TY - JOUR
T1 - Cerebrovascular Disease in Children Perinatally Infected With Human Immunodeficiency Virus in Zambia
AU - Schneider, Colleen L.
AU - Mohajeri-Moghaddam, Sarah
AU - Mbewe, Esau G.
AU - Kabundula, Pelekelo P.
AU - Dean, Owen
AU - Buda, Alexandra
AU - Potchen, Michael J.
AU - Mwanza-Kabaghe, Sylvia
AU - Saylor, Deanna
AU - Adams, Heather R.
AU - Birbeck, Gretchen L.
AU - Bearden, David R.
N1 - Funding Information:
Funding source: This work was supported by the University of Rochester Center for AIDS Research (CFAR), an NIH funded program ( P30 AI 78498 ); by a pilot grant from the McGowan Foundation ; and by the University of Rochester Medical Center Office of Medical Education International Research Grant. Preparation of this manuscript was supported, in part, by NIH grant F30EY027988 (C.L.S.)
Funding Information:
Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number K23NS117310 and R01NS094037 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
Funding source: This work was supported by the University of Rochester Center for AIDS Research (CFAR), an NIH funded program (P30 AI 78498); by a pilot grant from the McGowan Foundation; and by the University of Rochester Medical Center Office of Medical Education International Research Grant. Preparation of this manuscript was supported, in part, by NIH grant F30EY027988 (C.L.S.)Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number K23NS117310 and R01NS094037. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/11
Y1 - 2020/11
N2 - Background: High rates of cerebrovascular disease (CVD) have previously been described in pediatric human immunodeficiency virus (HIV). However, little is known about pediatric CVD in the era of antiretroviral therapy or about the contribution of CVD to HIV-associated neurocognitive disorders. Methods: We completed a neuroimaging substudy of the HIV-Associated Neurocognitive Disorders in Zambia study, a prospective cohort study of neurocognitive complications of pediatric HIV. Brain magnetic resonance imaging (1.5 T) was acquired for 34 HIV+ children on antiretroviral therapy and 17 HIV-exposed uninfected children (aged eight to 17 years). Demographics, medical history, neurological examination, and neuropsychologic testing results were collected. Two neuroradiologists, unaware of HIV status and clinical course, read the scans. Results: CVD was identified in seven of 34 children with HIV (HIV+ CVD+) and no HIV-exposed uninfected children (21% vs 0%, P = 0.05). Three participants had white matter changes suggestive of small vessel disease, four had infarcts, and two had evidence of intracranial artery stenosis. Age of antiretroviral therapy initiation and exposure to protease inhibitors or efavirenz was not significantly different between children with and without CVD. HIV+ CVD+ children had significantly worse scores on a summary measure of cognition than the HIV+ CVD− group (NPZ8 score −0.57 vs 0.33, P = 0.04). Conclusions: This study demonstrates high rates of CVD in children with HIV despite antiretroviral therapy, and worse cognitive performance in children with CVD. Longitudinal studies are necessary to determine the mechanisms and incidence of new-onset CVD in children with HIV.
AB - Background: High rates of cerebrovascular disease (CVD) have previously been described in pediatric human immunodeficiency virus (HIV). However, little is known about pediatric CVD in the era of antiretroviral therapy or about the contribution of CVD to HIV-associated neurocognitive disorders. Methods: We completed a neuroimaging substudy of the HIV-Associated Neurocognitive Disorders in Zambia study, a prospective cohort study of neurocognitive complications of pediatric HIV. Brain magnetic resonance imaging (1.5 T) was acquired for 34 HIV+ children on antiretroviral therapy and 17 HIV-exposed uninfected children (aged eight to 17 years). Demographics, medical history, neurological examination, and neuropsychologic testing results were collected. Two neuroradiologists, unaware of HIV status and clinical course, read the scans. Results: CVD was identified in seven of 34 children with HIV (HIV+ CVD+) and no HIV-exposed uninfected children (21% vs 0%, P = 0.05). Three participants had white matter changes suggestive of small vessel disease, four had infarcts, and two had evidence of intracranial artery stenosis. Age of antiretroviral therapy initiation and exposure to protease inhibitors or efavirenz was not significantly different between children with and without CVD. HIV+ CVD+ children had significantly worse scores on a summary measure of cognition than the HIV+ CVD− group (NPZ8 score −0.57 vs 0.33, P = 0.04). Conclusions: This study demonstrates high rates of CVD in children with HIV despite antiretroviral therapy, and worse cognitive performance in children with CVD. Longitudinal studies are necessary to determine the mechanisms and incidence of new-onset CVD in children with HIV.
KW - Africa
KW - Cerebrovascular disease
KW - Global health
KW - HIV
KW - Pediatric neurology
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U2 - 10.1016/j.pediatrneurol.2020.08.003
DO - 10.1016/j.pediatrneurol.2020.08.003
M3 - Article
C2 - 32871411
AN - SCOPUS:85090027377
SN - 0887-8994
VL - 112
SP - 14
EP - 21
JO - Pediatric Neurology
JF - Pediatric Neurology
ER -