Impacto da Neuro-AIDS na infância: [revisão]

Introducao: a influencia da infeccao do sistema nervoso central no neurodesenvolvimento da crianca com infeccao pelo HIV-1 merece melhor compreensao. Objetivo: identificar as desordens neurologicas da infeccao pelo HIV-1 em criancas e analisar possiveis fatores associados. Metodos: revisao de mais de 100 artigos recentemente publicados na literatura medica nacional e internacional referentes a patogenese da neuro-aids e sua implicacao no desenvolvimento neurologico da crianca com infeccao pelo HIV-1. Resultados: o HIV-1 penetra precocemente no sistema nervoso central (SNC) e seu acometimento pode representar a manifestacao inicial da aids em ate 18% das criancas infectadas. Na neuropatogenese da aids na crianca, destacam-se as interacoes virais com astrocitos. A diferenca nos niveis de citocinas no liquor e a infeccao ativa de neuronios sao as principais diferencas da infeccao do SNC pelo HIV-1 quando comparada com adultos. Apos a era HAART, os quadros de encefalopatia diminuiram significativamente, permanecendo as alteracoes no neurodesenvolvimento, cuja prevalencia varia de 8% a mais de 60%. Demonstra-se a associacao com a gravidade da infeccao, idade da crianca, mas tambem com regimes de HAART eficientes. Os diferentes trabalhos analisados apresentam resultados contraditorios quanto a influencia de fatores de risco no neurodesenvolvimento de criancas infectadas pelo HIV-1. Conclusao: os mecanismos da neuropatogenese da infeccao pelo HIV sao extremamente complexos e ainda pouco compreendidos. Ostrabalhos apontam que atraso no neurodesenvolvimento pode ser importante indicador de progressao da doenca. Identificar precocemente, por meio de instrumentos de avaliacao de neurodesenvolvimento, sinais associados a desordens do SNC em criancas infectadas pelo HIV-1 e essencial.(AU) Introduction: the influence of the infection of the central nervous system in the neurodevelopment of the child infected with HIV-1 deserves better understanding. Objective: to evaluate neurological disorders in HIV-1 infected children and possible associated factors. Methods: review of more than 100 papers published recently in national and international medical literature concerning neuropathogenesis of AIDS and its influence in the neurological development of HIV infected children. Results: HIV-1 invades the central nervous system (CNS) early in infection and is the first AIDS-defining illness in as many as 18% of pediatric patients. In the neuropathogenesis of AIDS in children we must stress the viral interactions with astrocytes. Differences in the level of proinflammatory mediators in the cerebrospinal fluid (CSF), and the productive infection of neurons are the main differences in children. The reported prevalence of delay in neurodevelopment among HIV-infected children has varied from 8% to more than 60%. An increased prevalence is associated with the severity of the infection, increasing age, but also occur with children with efficient HAART regimens. Papers selected have distinct conclusions in relation to the risk factors associated with neurodevelpmental delays of HIV infected children. Conclusion: the molecular and cellular mechanisms of the neuropathogenesis of HIV-1 infection are extremely complex and not well understood. Neurodevel pmental delay is clearly associated with HIV-1 infection in children and can be an important indicator of the infection evolution. It is essential to idenfity, using neurodevelopmental assessment tools, early warning signs of HIV-1 associated neurological disorders in infected children.(AU)