HIV in Children
GRAND ROUNDS AND TEACHING FILES
HIV and CNS- Which antiretrovirals to use?
Ira Shah
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital, Mumbai, India
Incharge, Pediatric HIV and TB Clinic, B J Wadia Hospital for Children, Mumbai, India

A 10 years old HIV infected boy presented with fever and cough for 7 days, vomiting and diarrhea for 2 days and 2 episodes of generalized tonic clonic convulsion. He had similar seizure episodes 15 days ago. He had received nevirapine intermittently previously. His elder sister aged 16 years was diagnosed to have abdominal TB and was on treatment since 2 months. On examination, child had hypertonia with brisk reflexes and bilateral crepitations without meningeal signs. Investigations showed hemoglobin of 9.5 gm/dl, WBC count of 12,600/cumm (91% polymorphs, 9% lymphocytes), platelet count of 4,64,000/cumm with CD4 count of 9 cells/cumm. CSF examination was normal. Chest X-Ray showed bilateral lower zone haziness. Urine and stool were normal. Fundus was normal. MRI brain was suggestive of PML. He was treated with IV antibiotics for 7 days following which pneumonia subsided and subsequently started on zidovudine, lamivudine and Lopinavir/Ritonavir. He was alright for 4 days but developed severe respiratory distress and hypoxia for which he was given IV TMP-SMX (20 mg/kg/day) and steroids to which he had a partial response.

Which are the antiretroviral drugs that penetrate the CNS?
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