In the Journals

Children with HIV show poorer neuropsychological performance

Michael J. Boivin

Children who were perinatally infected with HIV showed poorer scores on tests measuring cognitive ability, attention and motor function than their uninfected peers, according to results from a 2-year study published in Clinical Infectious Diseases.

Researchers enrolled 611 children aged 5 to 11 years at six evaluation sites — three in South Africa and one each in Malawi, Uganda and Zimbabwe. Of the children, 246 were HIV positive and were initiated on ART before 3 years of age as part of a previous International Maternal Pediatric AIDS Clinical Trials Network study.

“A big concern whenever you are doing these types of cognitive assessments is, ‘Do the measures mean the same thing across different languages, different centuries, urban vs. rural, different socioeconomic and ethnic classes and communities — are you measuring the same thing?” Michael J. Boivin, PhD, MPH, professor and director of the psychiatry research program at Michigan State University, told Healio. “The kinds of measures that we have used and the way in which they were standardized through quality assurance ... are calibrated and quality assured by virtue of a centralized assessment center where we look at every tester’s quality of their assessment battery every month from all six sites.”

Of the children without HIV, 183 were age exposed but uninfected (HEU) and 182 were unexposed and uninfected (HUU). Boivin and colleagues evaluated all study participants at weeks zero, 48 and 96 on their cognitive ability via the second edition of the Kaufman Assessment Battery for Children, their attention and impulsivity via the Tests of Variables of Attention, and their motor proficiency via the second edition of the Bruininks-Oseretsky Test and the Behavior Rating Inventory of Executive Function test.

Despite early ART initiation, HIV-positive children showed poorer neuropsychological performance than the HEU or HUU groups, with the gap steadily worsening in reasoning and planning over time, according to Boivin and colleagues.

Boivin said caregiver intervention is essential to improving this cognitive gap in HIV-positive children.

“I can't emphasize enough the importance of solid environment enrichment, nutrition and neural cognitive stimulation by training caregivers,” Boivin said.

The researchers noted significantly lower scores among HIV-positive children on the learning and planning portions of the Kaufman Assessment. HIV-positive children scored an average of 82.6 (95% CI, 80.42-84.79) on the learning portion, whereas the HEU and HUU groups scored an average of 85.48 (95% CI, 82.58-88.38) and 87.31 (95% CI, 84.45-90.17) at week 0, respectively. Similarly, children in the HIV-positive group showed average scores on the planning portion of the assessment of 71.66 (95% CI, 69.56-73.75), whereas the HEU and HUU children had average scores of 74.33 (95% CI, 71.68-76.98) and 74.58 (95% CI, 72.07-77.09) at week 0, respectively.

Boivin also noted the importance of maternal health in improving outcomes for HIV-exposed children.

“We were worried about the risk of moms being on highly active antiretroviral drugs through pregnancy and how that might affect gestational development in terms of toxic exposure,” Boivin said. “We found out that maybe there is some risk there, like with efavirenz, for example, but the health benefits to the mom of keeping her virally suppressed, immunologically stronger and in better health in general far outweighs any risk of the specific combination drug therapies themselves during pregnancy and after. Keeping the mom with HIV in good health is the single best thing we can do for the early development of the HIV-exposed child.” – by Eamon Dreisbach

Disclosure: Boivin reports no relevant financial disclosures.

Michael J. Boivin

Children who were perinatally infected with HIV showed poorer scores on tests measuring cognitive ability, attention and motor function than their uninfected peers, according to results from a 2-year study published in Clinical Infectious Diseases.

Researchers enrolled 611 children aged 5 to 11 years at six evaluation sites — three in South Africa and one each in Malawi, Uganda and Zimbabwe. Of the children, 246 were HIV positive and were initiated on ART before 3 years of age as part of a previous International Maternal Pediatric AIDS Clinical Trials Network study.

“A big concern whenever you are doing these types of cognitive assessments is, ‘Do the measures mean the same thing across different languages, different centuries, urban vs. rural, different socioeconomic and ethnic classes and communities — are you measuring the same thing?” Michael J. Boivin, PhD, MPH, professor and director of the psychiatry research program at Michigan State University, told Healio. “The kinds of measures that we have used and the way in which they were standardized through quality assurance ... are calibrated and quality assured by virtue of a centralized assessment center where we look at every tester’s quality of their assessment battery every month from all six sites.”

Of the children without HIV, 183 were age exposed but uninfected (HEU) and 182 were unexposed and uninfected (HUU). Boivin and colleagues evaluated all study participants at weeks zero, 48 and 96 on their cognitive ability via the second edition of the Kaufman Assessment Battery for Children, their attention and impulsivity via the Tests of Variables of Attention, and their motor proficiency via the second edition of the Bruininks-Oseretsky Test and the Behavior Rating Inventory of Executive Function test.

Despite early ART initiation, HIV-positive children showed poorer neuropsychological performance than the HEU or HUU groups, with the gap steadily worsening in reasoning and planning over time, according to Boivin and colleagues.

Boivin said caregiver intervention is essential to improving this cognitive gap in HIV-positive children.

“I can't emphasize enough the importance of solid environment enrichment, nutrition and neural cognitive stimulation by training caregivers,” Boivin said.

The researchers noted significantly lower scores among HIV-positive children on the learning and planning portions of the Kaufman Assessment. HIV-positive children scored an average of 82.6 (95% CI, 80.42-84.79) on the learning portion, whereas the HEU and HUU groups scored an average of 85.48 (95% CI, 82.58-88.38) and 87.31 (95% CI, 84.45-90.17) at week 0, respectively. Similarly, children in the HIV-positive group showed average scores on the planning portion of the assessment of 71.66 (95% CI, 69.56-73.75), whereas the HEU and HUU children had average scores of 74.33 (95% CI, 71.68-76.98) and 74.58 (95% CI, 72.07-77.09) at week 0, respectively.

Boivin also noted the importance of maternal health in improving outcomes for HIV-exposed children.

“We were worried about the risk of moms being on highly active antiretroviral drugs through pregnancy and how that might affect gestational development in terms of toxic exposure,” Boivin said. “We found out that maybe there is some risk there, like with efavirenz, for example, but the health benefits to the mom of keeping her virally suppressed, immunologically stronger and in better health in general far outweighs any risk of the specific combination drug therapies themselves during pregnancy and after. Keeping the mom with HIV in good health is the single best thing we can do for the early development of the HIV-exposed child.” – by Eamon Dreisbach

Disclosure: Boivin reports no relevant financial disclosures.