Table 10.

Complications and Problems in Perinatally Infected Children and Youth Receiving Effective cART

BODY SYSTEMPROBLEM OR COMPLICATIONDESCRIPTION
NeurocognitiveLearning or cognitive impairment, attention disorders, behavioral problems and mental illnessCommon, likely multifactorial
NeurologicPeripheral neuropathy, static encephalopathyWas more common with certain drugs (stavudine, didanosine) no longer commonly used; residual effects of encephalopathy and/or strokes that occurred before effective cart
Growth and nutritionShort stature Lipoatrophy LipohypertrophyEarly cART improves growth but cannot fully correct years of poor linear growth if effective cART started late; Subcutaneous fat loss in face, extremities, and buttocks; especially related to stavudine use; may not normalize after stavudine therapy discontinued; Excessive central fat deposition in abdomen, breasts, dorsocervical “buffalo hump”; may be related to HIV and/or to certain ARV drugs
Cardiovascular risk factorsDyslipidemia, insulin resistance Chronic inflammationEspecially related to ARV drugs (protease inhibitors, some NRTIs); Evidence of persistent multifactorial inflammation and immune activation despite early and prolonged effective cART
PulmonaryChronic lung disease AsthmaBronchiectasis and other chronic lung changes from pre-cART lymphocytic interstitial pneumonitis and repeated infections; May be related to incomplete immune system normalization despite effective cart
RenalRenal failureFrank renal failure uncommon with cART; ARV-related tubulopathy and glomerulopathy; multifactorial progressive loss of renal function
HepaticLiver inflammation or damageRelated to ARV, concomitant viral hepatitis
BoneLow bone mineral density; bone fragilityMultifactorial including certain ARV drugs (tenofovir) and traditional (non-HIV) risk factors for poor bone health
Reproductive healthAnogenital HPV-related dysplasia or malignant tumorNot clear how much this risk is attenuated by effective cART
Malignant tumorOverall higher rate
HematologicAnemia, neutropeniaMultifactorial, including ARV related (zidovudine)
Mitochondrial functionLactic acidosis and other manifestationsThought due to inhibition of mitochondrial DNA synthesis, especially by stavudine and didanosine; manifestations highly variable: asymptomatic lactate elevation; fatigue, weakness, myalgias, abdominal pain, and dyspnea; to severe multiorgan involvement; implicated in peripheral neuropathy, cardiomyopathy, and neurotoxicity
  • ARV=antiretroviral; cART=combination antiretroviral therapy; HIV=human immunodeficiency virus; NRTI=nucleoside reverse transcriptase inhibitor.

  • See Chapter 113, Siberry GK and Hazra R. Management of HIV Infection, in Principles and Practice of Pediatric Infectious Diseases, 4th ed., Long SS, Pickering LK and Prober CG, eds. Elsevier Saunders, 2011, Philadelphia.(51)