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close this bookNational Guidelines for the Clinical Management of HIV/AIDS - Tanzania (NACP; 2005; 131 pages)
View the documentLIST OF ABBREVIATIONS
View the documentACKNOWLEDGEMENTS
View the documentFOREWORD
Open this folder and view contentsCHAPTER 1: INTRODUCTION
Open this folder and view contentsCHAPTER 2: ORGANIZATION OF HIV/AIDS CARE AND TREATMENT
Open this folder and view contentsCHAPTER 3: HIV/AIDS PREVENTION
Open this folder and view contentsCHAPTER 4: PROTECTIVE MEASURES AGAINST HIV TRANSMISSION
Open this folder and view contentsCHAPTER 5: LABORATORY TESTS IN HIV/AIDS
Open this folder and view contentsCHAPTER 6: HIV/AIDS AND PREGNANCY
close this folderCHAPTER 7: PEDIATRIC HIV/AIDS AND RELATED CONDITIONS
View the document7.1 Introduction
View the document7.2 HIV/AIDS Manifestations in Children
View the document7.3 Diagnosis of HIV infection in infants
View the document7.4 Management of infants born to HIV positive women
View the document7.5Care of HIV infected Children
close this folder7.6 Clinical manifestations of paediatric HIV infection
View the document7.6.1 Respiratory conditions in children with HIV infection
View the document7.6.2 Oro-pharyngeal candidiasis in children with HIV infection
View the document7.6.3 Neurologic problems in children with HIV infection
View the document7.6.4 Persistent generalised lymphadenopathy (PGL) in children
View the document7.6.5 Chronic parotitis
View the document7.6.6 Chronic Ear Infection
View the document7.6.7 Persistent or recurrent fever in children
View the document7.6.8 Persistent Diarrhoea
View the document7.6.9 Impaired growth in children with HIV infection
View the document7.6.10 Supportive therapy
View the document7.6.11 Pain control in terminally ill children
Open this folder and view contentsCHAPTER 8: COMMUNITY AND HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS (PLHA)
Open this folder and view contentsCHAPTER 9: COUNSELLING RELATED TO HIV-TESTING AND TREATMENT ADHERENCE
Open this folder and view contentsCHAPTER 10: MANAGEMENT OF COMMON SYMPTOMS AND OPPORTUNISTIC INFECTIONS IN HIV/AIDS
Open this folder and view contentsCHAPTER 11: MANAGEMENT OF MENTAL HEALTH PROBLEMS IN HIV/AIDS
Open this folder and view contentsCHAPTER 12: MANAGEMENT OF HIV INFECTED PATIENTS USING ANTIRETROVIRAL DRUGS
Open this folder and view contentsCHAPTER 13: ARV THERAPY IN INFANTS AND CHILDREN
Open this folder and view contentsCHAPTER 14: USE OF ARVS IN SPECIAL CIRCUMSTANCES
Open this folder and view contentsCHAPTER 15: HIV/AIDS AND NUTRITION
Open this folder and view contentsCHAPTER 16: MANAGEMENT OF ANTIRETROVIRAL MEDICINES
Open this folder and view contentsCHAPTER 17: CERTIFICATION OF HEALTHCARE FACILITIES AS CARE AND TREATMENT SITES
 

7.6.3 Neurologic problems in children with HIV infection

A careful history and physical examination is of particular importance as the management of acute episodes differs from that of progressive and static encephalopathy. The acute episode may be indicative of meningitis or encephalitis. A condition with gradual onset with slow progression may suggest a degenerative disorder. Appropriate investigations will need to be carried out to establish the diagnosis. Neurologic abnormalities in HIV infected children may include:

Acute episodes: Sudden development of fits, neck stiffness or irritation may occur and this may indicate opportunistic infection. Physical deficits such as hemiplegia, monoplegia or paraplegia may occur as a result of opportunistic infection of the brain and/or spinal cord.

Progressive encephalopathy: This is a slow but progressive reduction in motor and intellectual function beginning in the first year of life. There may be a delay or regression of developmental milestones, hypotonia, or microcephaly. Often children with neurologic problems may simply lose interest in their surroundings and have no interest in playing. Some children may lose learned language or social skills while others may show increased clumsiness. There may be a progressive decline in intellectual and behavioural function.

Static encephalopathy: A non-progressive mental impairment may occur. Neurologic deficits such as loss of milestones simply persist and the child is considered to be simply "slow" in everything.

Managing encephalopathy should include evaluating the child with the help of a neurologist, where possible. If nothing other than HIV is found, the treatment goal is to reduce viral load. Depending on the severity, the patient will need a support system, which includes physical therapy, a social worker, and surgery to minimize contractures

Peripheral neuropathy: Several types of peripheral neuropathy affecting single or multiple nerves have been documented (e.g. axonal neuropathy, demyelinated neuropathy, polyradiculopathy and radiculopathy). HIV related neuropathy occurs in as many as one third of patients with %CD4 <15; it presents with dysaesthesias and numbness in a "glove and stocking distribution".

Neuropathy in children is more difficult to diagnose and less well described than in adults. In fact some ARV’s can cause neropathy (eg stavudine, didanosine, and zalcitabine) which may necessitate changing the drug regimen

Pain associated with neuropathy may respond to analgesics combined with antidepressants (eg amitryptyliine) or anticonvulsants (eg carbamazepine)

Seizures

Seizures are common non specific manifestations of neurological illnesses associated with HIV. Seizures may be due to:

Space-occupying lesions (most often cerebral toxoplamosis or tuberculoma)

Meningitis

Metabolic disturbances

No identified cause other than HIV infection

Treatment is aimed at underlying disorder and seizure control through standard anti-epileptic medication. NB drug interactions may be a problem for patients on HAART; for those on HAART the drug of choice if sodium valproate

In patients presenting with focal seizures, treatment for toxoplasmosis should be considered if no other cause is apparent.

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