Cerebrovascular disease in HIV-infected pediatric patients: Neuroimaging findings

OBJECTIVE. The goal of our study was to report on the prevalence and the neuroradiologic manifestations of cerebrovascular complications in children infected with HIV. We also elucidate the types of vascular involvement, identify their anatomic distribution, and discuss possible causes. MATERIALS AND METHODS. We conducted a retrospective study of 567 patients (age range, 1 month-29 years; median age, 5.47 years) who acquired HIV as children. Of these, 426 patients (75%) were evaluated with neuroinraging studies. We reviewed these studies to identify the cerebrovascular abnormalities and classify them by type, anatomic location, and shape. RESULTS. Eleven children (2.6%) were found to have cerebrovascular lesions. Only one had focal neurologic symptoms at the time of diagnosis. Twenty-six aneurysms were found in seven patients, and 27 infarctions were found in eight patients. In four of the patients with infarctions, fusiform aneurysms of the cerebral arteries were also identified. Most patients had advanced HIV disease. Nine of the 11 patients were infected by a vertical transmission route or during blood transfusion early in the neonatal period. In this group of patients, the diagnosis of cerebrovascular disease was made earlier (mean age at diagnosis, 8.2 years) than in the two patients who were infected later in life (mean age at diagnosis, 14.9 years). CONCLUSION. HIV-infected children have an increased incidence of cerebrovascular disease that is associated with severe immune suppression and with vertically acquired HIV infection or exposure to the virus in the neonatal period. Despite extensive lesions, most children in our study were asymptomatic. Screening with MR imaging should be considered for high-risk children and is advisable when evidence of neurologic symptoms or neurocognitive dysfunction is noted.