ENCEPHALOPATHY AND PROGRESSION OF HUMAN-IMMUNODEFICIENCY-VIRUS DISEASE IN A COHORT OF CHILDREN WITH PERINATALLY ACQUIRED HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Objective: To describe the incidence, predictors, and survival of chil dren with human immunodeficiency virus (HIV) encephalopathy followed i n the Women and Infants Transmission Study cohort. Study design: Retro spective review of clinical and immunologic staging of perinatally HIV -infected infants, based on the 1994 Centers for Disease Control and P revention Classification System. Results: Data were available for 128 HIV-infected children, with a median follow-up of 24 months. HIV encep halopathy was diagnosed in 27 (21%) of children. Median survival after diagnosis was 14 months. Of children with encephalopathy, 74% had at least moderate immunosuppression by the time of diagnosis. Encephalopa thy represented the first acquired immunodeficiency syndrome-defining condition in 67%, and the only one in 26% of children. Hepatosplenomeg aly or lymphadenopathy during the first 3 months of life was diagnosed in 63%, in contrast to 29% of those without encephalopathy (p value = 0.001). Cardiomyopathy was present in 30% of the children with enceph alopathy versus 2% of those without encephalopathy. High viral load in infancy was associated with increased risk of encephalopathy but was not predictive of age at onset. Conclusions: Encephalopathy in childre n with HIV is common and is associated with high viral load, immunodef iciency, and shortened survival. Encephalopathy was more likely to dev elop in infants with early signs and symptoms of HIV, although age at onset could not be predicted.