ABSTRACT
The neuroradiological studies (CT, MRI, angiography) in 21 children with perinatal HIV infection were reviewed retrospectively. No patient showed an intracranial mass lesion; after intravenous contrast medium application there was no case with disturbed blood-brain barrier. Common non-specific findings were atrophy and delayed myelination. In 7 cases atrophy was combined with multifocal nearly symmetric white matter lesions, which characteristically spared the U-fibres. Further findings included an intramedullary ring-shaped structure in the cervical cord, an AIDS-associated vasculopathy and symmetric calcifications in the basal ganglia. The spectrum of neuroradiological findings in paediatric AIDS patients differs from that in adults. Knowledge of these age-specific findings is important because the number of HIV-infected children is rising.
Subject(s)
Central Nervous System/diagnostic imaging , HIV Infections/diagnostic imaging , Age Factors , Atrophy , Basal Ganglia/pathology , Brain/pathology , Cerebral Angiography , Child , Child, Preschool , Female , HIV Infections/diagnosis , Humans , Infant , Magnetic Resonance Imaging , Male , Retrospective Studies , Spinal Cord/pathology , Tomography, X-Ray ComputedABSTRACT
Treatment of secondary infections in HIV infected children represents a problem of increasing importance in several children's hospitals. As it is unlikely that the AIDS-problem will be solved by itself within the next years it seems reasonable to summarize our current knowledge about opportunistic infections in order to establish standards for therapy. We will mainly focus on microorganisms endemic in Germany.
Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Anti-Infective Agents/therapeutic use , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/mortality , Anti-Infective Agents/adverse effects , Cause of Death , Child , Humans , Retrospective Studies , Survival RateABSTRACT
AIM OF THE STUDY: In most cases (about 80%) the HIV-infection of children is acquired during pregnancy or birth. Therefore peculiarities for diagnostic procedures and in the natural course of the disease can be expected if compared to AIDS acquired at adult age. Further interesting questions are the frequency of the (vertical) transmission from the infected mother to the child, the influence of mother- and/or child-related factors as well as the method of delivery on this transmission frequency. METHODS: In order to answer these questions the children of HIV-infected mothers since April 1, 1988 have been examined virologically, immunologically and clinically since birth by 6 study centers according to a standard protocol. The pregnancy data of the mothers have been documented, according to uniform criteria. Pre- or perinatally infected children not known to be antibody-positive at birth have been separately analysed. RESULTS: The frequency of pre/perinatal transmission from the mother to the child is 15.3%, the elective caesarean section seems to lower the transmission rate. Mother and/or infant related cofactors of the transmission could not be defined. In comparison to the control groups of the intrauterine HIV-exposed but not infected children, at birth the HIV-infected children were clinically and immunologically not ill. During their first months some of the infected children had a significant increase of serum IgG. Oral candidiasis, chronic recurrent diarrhoea and bacterial infections are indicator symptoms of beginning HIV-disease. The Minimum-AIDS-Prevalence in the child's first year is 24%. The relatively late AIDS manifestation (3.7 years) and the average value of 28 months of survival in retrospective observed children were a remarkable result. CONCLUSION: In general, the course of an HIV-infection in children of HIV-positive women in Germany seems to be comparable to results in other countries. The frequency of transmission from mother to child is relatively low (15.3%) and is an important result for maternity care. The caesarean section should be considered. The course of pregnancy must be examined more subtly in order to find out the still unclear causes of transmission. The Minimum-AIDS-Prevalence of 24% and the frequency of HIV-related signs and symptoms of 29% in the child's first year make it necessary to observe these children rather closely during this time.
