Effects of Pediatric HIV Infection on Mental and Psychomotor Development

Abstract

These data suggest that CNS involvement is a critical pathway by which HIV affects infants' neurodevelopment.

Effects of highly active antiretroviral therapy (HAART) on psychomotor performance in children with HIV disease

“…Since the era of HAART, we are seeing less and less of the severe progressive encephalopathy from HIV; however, the pathogenesis and the effect of HAART on the less severe deficits such as psychomotor or neuropsychological dysfunctions are not well understood. There is evidence that children with HIV infection when compared with HIV-negative children exhibit more problems in these areas [23,44]. There are studies showing that higher cerebrospinal fluid (CSF) HIV RNA and higher levels of inflammatory cytokines especially monocyte chemotactic factor-1 and matrix metalloproteinase-9 are associated with abnormal motor deficits [28,42,44].…”

“…Some studies show an improvement in performance on intelligence tests [4,7,14,29,33] and other studies show no change [20,30]. Some studies show HAART to lower CSF HIV RNA and subsequently to improve neurological function [23], while others do not show any benefit [36]. Successful HAART results in lower plasma viral load which has been shown to correlate with lower CSF HIV RNA [47].…”

“…Varying degrees of intellectual impairment have been documented in symptomatic children with HIV infection [17,18,25,32], while more specific neuropsychological deficits were found in the following domains: language [46], short-term memory [18], visual-spatial functioning [41], executive functioning [2], and fine motor control [3]. In addition, a significant proportion of HIV-infected infants show early cognitive and motor delays or declines that may be important indicators of HIV disease progression [8,23,26].…”

Neuropsychological Functioning and Viral Load in Stable Antiretroviral Therapy-Experienced HIV-Infected Children

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] HIV infects a variety of cell types in the brain, leading to damage of the central nervous system (CNS). 20 Measures of cognitive, neurologic, and behavioral functioning, referred to jointly as neuropsychological (NP) functioning, serve as indirect measures to assess CNS functioning along with more direct measures such as computed tomography and magnetic resonance imaging scans.…”

Facing Adolescence and Adulthood: The Importance of Mental Health Care in the Global Pediatric AIDS Epidemic

“…[12][13][14][15][16] Despite this research, however, little is actually known regarding the etiology of mental health disorders in HIV-positive children and adolescents and whether the same prevalence holds true for children in low and middle income countries. While the virus itself or an opportunistic infection, such as one causing meningitis or encephalitis, may lead to neurodevelopmental impairments that affect mental and psychomotor development, 17 it appears that the social context of HIV (such as familial disruption, poverty, and stigmatization) may play a greater role in the higher prevalence of mental health problems among this population. 18 The mental health issues facing HIV-positive children and the development of these psychosocial problems are certainly important areas for further study, especially the unique stressors facing children in low and middle income countries.…”