HIV+ Children and Neuropathy

Information about the number of children with HIV and neuropathy is surprisingly difficult to find. At the beginning of the history of HIV, it was often stated that children were far less prone to neuropathic problems than adults. However, this turned out to be mainly due to under-reporting and inaccurate diagnosis. These days there are a few more studies to be found on the internet but not many (if anyone knows of any articles pertaining to this subject, please let me know). From the little amount of information available, it seems that HIV+ children are just as likely to get neuropathy as adults. The two short studies in today's post come from scielo.br and biomedcentral.com respectively (see links below the article)and concern studies in Brazil and Peru. It seems clear that much more research needs to be done both to identify the problem in children and work towards making their lives easier. By definition, they're going to be living with the disease much longer.

PERIPHERAL NEUROPATHY IN IMMUNODEFICIENCY VIRUS (HIV) INFECTED CHILDREN
ALEXANDRA PRUFER DE QUEIROZ CAMPOS ARAÚJO

Peripheral neuropathy in HIV infected children has not been thoroughly studied as it has been in adults. To determine if symptoms and signs of peripheral neuropathy occur in HIV infected children and to estimate the prevalence of peripheral neuropathy in this population, a descriptive cross-sectional study was elaborated.

We evaluated a cohort of 55 children older than five years from the HIV out-patient clinic from the Pediatric Institute of the Federal University of Rio de Janeiro. A total of 39 children were interviewed and examined systematically for peripheral nerve symptoms and signs, and referred for nerve conduction studies. Of this clinically evaluated group 13 (34%) had symptoms and signs of peripheral nerve involvement.

Distal paresthesiae and/or pain plus diminished ankle jerks and/or diminished vibration sense were the most common clinical findings. Most children were classified as C3, were undernourished and using potentially neurotoxic drug. However, those findings, as well as the presence of encephalopathy and longer disease duration were not significantly associated with the presence of peripheral neuropathy. Nerve conduction studies indicated a predominance of axonal abnormalities.

Peripheral neuropathy occurs in one third of HIV infected children older than five years with similar features as the distal sensory polyneuropathy described in adults.

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X1999000400033

Distal peripheral neuropathy in HIV-infected children
Peggy M Esteban, Joseph R Zunt, Silvia M Torres, Julio F Bravo, Lenka K Roca and Nicanor M Quispe

Background

Distal symmetric peripheral neuropathy (DSPN) is the most common form of peripheral neuropathy in HIV-infected children, but little is known about its prevalence in HIV-infected children living in the developing world. The aims were to determine the frequency of symptoms, signs and risk factors for DSPN in HIV-infected children living in Peru.

Methods

Cross sectional study of children older than 18 months attending the Instituto Nacional de Salud Del Niño. Medical records were reviewed to obtain information regarding HIV infection and treatment. Patients older than 5 years old completed a standardized questionnaire regarding neuropathic symptoms. All subjects underwent detailed neurologic examination and nerve conduction study. Presence of DSPN was defined according to guidelines of the American Academy of Neurology, American Academy of Electrodiagnostic Medicine, American Association or Physical Medicine & Rehabilitation [1].

Results

90 subjects were enrolled. Age ranged from 18 months to 18 years. 12 patients (13.3%) had DSPN, with diminished ankle jerks and paresthesias the most common clinical findings. In 84 (93.3%) subjects HIV infections was acquired vertically, 76 (84.4%) were on antiretroviral treatment, and 51 (56.7%) were at C3 CDC classification. Malnutrition was associated with presence of DSPN (OR 12.82; IC 95% 1.14–144.42). Duration of HIV infection, viral load, CD4 count and antiretroviral treatment were not associated with presence of DSPN.

Conclusion

Distal symmetric polyneuropathy was present in 13.3% of HIV-infected children and was associated with malnutrition. Future longitudinal studies could examine other risk factors associated with DSPN in HIV-infected children.

http://www.biomedcentral.com/1753-6561/2/S1/P37