Neurodevelopment in perinatally HIV‐infected children: a concern for adolescence

Abstract

Globally, an estimated 3.4 million children are living with HIV, yet little is known about the effects of HIV and antiretroviral treatment (ART) on the developing brain, and the neurodevelopmental and behavioural outcomes of perinatally HIV-infected (PHIV+) adolescents.We reviewed the literature on neurodevelopmental outcomes in PHIV+ children and adolescents, and summarized the current evidence on behaviour, general cognition, specific domains, hearing and language, school performance and physical disabilities due to neurological problems.Evidence suggests that PHIV+ children do not perform as well as controls on general cognitive tests, processing speed and visual–spatial tasks, and are at much higher risk for psychiatric and mental health problems. Children with AIDS-defining diagnoses are particularly at risk for poorer outcomes.A striking finding is the lack of published data specific to the adolescent age group (10–25 years), particularly from resource-constrained countries, which have the highest HIV prevalence. In addition, extreme heterogeneity in terms of timing and source of infection, and antiretroviral experience limits our ability to summarize findings of studies and generalize results to other settings.Due to the complex nature of the developing adolescent brain, environmental influences and variation in access to ART, there is an urgent need for research on the longitudinal trajectory of neurodevelopment among children and adolescents perinatally infected with HIV, especially in high burden resource-constrained settings.

Associations of Memory and Executive Functioning With Academic and Adaptive Functioning Among Youth With Perinatal HIV Exposure and/or Infection

“…Performance on measures of RM, PM, and EF was strongly associated with achievement in reading and math. Consistent with previous research [2][3][4], in general, children in the PHEU and PHIV/non-C groups performed in the average range for age in word reading and low-average range in arithmetic computation; the PHIV/C children were in the low-average and borderline ranges, respectively. Impairments in reading and math occurred more frequently than expected in all 3 groups relative to the general US population.…”

“…Impairments in reading and math occurred more frequently than expected in all 3 groups relative to the general US population. Also consistent with previous research [2,3], in general, the children's adaptive skills were within the average range for age according to caregiver report. Verbal measures of RM and EF were strongly associated with conceptual, social, and practical skills.…”

“…Thus, aspects of EF are considered core competencies for academic achievement [9]. Deficits in EF and memory have been observed in children with PHIV, particularly those with advanced disease [2,12,13]. In adults with HIV, deficits in EF, retrospective memory (RM), and prospective memory (PM) have been noted, and some of these difficulties predict global neuropsychological impairment, difficulties in daily living, and medication nonadherence [14][15][16][17].…”

“…In general, children with PHIV perform in the low-average to average range on measures of global cognitive ability and adaptive behavior [2,3] but underperform relative to global cognitive ability on measures of academic achievement [4,5]. Those with a history of encephalopathy or another Centers for Disease Control and Prevention (CDC) class C (AIDS-defining) diagnosis [6] generally perform more poorly on these measures than those without such history [2,3].…”

Effectiveness of Spirulina Supplement and Selected Yogasanas on Quality of Life of Children With Hiv Infection

“…The review also revealed that they are prone for psychiatric and mental Health problems and recommended the need for a longitudinal study to recognize the developing brain of children and adolescents prenatally infected and the environmental influences on variation in access to ART especially in resource constrained countries. 8 A cross-sectional study was conducted among 940 School aged HIV children. They found that about 50% of infected children had some physical limitations mainly on energy demanding activities and their behavior problems were found significant with the chronicity of illness, social and economic limitations of the environment.…”