Impact of the HIV/AIDS Epidemic on the Neurodevelopment of Preschool-Aged Children in Kinshasa, Democratic Republic of the Congo

Abstract

OBJECTIVES-Pediatric HIV infection is a growing problem in most regions of the world. Data on the effects of HIV on the neurodevelopment of children in resource-poor settings are scarce but necessary to guide interventions. The purpose of this study was to compare the neurodevelopment of preschool-aged HIV-infected, HIV-affected (HIV-uninfected AIDS orphans and HIV-uninfected children whose mother had symptomatic AIDS), and healthy control children in Kinshasa, Democratic Republic of Congo. METHODS-Thirty-five HIV-infected, 35HIV-affected, and 90 control children aged 18 to 72 months were assessed by using the Bayley Scales of Infant Development II, Peabody Developmental Motor Scales, Snijders-Oomen Nonverbal Intelligence Test, and Rossetti Infant-Toddler Language Scale, as appropriate for age.RESULTS-Overall, 60% of HIV-infected children had severe delay in cognitive function, 29% had severe delay in motor skills, 85% had delays in language expression, and 77% had delays in language comprehension, all significantly higher rates as compared with control children. Young HIV-infected children (aged 18-29 months) performed worse, with 91% and 82% demonstrating severe mental and motor delay, respectively, compared with 46% and 4% in older HIV-infected children (aged 30-72 months). HIV-affected children had significantly more motor and language expression delay than control children.CONCLUSIONS-The impact of the HIV pandemic on children's neurodevelopment extends beyond the direct effect of the HIV virus on the central nervous system. AIDS orphans and HIVnegative children whose mothers had AIDS demonstrated significant delays in their neurodevelopment, although to a lesser degree and in fewer developmental domains than HIVinfected children. Young HIV-infected children were the most severely afflicted group, indicating the need for early interventions. Older children performed better as a result of a "survival effect," with only those children with less aggressive disease surviving.

Developmental delay in HIV-exposed infants in Harare, Zimbabwe

“…A possible confounding variable was that the authors were unable to determine the status of the apparently healthy comparison group, as well as being unable to control for other risk factors of early child development (see section 2.6). Van Rie et al (2008) found that 60% of HIV-infected children in the DRC showed severe cognitive delay, 28.6% showed severe motor delay, and 84.6% and 76.7% of HIV-infected children showed delay in language expression, and comprehension, respectively. Comparisons cannot be made between these studies as they both employed different assessments of child development.…”

“…With increasing use of ART in paediatric populations in sub-Saharan Africa, researchers have identified the need to continue to research the effects of HIV on neurodevelopment in populations which are increasing in prevalence, for example preschoolers (Lowick, et al, 2012;Van Rie, et al, 2008). Lowick et al (2012) found that 90% of the HIV-infected children in Soweto, South Africa, exhibited general developmental delay despite ART.…”

“…All studies which measured motor development (Lowick, et al, 2012;Ruel, et al, 2012;Jelsma, et al, 2011;Shead, et al, 2010;Potterton, et al, 2009b;Baillieu and Potterton, 2008;Smith, et al, 2008;Van Rie, et al, 2008;McGrath, et al, 2006;Drotar, et al, 1997;Boivin, et al, 1995;Msellati, et al, 1993) and most of the studies that assessed language development (Lowick, et al, 2012;Baillieu and Potterton, 2008;Smith, et al, 2008;Van Rie, et al, 2008;Msellati, et al, 1993) reported significant differences between the HIV-infected children and the uninfected children.…”

“…Infants who are infected through vertical transmission are noted to have cognitive, language and motor impairments (Abubakar, et al, 2009;Potterton, et al, 2009;Baillieu and Potterton, 2008;Van Rie, et al, 2008;Lindsey, et al, 2007;Foster, et al, 2006;Blanchette, et al, 2001;Drotar, et al, 1997;Belman, et al, 1996;Pollack, et al, 1996). HIV infection is associated with stunting and wasting (weight-for-length) in the first three months of life (Venkatesh, et al, 2010).…”

“…Although none of the BSID editions (I-III) have been normed on Zimbabwean children, the tool was employed for its superior ability to identify developmental delay as seen in many other studies in sub-Saharan Africa (Shead, et al, 2010;Potterton, et al, 2009b;Baillieu and Potterton, 2008;Van Rie, et al, 2008;McGrath, et al, 2006;Drotar, et al, 1997). …”