Abstract:
Background
Human immunodeficiency virus (HIV) type-1 infection is a major
cause of morbidity and mortality in children in Tanzania.
Neurological manifestations are some of the commonest modes of
clinical presentation of HIV / AIDS but they are underscored in
Tanzanian children. To manage these children it is crucial to develop
a better understanding of HIV -1 neurological manifestations and
associated factors.
Objectives
To determine neurological manifestations, the factors associated with
neurological manifestations in HIV -1 infected children, the
association with the clinical stage of Hl'V, CD4 counts, age and
nutritional status.
Methods
An unmatched case-control study was done at Muhimbili National
Hospital in Dar-es-Salaam, Tanzania over a period of nine months.
Children age one month to eight years admitted in the paediatric
wards or attending follow-up at the outpatient clinics with clinical
symptomatic fIIV infection/AIDS or children known to have HIV-1
infection were enrolled into the study until the sample size of 190
patients was reached.' Children were examined and investigated for
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neurological manifestations and HIV status, CD4 counts and their
nutritional status was assessed.
Results
From May 2001 - March 2002, a sample size of 190 patients was
reached. Cases and controls were 107 and 83 respectively. Cases and
control were comparable in terms of sex. Neurological manifestations
found were mainly encephalopathy (91.5%), neuropathy (14.9%) and
others accounted for (10.2%) of cases.
Global neurodevelopmental delay was present in 65% of cases.
Locomotor development was the most affected parameter (75.7%).
Neurological manifestations were significantly associated with AIDS,
moderate and severe stunting, (OR 4.44,6.11 and 3.92 respectively).
There was no association between neurological manifestations and
wasting or age. However in a separate analysis, encephalopathy was
significantly associated with age, with a high peak age incidence
being the second year of life.
In a sub-sample of 45 children, CD4 counts were done. There was no
significant association between neurological manifestations and CD4
counts.
Conclusion
Encepahalopathy IS the most common neurological problem; it is
associated with age, with a high peak age incidence being in the
second year of life.
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Neurological manifestations are associated with AIDS, moderate and
severe stunting.
Recommendations
HN -1 infection should be suspected in children with
neurodevelopmental delay even in isolated speech delay.
All HN -1 infected children should have a thorough neurological
examination and assessment.
Affordable means of reducing neurological manifestations in HIV-1
infected children need to be sought.
