COMPUTED TOMOGRAPHY ABNORMALITIES IN HIV PATIENTS WITH NEUROLOGICAL SYMPTOMS: WHEN DO WE NEED TO INVESTIGATE?

Background: 
HIV-1 is a neurotropic virus that invades the central nervous system (SNC) early in the course of infection. Children are more vulnerable to neurological and neurodevelopmental complications of HIV. 

Our aim was to evaluate the tomographic findings of children and adolescents living with HIV-AIDS that had neurological symptoms and identify risk factors for having an abnormal exam in HIV patients with headache.

Methods: 
We reviewed the medical records of 86 pediatric patients living with HIV-AIDS followed in a tertiary hospital in São Paulo, Brazil. We selected the patients who had neurological signs or symptoms and had at least one computed tomography scan (CT) of the brain during follow-up. 

We collected demographic data (sex, age when the CTs were performed), clinical and immunological classification and information about neurological development.

Results: 
One third (n=29; 62% females, age 5 months to 17 years) of our patients had neurological symptoms that lead to a CT scan. 

Fifteen patients had abnormal CTs (white matter abnormalities n=6; other congenital infections n=4; ischemic injuries n=2; vascular abnormalities n=1; calcifications n=1; neurotoxoplasmosis n=1). 

Delay in neurodevelopment was the most common symptom (67,8%). Abnormal CT was present in 57.9% of these patients versus 11% in children with normal neurodevelopment (p=0,039). All patients (n=6) with normal CD4 count and headache as the only neurological symptom had no CT abnormalities.

Conclusions:
Neurodevelopmental delay was the most common neurological symptom in our casuistic and was frequently associated with structural abnormalities of the SNC.

Our findings suggest that it is reasonable not to perform CTs in patients with headache as only symptom with normal neurological exam and adequate CD4 count. Further studies are needed to evaluate the indications of CT in children with HIV.