White matter signal abnormalities in children with suspected HIV-related neurologic disease on early combination antiretroviral therapy.

HIV-encephalopathy is an AIDS defining event, [1] which in its most severe form, presents with developmental delay and motor dysfunction [2]. However, with combination antiretroviral therapy (ART), manifestations are likely to be subtle and have not yet been well described in children receiving early ART. It is critical to identify a good marker of HIV-related manifestations in the central nervous system (CNS) [3] as early treatment can slow deterioration and partially improve manifestations [4, 5]. HIV-encephalopathy demonstrates white matter signal abnormality (WMSA), mainly hyperintensity on magnetic resonance imaging (MRI) [6]. In adults treated with ART, resolution of WMSA mirrors clinical improvement [7, 8]. The imaging findings in children with HIV-encephalopathy show basal ganglia calcification and atrophy. One limited study (21 children) antedating the availability of ART, demonstrated deep white matter hyperintensity sparing the subcortical U-fibers in a third of children [9]. Our aim was to determine the prevalence, distribution and characteristics of WMSA on T2 /FLAIR (fluid attenuated inversion recovery) sequences in a larger number of children initiating ART from an early age, but with suspected HIV-related neurological disease. We also sought to correlate WMSA with developmental scores, clinical presentation and laboratory studies.