Neurocognitive function among HIV-infected children on protease inhibitor -based versus non-protease inhibitor based antiretroviral therapy in Uganda: a pilot study
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Published on: August 31, 2014
Damalie Nalwanga1,2, Victor Musiime3,4, Paul Bangirana5
1Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda. damalielwanga@gmail.com.
Insights
This study found no difference in neurocognitive function between children with HIV on protease inhibitor (PI) or non-protease inhibitor (non-PI) antiretroviral therapy (ART). However, PI-based ART was associated with better motor skills in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neuroscience
Background:
- HIV infection can cause neurocognitive deficits in children.
- Antiretroviral therapy (ART) aims to improve cognitive function.
- Non-protease inhibitor (non-PI) ART may offer better cerebral spinal fluid drug levels than protease inhibitor (PI) ART.
Purpose of the Study:
- To compare neurocognitive function in children with HIV on PI-based versus non-PI-based ART.
- To investigate the impact of different ART regimens on cognitive outcomes in pediatric HIV.
Main Methods:
- 76 children (5-12 years) with HIV on ART for ≥1 year were assessed.
- Neurocognitive function was evaluated using Kaufman Assessment Battery for Children (KABC), Test of Variables of Attention (TOVA), and Bruininks-Oseretsky Test of Motor Proficiency (BOT).
- Linear regression models compared age-adjusted neurocognitive z-scores between PI and non-PI ART groups.
Main Results:
- No significant differences in neurocognitive function were found between the PI and non-PI ART groups based on KABC and TOVA tests.
- Children on PI-based ART demonstrated significantly better motor function (BOT scores) compared to those on non-PI ART.
- The non-PI group had a higher mean age and lower socioeconomic scores than the PI group.
Conclusions:
- No neurocognitive differences were observed between PI and non-PI ART regimens in children with HIV using KABC and TOVA.
- PI-based ART was associated with superior motor function in this cohort.
- Further research with larger sample sizes is recommended to confirm these findings.
Background:
HIV infection is associated with significant neurocognitive deficits making maximization of cognitive function among children receiving antiretroviral therapy (ART) a public health imperative. Non-protease inhibitors (non-PIs) achieve higher drug levels in the cerebral spinal fluid (CSF) compared to PIs, potentially leading to better neurocognitive function by reducing CSF viral load and inflammation. ART that maximises children's neurodevelopment and school achievement could result in improved quality of life and productivity as adults, but little research to date has examined whether non-PI ART is associated with better neurocognitive outcomes. We compared the neurocognitive function between children living with HIV receiving PI-based and non PI-based ART.
Methods:
We recruited a consecutive sample of clinically stable Ugandan children living with HIV aged 5-12 years who received PI-based or non PI-based ART for ≥ 1 year (viral load < 1000 copies). Neurocognitive function was assessed using the Kaufman Assessment Battery for Children, the Test of Variables of Attention, and Bruininks-Oseretsky Test of Motor Proficiency. Age-adjusted neurocognitive z-scores for the two groups were compared using linear regression models in STATA version 13. The Hommel's method was used to adjust for multiple testing.
Results:
We enrolled 76 children living with HIV; 34 on PI ART and 42 on non-PI ART. Mean (±SD) age was greater in the non-PI vs. PI group (9.5 ± 1.9 vs. 8.5 ± 2.0) years (p = 0.03). Children in the non-PI group had lower socioeconomic scores (5.7 ± 3.3 vs. 7.4 ± 2.8, p = 0.02). There was no difference in neurocognitive function between the groups (adjusted p > 0.05) for KABC and TOVA. Children in the PI group had better total BOT scores than their counterparts (46.07 ± 1.40) vs. 40.51 (1.24), p = 0.03).
Conclusions:
We detected no difference in neurocognitive function among children on PI and non PI-based ART therapy based on KABC and TOVA tests. Children on PI based ART had better motor function than their counterparts. We recommend a prospective study with a larger sample size.
