Brain MRI and neurocognitive characteristics of children and adolescents living with HIV

Despite improved outcomes with modern antiretroviral therapy (ART), children living with HIV (CLWHIV) may still face significant cognitive deficits. There are no published studies of the neurocognitive and neuroimaging status of CLWHIV in Eastern Europe. This was a cross-sectional study in a pediatric HIV referral center in St Petersburg, Russian Federation. Thirty-seven CLWHIV underwent brain magnetic resonance imaging (MRI) and completed the Wechsler Intelligence Scale for Children, third edition (WISC-III) as part of routine care in 2013-15. WISC-III scores were summarized for full-scale intelligence quotient (FSIQ), performance IQ (PIQ) and performance IQ (PIQ) (all with population mean 100), and for subtests of these scores. Factors associated with MRI abnormalities were assessed using logistic regression. Median [IQR] age at the time of the earlier assessment (either MRI or WISC-III) was 10.5 [8.7-11.9] years, 54% were female, 35/37 (95%) had initiated ART at a median age of 57 [27-93] months. Median WISC-III scores were within the average range: 99 [IQR 91-111, range 62-123] for FSIQ, 97 [IQR 85-111, range 67-129] for VIQ and 101 [IQR 94-106, range 62-129] for PIQ. Thirty-four children (92%) scored below average on at least one subtest score. Of 32 children who underwent MRI, 15 (47%) had at least one abnormality. Older age at ART start was associated with MRI abnormalities (OR 1.37 (95% CI 1.01-1.86), p = 0.05 per year increase). Although median group indexes were within the average range, a high percentage of CLWHIV underperformed in at least one subtest and might benefit from supportive interventions.