HIV Encephalopathy (HIVE) in Children at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria

Nsirimobu Ichendu  Paul; Boma Alali Ngozi  Okoh; Edward Achinike Daniel  Alikor

doi:10.4236/ijcm.2018.96042

Nsirimobu Ichendu Paul^*, Boma Alali Ngozi Okoh, Edward Achinike Daniel Alikor

Abstract: Background: HIV encephalopathy (HIVE) is associated with cognitive impairment in children with HIV infection, early diagnosis and initiation of HAART may reduce the morbidity associated with HIVE. Objective: To determine the prevalence of HIVE and associated comorbiditiesin children at the UPTH. Methodology: This was a retrospective study carried out from January to June 2017. The case notes of all HIV positive children presenting to the Paediatric Department of the University of Port Harcourt Teaching Hospital (UPTH) were studied. Children who met the diagnostic criteria for HIVE according to the Centre for Disease Control (CDC) definition were selected. The socio-demographic characteristics of the patients, mode of HIV transmission, CD4 count and associated comorbidities in these children were retrieved from the case notes. Obtained data was analyzed using Epi Info version 7.2. Comparisms of subgroups was carried out using the chi square test while statistical significance at 95% confidence interval was p value < 0.05. Results: A total of thirty five out of the 196 HIV positive children presenting to the hospital had HIV encephalopathy (HIVE) giving a prevalence rate of 17.9%. Of these 35 children, 18 were males and 17 females, giving a male to female ratio of 1:1. The mean age of the children was 5.7 ± 3.1 years. The mean age for the males was 6.4 ± 3.2 years and 5.0 ± 2.8 years for the females. There was no statistically significant difference observed between the sexes (t = 1.35, p = 0.187). Thirty (85.7%) of the patients with HIVE were on HAART at diagnosis. The mean age at diagnosis of HIV was 3.2 ± 3.1 years and the mean age at diagnosis of HIV encephalopathy was 3.4 ± 3.2 years. The documented route of transmission for all the subjects was mother-to-child-transmission (MTCT). Seventy five percent of the children were breastfed from birth and at 6 months all the mothers had discontinued breastfeeding. The mean CD4 count was 1053 ± 630 cells/ml. Tuberculosis was the most prevalent co-morbidity occurring among the patients. Conclusion: The prevalence of HIVE in children at the UPTH is high and Tuberculosis is the commonest comorbidity. Early infant diagnosis, use of modern diagnostic tool and early initiation of HAART are advocated to reduce its associated morbidity.

Keywords: HIV, Encephalopathy, Children, UPTH

Cite this paper: Paul, N. , Okoh, B. and Alikor, E. (2018) HIV Encephalopathy (HIVE) in Children at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria. International Journal of Clinical Medicine, 9, 495-504. doi: 10.4236/ijcm.2018.96042.

References

[1] Tindyebwa, D., Kayita, J., Musoke, P., Eley, B., Nduati, R., Tumwesigye, N., et al. (2011) Handbook on Paediatric AIDS in Africa. 2nd Edition, African Network for the Care of Children Affected by AIDS (ANECCA), Kampala.

[2] UNAIDS (2012) Together We Will End AIDS. 1-140.

[3] WHO, UNAIDS and UNICEF (2011) Global HIV/AIDS Response-Progress Report 2011. 1-219.

[4] Eley, B. (2006) Addressing the Paediatric HIV Epidemic: A Perspective from the Western Cape Region of South Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 100, 19-23.
https://doi.org/10.1016/j.trstmh.2005.04.015

[5] (2007) Western Cape Department of Health: Revision of the Protocol for the Prevention of Mother-to-Child Transmission of HIV. Circular No: H127/2007.

[6] Van Rie, A., Harrington, P.R., Dow, A. and Robertson, K. (2007) Neurologic and Neurodevelopmental Manifestations of Pediatric HIV/AIDS: A Global Perspective. European Journal of Paediatric Neurology, 11, 1-9.
https://doi.org/10.1016/j.ejpn.2006.10.006

[7] Lobato, M.N., Caldwell, M.B., Ng, P. and Oxtoby, M.J. (1995) Encephalopathy in Children with Perinatally Acquired Human Immunodeficiency Virus Infection. Pediatric Spectrum of Disease Clinical Consortium. The Journal of Pediatrics, 126, 710-715.
https://doi.org/10.1016/S0022-3476(95)70397-7

[8] Tahan, T.T., Bruck, I., Burger, M. and Cruz, C.R. (2006) Neurological Profile and Neurodevelopment of 88 Children Infected with HIV and 84 Seroreverter Children Followed from 1995 to 2002. The Brazilian Journal of Infectious Diseases, 10, 322-326.

[9] Blanche, S., Rouzioux, C., Moscato, M.L., Veber, F., Mayaux, M.J., Jacomet, C., et al. (1989) A Prospective Study of Infants Born to Women Seropositive for Human Immunodeficiency Virus Type 1. HIV Infection in Newborns French Collaborative Study Group. New England Journal of Medicine, 320, 1643-1648.

[10] Bruck, I., Tahan, T.T., Cruz, C.R., Martins, L.T., Antoniuk, S.A., Rodrigues, M., et al. (2001) Developmental Milestones of Vertically HIV Infected and Seroreverters Children: Follow up of 83 Children. Arquivos de Neuro-Psiquiatria, 59, 691-695.
https://doi.org/10.1590/S0004-282X2001000500007

[11] Chase, C., Ware, J., Hittelman, J., Blasini, I., Llorente, A., Anisfeld, E., et al. (2000) Early Cognitive and Motor Development among Infants Born to Women Infected with Human Immunodeficiency Virus. Pediatrics, 106, e25.
https://doi.org/10.1542/peds.106.2.e25

[12] Englund, J.A., Baker, C.J., Raskino, C., McKinney, R.E., Lifschitz, M.H., Petrie, B., et al. (1996) Clinical and Laboratory Characteristics of a Large Cohort of Symptomatic, Human Immunodeficiency Virus-Infected Infants and Children. AIDS Clinical Trials Group Protocol 152 Study Team. Pediatric Infectious Disease Journal, 15, 1025-1036.

[13] Epstein, L.G., Sharer, L.R., Oleske, J.M., Connor, E.M., Goudsmit, J., Bagdon, L., et al. (1986) Neurologic Manifestations of Human Immunodeficiency Virus Infection in Children. Pediatrics, 78, 678-687.

[14] Foster, C.J., Biggs, R.L., Melvin, D., Walters, M.D., Tudor-Williams, G. and Lyall, E.G. (2006) Neurodevelopmental Outcomes in Children with HIV Infection under 3 Years of Age. Developmental Medicine & Child Neurology, 48, 677-682.

[15] CDC: 1994 Revised Classification System for HIV Infection in Children Less than 13 Years of Age. CDC 1994, 443, 1-10.

[16] Thomas, S.A. (2004) Anti-HIV Drug Distribution to the Central Nervous System. Current Pharmaceutical Design, 10, 1313-1324.

[17] Van Rie, A., Mupuala, A. and Dow, A. (2008) Impact of the HIV/AIDS Epidemic on the Neurodevelopment of Preschool-Aged Children in Kinshasa. Democratic Republic of the Congo. Pediatrics, 122, e123-e128.

[18] Laughton, B., Cornell, M., Grove, D., Kidd, M., Springer, P., Dobbels, E., et al. (2012) Early Antiretroviral Therapy Improves Neurodevelopmental Outcomes in Infants. AIDS, 26, 1685.

[19] Abubakar, A., Van Baar, A., Van de Vijver, F.J., Holding, P. and Newton, C.R. (2008) Paediatric HIV and Neurodevelopment in Sub-Saharan Africa: A Systematic Review. Tropical Medicine & International Health, 13, 880-887.
https://doi.org/10.1111/j.1365-3156.2008.02079.x

[20] Laughton, B., Cornell, M., Boivin, M. and Van Rie, A. (2013) Neurodevelopment in Perinatally HIV-Infected Children: A Concern for Adolescence. Journal of the International AIDS Society, 16, Article ID: 18603.

[21] Ackermann, C., Andronikou, S.F., Laughton, B.F., Kidd, M.F., Dobbels, E.F., Innes, S., et al. (2014) White Matter Signal Abnormalities in Children with Suspected HIV-Related Neurologic Disease on Early Combination Antiretroviral Therapy. The Pediatric Infectious Disease Journal, 33, e207-e212.

[22] Hoare, J., Ransford, G.L., Phillips, N., Amos, T., Donald, K. and Stein, D.J. (2014) Systematic Review of Neuroimaging Studies in Vertically Transmitted HIV Positive Children and Adolescents. Metabolic Brain Disease, 29, 221-229.

[23] Hoare, J., Fouche, J.P., Spottiswoode, B., Donald, K., Philipps, N., Bezuidenhout, H., et al. (2012) A Diffusion Tensor Imaging and Neurocognitive Study of HIV-Positive Children Who Are HAART-Naïve “Slow Progressors”. Journal of NeuroVirology, 18, 205-212.

[24] Prado, P.C., Escorsi-Rosset, S., Cervi, M. and Santos, A. (2011) Image Evaluation of HIV Encephalopathy: A Multimodal Approach Using Quantitative MR Techniques. Neuroradiology, 53, 899-908.

[25] Peter, S.B., Alan, S.R., Marianne, H.E.P.D.R. and Ingram, W. (2009) Acquired Microcephaly: Causes, Patterns, Motor and IQ Effects, and Associated Growth Changes. Paediatrics, 124, 590.