AIDS virus

Abstract

HIV affects both the central and peripheral nervous systems, resulting in a wide range of neurological complications due to direct viral effects, chronic inflammation, opportunistic infections, and adverse effects of antiretroviral therapy (ART), collectively referred to as neuroAIDS. In children, the underdeveloped blood-brain barrier heightens the vulnerability of the brain to neuroAIDS, impacting cognitive and motor development. Even HIV-exposed, uninfected children exhibit neurodevelopmental delays.

Chronic infection leads to a sustained viral presence in the cerebrospinal fluid, resulting in neuroinflammation. HIV encephalopathy (HIVE) remains a major concern, causing developmental regression, cognitive impairment, and motor dysfunction. Although the prevalence of HIVE has declined with the advent of combination antiretroviral therapy, rates remain high in low-resource settings.

Opportunistic infections such as tuberculous meningitis, viral encephalitis, and fungal infections are prevalent among children with HIV-AIDS. Children with HIV are also at risk for cerebrovascular diseases, neurocognitive impairments, and neuropsychiatric conditions such as mood disorders and high-risk behaviors. Epilepsy and peripheral neuropathy are more common in children with HIV, with ART regimens sometimes contributing to neuropathy.

Early ART initiation remains crucial in improving neurodevelopmental outcomes. Careful drug selection and adequate treatment of opportunistic infections before ART initiation are important to prevent drug-drug interactions and immune reconstitution inflammatory syndrome, respectively. While treatment progress has improved neurological outcomes, disparities in access to healthcare continue to impact children in resource-limited settings.