title: White matter signal abnormalities in children with suspected HIV-related neurologic disease on early combination antiretroviral therapy.
abstract: BACKGROUND
  The natural history and manifestation of HIV-related neurologic disease have been ameliorated by combination antiretroviral therapy (ART). We describe the characteristics of white matter signal abnormalities (WMSA) on magnetic resonance imaging in children with HIV-related neurologic disease.
  
  
  METHODS
  We reviewed magnetic resonance imaging scans of children with suspected HIV-related neurologic disease despite early ART and correlated with clinical, neurodevelopmental data, virologic markers and time on ART. These children were also on the Children with HIV Early Antiretroviral (CHER) trial.
  
  
  RESULTS
  Magnetic resonance imaging scans were performed at a mean age 31.9 months (range 8-54) on 44 children: 10 on deferred and 34 on early treatment arms, commencing ART at mean age of 18.5 and 8 weeks, respectively. Multiple high signal intensity lesions on T2/fluid attenuated inversion recovery were documented in 22 patients (50%), predominantly in frontal (91%) and parietal (82%) white matter. No differences in neurodevelopmental scores comparing children with and without WMSA were found. Neither lesion load nor distribution showed significant correlation with neurodevelopmental scores or neurologic examination. Normal head growth was more common in the WMSA group (P = 0.01). There was a trend for association of WMSA and longer time on ART (P = 0.13) and nadir CD4% (P = 0.08).
  
  
  CONCLUSIONS
  Half of children referred with HIV-related brain disease had WMSA on T2/fluid attenuated inversion recovery. Our findings of the association with normal head growth and duration of ART require further study. We suspect that WMSA can occur early and that initiating ART by 8 weeks of life may be too late to prevent HIV from entering the central nervous system.
authors.affiliation: From the *Department of Radiology, Stellenbosch University, Tygerberg; †Department of Radiology, University of Witwatersrand, Johannesburg, Gauteng; ‡Children's Infectious Diseases Clinical Research Unit, Stellenbosch University; §Tygerberg Children's Hospital; ¶Centre for Statistical Consultation and ‖Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Cape Town, South Africa.
authors.forename: Christelle
authors.initials: C
authors.lastname: Ackermann
authors.forename: Savvas
authors.initials: S
authors.lastname: Andronikou
authors.forename: Barbara
authors.initials: B
authors.lastname: Laughton
authors.forename: Martin
authors.initials: M
authors.lastname: Kidd
authors.forename: Els
authors.initials: E
authors.lastname: Dobbels
authors.forename: Steve
authors.initials: S
authors.lastname: Innes
authors.forename: Ronald
authors.initials: R
authors.lastname: van Toorn
authors.forename: Mark
authors.initials: M
authors.lastname: Cotton
mesh_terms: D015526:AIDS Dementia Complex / Q000188:drug therapy* / Q000503:physiopathology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001921:Brain / Q000503:physiopathology; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D056784:Leukoencephalopathies / Q000503:physiopathology / Q000821:virology*; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D013019:South Africa
chemical_list: D044966:Anti-Retroviral Agents