HIV in Children

HIV AND NEUROLOGICAL MANIFESTATIONS

Dr. Ira Shah
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Last Updated : 1st September 2012
HIV-1 is known to have a strong tropism for the neurological tissues right from the initial stages of infection. The CNS microglial cells form one of the early and most important reservoirs for the virus, where it lies dormant until activated. With early immunodeficiency there is a polyclonal hypergammaglobulinemia resulting in number demyelinating and inflammatory disorders. With advanced immunosuppression the direct toxic effects of the virus come into play, predominantly due to excessive and inappropriate elaboration of cytokines.

Neurological complications occur from HIV itself, opportunistic infections, tumors or drug related complications. HIV enters the central nervous system (CNS) via microglial cells, the monocytes of the CNS, during the high-level viremia of primary infection. As a result a neurotoxic process is set in train, leading over time to cell death with loss of both white and grey matter. Vasculitis due to inflammatory changes in brain endothelium can result in endothelial calcification.

HIV encephalopathy


Up to 10% of infants presenting with HIV have severe developmental delay and encephalopathy.

HIV encephalopathy can be static or progressive. The subtle neurological manifestations include spasticity, hyperreflexia, and abnormal plantar reflex suggestive of pyramidal tract involvement. Common symptomatic manifestation include delayed developmental milestones in static type of encephalopathy and loss of achieved motor, fine motor and language milestones in progressive type of encephalopathy. Imaging of the CNS in infancy often demonstrates calcific-vasculopathy of the basal ganglia, and generalized atrophy is a later finding. Effective treatment of the HIV infection, although it may prevent further deterioration, cannot restore permanently damaged CNS tissue. With the advent of HAART, the prevalence of progressive encephalopathy is reduced.

HIV AND NEUROLOGICAL MANIFESTATIONS
Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.