Saroj Bakshi

Central brain atrophy in childhood AIDS encephalopathy

OBJECTIVE To determine differential patterns of brain atrophy in pediatric AIDS encephalopathy. DESIGN We measured the bicaudate, bifrontal, and ventricle-brain ratio in brain magnetic resonance imaging scans of 42 control children, nine children with progressive AIDS encephalopathy, 25 AIDS children without progressive encephalopathy, and 23 children with cerebral atrophy of other causes. RESULTS When compared with controls, encephalopathy patients showed significantly increased bicaudate and ventricle-brain ratios, but no significant increase in bifrontal ratio, whereas children with brain atrophy from causes other than AIDS showed increases in all three ratios. CONCLUSION Children with AIDS encephalopathy demonstrate a specific pattern of brain atrophy distinct from other etiologies: a central atrophy, primarily affecting the subcortical white matter or the basal ganglia regions.

Reversible occipital-parietal encephalopathy syndrome in an HIV-infected child

A reversible syndrome of headache, altered mental status, seizures, and cerebral visual abnormalities has been described in adults and children with hypertension, eclampsia, treatment with cyclosporin after organ transplantation, and interferon therapy.1-5 Neuroradiologic studies suggest predominantly posterior white matter abnormalities. Therefore, the syndrome has been referred to as reversible posterior leukoencephalopathy (RPL). We present a child with AIDS and RPL. We suggest that the brain is affected in a more extensive way and that both gray and white matter are involved. Case report. We report a girl with perinatal HIV infection untreated with antiretroviral medications until her first admission at the age of 12 years with Pneumocystic carinii pneumonia and disseminated mycobacterium avium intracellularae. She was severely immunosuppressed (CD4 = 1%, absolute 10, viral load 28,890 RNA copies/mL). Neurologic, cognitive, and ophthalmologic examinations were normal. She was doing well academically. Brain CT demonstrated diffuse atrophy. Antiretroviral therapy was begun, with improvement of CD4 values and reduction in viral load to …

Possible linkage of amprenavir with intracranial bleeding in an HIV-infected hemophiliac

The use of protease Inhibitors (PI) has been associated with many adverse effects including increased tendency to bleed, which is particularly problematic in individuals with congenital coagulation disorders. We report the occurrence of spontaneous intracranial bleeding in an human immunodeficiency virus (HIV)-infected adolescent with hemophilia A who was receiving amprenavir (APV). The bleeding resolved on discontinuation of APV. This case report highlights a need for awareness of increased bleeding as a potentially serious complication associated with the use of all currently licensed PIs in individuals with hemophilia.

Chemokine pattern in relation to disease state in human immunodeficiency virus-infected children.

Although beta chemokines can block human immunodeficiency virus (HIV) entry into target cells, their role in HIV disease progression is controversial. To determine the association of RANTES with HIV disease state, we examined constitutive mRNA expression by reverse-transcribed polymerase chain reaction (RT-PCR) in peripheral blood mononuclear cells (PBMCs) and induction of RANTES secretion by enzyme-linked immunosorbent assay (ELISA) in anti-CD3 monoclonal antibody (MAb)-stimulated cultures of PBMCs, and in CD4+ and CD8+ T cell subsets of 17 HIV-infected children. In comparison with uninfected subjects, PBMCs of HIV-infected children were deficient in both constitutive RANTES mRNA expression as well as in stimulus-induced RANTES production. Children in clinical category C were found to be more deficient than children in clinical category A. Expression of RANTES mRNA in PMBCs was inversely correlated with plasma virus load and correlated directly with CD4+ T cell counts. In T cell subsets, RANTES production was equivalent between CD4+ and CD8+ T cells in patients and controls but CD8+ T cells of children in clinical category A produced higher RANTES levels than those of children in clinical category C. The beta-chemokine RANTES may play an important role in slowing clinical disease progression in HIV-infected children.