Neurodevelopmental delay in pediatric HIV/AIDS: current perspectives

Charlotte Blokhuis,1 Neeltje A Kootstra,2 Matthan WA Caan,3 Dasja Pajkrt1 1Department of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital, 2Department of Experimental Immunology, 3Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands Abstract: The effects of HIV on the developing nervous system of perinatally HIV (PHIV)-infected children are substantial, yet poorly understood. While the introduction of combination antiretroviral therapy (cART) reduced the prevalence of HIV encephalopathy, many cART-treated PHIV-infected children still present with neurodevelopmental delays and cognitive impairment. The underlying pathogenesis may partially differ from that in adults, as HIV not only causes direct injury to the central nervous system (CNS) but may also impede the development of the pediatric brain. Increasing evidence implies significant roles for ongoing neuroinflammation, vascular dysfunction and hypercoagulability induced by HIV despite adequate viral suppression. Subsequent manifestations of HIV in the pediatric brain include gray-matter volume reduction, white-matter lesions, and basal ganglia calcifications, but even in the absence of such macrostructural changes, the detrimental effects of HIV are clearly revealed in widespread microstructural changes, such as poorer white-matter integrity and alterations in cerebral metabolites and blood flow. Viral suppression on cART evidently does not fully protect agains...
Source: Neurobehavioral HIV Medicine - Category: Psychiatry Tags: Neurobehavioral HIV Medicine Source Type: research