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Predicting HIV disease progression in children using measures of neuropsychological and neurological functioning.
D A Pearson1, N M McGrath, M Nozyce
1Department of Psychiatry and Behavioral Sciences, University of Texas-Houston Medical School, Houston, Texas, USA.
Insights
Neuropsychological and motor function assessments effectively predict human immunodeficiency virus (HIV) disease progression in children. These measures offer unique insights beyond standard markers like CD4 count and viral load.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuropsychology
Background:
- Assessed neuropsychological testing, cortical atrophy, and motor dysfunction for predicting HIV disease progression in pediatric patients.
- Utilized data from Pediatric AIDS Clinical Trials Group Protocol 152 (PACTG 152).
Purpose of the Study:
- To evaluate the predictive utility of neuropsychological and neurological status measures for HIV disease progression in children.
- To determine if these measures provide information beyond established HIV biomarkers.
Main Methods:
- Assessed 722 antiretroviral therapy-naive, symptomatic HIV-infected children.
- Included neurodevelopmental testing, neuroradiologic imaging, and neurological motor function exams.
- Measured CD4 cell count and plasma RNA viral load at baseline and intervals.
Main Results:
- Lowest baseline neuropsychological functioning (IQ < 70) correlated with highest HIV progression risk (56%).
- Motor dysfunction at entry also predicted disease progression.
- Motor function and week 48 neuropsychological status provided predictive value beyond CD4 count and viral load.
- Cortical atrophy predicted progression but offered no additional information when CD4 and viral load were known.
Conclusions:
- Neuropsychological and motor function assessments are valuable for predicting pediatric HIV disease progression.
- These findings are crucial for forecasting long-term outcomes, including longevity, in pediatric HIV patients.
Background:
Neuropsychological testing and 2 measures of neurological status, cortical atrophy, and motor dysfunction were assessed for their usefulness in predicting human immunodeficiency virus (HIV) disease progression in infants, children, and adolescents who participated in Pediatric AIDS Clinical Trials Group Protocol 152 (PACTG 152).
Methods:
A cohort of 722 antiretroviral therapy-naive children with symptomatic HIV infection were assessed at study entry and at later intervals. Assessments included neurodevelopmental testing, neuroradiologic imaging, and neurological examination of motor function. CD4 cell count and plasma RNA viral load also were measured.
Results:
Children with the lowest neuropsychological functioning (IQ < 70) at baseline had the highest risk for later HIV disease progression (56%), compared with those with borderline/low (IQ = 70-89) functioning (26%), or with average or above (IQ > 90) functioning (18%). This was also true of week 48 neuropsychological functioning. Motor dysfunction (especially reduced muscle mass) at entry also predicted disease progression. Furthermore, motor dysfunction and week 48 neuropsychological functioning provided predictive information beyond that obtainable from surrogate markers of HIV disease status (eg, CD4 count, HIV RNA level). Children with cortical atrophy also were at higher risk for later disease progression, but when CD4 count and RNA viral load were known, cortical atrophy information provided no additional predictive information.
Conclusions:
Measures of neuropsychological and motor function status provide unique information regarding pediatric HIV disease progression. As such, these findings have important implications for predicting long-term outcomes (eg, longevity) in pediatric patients.