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Published on: September 6, 2019
Poorer cognitive performance in perinatally HIV-infected children versus healthy socioeconomically matched controls
Sophie Cohen1, Jacqueline A Ter Stege2, Gert J Geurtsen3
1Department of Pediatric Hematology, Immunology, and Infectious Diseases.
Insights
Children with human immunodeficiency virus (HIV) infection show poorer cognitive performance compared to healthy peers. These deficits impact future academic and social opportunities, highlighting the need for further research.
Area of Science:
- Neuroscience
- Pediatrics
- Infectious Diseases
Background:
- Human immunodeficiency virus (HIV) infection in children, despite declining severe neurological complications, is linked to cognitive issues.
- Most HIV-infected children in industrialized nations are immigrants with lower socioeconomic status (SES), yet comparative cognitive studies are scarce.
Purpose of the Study:
- To compare cognitive performance in perinatally HIV-infected children with SES-matched healthy controls.
- To identify factors associated with cognitive deficits in HIV-infected children.
Main Methods:
- Cross-sectional study involving perinatally HIV-infected children and SES-matched healthy controls.
- Neuropsychological assessment covering intelligence, processing speed, attention, memory, executive function, and visual-motor skills.
- Multivariate normative comparison and multivariable regression analyses.
Main Results:
- HIV-infected children performed significantly lower than controls across all cognitive domains (e.g., IQ: 76 vs. 87.5, P = .002).
- Cognitive impairment was identified in 17% of HIV-infected children.
- A lower Centers for Disease Control and Prevention (CDC) clinical category at diagnosis correlated with lower verbal IQ.
Conclusions:
- HIV-infected children exhibit poorer cognitive performance compared to SES-matched healthy peers.
- Understanding these cognitive deficits is crucial for addressing potential long-term impacts on intellectual performance and community integration.
Background:
Despite the declining incidence of severe neurological complications such as HIV encephalopathy, human immunodeficiency virus (HIV) infection in children is still associated with a range of cognitive problems. Although most HIV-infected children in industrialized countries are immigrants with a relatively low socioeconomic status (SES), cognitive studies comparing HIV-infected children to SES-matched controls are lacking.
Methods:
This cross-sectional study included perinatally HIV-infected children and controls matched for age, sex, ethnicity, and SES, who completed a neuropsychological assessment evaluating intelligence, information processing speed, attention, memory, executive function, and visual-motor function. Multivariate normative comparison was used to assess the prevalence of cognitive impairment in the HIV-infected group. Multivariable regression analyses were performed to identify HIV- and combination antiretroviral therapy-related factors associated with cognitive performance.
Results:
In total, 35 perinatally HIV-infected children (median age, 13.8 years; median CD4 count, 770 × 10(6) cells/L; 83% with undetectable HIV RNA) and 37 healthy children (median age, 12.1 years) were included. HIV-infected children scored lower than the healthy controls on all cognitive domains (eg, intelligence quotient [IQ], 76 [standard deviation {SD}, 15.7] vs 87.5 [SD, 13.6] for HIV-infected vs healthy children; P = .002). Cognitive impairment was found in 6 HIV-infected children (17%). The Centers for Disease Control and Prevention (CDC) clinical category at HIV diagnosis was inversely associated with verbal IQ (CDC clinical category C: coefficient -22.98; P = .010).
Conclusions:
Our results show that cognitive performance of HIV-infected children is poor compared with that of SES-matched healthy controls. Gaining insight into these cognitive deficits is essential, as subtle impairments may progress to more pronounced complications that will influence future intellectual performance, job opportunities, and community participation of HIV-infected children.
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