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19 - Neurologic problems

Published online by Cambridge University Press:  23 December 2009

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

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).

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Handbook of Pediatric HIV Care , pp. 503 - 519
Publisher: Cambridge University Press
Print publication year: 2006

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  • Neurologic problems
    • By Lucy Civitello, Department of Neurology, Children's National Medical Center, Washington, DC and National Institutes of Health, Bethesda, MD
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.021
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Neurologic problems
    • By Lucy Civitello, Department of Neurology, Children's National Medical Center, Washington, DC and National Institutes of Health, Bethesda, MD
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.021
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Neurologic problems
    • By Lucy Civitello, Department of Neurology, Children's National Medical Center, Washington, DC and National Institutes of Health, Bethesda, MD
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.021
Available formats
×