Page 414 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 6 Original Research

Late diagnosis of human immunodeficiency virus

infection is linked to higher rates of epilepsy in

children in the Eastern Cape of South Africa

Authors: Background: Human immunodeficiency virus (HIV)-positive children may present with a
Isabel A. Michaelis 1 wide range of neurological disorders. Among these, epilepsy is of key concern because of its
Maryke Nielsen 2,3,4 lifelong impact and potential for damage to the central nervous system (CNS). Few studies in
Craig Carty 5
Markus Wolff developing regions have investigated the prevalence and aetiology of epilepsy in HIV-infected
6
Caroline A. Sabin 7 children as a key population.
John S. Lambert
8
Objectives: We describe the prevalence of epilepsy, associated neurological disabilities,
Affiliations: immunological status, clinical stage and history of CNS infection at epilepsy diagnosis in a
1 Department of Health, cohort of HIV-infected children receiving antiretroviral therapy (ART) in the Eastern Cape of
Faculty of Paediatrics, Walter South Africa.
Sisulu University, Mthatha,
South Africa Methods: We conducted a retrospective study (2004–2014) at two major referral sites for
HIV-infected children diagnosed with epilepsy aged 0–16 years. Eligible subjects were
2 Department of Paediatrics
and Child Health, Faculty of extracted from the electronic medicine bridging access to care in excellence (EMBRACE)
Infectious Disease, Malawi- Paediatric Cohort using the Paediatric ART Data Management Tool (PADMT). Fixed data
Liverpool-Wellcome Clinical fields were interrogated for exposures to antiepileptic drugs. Unstructured ‘comments’ fields
Research Facility, Blantyre, were searched for the terms: epilepsy, seizures, fits and szs, as well as abbreviated versions of
Malawi common antiepileptic drug names. Eligible subject folders were then retrieved to validate the
digital data.
3 Institute of Infection and
Global Health, Faculty of Results: From 2139 children enrolled in the two sites, 53 children were diagnosed with epilepsy
Clinical Infection, Immunology (2.48%). In these, the median CD4 count was 591 cells/mm , and the mean viral load was
3
and Microbiology, University
of Liverpool, Liverpool, 4.9 log copies/mL, with undetectable viral loads in only seven children (14.0%). World Health
United Kingdom Organization (WHO) clinical HIV stage was available for 46 patients of the sample, with 3, 6,
26 and 11 children graded at stages 1, 2, 3 and 4, respectively. Forty percent children had a
4 Department of Paediatrics, history of CNS infection prior to the epilepsy diagnosis, and 55% children were reported to
Queen Elizabeth Central have school problems.
Hospital, Blantyre, Malawi
Conclusions: In this descriptive study, the prevalence of epilepsy among children with HIV
5 Department of Evidence- was 2.48%, mostly diagnosed in advanced HIV-disease stages. Our findings support the
Based Social Intervention, usefulness of early detection and initiation of ART in HIV-infected children in order to reduce
Faculty of Sociology,
University of Oxford, the risk of epilepsy. In addition, our study demonstrates that novel techniques are effective in
Oxford, United Kingdom accessing cohort-level data that allow interrogation of both structured and unstructured
clinical data.
6 Department of
Neuropaediatrics and Social Keywords: epilepsy; HIV-infection; children; WHO staging; paediatric ART data
Paediatrics, Faculty of management tool.
Paediatrics, Vivantes Klinikum
Neukolln, Berlin, Germany
Introduction
7 Department of Medical
Statistics and Epidemiology, The latest World Health Organization (WHO) report on human immunodeficiency virus (HIV)
Faculty of Population Health and acquired immunodeficiency syndrome (AIDS) estimates that 3.2 million children are infected
Sciences, University College 1
London, London, United with HIV worldwide, of whom 91% are living in sub-Saharan Africa. South Africa is regarded as
Kingdom having the largest HIV and AIDS burden in the world, with an estimated 17.6% of the population
living with the disease; between 370 000 and 450 000 children younger than 14 years in South
Africa are thought to be infected with the virus. 1

8 Department of Infectious Diseases, Faculty of Infectious Diseases and Genitourinary Medicine, UCD School of Medicine, Dublin, Ireland
Read online: Corresponding author: Isabel Michaelis, [email protected]
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Scan this QR Dates: Received: 23 Nov. 2019 | Accepted: 07 Jan. 2020 | Published: 30 June 2020
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