Title : Poor scholastic Performance in an HIV infected girl
 
Author Details : Ira Shah
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital and Incharge Pediatric HIV, TB and Liver Clinics, B J Wadia Hospital for Children, Mumbai, India.

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056.
 
Clinical Problem : A 10 years old HIV infected girl on anti-retroviral therapy {ART} consisting of zidovudine {AZT}, lamivudine {3TC} and nevirapine {NVP} for 5 years presented with poor scholastic performance. As per the mother, she had difficulty in understanding simple commands and was not performing poorly in school. On examination, neurological examination was normal. Her IQ test showed borderline IQ. Her MRI brain is depicted in Figure 1. Her CD4 count was 820 cells, cumm and HIV viral load was undetectable. Cerebrospinal fluid {CSF} was normal though HIV PCR could not be done.
 

 
Question : What could be the cause of her worsening neurological status_?
 
Expert Opinion : Neurological complications occurring commonly in HIV-AIDS infected individuals are either due to primary HIV infection or due to opportunistic infections. Highly active antiretroviral therapy {HAART} has been found to decrease the risk of such neurological damage however continued damage can persist inspite of vigorous antiretroviral therapy. This because HAART decreases the viral load in the blood but due to poor penetration of the drugs into the central nervous system {CNS}, the virus can continue to multiple in the CNS. {1} Thus, ART should be initiated as soon as any neurocognitive impairment is diagnosed so as to prevent any irreversible neurological damage and drugs that have a better CNS penetration should be used.

References
1} Tozzi V, Balestra P, Bellagamba R, Corpolongo A, Salvatori MF, Visco-Comandini U, et al. Persistence of neuropsychologic deficits despite long-term highly active antiretroviral therapy in patients with HIV-related neurocognitive impairment: prevalence and risk factors. J Acquir Immune Defic Syndr. 2007` 45: 174-82.
 
Funding : None
 
Conflict of Interest : None
 
DOI No. : 10.7199/ped.oncall.2017.12
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