Neurodevelopmental Trajectory of HIV-Infected Children Accessing Care in Kinshasa, Democratic Republic of Congo

Rie, Annelies Van; Dow, Anna; Mupuala, Aimee; Stewart, Paul W.

doi:10.1097/qai.0b013e3181b32646

Cited by 60 publications

(53 citation statements)

References 31 publications

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“…The study concluded that cognitive deficits in HIV positive children potentially occur in infancy and they do not improve with initiation of ART after one year of age. However, another study of HIV-positive children aged 18 to 71 months 21 found that early initiation of primary HIV care and ART, resulted in improved motor development and possibly cognitive development. Our study supports this observation.…”

Section: Discussionmentioning

confidence: 99%

“…This in part may be due to differences in neurodevelopmental assessment, poor ART availability and adherence, differences in populations assessed as a majority of these studies were in urban settings, as well as the lack of prospective data where confounders could potentially be controlled for. Antiretroviral Therapy (ART) improves survival of HIV-infected children, and has been shown to reduce neurologic pathology, 19;20 and HIV-infected children accessing care have improved motor development scores 21 . ART is becoming increasingly available in resource-poor settings, although little is known about the impact of age at initiation and duration of ART on neurodevelopment.…”

Section: Introductionmentioning

confidence: 99%

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Neurodevelopmental Benefits of Antiretroviral Therapy in Ugandan Children Aged 0–6 Years With HIV

Brahmbhatt

Boivin

Ssempijja

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Insufficient data on neurodevelopmental benefits of antiretroviral therapy (ART) in children. Methods Prospective study of 329 mothers and children aged 0–6 years to assess neurodevelopment. Results stratified by the maternal (M) and child (C) HIV status (MHIV−/CHIV−, MHIV+/CHIV−, and MHIV+/CHIV+). Gross Motor, Visual Reception, Fine Motor, Receptive and Expressive Language scores assessed by Mullen Scales of Early Learning. Global cognitive function was derived from an Early Learning Composite score (ELC). Standardized Weight and Height for Age z-scores were constructed and the lowest 15% cutoff defined disability. Generalized linear models were used to estimate Prevalence Rate Ratios (PRR) adjusted for the child’s age, weight and height. In HIV-positive children, generalized linear models assessed the impact of ART initiation and duration on neurodevelopment. Results Compared to MHIV−/CHIV− children, HIV+ children were more likely to have global deficits in all measures of neurodevelopment except gross motor skills, whereas in MHIV+/CHIV− children, there was impairment in receptive language (adj.PRR=2.67, CI: 1·08, 6.60) and the ELC (adj.PRR=2.94, CI: 1.11, 7.82). Of the children born to HIV positive mothers, HIV+ children did worse than - MHIV+/CHIV− only in Visual Reception skills (adj.PRR=2.86; CI: 1.23–6.65). Of the 116 HIV+ children, 44% had initiated ART. Compared to ART duration of <12 months, ART durations 24–60 months was associated with decreased impairments in Fine Motor, Receptive Language, Expressive Language and ELC scores. Conclusions Longer duration on ART is associated with reduction of some neurologic impairment and early diagnosis and treatment of HIV+ children is a priority.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neurodevelopmental Benefits of Antiretroviral Therapy in Ugandan Children Aged 0–6 Years With HIV

Brahmbhatt

Boivin

Ssempijja

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…[9] Initiating cART during the pre-school years (<6 years) also appears to positively affect neurodevelopment, since PHIV+ children ages 18-71 months with lower neurodevelopmental function relative to their HIV-exposed uninfected peers demonstrated developmental gains after one year of cART. [10] In contrast, children who initiated early cART (i.e, without clinical and/or immunological progression) later in childhood (median age 6.4 years) did not experience greater cognitive improvement compared to children who initiated cART when such progression had occurred, highlighting the importance of early cART initiation in infancy. [11] Despite the recent evidence for the benefit of early cART on neurodevelopment in early childhood, it remains unclear if this positive effect will persist through school-age years and adolescence.…”

Section: Introductionmentioning

confidence: 99%

Early viral suppression improves neurocognitive outcomes in HIV-infected children

Crowell

Huo

Tassiopoulos

et al. 2015

Aids

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Objective To estimate the association of age of viral suppression and central nervous system penetration effectiveness (CPE) score with neurocognitive functioning among school-age children with perinatally-acquired HIV infection (PHIV+). Design We analyzed data from two U.S.-based multisite prospective cohort studies. Methods Multivariable general linear regression models were used to evaluate associations of age at viral suppression and CPE scores [of initial ART regimen and weighted average] with WISC-III or WISC-IV neurocognitive assessments [full scale IQ (FSIQ); performance IQ/ perceptual reasoning index (PIQ/PRI); and verbal IQ/ verbal comprehension index (VIQ/VCI)], adjusted for demographic and clinical covariates. Sensitivity analyses were stratified by birth cohort (before vs after 1996). Results 396 PHIV+ children were included. Estimated differences in mean FSIQ (comparing virally suppressed vs. unsuppressed children) by each age cutoff were 3.7, 2.2, 3.2, 4.4, and 3.9 points at ages 1, 2, 3, 4, and 5, respectively. For PIQ/PRI, estimated mean differences were 3.7, 2.4, 2.2, 4.6, and 4.5 at ages 1 through 5 respectively. In both cases, these differences were significant only at the age 4 and 5 thresholds. After stratifying by birth cohort the association between age at suppression and cognitive function persisted only among those born after 1996. Age at viral suppression was not associated with VIQ/VCI; CPE score was not associated with FSIQ, verbal comprehension or perceptual reasoning indices. Conclusions Virologic suppression during infancy or early childhood is associated with improved neurocognitive outcomes in school-aged PHIV+ children. In contrast, CPE scores showed no association with neurocognitive outcomes.

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“…However, there are few studies on the effects of ART on neurocognitive development in Sub Saharan Africa. Findings have been variable and early initiation of ART appears to be critical (Feucht, Hoehnen, Brisley, Forsyth, & Kruger, 2009;Laughton et al, 2009;Smith, Adnams, & Eley, 2008;Van Rie, Dow, Mupuala, & Stewart, 2009;Van Rie, Mupuala, & Dow, 2008;Van Rie et al, 2007). Two South African cohort studies found high pre-ART levels of neurocognitive delay with no improvement following six months of ART (Feucht et al, 2009;Smith et al, 2008).…”

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confidence: 99%

Neurodevelopmental delay among HIV-infected preschool children receiving antiretroviral therapy and healthy preschool children in Soweto, South Africa

Lowick¹,

Sawry²,

Meyers³

2012

Psychology, Health & Medicine

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Neurodevelopmental delay has been documented in up to 97.5% of HIV-infected children in Soweto who were not yet on antiretroviral treatment (ART). With growing numbers of children in South Africa being successfully treated with ART, the effects of ART on neurocognitive functioning in children require investigation. The objective of this study was to determine the extent of neurodevelopmental delay in stable HIV-infected preschool children (aged five to six years) receiving ART and compare it to an apparently healthy (unconfirmed HIV-status) group of preschool children. Thirty HIV-infected preschool children (virologically and immunologically stable on ART for more than one year) were conveniently sampled from 350 eligible children on ART at the Harriet Shezi Children's Clinic in Soweto, Johannesburg. The comparison group comprised 30 well-nourished preschool children attending the Lilian Ngoyi Primary Health Care Clinic in Soweto for routine immunizations. Each child was assessed using the Griffiths Mental Development Scales-Extended Revised Version (GMDS-ER), at a single point in time. The overall developmental z-scores on GMDS-ER were <-2 (indicating severe delay) in 27 (90%) children in the HIV-infected group compared to 23 (76%) in the comparison group (p = 0.166). Mental handicap (overall GQ < 70) was evident in 46.7% of children in the HIV-infected group compared to 10% in the comparison group (p = 0.002). There was a 7.88-fold increased likelihood of severe delay in the HIV infected group. The HIV-infected group and comparison group had significantly different (p = 0.001) mean overall GQ scores of 70 (95% CI: 66.0-74.0) and 78 (95% CI: 75.6-80.5), respectively, with lower mean scores in the HIV-infected group in all individual domains. Early initiation of ART in HIV-infected infants may improve cognitive functioning among this group; however, intervention strategies which optimize early cognitive development for all children in the area need to be urgently considered.

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Neurodevelopmental Trajectory of HIV-Infected Children Accessing Care in Kinshasa, Democratic Republic of Congo

Cited by 60 publications

References 31 publications

Neurodevelopmental Benefits of Antiretroviral Therapy in Ugandan Children Aged 0–6 Years With HIV

Neurodevelopmental Benefits of Antiretroviral Therapy in Ugandan Children Aged 0–6 Years With HIV

Early viral suppression improves neurocognitive outcomes in HIV-infected children

Neurodevelopmental delay among HIV-infected preschool children receiving antiretroviral therapy and healthy preschool children in Soweto, South Africa

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