CNS Impact of Perinatal HIV Infection and Early Treatment: the Need for Behavioral Rehabilitative Interventions Along with Medical Treatment and Care

Abstract

There is growing concern that although the more severe forms of HIV associated neurologic deficits are reduced following highly active anti-retroviral therapy (HAART), mild to moderate cognitive disorders may persist for years after HAART initiation and this may occur despite complete plasma viral suppression. According to the UNAIDS 2014 report, there were 3.2 million children living with HIV around the world at the end of 2013 and 91% of these resided in sub-Sahara Africa. In the same year only 24% of children who needed antiretroviral treatment (ART) received it and 190,000 children died of AIDS-related illnesses. We propose that behavioral interventions are needed in combination with medical treatment and care in order to fully address the needs of children and adolescents in Africa living with HIV. In early childhood, caregiver training programs to enhance the developmental milieu of the child with HIV can enhance their cognitive and social development, and that such interventions are both feasible and well-accepted by the local population. For school-age children, computerized cognitive rehabilitation training can be an entertaining and engaging way to improve attention, working memory, and problem solving skills for children with HIV. Further dissemination and implementation science work is needed for arriving at cost effective strategies for scaling up such behavioral interventions in African resource-constrained settings, given that the vast majority of HIV-affected children and youth worldwide presently live in sub-Sahara Africa.

Mental health interventions for adolescents living with HIV or affected by HIV in low- and middle-income countries: systematic review

“…21 These mild-to-moderate neurocognitive disorders persist over time despite being on highly active antiretroviral treatment. 22 But despite the heightened risk of mental health difficulties among adolescents living with HIV, evidence suggests that parent-child involvement, as well as communication and social support from peers, parents and teachers, can act as a protective factor. 11 Adolescents who are not living with HIV but come from a household where someone else is, are also at risk for a range of mental health problems including depression, anxiety and social problems.…”

Propelling the Pediatric HIV Therapeutic Agenda With Science, Innovation, and Collaboration

“…Although much of the earlier work characterized the neurobehavioral abnormalities, current research has focused on the prevention and rehabilitation of the deficits. 110 Besides very early ART, 91 ability-based and parent-based interventions may ameliorate some of the neurobehavioral deficits. 111 – 113 Even as effective ART is available to prevent and treat infant HIV infection, long-term outcomes with respect to brain structure and function remain a concern and require continued monitoring and tailored preventive and rehabilitative interventions.…”

Neurodevelopment of HIV-exposed uninfected children in Cape Town, South Africa

“…HEUs from SSA most commonly experience delay in motor and language scores [1,[14][15][16][17], with exposure to efavirenz (EFV) regimen associated with worse delay in motor development compared to non-EFV regimen [15]. Further, earlier rather than later maternal ART initiation has been implicated in worse outcomes on HEU development [15], although this has not been confirmed in other studies which also suggested that maternal ART exposure may become less important in predicting child's development with increasing child age [12,18]. Therefore, further investigation of the role of ART exposure during pregnancy and timing of initiation on HEU development is needed.…”

“…In high income countries, appropriate neurodevelopmental learning opportunities have shown significant benefits including improved cognitive function, school achievement and increased earnings [9,10]. In sub-Saharan Africa (SSA), behavioural programs promoting child-parent/caregiver interaction and combined infant/young child feeding, improved water, sanitation and hygiene are recommended for minimizing the risk of poor child development, especially in children affected by HIV [11,12].…”