ABSTRACT
OBJECTIVE: To find out whether HIV-associated subclinical psychomotor slowing is present in HIV-infected children despite effective highly active antiretroviral therapy (HAART). PATIENTS AND METHODS: An electrophysiological motor test battery shown to sensitively describe HIV-associated CNS disease in adults (tremor peak frequency []TPF], most rapid alternating movements [MRAM], reaction time [RT] and contraction time [CT]) was performed in 17 HIV seropositive (+) right-handed children. Results were compared to 16 HIV seronegative (-) children. RESULTS: HIV (-) children showed slower frequencies (TPF, MRAM) and longer RT and CT than (-) adults. They showed a significant correlation (p = 0.0263) between RT (right = dominant hand) and age. HIV (+) children showed significant prolongations of RT (right hand) and CT (both hands) compared to HIV (-) children. RT right hand did not accelerate with age in HIV (+) children. CT were significantly prolonged in 10 children with detectable HIV plasma viral burden and normal in 7 children with no detectable HIV plasma viral load. There was no correlation between CT and CD 4 cell counts. CONCLUSIONS: Despite effective HAART, electrophysiological motor testing in HIV (+) children reveals significant subclinical CNS dysfunction, especially in children with insufficient viral load suppression.
Subject(s)
Antiretroviral Therapy, Highly Active , HIV Infections/complications , HIV Infections/drug therapy , Motor Skills Disorders/etiology , Psychomotor Disorders/etiology , Adolescent , Age Factors , Child , Female , HIV Infections/physiopathology , Humans , Male , Motor Skills Disorders/physiopathology , Muscle Contraction/physiology , Psychomotor Disorders/physiopathology , Reaction Time/physiology , Risk Factors , Severity of Illness Index , Viral LoadABSTRACT
Despite the undisputable therapeutic success of highly active antiretroviral therapy (HAART), neurological complications of HIV-infection are still an unresolved problem. Most important are the directly HIV-associated complications, which comprise HIV-associated encephalopathy, myelopathy as well as peripheral neuropathies and muscle diseases. Among the nowadays relevant opportunistic infections are toxoplasma encephalitis and JC-virus related progressive multifocal leukencephalopathy, finally neurological complications are provoked by so called immune reconstitution phenomena. This reviews' aim is to provide a diagnostic manual leading to appropriate therapy by effective diagnostic procedures.
Subject(s)
AIDS Dementia Complex/diagnosis , AIDS Dementia Complex/drug therapy , AIDS-Related Opportunistic Infections/diagnosis , Acquired Immunodeficiency Syndrome/diagnosis , Antiretroviral Therapy, Highly Active , Peripheral Nervous System Diseases/diagnosis , Spinal Cord Diseases/diagnosis , Toxoplasmosis, Cerebral/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Acquired Immunodeficiency Syndrome/drug therapy , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Peripheral Nervous System Diseases/drug therapy , Spinal Cord Diseases/drug therapy , Toxoplasmosis, Cerebral/drug therapyABSTRACT
Psychiatric disease is a frequent complication of HIV-infection. Schizophrenic psychosis, major depression, affective disorders, phobia and drug addiction occur among others. Furthermore, highly active antiretroviral therapy (HAART) can provoke psychiatric illness in HIV-infected patients. Intrapersonnel and psychosocial factors of this systemic manifestation are described, additionally, diagnostic and therapeutic problems are presented in detail.
