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Published on: August 31, 2014
Neuropsychological performance in African children with HIV enrolled in a multisite antiretroviral clinical trial
Michael J Boivin1, Linda Barlow-Mosha2, Miriam C Chernoff3
1Departments of Psychiatry and Neurology & Ophthalmology, Michigan State University, East Lansing, Michigan, USA.
Insights
Children with HIV infection show significant cognitive deficits by school age, even with early treatment. Neuropsychological monitoring and interventions are crucial for improving outcomes in these children.
Area of Science:
- Pediatric Neuropsychology
- Infectious Diseases
- Global Health
Background:
- Children with HIV infection (HIV+) face neuropsychological risks, with limited data from low- and middle-income countries.
- Previous studies have not extensively compared neuropsychological outcomes across different HIV exposure statuses in these regions.
Purpose of the Study:
- To compare neuropsychological outcomes in school-aged children with HIV (HIV+), perinatally exposed but uninfected (HEU), and unexposed (HUU) children.
- To assess the impact of early antiretroviral treatment (ART) initiation on neuropsychological performance in HIV+ children.
Main Methods:
- The study enrolled children aged 5-11 years from four sub-Saharan African countries.
- Neuropsychological performance was evaluated using KABC-II, TOVA, BOT-2, and parent-reported BRIEF.
- Comparisons were made between HIV+, HEU, and HUU cohorts using generalized estimating equations.
Main Results:
- HIV+ children performed significantly worse on cognitive and motor skills compared to HEU and HUU children.
- No significant differences were found between HEU and HUU children in cognitive outcomes.
- HIV+ children who started ART before one year of age showed better executive function behaviors.
Conclusions:
- Significant cognitive deficits are present in school-aged children with HIV, even with early ART.
- Earlier HIV treatment initiation, ongoing neuropsychological monitoring, and rehabilitative interventions are recommended.
- Further research will track developmental trajectories over two additional years.
Objective And Design:
Children with HIV infection (HIV+) are at neuropsychological risk, but few studies have evaluated this at multiple sites in low-income and middle-income countries. We compared neuropsychological outcomes at enrollment (>5 years age) among HIV+, HIV perinatally exposed uninfected (HEU), and HIV unexposed uninfected (HUU) children from four sub-Saharan countries.
Methods:
IMPAACT P1060 compared nevirapine versus lopinavir/ritonavir-based antiretroviral treatment (ART) in HIV-infected children 6-35 months of age. The present study (P1104s) enrolled P1060 children at 5-11 years of age and evaluated their neuropsychological performance over 2 years using the Kaufman Assessment Battery for Children, 2nd edition (KABC-II), Tests of Variables of Attention (TOVA), Bruininks-Oseretsky Test, 2nd edition (BOT-2), and parent-reported Behavior Rating Inventory of Executive Function (BRIEF). Cohorts were compared using generalized estimating equations least-squares means adjusted for site, child age and sex, and personal and social characteristics for child and caregiver.
Results:
Six hundred and eleven (246 HIV+, 183 HEU, 182 HUU) of the 615 enrolled at six sites [South Africa (three), Zimbabwe, Malawi, Uganda] were available for analysis. Mean age was 7.2 years, 48% male, 69% in school. Unadjusted and adjusted comparisons were consistent. HIV+ children performed significantly worse than HEU and HUU cohorts on all KABC-II cognitive performance domains and on BOT-2 total motor proficiency (P < 0.001), but not on the BRIEF Global Executive Indices. HUU and HEU cohorts were comparable on cognitive outcomes. HIV+ children initiated on ART before 1 year of age had significantly better BRIEF evaluations (lower scores - fewer behavior problems), compared with those started after (P = 0.03).
Conclusion:
Significant cognitive deficits were documented among HIV+ children at school age, even when started on ART at an early age. Earlier HIV treatment, neuropsychological monitoring, and rehabilitative interventions are all needed. Subsequent testing for 2 more years will help further evaluate how HIV infection and exposure affect the developmental trajectory.
