Grand rounds and Teaching Files - Pediatric Oncall
Poor scholastic Performance in an HIV infected girl

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Clinical Problem:

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.

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.

What could be the cause of her worsening neurological status_?

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