26 - Neurologic problems

from Part IV - Clinical manifestations of HIV infection in children

Published online by Cambridge University Press: 03 February 2010

Lucy Civitello

Edited by

Steven L. Zeichner and

Jennifer S. Read

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Lucy Civitello: Affiliation:
Department of Neurology, Children's National Medical Center, Washington, DC, National Institutes of Health, Bethesda, MD
Steven L. Zeichner: Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read: Affiliation:
National Cancer Institute, Bethesda, Maryland

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Summary

Introduction

Since the first descriptions of pediatric AIDS in the 1980s, neurodevelopmental abnormalities have been a well-known complication of HIV disease in children, causing significant morbidity and mortality [1–3]. Over the last decade, significant progress has been made in the early diagnosis and treatment of the HIV-infected infant and child. As a result, the prevalence and natural history of neurological illnesses in these patients have changed, with improvement in neurologic outcome in many cases.

The central nervous system (CNS) manifestations of HIV disease can be subdivided into two main groups: (1) those indirectly related to the effects of HIV disease on the brain, such as CNS opportunistic infections (OIs), malignancies, and cerebrovascular disease; and (2) those directly attributable 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 [4–7]. Although much less common in infants and children, neuropathies and myopathies do occur, with similar etiologies [8, 9].

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. Nevertheless, CNS OIs can present significant problems in children, and their incidence may increase because children with HIV disease are living longer. Generally, OIs are seen in patients with severe immunosuppression (CD4+ lymphocyte counts less than 200 cells/μ), and in older children and adolescents.

Type: Chapter
Information: Textbook of Pediatric HIV Care , pp. 431 - 444

DOI: https://doi.org/10.1017/CBO9780511544798.029 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2005

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26 - Neurologic problems

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