HIV-positive, exposed children more likely to have worse neurodevelopmental outcomes

Megan S. McHenry

Children who are HIV-positive or have been exposed to HIV are at increased risk of having poorer outcomes regarding cognitive and motor development when compared with children who are HIV-negative and have not been exposed, according to findings published in Pediatrics.

“At this time, we still do not have enough data to clearly understand the long-lasting effects of HIV-exposure for children and their neurodevelopment,” Megan S. McHenry, MD, MS, FAAP, assistant professor of pediatrics and director of pediatric resident global health education at the Indiana University School of Medicine, told Infectious Diseases in Children. “Our study found that young children who are either infected or exposed to HIV have worse developmental scores than children who are unexposed; however, the cause for this worse development is still unknown.”

“We suspect that multiple factors likely play a role, including biological and social [influences],” she continued. “As children age, these factors become even more diverse. More research is needed to understand [long-lasting effects of exposure and infection].”

To determine the effect of HIV infection and exposure on neurodevelopmental outcomes of children, the researchers conducted a systematic review of studies that included HIV-positive, HIV-exposed and HIV-unexposed and uninfected children aged younger than 8 years. Additionally, the researchers required that all data be collected using a standardized neuropsychological instrument.

All data were collected from Ovid Medline, Embase, PsycINFO, Education Resources Information Center and the Cochrane Database of Systematic Reviews. Once studies were collected, data were pulled by two reviewers, with cross-checking performed by two other reviewers.

Of the 45 studies that met inclusion criteria, most demonstrated worse developmental outcomes in children with HIV when compared with those without (n = 28). Three studies described also worse outcomes in children who had been exposed to HIV when compared with children who had not been exposed.

Of the HIV-positive children included in the studies, the rate of developmental delay ranged from 3% to 90.0%; however, the researchers observed a more concise range in those who experienced severe cognitive delays (21%-35%). Motor delays were observed in 14% to 81% of children with HIV, and severe motor delay was reported in 21% to 66% of HIV-positive children.

For children who had been exposed to HIV, severe cognitive delays were reported in 1% to 31% of participants. Severe motor delays were observed in 0% to 39%, and when compared with children who had not been exposed to HIV, 1% to 15% of HIV-exposed children had severe cognitive delays. When compared with unexposed children, HIV-exposed children had a 0% to 6% rate of severe motor delay.

 “All children who are born to mothers with HIV require special attention during the first few months of their lives in order to be monitored for HIV and receive the appropriate medications,” McHenry said. “In addition to HIV-specific care, pediatricians should encourage mothers caring for children exposed to HIV to focus on other areas that we know can positively impact child development in all children such as good nutrition, nurturing environments and stimulating play.”

“By providing these experiences, as well as being compliant with anti-retroviral medications during pregnancy, HIV-infected mothers will be maximizing the developmental potential of their children,” she continued. – by Katherine Bortz

Disclosure: The authors report no relevant financial disclosures.
Megan S. McHenry

Children who are HIV-positive or have been exposed to HIV are at increased risk of having poorer outcomes regarding cognitive and motor development when compared with children who are HIV-negative and have not been exposed, according to findings published in Pediatrics.

“At this time, we still do not have enough data to clearly understand the long-lasting effects of HIV-exposure for children and their neurodevelopment,” Megan S. McHenry, MD, MS, FAAP, assistant professor of pediatrics and director of pediatric resident global health education at the Indiana University School of Medicine, told Infectious Diseases in Children. “Our study found that young children who are either infected or exposed to HIV have worse developmental scores than children who are unexposed; however, the cause for this worse development is still unknown.”

“We suspect that multiple factors likely play a role, including biological and social [influences],” she continued. “As children age, these factors become even more diverse. More research is needed to understand [long-lasting effects of exposure and infection].”

To determine the effect of HIV infection and exposure on neurodevelopmental outcomes of children, the researchers conducted a systematic review of studies that included HIV-positive, HIV-exposed and HIV-unexposed and uninfected children aged younger than 8 years. Additionally, the researchers required that all data be collected using a standardized neuropsychological instrument.

All data were collected from Ovid Medline, Embase, PsycINFO, Education Resources Information Center and the Cochrane Database of Systematic Reviews. Once studies were collected, data were pulled by two reviewers, with cross-checking performed by two other reviewers.

Of the 45 studies that met inclusion criteria, most demonstrated worse developmental outcomes in children with HIV when compared with those without (n = 28). Three studies described also worse outcomes in children who had been exposed to HIV when compared with children who had not been exposed.

Of the HIV-positive children included in the studies, the rate of developmental delay ranged from 3% to 90.0%; however, the researchers observed a more concise range in those who experienced severe cognitive delays (21%-35%). Motor delays were observed in 14% to 81% of children with HIV, and severe motor delay was reported in 21% to 66% of HIV-positive children.

For children who had been exposed to HIV, severe cognitive delays were reported in 1% to 31% of participants. Severe motor delays were observed in 0% to 39%, and when compared with children who had not been exposed to HIV, 1% to 15% of HIV-exposed children had severe cognitive delays. When compared with unexposed children, HIV-exposed children had a 0% to 6% rate of severe motor delay.

 “All children who are born to mothers with HIV require special attention during the first few months of their lives in order to be monitored for HIV and receive the appropriate medications,” McHenry said. “In addition to HIV-specific care, pediatricians should encourage mothers caring for children exposed to HIV to focus on other areas that we know can positively impact child development in all children such as good nutrition, nurturing environments and stimulating play.”

“By providing these experiences, as well as being compliant with anti-retroviral medications during pregnancy, HIV-infected mothers will be maximizing the developmental potential of their children,” she continued. – by Katherine Bortz

Disclosure: The authors report no relevant financial disclosures.