Neurological manifestations among children infected with human immunodeficieny virus / acquired immunodeficiency syndrome and associated factors

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

vii 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.

viii

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.