Subscribe to RSS
DOI: 10.1055/s-2003-42205
Georg Thieme Verlag Stuttgart · New York
Delayed Motor Learning and Psychomotor Slowing in HIV-Infected Children
Publication History
Received: February 17, 2003
Accepted after Revision: May 15, 2003
Publication Date:
15 September 2003 (online)
![](https://www.thieme-connect.de/media/neuropediatrics/200304/lookinside/thumbnails/10.1055-s-2003-42205-1.jpg)
Abstract
Objective
To find out whether HIV-associated subclinical psychomotor slowing is present in HIV-infected children despite effective highly active antiretroviral therapy (HAART).
Patients and Methods
An electrophysiological motor test battery shown to sensitively describe HIV-associated CNS disease in adults (tremor peak frequency []TPF], most rapid alternating movements [MRAM], reaction time [RT] and contraction time [CT]) was performed in 17 HIV seropositive (+) right-handed children. Results were compared to 16 HIV seronegative (-) children.
Results
HIV (-) children showed slower frequencies (TPF, MRAM) and longer RT and CT than (-) adults. They showed a significant correlation (p = 0.0263) between RT (right = dominant hand) and age. HIV (+) children showed significant prolongations of RT (right hand) and CT (both hands) compared to HIV (-) children. RT right hand did not accelerate with age in HIV (+) children. CT were significantly prolonged in 10 children with detectable HIV plasma viral burden and normal in 7 children with no detectable HIV plasma viral load. There was no correlation between CT and CD 4 cell counts.
Conclusions
Despite effective HAART, electrophysiological motor testing in HIV (+) children reveals significant subclinical CNS dysfunction, especially in children with insufficient viral load suppression.
Key words
HIV - children - encephalopathy - psychomotor slowing - central nervous system
References
- 1 Arendt G, Hefter H, Buescher L, Hilperath F, Elsing C, Freund H J. Improvement of motor performance of HIV-positive patients under AZT therapy. Neurology. 1992; 42 891-896
- 2 Arendt G, Hefter H, Elsing C, Strohmeyer G, Freund H J. Motor dysfunction in HIV-infected patients without clinically detectable central-nervous deficit. J Neurol. 1990; 237 362-368
- 3 Arendt G, Hefter H, Hilperath F, von Giesen H J, Strohmeyer G, Freund H J. Motor analysis predicts progression in HIV-associated brain disease. J Neurol Sci. 1994; 123 180-185
- 4 Aylward E H, Henderer J D, McArthur J C. et al . Reduced basal ganglia volume in HIV-1-associated dementia: Results from quantitative neuroimaging. Neurology. 1993; 43 2099-2104
- 5 Belman A L, Diamond G, Dickson D. et al . Pediatric acquired immunodeficiency syndrome. Neurologic syndromes. Am J Dis Child. 1988; 142 29-35
- 6 Belman A L, Lantos G, Horoupian D. et al . AIDS: calcification of the basal ganglia in infants and children. Neurology. 1986; 36 1192-1199
- 7 Berger J R, Arendt G. HIV dementia: the role of the basal ganglia and dopaminergic systems. J Psychopharmacol. 2000; 14 214-221
- 8 Berger J R, Nath A. HIV dementia and the basal ganglia. Intervirology. 1997; 40 122-131
- 9 Blanche S, Tardieu M, Duliege A. et al . Longitudinal study of 94 symptomatic infants with perinatally acquired human immunodeficiency virus infection. Evidence for a bimodal expression of clinical and biological symptoms. Am J Dis Child. 1990; 144 1210-1215
- 10 Blanchette N, Smith M L, Fernandes-Penney A, King S, Read S. Cognitive and motor development in children with vertically transmitted HIV infection. Brain Cogn. 2001; 46 50-53
- 11 Cooper E R, Hanson C, Diaz C. et al . Encephalopathy and progression of human immunodeficiency virus disease in a cohort of children with perinatally acquired human immunodeficiency virus infection. Women and Infants Transmission Study Group. J Pediatr. 1998; 132 808-812
- 12 de Martino M, Tovo P A, Balducci M. et al . Reduction in mortality with availability of antiretroviral therapy for children with perinatal HIV-1 infection. Italian Register for HIV Infection in Children and the Italian National AIDS Registry. JAMA. 2000; 284 190-197
- 13 Dickson D W, Llena J F, Nelson S J, Weidenheim K M. Central nervous system pathology in pediatric AIDS. Ann N Y Acad Sci. 1993; 693 93-106
- 14 Epstein L G, Sharer L R, Joshi V V, Fojas M M, Koenigsberger M R, Oleske J M. Progressive encephalopathy in children with Acquired Immune Deficiency Syndrome. Ann Neurol. 1985; 17 488-496
- 15 Epstein L G, Sharer L R, Oleske J M. et al . Neurologic manifestations of human immunodeficiency virus infection in children. Pediatrics. 1986; 78 678-687
- 16 Fowler M G. Pediatric HIV infection: neurologic and neuro-psychologic findings. Acta Paediatr. 1994; 400 (Suppl) 59-62
- 17 Gavin P, Yogev R. Central nervous system abnormalities in pediatric human immunodeficiency virus infection. Pediatr Neurosurg. 1999; 31 115-123
- 18 Gortmaker S L, Hughes M, Cervia J. et al . Effect of combination therapy including protease inhibitors on mortality among children and adolescents infected with HIV-1. N Engl J Med. 2001; 345 1522-1528
- 19 Janssen R S, Cornblath D R, Epstein L G. et al . Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus-type 1 (HIV-1) infection. Neurology. 1991; 41 778-785
- 20 McCoig C, Castrejon M M, Castano E. et al . Effect of combination antiretroviral therapy on cerebrospinal fluid HIV RNA, HIV resistance, and clinical manifestations of encephalopathy. J Pediatr. 2002; 141 36-44
- 21 Mintz M, Epstein L G. Neurologic manifestations of pediatric acquired immunodeficiency syndrome: clinical features and therapeutic approaches. Semin Neurol. 1992; 12 51-56
- 22 Mintz M, Tardieu M, Hoyt L. et al . Levodopa therapy improves motor function in HIV-infected children with extrapyramidal syndromes. Neurology. 1996; 47 1583-1585
- 23 Palella Jr F J, Delaney K M, Moorman A C. et al . Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med. 1998; 338 853-860
- 24 Parks R A, Danoff J V. Motor performance changes in children testing positive for HIV over 2 years. Am J Occup Ther. 1999; 53 524-528
- 25 Price R W, Yiannoutsos C T, Clifford D B. et al . Neurological outcomes in late HIV infection: adverse impact of neurological impairment on survival and protective effect of antiviral therapy. AIDS Clinical Trial Group and Neurological AIDS Research Consortium study team. AIDS. 1999; 13 1677-1685
- 26 Raskino C, Pearson D A, Baker C J. et al . Neurologic, neurocognitive, and brain growth outcomes in human immunodeficiency virus-infected children receiving different nucleoside antiretroviral regimens. Pediatric AIDS Clinical Trials Group 152 Study Team. Pediatrics. 1999; 104 e32
- 27 Sacktor N C, Bacellar H, Hoover D R. et al . Psychomotor slowing in HIV infection: a predictor of dementia, AIDS, and death. J Neurovirol. 1996; 2 404-410
- 28 Sacktor N C, Lyles R H, Skolasky R L. et al . Combination antiretroviral therapy improves psychomotor speed performance in HIV-seropositive homosexual men. Multicenter AIDS Cohort Study (MACS). Neurology. 1999; 52 1640-1647
- 29 Sei S, Stewart S K, Farley M. et al . Evaluation of human immunodeficiency virus (HIV) type 1 RNA levels in cerebrospinal fluid and viral resistance to zidovudine in children with HIV encephalopathy. J Infect Dis. 1996; 174 1200-1206
- 30 Spector S A, Hsia K, Pratt D. et al . Virologic markers of human immunodeficiency virus type 1 in cerebrospinal fluid. The HIV Neurobehavioral Research Center Group. J Infect Dis. 1993; 168 68-74
- 31 Stern Y, McDermott M P, Albert S. et al . Factors associated with incident human immunodeficiency virus-dementia. Arch Neurol. 2001; 58 473-479
- 32 Tardieu M, Le Chenadec J, Persoz A, Meyer L, Blanche S, Mayaux M J. HIV-1-related encephalopathy in infants compared with children and adults. French Pediatric HIV Infection Study and the SEROCO Group. Neurology. 2000; 54 1089-1095
- 33 Tardieu M, Mayaux M J, Seibel N. et al . Cognitive assessment of school-age children infected with maternally transmitted human immunodeficiency virus type 1. J Pediatr. 1995; 126 375-379
- 34 Tozzi V, Balestra P, Galgani S. et al . Positive and sustained effects of highly active antiretroviral therapy on HIV-1-associated neurocognitive impairment. AIDS. 1999; 13 1889-1897
- 35 Tozzi V, Balestra P, Galgani S. et al . Changes in neurocognitive performance in a cohort of patients treated with haart for 3 years. J Acquir Immune Defic Syndr. 2001; 28 19-27
- 36 von Giesen H J, Hefter H, Jablonowski H, Arendt G. HAART is neuroprophylactic in HIV-1 infection. J Acquir Immune Defic Syndr. 2000; 23 380-385
- 37 von Giesen H J, Hefter H, Roick H, Mauss S, Arendt G. HIV-specific changes in the motor performance of HIV-positive intravenous drug abusers. J Neurol. 1994; 242 20-25
- 38 von Giesen H J, Koller H, Theisen A, Arendt G. Therapeutic effects of nonnucleoside reverse transcriptase inhibitors on the central nervous system in HIV-1-infected patients. J Acquir Immune Defic Syndr. 2002; 29 363-367
- 39 von Giesen H J, Wittsack H J, Wenserski F, Köller H, Hefter H, Arendt G. Basal ganglia metabolite abnormalities in HIV-1 associated minor motor deficits. Arch Neurol. 2001; 58 1281-1286
PD Dr. med. Hans-Jürgen von Giesen
Department of Neurology, Heinrich Heine University of Düsseldorf
Postfach 101007
40001 Düsseldorf
Germany
Email: giesenhj@uni-duesseldorf.de