title: Cerebral MR imaging in uninfected children born to HIV-seropositive mothers and perinatally exposed to zidovudine.
abstract: OBJECTIVE
  Mitochondrial dysfunction has been reported in HIV-negative children perinatally exposed to zidovudine, a drug often used in HIV-seropositive mothers during pregnancy. The purpose of this study was to determine the incidence of cerebral MR imaging findings in HIV-uninfected children exposed to zidovudine who present with unexplained neurologic symptoms.
  
  
  METHODS
  Two expert groups conducted a systematic, retrospective review of all cerebral MR images available in a multicentric, nationwide French prospective cohort of children born to HIV-seropositive mothers to identify imaging abnormalities. Experts were blinded to each others' interpretations, to the children's neurologic symptoms, and to laboratory evidence of mitochondrial dysfunction. The incidence of abnormalities was determined and compared with the neurologic presentation and laboratory evidence of mitochondrial dysfunction.
  
  
  RESULTS
  MR images from 49 HIV-uninfected children (mean age, 26 months) were available for study. All children were perinatally exposed to zidovudine. Twenty-two had probable or established mitochondrial dysfunction according to their symptoms and laboratory data. Twenty-seven children without mitochondrial dysfunction presented with unexplained neurologic symptoms (n = 14) or nonneurologic symptoms (n = 7), and six were asymptomatic. Sixteen of 22 MR images in children with mitochondriopathy were considered abnormal in both independent analyses. Diffuse hyperintensity in the supratentorial white matter (n = 9) and in the tegmentum pons (n = 9) were the most frequent anomalies. Imaging abnormalities were often multifocal (n = 10) and sometimes associated with necrotic areas (n = 3) and volume loss (n = 8). Although 19 of 27 MR images of children without mitochondrial dysfunction were mainly normal, abnormal images were observed in five of 14 children with unexplained neurologic symptoms and in three of six asymptomatic children.
  
  
  CONCLUSIONS
  Images observed in children with antiretroviral-induced mitochondrial dysfunction are similar to those observed in congenital mitochondrial diseases. These images were also observed in symptomatic or asymptomatic children without evidence of systemic mitochondrial dysfunction.
authors.affiliation: Department of Pediatric Neurology, Hôpital Bicêtre AP-HP, Le Kremlin Bicêtre.
authors.forename: Marc
authors.initials: M
authors.lastname: Tardieu
authors.forename: Francis
authors.initials: F
authors.lastname: Brunelle
authors.forename: Charles
authors.initials: C
authors.lastname: Raybaud
authors.forename: William
authors.initials: W
authors.lastname: Ball
authors.forename: Béatrice
authors.initials: B
authors.lastname: Barret
authors.forename: Brigitte
authors.initials: B
authors.lastname: Pautard
authors.forename: Eric
authors.initials: E
authors.lastname: Lachassine
authors.forename: Marie-Jeanne
authors.initials: MJ
authors.lastname: Mayaux
authors.forename: Stéphane
authors.initials: S
authors.lastname: Blanche
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects*; D001921:Brain / Q000473:pathology*; D002675:Child, Preschool; D005260:Female; D006679:HIV Seropositivity; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D017237:Mitochondrial Encephalomyopathies / Q000139:chemically induced* / Q000473:pathology*; D009035:Mothers; D010865:Pilot Projects; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced* / Q000473:pathology*; D012189:Retrospective Studies; D015215:Zidovudine / Q000009:adverse effects*
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine