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10 - Neurobehavioral function and assessment of children and adolescents with HIV infection

Published online by Cambridge University Press:  23 December 2009

By
Pamela L. Wolters  and
Pim Brouwers
Edited by
Steven L. Zeichner  and
Jennifer S. Read
Pamela L. Wolters
Affiliation:
HIV and AIDS Malignancy Branch, National Cancer Institute and Medical Illness Counseling Center, Bethesda, MD Texas Children's Cancer & Sickle Cell Centers and Baylor College of Medicine, Houston, TX
Pim Brouwers
Affiliation:
HIV and AIDS Malignancy Branch, National Cancer Institute and Medical Illness Counseling Center, Bethesda, MD Texas Children's Cancer & Sickle Cell Centers and Baylor College of Medicine, Houston, TX
Steven L. Zeichner
Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read
Affiliation:
National Institutes of Health, Bethesda, Maryland
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Summary

Children infected with human immunodeficiency virus-type 1 (HIV-1) are at increased risk for central nervous system (CNS) disease characterized by cognitive, language, motor, and behavioral impairments. The severity of HIV-related CNS manifestations in children ranges from subtle impairments in selective domains to severe deterioration of global developmental skills.

HIV-related CNS dysfunction in children is primarily the result of HIV-1 infection in the brain [1, 2]. Various host or viral neurotoxic factors are postulated as the main cause of neurologic damage as neurons seem to remain largely uninfected [1, 3]. Secondary CNS complications due to immune deficiency, such as brain tumors, other infections, or cerebrovascular diseases, also may cause CNS manifestations but are less common and usually occur in older children [4].

Early in the epidemic, approximately 50% to 90% of children with HIV-1 infection exhibited severe CNS manifestations [5, 6] termed HIV encephalopathy. More recent studies, however, report that the prevalence of encephalopathy in HIV-infected children is approximately 13% to 23% percent [7–10]. This decline in the prevalence of severe HIV-related CNS manifestations may be related in part to the earlier and more generalized use of combination antiretroviral treatment (ART), including highly active antiretroviral therapy (HAART) [11–14]. HAART is effective in suppressing systemic viral replication [15], which in turn may reduce the number of HIV-infected cells entering the CNS. However, the CNS is a separate compartment from the rest of the body and it may serve as a reservoir for persistent HIV-1 infection [16].

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Handbook of Pediatric HIV Care , pp. 309 - 332
Publisher: Cambridge University Press
Print publication year: 2006

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