TABLE 10.
Complications and Problems in Perinatally Infected Children and Youth Receiving Effective cART [49]
| Body System | Problem/Complication | Description |
|---|---|---|
| Neurocognitive | Learning/cognitive impairment, attention disorders, behavioral problems and mental illness | Common, likely multifactorial. |
| Neurologic | Peripheral neuropathy | Was more common with certain drugs (stavudine, didanosine) no longer commonly used. |
| Static encephalopathy | Residual effects of encephalopathy and/or strokes that occurred before effective cART | |
| Growth & Nutrition | Short stature | Early cART improves growth but cannot fully correct years of poor linear growth if effective cART started late. |
| Lipoatrophy | Subcutaneous fat loss in face, extremities, and buttocks; especially related to stavudine use. May not normalize after stavudine discontinued. | |
| Lipohypertrophy | Excessive central fat deposition in abdomen, breasts, dorsocervical “buffalo hump”. May be related to HIV and/or to certain ARVs. | |
| Cardiovascular risk factors | Dyslipidemia, insulin resistance | Especially related to ARV drugs (protease inhibitors, some NRTIs) |
| Chronic inflammation | Evidence of persistent multifactorial inflammation and immune activation despite early and prolonged effective cART. | |
| Pulmonary | Chronic lung disease | Bronchiectasis and other chronic lung changes from precART LIP and repeated infections. |
| Asthma | May be related to incomplete immune system normalization despite effective cART | |
| Renal | Renal failure | Frank renal failure uncommon with cART; ARV-related tubulopathy and glomerulopathy; multifactorial progressive loss of renal function. |
| Hepatic | Liver inflammation/damage | Related to ARV, concomitant viral hepatitis |
| Bone | Low bone mineral density; Bone fragility | Multifactorial including certain ARVs (Tenofovir) and traditional (nonHIV) risk factors for poor bone health |
| Reproductive health | Anogenital HPV-related dysplasia/malignancy | Not clear how much this risk is attenuated by effective cART |
| Malignancy | Overall higher rate | |
| Hematologic | Anemia | Multifactorial including ARV related (zidovudine) |
| Neutropenia | Multifactorial including ARV related (zidovudine) | |
| Mitochondrial function | Lactic acidosis and other manifestations | Thought due to inhibition of mitochondrial DNA synthesis, especially by stavudine and didanosine. Manifestations highly variable: asymptomatic lactate elevation; fatigue, weakness, myalgias, abdominal pain, and dyspnea; to severe multi-organ involvement. Implicated in peripheral neuropathy, cardiomyopathy, and neurotoxicity. |
See Chapter 113, Siberry GK and Hazra R. Management of HIV Infection, in Principles and Practice of Pediatric Infectious Diseases, 4th ed., Long SS, Pickering LK and Prober CG, eds. Elsevier Saunders, 2011, Philadelphia.