Page 416 - HIVMED_v21_i1.indb

Page 3 of 6 Original Research

illness other than HIV infection: (1) failure to attain or loss The WHO clinical staging at diagnosis of HIV infection was
of developmental milestones or loss of intellectual ability; available in the records for 46 children, with 4 (8%), 5 (10%),
(2) impaired brain growth or acquired microcephaly; or 26 (53%) and 11 (23%) children graded at stages 1, 2, 3 and 4,
(3) acquired symmetric motor deficit. 28 respectively. Staging data were missing in three (6%) children
(Table 1).
The intent of this study was to see how many children in
this cohort have epilepsy, even if it was not caused by the For children who developed epilepsy at the beginning of or
HIV infection. after initiating ART (n = 29; 59%), the median CD4 count was
591 cells/mm (range 15 cells/mm – 1980 cells/mm ), and
3
3
3
Absolute CD4 count and CD4%, baseline VL at the start of the mean VL was 782 768 copies/mL (range from lower than
ART, the VL between 6 and 12 months after initiating ART, detectable limit [LDL] to 10 000 000), at the time of diagnosis
the VL nearest to the diagnosis of epilepsy (for those of epilepsy.
diagnosed with epilepsy while on ART and where the value
was available within a window of 5 months before or after In nine of the 14 children (64%) who were diagnosed with
diagnosis) and VL at last available follow-up assessment epilepsy while already on ART, the VL was lower than
were retrieved. Neurological deficits and indicators of 800 copies/mL or undetectable at the time of epilepsy
developmental delay were also recorded, as well as reports diagnosis. In four (29%) children, VL was > 800 copies/mL at
of previous CNS infection. Prescribed antiepileptic drugs the time of diagnosis, with one child having no VL data
were also recorded. Clinical staging of HIV infection as available in the time period. In six (43%) children, the CD4
assessed by the attending doctor following the WHO percentage was < 25%, even though they had been on ART
guidelines were documented. for at least 7 months at the time of diagnosis of epilepsy. Five
(36%) children had CD4% > 25%, while CD4% data were not
Children attending the clinics were followed up at regular available for three (21%) of the children (Table 2).
3-monthly intervals (monthly for children with social
problems or adherence issues). About 74% (26/35) of the children who were diagnosed with
epilepsy before or at ART initiation had a VL that was below
Ethical consideration the limit of detection or below 800 copies/mL between 6 and
12 months after ART initiation, with only six (17% [6/35])
This article followed all ethical standards for a research having VL values > 800 copies/mL. In the group which
without direct contact with human or animal subjects. developed epilepsy at least 7 months after initiation of ART,
viral suppression was seen only in 57% (8/14). For three
Results children (9% [3/35]), no data were available.

Of the 2137 children with confirmed HIV infection enrolled
in the two clinics, 53 (2.5%) were diagnosed with epilepsy. Nineteen children (39%) were found to have a CNS infection,
Comprehensive medical records were available in 49 (92%) of mainly tuberculosis (n = 13), but also other bacterial
CNS infections. Three children were diagnosed with
the 53 patients. Only those children were included in neurocysticercosis. Eighteen per cent of the children were
this study. The age of the children ranged from 1 month to
12 years (median 4 years) at the time of diagnosis of epilepsy, TABLE 1: Clinical staging of HIV infected patients according the World Health
and 26 (53%) were boys. Organization guidelines at initiation of treatment.
WHO stage Number % of all Number of children % of group
of HIV of epileptic epileptic in clinic without
All children and infants with HIV infection and epilepsy infection children patients epilepsy
were initiated on ART during the study assessment period. 1 4 8 1688 81
Eighty-one per cent of the children were on first-line 2 5 10 84 4
treatment, which comprised abacavir, lamivudine and 3 26 53 230 11
lopinavir/ritonavir (n = 18) or efavirenz (n = 22), depending 4 Unknown 11 23 42 2 2
3
42
6
on the age of the child at initiation and the year of treatment WHO, World Health Organization; HIV, human immunodeficiency virus.
initiation. In 16 of the children, stavudine was replaced by
abacavir as part of the change in guidelines for first-line TABLE 2: Viral loads of patients at diagnosis of epilepsy OR at 6–12 months after
treatment. Four (8%) of the children were placed on initiation of antiretroviral therapy if diagnosis of epilepsy was made before
antiretroviral therapy initiation.
lamivudine-holding regimes, mostly for treatment failure VLs Patients’ VL at time Patients with diagnosis
of epilepsy at or before
because of non-compliance after extensive counselling of of diagnosis of epilepsy, initiation of HIV treatment,
max 5 months before or
the family. The others (11%) were started on second-line after (N = 14) VL at 6–12 months after ART
treatment following treatment guidelines. n % initiation (N = 35)
%
n
LDL or < 800 cps/mL 7 50 26 74
Antiretroviral therapy was started either after (20 patients; > 800 cps/mL 6 43 6 17
40%), at (15 patients; 31%) or before (14 patients; 29%) Unavailable 1 7 3 9
diagnosis of epilepsy. LDL, lower than detectable levels; HIV, human immunodeficiency virus; VLs, Viral loads.
http://www.sajhivmed.org.za 408 Open Access