The state of the nervous system, psychology and eyes of HIV-infected children in comparison to healthy children.

ationale: Before the era of combined antiretroviral therapy (cART), perinatally infected HIV‐positive children
frequently presented with serious neurological dysfunctioning (prevalence varying from 30%‐50%), including
HIV‐encephalopathy, as characterized by impaired brain growth and acquired microcephaly, symmetrical
motor deficits and loss of or failure to attain developmental milestones1. Early neuroimaging studies of HIVencephalopathy
using computed tomography (CT) demonstrated cerebral atrophy, calcifications in the basal
ganglia and white matter changes2. Since HIV‐infected children are being treated with cART, the incidence of
HIV‐encephalopathy has decreased while in the meantime neuro‐imaging abnormalities shown by these
conventional neuroimaging techniques have improved1. Children can present with other neurologic disorders
such as seizures, headaches and neurocognitive impairments (e.g. learning‐, behavioural‐, and motor deficits)3.
The etiology of this neurocognitive impairment is complex and, most likely, not purely biologically determined.
Environmental factors, such as home environment and socioeconomic status (SES), may play a confounding
role in cognitive development4. In our patient group, the SES is generally lower than in the average population.
Comparative data on neurological and neurocognitive findings between HIV‐infected and healthy controls with
equal SES and living within similar environments are lacking.
Since neurological and neurocognitive disorders cannot be diagnosed until they are clinically obvious, the
availability of objective, reliable, non‐invasive markers may offer great advantages in assessing early central
nervous system (CNS) involvement in HIV‐positive children. Standardized neuropsychological assessment (NPA)
and several advanced neuroimaging tests as well as ophthalmological measurements are available to study the
neurological, neurocognitive and ophthalmological disorders in HIV‐positive children. In addition, biochemical
tests and measurement of cART concentration levels in cerebrospinal fluid (CSF) and blood, and combining
these results with the earlier mentioned NPA, neuroimaging and ophthalmological tests, will provide more
insight in the pathophysiology of CNS involvement of HIV and its clinical consequences.

HIV-infection and antiretroviral therapy use may lead to a diminished neurological and neurocognitive performance in HIV-infected children.

Cross-sectional

None (observational study)