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Acquired immunodeficiency syndrome by vertical transmission: neurological disorders
INTRODUCTION. Forty million people are currently infected by HIV; of these, 50% are women and children. Vertical transmission occurs in 90% of the cases reported in the literature and was also observed by the authors of the present study at Hospital de Clínicas de Porto Alegre, Brazil, in the follow-up of 340 HIV-positive children since 1985. Transmission can occur during pregnancy (intrauterine) or during labor and delivery (intrapartum). In addition, HIV has been identified in the breast milk of infected mothers, which represents a contraindication for breastfeeding in these cases. Laboratory diagnosis is carried out using the following tests: ELISA, Western-blot, and indirect immunofluorescence. DEVELOPMENT. Neurological manifestations in children may be divided into primary neurological diseases and secondary complications. Primary neurological diseases include both static encephalopathy, of slow evolution, and progressive encephalopathy, which affects neuropsychomotor development. The follow-up of 340 children with AIDS showed encephalopathy in 32.5% of cases and delayed neuropsychomotor development in 42.5%. Opportunistic infections occurred in 33.8% of cases (one infant presented meningoencephalitis caused by Trypanosoma cruzi). One child presented lymphomas, 2.6% had cerebrovascular accidents, and 5% had peripheral neuropathies. Currently, 54 children of those followed since birth have over 10 years of age, and of these, 31 (57%) present neurological symptoms –40% with encephalopathy and 30% with neurological complications; the remaining children present educational, behavioral, and developmental difficulties.
CONCLUSIONS. Several factors have influenced the natural history of AIDS in childhood, such as early diagnosis, drug regimen used, social, economic, and nutritional conditions, as well as health practices aimed at this population.