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Lower Neurocognitive Functioning in HIV-Exposed Uninfected Children Compared With That in HIV-Unexposed Children
Sarah F Benki-Nugent1, Rabi Yunusa1, Alice Mueni2
1Department of Global Health, University of Washington, Seattle, WA.
Insights
Children exposed to HIV (CHEU) showed poorer long-term neurocognitive outcomes compared to HIV-unexposed children (CHUU). Further research on neurocognitive and educational development in CHEU is recommended.
Area of Science:
- Neuroscience
- Pediatrics
- Public Health
Background:
- Perinatal HIV exposure and antiretroviral therapy (ART) may impact neurocognitive development, but evidence is mixed and often limited to early childhood.
- Most existing studies focus on neurocognitive outcomes within the first 24 months of life.
Purpose of the Study:
- To compare neurocognitive outcomes in school-aged children exposed to HIV but uninfected (CHEU) with those of HIV-unexposed and uninfected children (CHUU).
Main Methods:
- Children aged 5-12 years from Nairobi, Kenya, were recruited.
- Neuropsychological tests and behavioral assessments were administered to compare CHEU and CHUU groups using linear regression, adjusting for various covariates.
Main Results:
- CHEU demonstrated significantly lower mean z scores in global cognitive ability, short-term memory, delayed memory, attention, and processing speed compared to CHUU.
- Adjusted analyses, considering factors like caregiver education and household rent, confirmed these cognitive deficits in CHEU.
Conclusions:
- HIV-exposed children exhibit poorer long-term neurocognitive outcomes than their unexposed peers.
- Long-term studies investigating neurocognitive and educational attainment in CHEU are essential to understand and address these disparities.
Background:
Perinatal HIV and antiretroviral therapy exposure may influence neurocognitive outcomes, although evidence is mixed and most studies are limited to outcomes in the first 24 months. We compared neurocognitive outcomes in school-aged children who were HIV exposed uninfected (CHEU) with those in children who were HIV unexposed uninfected (CHUU).
Setting:
Children were recruited from a health center in Nairobi, Kenya.
Methods:
Key inclusion criteria were children aged 5-12 years and confirmed child and maternal HIV status; for CHEU, mothers reported knowing HIV-positive status before or at delivery of the index child. Children underwent a detailed battery of neuropsychological tests and behavioral assessment, and comparisons of scores between CHEU and CHUU were conducted using linear regression.
Results:
Among 56 CHEU and 65 CHUU, the median age and sex distributions were 6.8 and 7.0 years (P = 0.8) and 48% and 60% girls (P = 0.2), respectively. In analyses adjusted for child's age and sex and caregiver's age, education, and household rent, CHEU had significantly lower mean z scores for global cognitive ability than CHUU [-0.35, 95% confidence interval (CI): -0.64 to -0.05; P = 0.02], short-term memory (-0.44, 95% CI: -0.76 to -0.12; P = 0.008), delayed memory (-0.43, 95% CI: -0.79 to -0.08; P = 0.02), attention (-0.41, 95% CI: -0.78 to -0.05; P = 0.03), and processing speed (-0.76, 95% CI: -1.37 to -0.16; P = 0.01). Models adjusted for child nutritional status, household food security, and orphanhood yielded similar results.
Conclusions:
Children exposed to HIV had poorer long-term neurocognitive outcomes than CHUU. These data suggest that long-term studies of neurocognitive and educational attainment in CHEU are warranted.
