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Neurobehavioral Manifestations of Symptomatic HIV-1 Disease in Children: Can Nutritional Factors Play a Role?¹

Pim Brouwers^*,2, Charles Decarli, Melvyn P. Heyes^**, Howard A. Moss^*,,, Pamela L. Wolters^*,,, Gareth Tudor-Williams^*, Lucy A. Civitello^*,, and Philip A. Pizzo^*

^* Pediatric Branch, National Cancer Institute Epilepsy Research Branch, National Institute of Neurological Disorders & Stroke ^** Laboratory of Clinical Sciences, National Institute of Mental Health, Bethesda, MD 20892 Medical Illness Counseling Center, Chevy Chase, MD 20814 Children's National Medical Center, Washington, DC 20010

Central nervous system (CNS) abnormalities are significant and frequent complications of human immunodeficiency virus (HIV-1) infection in infants and children. Although the predominant cause of neurological and neuropsychological abnormalities appears to be related to HIV infection of the CNS, other factors including malnutrition may also play a role. We retrospectively evaluated the association of change in body weight with changes in neurocognitive function, ventricular brain ratio, and cerebrospinal quinolinic acid levels in a small cohort of children (n=15; mean age 6.3 years) with symptomatic HIV-1 disease before and after 6 months of antiretroviral therapy with continuous intravenous infusion of zidovudine (ZVD). Significant increases in weight and neurocognitive function as well as decreases in ventricular brain ratio and cerebrospinal quinolinic acid levels were noted after therapy. Only the relation between increase in weight and decrease in ventricular brain ratio was statistically significant (P<.01); contrary to expectations, an increase in weight seemed to correlate with a decrease in neurocognitive function (NS). Another group of children treated at the same time with oral intermittent ZVD, but otherwise receiving the same care did not show the same magnitude of improvement in neurocognitive function. These results seem to suggest that general supportive and medical care as well as nutritional factors may only play a limited role in the neurocognitive improvements after antiretroviral therapy with continuous infusion ZVD. Our sample size was, however, small and the nutritional measure rather global; thus these findings have to be considered as very preliminary.

KEY WORDS: • human • encephalopathy • pediatric HIV-1 disease • brain imaging • neuropsychological test

¹ Presented at the workshop entitled "Nutrition in Pediatric HIV Infection: Setting the Research Agenda" held in Bethesda, MD on September 28–29, 1995. The workshop was sponsored by the Office of AIDS Research of the National Institutes of Health, The National Institute of Child Health and Human Development, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Mental Health, Food and Drug Administration, Pediatric AIDS Foundation, National Dairy Council, Sandoz Nutrition Corporation, Bistol-Meyers Squibb Company, Clintec Nutrition Company, Ross Products Division-Abbott Laboratories, Serono Laboratories, Inc., and the American Institute of Nutrition. Workshop proceedings are published as a supplement to The Journal of Nutrition. Guest Editors for this supplement publication were Daniel J. Raiten and John M. Talbolt, Life Sciences Research Office, Federation of American Societies for Experimental Biology, Bethesda, MD.

² To whom correspondence should be addressed: Dr. Pim Brouwers, Pediatric Branch, National Cancer Institute, NIH Clinical Cancer, Room 13N240, Bethesda, MD 20892-1928.