Complications and Problems in Perinatally Infected Children and Youth Receiving Effective cART
| BODY SYSTEM | PROBLEM OR COMPLICATION | DESCRIPTION |
| Neurocognitive | Learning or cognitive impairment, attention disorders, behavioral problems and mental illness | Common, likely multifactorial |
| Neurologic | Peripheral neuropathy, static encephalopathy | Was 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 nutrition | Short stature Lipoatrophy Lipohypertrophy | Early 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 factors | Dyslipidemia, insulin resistance Chronic inflammation | Especially related to ARV drugs (protease inhibitors, some NRTIs); Evidence of persistent multifactorial inflammation and immune activation despite early and prolonged effective cART |
| Pulmonary | Chronic lung disease Asthma | Bronchiectasis 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 |
| Renal | Renal failure | Frank renal failure uncommon with cART; ARV-related tubulopathy and glomerulopathy; multifactorial progressive loss of renal function |
| Hepatic | Liver inflammation or damage | Related to ARV, concomitant viral hepatitis |
| Bone | Low bone mineral density; bone fragility | Multifactorial including certain ARV drugs (tenofovir) and traditional (non-HIV) risk factors for poor bone health |
| Reproductive health | Anogenital HPV-related dysplasia or malignant tumor | Not clear how much this risk is attenuated by effective cART |
| Malignant tumor | Overall higher rate | |
| Hematologic | Anemia, neutropenia | Multifactorial, including ARV related (zidovudine) |
| Mitochondrial function | Lactic acidosis and other manifestations | Thought 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)