HIV encephalopathy with bilateral lower limb spasticity: gross motor function and antiretroviral therapy

• Published in: Developmental medicine and child neurology Vol. 59; no. 4; pp. 407 - 411
• Main Authors: Mann, Theresa N, Laughton, Barbara, Donald, Kirsten A, Langerak, Nelleke G
• Format: Journal Article
• Language: English
• Published: England 01-04-2017
• Subjects: AIDS Dementia Complex - complications; AIDS Dementia Complex - drug therapy; Anti-Retroviral Agents - pharmacokinetics; Anti-Retroviral Agents - therapeutic use; Child; Disability Evaluation; Female; Humans; Lower Extremity - physiopathology; Male; Motor Activity - drug effects; Muscle Spasticity - drug therapy; Muscle Spasticity - etiology; Outcome Assessment (Health Care); Severity of Illness Index
• ISSN: 0012-1622; 1469-8749
• DOI: 10.1111/dmcn.13377

Aim
To describe gross motor function in children with bilateral lower limb (BLL) spasticity due to human immunodeficiency virus encephalopathy (HIVE), and to investigate the association between age, CD4 percentage, and viral load at initiation of antiretroviral therapy (ART) and current gross motor function.
Method
Thirty ambulant children with HIVE and BLL spasticity were recruited. Clinical parameters, including ART, were obtained from medical records. Gross motor function was assessed using the 88‐item Gross Motor Function Measure (GMFM‐88).
Results
The participant group was comprised of 14 males and 16 females (median age 8y; interquartile range [IQR] 7–11y). ART was initiated at a median age of 7 months (IQR 5–11mo) with a median CD4 percentage of 4.7% (IQR 2.3–8.0) and viral load of log10 6.0 (IQR 5.6–6.4). The median total GMFM‐88 score was 89% (IQR 78–94%), with a wide range of scores in the ‘Standing’ domain (26–97%) and ‘Walking, Running, and Jumping’ domain (8–99%). No associations were detected between age at initiation of ART, CD4 percentage, or viral load and total GMFM‐88 score.
Interpretation
Limitations in gross motor function in children with HIVE and BLL spasticity range from mild to severe. ART initiation factors were not able to predict functional status in this sample.
What this paper adds
Gross motor function limitations associated with human immunodeficiency virus encephalopathy and bilateral lower limb spasticity range from mild to severe.
Age, CD4 percentage, or viral load at initiation of antiretroviral therapy are not predictive factors for functional status.
This article is commented on by Green on pages 348–349 of this issue.