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

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.