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Panminerva Medica 1999 September;41(3):221-6


lingua: Inglese

Evolution of HIV-1 encephalopathy in children

Rigardetto R., Vigliano P., Boffi P., Marotta C., Rainò E., Arfelli P., Bonassi E., Gandione M., Vigna Taglianti M., Tovo P. A.*, Russo R.*

From the Department of Pediatric and Adolescence Sciences, Division of Child Neuropsychiatry * Department of Pediatric and Adolescence Sciences ** Department of Hygiene and Community Medicine University of Turin, Italy


Background. This ­study has ­been con­duct­ed on a ­series of HIV-1 infect­ed chil­dren, ­with the aim of illus­trat­ing the fea­tures of enceph­a­lop­a­thy ­onset, its evo­lu­tion and its influ­ence on ­life expec­tan­cy. The ­most use­ful ­exams for diag­no­sis are ­also out­lined.
Methods. The per­spec­tive ­study last­ed ­from January 1989 to June 1997. Forty six symp­to­mat­ic ­patients, out of 142 ser­o­pos­i­tive chil­dren, ­were fol­lowed up in the Department of Paediatric and Adolescence Sciences of the University of Turin. The ­patients, now ­between 1 yr 2 mth and 13 yr 9 mth old, ­were ­born ­from HIV-1 ser­o­pos­i­tive moth­ers; seror­e­vert­ers ­have ­been exclud­ed. Scheduled neu­ro­psy­chi­at­ric con­sul­ta­tions ­were ­used, con­sist­ing of a neu­ro­log­ic ­exam and an inter­view ­with par­ents, cog­ni­tive eval­u­a­tions, EEGs, Evoked Potentials and CT ­scans. The ­results ­have ­been eval­u­at­ed ­with log-­rank ­test for the anal­y­sis of the sur­vi­val ­curves.
Results. We ­found a sig­nif­i­cant­ly high­er mor­tal­ity ­rate in ence­phal­o­path­ic ver­sus non ence­phal­o­path­ic ­patients; ence­phal­o­path­ic ­patients, in ­whom neu­ro­log­ic ­signs ­began in the ­first ­year of ­life, ­have a ­worse prog­no­sis ­than the oth­er ­patients, in ­whom enceph­a­lop­a­thy ­appeared lat­er. We did not ­find a sta­tis­ti­cal cor­re­la­tion ­between clin­i­cal ­course and immu­no­log­i­cal def­i­cit. The clin­i­cal fea­tures of enceph­a­lop­a­thy are main­ly char­ac­ter­ized by pyram­i­dal ­signs and cog­ni­tive dete­ri­ora­tion. Clinical ­sign evo­lu­tion is ­linked to the age of enceph­a­lop­a­thy ­onset: pla­teau pat­tern enceph­a­lop­a­thy, char­ac­ter­ized by an ear­ly ­onset, ­severe ­motor ­signs and cog­ni­tive ­delay ­from the ­very begin­ning, ­shows a great­er sever­ity and a short­er sur­vi­val ­than pro­gres­sive enceph­a­lop­a­thy, char­ac­ter­ized by a slow­ly pro­gres­sive evo­lu­tion of pyram­i­dal ­signs, to ­which a cog­ni­tive dete­ri­ora­tion may be add­ed.
Conclusions. Neuropsychological ­exams can be help­ful in the diag­no­sis and fol­low-up of enceph­a­lop­a­thy.

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