PEDIATRICS Vol. 78 No. 4 October 1986, pp. 678-687
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Neurologic Manifestations of Human Immunodeficiency Virus Infection in Children

Leon G. Epstein MD1, Leroy R. Sharer MD1, James M. Oleske MD1, Edward M. Connor MD1, Jaap Goudsmit MD, PhD1, Leta Bagdon MD1, Marjorie Robert-Guroff PhD1, and M. Richard Koenigsberger MD1

1 From the Departments of Neuroscience, Pediatrics, and Pathology, University of Medicine and Dentistry—New Jersey Medical School, Newark; Department of Pediatrics, Children's Hospital of New Jersey, Newark; Virology Department, Academic Medical Center, University of Amsterdam, Amsterdam; and Laboratory of Tumor Cell Biology, National Cancer Institute, Bethesda, Maryland

This report describes the neurologic manifestations of 36 children with human immunodeficiency virus (HIV) infection. In this cohort, in 16 of 21 children with acquired immunodeficiency syndrome (AIDS), three of 12 children with AIDS-related complex, and one of three asymptomatic seropositive children, a progressive encephalopathy developed. Neurologic signs were often detected early but tended to worsen coincident with progression of the immunodeficiency. The presence of progressive encephalopathy correlated with the absence of serum neutralizing antibodies to HIV and with a poor, usually fatal, outcome. The incubation period from initial HIV infection in the perinatal period to the onset of progressive encephalopathy varied from 2 months to 5 years. Intrablood-brain barrier synthesis of HIV-specific antibodies was demonstrated in eight of 14 children with AIDS and AIDS-related complex, indicating active brain infection with HIV. In three cases this was unassociated with progressive neurologic signs. Unique neuropathologic findings in children who died with HIV infection further suggest that the progressive encephalopathy is the result of primary and persistent infection of the brain with this retrovirus. These findings broaden the spectrum of HIV infection in children and have important implications for the development of antiviral therapy.

Key Words: acquired immunodeficiency syndrome (AIDS) • human immunodeficiency virus • encephalopathy

Submitted on March 27, 1986
Accepted on May 23, 1986




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