Antiretroviral Therapy in HIV-Infected Children Can Stop Neurological Damage

Treating HIV-infected children with antiretroviral therapy can stop and potentially even reverse neurological damage caused by the virus, doctors from the University of Texas Southwestern Medical Center report in Journal of Pediatrics (2002;141(1);36-44). Neurological symptoms are often one of the first signs HIV has progressed to AIDS in children.

Senior author Dr. Octavio Ramilo, an associate professor of pediatrics at UTS, and colleagues write that children with HIV often fail to reach developmental milestones, show impaired brain growth, and have trouble with fine motor skills even before other signs of developing AIDS are manifested. When treated with antiretroviral therapy targeting the central nervous system, however, children showed neurological improvement. In adult patients, HIV attacks the brain late in the course of the illness. "Kids don't have a developed immune system like adults, so the virus is able to spread much, much faster," Ramilo said.

Twenty-three children ages seven months to ten years were enrolled in the study at the Hospital del Nino in Panama City, Panama. All of the children had been infected with HIV at birth. At the beginning of the study, 83 percent of the children showed neurological abnormalities. After 48 weeks on antiretroviral therapy, only 35 percent of the children continued to show neurological abnormalities.

"This study proves that HIV infects the central nervous system of children, causing severe neurological problems," Ramilo said. "The study underscores the importance of using antiretroviral agents which are active in the central nervous system for treatment of children infected with HIV," he said. "You can see the difference in kids treated with antiretroviral therapy. They lead almost normal lives. They do much better."

The study findings showed the children's central nervous system had fewer HIV-infected cells after antiretroviral therapy treatment. HIV in children's blood and cerebrospinal fluid also showed different patterns of mutation, suggesting the two systems respond differently to drug treatment. The researchers recommended treating children with antiretroviral therapy targeting both the blood and central nervous system. "In the context of the current debates on when to initiate antiretroviral therapy in children, one must take into consideration potentially reversible early neurologic manifestations, which may be underappreciated unless formal neurologic/neuropsychologic testing is performed," the researchers wrote.

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