Central Nervous System Disease in HIV-infected Children on HAART

Background: Highly active antiretroviral therapy (HAART) has altered the natural history of HIV disease in children. A significant minority of HIV-infected children has evidence of ongoing CNS disease. Specific markers for CNS disease, factors predictive of risk for neurological decline, and pathophysiologic mechanisms have not yet been identified in HIV-infected children. Objective: To explore the clinical features (neurological and psychiatric exams, neuropsychological evaluation, and neuroimaging), viral and neuroinflammatory factors, anatomic changes (brain MRI) and patterns of brain metabolites (1H-MRS) associated with HIV-related CNS disease in HIV-infected children in the HAART era. Eligibility: HIV disease acquired in the first decade of life. Evidence of CNS disease (classification of encephalopathy or CNS compromise or diagnosis of ADHD, bipolar disease, major depression, or psychosis). Design: Serial neurologic and psychiatric examinations, neuropsychologic test, neuroimaging, and CSF sampling will be performed once a year for a total of 3 evaluations.