Full text loading...
Chapter 32 : Pediatric Neuro-AIDS
Category: Viruses and Viral Pathogenesis
Ebook: Choose a downloadable PDF or ePub file. Chapter is a downloadable PDF file. File must be downloaded within 48 hours of purchase
This chapter reviews the clinical, neuroimaging, and neuropathological features of pediatric neuro-AIDS (prior to the use of antiretroviral (ARV) agents) and the changing neuroepidemiology in the highly active ARV therapy (HAART) era. Salient features of pediatric HIV/AIDS and its epidemiology are briefly summarized, since there are major differences between adult and pediatric HIV/AIDS, and neurological aspects need to be viewed in the context of this complex and progressive illness for which the epidemiology is diverse and changing, as are treatment protocols and their availabilities. Among adolescents, intravenous drug use and sexual exposure are the most common risk factors for acquiring HIV-1 infection. Some children develop progressive and disabling motor deficits yet maintain relatively stable (albeit impaired) cognitive and adaptive social skills, whereas others have more impaired cognitive than motor function. Some children can also have relatively stable minor motor and cognitive findings. Host genetic factors are relevant as well (e.g., CCR5 and CXCR4 polymorphisms, virus-host interactions affecting genes and gene products, and as-yet-undefined virus-host interactions). Secondary central nervous system (CNS) complications should be considered in the differential diagnosis of the HIV-1-infected child who presents with new onset of mental status changes, headache, seizures, or focal neurological deficits. The most effective way to prevent pediatric HIV-1-associated neurological syndromes is to prevent vertically acquired HIV-1 infection. Clearly the most effective strategy to achieve this goal is to prevent HIV-1 infection in all women of childbearing age.