NEUROLOGIC STATUS OF HUMAN-IMMUNODEFICIENCY-VIRUS 1-INFECTED INFANTS AND THEIR CONTROLS - A PROSPECTIVE-STUDY FROM BIRTH TO 2 YEARS

Objective. To determine the timing, extent, severity, and persistence of neurologic abnormalities in children with perinatally acquired huma n immunodeficiency virus 1 (HIV-1) infection compared with similar uni nfected children of HIV-I-infected women and control children; Methods . Serial neurologic examinations and head circumference measurements w ere performed on a cohort of HIV-I-infected children horn to HIV-l-inf ected women, seroreverting children born to HIV-I-infected women, and control children born to uninfected women. Examination data from 32 HI V-1-infected children, 99 reverters, and 116 control children were sum marized by eight neurologic domains. Data were analyzed by longitudina l analysis. Results. Reverter children were not different from control children in neurologic function for any of the eight domains or head circumference. HIV-1-infected children had significantly more neurolog ic problems than the control and reverter children for seven of the ei ght domains. The HIV-l-infected children were further classified by wh ether they had acquired immunodeficiency syndrome (AIDS)-defining clin ical conditions (other than lymphoid interstitial pneumonitis) in the first 24 months of life (the AIDS-opportunistic infection group) or di d not (the infected-other group). Neurologic abnormalities were early, severe, pervasive, and persistent in the AIDS-opportunistic infection group, and nearly all in this group had head circumference measuremen ts below the 10th percentile. The infected-other group had no statisti cally significant differences from the uninfected children, although i ndividual children in the infected-other group had some abnormalities. Conclusions. In utero exposure to HIV-1 without infection seems to ha ve no negative impact on neurologic function in children in the first 2 years of life. Among children with perinatally acquired HIV-I infect ion, the most severe and pervasive neurologic problems occur in those children who have early serious HIV-1 clinical disease. Most children without serious AIDS-defining clinical conditions in the first 2 years of life are also free from serious neurologic problems during that pe riod.