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Neuropsychological functioning and viral load in stable antiretroviral therapy-experienced HIV-infected children

Rita J Jeremy1, Soyeon Kim, Molly Nozyce

  • 1Pediatric Clinical Research Center, Department of Pediatrics, School of Medicine, University of California-San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0105, USA. jeremyr@peds.ucsf.edu

Pediatrics
|February 3, 2005
PubMed

Insights

HIV-infected children exhibit poorer neuropsychological functioning, especially with higher viral loads. Antiretroviral therapy improved vocabulary but not overall cognitive function, necessitating revised treatment strategies for HIV disease.

Area of Science:

  • Pediatric infectious diseases
  • Neuroimmunology
  • Clinical pharmacology

Background:

  • HIV infection in children can impact neurodevelopment.
  • Antiretroviral therapy (ART) is crucial for managing HIV but its effect on neuropsychological functioning requires further investigation.
  • Previous treatment regimens may influence outcomes after treatment changes.

Purpose of the Study:

  • To investigate neuropsychological functioning in previously treated HIV-infected children.
  • To examine the correlation between viral load and neuropsychological performance.
  • To evaluate the impact of a new treatment regimen, including protease inhibitors (PIs), on neuropsychological outcomes.

Main Methods:

  • 489 HIV-infected children (4 months to 17 years) previously treated with ART were randomized to 7 different treatment combinations (6 with PIs).
  • Neuropsychological functioning was assessed using 13 age-appropriate measures of cognitive, neurologic, and behavioral function.
  • Children were prospectively evaluated for 48 weeks, monitoring changes in neuropsychological performance and viral load.

Main Results:

  • At baseline, HIV-infected children showed poorer neuropsychological functioning compared to age-matched norms.
  • Higher viral load at baseline was associated with poorer cognitive, fine-motor, and neurologic function.
  • After 48 weeks of PI-containing therapy, only vocabulary scores significantly improved; overall neuropsychological functioning remained below norms even with undetectable viral loads.

Conclusions:

  • HIV-infected children present with significant neuropsychological deficits, exacerbated by higher viral loads.
  • Current PI-containing combination therapies show limited efficacy in restoring neuropsychological functioning.
  • Treatment strategies for pediatric HIV disease should be reevaluated to prioritize neuropsychological recovery alongside viral load suppression.
Abstract

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