EVALUATION OF THE ROLE OF ROUTINE SERIAL CRANIAL COMPUTED-TOMOGRAPHY IN THE MANAGEMENT OF CHILDREN WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Objective: To review the impact of routine followup cranial computed t omography (CT) scans on the management of children with human immunode ficiency virus (HIV) infection. Design: Longitudinal data collected fr om 58 HIV-infected children followed in one center for mean of 3.8 +/- 1.8 years. Setting: HIV/AIDS pediatric program following over 90% of the identified HIV-infected children in one region in Canada. Results: The baseline CT scans showed intracranial abnormalities in 35 of 58 c hildren (60%). In five children with basal ganglia calcifications (BGC ) without cerebral atrophy, there has not been progressive encephalopa thy. For the 43 children who had serial CT scans for routine follow-up , 34 (79%) had changes in the scans that were concordant with the clin ical assessment. In all but five children with progressive ventricular and sulcal dilatation on CT scan, there was simultaneous clinical evi dence of encephalopathy. Those five children were already on antiretro viral therapy, and therapy was not changed in response to the CT scan findings. Conclusion: Baseline CT scans provide useful diagnostic and prognostic information. Further research is needed to evaluate the rol e of cranial CT imaging in the management of pediatric HIV encephalopa thy.