Neurocognitive Complications of Pediatric HIV Infections

Benki-Nugent, Sarah; Boivin, Michael J.

doi:10.1007/7854_2019_102

Cited by 9 publications

(11 citation statements)

References 150 publications

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“…D. To explore for association and risk factors for glu-life is associated with a > 60% reduction in mortality [3]. In addition, early ART initiation protects the infected children neurocognition, and protects them from other complications associated with chronic untreated HIV disease [4]. Currently the global strategy implemented in many countries is to start ART in children as soon as the diagnosis is made with a global goal to provide it to at last 80% of the children in need [5].…”

Section: Discussionmentioning

confidence: 99%

Insulin Resistance and Glucose Intolerance in HIV Infected Children on Antiretroviral Therapy at Lubango Pediatric Hospital - Angola

Ketha¹,

Beatriz²,

Sandra³

et al. 2020

Int J Virol AIDS

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Introduction: Antiretroviral therapy (ART) has proved to be an important intervention in the reduction of both morbidity and mortality of HIV infected patients. As the use of ART increases, a number of studies have associate it to some metabolic complications including glucose intolerance, dyslipidaemia, and diabetes mellitus. Despite the high prevalence of HIV/AIDS in Africa and the recent increased access to Antiretroviral drugs, information on ART related insulin resistance and glucose metabolism in the African population including children is scarce if not almost non-existent posing a barrier to implementation of a monitoring plan in Angola. Objective: To describe the pattern of insulin resistance and glucose metabolism among HIV infected children on ART between 3-14 years of age at Lubango paediatric hospital. Methods: The study adopted a Cross-sectional study design and data were collected using an interviewer administered questionnaire, clinical examination and anthropometric measurements of HIV infected children on ART. Venous blood sample was obtained for fasting blood glucose and fasting insulin and HOMA-IR was calculated, followed by an Oral glucose tolerance test as per World Health Organization guidelines. Result: In this study, 40% (20) and 20% (10) of the children had an OGTT and calculated HOMA-IR of more than 7.8 mm/l and 1.999 respectively. In the bivariate analysis, children who had history of diabetes in the family were significantly more likely to have Insulin Resistance (p 0.027). Female sex (p 0.038), advanced clinical stage of the AIDS disease (p < 0.001) had a strong association with abnormal OGTT while long time on ARV were moderately associated with abnormal OGTT (p 0.057). Conclusion: There is a high prevalence of insulin resistance and glucose intolerance among HIV positive children on ART on follow up at Lubango paediatrics hospital. Insulin resistance was associated with family history of Diabetes white glucose intolerance was associated with female sex, advance stage of AIDS and long time on antiretroviral therapy.

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Section: Discussionmentioning

confidence: 99%

Insulin Resistance and Glucose Intolerance in HIV Infected Children on Antiretroviral Therapy at Lubango Pediatric Hospital - Angola

Ketha¹,

Beatriz²,

Sandra³

et al. 2020

Int J Virol AIDS

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“…Thus, the goal of ensuring the best youth outcomes requires global efforts to provide early ART for those children who are born with HIV. Because of the sensitivity of the developing CNS, studies on optimization of ART to balance effectiveness with neurotoxicity and address issues such as penetrance of medications through the blood-brain barrier are critical [ 9 , 10 , 12 ], as is development of pharmacological treatments targeted towards neuropathogenesis and underlying immune and inflammatory mechanisms [ 101 ]. The ultimate therapeutic goal, eradicating HIV from the body, requires eliminating the HIV reservoir present in the CNS [ 102 ]; cure strategies involving viral activation are complicated in infants and children by the increased vulnerability of their CNS to viral activity.…”

Section: Conclusion and Current Directionsmentioning

confidence: 99%

“…As shown in previous studies of children and younger adolescents, this literature suggests optimism in that the majority of youth with PHIV do not have severe impairments [9] and display considerable resilience [83]. However, they remain at risk by virtue not only of their HIV infection but also numerous other environmental or psychosocial stressors that can negatively impact neurodevelopment, such as poverty, food insecurity, trauma, loss of caregivers, caregiver physical and mental illness, barriers to medical care, and stigma and isolation, emphasizing the need to address and measure social and structural determinants of health in research on PHIV [10,21,84]. Furthermore, lower neurocognitive functioning has been associated with poorer daily and academic functioning [30][31][32].…”

Section: Conclusion and Current Directionsmentioning

confidence: 99%

“…This is particularly critical given the aforementioned concerns about developmental effects of substance use during adolescence and complex interactions with cannabis, popular among adolescents [91,96,109]. Scalable preventive interventions to boost child outcomes through such strategies as caregiver training are being developed and implemented [10,103]. Where deficits are present, specialized academic and cognitive remediation programs may help youth optimize their long-term healthcare management, occupational attainment, and quality of life [10,[110][111][112][113].…”

Section: Conclusion and Current Directionsmentioning

confidence: 99%

“…A number of recent reviews have summarized the literature on cognitive and neuroimaging findings among children with PHIV [5,[8][9][10][11][12][13][14][15]. In general, these reviews acknowledge that, despite decreases in severe neurological sequelae since the advent of cART for children, cognitive impairments continue to be a concern, particularly in the developing world where ART is less available, older antiretroviral medications with greater neurotoxicity are more commonly used, and HIV encephalopathy continues to occur [16].…”

Section: Introductionmentioning

confidence: 99%

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Central Nervous System Impact of Perinatally Acquired HIV in Adolescents and Adults: an Update

Nichols

2022

Curr HIV/AIDS Rep

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Purpose of Review Perinatally acquired HIV infection (PHIV) can confer neurodevelopmental risk. As children with PHIV increasingly survive through adolescence and into adulthood, understanding its long-term central nervous system (CNS) impacts is critical for maximizing adult outcomes and quality of life. Recent Findings Recently published neurocognitive and neuroimaging findings show impacts on the CNS associated with early HIV disease progression that endure into adolescence and young adulthood. Although developmental trajectories in adolescence largely appear stable, further research on maturational processes is indicated. Summary Although early antiretroviral therapy in infancy appears to be protective, it is not universally available and current youth largely developed without its benefit. The neurocognitive effects of HIV and the multiple other risks to neurodevelopment experienced by youth with PHIV call for further longitudinal research and a multifaceted approach to prevention and intervention.

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Multimodal magnetic resonance neuroimaging measures characteristic of early cART‐treated pediatric HIV: A feature selection approach

Khobo

Jankiewicz

Holmes

et al. 2022

Human Brain Mapping

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Children with perinatally acquired HIV (CPHIV) have poor cognitive outcomes despite early combination antiretroviral therapy (cART). While CPHIV‐related brain alterations can be investigated separately using proton magnetic resonance spectroscopy ( 1 H‐MRS), structural magnetic resonance imaging (sMRI), diffusion tensor imaging (DTI), and functional MRI (fMRI), a set of multimodal MRI measures characteristic of children on cART has not been previously identified. We used the embedded feature selection of a logistic elastic‐net (EN) regularization to select neuroimaging measures that distinguish CPHIV from controls and measured their classification performance via the area under the receiver operating characteristic curve (AUC) using repeated cross validation. We also wished to establish whether combining MRI modalities improved the models. In single modality analysis, sMRI volumes performed best followed by DTI, whereas individual EN models on spectroscopic, gyrification, and cortical thickness measures showed no class discrimination capability. Adding DTI and 1 H‐MRS in basal measures to sMRI volumes produced the highest classification performance . The best multimodal MRI set consisted of 22 DTI and sMRI volume features, which included reduced volumes of the bilateral globus pallidus and amygdala, as well as increased mean diffusivity (MD) and radial diffusivity (RD) in the right corticospinal tract in cART‐treated CPHIV. Consistent with previous studies of CPHIV, select subcortical volumes obtained from sMRI provide reasonable discrimination between CPHIV and controls. This may give insight into neuroimaging measures that are relevant in understanding the effects of HIV on the brain, thereby providing a starting point for evaluating their link with cognitive performance in CPHIV.

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Neurocognitive Complications of Pediatric HIV Infections

Cited by 9 publications

References 150 publications

Insulin Resistance and Glucose Intolerance in HIV Infected Children on Antiretroviral Therapy at Lubango Pediatric Hospital - Angola

Insulin Resistance and Glucose Intolerance in HIV Infected Children on Antiretroviral Therapy at Lubango Pediatric Hospital - Angola

Central Nervous System Impact of Perinatally Acquired HIV in Adolescents and Adults: an Update

Multimodal magnetic resonance neuroimaging measures characteristic of early cART‐treated pediatric HIV: A feature selection approach

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