The Impact of Perinatal HIV Infection on Older School-Aged Children's and Adolescents' Receptive Language and Word Recognition Skills

Abstract

Perinatally HIV-infected youths are reaching adolescence in large numbers. Little is known about their cognitive functioning. This study aims to describe and compare the receptive language ability, word recognition skills, and school functioning of older school-aged children and adolescents perinatally HIV infected (HIV-positive) and perinatally HIV-exposed but uninfected (seroreverters; HIV-negative). Participants included 340 youths (206 HIV-positive, 134 HIV-negative), 9–16 years old, and their caregivers. Youths completed the Peabody Picture Vocabulary Test, Third Edition (PPVT-III) and the Reading Subtest of the Wide Range Achievement Test, Third Edition (WRAT-3). Caregivers were interviewed regarding demographic characteristics and school placement of youths. Medical information was abstracted from medical charts. Both groups of youths scored poorly on the PPVT-III and WRAT-3 with about one third of youths scoring in less than the 10th percentile. The HIV-positive youths scored lower than the seroreverters (M = 83.8 versus 87.6, t = 2.21, p = 0.028) on the PPVT-III and on the WRAT-3 (M = 88.2 versus 93.8, t = 2.69, p = 0.008). Among the HIV-positive youths, neither CD4+ cell count, HIV RNA viral load or Centers for Disease Control and Prevention (CDC) classification were significantly associated with either PPVT-III or WRAT-3 scores. However, youths who were taking antiretroviral medication had lower WRAT-3 scores than youths not taking medication (M = 95.03 versus 86.89, t = 2.38, p = 0.018). HIV status remained significantly associated with PPVT-III and WRAT-3 standard scores after adjusting for demographic variables. Many youths had been retained in school and attended special education classes. Findings highlight poor language ability among youths infected with and affected by HIV, and the importance of educational interventions that address this emerging need.

Poor Cognitive Functioning of School-Aged Children in Thailand with Perinatally Acquired HIV Infection Taking Antiretroviral Therapy

“…8,11,13 The mean IQ among HIV-infected Thai school-aged children in this study is 79 (SD 13), which is slightly lower than report from a large study among U.S. children with a mean IQ of 84 (SD 15). 8 However, in the U.S. study, the children had better immunologic status with average CD4 of approximately 690 cells.…”

“…The study among U.S. HIV-infected and HIV-affected school-aged children focused on the receptive language ability, which is highly correlated with IQ score, found that the HIV infected group had significany lower score than HIV-affected group (mean score of 83.8 versus 87.6). 11 The recently reported data among 58 Thai HIV-infected children with median age of 7 years and median CD4 percentage of 20 showed a median (IQR) of IQ of 72 (65-84). 13 The poor neurocognitive function in school-aged HIVinfected children might be explained by many reasons.…”

“…4 Few studies have demonstrated a neurocognitive deficit in HIV-infected preschool 5,6 and school-aged children. [7][8][9][10][11] Data from HIVinfected children aged from 4 months to 17 years in the United States showed lower cognitive function among the HIVinfected group compared to normal controls. 8 Moreover, cognitive function was not improved after 48 weeks of antiretroviral therapy.…”

“…8 The study among U.S. HIV-infected school-aged children and adolescents showed that one third of them had poor receptive language and word recognition skills, which lead to compromise in learning skills. 11 Children with abnormal structural brain findings such as cortical atrophy, poor immune function, or an AIDS-defining illness have more risk of poor cognitive function. 9,12 Most of the neurocognitive assessment studies of HIVinfected children have been performed in the United States and Europe where children have access to treatment earlier than children in resource-limited settings.…”

Speech, language and swallowing difficulties in a child with aids

“…The prevalence of speech-language impairments among children infected with HIV is relatively high [11]. Children infected with HIV who demonstrate language impairments would be at risk of poor academic performance [17]. Language impairment is classified as primary and concurrent; former being isolated language impairment without cognitive or hearing impairment and the latter language impairment being associated with cognitive and/or hearing impairment [18].…”