Acquired immune deficiency syndrome presenting as progressive infantile encephalopathy

Diagnostic imaging in pediatric AIDS

The manifestations of acquired immune deficiency syndrome (AIDS) in children are mainly secondary to opportunistic infection, lymphoproliferative diseases, and AIDS-related neoplasms. This article reviews the pathologic findings of various disorders afflicting children with AIDS and emphasizes the imaging of these disorders. Although many of the radiologic findings are not specific for a particular infection or neoplasm, the differential diagnostic possibilities for an abnormality can be narrowed down significantly with proper clinical correlation and knowledge of the imaging findings and pathologies specific to children with AIDS.

Vertical human immunodeficiency virus-1 infection: involvement of the central nervous system and treatment

Involvement of the central nervous system (CNS) contributes substantially to morbidity and mortality of vertical infection with the human immunodeficiency virus (HIV)-1. The clinical spectrum ranges from minor developmental disabilities to severe and progressive encephalopathy. Progression of the disease varies considerably. Both direct viral and indirect host-related pathogenic mechanisms have been proposed. The diagnosis depends on neurological and neurodevelopmental assessments. So far, HIV-1-specific antiviral treatment has shown limited effects on neurological manifestations in symptomatic children. Thus, efforts are needed to improve prevention and treatment of CNS involvement. It is still unclear whether early use of antiretroviral agents is of benefit.

CONCLUSION

Since experience of treatment of HIV-1 infections in adults cannot easily be translated to children, paediatric clinical trials are needed to answer questions specific to the unique characteristics of children.

Pediatric HIV infection: an imaging update

Infection with the human immunodeficiency virus (HIV) can produce a broad range of illness, including opportunistic infections, lymphoproliferative diseases, and benign and malignant neoplasms. Each conditions has its own spectrum of imaging findings. This paper will highlight those findings in children suffering from HIV infection/AIDS. We will stress the findings in the more frequently involved organ systems and those that are unique to children.

Human immunodeficiency virus type 1 infection of the brain

Direct infection of the central nervous system by human immunodeficiency virus type 1 (HIV-1), the causative agent of AIDS, was not appreciated in the early years of the AIDS epidemic. Neurological complications associated with AIDS were largely attributed to opportunistic infections that arose as a result of the immunocompromised state of the patient and to depression. In 1985, several groups succeeded in isolating HIV-1 directly from brain tissue. Also that year, the viral genome was completely sequenced, and HIV-1 was found to belong to a neurotropic subfamily of retrovirus known as the Lentivirinae. These findings clearly indicated that direct HIV-1 infection of the central nervous system played a role in the development of AIDS-related neurological disease. This review summarizes the clinical manifestations of HIV-1 infection of the central nervous system and the related neuropathology, the tropism of HIV-1 for specific cell types both within and outside of the nervous system, the possible mechanisms by which HIV-1 damages the nervous system, and the current strategies for diagnosis and treatment of HIV-1-associated neuropathology.

Neuropsychologic functioning of human immunodeficiency virus-infected children with hemophilia

Efforts to detect subtle but objective neuropsychologic deficits could clarify the early involvement of the central nervous system and the progression of human immunodeficiency virus (HIV) infection in older children and young adolescents. Baseline examinations of 63 children and adolescents with hemophilia were conducted by examiners unaware of HIV status or staging or of our study's major hypotheses. They measured six domains of neuropsychologic functioning (motor, language, memory, attention, visual processing, and problem solving), and no differences between groups of similar age, race, and socioeconomic status defined by HIV seropositivity (n = 25) and HIV seronegativity (n = 38) were revealed. A high incidence of subtle neuropsychologic deficits relative to (1) age norms and (2) individual cognitive potential was found on measures of motor performance, attention, and speeded visual processing within both infected and uninfected groups. On the basis of these baseline data, it seems premature to attribute early, subtle neuropsychologic deficits in seropositive children with hemophilia to the central nervous system effects of HIV infection.

Imaging of the central nervous system in pediatrics and adolescence

Magnetic resonance imaging (MRI) has taken its place beside computed tomography (CT) and ultrasonography in effective imaging of the central nervous system in infants and children. The major initial impact of MRI in pediatric neuroradiology has been the displacement or replacement of the more expensive and invasive procedures such as angiography, myelography, cisternography, and ventriculography. Ultrasonography remains the screening procedure for fetal and infant central nervous system abnormalities, whereas CT continues to be an effective brain screening technique after loss of the ultrasonography windows with growth of the child. The better the clinical information transmitted to the radiologist in advance of imaging of the patient, the more likely the clinician will receive valuable information in return.

Acquired immune deficiency syndrome in childhood. Neurological aspects

Central nervous system (CNS) involvement is very frequently observed in pediatric AIDS. Clinical manifestations include encephalopathy, cognitive deficits, acquired microcephaly, neurological signs, myelopathy, and peripheral neuropathy. Neurological complications can be related to opportunistic viral infections such as encephalitis, atypical aseptic meningitis, progressive multifocal leukoencephalopathy, and myelitis. Nonviral syndromes include: toxoplasmosis, cryptococcal meningitis, candidiasis, Mycobacterium tuberculosis meningitis, and Mycobacterium avium subacute encephalitis. Bacterial infections, tumors, cerebrovascular complications, and peripheral neuropathies are not frequently observed in pediatric AIDS. The most severe complications of HIV infection is encephalopathy resulting from HIV infection of brain tissue. Direct HIV invasion of the CNS has been demonstrated. Clinical features of HIV encephalopathy are classified into three categories: (1) normal neurological findings; (2) static encephalopathy; and (3) progressive encephalopathy. AIDS dementia complex can be differentiated from the predominance of behavioral and cognitive disabilities.

AIDS in infancy: diagnostic, therapeutic, and ethical problems

Congenital AIDS is on the rise and will pose multiple problems to society and to health care workers in particular, as more infants develop the disorder. Differentiation of AIDS from infantile grief reactions is of critical importance, as infants at risk for AIDS lose their mothers who have AIDS. Team approaches are optimal and should include psychiatric perspectives. Issues of diagnosis, maladaptive psychological reactions and ethical dilemmas are discussed and illustrated in a case history.