Paediatric HIV encephalopathy in sub-Saharan Africa

Background: HIV/AIDS continues to be one of the greatest health challenges which sub-Saharan Africa faces. HIV is known to invade the central nervous system at the time of infection, and causes widespread damage. In children, this leads to a well-researched condition known as HIV encephalopathy, which affects all areas of neurodevelopment.

Objectives: To discuss HIV encephalopathy in sub-Saharan Africa, and highlight the importance of early detection and intervention.

Major findings: The effects of timely initiation of antiretroviral therapy on alleviating the impact of encephalopathy have been well described. Neurodevelopmental delay is a stage four disease indicator according to the World Health Organization (WHO), and therefore is a criterion for initiation of highly active antiretroviral therapy (HAART). HAART is often only administered according to the virologic and immunologic status of a child, as standardized neurodevelopmental assessment tools are not widely available in clinics in developing countries. When HAART initiation is dependent on immunologic status, it is often too late to prevent encephalopathy. To date, the only means of prevention of this condition is early initiation of HAART. Stringent guidelines for the commencement of this therapy have had to be followed due to a shortage of and lack of access to antiretrovirals, leading to late initiation of HAART, and widespread central nervous system encephalopathy.

Conclusion: Early detection of encephalopathy is vital, so that children may commence treatment, and be referred for assessments in all facets of development in order to initiate intervention.