Neurologic Status of Human Immunodeficiency Virus 1-Infected Infants and Their Controls: A Prospective Study From Birth to 2 Years
1 The Department of Neurology, State University of New York Health Sciences center at Stony Brook
2 Westat, Inc, Rockville, Maryland
3 Department of Neurology, State University of New York Health Sciences center at Brooklyn
4 Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
5 Internal Medicine, State University of New York Health Sciences center at Brooklyn
6 Department of Allergy and Immunology, Albert Einstein College of Medicine, Bronx, New York
7 Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children, National Institute of Child Health and Human Development, Rockville, Maryland.
Objective. To determine the timing, extent, severity, and persistence of neurologic abnormalities in children with perinatally acquired human immunodeficiency virus 1 (HIV-1) infection compared with similar uninfected children of HIV-1-infected women and control children.
Methods. Serial neurologic examinations and head circumference measurements were performed on a cohort of HIV-1-infected children born to HIV-1-infected women, seroreverting children born to HIV-1-infected women, and control children born to uninfected women. Examination data from 32 HIV-1-infected children, 99 reverters, and 116 control children were summarized by eight neurologic domains. Data were analyzed by longitudinal 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 neurologic problems than the control and reverter children for seven of the eight domains. The HIV-1-infected children were further classified by whether they had acquired immunodeficiency syndrome (AIDS)-defining clinical conditions (other than lymphoid interstitial pneumonitis) in the first 24 months of life (the AIDS-opportunistic infection group) or did 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 measurements below the 10th percentile. The infected-other group had no statistically significant differences from the uninfected children, although individual children in the infected-other group had some abnormalities.
Conclusions. In utero exposure to HIV-1 without infection seems to have no negative impact on neurologic function in children in the first 2 years of life. Among children with perinatally acquired HIV-1 infection, 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 period.
Key Words: pediatric acquired immunodeficiency syndrome and human immunodeficiency virus • central nervous system • human immunodeficiency virus and acquired immunodeficiency syndrome encephalopathy • human immunodeficiency virus 1-associated central nervous system disease
Submitted on July 12, 1995
Accepted on January 6, 1996
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