Recovery of HIV encephalopathy in perinatally infected children on antiretroviral therapy
Recovery of HIV encephalopathy in perinatally infected children on antiretroviral therapy
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DOI：
10.1111/dmcn.14639
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发表时间：
2020-08-10
影响因子：
3.8
通讯作者：
Cotton, Mark F.
中科院分区：
文献类型：
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作者：
Innes, Steve;Laughton, Barbara;Cotton, Mark F.
目的描述早期抗逆转录病毒治疗（ART）后发生人类免疫缺陷病毒脑病（HIVE）的儿童的临床体征轨迹。方法这是一项回顾性的病例队列描述，来自开普敦HIV儿童早期抗逆转录病毒治疗（CHER）试验的参与者中HIVE。HIVE的诊断标准至少有两个：(1)获得性中枢运动缺陷，(2)大脑发育受损，(3)在没有其他病因的情况下未能达到或丧失发育里程碑。133名存活的参与者在中位年龄为9周时开始ART治疗，随访至中位年龄为6岁，其中20名（12%）在中位年龄31个月时发展为HIVE（四分位数范围19-37）。在这些患者中，首次出现神经退化的年龄中位数为19个月，其中16人接受抗逆转录病毒治疗，9人的艾滋病毒载量中位数为12个月。18例患者出现上运动神经元症状，其中12例消退，4例持续性痉挛性双瘫；运动迟滞19例，其中消退14例；12人有语言迟缓，其中11人已痊愈；16人大脑发育受损，其中只有5人康复。对于在HIVE诊断时已经接受抗逆转录病毒治疗的16名参与者，治疗方案没有因诊断而改变。HIVE可能在早期ART启动和病毒学抑制时发生，然后在未改变ART时消退，最有可能是鞘内炎症消退。
Aim To describe the trajectory of clinical signs in children who developed human immunodeficiency virus encephalopathy (HIVE) after starting early antiretroviral therapy (ART). Method This was a retrospective case-cohort description of HIVE among Cape Town participants from the Children with HIV Early AntiRetroviral treatment (CHER) trial. Criteria for HIVE diagnosis were at least two of: (1) acquired central motor deficit, (2) impaired brain growth, and (3) failure to attain or loss of developmental milestones in the absence of an alternative aetiology. Results Of 133 surviving participants who initiated ART at a median age of 9 weeks and who were followed until a median age of 6 years, 20 (12%) developed HIVE at a median age 31 months (interquartile range 19-37). In these, the first neurological deterioration was noticed at a median age of 19 months, when 16 were on ART and nine had undetectable HIV viral load for a median of 12 months. Signs of upper motor neurons were present in 18, of whom 12 resolved and four had persistent spastic diplegia; 19 had motor delay, of whom 14 resolved; 12 had language delay, of whom 11 resolved; and 16 had impaired brain growth, of whom only five recovered. For the 16 participants already on ART at HIVE diagnosis, regimens were not altered in response to diagnosis. Interpretation HIVE may occur despite early ART initiation and virological suppression and then resolve on unchanged ART, most likely as intrathecal inflammation subsides.