Usefulness of neuro-imaging for the diagnosis of HIV encephalopathy in children

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South African Medical Journal

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Health and Medical Publishing Group


University of Cape Town

It is important to recognise the central nervous system (CNS) imaging appearances of HIV, in particular those of HIV encephalopathy, as this is an AIDS-defining illness. HIV encephalopathy is a common manifestation of HIV, with distinct neuro-imaging features. With the use of images we aim to draw the clinician’s attention to the neuro-imaging modalities best suited to demonstrating these features. Neurological dysfunction in AIDS is common, occurring in as many as 80% of children.1 The spectrum of diseases includes HIV encephalopathy, cerebrovascular disease, PML (progressive multifocal leuko-encephalopathy), infections and malignancies. Opportunistic CNS infections are extremely rare in paediatric AIDS patients compared with adults,2-4 even in the presence of systemic infections by Pneumocystis carinii pneumonia, candida and cytomegalovirus (CMV) (CMV being the most common paediatric opportunistic infection).3 Toxoplasmosis is almost never seen in young children.3,5,6 Lymphoma (4% of HIV-positive children)6 is more common than toxoplasmosis,3,5,6 but is also not commonly encountered in paediatric practice. The JC virus is considered an opportunistic infection and manifests as PML, which is still rare in children.3,5,7,8 The imaging manifestations of CNS infections, malignancies and vascular diseases fall outside the scope of this article. Up to 76% of asymptomatic HIV-positive children are found to have at least one abnormality on computed tomography (CT).3 Chamberlain et al. 1 found that 40% of HIV-positive children have abnormal CT or magnetic resonance imaging (MRI) scans by the age of 1 year. The most common findings on imaging are cerebral atrophy1-4,6 and basal ganglia calcifications.1-4,6 White matter changes related to HIV itself are less common,1-3 but occur more frequently than PML.