Neurologic manifestations of childhood AIDS in Benin City, Nigeria

Abstract

The human immunodeficiency virus (HIV) infection is a multi-systemic illness and often leads to acquired immun- odeficiency syndrome (AIDS) in untreated cases. In children, neurologic manifestations are common. HIV encephalopathy is a neurological dysfunction arising from direct HIV infection of the brain. It ranges between 30% to 50% in untreated cases and 5% to 10% in those on Highly Active Anti-retroviral Therapy (HAART). There is a paucity of information on neurological manifestations of HIV/AIDS in children from sub-Sahara Africa. We reviewed the records of all consecutive HIV infected non-neonatal children presenting to the pediatric department of the University of Benin Teaching Hospital, Benin City, Nigeria, between January 1999 and December 2004. Those who had neurologic manifestations were included in the study. Their biodata, the results of cerebrospinal fluid analysis, Mantoux tests and acid- and alcohol-fast bacilli (AAFB) determination were obtained. The HIV sero-status was determined using enzyme-linked immunosorbent assay test and confirmed by Western blot. In children less than 18 months, the Centers for Disease Control (CDC) criteria for surveillance case definition for AIDS were used. HIV encephalopathy was diagnosed based on CDC revised classification criteria. Of the 203 HIV seropositive children, 15 (7.4%) had neurologic manifestations. The most common manifestations were brisk deep tendon reflexes in 14 (93.3%), extensor plantar responses in 10 (66.7%) and cortical fisting in eight (53.3%). The male/female ratio was 1:2; mean age was 7.7 ± 4.8 months (range 3-18 months). As a result of cost, five (33.3%) patients had their CD4 + count determined on presentation and ranged between 30 and 300/µL. Of the 15 patients, 12 (80.0%) died, eight while in hospital and four at follow-up visit. Three patients were lost to follow-up. Five patients received HAART for a mean 11.3 ± 2.5 weeks (range 7-14 weeks). Children with HIV/AIDS present with severe neurologic manifestations and often delay in seeking appropriate medical care. It is envisioned that the promotion of the 'Prevention of Mother to Child Transmission' program coupled with early therapy with HAART, will prevent the high mortality currently associated with this condition.