HIV encephalopathy with bilateral lower limb spasticity: gross motor function and antiretroviral therapy

Aim To describe gross motor function in children with bilateral lower limb (BLL) spasticity due to human immunodeficiency virus encephalopathy (HIVE), and to investigate the association between age, CD4 percentage, and viral load at initiation of antiretroviral therapy (ART) and current gross motor function. Method Thirty ambulant children with HIVE and BLL spasticity were recruited. Clinical parameters, including ART, were obtained from medical records. Gross motor function was assessed using the 88-item Gross Motor Function Measure (GMFM-88). Results The participant group was comprised of 14 males and 16 females (median age 8y; interquartile range [IQR] 7–11y). ART was initiated at a median age of 7 months (IQR 5–11mo) with a median CD4 percentage of 4.7% (IQR 2.3–8.0) and viral load of log10 6.0 (IQR 5.6–6.4). The median total GMFM-88 score was 89% (IQR 78–94%), with a wide range of scores in the ‘Standing’ domain (26–97%) and ‘Walking, Running, and Jumping’ domain (8–99%). No associations were detected between age at initiation of ART, CD4 percentage, or viral load and total GMFM-88 score. Interpretation Limitations in gross motor function in children with HIVE and BLL spasticity range from mild to severe. ART initiation factors were not able to predict functional status in this sample.