NEUROBEHAVIORAL MANIFESTATIONS OF SYMPTOMATIC HIV-1 DISEASE IN CHILDREN - CAN NUTRITIONAL FACTORS PLAY A ROLE

Central nervous system (CNS) abnormalities are significant and frequen t complications of human immunodeficiency virus (HIV-1) infection in i nfants and children. Although the predominant cause of neurological an d neuropsychological abnormalities appears to be related to HIV infect ion of the CNS, other factors including malnutrition may also play a r ole. We retrospectively evaluated the association of change in body we ight with changes in neurocognitive function, ventricular brain ratio, and cerebrospinal quinolinic acid levels in a small cohort of childre n (n = 15; mean age 6.3 years) with symptomatic HIV-1 disease before a nd after 6 months of antiretroviral therapy with continuous intravenou s infusion of zidovudine (ZVD). Significant increases in weight and ne urocognitive function as well as decreases in ventricular brain ratio and cerebrospinal quinolinic acid levels were noted after therapy. Onl y the relation between increase in weight and decrease in ventricular brain ratio was statistically significant (P < .01); contrary to expec tations, an increase in weight seemed to correlate with a decrease in neurocognitive function (NS). Another group of children treated at the same time with oral intermittent ZVD, but otherwise receiving the sam e care did not show the same magnitude of improvement in neurocognitiv e function. These results seem to suggest that general supportive and medical care as well as nutritional factors may only play a limited ro le in the neurocognitive improvements after antiretroviral therapy wit h continuous infusion ZVD. Our sample size was, however, small and the nutritional measure rather global; thus these findings have to be con sidered as very preliminary.