Early Antiretroviral Therapy Is Protective Against Epilepsy in Children With Human Immunodeficiency Virus Infection in Botswana

被引:18
作者
Bearden, David [1 ,2 ,3 ]
Steenhoff, Andrew P. [2 ,4 ]
Dlugos, Dennis J. [1 ]
Kolson, Dennis [5 ]
Mehta, Parth [6 ,7 ]
Kessler, Sudha [1 ,3 ]
Lowenthal, Elizabeth [2 ,3 ,8 ]
Monokwane, Baphaleng [9 ]
Anabwani, Gabriel [10 ]
Bisson, Gregory P. [2 ,3 ,11 ]
机构
[1] Childrens Hosp Philadelphia, Div Neurol, Philadelphia, PA 19104 USA
[2] Botswana UPenn Partnership, Philadelphia, PA USA
[3] Univ Penn, Perelman Sch Med, Ctr Clin Epidemiol & Biostat, Philadelphia, PA 19104 USA
[4] Childrens Hosp Philadelphia, Div Infect Dis, Philadelphia, PA 19104 USA
[5] Hosp Univ Penn, Perelman Sch Med, Div Neurol, Philadelphia, PA 19104 USA
[6] Baylor Coll Med, Texas Childrens Canc Ctr, Houston, TX 77030 USA
[7] Baylor Coll Med, Hematol Ctr, Houston, TX 77030 USA
[8] Childrens Hosp Philadelphia, Dept Pediat, Philadelphia, PA 19104 USA
[9] Univ Botswana, Dept Pediat, Gaborone, Botswana
[10] Botswana Baylor Childrens Clin Ctr Excellence, Gaborone, Botswana
[11] Hosp Univ Penn, Perelman Sch Med, Div Infect Dis, Philadelphia, PA 19104 USA
关键词
epilepsy; seizures; HIV; pediatric; Botswana; antiretroviral therapy; highly active; NEW-ONSET SEIZURES; HIV; INITIATION; AGE;
D O I
10.1097/QAI.0000000000000563
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: Seizures are common among patients with HIV/AIDS in the developing world and are associated with significant morbidity and mortality. Early treatment with combination anti-retroviral therapy (cART) may reduce this risk by decreasing rates of central nervous system infections and HIV encephalopathy. Methods: A case-control study of new-onset epilepsy among children aged 0-18 years with perinatally acquired HIV/AIDS followed in Gaborone, Botswana, during the period 2003-2009 was conducted. Children with epilepsy were identified and compared with age-and sex-matched controls without epilepsy with respect to timing of cART initiation. Early treatment was defined as treatment with cART before the age of 12 months, at a CD4% of greater than 25 in children aged 1-5 years, or at an absolute CD4 count of >350 cell per cubic millimeter in children aged 5 years and older. Results: We identified 29 cases of new-onset epilepsy and 58 age- and sex-matched controls. The most common identified etiologies for epilepsy were central nervous system infections and direct HIV neurotoxicity. Only 8 (28%) of the children who developed epilepsy received early treatment compared with 31 (53%) controls (odds effect was primarily driven by differences in rates of epilepsy among children who initiated treatment with cART between the ages of 1 and 5 years (11% vs. 53%, odds ratio: 0.11, 95% confidence interval: 0.01 to 1.1, P = 0.06). Conclusions: Earlier initiation of cART may be protective against epilepsy in children with HIV.
引用
收藏
页码:193 / 199
页数:7
相关论文
共 28 条
[1]  
[Anonymous], COCHRANE DATABASE SY
[2]   Current issues in the management of epilepsy: The impact of frequent seizures on cost of illness, quality of life, and mortality [J].
Baker, GA ;
Nashef, L ;
vanHout, BA .
EPILEPSIA, 1997, 38 :S1-S8
[3]   Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009 [J].
Berg, Anne T. ;
Berkovic, Samuel F. ;
Brodie, Martin J. ;
Buchhalter, Jeffrey ;
Cross, J. Helen ;
Boas, Walter van Emde ;
Engel, Jerome ;
French, Jacqueline ;
Glauser, Tracy A. ;
Mathern, Gary W. ;
Moshe, Solomon L. ;
Nordli, Douglas ;
Plouin, Perrine ;
Scheffer, Ingrid E. .
EPILEPSIA, 2010, 51 (04) :676-685
[4]   Immediate antiretroviral therapy in young HIV-infected children: benefits and risks [J].
Collins, Intira J. ;
Judd, Ali ;
Gibb, Diana M. .
CURRENT OPINION IN HIV AND AIDS, 2014, 9 (01) :87-94
[5]   Early time-limited antiretroviral therapy versus deferred therapy in South African infants infected with HIV: results from the children with HIV early antiretroviral (CHER) randomised trial [J].
Cotton, Mark F. ;
Violari, Avy ;
Otwombe, Kennedy ;
Panchia, Ravindre ;
Dobbels, Els ;
Rabie, Helena ;
Josipovic, Deirdre ;
Liberty, Afaaf ;
Lazarus, Erica ;
Innes, Steve ;
van Rensburg, Anita Janse ;
Pelser, Wilma ;
Truter, Handre ;
Madhi, Shabir A. ;
Handelsman, Edward ;
Jean-Philippe, Patrick ;
McIntyre, James A. ;
Gibb, Diana M. ;
Babiker, Abdel G. .
LANCET, 2013, 382 (9904) :1555-1563
[6]   The 2013 WHO guidelines for antiretroviral therapy: evidence-based recommendations to face new epidemic realities [J].
Doherty, Meg ;
Ford, Nathan ;
Vitoria, Marco ;
Weiler, Gundo ;
Hirnschall, Gottfried .
CURRENT OPINION IN HIV AND AIDS, 2013, 8 (06) :528-534
[7]   Global Policy Review of Antiretroviral Therapy Eligibility Criteria for Treatment and Prevention of HIV and Tuberculosis in Adults, Pregnant Women, and Serodiscordant Couples [J].
Gupta, Somya ;
Granich, Reuben ;
Suthar, Amitabh B. ;
Smyth, Caoimhe ;
Baggaley, Rachel ;
Sculier, Delphine ;
Date, Anand ;
Desai, Mitesh A. ;
Lule, Frank ;
Raizes, Elliot ;
Blanc, Leopold ;
Hirnschall, Gottfried .
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 2013, 62 (03) :E87-E97
[8]  
JANSSEN RS, 1991, NEUROLOGY, V41, P778
[9]   The Validity and Reliability of Characterizing Epilepsy Based on an External Review of Medical Records [J].
Kang, Bong Su ;
Cheong, Hae-Kwan ;
Jung, Ki-Young ;
Jang, Sang Hyeon ;
Yoo, Jae Kook ;
Kim, Dong Wook ;
Chung, Soo-Eun ;
Lee, Seo-Young .
EPIDEMIOLOGY AND HEALTH, 2013, 35
[10]   Frequency of seizures and epilepsy in neurological HIV-infected patients [J].
Kellinghaus, C. ;
Engbring, C. ;
Kovac, S. ;
Moeddel, G. ;
Boesebecka, F. ;
Fischera, M. ;
Anneken, K. ;
Kloenne, K. ;
Reichelt, D. ;
Evers, S. ;
Husstedt, I. W. .
SEIZURE-EUROPEAN JOURNAL OF EPILEPSY, 2008, 17 (01) :27-33