Neurocognitive function in HIV-positive children in a developing country

Int J Infect Dis. 2013 Oct;17(10):e862-7. doi: 10.1016/j.ijid.2013.02.014. Epub 2013 Apr 4.

Abstract

Objectives: We aimed to characterize neurological outcomes and determine the prevalence of HIV encephalopathy in a cohort of HIV-infected children in Jamaica.

Methods: Data for 287 HIV-infected children presenting between 2002 and 2008 were reviewed and neurological outcomes characterized. A nested case-control study was conducted between July and September 2009 used 15 randomly selected encephalopathic HIV-infected children aged 7-10 years and 15 matched controls (non-encephalopathic HIV-infected). Their neurocognitive functions were evaluated using clinical assessment and standardized tests for intelligence, short term memory (visuo-spatial and auditory), selective attention, and fine motor and coordination functions. Outcomes were compared using Fisher's exact test and the Mann-Whitney U-test.

Results: Sixty-seven (23.3%) children were encephalopathic. The median age at diagnosis of HIV encephalopathy was 1.6 years (interquartile range (IQR) 1.1-3.4 years). Predominant abnormalities were delayed milestones (59, 88.1%), hyperreflexia (59, 86.5%), spasticity (50, 74.6%), microcephaly (42, 61.7%), and quadriparesis (21, 31.3%). The median age of tested children was 8.7 years (IQR 7.6-10.8 years) in the encephalopathic group and 9 years (IQR 7.4-10.7 years) in the non-encephalopathic group. Encephalopathic children performed worse in all domains of neurocognitive function (p<0.05).

Conclusions: A high prevalence of HIV encephalopathy was noted, and significant neurocognitive dysfunction identified in encephalopathic children. Optimized management through the early identification of neurological impairment and implementation of appropriate interventions is recommended to improve quality of life.

Keywords: Encephalopathy; HAART; HIV; Jamaica; Neurocognitive; Pediatric.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS Dementia Complex / drug therapy
  • AIDS Dementia Complex / epidemiology
  • AIDS Dementia Complex / psychology*
  • Anti-HIV Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cognition Disorders / epidemiology
  • Cognition Disorders / virology*
  • Developing Countries*
  • Humans
  • Infant
  • Jamaica / epidemiology
  • Learning Disabilities / epidemiology
  • Learning Disabilities / virology
  • Memory Disorders / epidemiology
  • Memory Disorders / virology
  • Microcephaly / epidemiology
  • Microcephaly / virology
  • Prevalence
  • Quality of Life
  • Reflex, Abnormal

Substances

  • Anti-HIV Agents