Neurodesarrollo en niños pequeños expuestos al VIH-1

Abstract

El objetivo del trabajo es analizar si las pruebas: Escala de evaluación del Desarrollo Psicomotor de 0-24 meses –EEDP- (Rodríguez, Arancibia y Undurraga, 1978) y Valoración Neurológica del Recién Nacido y el Lactante –AT- (Amiel-Tison & Grenier, 1981), permiten detectar precozmente indicadores neurológicos y psicomotores de infección por VIH, en bebés de 0 a 24 meses de edad (hijos de madres VIH positivas), que sean portadores asintomáticos del VIH. Se administró una encuesta para describir factores psicosociales asociados al VIH/SIDA, a una muestra de 93 madres subdividida en dos grupos: uno de 38 madres seropositivas para el VIH y otro de 55 madres sanas, con serología negativa para el VIH. Se administraron las pruebas –EEDP y AT- a un grupo de 38 bebés de 0 a 24 meses, hijos de madres portadoras asintomáticas del VIH. Los resultados parciales mostraron una mayor sensibilidad de AT con respecto a EEDP, para la detección de anomalías del desarrollo, principalmente en los meses 3, 6 y 9; aunque AT resultó ser poco específica pues no todos los bebés que obtuvieron resultados anormales resultaron ser seropositivos. En cambio con la EEDP, se observó que en la población de bebés seropositivos para el VIH en seguimiento, no se evidenció una importante sensibilidad de esta escala en el primer año de vida, en relación a signos psicomotores que indiquen la seropositividad de estos bebés, aunque parece más sensible en el segundo año de vida. Se puede concluir en el estado actual de esta investigación, que sería pertinente utilizar en la evaluación del desarrollo de los bebés hijos de madres VIH+, las dos escalas estudiadas; ya que AT funcionaría como un screening básico a partir del cual al detectar resultados de riesgo se debería ahondar con EEDP.

Children infected with HIV are one of the fastest increasing segments of the AIDS epidemic. Central Nervous System can be directly infected by HIV. Imaging studies have demonstrated abnormalities in the developing brains of HIV-infected children. Pediatric neuro-AIDS may be the first clinical manifestation of HIV infection in children born to HIV infected mothers. Neurodevelopmental and psychomotor problems may be the first presenting symptoms of AIDS. These symptoms may be an important determinant of therapeutic efficacy and may cause significant impairments in both the child’s overall functioning and quality of life. A multicenter epidemiologic study in the United States showed HIV-1 encephalopathy diagnosed in 23% of children with perinatally acquired AIDS. In Argentine, HIV-1 related encephalopathy and developmental impairment may appear early in the disease process, in 24% rate of children under 13 years of age. In some children, developmental impairment may appear early in the disease process, preceding other medical symptoms of infection, while in other children, this impairment occurs only after a period of normal development. Psychomotor and neurodevelopmental examination of infants born to HIV-infected women, may be useful for the prompt and reliable identification of infants at high risk of Central Nervous System disease progression, before the onset of encephalopathy. The aim of this study was to evaluate the effectiveness of the Scale of Psychomotor Development Examination (EEDP) of Rodriguez, Arancibia and Undurraga (1978) and Method for Neurologic Evaluation within the First Year of Life (AT) of Amiel Tison and Grenier (1981), to detect and monitor early signs of abnormality in cognitive and motor development, associated to HIV encephalopathy, in infants born to HIV-infected women, during the first 24 months of age. The scales selected were administered to 38 infants born to HIV-infected women, with a median follow-up of 24 months. A psychosocial questionnaire was administered to a sample of 93 mothers –who have 20-30 years old–, in order to describe psychosocial factors associated to HIV/AIDS. The sample of 93 mothers was divided en two groups: a group of 38 HIV+ mothers (whose babys are the possible HIV infected babys of the sample), and a group of 55 seronegative healthy mothers, whose babys are healthy and born in term. The psychosocial questionnaire shows significative presence (Chi square test) of biopsychosocial risk in seropositive mothers and her partners. That was show by the presence of ilegal drug use, alcoholism, delinquency, promiscuousy, tatoo, etc. In concern to the scales we are studying, preliminary results showed more sensitivity of AT to detect neurodevelopmental problems than EEDP –specially in the 3º, 6º and 9º month of age–, but low specificity; because all infants that obtained abnormal results do not result HIV infected. Only one acute severe HIV-related encephalopathy was identified among the 38 infants born to HIV-infected women. In the present study, the EEDP was not sensitive among infants born to HIV-infected women in the first year of life, but it was in the second year of life. The EEDP was found to detect psychomotor-developmental differences between HIV-infected and uninfected children al 15 and 24 months of age. In summary, the two test studied appears to be usefully tools to monitor neurodevelopment in infants born to HIV-infected women. AT would be a base screening. If this screening shows risk values, we should use a more complete mental test as EEDP.