CNS AFFECTION IN PERINATALLY HIV-INFECTED CHILDREN

In 34 perinatally HIV infected children time of manifestation, type an d treatability of neurologic disorders were investigated for a period of 7 years (1987-1994). Neurological investigations were done every 6 months; EEG and MRI/CT were examined initially in the asymptomatic sta ge and were repeated when neurologic Symptoms occured. Zidovudine ther apy was started after onset of symptoms, dosage was raised, when treat ment with Zidovudine had already begun (600-720 mg/m(2)/day). Various neurological manifestations were seen in 4 of 12 patients in stage B ( 33%) and in 11 of 14 children in AIDS (80%). 7 of the 14 AIDS-patients (50%) developed a subacute progressive course or progressive plateau course and 4 of 14 (30%) a static course of encephalopathy. Pathologic al changes in EEG were seen in 54% of investigated patients with neuro logical deficits. Neuroimaging revealed pathological findings in all s ymptomatic subjects, 6 of 11 patients in AIDS (55%) had a severe gener al cerebral atrophy and multifocal white matter lesions. Zidovudine ha d a positive temporary effect from 6 to 12 months in 5 of 11 treated p atients (45%). At present a thorough neurological examination is the m ost sensitive method to detect neurological impairment in HIV infected children. In most cases CT/MRI scan provides information about the co urse of the encephalopathy. Antiretroviral therapy has a limited benef it, if neurologic symptoms start after the second year of life.