A systematic review of cognitive development and child human immunodeficiency virus infection

The objective was to systematically review measures and effects of human immunodeficiency virus (HIV) on neurocognitive outcomes for children. Published studies were identified through the use of electronic databases (Cochrane database, Medline, PubMed, Psychinfo) supplemented by hand searching and coverage of the gray literature. All studies including children with HIV infection, which utilized at least one systematic measure of cognitive functioning, reported on place, sample size, age, and outcome measures, and included a control group were eligible for inclusion. Outcomes were coded for each study and broken down by measures when multiple measures were used. A systematic analysis of all measures used was also undertaken, as was a specific investigation of gender. Meta-analysis was not performed due to the heterogeneity of studies, the noncomparability of measures, and the wide age ranges of children included. Fifty-four studies were identified, of which had control groups. The data are highly North American biased (63%) with European studies accounting for 13% and only two from South America and seven from Africa, where the vast majority of HIV-infected children are found. Eighty-one percent of studies reported a detrimental effect on neurocognitive development, however measured, whilst three reported no differences and four had mixed findings. Thirty-three percent provided data on child gender, but only 8% went on to analyse data according to gender. The numbers are too small for definitive findings, but of note that three quarters found no gender differences. There seems to be some evidence of detrimental effects of HIV infection and exposure on cognitive development, but the lack of systematic measures, controlled trials and age-specific investigations render the literature inadequate. There is an urgent need for internationally agreed and validated measures to be incorporated and for these to record data by age and gender. This will allow for clarity of understanding of the effects, the ability to monitor change as a result of intervention, and to mobilize resources.