Cerebrovascular Disease in Children Perinatally Infected With Human Immunodeficiency Virus in Zambia.,Pediatric Neurology

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Cerebrovascular Disease in Children Perinatally Infected With Human Immunodeficiency Virus in Zambia.
Pediatric Neurology ( IF 3.2 ) Pub Date : 2020-08-05 , DOI: 10.1016/j.pediatrneurol.2020.08.003
Colleen L Schneider ₁ , Sarah Mohajeri-Moghaddam ₂ , Esau G Mbewe ₃ , Pelekelo P Kabundula ₃ , Owen Dean ₄ , Alexandra Buda ₄ , Michael J Potchen ₅ , Sylvia Mwanza-Kabaghe ₃ , Deanna Saylor ₆ , Heather R Adams ₇ , Gretchen L Birbeck ₈ , David R Bearden ₉

Affiliation

Medical Scientist Training Program, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Brain and Cognitive Science, University of Rochester, Rochester, New York; Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania; University of Rochester School of Medicine and Dentistry, Rochester, New York.
Department of Radiology, University of California at Los Angeles, Los Angeles, California.
Department of Educational Psychology, Sociology and Special Education, The University of Zambia, Lusaka, Zambia.
University of Rochester School of Medicine and Dentistry, Rochester, New York.
Department of Radiology, University of Rochester Medical Center, Rochester, New York; Department of Radiology, Lusaka Apex Medical University, Lusaka, Zambia.
Department of Neurology, Johns Hopkins University, Baltimore, Maryland; Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia; Zambian Institute for Neurological Care, Research, and Education, Lusaka, Zambia.
Division of Child Neurology, Department of Neurology, University of Rochester Medical Center, Rochester, New York.
Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia; Zambian Institute for Neurological Care, Research, and Education, Lusaka, Zambia; Division of Epilepsy, Department of Neurology, University of Rochester Medical Center, Rochester, New York; University Teaching Hospital Children's Hospital, Lusaka, Zambia.
Department of Educational Psychology, Sociology and Special Education, The University of Zambia, Lusaka, Zambia; Zambian Institute for Neurological Care, Research, and Education, Lusaka, Zambia; Division of Child Neurology, Department of Neurology, University of Rochester Medical Center, Rochester, New York.

Background

High rates of cerebrovascular disease (CVD) have previously been described in pediatric human immunodeficiency virus (HIV). However, little is known about pediatric CVD in the era of antiretroviral therapy or about the contribution of CVD to HIV-associated neurocognitive disorders.

Methods

We completed a neuroimaging substudy of the HIV-Associated Neurocognitive Disorders in Zambia study, a prospective cohort study of neurocognitive complications of pediatric HIV. Brain magnetic resonance imaging (1.5 T) was acquired for 34 HIV+ children on antiretroviral therapy and 17 HIV-exposed uninfected children (aged eight to 17 years). Demographics, medical history, neurological examination, and neuropsychologic testing results were collected. Two neuroradiologists, unaware of HIV status and clinical course, read the scans.

Results

CVD was identified in seven of 34 children with HIV (HIV+ CVD+) and no HIV-exposed uninfected children (21% vs 0%, P = 0.05). Three participants had white matter changes suggestive of small vessel disease, four had infarcts, and two had evidence of intracranial artery stenosis. Age of antiretroviral therapy initiation and exposure to protease inhibitors or efavirenz was not significantly different between children with and without CVD. HIV+ CVD+ children had significantly worse scores on a summary measure of cognition than the HIV+ CVD− group (NPZ8 score −0.57 vs 0.33, P = 0.04).

Conclusions

This study demonstrates high rates of CVD in children with HIV despite antiretroviral therapy, and worse cognitive performance in children with CVD. Longitudinal studies are necessary to determine the mechanisms and incidence of new-onset CVD in children with HIV.

中文翻译：

赞比亚围产期感染人类免疫缺陷病毒的儿童的脑血管疾病。

背景

先前已在儿童人类免疫缺陷病毒 (HIV) 中描述了高脑血管疾病 (CVD) 发病率。然而，对于抗逆转录病毒治疗时代的儿科 CVD 或 CVD 对 HIV 相关神经认知障碍的贡献知之甚少。

方法

我们完成了赞比亚研究中 HIV 相关神经认知障碍的神经影像学子研究，这是一项针对儿童 HIV 神经认知并发症的前瞻性队列研究。对 34 名接受抗逆转录病毒治疗的 HIV+ 儿童和 17 名暴露于 HIV 的未感染儿童（8 至 17 岁）进行了脑磁共振成像（1.5 T）。收集了人口统计学、病史、神经系统检查和神经心理测试结果。两名不了解 HIV 感染状况和临床病程的神经放射科医生阅读了扫描结果。

结果

在 34 名感染 HIV 的儿童（HIV+ CVD+）中，有 7 名发现了 CVD，并且没有暴露于 HIV 的未感染儿童（21% 对 0%，P = 0.05）。三名参与者有提示小血管疾病的白质变化，四名有梗塞，两名有颅内动脉狭窄的证据。抗逆转录病毒治疗的开始年龄和蛋白酶抑制剂或依法韦仑暴露在患有和未患有心血管疾病的儿童之间没有显着差异。HIV+ CVD+ 儿童在总体认知测量上的得分明显低于 HIV+ CVD- 组（NPZ8 得分 -0.57 对 0.33，P = 0.04）。