Editorial

Orphans, HIVE and HAND: Who are the watch-keepers?

Kathleen Gwen Walker, Mandy Inglis, Gwen Norton, Rebecca Sher, Dayle Zieff, Taryn McCann, Paul Roux

Abstract


Untreated children with HIV infection are at risk of central nervous system (CNS) sequelae, with prevalence rates of 20 - 60%. HIV-1 invades the developing CNS earlier and with greater severity than in adults, resulting in the condition known as HIV encephalopathy (HIVE). In addition, patients on highly active antiretroviral therapy may remain vulnerable to the effects of HIV on the brain, because the CNS may be a reservoir for persistent viral replication. The concept of a ‘milder’ form of neurocognitive disturbance in HIV-infected children, akin to the adult condition of HAND (HIV-associated neurocognitive disorder), is recognised but has yet to be defined. In SA, children with severe learning difficulties may remain in mainstream schooling with minimal remedial support. Two short case scenarios and a letter from an educator highlight the limitations of this system in the context of children living with HIV.

Authors' affiliations

Kathleen Gwen Walker, Medical Officer, Neurology and Cardiology, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa; G26 HIV/AIDS Service, Groote Schuur Hospital, Cape Town, South Africa

Mandy Inglis, Medical Officer, G26 HIV/AIDS Service, Groote Schuur Hospital, Cape Town, South Africa

Gwen Norton, Medical Officer, G26 HIV/AIDS Service, Groote Schuur Hospital, Cape Town, South Africa; Crossroads HIV/AIDS Service, Cape Town; Mitchell’s Plain HIV/AIDS Service, Cape Town, South Africa

Rebecca Sher, Medical Officer, G26 HIV/AIDS Service, Groote Schuur Hospital, Cape Town, South Africa; Crossroads HIV/AIDS Service, Cape Town; Mitchell’s Plain HIV/AIDS Service, Cape Town, South Africa

Dayle Zieff, Medical Officer, G26 HIV/AIDS Service, Groote Schuur Hospital, Cape Town, South Africa; Crossroads HIV/AIDS Service, Cape Town; Mitchell’s Plain HIV/AIDS Service, Cape Town, South Africa

Taryn McCann, Clinical Psychologist, HIV/TB Specialised Health Department, City of Cape Town, South Africa

Paul Roux, Director, G26 HIV/AIDS Service, Groote Schuur Hospital, Cape Town, South Africa

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Keywords

Orphans; HIVE; HAND; Learning difficulties

Cite this article

South African Medical Journal 2014;104(10):678-679. DOI:10.7196/SAMJ.8274

Article History

Date submitted: 2014-03-31
Date published: 2014-08-11

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