There were no differences in
neurodevelopmental outcomes among children who had deferred antiretroviral
therapy compared with children who immediately started antiretroviral therapy.
“HIV-positive children should be diagnosed and
started on treatment during their first year of life,” Jintanat
Ananworanich, MD, PhD, of HIV-NAT and the Thai Red Cross AIDS Research
Center, said during a press conference here. “Our study provides
information on what to do in older children who survive their HIV
disease.”
HIV-positive children from Thailand and Cambodia, aged 1
to 12 years, who had CD4 counts of 15% to 24% and no AIDS-defining illness were
randomly assigned to initiate ART immediately or when CD4 counts reached less
than 15%. Children underwent neuropsychological testing, including the Beery
Visual-Motor Integration, the Purdue Pegboard, Color Traits and child
behavioral checklist. The Thai children also completed the Wechsler
Intelligence Scale.
The study included 284 HIV-positive children and 164
HIV-negative children with a median age of 7 years. Females comprised 58% of
the children, and 62% of the children were Thai. Median CD4 nadirs were 18% in
the children who received immediate ART, and 15% in the children who received
delayed ART.
At week 144, 48% of the children in the deferred arm had
started ART. The median CD4 count was 33% in the group that had immediate ART
and 24% in the group that had deferred ART. There were no significant
differences between either of the arms for any of the neurodevelopmental
scores. But both of the HIV-positive groups scored lower than the HIV-negative
controls on the IQ and the Berry Visual-Motor Integration, but not the Purdue
Pegboard or the Color Traits.
“The fact that we saw worse neurodevelopment
outcomes in HIV-positive children compared to HIV-negative children suggests
that HIV affects the brain,” Ananworanich said. “Even though these
older children survived their infancy, there are still neurodevelopmental
consequences related to HIV.”
For more information:
- Ananworanich J. #24. Presented at: 19th Conference on Retroviruses
and Opportunistic Infections; March 3-8, 2012; Seattle.
Disclosure: Dr. Ananworanich reports no relevant
financial disclosures.
