Virus-induced lesions and the fetal brain: examples of the transmission of HIV-1 and CMV from mother to offspring

Abstract

Human immunodeficiency virus 1 (HIV-1) and cytomegalovirus (CMV) are among the most frequently transmitted viruses from an infected mother to her offspring. The clinical consequences of transmission depend heavily on the time of transmission, the virus concerned, and maternal status. This chapter describes first the natural course of neurological aspects of HIV-1 infection and the way in which it has been modified by HAART in developed countries. It then describes the situation in the African context (taking Cameroon as an example) where HAART is not readily available and the natural course of the disease may be different. Finally, we consider the possible toxic effects on the developing central nervous system of antiretroviral drug administration during pregnancy. Congenital CMV infection leads to a wide spectrum of symptoms and is not always apparent at birth. When CMV infection occurs early during gestation, it disturbs the neurogenesis of the central nervous system while late-onset CMV infection affects brain growth and the development of the white matter, leading to leukomalacia and cyst formation, usually associated with intraparenchymatous calcifications. Neurosensory hearing loss frequently occurs and may be the only symptom in cases of perinatal infection.