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Neurodevelopmental outcomes in HIV-infected and uninfected African children
Pierre Debeaudrap1, Florence Bodeau-Livinec2, Estelle Pasquier3
1CEPED, Institut de Recherche pour le Développement, Paris Descartes University, INSERM 1244,Paris.
Insights
Perinatal HIV infection in children, even with early antiretroviral therapy (ART), is linked to poorer neurocognitive outcomes and increased behavioral issues. Contextual factors significantly influence these outcomes, highlighting the need for early interventions.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Developmental Psychology
Background:
- HIV infection can cause cognitive impairments, but outcomes in children receiving early antiretroviral therapy (ART) or those exposed but uninfected are not well understood.
- Understanding neurocognitive and behavioral development in HIV-affected children is crucial for effective interventions.
Purpose of the Study:
- To evaluate the neurocognitive and behavioral outcomes of HIV-infected children, HIV-exposed uninfected (HEU) children, and HIV-unexposed (HUU) children.
- To assess the impact of contextual factors on these outcomes in children aged 4-9 years.
Main Methods:
- A nested cross-sectional study followed Cameroonian children aged 4-9 years.
- Cognitive development (KABC-II), neurological dysfunction (Touwen examination), and behavioral difficulties (SDQ) were assessed.
- Analyses adjusted for age, sex, language, and contextual factors.
Main Results:
- HIV-infected children and HEU children showed lower cognitive scores compared to HUU children.
- After adjusting for contextual factors, HEU children's scores did not significantly differ from HUU children.
- HIV-infected children exhibited more neurological dysfunctions and higher behavioral difficulty scores than uninfected children.
Conclusions:
- Early perinatal HIV infection is associated with impaired neurocognitive development and increased behavioral problems in childhood, despite early ART.
- Contextual factors play a significant role in the neurodevelopmental outcomes of HIV-affected children.
- Early nutritional and developmental interventions for both HIV-affected infants and their families are essential.
Objective:
HIV infection is associated with cognitive impairments, but outcomes are poorly explored in children starting antiretroviral therapy (ART) early or in those exposed but uninfected.
Design:
Nested cross-sectional evaluation of the neurocognitive and behavioural outcomes of HIV-infected, HIV-exposed uninfected (HEU) and HIV-unexposed (HUU) Cameroonian children at age 4-9 years prospectively followed.
Methods:
Cognitive development was assessed in 127 HIV-infected, 101 HEU, 110 HUU children using the KABC-II, neurologic dysfunction using the Touwen examination and behavioural difficulties using the Strength and Difficulties Questionnaire (SDQ). Analyses were adjusted for children age, sex and primary language. Contextual factors were included in a second step to assess their effects on outcomes.
Results:
All HIV-infected children were treated before 12 months. There was a negative linear gradient in KABC-II scores from HUU children to HEU and HIV-infected children [gradient: -6.0 (-7.7; -4.3) for nonverbal index, NVI, and -8.8 (-10.7; -6.8) for mental processing index, MPI]. After adjusting for contextual factors, scores of HEU children were not significantly different from those of HUU children (all P > 0.1) and differences between HIV-uninfected and HUU children reduced [NVI: from -11.9 (-15.3; -8.5) to -3.4 (-6.8; -0.01), MPI: from -17.6 (-21.3; -13.8) to -5.5 (-9.3; -1.7)]. Compared with uninfected children, HIV-infected children had more neurological dysfunctions and higher SDQ scores (P = 0.002).
Conclusion:
Despite early ART, perinatal-HIV infection is associated with poorer neurocognitive scores and increased behavioural difficulties during childhood. Contextual factors play an important role in this association, which emphasizes the need for early nutritional and developmental interventions targeting both HIV-affected infants and their relatives.
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