Early antiretroviral therapy is protective against epilepsy in children with human immunodeficiency virus infection in botswana.

TitleEarly antiretroviral therapy is protective against epilepsy in children with human immunodeficiency virus infection in botswana.
Publication TypeJournal Article
Year of Publication2015
AuthorsBearden D, Steenhoff AP, Dlugos DJ, Kolson D, Mehta P, Kessler S, Lowenthal ED, Monokwane B, Anabwani GM, Bisson GP
JournalJ Acquir Immune Defic Syndr
Volume69
Issue2
Pagination193-9
Date Published06/2015
ISSN1944-7884
KeywordsAdolescent, Anti-Retroviral Agents, Antiretroviral Therapy, Highly Active, Botswana, Case-Control Studies, Child, Child, Preschool, Epilepsy, Female, HIV Infections, Humans, Infant, Infant, Newborn, Male, Retrospective Studies, Secondary Prevention
Abstract

BACKGROUND: Seizures are common among patients with HIV/AIDS in the developing world and are associated with significant morbidity and mortality. Early treatment with combination antiretroviral therapy (cART) may reduce this risk by decreasing rates of central nervous system infections and HIV encephalopathy.

METHODS: A case-control study of new-onset epilepsy among children aged 0-18 years with perinatally acquired HIV/AIDS followed in Gaborone, Botswana, during the period 2003-2009 was conducted. Children with epilepsy were identified and compared with age- and sex-matched controls without epilepsy with respect to timing of cART initiation. Early treatment was defined as treatment with cART before the age of 12 months, at a CD4% of greater than 25 in children aged 1-5 years, or at an absolute CD4 count of >350 cell per cubic millimeter in children aged 5 years and older.

RESULTS: We identified 29 cases of new-onset epilepsy and 58 age- and sex-matched controls. The most common identified etiologies for epilepsy were central nervous system infections and direct HIV neurotoxicity. Only 8 (28%) of the children who developed epilepsy received early treatment compared with 31 (53%) controls (odds ratio: 0.36, 95% confidence interval: 0.14 to 0.92, P = 0.03). This effect was primarily driven by differences in rates of epilepsy among children who initiated treatment with cART between the ages of 1 and 5 years (11% vs. 53%, odds ratio: 0.11, 95% confidence interval: 0.01 to 1.1, P = 0.06).

CONCLUSIONS: Earlier initiation of cART may be protective against epilepsy in children with HIV.

DOI10.1097/QAI.0000000000000563
Alternate JournalJ. Acquir. Immune Defic. Syndr.
PubMed ID25647527
PubMed Central IDPMC4446226
Grant ListK23 MH095669 / MH / NIMH NIH HHS / United States
P30 AI 045008 / AI / NIAID NIH HHS / United States
P30 AI045008 / AI / NIAID NIH HHS / United States