White Matter Signal Abnormalities in Children With Suspected HIV-related Neurologic Disease on Early Combination Antiretroviral Therapy
White Matter Signal Abnormalities in Children With Suspected HIV-related Neurologic Disease on Early Combination Antiretroviral Therapy
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DOI：
10.1097/inf.0000000000000288
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发表时间：
2014-08-01
影响因子：
3.6
通讯作者：
Cotton, Mark
中科院分区：
文献类型：
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作者：
Ackermann, Christelle;Andronikou, Savvas;Cotton, Mark
背景：联合抗逆转录病毒治疗（ART）可以改善HIV相关神经系统疾病的自然病程和表现。我们描述了艾滋病毒相关神经系统疾病儿童的磁共振成像白色信号异常（WMSA）的特点。我们回顾了疑似HIV相关神经系统疾病的儿童的磁共振成像扫描，尽管早期接受了ART，并与临床，神经发育数据，病毒学标志物和ART治疗时间。这些儿童也参加了儿童艾滋病毒早期抗逆转录病毒（CHER）试验。在平均年龄31.9个月（范围8-54）时对44名儿童进行了磁共振成像扫描：10名延迟治疗组和34名早期治疗组，分别在平均年龄18.5周和8周时开始ART。22名患者（50%）在T2/液体衰减反转恢复时记录到多发性高信号病变，主要位于额叶（91%）和顶叶（82%）白色物质。神经发育评分与无WMSA儿童相比无差异，病灶负荷和分布与神经发育评分或神经系统检查均无显著相关性。正常头部生长在WMSA组中更常见（P = 0.01）。有一种趋势，WMSA和ART时间较长（P = 0.13）和最低CD4%（P = 0.08）。结论：一半的儿童提到与HIV相关的脑部疾病有WMSA的T2/液体衰减反转恢复。我们的研究结果与正常的头部生长和ART的持续时间需要进一步的研究。我们怀疑WMSA可能发生在早期，并且在出生后8周开始ART可能为时已晚，无法阻止HIV进入中枢神经系统。
Background: The natural history and manifestation of HIV-related neurologic disease have been ameliorated by combination antiretroviral therapy (ART). We describe the characteristics of white matter signal abnormalities (WMSA) on magnetic resonance imaging in children with HIV-related neurologic disease.Methods: We reviewed magnetic resonance imaging scans of children with suspected HIV-related neurologic disease despite early ART and correlated with clinical, neurodevelopmental data, virologic markers and time on ART. These children were also on the Children with HIV Early Antiretroviral (CHER) trial.Results: Magnetic resonance imaging scans were performed at a mean age 31.9 months (range 8-54) on 44 children: 10 on deferred and 34 on early treatment arms, commencing ART at mean age of 18.5 and 8 weeks, respectively. Multiple high signal intensity lesions on T2/fluid attenuated inversion recovery were documented in 22 patients (50%), predominantly in frontal (91%) and parietal (82%) white matter. No differences in neurodevelopmental scores comparing children with and without WMSA were found. Neither lesion load nor distribution showed significant correlation with neurodevelopmental scores or neurologic examination. Normal head growth was more common in the WMSA group (P = 0.01). There was a trend for association of WMSA and longer time on ART (P = 0.13) and nadir CD4% (P = 0.08).Conclusions: Half of children referred with HIV-related brain disease had WMSA on T2/fluid attenuated inversion recovery. Our findings of the association with normal head growth and duration of ART require further study. We suspect that WMSA can occur early and that initiating ART by 8 weeks of life may be too late to prevent HIV from entering the central nervous system.