Grand Rounds

Poor scholastic Performance in an HIV infected girl

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.

What could be the cause of her worsening neurological status_?

Discussion :
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.

Correct Answers :  yes 16%
Disclaimer: The information given by is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0