HIV INFECTION OF THE CENTRAL NERVOUS SYSTEM

Objective: To provide an overview of neurological consequences of HIV infection in infants, children and adolescents and to describe the impact of Highly Active Antiretroviral Therapies (HAART) on neurological outcomes.

Methods: A critical review of current and past literature.

Results: The incidence of neurological disorders due to HIV has declined in the U.S. and Western Europe since the introduction of HAART in large part due to a dramatic decrease in mother to child transmission of HIV infection and due to early and sustained suppression of viral replication in HIV infected children. The clinical syndromes of children and adolescents surviving for many years with varying degrees of viral suppression have changed and are still being defined. The long term neurological outcomes remain to be determined. A high rate of progressive encephalopathy and other neurological complications associated with increased mortality continues to be reported from resource limited nations where HAART is unavailable.

Conclusion: HIV infection of the nervous system remains an important public health problem more than 20 years after the onset of the AIDS pandemic. There is a striking contrast in neurological outcomes of HIV infection in children determined by access to HAART in resource rich versus research poor nations.

Keywords: Human immunodeficiency virus (HIV), viral infection, highly active anti-retroviral therapy, HAART.