Diagnostic markers in the aspect of the development of HIV-encephalopathy in children

The aim of the study was to evaluate the diagnostic markers in children with HIV —encephalopathy (HIVE) with varying degrees of severity.Material and methods of research: The study included 260 children (153 boys — 58.85% and 107 girls —41.7%) with HIV-positive status and receiving antiretroviral therapy according to an individually selected scheme for at least 6 months. All children included in the study showed signs of HIV encephalopathy. The activity response was assessed by the concentration of IL-6, IL-10, TNF-alpha, C-reactive protein, C3, C4 components of the complement (immunofelometric analysis).Results: The study of the activity response in children with HIV encephalopathy found that the concentration of TNF —alpha and IL-6 were increased, compared, to the reference values (12.67±0.25 PG/ml and 23.04±0.64 PG/ml, respectively, with reference values of less than 8.1 PG/ml and 7pg/ml, respectively), and the concentration of IL-10 was reduced (5.93±0.10 PG/ml with a reference value of more than 9.1 PG/ml). The study analyzed the predictor significance of various parameters response in the aspect of the development of symptomatic HIV- encephalopathy. A comparative analysis of the concentration markers was performed, and the incidence of symptomatic HIV —encephalopathy was determined depending on the diagnostic concentration of the diagnostic marker. This finding is probably explained by the effector role of systemic inflammation in the development of damage to the Central nervous system.Conclusion. The maximum predictor significance in the aspect of the development of symptomatic HIV -encephalopathy was found in proinflammatory cytokines: an increase in IL-6 concentration above 19.6 PG / ml is associated with an increase in the risk of developing symptomatic HIV encephalopathy by 9.14 times, and an increase in TNF -alpha concentration above 12.5 PG/ml by 4.07 times (p<0.001 for both factors).

Modern approach to neurorehabilitation of children with hiv-encephalopathy

Background. Currently, there is no standardized and evidence-based medicine specific therapy for HIV-associated neurocognitive disorders. The aim of the study was to evaluate the effectiveness of various neurorehabilitation programs, including the use of memantine hydrochloride and the virtual reality feedback method (NIRVANA) in children with HIV encephalopathy (HIVE) in the aspect of neurocognitive status. Material and methods. The study included 260 children with HIV-positive status and receiving highly active antiretroviral therapy (НAART) according to an individually selected scheme for at least 6 months. All the children included in the study showed signs of HIVE. After the initial examination, all patients were divided into 4 groups: only НAART, НAART + memantine, НAART + NIRVANA and НAART + memantine + NIRVANA. The follow-up period was 3 months. The neurological study included a standard neurological examination, as well as various psychometric scales and questionnaires. Results. In the groups of active neurorehabilitation, there were significant positive changes in the neurocognitive status: the score of all components of neurocognitive disorders decreased in all three groups with comparable relative dynamics. As a result, by the end of the 3rd month of follow-up in children taking memantine (НAART group + M and НAART + M + H) achieved a significantly lower IQ score compared to children who were only on НAART (p 0.001 for both comparisons). Also in children who received complex neurorehabilitation (НAART + M + H) by the end of the 3rd month of observation, a significantly lower integral score of neurocognitive status assessment was achieved compared to children of the НAART group (p 0.05). Conclusion. Thus, in the course of this study, it was found that children with HIVE, despite the ongoing НAART, have a tendency to progress HIVE. Children with HIV-associated dementia are most susceptible to progression. The use of active neurorehabilitation, especially a combination of memantine and virtual reality techniques, can significantly improve the indicators of neurocognitive status.

366. Severe Neurologic Impairment Persists Despite Potent ART in HIV Encephalopathy

Background Approximately 4–8% of the 1.1 million HIV patients in the United States have or will be diagnosed with HIV encephalopathy or HIV associated dementia (HAD). There are no published studies of the long-term outcomes of HAD treated with potent antiretroviral therapy (ART). We hypothesize that more than 60% of individuals diagnosed with HAD will have persistent neurocognitive impairment despite the successful use of potent ART and fewer than 20% will be employed. Methods This is a cross-sectional prospective and retrospective study of outcomes in individuals previously diagnosed with HAD. We identified all individuals with the diagnosis of dementia and HIV at the UC Infectious Diseases Center (IDC). For those who matched the 1993 CDC HAD definition, we collected medical, neurocognitive, and functional information. We attempted to contact all individuals alive and still in the IDC practice (N = 26) to perform a validated battery of neuropsychological tests. We excluded individuals with HIV-associated neurocognitive disease that developed after treatment with ART. Results We confirmed 39 diagnoses of HAD out of 137 records reviewed. The median CD4 count at the time of diagnosis of HAD was 47 cells/mm3 with a median viral load of 211,475 copies/mL. The median length of follow-up after diagnosis of HAD was 72 months (range 1–166 months). Potent ART was prescribed to all individuals, with 67.5% reaching consistent undetectable viral loads (< 200 copies/mL, occasional blips allowed). Persistent neurologic deficits were noted in 32.5%, while 60% had persistent cognitive deficits. Psychiatric disturbances were present in 72.5%. Only 2.5% reported any employment. To date, 28% have died. Ten participants have undergone formal neurocognitive testing to date (N = 26 available). The median overall summary score (total Z score) was -1.17 (range 0.08, -1.95) and median global deficit (GDS) score was 1.48 (range 0, 2.92). Conclusion HIV-associated dementia results in substantial morbidity and mortality despite potent antiretroviral therapy. Prospective neurocognitive assessment documents significant impairments in most individuals. HIV-associated dementia will require additional strategies to mitigate the profound impact on the quality of life and longevity. Disclosures All authors: No reported disclosures.

Clinical spectrum of paediatric HIV infection in a tertiary care centre in South India

Background: The global burden of paediatric HIV and acquired immune deficiency syndrome (AIDS) remains a challenge for healthcare workers around the world, particularly in developing countries. The objective of this study is to describe the spectrum of HIV infection in children including the mode of transmission, clinical manifestations and opportunistic infections associated with HIV infection.Methods: Confirmed HIV seropositive children aged between 18 months to 19 years admitted to paediatric ward of JSS hospital, Mysore during two-year period were enrolled in this prospective observational study. Detailed history, socio-demographic characteristics and clinical manifestations were recorded in the predesigned performa. Nutritional assessment, complete physical, systemic and neurological examination was performed at the time of admission and was supplemented with ancillary investigations. Patients were correlated with modified WHO clinical case definition for AIDS and categorized as per revised CDC NABC classification of pediatric HIV infection.Results: Forty HIV-infected children were enrolled: with mean age of 4.5 years. Vertical transmission was the predominant mode of HIV transmission (97.5%). Most of the children were severely symptomatic belonging to category-C of NABC classification. Common clinical manifestations noted were failure to thrive (45%), recurrent respiratory infections (42%), bacterial skin infection (36%), recurrent otitis (42.5%), papulo-pruritic dermatitis (22%), hepatosplenomegaly (85%), lymphadenopathy (45%) and HIV encephalopathy (52%). The common opportunistic infections observed were pulmonary tuberculosis (45%), recurrent diarrhoea (35%), oral candidiasis (30%). The rare presentations of HIV noted were chronic thrombocytopenia and a case of dilated cardiomyopathy.Conclusions: Vertical transmission was the major route of HIV infection. HIV encephalopathy was more common among severely affected children. Tuberculosis was the commonest opportunistic infection.