Distal Sensory Polyneuropathy in a Cohort of HIV-Infected Children Over Five Years of Age

Abstract

ABSTRACT. Background. Peripheral neuropathy in children with human immunodeficiency virus (HIV) infection has not been systematically studied.Objectives. To describe the symptoms and signs of peripheral neuropathy in HIV-infected children and to determine their frequency.Methods. A cross-sectional study was conducted on a convenience sample from a cohort of children older than 5 years of age at the pediatric HIV outpatient clinic of the Federal University of Rio de Janeiro. Those patients were interviewed and examined systematically for peripheral nerve symptoms and signs.Results. A total of 39 patients were clinically evaluated. Their ages ranged from 5 to 14 years, and 13 patients (34%) had symptoms and signs of peripheral nerve involvement. Distal paresthesia and/or pain plus diminished ankle jerks and/or diminished vibration sense were the most common clinical findings. Symptoms were chronic and fluctuating, and pain was, in general, not severe. Nerve conduction studies primarily revealed axonal changes.Conclusions. Peripheral neuropathy occurs in one third of HIV-infected children, and, in general, has less severe features than the distal sensory polyneuropathy described in adults. Pediatrics 2000;106(3). URL: http:// www.pediatrics.org/cgi/content/full/106/3/e35; peripheral neuropathy, human immunodeficiency virus, children.ABBREVIATIONS. HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; CDC, Centers for Disease Control and Prevention; ddI, dideoxyinosine. W orldwide, children are still becoming infected with the human immunodeficiency virus (HIV). 1 Although pediatric acquired immunodeficiency syndrome (AIDS) cases have been reported since 1983 2,3 and, soon after, many authors started to highlight the central nervous system involvement in the course of the disease, 4,5 little is known concerning these patients' peripheral nervous system status. 6,7 Peripheral neuropathy is common in HIV-infected adults, 8 -10 either related to the disease or to its treatment. It may present as inflammatory demyelinating polyneuropathy, mononeuropathy, mononeuritis multiplex, polyradiculopathy, subclinical neuropathy, or, more frequently, as distal sensory polyneuropathy.In 1991, Raphael et al 6 reported the case of a 5-year-old boy with AIDS who had developed an inflammatory demyelinating polyneuropathy. In 1997, Floeter et al 7 described the electrophysiologic data of 50 HIV-infected patients under 18 years of age referred for evaluation of suspected neuropathy. A variety of abnormalities were described, including a probable distal sensory axonal neuropathy in 7 of the oldest children. Although biased by referral, this study suggested that at least some children eventually do develop peripheral neuropathy.The epidemiology of HIV infection is evolving. More children are becoming infected, and attributable to better management strategies, they are surviving longer. The paucity of reports on peripheral neuropathy in HIV-infected children may reflect agerelated differences in regenerative capacit...

CD8+ Lymphocyte-Mediated Injury of Dorsal Root Ganglion Neurons during Lentivirus Infection: CD154-Dependent Cell Contact Neurotoxicity

“…Damage to small-diameter axons in peripheral nerves and DRG neurons are the hallmarks of HIV-1 associated DSP (Bradley et al, 1998;Araujo et al, 2000). Nonetheless, little is known about the contribution of infiltrating lymphocytes in terms of neuronal injury in DRGs of HIV-infected patients with DSP.…”

Malnutrition Associated With Increased Risk of Peripheral Neuropathy in Peruvian Children With HIV Infection

“…11,12 The higher prevalence reported in the Brazilian study may be partially explained by their case definition; if children with both symptoms and electromography evidence of DSPN in the lower limbs are included, then only 18% (7 of 39) met criteria for DSPN. Our study used diagnostic criteria recommended by AAN and AAEM experts, and included a combination of symptoms, neurologic examination, and electrophysiologic criteria to provide a more specific diagnosis of DSPN.…”

Cutaneous silent period in human immunodeficiency virus‐related peripheral neuropathy

“…Patients with DSP display a broad spectrum of PNS impairment, ranging from degeneration of long axons ( Pardo et al, 2001 ) and dorsal root ganglia ( Bradley et al, 1998 ) to damage of the gracile tracts ( Rance et al, 1988 ) and both myelinated and unmyelinated fibres ( Araujo et al, 2000 ) .…”