Background:  The Romanian cohort consists of young adults who have been living with HIV for approximately 2 decades, having been infected with clade F as infants. Due to the lack of specific case definition, we aimed to describe the features HIV encephalopathy (HIVE) in adolescents with parenterally acquired HIV-infection and to evaluate their current neurocognitive status.

Methods:  We designed a retrospective study (1996 to 2008) on the prevalence, clinical, and neuroimaging features of HIVE. We have also evaluated prospectively the neurocognitve deficit in a subgroup of adolescents based on the current HIV-associated neurocognitive disorders (HAND) criteria.

Results:  The original study cohort consisted of 110 children (76 boys), mean age of 11.1±3.7 years. The prevalence of HIVE was 20.1% of AIDS-defining diseases (21.3% pre-HAART and 18.8% during the HAART period). The most frequent manifestations were cognitive deficit 61.8%, behavioral disorders 24.5%, pyramidal syndrome 39.1%, and cerebellar syndrome 37.3%. Cerebrospinal fluid (CSF) studies (57 patients) revealed a positive correlation between pleocytosis and CSF albumin levels ρ = 0.29, p = 0.02. Of 19 patients with HIVE and paired plasma-CSF samples, 12 had higher CSF than plasma HIV RNA levels (5.42±1.18 log₁₀ copies/mL vs 4.51±1.26 log₁₀ copies/mL, p <0.05). Imaging studies using computed tomography scanning revealed that brain atrophy was the most frequent finding (84%), while MRI revealed demyelinating lesions in 2 of 3 of the patients studied. The mortality was 27.3%, and the risk factors associated with it were low age at the time of HIVE diagnosis (p = 0.01) and absence of ART/HAART (p = 0.01). Cognitive evaluation (WISC) between 1996 and 1999, revealed a reduced IQ in the HIVE group compared to patients without HIVE (62.1 vs 73.9, p = 0.007). The prospective evaluation of neurocognitive impairment in a subgroup of 43 patients using the current HAND definitions detected in 60.5% of the subjects various levels of deficit in the 7 cognitive areas, with 16 patients having minor deficit, 4 patients moderate impairment, and 6 patients severe impairment.

Conclusions:  The high prevalence of HIVE among AIDS-defining diseases remains significant in the HAART era. High HIV RNA CSF values strongly correlate with the diagnosis of HIVE. We propose that the current HAND diagnostic criteria are useful tools in detecting the early stages of neurocognitive impairment and neurologic deficits in young patients with HIV clade F.