Evaluation of the role of routine serial cranial computed tomography in the management of children with human immunodeficiency virus infection.

OBJECTIVE

To review the impact of routine follow-up cranial computed tomography (CT) scans on the management of children with human immunodeficiency virus (HIV) infection.

DESIGN

Longitudinal data collected from 58 HIV-infected children followed in one center for mean of 3.8 +/- 1.8 years.

SETTING

HIV/AIDS pediatric program following over 90% of the identified HIV-infected children in one region in Canada.

RESULTS

The baseline CT scans showed intracranial abnormalities in 35 of 58 children (60%). In five children with basal ganglia calcifications (BGC) without cerebral atrophy, there has not been progressive encephalopathy. For the 43 children who had serial CT scans for routine follow-up, 34 (79%) had changes in the scans that were concordant with the clinical assessment. In all but five children with progressive ventricular and sulcal dilatation on CT scan, there was simultaneous clinical evidence of encephalopathy. Those five children were already on antiretroviral therapy, and therapy was not changed in response to the CT scan findings.

CONCLUSION

Baseline CT scans provide useful diagnostic and prognostic information. Further research is needed to evaluate the role of cranial CT imaging in the management of pediatric HIV encephalopathy.