Neuropediatrics 2003; 34(4): 177-181
DOI: 10.1055/s-2003-42205
Original Article

Georg Thieme Verlag Stuttgart · New York

Delayed Motor Learning and Psychomotor Slowing in HIV-Infected Children

H. J. von Giesen 1 , T. Niehues 2 , J. Reumel 1 , B. A. Haslinger 1 , J. Ndagijimana 2 , G. Arendt 1
  • 1Department of Neurology, Heinrich Heine University Düsseldorf, Germany
  • 2Department of Paediatrics, Heinrich Heine University Düsseldorf, Germany
Further Information

Publication History

Received: February 17, 2003

Accepted after Revision: May 15, 2003

Publication Date:
15 September 2003 (online)

Abstract

Objective

To find out whether HIV-associated subclinical psychomotor slowing is present in HIV-infected children despite effective highly active antiretroviral therapy (HAART).

Patients and Methods

An electrophysiological motor test battery shown to sensitively describe HIV-associated CNS disease in adults (tremor peak frequency []TPF], most rapid alternating movements [MRAM], reaction time [RT] and contraction time [CT]) was performed in 17 HIV seropositive (+) right-handed children. Results were compared to 16 HIV seronegative (-) children.

Results

HIV (-) children showed slower frequencies (TPF, MRAM) and longer RT and CT than (-) adults. They showed a significant correlation (p = 0.0263) between RT (right = dominant hand) and age. HIV (+) children showed significant prolongations of RT (right hand) and CT (both hands) compared to HIV (-) children. RT right hand did not accelerate with age in HIV (+) children. CT were significantly prolonged in 10 children with detectable HIV plasma viral burden and normal in 7 children with no detectable HIV plasma viral load. There was no correlation between CT and CD 4 cell counts.

Conclusions

Despite effective HAART, electrophysiological motor testing in HIV (+) children reveals significant subclinical CNS dysfunction, especially in children with insufficient viral load suppression.

References

  • 1 Arendt G, Hefter H, Buescher L, Hilperath F, Elsing C, Freund H J. Improvement of motor performance of HIV-positive patients under AZT therapy.  Neurology. 1992;  42 891-896
  • 2 Arendt G, Hefter H, Elsing C, Strohmeyer G, Freund H J. Motor dysfunction in HIV-infected patients without clinically detectable central-nervous deficit.  J Neurol. 1990;  237 362-368
  • 3 Arendt G, Hefter H, Hilperath F, von Giesen H J, Strohmeyer G, Freund H J. Motor analysis predicts progression in HIV-associated brain disease.  J Neurol Sci. 1994;  123 180-185
  • 4 Aylward E H, Henderer J D, McArthur J C. et al . Reduced basal ganglia volume in HIV-1-associated dementia: Results from quantitative neuroimaging.  Neurology. 1993;  43 2099-2104
  • 5 Belman A L, Diamond G, Dickson D. et al . Pediatric acquired immunodeficiency syndrome. Neurologic syndromes.  Am J Dis Child. 1988;  142 29-35
  • 6 Belman A L, Lantos G, Horoupian D. et al . AIDS: calcification of the basal ganglia in infants and children.  Neurology. 1986;  36 1192-1199
  • 7 Berger J R, Arendt G. HIV dementia: the role of the basal ganglia and dopaminergic systems.  J Psychopharmacol. 2000;  14 214-221
  • 8 Berger J R, Nath A. HIV dementia and the basal ganglia.  Intervirology. 1997;  40 122-131
  • 9 Blanche S, Tardieu M, Duliege A. et al . Longitudinal study of 94 symptomatic infants with perinatally acquired human immunodeficiency virus infection. Evidence for a bimodal expression of clinical and biological symptoms.  Am J Dis Child. 1990;  144 1210-1215
  • 10 Blanchette N, Smith M L, Fernandes-Penney A, King S, Read S. Cognitive and motor development in children with vertically transmitted HIV infection.  Brain Cogn. 2001;  46 50-53
  • 11 Cooper E R, Hanson C, Diaz C. et al . Encephalopathy and progression of human immunodeficiency virus disease in a cohort of children with perinatally acquired human immunodeficiency virus infection. Women and Infants Transmission Study Group.  J Pediatr. 1998;  132 808-812
  • 12 de Martino M, Tovo P A, Balducci M. et al . Reduction in mortality with availability of antiretroviral therapy for children with perinatal HIV-1 infection. Italian Register for HIV Infection in Children and the Italian National AIDS Registry.  JAMA. 2000;  284 190-197
  • 13 Dickson D W, Llena J F, Nelson S J, Weidenheim K M. Central nervous system pathology in pediatric AIDS.  Ann N Y Acad Sci. 1993;  693 93-106
  • 14 Epstein L G, Sharer L R, Joshi V V, Fojas M M, Koenigsberger M R, Oleske J M. Progressive encephalopathy in children with Acquired Immune Deficiency Syndrome.  Ann Neurol. 1985;  17 488-496
  • 15 Epstein L G, Sharer L R, Oleske J M. et al . Neurologic manifestations of human immunodeficiency virus infection in children.  Pediatrics. 1986;  78 678-687
  • 16 Fowler M G. Pediatric HIV infection: neurologic and neuro-psychologic findings.  Acta Paediatr. 1994;  400 (Suppl) 59-62
  • 17 Gavin P, Yogev R. Central nervous system abnormalities in pediatric human immunodeficiency virus infection.  Pediatr Neurosurg. 1999;  31 115-123
  • 18 Gortmaker S L, Hughes M, Cervia J. et al . Effect of combination therapy including protease inhibitors on mortality among children and adolescents infected with HIV-1.  N Engl J Med. 2001;  345 1522-1528
  • 19 Janssen R S, Cornblath D R, Epstein L G. et al . Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus-type 1 (HIV-1) infection.  Neurology. 1991;  41 778-785
  • 20 McCoig C, Castrejon M M, Castano E. et al . Effect of combination antiretroviral therapy on cerebrospinal fluid HIV RNA, HIV resistance, and clinical manifestations of encephalopathy.  J Pediatr. 2002;  141 36-44
  • 21 Mintz M, Epstein L G. Neurologic manifestations of pediatric acquired immunodeficiency syndrome: clinical features and therapeutic approaches.  Semin Neurol. 1992;  12 51-56
  • 22 Mintz M, Tardieu M, Hoyt L. et al . Levodopa therapy improves motor function in HIV-infected children with extrapyramidal syndromes.  Neurology. 1996;  47 1583-1585
  • 23 Palella Jr F J, Delaney K M, Moorman A C. et al . Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection.  N Engl J Med. 1998;  338 853-860
  • 24 Parks R A, Danoff J V. Motor performance changes in children testing positive for HIV over 2 years.  Am J Occup Ther. 1999;  53 524-528
  • 25 Price R W, Yiannoutsos C T, Clifford D B. et al . Neurological outcomes in late HIV infection: adverse impact of neurological impairment on survival and protective effect of antiviral therapy. AIDS Clinical Trial Group and Neurological AIDS Research Consortium study team.  AIDS. 1999;  13 1677-1685
  • 26 Raskino C, Pearson D A, Baker C J. et al . Neurologic, neurocognitive, and brain growth outcomes in human immunodeficiency virus-infected children receiving different nucleoside antiretroviral regimens. Pediatric AIDS Clinical Trials Group 152 Study Team.  Pediatrics. 1999;  104 e32
  • 27 Sacktor N C, Bacellar H, Hoover D R. et al . Psychomotor slowing in HIV infection: a predictor of dementia, AIDS, and death.  J Neurovirol. 1996;  2 404-410
  • 28 Sacktor N C, Lyles R H, Skolasky R L. et al . Combination antiretroviral therapy improves psychomotor speed performance in HIV-seropositive homosexual men. Multicenter AIDS Cohort Study (MACS).  Neurology. 1999;  52 1640-1647
  • 29 Sei S, Stewart S K, Farley M. et al . Evaluation of human immunodeficiency virus (HIV) type 1 RNA levels in cerebrospinal fluid and viral resistance to zidovudine in children with HIV encephalopathy.  J Infect Dis. 1996;  174 1200-1206
  • 30 Spector S A, Hsia K, Pratt D. et al . Virologic markers of human immunodeficiency virus type 1 in cerebrospinal fluid. The HIV Neurobehavioral Research Center Group.  J Infect Dis. 1993;  168 68-74
  • 31 Stern Y, McDermott M P, Albert S. et al . Factors associated with incident human immunodeficiency virus-dementia.  Arch Neurol. 2001;  58 473-479
  • 32 Tardieu M, Le Chenadec J, Persoz A, Meyer L, Blanche S, Mayaux M J. HIV-1-related encephalopathy in infants compared with children and adults. French Pediatric HIV Infection Study and the SEROCO Group.  Neurology. 2000;  54 1089-1095
  • 33 Tardieu M, Mayaux M J, Seibel N. et al . Cognitive assessment of school-age children infected with maternally transmitted human immunodeficiency virus type 1.  J Pediatr. 1995;  126 375-379
  • 34 Tozzi V, Balestra P, Galgani S. et al . Positive and sustained effects of highly active antiretroviral therapy on HIV-1-associated neurocognitive impairment.  AIDS. 1999;  13 1889-1897
  • 35 Tozzi V, Balestra P, Galgani S. et al . Changes in neurocognitive performance in a cohort of patients treated with haart for 3 years.  J Acquir Immune Defic Syndr. 2001;  28 19-27
  • 36 von Giesen H J, Hefter H, Jablonowski H, Arendt G. HAART is neuroprophylactic in HIV-1 infection.  J Acquir Immune Defic Syndr. 2000;  23 380-385
  • 37 von Giesen H J, Hefter H, Roick H, Mauss S, Arendt G. HIV-specific changes in the motor performance of HIV-positive intravenous drug abusers.  J Neurol. 1994;  242 20-25
  • 38 von Giesen H J, Koller H, Theisen A, Arendt G. Therapeutic effects of nonnucleoside reverse transcriptase inhibitors on the central nervous system in HIV-1-infected patients.  J Acquir Immune Defic Syndr. 2002;  29 363-367
  • 39 von Giesen H J, Wittsack H J, Wenserski F, Köller H, Hefter H, Arendt G. Basal ganglia metabolite abnormalities in HIV-1 associated minor motor deficits.  Arch Neurol. 2001;  58 1281-1286

PD Dr. med. Hans-Jürgen von Giesen

Department of Neurology, Heinrich Heine University of Düsseldorf

Postfach 101007

40001 Düsseldorf

Germany

Email: giesenhj@uni-duesseldorf.de

    >