Age-dependent neurologic manifestations of HIV infection in childhood

Although the neurologic complications of HIV-1 infection during the first t wo years of life have been defined, the neurologic features in older childr en are not so well described. The present report is focused on the age-depe ndent neurologic presentation of HIV-1 infection. Sixty-two vertically HIV- 1 infected children underwent detailed serial evaluations: neurologic asses sment, neuropsychological tests, neuroimaging studies, and cerebrospinal fl uid analysis. Neurologic involvement was found in 30 patients (48.3%). This population was divided into two groups, exhibiting progressive (83.3%) or nonprogressive (16.6%)neurologic signs and symptoms. In the first group of patients, progressive encephalopathy was distinguished from spastic parapar esis, possibly due to spinal cord involvement. The second group, represente d by long-term survivors, requires clinical monitoring due to the possible prognostic value of acquired but presently nonprogressive signs of brain in volvement. In contrast with the stereotyped features of the early form of p rogressive encephalopathy, the late form showed a poly morphic picture, wit h age-dependent neurologic manifestations. Multifocal white matter alterati ons and cerebral calcifications (sometimes with delayed onset and progressi on) were the prominent imaging findings. A correlation between cerebrospina l fluid HIV RNA levels, suggestive of viral replication within the central nervous system, and progressive neurological disease were also found.