involving the pulmonary parenchyma, primary central nervous system lymphomas, primary effusion lymphoma, and progressive multifocal leukoencephalopathy) are rare in children, but have been reported. Accordingly, a similar listing should be included in the pediatric HIV Infection Listing. Modifications should include the replacement of HIV-associated dementia with the current listing for neurological manifestations of HIV infection (currently 114.08G). Even in the era of combination antiretroviral therapy, neurological manifestations still present serious challenges for children. Therefore, neurological manifestations in children and adolescents should be maintained under Part B. The presence of neurological manifestations in children serves as an indicator of disease severity and progression resulting in higher mortality rates among those children who have been diagnosed with early onset (Mitchell, 2001). Neurological manifestations can be characterized by the following:
Impaired brain growth. Impaired brain growth is the decrease in serial measurements of head circumference velocity and is typically seen in children under age 2 (Mintz, 1996). This condition can lead to microcephaly or brain atrophy. Older children who develop impaired brain growth do so at a slower rate, and it is similar to that seen in adults (Mitchell, 2001).
Progressive motor dysfunction. Progressive motor dysfunction is when motor milestones are not achieved. It is possible to have once attained these milestones, but lose the ability to perform them, resulting in the impairment of fine and gross motor skills (Mintz, 1996).
Loss of previously acquired or delay of developmental milestones and intellectual ability. This is the plateau of acquisition or a regression of age-appropriate neurodevelopmental milestones, which can be standard developmental scales or neuropsychological tests. Such loss is often seen more in school-age children, thus labeling them as “at risk” (Mitchell, 2001).
In addition, growth development is an important indicator of children’s health and is seen as one of the most sensitive indicators of disease progression (Hirschfeld, 1996). Growth disturbance or failure to grow has been associated with rapid progression from asymptomatic HIV infection to AIDS in children, thus leading to shorter survival (Baylor International Pediatric AIDS Initiative, 2010). As a result, the committee concluded that the current listing for growth disturbance (currently 114.08H) should be retained in Part B.