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Wedderburn CJ, Sevenoaks T, Fouche JP, Phillips NJ, Lawn SD, Stein DJ, Hoare J. Motivation levels and white matter microstructure in children living with HIV. Sci Rep 2024; 14:4425. [PMID: 38396081 PMCID: PMC10891087 DOI: 10.1038/s41598-024-54411-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Central nervous system involvement in HIV infection leads to neurobehavioural sequelae. Although apathy is a well-recognised symptom in adults living with HIV linked to alterations in brain structure, there is scarce research examining motivation in children living with HIV (CLWH). We used the Children's Motivation Scale (CMS; normative mean = 50, SD = 10) to assess motivation levels in 76 CLWH aged 6-16 years (63 on antiretroviral therapy [ART]; 13 ART-naïve slow progressors) in South Africa. Overall, CLWH scored low on the CMS (mean = 35.70 [SD = 5.87]). Motivation levels were significantly reduced in children taking ART compared to ART-naïve slow progressors (p = 0.02), but were not correlated with markers of HIV disease (CD4 + cell count or viral load), or neurocognitive function (p > 0.05). CMS scores were correlated with diffusion tensor imaging metrics of white matter microstructure in specific frontostriatal brain regions (p < 0.05). On multiple regression, associations with the anterior limb of the internal capsule, a subcortical white matter region, remained significant after adjusting for potential confounders. These findings suggest that reduced motivation may be an important neurobehavioural symptom in CLWH and may reflect changes in white matter microstructure of frontostriatal brain regions.
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Affiliation(s)
- Catherine J Wedderburn
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
| | - Tatum Sevenoaks
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jean-Paul Fouche
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Nicole J Phillips
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Stephen D Lawn
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Dan J Stein
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- SA MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Jacqueline Hoare
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Zoumenou R, Bodeau-Livinec F, Chausseboeuf L, Boivin MJ, Wendland J. Is Neurodevelopmental Assessment in Early Childhood Predictive of Performance Assessed Later in Childhood and Adolescence in Sub-Saharan Africa? A Systematic Review of the Literature. Arch Clin Neuropsychol 2024; 39:98-116. [PMID: 37470401 PMCID: PMC10802230 DOI: 10.1093/arclin/acad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Most neurodevelopmental tests used to assess child development in sub-Saharan Africa were developed in western or high-income countries, raising the question of their usefulness with African children. OBJECTIVE This systematic review identified and synthesized key findings from studies measuring development in children in Sub-Saharan Africa in early childhood and again at school age, to assess neurocognitive associations longitudinally from infancy through middle childhood. METHODS The study was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, selecting articles referenced in the PubMed, PsycInfo, and Embase databases using the following inclusion criteria: published between 2000 and 2022, written in French or English, and presenting results dealing with the objective assessment of child's neurodevelopment. All articles were registered in the Zotero reference manager and analyzed by title, abstract, and full text. RESULTS Several of the seven selected studies confirmed that attention and working memory in infancy can predict children's neurocognitive performance, including mathematical ability, at school age. In two of the studies, children with poor mental development at 1 year of age are more likely to present with poorer behavioral development at school age, including learning difficulties in school and risk for grade repetition. CONCLUSION Cognitive ability assessed in early childhood is strongly associated with performance at school age in cohorts of African children followed longitudinally. Even with assessments adapted cross-culturally, infants and preschoolers at risk for poor developmental outcomes can be identified to better receive strategic early interventions to enhance their development.
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Affiliation(s)
- Roméo Zoumenou
- Institut de Recherche pour le Developpement, Mère et enfant face aux infections tropicales, 75006 Paris, France
- Laboratoire psychopathologie et processus en santé, Institute de psychologie, 92774 Boulogne, France
| | - Florence Bodeau-Livinec
- Institut de recherche en santé, environnement et travail (IRSET), Ecole des hautes etudes en santé (EHESP), 93210 Saint-Denis, France
| | - Léa Chausseboeuf
- Laboratoire psychopathologie et processus en santé, Institute de psychologie, 92774 Boulogne, France
| | - Michael J Boivin
- Department of Psychiatry and Department of Neurology & Ophthalmology, Michigan State University, East Lansing, MI 48824 USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48104, USA
| | - Jaqueline Wendland
- Laboratoire psychopathologie et processus en santé, Institute de psychologie, 92774 Boulogne, France
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Kaseka PU, Zgambo M, Mbakaya BC, Lazarus M, Nkhata O, Kalembo FW. Emotional and behavioural difficulties among children and adolescents attending "ART teen clubs" in Mzuzu City in northern Malawi: a cross-sectional study. BMC Pediatr 2024; 24:41. [PMID: 38218758 PMCID: PMC10787500 DOI: 10.1186/s12887-023-04504-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND While triple anti-retroviral therapy (ART) has improved HIV-infected children surviving into adolescence and adulthood, these children remain vulnerable to HIV-related psychological disturbance due to both the direct HIV infection effects on the brain and indirect effects related to coping with a range of medical, psychological and social stresses associated with HIV, which makes it vital to identify their mental health needs. This study assessed the emotional and behavioural challenges of HIV perinatally infected children and adolescents with a completed disclosure process attending "ART teen club" in Malawi. METHODS A cross-sectional descriptive study design was conducted to obtain quantitative descriptive descriptions of emotional and behavioural challenges among HIV-infected children and adolescents between 10 and 22 years of age. They were interviewed on their family socio-demographic characteristics, clinical characteristics as well as emotional, conduct, hyperactivity, peer and prosocial problems using the Chichewa version of the Strengths and Difficulties Questionnaire. Data were analyzed using descriptive analysis and logistic regression. RESULTS Based on the four-band categorization of the SDQ, higher scores for total difficulties score were observed in 72.9% of the children. According to the subscales of the SDQ, results show that children had higher scores in peer problems (62.8%), emotional (68.2%), conduct (68.6%) and prosocial (57.8%) subscales while lower scores were identified in the hyperactivity (16.6%) subscale. Results show that within each level, males are having lower frequencies as compared to females. Results from multivariate binary logistic regression indicate that those with a single parent or not as well as the WHO HIV clinical stage had an impact on the mental health status of the children. Children who do not have a single parent (AOR 3.404; 95% CI:1.563-7.416, p = 0.002) had 3.404 odds of having abnormal mental health status unlike those children with a single parent and children who were in WHO HIV clinical stage 2 (AOR 2.536; 95% CI:1.005-6.395, p = 0.049) or 3 and 4 (AOR 8.459; 95% CI:1.5.820-10.544, p < 0.001) had more odds of having the mental disorder as compared with those children in WHO HIV clinical stage 1. CONCLUSION The findings of this research underscore the multifaceted nature of mental well-being among children and adolescents living with HIV. Elevated scores in total difficulties, emotional, conduct, and peer problems signify areas of concern, while disparities in hyperactivity and prosocial behavior highlight the nuanced nature of their behavioral challenges. Recognizing the inadequacy of a one-size-fits-all approach, the research emphasizes the necessity of a comprehensive strategy, incorporating factors like religious background, family structure, and clinical HIV stage. Furthermore, the role of "ART teen clubs" in this context is pivotal. Beyond addressing identified risk factors, these clubs must actively foster resilience. Creating an inclusive environment, tapping into individual strengths, and nurturing a sense of community are vital components. By adopting such a holistic approach, Teen support clubs can significantly contribute to the overall mental well-being of adolescents living with HIV, enabling them to navigate challenges effectively and thrive amidst their circumstances.
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Affiliation(s)
- Paul Uchizi Kaseka
- Paediatric Department, Mzuzu Central Hospital, Private Bag 209, Mzuzu, Malawi.
| | - Maggie Zgambo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia
| | - Balwani Chingatichifwe Mbakaya
- Public Health, University of Livingstonia, Mzuzu, Malawi
- Nursing and Midwifery Department, Mzuzu University, Mzuzu, Malawi
| | - Mathews Lazarus
- Basic Department, Kamuzu University for Health Sciences, Lilongwe, Malawi
| | - Obed Nkhata
- Investigations Department, Nurses and Midwives Council of Malawi, Mzuzu, Malawi
| | - Fatch W Kalembo
- School of Nursing, Curtin University, Bentley, Western Australia
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Chongwo EJ, Wedderburn CJ, Nyongesa MK, Sigilai A, Mwangi P, Thoya J, Odhiambo R, Ngombo K, Kabunda B, Newton CR, Abubakar A. Neurocognitive outcomes of children exposed to and living with HIV aged 3-5 years in Kilifi, Kenya. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1193183. [PMID: 37732169 PMCID: PMC10508958 DOI: 10.3389/frph.2023.1193183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Globally, 1.7 million children are living with HIV, with the majority of them residing in sub-Saharan Africa. Due to reduced rates of vertical transmission of HIV, there is an increasing population of children born to HIV-infected mothers who remain uninfected. There is a growing concern around the development of these children in the antiretroviral therapy era. This study examined the neurocognitive outcomes of children who are HIV-exposed infected (CHEI), HIV-exposed uninfected (CHEU) and HIV-unexposed uninfected (CHUU) and explored the relationship between child neurocognitive outcomes and child's biomedical and caregivers' psychosocial factors. Methods CHEI, CHUU and CHEU aged 3-5 years and their caregivers were recruited into the study. Neurocognitive outcomes were assessed using a validated battery of assessments. One-way analysis of variance and covariance (ANOVA and ANCOVA) were used to evaluate differences among the three groups by neurocognitive outcomes. Linear regression models were used to investigate the association between child neurocognitive outcomes and biomedical factors (nutritional status, HIV disease staging) and caregivers' psychosocial factors [symptoms of common mental disorders (CMDs) and parenting behaviour]. Results The study included 153 children and their caregivers: 43 (28.1%) CHEI, 52 (34.0%) CHEU and 58 (39.9%) CHUU. ANOVA and ANCOVA revealed a significant difference in cognitive ability mean scores across the child groups. Post hoc analysis indicated that CHEU children had higher cognitive ability mean scores than the CHUU group. Better nutritional status was significantly associated with higher cognitive ability scores (β = 0.68, 95% CI [0.18-1.18], p = 0.008). Higher scores of CMDs were negatively associated with inhibitory control (β = -0.28, 95% CI [-0.53 to 0.02], p = 0.036). While comparing HIV stages 2 and 3, large effect sizes were seen in working memory (0.96, CI [0.08-1.80]) and cognitive ability scores (0.83 CI [0.01-1.63]), indicating those in stage 3 had poor performance. Conclusions Neurocognitive outcomes were similar across CHEI, CHEU and CHUU, although subtle differences were seen in cognitive ability scores where CHEU had significantly higher cognitive mean scores than the CHUU. Well-designed longitudinal studies are needed to ascertain these findings. Nonetheless, study findings underscore the need for strategies to promote better child nutrition, mental health, and early antiretroviral therapy initiation.
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Affiliation(s)
| | - Catherine J. Wedderburn
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Paediatrics and Child Health and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | | | - Antipa Sigilai
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Paul Mwangi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Janet Thoya
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Rachel Odhiambo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Katana Ngombo
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Beatrice Kabunda
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Charles R. Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Musindo O, Krabbendam L, Mutahi J, García MP, Bangirana P, Kumar M. Neurocognitive deficits and socioeconomic risk factors among children and adolescents living with HIV in sub-Saharan Africa: a systematic review. Child Adolesc Psychiatry Ment Health 2022; 16:31. [PMID: 35477577 PMCID: PMC9047261 DOI: 10.1186/s13034-022-00465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/02/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Children and adolescents living with HIV (C/ALHIV) are at a risk for significant neurocognitive deficits. There is limited literature that addresses the role of socioeconomic factors in neurocognitive deficits among CALHIV in Sub Saharan Africa (SSA), as it is very difficult to establish this causal relationship. Our systematic review was guided by the biodevelopmental framework that assumes that foundations of health and adversity affect later development and life outcomes. This systematic review aims to assess available evidence on the relationship between neurocognitive deficits and socioeconomic factors among HIV children and adolescents in SSA region. METHOD Using a pre-determined search strategy, we searched electronic databases including PubMed, web of Science and EBSCOhost (CINAHL and MEDLINE). Peer-reviewed publications that address neurocognitive deficits, psychosocial and socioeconomic risk factors among children and adolescents living with HIV in SSA were included in review. RESULTS Out of 640 articles, 17 studies from SSA met the inclusion criteria. Four studies reported no significant differences in the neurocognitive measures comparing children and adolescents with HIV infection to those uninfected. However, 10 studies suggest that C/ALHIV scored significantly low in general intellectual functions as compared to their uninfected peers. C/ALHIV were found to have substantial deficits in specific cognitive domains such as sequential processing, simultaneous processing, and learning. In addition, deficits in visuo-spatial processing, visual memory and semantic fluency were mentioned. Socioeconomic factors such as lower socioeconomic status (income, education and occupation), child orphanhood status and under-nutrition were linked with neurocognitive deficits. CONCLUSION Our findings suggest that CALHIV presented with poorer neurocognitive outcomes when compared to other populations which were associated with specific socioeconomic factors.
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Affiliation(s)
- Otsetswe Musindo
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Lydiah Krabbendam
- grid.12380.380000 0004 1754 9227Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joan Mutahi
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Miguel Pérez García
- grid.4489.10000000121678994Facultad de Psicología, Universidad de Granada, Granada, Spain
| | - Paul Bangirana
- grid.11194.3c0000 0004 0620 0548Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Manasi Kumar
- grid.10604.330000 0001 2019 0495Department of Psychiatry , University of Nairobi to Brain and Mind Institute Aga Khan University , Nairobi, Kenya
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Neurocognitive function among HIV-infected children on protease inhibitor -based versus non-protease inhibitor based antiretroviral therapy in Uganda: a pilot study. BMC Pediatr 2021; 21:198. [PMID: 33902506 PMCID: PMC8073947 DOI: 10.1186/s12887-021-02676-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND HIV infection is associated with significant neurocognitive deficits making maximization of cognitive function among children receiving antiretroviral therapy (ART) a public health imperative. Non-protease inhibitors (non-PIs) achieve higher drug levels in the cerebral spinal fluid (CSF) compared to PIs, potentially leading to better neurocognitive function by reducing CSF viral load and inflammation. ART that maximises children's neurodevelopment and school achievement could result in improved quality of life and productivity as adults, but little research to date has examined whether non-PI ART is associated with better neurocognitive outcomes. We compared the neurocognitive function between children living with HIV receiving PI-based and non PI-based ART. METHODS We recruited a consecutive sample of clinically stable Ugandan children living with HIV aged 5-12 years who received PI-based or non PI-based ART for ≥ 1 year (viral load < 1000 copies). Neurocognitive function was assessed using the Kaufman Assessment Battery for Children, the Test of Variables of Attention, and Bruininks-Oseretsky Test of Motor Proficiency. Age-adjusted neurocognitive z-scores for the two groups were compared using linear regression models in STATA version 13. The Hommel's method was used to adjust for multiple testing. RESULTS We enrolled 76 children living with HIV; 34 on PI ART and 42 on non-PI ART. Mean (±SD) age was greater in the non-PI vs. PI group (9.5 ± 1.9 vs. 8.5 ± 2.0) years (p = 0.03). Children in the non-PI group had lower socioeconomic scores (5.7 ± 3.3 vs. 7.4 ± 2.8, p = 0.02). There was no difference in neurocognitive function between the groups (adjusted p > 0.05) for KABC and TOVA. Children in the PI group had better total BOT scores than their counterparts (46.07 ± 1.40) vs. 40.51 (1.24), p = 0.03). CONCLUSIONS We detected no difference in neurocognitive function among children on PI and non PI-based ART therapy based on KABC and TOVA tests. Children on PI based ART had better motor function than their counterparts. We recommend a prospective study with a larger sample size.
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Rowe K, Buivydaite R, Heinsohn T, Rahimzadeh M, Wagner RG, Scerif G, Stein A. Executive function in HIV-affected children and adolescents: a systematic review and meta-analyses. AIDS Care 2021; 33:833-857. [PMID: 33764813 DOI: 10.1080/09540121.2021.1873232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This review aimed to determine: whether EF is affected in children and adolescents (2-24-years-old) with perinatal HIV infection, perinatal HIV exposure without infection, and behaviourally acquired HIV. A systematic review (PROSPERO number: CRD42017067813) was conducted using 11 electronic databases (01.01.1981-09.07.2019) and 8 conference websites. Primary quantitative studies with EF scores on cognitive tasks and/or behavioural report measures were included. Meta-analyses were performed by EF subtype and subpopulations compared. 1789 records were found. Sixty-one studies were included in the narrative synthesis; 32 (N = 7884 participants) were included in meta-analyses. There was a distinct pattern of reduced EF in those with perinatal HIV infection on antiretroviral therapy compared to controls: pooled effect sizes were largest for verbal and visuospatial working memory, with smaller effects on planning, inhibitory control and set-shifting. Data were limited for other HIV-affected subpopulations. Perinatal HIV infection is associated with reduced EF with varying effect sizes for the different EF subtypes.
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Affiliation(s)
- Kirsten Rowe
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Ruta Buivydaite
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Torben Heinsohn
- Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Mana Rahimzadeh
- Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa.,Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Gaia Scerif
- Developmental Cognitive Neuroscience, Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Alan Stein
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Shiau S, Evans H, Strehlau R, Shen Y, Burke M, Liberty A, Coovadia A, Abrams EJ, Yin MT, Violari A, Kuhn L, Arpadi SM. Behavioral Functioning and Quality of Life in South African Children Living with HIV on Antiretroviral Therapy. J Pediatr 2020; 227:308-313.e2. [PMID: 32712285 PMCID: PMC8811608 DOI: 10.1016/j.jpeds.2020.07.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022]
Abstract
This study examined behavioral functioning and quality of life in South African children living with perinatally acquired HIV. Compared with controls, children living with perinatally acquired HIV had a higher mean total difficulties score assessed by the Strengths and Difficulties Questionnaire and lower mean quality of life scores assessed by the Pediatric Quality of Life Inventory.
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Affiliation(s)
- Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Henry Evans
- Department of Medicine, Division of Infectious Diseases, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yanhan Shen
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Megan Burke
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Ashraf Coovadia
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elaine J Abrams
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY; Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael T Yin
- Department of Medicine, Division of Infectious Diseases, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Avy Violari
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Louise Kuhn
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY; G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Stephen M Arpadi
- ICAP at Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY; G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY; Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
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García-Navarro C, Martín-Bejarano M, Jimenez de Ory S, Zamora B, Ruiz-Saez B, Velo C, Cuéllar-Flores I, Garcia Lopez-Hortelano M, Guillen-Martin S, Navarro-Gómez ML, Ramos JT, González-Tomé MI. Neurocognitive and quality of life study in perinatally HIV-infected young people and their peers. NeuroCoRISpeS study. Enferm Infecc Microbiol Clin 2020; 38:417-424. [PMID: 32113706 DOI: 10.1016/j.eimc.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/22/2019] [Accepted: 01/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Assessing the role of HIV and non-HIV related factors is essential for a better understanding of the neurocognitive outcomes in perinatally HIV-infected (PHIV+) young people. The aim of our study was to assess cognition and quality of life (QoL) of a PHIV+ cohort of young people and to compare it with a control group. METHODS Thirty PHIV+ and 30 HIV(-) healthy young adults matched by age, sex and socioeconomic status completed a protocol that included neurocognitive tests, a psychosocial semi-structured interview and a QoL questionnaire (PedsQL). Neurocognitive domain-specific and domain-general (NPZ-5) Z-scores were calculated. CDC AIDS-defining category C or not C (PHIV+/C, PHIV+/noC) was considered to evaluate differences within the PHIV+ group. Univariate and multivariate analysis were performed. RESULTS Sixty patients were included; 67% were female; median age (IQR) 19 years (18-21). Regarding PHIV+ young people, 27% showed CDC C category (none encephalopathy), 93% were on ART and 77% had undetectable viral load. No differences regarding occupation were found, although the HIV(-) group repeated less grades (p=0.028) and had a higher education level (p=0.021). No differences were found between PHIV+/noC and HIV(-) participants. However, the PHIV+/C group showed poorer performance than PHIV+/noC (NPZ-5, p=0.037) and HIV(-) subjects (crystallised intelligence, p=0.025; intelligence quotient, p=0.016). Higher nadir CD4+ T-cell count was related to better Z-score in memory (p=0.007) and NPZ-5 (p=0.025). Earlier and longer exposure to ART resulted in better performance in memory (p=0.004) and executive functions (p=0.015), respectively. CONCLUSIONS No significant differences were found in the neurocognitive profile nor QoL between PHIV+/noC and HIV(-) adolescents; however, PHIV+/C participants obtained lower scores. The use of longer and earlier ART seems to have a beneficial effect.
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Affiliation(s)
- Cristina García-Navarro
- Department of Paediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Manuela Martín-Bejarano
- Department of Paediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Santiago Jimenez de Ory
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Madrid, Spain
| | - Berta Zamora
- Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Beatriz Ruiz-Saez
- Molecular Biology and Immunology Laboratory, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Spanish HIV HGM BioBank, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Madrid, Spain
| | - Carlos Velo
- Department of Paediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Isabel Cuéllar-Flores
- Department of Psychology/Paediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Milagros Garcia Lopez-Hortelano
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Madrid, Spain; La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Sara Guillen-Martin
- Department of Pediatric Infectious Diseases, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Maria Luisa Navarro-Gómez
- Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Madrid, Spain; Department of Paediatric Infectious Diseases, Hospital Universitario Gregorio Marañón, Madrid, Spain; Complutense University (UCM), Madrid, Spain; Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - José Tomás Ramos
- Department of Paediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain; Departamento de Salud Pública y Materno-Infantil (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
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Akellot J, Bangirana P. Association between parental involvement and academic achievement of deaf children at Mulago school for the deaf, Kampala, Uganda. Afr Health Sci 2019; 19:2270-2281. [PMID: 31656513 PMCID: PMC6794534 DOI: 10.4314/ahs.v19i2.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Deaf children face many challenges in dealing with educational opportunities and ensuring attainment of academic skills. A parent's involvement in the child's education has the potential to enhance academic performance. We sought to study the association between parental involvement and academic achievement among deaf children in Uganda. Methods Using purposive consecutive sampling, one hundred and eight parents of deaf children (Primary 1 to 7) were recruited from Mulago School for the Deaf in Kampala, Uganda. The Parental Involvement Questionnaire was used to measure parents' involvement in school activities while the Wide Range Assessment Test, third edition, was used to measure academic achievement (reading, spelling and arithmetic). Linear regression was used to test the association between parental involvement and academic achievement. Results One hundred and five children with mean age 11.09 years (SD = 2.89) were enrolled of whom 56 (35.3%) were female. With a Beta coefficient of 0.07, a 7% unit increase of summed parental involvement showed no significant association between parental involvement and academic achievement (p = 0.46) of the deaf children. Conclusion Parental involvement was not associated with academic achievement among deaf children in Kampala. Other factors associated with academic achievement need to be identified to enhance deaf children's performance at school.
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Affiliation(s)
- Josephine Akellot
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
| | - Paul Bangirana
- Department of Psychiatry, Makerere University, Kampala, Uganda
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Kohns Vasconcelos M, Laws H, Borkhardt A, Neubert J. Medical history and clinical examinations are insufficient to exclude vertical human immunodeficiency virus transmission in healthy, at-risk adolescents. Acta Paediatr 2019; 108:994-997. [PMID: 30901119 DOI: 10.1111/apa.14793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Malte Kohns Vasconcelos
- Paediatric Infectious Diseases Research Group Institute for Infection and Immunity St George's University of London London UK
| | - Hans‐Jürgen Laws
- Department of Pediatric Oncology, Hematology and Clinical Immunology Center for Child and Adolescent Health Medical Faculty Heinrich‐Heine‐University Düsseldorf Germany
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology Center for Child and Adolescent Health Medical Faculty Heinrich‐Heine‐University Düsseldorf Germany
| | - Jennifer Neubert
- Department of Pediatric Oncology, Hematology and Clinical Immunology Center for Child and Adolescent Health Medical Faculty Heinrich‐Heine‐University Düsseldorf Germany
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Abstract
BACKGROUND HIV-exposed but uninfected (HEU) children may be at an increased risk of impaired growth when compared with their HIV-unexposed and uninfected (HUU) counterparts. We compared the growth patterns of HEU to HUU children in Nigeria. METHODS Pregnant women with and without HIV infection were enrolled at the Plateau State Specialist Hospital, Jos, Nigeria. Infants born to these mothers were recruited at birth and the mother-infant pairs followed up for 18 months. Weight, length and head circumference of the infants were measured at each visit. Age- and sex-standardized Z scores were generated for each anthropometric measure using the World Health Organization Child Growth Standards. Children with length-for-age, weight-for-age and weight-for-length Z scores <-2 were classified as stunted, underweight and wasted, respectively. RESULTS Of 415 children (307 HEU and 108 HUU) recruited for this study, 117 (28.4%), 9 (2.2%) and 32 (7.8%) infants were stunted, underweight and wasted, respectively, at birth. In a multivariable longitudinal analysis, the odds of stunting were higher among HEU as compared with HUU children [adjusted odds ratio: 2.4 (95% confidence interval: 1.4-4.1)]. Similarly, odds of being underweight were higher among the HEU children [adjusted odds ratio: 1.6 (95% confidence interval: 1.1-2.2)]. CONCLUSIONS Linear and ponderal growth were more impaired among HEU as compared with HUU children in Nigeria during the first 18 months of life. Further studies are needed to explore the causal basis for these differences.
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Cockcroft K, Milligan R. Working Memory Structure in Atypical Development: HIV-infected and HIV-exposed, Uninfected School Beginners. Dev Neuropsychol 2019; 44:248-272. [PMID: 30623681 DOI: 10.1080/87565641.2018.1564309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Not much is known about the structure of working memory in atypical development. We undertook a detailed comparison of the functional organization of working memory in HIV-infected (n = 95; Mage = 7.42 years), and HIV-exposed (n = 86; Mage = 7.36 years) children, together with an uninfected, unexposed typically developing comparison group (n = 92; Mage = 7.05 years). Participants were in their first year of formal education. Within-group comparisons of five models showed that a four-factor model with separate verbal and visuospatial storage and processing accounted for the typically developing group, while working memory was structurally undifferentiated in the HIV-affected groups.
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Affiliation(s)
- Kate Cockcroft
- a Department of Psychology, School of Human and Community Development , University of the Witwatersrand , Johannesburg , South Africa
| | - Robyn Milligan
- a Department of Psychology, School of Human and Community Development , University of the Witwatersrand , Johannesburg , South Africa
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Hoare J, Heany SJ, Fouche JP, Phillips N, Joska JA, Myer L, Zar HJ, Stein DJ. Initiation of antiretroviral therapy after the critical neuronal developmental period of the second postnatal year affects white matter microstructure in adolescents living with HIV. J Neurovirol 2019; 25:254-262. [PMID: 30617850 DOI: 10.1007/s13365-018-0712-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/12/2018] [Accepted: 12/03/2018] [Indexed: 11/30/2022]
Abstract
Rapid maturation of major white matter pathways occurs in the first 2 years of life, indicating a critical neuronal developmental period. The impact of initiating antiretroviral therapy (ART) in children perinatally infected with HIV-1, after the age of 2 years on neurocognitive functioning and white matter development in adolescence has not been studied. Forty-six adolescents who initiated ART during the first 2 years of life (< 2 years) and 79 adolescents who initiated ART after 2 years of age (> 2 years), with perinatally acquired HIV were enrolled in the Cape Town Adolescent Antiretroviral Cohort. Adolescents completed a comprehensive neurocognitive battery testing a number of cognitive domains. Diffusion tensor imaging (DTI) was done to determine fractional anisotropy (FA), mean diffusivity (MD), axial diffusion (AD), and radial diffusion (RD) in a region of interest analysis. Neurocognitive performance was similar between adolescents who initiated ART < 2 years or > 2 years. There was a trend towards attention (p = .07) and working memory (p = .05) being poorer in the group who initiated ART > 2 years. FA was lower in the > 2-year group in the superior corona radiata (p = .03), and the external capsule (p = .04). MD was higher in the > 2-year group in the cerebral peduncle (p = .02), the superior corona radiata (p = .01), and the superior fronto-occipital fasciculus (p = .03). RD was higher in the > 2-year group in the superior corona radiata (p = .02), the cerebral peduncle (p = .01), and the superior fronto-occipital fasciculus (p = .01). However, the higher AD in the > 2-year group in the superior corona radiata was not in the expected direction (p = .01). Initiation of ART after the neuronal development period of the second postnatal year is associated with white matter alterations on neuroimaging.
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Affiliation(s)
- Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa.
| | - Sarah J Heany
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Jean-Paul Fouche
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Nicole Phillips
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - John A Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Pediatrics & Child Health, Red Cross Children's Hospital, UCT, Cape Town, South Africa.,SA Medical Research Council Unit on Child & Adolescent Health, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa.,Medical Research Council Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
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Lentoor AG. The Association of Home Environment and Caregiver Factors With Neurocognitive Function in Pre-school- and School-Aged Perinatally Acquired HIV-Positive Children on cART in South Africa. Front Pediatr 2019; 7:77. [PMID: 30972309 PMCID: PMC6443980 DOI: 10.3389/fped.2019.00077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 02/25/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Children with perinatally acquired HIV in low resource settings are at risk for neurocognitive impairments not only due to the direct effects of HIV on the brain and in utero ART exposure but also due to factors associated with their environment. Thus, the aim of this study was to examine the association between home environment and caregiver factors and the neurocognitive function of pre-school- and-school-aged HIV-positive South African children from low resource rural communities. Materials and Methods: The Wechsler Preschool and Primary Scale of Intelligence-III was administered to assess the neurocognitive functioning of 152 purposively sampled perinatally acquired HIV-positive children on cART, aged 3 years to 7 years 6 months (mean age 63.13 months). The primary caregivers (n = 152) completed the Home Screening Questionnaire to assess the quality of the home-environment of the children. Results :The results showed that unfavorable environment, caregiver type, and quality of stimulation in the home were negatively associated with the neurocognitive development of perinatally HIV-positive children on cART. Most of the HIV-positive children (n = 95) were under the care of an extended relative. Older HIV-positive boys, reared by biological mothers, who also lived in suboptimal and poor quality home-environments had poorer neurocognitive function when compared to HIV-positive children reared by non-biological (extended relatives) caregivers, [F (2,149) = 14.42, p < 0.001]. Conclusion: The child's early home environment is associated with general neurocognitive development, which highlights the need for early psychosocial interventions that can promote better cognitive outcomes among children living with HIV.
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Affiliation(s)
- Antonio G Lentoor
- Department of Clinical Psychology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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16
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Abstract
OBJECTIVE HIV infection is associated with cognitive impairments, but outcomes are poorly explored in children starting antiretroviral therapy (ART) early or in those exposed but uninfected. DESIGN Nested cross-sectional evaluation of the neurocognitive and behavioural outcomes of HIV-infected, HIV-exposed uninfected (HEU) and HIV-unexposed (HUU) Cameroonian children at age 4-9 years prospectively followed. METHODS Cognitive development was assessed in 127 HIV-infected, 101 HEU, 110 HUU children using the KABC-II, neurologic dysfunction using the Touwen examination and behavioural difficulties using the Strength and Difficulties Questionnaire (SDQ). Analyses were adjusted for children age, sex and primary language. Contextual factors were included in a second step to assess their effects on outcomes. RESULTS All HIV-infected children were treated before 12 months. There was a negative linear gradient in KABC-II scores from HUU children to HEU and HIV-infected children [gradient: -6.0 (-7.7; -4.3) for nonverbal index, NVI, and -8.8 (-10.7; -6.8) for mental processing index, MPI]. After adjusting for contextual factors, scores of HEU children were not significantly different from those of HUU children (all P > 0.1) and differences between HIV-uninfected and HUU children reduced [NVI: from -11.9 (-15.3; -8.5) to -3.4 (-6.8; -0.01), MPI: from -17.6 (-21.3; -13.8) to -5.5 (-9.3; -1.7)]. Compared with uninfected children, HIV-infected children had more neurological dysfunctions and higher SDQ scores (P = 0.002). CONCLUSION Despite early ART, perinatal-HIV infection is associated with poorer neurocognitive scores and increased behavioural difficulties during childhood. Contextual factors play an important role in this association, which emphasizes the need for early nutritional and developmental interventions targeting both HIV-affected infants and their relatives.
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Wu J, Li J, Li Y, Loo KK, Yang H, Wang Q, Duan R, Xiao X, Song X, Yang S, Sun L. Neurodevelopmental outcomes in young children born to HIV-positive mothers in rural Yunnan, China. Pediatr Int 2018; 60:618-625. [PMID: 29663621 DOI: 10.1111/ped.13584] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/07/2017] [Accepted: 03/15/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Children born to HIV-infected mothers are at risk for neurodevelopmental delay. Little is known about the neurodevelopmental outcomes of infants and toddlers born to HIV-positive mothers but who were not themselves infected by HIV, especially in poor rural areas. This study was conducted to compare developmental outcomes between young children who were HIV exposed but uninfected (HEU), and their HIV unexposed and uninfected (HUU) peers in rural Yunnan, China. METHODS A total of 250 HEU children aged 6-36 months and 250 HUU children matched for age, gender and residency were recruited from rural Yunnan, China. Neurodevelopmental outcomes were measured using Bayley Scales of Infant and Toddler Development-Third Edition (Bayley III). Multivariate analysis was performed to adjust for potential confounding effects of caregiver demographic data, maternal health status, birth outcome and children's health status. RESULTS HIV exposed but uninfected children had significantly lower composite scores in Bayley III assessment than HUU children (in the cognitive domain: 90.34 vs 92.75, P<0.05; in the adaptive behavior domain: 77.04 vs 80.80, P< 0.05). On stepwise logistic regression analysis, HIV exposure (OR, 1.45; 95%CI: 1.04-1.98) and child malnutrition (OR, 1.67; 95%CI: 1.09-2.23) were risk factors for below-average cognition development. Mother's low education and child anemia were significant risk factors for below-average motor and adaptive behavior development. CONCLUSION Perinatal HIV infection may have a negative impact on neurodevelopment in young children. Other factors such as mother's education and child nutrition status may play important roles in child neurodevelopment, especially in resource-poor areas. Further studies are needed to examine the long-term effect of perinatal HIV infection on later childhood neurodevelopment.
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Affiliation(s)
- Jie Wu
- Department of Pediatrics, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jing Li
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
| | - Yan Li
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
| | - Kek Khee Loo
- Department of Pediatrics, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Haixia Yang
- Department of Health Care, Kunming Maternal and Child Health Hospital, Kunming, China
| | - Qiong Wang
- Department of Health Care, Kunming Maternal and Child Health Hospital, Kunming, China
| | - Rufei Duan
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
| | - Xia Xiao
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
| | - Xiaoxiao Song
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
| | - Siwei Yang
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
| | - Lin Sun
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
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Paul R, Apornpong T, Prasitsuebsai W, Puthanakit T, Saphonn V, Aurpibul L, Kosalaraksa P, Kanjanavanit S, Luesomboon W, Ngampiyaskul C, Suwanlerk T, Chettra K, Shearer WT, Valcour V, Ananworanich J, Kerr S. Cognition, Emotional Health, and Immunological Markers in Children With Long-Term Nonprogressive HIV. J Acquir Immune Defic Syndr 2018; 77:417-426. [PMID: 29303843 PMCID: PMC5825279 DOI: 10.1097/qai.0000000000001619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV-infected children with long-term nonprogressive (LTNP) disease eventually convert to a progressive disease type, yet the extent to which these children experience the cognitive and emotional symptoms observed in typical progressive HIV (Progressors) is unknown. METHODS Eighty-eight LTNPs, 53 Progressors, and 323 healthy controls completed annual assessments of cognitive and emotional health as part of a prospective study. The 2 HIV-infected groups and the healthy controls were matched on age and sex distribution at enrollment. Plasma HIV RNA, T-cell counts/percentages, activated monocytes, perivascular monocytes, and markers of macrophage activation (sCD163 and sCD14) were compared by progression subtype. Cognitive and emotional outcomes were compared using cross-sectional linear regression analysis and longitudinal sensitivity models. RESULTS LTNPs exhibited the same cognitive phenotype and emotional dysregulation as Progressors, with worse outcomes in both groups compared with controls. In addition, cognitive and emotional symptoms were evident before children reached the minimum age for LTNP designation (8 years). Baseline plasma HIV RNA, sCD163, activated monocytes, and perivascular monocytes were lower in LTNPs versus Progressors, with no difference in T-cell counts/percentages or sCD14 levels. Most LTNPs converted to a progressive disease subtype during the study, with similar cognitive and emotion profiles between these subgroups. CONCLUSIONS Pediatric LTNPs experience cognitive and emotional difficulties that mirror symptoms of progressive disease. The abnormalities are present at young ages and persist independent of plasma T-cell counts. The findings highlight the neurodevelopmental risk of pediatric HIV, even in those with early innate disease control.
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Affiliation(s)
- Robert Paul
- Missouri Institute of Mental Health, University of Missouri-St. Louis, MO, USA
| | - Tanakorn Apornpong
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | - Wasana Prasitsuebsai
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | - Thanyawee Puthanakit
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Pope Kosalaraksa
- Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | | | | | | | | | - Victor Valcour
- Memory and Aging Center, Department of Neurology University of California, San Francisco, CA, USA
| | - Jintanat Ananworanich
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Department of Global Health, Academic Medical Center, The University of Amsterdam, Amsterdam, The Netherlands
| | - Stephen Kerr
- HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- The Kirby Institute, University of New South Wales, Sydney, Australia
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Siegle CBH, Dos Santos Cardoso de Sá C. Concurrent validity between instruments of assessment of motor development in infants exposed to HIV. Infant Behav Dev 2018; 50:198-206. [PMID: 29407429 DOI: 10.1016/j.infbeh.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/16/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Exposure to HIV during pregnancy is a risks to development. Exposed child should have assessed its development since birth. Alberta Infant Motor Scale is a tool which assess gross motor skills, with easy application and low cost. Up to now, this scale had not proven its validity for the population exposed to HIV. It's necessary to compare its with a gold standard tool, Bayley scale, which assess gross and fine motor skills, has a high cost and longer application time required. Studies compare results of Alberta with Bayley's total motor score (gross + fine). However, it's also necessary to compare Alberta's result with only Bayley's gross motor result, because it's what both evaluate in common. AIMS to verify the concurrent validity of AIMS in infants exposed to HIV; to verify the correlation of AIMS and BSITD III for this population and to compare if these coefficients differ in the central age groups and extremities of the AIMS. METHODS 82 infants exposed to HIV evaluated in 1st, 2nd, 3rd, 4th, 8th, 12th, 15th, 16th, 17th and 18th months, with Alberta Infant Motor Scale and Bayley Scale (motor subscale). For analysis of concurrent validity, results of raw scores of the scales were compared with the correlation analysis. First analysis: Alberta's score with Bayley's total (gross + fine) motor score. Second analysis: Alberta's score with Bayley's gross motor score. RESULTS In the first correlation analysis, results were: r = 0.62 in 1 st month, r = 0.64 in 2nd month, r = 0.08 in 3rd month, r = 0.45 in 4th month; r = 0.62 in 8th month, r = 0.60 in the 12th month. In the second correlation analysis, results were: r = 0.69 in 1 st month; r = 0.58 in 2nd month; r = 0.25 in 3rd month; r = 0.45 in the 4th month; r = 0.77 in 8th month; r = 0.73 in 12th month. Analyzes of the 15th, 16th, 17th and 18th months couldn't be performed because at these ages all the children had already reached the maximum score in the AIMS. Results were significant and indicate correlation between scales. Found results agree with other studies that found high correlations between the scales in premature and risk groups. However, these studies compare results of gross motor skills assessments with gross and fine motor skills assessments. Our results show that correlation only between the gross motor skills have higher coefficient values, and we believe this is the best way to compare the scales, with what both assessed in common. CONCLUSIONS Alberta scale has correlation with Bayley scale in assessing of children exposed to HIV, and can be a substitute to Bayley in assessing of these children. Results are stronger when comparing only what both scales assess in common.
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Musindo O, Bangirana P, Kigamwa P, Okoth R, Kumar M. Neurocognitive functioning of HIV positive children attending the comprehensive care clinic at Kenyatta national hospital: exploring neurocognitive deficits and psychosocial risk factors. AIDS Care 2018; 30:618-622. [PMID: 29353495 DOI: 10.1080/09540121.2018.1426829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Children and adolescents are affected in different ways by HIV/AIDS. Neurocognitive deficits are one of the most significant long term effects on HIV infected children and adolescents. Several factors are thought to influence cognitive outcomes and this include immune status, Highly Active Antiretroviral Therapy (HAART), education and social support. The aim of the study was to assess the neurocognitive function of HIV infected children and adolescents and correlate it with psychosocial factors. A cross sectional study was carried out involving a sample of 90 children living with HIV between 8 and 15 years (M = 11.38, SD = 2.06) attending Comprehensive Care Clinic (CCC) at Kenyatta National Hospital (KNH). Samples were selected by using purposive sample technique. Kaufman Assessment Battery for Children-Second Edition was used to assess cognitive function and psychosocial issues were assessed using HEADS-ED. Data was analyzed using SPSS v23 and independent T-tests, Pearson's correlation and linear regression were used. The prevalence of neurocognitive deficits among HIV positive children attending CCC at KNH was 60% with neurocognitive performance of 54 children being at least 2SD below the mean based on the KABC-II scores. There was no significant correlation between mental processing index and CD4 count (Pearson's rho = -0.01, p = 0.39). There was no significant association between Mental Processing Index and viral load (p = 0.056) and early ARV initiation (0.27). Using the HEADS-ED, risks factors related to education (β = -5.67, p = 0.02) and activities and peer support (β = -9.1, p = 0.002) were significantly associated with poor neurocognitive performance. Neurocognitive deficits are prevalent among HIV positive children attending CCC-KNH. This extent of the deficits was not associated with low CD4 count, high viral load or early initiation in HIV care. However, poor school performance and problem with peers was associated with poor neurocognitive performance.
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Affiliation(s)
- Otsetswe Musindo
- a Department of Psychiatry , College of Health Sciences, University of Nairobi , Nairobi , Kenya
| | - Paul Bangirana
- b Department of Psychiatry , College of Health Sciences, Makerere University , Kampala , Uganda
| | - Pius Kigamwa
- a Department of Psychiatry , College of Health Sciences, University of Nairobi , Nairobi , Kenya
| | - Roselyne Okoth
- a Department of Psychiatry , College of Health Sciences, University of Nairobi , Nairobi , Kenya
| | - Manasi Kumar
- a Department of Psychiatry , College of Health Sciences, University of Nairobi , Nairobi , Kenya
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Neuropsychological performance in African children with HIV enrolled in a multisite antiretroviral clinical trial. AIDS 2018; 32:189-204. [PMID: 29112069 DOI: 10.1097/qad.0000000000001683] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE AND DESIGN Children with HIV infection (HIV+) are at neuropsychological risk, but few studies have evaluated this at multiple sites in low-income and middle-income countries. We compared neuropsychological outcomes at enrollment (>5 years age) among HIV+, HIV perinatally exposed uninfected (HEU), and HIV unexposed uninfected (HUU) children from four sub-Saharan countries. METHODS IMPAACT P1060 compared nevirapine versus lopinavir/ritonavir-based antiretroviral treatment (ART) in HIV-infected children 6-35 months of age. The present study (P1104s) enrolled P1060 children at 5-11 years of age and evaluated their neuropsychological performance over 2 years using the Kaufman Assessment Battery for Children, 2nd edition (KABC-II), Tests of Variables of Attention (TOVA), Bruininks-Oseretsky Test, 2nd edition (BOT-2), and parent-reported Behavior Rating Inventory of Executive Function (BRIEF). Cohorts were compared using generalized estimating equations least-squares means adjusted for site, child age and sex, and personal and social characteristics for child and caregiver. RESULTS Six hundred and eleven (246 HIV+, 183 HEU, 182 HUU) of the 615 enrolled at six sites [South Africa (three), Zimbabwe, Malawi, Uganda] were available for analysis. Mean age was 7.2 years, 48% male, 69% in school. Unadjusted and adjusted comparisons were consistent. HIV+ children performed significantly worse than HEU and HUU cohorts on all KABC-II cognitive performance domains and on BOT-2 total motor proficiency (P < 0.001), but not on the BRIEF Global Executive Indices. HUU and HEU cohorts were comparable on cognitive outcomes. HIV+ children initiated on ART before 1 year of age had significantly better BRIEF evaluations (lower scores - fewer behavior problems), compared with those started after (P = 0.03). CONCLUSION Significant cognitive deficits were documented among HIV+ children at school age, even when started on ART at an early age. Earlier HIV treatment, neuropsychological monitoring, and rehabilitative interventions are all needed. Subsequent testing for 2 more years will help further evaluate how HIV infection and exposure affect the developmental trajectory.
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Milligan R, Cockcroft K. Working Memory Profiles in HIV-Exposed, Uninfected and HIV-Infected Children: A Comparison with Neurotypical Controls. Front Hum Neurosci 2017; 11:348. [PMID: 28729828 PMCID: PMC5498467 DOI: 10.3389/fnhum.2017.00348] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/19/2017] [Indexed: 11/13/2022] Open
Abstract
This study compared the working memory profiles of three groups of children, namely HIV-infected (HIV-I; n = 95), HIV-exposed, uninfected (HIV-EU; n = 86) and an HIV-unexposed, uninfected, (HIV-UU; n = 92) neurotypical control group. Working memory, an executive function, plays an important role in frontal lobe-controlled behaviors, such as motivation, planning, decision making, and social interaction, and is a strong predictor of academic success in school children. Memory impairments have been identified in HIV-I children, particularly in visuospatial processing. Verbal working memory has not been commonly investigated in this population, while it is unknown how the working memory profiles of HIV-EU children compare to their HIV-I and HIV-UU peers. Of interest was whether the working memory profiles of the HIV-EU children would be more similar to the HIV-I group or to the uninfected control group. The results revealed no significant differences in working memory performance between the HIV-I and HIV-EU groups. However, this does not mean that the etiology of the working memory deficits is the same in the two groups, as these groups showed important differences when compared to the control group. In comparison to the controls, the HIV-I group experienced difficulties with processing tasks irrespective of whether they drew on a verbal or visuospatial modality. This appears to stem from a generalized executive function deficit that also interferes with working memory. In the HIV-EU group, difficulties occurred with verbally based tasks, irrespective of whether they required storage or processing. For this group, the dual demands of complex processing and using a second language seem to result in demand exceeding capacity on verbal tasks. Both groups experienced the greatest difficulties with verbal processing tasks for these different reasons. Thus, disruption of different cognitive abilities could result in similar working memory profiles, as evidenced in this study. This has implications for the underlying developmental neurobiology of HIV-I and HIV-EU children, as well the choice of appropriate measures to assist affected children.
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Affiliation(s)
| | - Kate Cockcroft
- Department of Psychology, School of Human and Community Development, University of the WitwatersrandJohannesburg, South Africa
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Impact of HIV and Atiretroviral Therapy on Neurocognitive Outcomes Among School-Aged Children. J Acquir Immune Defic Syndr 2017; 75:1-8. [PMID: 28169874 DOI: 10.1097/qai.0000000000001305] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The impact of HIV infection and antiretroviral therapy (ART) on neurocognitive outcomes among children aged 7-14 years was assessed. We hypothesized that ART would ameliorate neurocognitive sequelae of HIV infection. METHODS HIV-positive and HIV-negative mother-child pairs from the Rakai Community Cohort Study and ART clinics in Rakai, Uganda, were followed prospectively for 4 years. Exposures were stratified as: perinatally HIV infected, perinatally HIV exposed but uninfected, and HIV unexposed and uninfected. The Kaufman Assessment Battery for Children assessed sequential and simultaneous processing, learning, planning, knowledge, and fluid crystalized index for overall functioning. Multivariable generalized linear models estimated adjusted prevalence rate ratios by age. RESULTS Of the 370 mother-child pairs, 55% were HIV unexposed and uninfected, 7% were perinatally HIV exposed but uninfected, and 37.9% were perinatally HIV infected. Among HIV-infected children, longer duration of ART was associated with a significant improvement of sequential processing skills (adjusted prevalence rate ratios 25-36 months: 0.55, 95% confidence interval [CI]: 0.34 to 0.9; 37-48 months: 0.39, 95% CI: 0.2 to 0.76; 49+ months: 0.23, 95% CI: 0.1 to 0.54). Each additional year of schooling was associated with a 30%-40% decrease of impairment for all neurocognitive measures assessed. Healthier children (higher age-standardized height and weight) had improved sequential and simultaneous processing and overall fluid crystalized index. CONCLUSIONS Sequential processing skills of working memory improved with prolonged ART, and increased duration of schooling was associated with a reduction of neurocognitive impairment. Early initiation and sustained use of ARTs and longer schooling are needed to reduce neurocognitive impairment among HIV-infected school-aged children.
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van Wyhe KS, van de Water T, Boivin MJ, Cotton MF, Thomas KGF. Cross-cultural assessment of HIV-associated cognitive impairment using the Kaufman assessment battery for children: a systematic review. J Int AIDS Soc 2017; 20:21412. [PMID: 28664684 PMCID: PMC5515037 DOI: 10.7448/ias.20.1.21412] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 04/25/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Despite improved efficacy of, and access to, combination antiretroviral therapy (cART), HIV-associated cognitive impairments remain prevalent in both children and adults. Neuropsychological tests that detect such impairment can help clinicians formulate effective treatment plans. The Kaufman Assessment Battery for Children (KABC), although developed and standardized in the United States, is used frequently in many different countries and cultural contexts to assess paediatric performance across various cognitive domains. This systematic review investigated the cross-cultural utility of the original KABC, and its 2nd edition (KABC-II), in detecting HIV-associated cognitive impairment in children and adolescents. METHODS We entered relevant keywords and MeSH terms into the PubMed, PsycInfo, EBSCOHost, ProQuest, and Scopus databases, with search limits set from 1983-2017. Two independent reviewers evaluated the retrieved abstracts and manuscripts. Studies eligible for inclusion in the review were those that (a) used the KABC/KABC-II to assess cognitive function in children/adolescents aged 2-18 years, (b) featured a definition of cognitive impairment (e.g. >2 SD below the mean) or compared the performance of HIV-infected and uninfected control groups, and (c) used a sample excluded from population on which the instruments were normed. RESULTS AND DISCUSSION We identified nine studies (eight conducted in African countries, and one in the United Kingdom) to comprise the review's sample. All studies detected cognitive impairment in HIV-infected children, including those who were cART-naïve or who were cART treated and clinically stable. KABC/KABC-II subtests assessing simultaneous processing appeared most sensitive. Evaluation of the methodological quality of the selected studies by two independent reviews suggested that shortcomings included reporting and selection biases. CONCLUSIONS This systematic review provides evidence for the cross-cultural utility of the KABC/KABC-II, particularly the simultaneous processing subtests, in detecting cognitive impairment in HIV-infected children (including those who are clinically stable). Although the current results suggest there is justification for using the KABC/KABC-II primarily in East Africa, further investigation is required to explore the instrument's utility in other HIV-prevalent regions of the globe.
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Affiliation(s)
- Kaylee S van Wyhe
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
- Children with Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, University of Stellenbosch, Cape Town, South Africa
| | - Tanya van de Water
- Children with Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, University of Stellenbosch, Cape Town, South Africa
- Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Michael J Boivin
- Department of Psychiatry and Neurology and Ophthalmology, Michigan State University, East Lansing, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mark F Cotton
- Children with Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, University of Stellenbosch, Cape Town, South Africa
| | - Kevin GF Thomas
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
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Vreeman RC, McCoy BM, Lee S. Mental health challenges among adolescents living with HIV. J Int AIDS Soc 2017; 20:21497. [PMID: 28530045 PMCID: PMC5577712 DOI: 10.7448/ias.20.4.21497] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 02/14/2017] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Mental health is a critical and neglected global health challenge for adolescents infected with HIV. The prevalence of mental and behavioural health issues among HIV-infected adolescents may not be well understood or addressed as the world scales up HIV prevention and treatment for adolescents. The objective of this narrative review is to assess the current literature related to mental health challenges faced by adolescents living with HIV, including access to mental health services, the role of mental health challenges during transition from paediatric to adult care services and responsibilities, and the impact of mental health interventions. METHODS For each of the topics included in this review, individual searches were run using Medline and PubMed, accompanied by scans of bibliographies of relevant articles. The topics on which searches were conducted for HIV-infected adolescents include depression and anxiety, transition from paediatric to adult HIV care and its impact on adherence and mental health, HIV-related, mental health services and interventions, and the measurement of mental health problems. Articles were included if the focus was consistent with one of the identified topics, involved HIV-infected adolescents, and was published in English. RESULTS AND DISCUSSION Mental and behavioural health challenges are prevalent in HIV-infected adolescents, including in resource-limited settings where most of them live, and they impact all aspects of HIV prevention and treatment. Too little has been done to measure the impact of mental health challenges for adolescents living with HIV, to evaluate interventions to best sustain or improve the mental health of this population, or to create healthcare systems with personnel or resources to promote mental health. CONCLUSIONS Mental health issues should be addressed proactively during adolescence for all HIV-infected youth. In addition, care systems need to pay greater attention to how mental health support is integrated into the care management for HIV, particularly throughout lifespan changes from childhood to adolescence to adulthood. The lack of research and support for mental health needs in resource-limited settings presents an enormous burden for which cost-effective solutions are urgently needed.
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Affiliation(s)
- Rachel C. Vreeman
- Indiana University School Medicine, Department of Pediatrics, Indianapolis, Indiana, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University, College of Health Sciences, School of Medicine, Department of Child Health and Paediatrics, Eldoret, Kenya
| | - Brittany M. McCoy
- Indiana University School Medicine, Department of Pediatrics, Indianapolis, Indiana, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sonia Lee
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal and Pediatric Infectious Disease Branch, Bethesda, Maryland, USA
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le Roux SM, Abrams EJ, Nguyen K, Myer L. Clinical outcomes of HIV-exposed, HIV-uninfected children in sub-Saharan Africa. Trop Med Int Health 2016; 21:829-45. [PMID: 27125333 DOI: 10.1111/tmi.12716] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE HIV-exposed but HIV-uninfected (HEU) children are widely considered at increased risk of mortality and morbidity. Recent advances in prevention of mother-to-child HIV transmission (PMTCT) strategies, incorporating life-long universal maternal antiretroviral therapy (ART, "Option B+") with extended breastfeeding, may improve HEU child health substantially. We critically reviewed reports of mortality/morbidity among HEU and HIV-unexposed (HU) children in sub-Saharan Africa. METHODS We searched Medline, EMBASE, CINAHL, PsycINFO, Academic Search Premier, Global Health & Psychosocial Instruments databases, conference abstracts, and reference lists for longitudinal studies from sub-Saharan Africa reporting mortality and clinical morbidity among HIV-uninfected children aged ≤10 years, by maternal HIV status. Studies were appraised by Newcastle-Ottawa Scale and ACROBAT-NRSI. Due to substantial heterogeneity of study designs, populations and results (I(2) = 75%), data were not synthesised. RESULTS We included 37 reports (28 studies, 11 164 HEU children); methodological and reporting quality were variable. Most reports came from settings without universal access to maternal ART (n = 35). Results were conflicting, with some studies indicating increased risk of mortality, hospitalisation and/or under-nutrition among HEU children, while others found no evidence of increased risk. In subanalyses, improved maternal health, ART use and breastfeeding were strongly protective for all outcomes. Only 39% (11/28) of studies adjusted for major confounders. Reports from settings using universal maternal ART with breastfeeding (n = 2) found no differences in growth or development but did not report mortality or infectious morbidity. CONCLUSIONS The existing literature provides little insight into HEU child health under recently adopted PMTCT strategies. There is a need for robust comparative data on HEU and HIV-unexposed child health outcomes under Option B+; optimising breastfeeding practices and increasing maternal use of ART should be urgent public health priorities.
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Affiliation(s)
- Stanzi M le Roux
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Diseases & Epidemiology Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Elaine J Abrams
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.,College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Kelly Nguyen
- Centre for Infectious Diseases & Epidemiology Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Diseases & Epidemiology Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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Hoare J, Phillips N, Joska JA, Paul R, Donald KA, Stein DJ, Thomas KGF. Applying the HIV-associated neurocognitive disorder diagnostic criteria to HIV-infected youth. Neurology 2016; 87:86-93. [PMID: 27206720 DOI: 10.1212/wnl.0000000000002669] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 03/02/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to apply the HIV-associated neurocognitive disorders (HAND) criteria for diagnosing HAND in HIV-infected adults, in a cohort of HIV-infected youth to thus establish whether this system is able to detect a spectrum of neurocognitive disorders (ND) in HIV-infected youth. METHODS We used a comprehensive pediatric neurocognitive battery, an assessment of functional competence, and the American Academy of Neurology system for diagnosing ND in a cross-sectional study of HIV-infected youth (n = 86) and HIV-negative controls (n = 34) to establish whether this system could detect a spectrum of ND in HIV-infected youth (6-16 years). RESULTS Compared to a well-matched control group of HIV-negative youth, HIV-infected youth performed significantly more poorly on tests of Verbal IQ, Full Scale IQ, processing speed, finger tapping, verbal memory, expressive language, cognitive flexibility, and inhibition. HIV-infected youth were also more likely to have impaired total competence on the Child Behavior Checklist. Using the criteria for HAND, we found that 45.35% of the 86 HIV-infected youth could be diagnosed with an ND. Furthermore, youth with HIV encephalopathy (HIVE) were 9.4 times more likely to have a diagnosis of a major ND compared to HIV-infected youth without HIVE. CONCLUSIONS The HAND criterion designed for adults was able to identify youth with important functional cognitive impairments who do not fit criteria for HIVE and would therefore not have been identified otherwise. This has major clinical implications regarding the importance of managing HIV-infected youth.
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Affiliation(s)
- Jacqueline Hoare
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis.
| | - Nicole Phillips
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis
| | - John A Joska
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis
| | - Robert Paul
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis
| | - Kirsten A Donald
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis
| | - Dan J Stein
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis
| | - Kevin G F Thomas
- From the Department of Psychiatry and Mental Health (J.H., N.P., J.A.J., D.J.S.), Department of Pediatrics, School of Child and Adolescent Health (K.A.D.), and Department of Psychology (K.G.F.T.), University of Cape Town, South Africa; and Department of Psychology and Behavioural Neuroscience (R.P.), University of Missouri, St. Louis
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Ezeamama AE, Kizza FN, Zalwango SK, Nkwata AK, Zhang M, Rivera ML, Sekandi JN, Kakaire R, Kiwanuka N, Whalen CC. Perinatal HIV Status and Executive Function During School-Age and Adolescence: A Comparative Study of Long-Term Cognitive Capacity Among Children From a High HIV Prevalence Setting. Medicine (Baltimore) 2016; 95:e3438. [PMID: 27124032 PMCID: PMC4998695 DOI: 10.1097/md.0000000000003438] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/19/2016] [Accepted: 03/24/2016] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to determine whether perinatal HIV infection (PHIV), HIV-exposed uninfected (PHEU) versus HIV-unexposed (PHU) status predicted long-term executive function (EF) deficit in school-aged Ugandan children.Perinatal HIV status was determined by 18 months via DNA polymerase chain reaction test and confirmed at cognitive assessment between 6 and 18 years using HIV rapid-diagnostic test. Primary outcome is child EF measured using behavior-rating inventory of executive function questionnaire across 8 subscales summed to derive the global executive composite (GEC). EF was proxy-reported by caregivers and self-reported by children 11 years or older. Descriptive analyses by perinatal HIV status included derivation of mean, standard deviations (SD), number, and percent (%) of children with EF deficits warranting clinical vigilance. Raw scores were internally standardized by age and sex adjustment. EF scores warranting clinical vigilance were defined as ≥ mean + 1.5SD. t Tests for mean score differences by perinatal HIV status and linear-regression models were implemented in SAS version 9.4 to derive HIV status-related EF deficits (β) and 95% confidence intervals (CIs).Proxy-reported and self-reported EF were assessed in 166 and 82 children, respectively. GEC deficit was highest for PHIV (mean = 121.9, SD = 29.9), intermediate for PHEU (mean = 107.5, SD = 26.8), and lowest for PHU (mean = 103.4, SD = 20.7; P-trend < 0.01). GEC deficit levels warranting clinical vigilance occurred in 9 (15.8%), 5 (9.3%) and 0 (0%) PHIV, PHEU, and PHU children, respectively (P-trend = 0.01). Nineteen percent (n = 32) children had deficits requiring clinical vigilance in ≥2 proxy-reported EF subscales. Of these, multisubscale deficits occurred in 35.1%, 13.0%, and 9.3% of PHIV, PHEU, and PHU respectively (P-trend = 0.001). Multivariable analyses find significantly higher GEC deficits for PHIV compared with PHU and PHEU children regardless of respondent (all P values <0.01). Proxy-reported EF performance was similar for PHEU compared with PHU; however, child self-reported GEC scores were elevated by 12.8 units (95% CI: 5.4-25.5) for PHEU compared with PHU.PHIV had long-term EF deficits compared with other groups. Furthermore, PHEU ≥11 years may have long-term EF deficits compared with PHU, but future studies are needed to clarify this relationship. Cognitive remediation interventions with emphasis on EF may translate to improvements in long-term functional survival in HIV-affected children from sub-Saharan Africa.
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Affiliation(s)
- Amara E Ezeamama
- From the Department of Epidemiology and Biostatistics (AEE, AKN, MZ, MLR, JNS, RK, NK, CCW), the University of Georgia, Athens; Division of Health Protection, Office of HIV, Georgia Department of Public Health (FNK), Atlanta, GA; Directorate of Public Health and Environment (SKZ), Kampala Capital City Authority; and Makerere University College of Health Sciences, School of Public Health (JNS, NK), Kampala, Uganda
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Vreeman RC, Scanlon ML, McHenry MS, Nyandiko WM. The physical and psychological effects of HIV infection and its treatment on perinatally HIV-infected children. J Int AIDS Soc 2015; 18:20258. [PMID: 26639114 PMCID: PMC4670835 DOI: 10.7448/ias.18.7.20258] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/25/2015] [Accepted: 09/02/2015] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION As highly active antiretroviral therapy (HAART) transforms human immunodeficiency virus (HIV) into a manageable chronic disease, new challenges are emerging in treating children born with HIV, including a number of risks to their physical and psychological health due to HIV infection and its lifelong treatment. METHODS We conducted a literature review to evaluate the evidence on the physical and psychological effects of perinatal HIV (PHIV+) infection and its treatment in the era of HAART, including major chronic comorbidities. RESULTS AND DISCUSSION Perinatally infected children face concerning levels of treatment failure and drug resistance, which may hamper their long-term treatment and result in more significant comorbidities. Physical complications from PHIV+ infection and treatment potentially affect all major organ systems. Although treatment with antiretroviral (ARV) therapy has reduced incidence of severe neurocognitive diseases like HIV encephalopathy, perinatally infected children may experience less severe neurocognitive complications related to HIV disease and ARV neurotoxicity. Major metabolic complications include dyslipidaemia and insulin resistance, complications that are associated with both HIV infection and several ARV agents and may significantly affect cardiovascular disease risk with age. Bone abnormalities, particularly amongst children treated with tenofovir, are a concern for perinatally infected children who may be at higher risk for bone fractures and osteoporosis. In many studies, rates of anaemia are significantly higher for HIV-infected children. Renal failure is a significant complication and cause of death amongst perinatally infected children, while new data on sexual and reproductive health suggest that sexually transmitted infections and birth complications may be additional concerns for perinatally infected children in adolescence. Finally, perinatally infected children may face psychological challenges, including higher rates of mental health and behavioural disorders. Existing studies have significant methodological limitations, including small sample sizes, inappropriate control groups and heterogeneous definitions, to name a few. CONCLUSIONS Success in treating perinatally HIV-infected children and better understanding of the physical and psychological implications of lifelong HIV infection require that we address a new set of challenges for children. A better understanding of these challenges will guide care providers, researchers and policymakers towards more effective HIV care management for perinatally infected children and their transition to adulthood.
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Affiliation(s)
- Rachel C Vreeman
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya;
| | - Michael L Scanlon
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Megan S McHenry
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Winstone M Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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Abubakar A. Biomedical risk, psychosocial influences, and developmental outcomes: lessons from the pediatric HIV population in Africa. New Dir Child Adolesc Dev 2015; 2014:23-41. [PMID: 25512044 DOI: 10.1002/cad.20071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sub-Saharan Africa is home to millions of HIV-affected children. These children are likely to experience multiple developmental delays. In this chapter, I present data highlighting compromised neurobehavioral, mental health, and scholastic outcomes for children affected by HIV. Furthermore, I discuss biomedical factors (e.g., disease severity and nutritional status) that may exacerbate the adverse effects of HIV on childhood outcomes. I also present evidence on how psychosocial risk factors such as poor maternal mental health, orphanhood, and poverty may aggravate the effects of HIV. The concluding section of the chapter highlights conceptual and methodological refinements in research on the impact of HIV on child development in Sub-Saharan Africa.
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Affiliation(s)
- Amina Abubakar
- Centre for Geographic Medicine Research-Coast, KEMRI/Wellcome Trust Research Progamme, Kilifi, Kenya
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Contemporary issues on the epidemiology and antiretroviral adherence of HIV-infected adolescents in sub-Saharan Africa: a narrative review. J Int AIDS Soc 2015; 18:20049. [PMID: 26385853 PMCID: PMC4575412 DOI: 10.7448/ias.18.1.20049] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 07/10/2015] [Accepted: 08/12/2015] [Indexed: 12/25/2022] Open
Abstract
Introduction Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour. Methods We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included “adherence,” “compliance,” “antiretroviral use” and “antiretroviral adherence,” in combination with “adolescents,” “youth,” “HIV,” “Africa,” “interventions” and the MeSH term “Africa South of the Sahara.” Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed. Discussion Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and behavioural strategies, most adherence interventions have been targeted at adults with HIV. Conclusions Although higher levels of ART adherence have been reported in sub-Saharan Africa than in other well-resourced settings, adolescents in the region may have poorer adherence patterns. There is substantial need for interventions to improve adherence in this unique population.
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Carryl H, Swang M, Lawrence J, Curtis K, Kamboj H, Van Rompay KKA, De Paris K, Burke MW. Of mice and monkeys: can animal models be utilized to study neurological consequences of pediatric HIV-1 infection? ACS Chem Neurosci 2015; 6:1276-89. [PMID: 26034832 PMCID: PMC4545399 DOI: 10.1021/acschemneuro.5b00044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pediatric human immunodeficiency virus (HIV-1) infection remains a global health crisis. Children are much more susceptible to HIV-1 neurological impairments than adults, which can be exacerbated by coinfections. Neurological characteristics of pediatric HIV-1 infection suggest dysfunction in the frontal cortex as well as the hippocampus; limited MRI data indicate global cerebral atrophy, and pathological data suggest accelerated neuronal apoptosis in the cortex. An obstacle to pediatric HIV-1 research is a human representative model system. Host-species specificity of HIV-1 limits the ability to model neurological consequences of pediatric HIV-1 infection in animals. Several models have been proposed including neonatal intracranial injections of HIV-1 viral proteins in rats and perinatal simian immunodeficiency virus (SIV) infection of infant macaques. Nonhuman primate models recapitulate the complexity of pediatric HIV-1 neuropathogenesis while rodent models are able to elucidate the role specific viral proteins exert on neurodevelopment. Nonhuman primate models show similar behavioral and neuropathological characteristics to pediatric HIV-1 infection and offer a stage to investigate early viral mechanisms, latency reservoirs, and therapeutic interventions. Here we review the relative strengths and limitations of pediatric HIV-1 model systems.
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Affiliation(s)
- Heather Carryl
- Department of Physiology & Biophysics, College of Medicine, Howard University, Washington, D.C. 20059, United States
| | - Melanie Swang
- Department of Biology, Howard University, Washington, D.C. 20059, United States
| | - Jerome Lawrence
- Department of Biology, Howard University, Washington, D.C. 20059, United States
| | - Kimberly Curtis
- Department of Physiology & Biophysics, College of Medicine, Howard University, Washington, D.C. 20059, United States
| | - Herman Kamboj
- Department of Physiology & Biophysics, College of Medicine, Howard University, Washington, D.C. 20059, United States
| | - Koen K. A. Van Rompay
- California National Primate Research Center, University of California at Davis, Davis, California 95616, United States
| | - Kristina De Paris
- Department of Microbiology and Immunology and Center for AIDS Research School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Mark W. Burke
- Department of Physiology & Biophysics, College of Medicine, Howard University, Washington, D.C. 20059, United States
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Nicholson L, Chisenga M, Siame J, Kasonka L, Filteau S. Growth and health outcomes at school age in HIV-exposed, uninfected Zambian children: follow-up of two cohorts studied in infancy. BMC Pediatr 2015; 15:66. [PMID: 26048411 PMCID: PMC4458018 DOI: 10.1186/s12887-015-0386-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early growth and health of HIV-exposed, uninfected (HEU) children is poorer than that of their HIV-unexposed, uninfected (HUU) counterparts but there is little information about longer term effects of early HIV exposure. We previously recruited two cohorts of HEU and HUU Zambian infants and documented the poorer infant growth and health of the HEU compared to the HUU children. We followed up HEU and HUU children from these cohorts when they were school-aged and compared their growth, health, biochemical markers of acute or chronic disease, and school grades. METHODS We recruited 111 HEU and 279 HUU children aged 6-12 years. We measured anthropometry, determined health by questionnaire and clinical examination, viewed the child's most recent school report, and measured blood pressure, haemoglobin (Hb), HbA1c, glucose, cholesterol, and C-reactive protein (CRP). RESULTS Anthropometric measures were lower among HEU than HUU children, significantly so for hip circumference (age- and sex-adjusted difference -1.74 cm; 95% confidence interval (CI) -3.24, -0.24; P = 0.023) and mid-upper-arm circumference (adjusted difference -0.63 cm, 95% CI -1.23, -0.04; P = 0.037) and with borderline effects for body mass index, thigh circumference and subscapular skinfolds. HEU children had significantly lower total, trunk, and limb fat percentages. All anthropometric and body composition differences became non-significant after adjustment for sociodemographic variables which differed between HEU and HUU children. More HEU than HUU children reported minor illnesses and were prescribed medication at the time of visit. There were no differences in biochemical markers between groups. HEU children had lower math grades than HUU children even after adjustment for socioeconomic variables. CONCLUSIONS Although HEU children were smaller and had lower percent fat than HUU children, this appeared to be due mainly to their poorer socioeconomic status. Reasons for lower school grades require further research.
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Affiliation(s)
- Laura Nicholson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.
| | - Molly Chisenga
- Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia.
| | - Joshua Siame
- Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia.
| | - Lackson Kasonka
- Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia.
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.
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Barbot B, Krivulskaya S, Hein S, Reich J, Thuma PE, Grigorenko EL. Identifying learning patterns of children at risk for Specific Reading Disability. Dev Sci 2015; 19:402-18. [PMID: 26037654 DOI: 10.1111/desc.12313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 02/26/2015] [Indexed: 11/29/2022]
Abstract
Differences in learning patterns of vocabulary acquisition in children at risk (+SRD) and not at risk (-SRD) for Specific Reading Disability (SRD) were examined using a microdevelopmental paradigm applied to the multi-trial Foreign Language Learning Task (FLLT; Baddeley et al., 1995). The FLLT was administered to 905 children from rural Chitonga-speaking Zambia. A multi-group Latent Growth Curve Model (LGCM) was implemented to study interindividual differences in intraindividual change across trials. Results showed that the +SRD group recalled fewer words correctly in the first trial, learned at a slower rate during the subsequent trials, and demonstrated a more linear learning pattern compared to the -SRD group. This study illustrates the promise of LGCM applied to multi-trial learning tasks, by isolating three components of the learning process (initial recall, rate of learning, and functional pattern of learning). Implications of this microdevelopmental approach to SRD research in low-to-middle income countries are discussed.
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Affiliation(s)
- Baptiste Barbot
- Department of Psychology, Pace University, New York, USA.,Child Study Center, Yale University, USA
| | | | | | - Jodi Reich
- Child Study Center, Yale University, USA.,Department of Communication Sciences and Disorders, Temple University, USA
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Ghate M, Narkhede H, Rahane G, Nirmalkar A, Gaikwad N, Kadam D. Cognitive Function among HIV Infected Children in Pune. Indian J Pediatr 2015; 82:515-8. [PMID: 25432090 DOI: 10.1007/s12098-014-1629-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 10/29/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess cognitive function of school-aged, perinatally acquired human immunodeficiency virus (HIV)-infected, antiretroviral therapy (ART) naïve children in Pune. METHODS HIV infected ART naïve children (n = 50) between 6 and 12 y attending outpatient clinic were administered the Indian Child Intelligence Test (ICIT) after their clinical evaluation. Age and gender matched HIV uninfected children (n = 50) were enrolled as controls. The test battery included measures of perception of form (Gestalt), concept formation, memory span, learning and remembering, associative memory span, transformation of visual field, quantitative concepts, spatial visualization and visual motor coordination. The information on adaptive behavior was obtained from the care giver and a brief interview with the child using Vineland Social Maturity Scale (VSMS). RESULTS Mean age of the children was 9.3 y (SD: 1.3) and mean education was 4.3 y (SD: 1.3). The mean CD4 count of HIV infected children was 588 cells/mm(3) (SD: 324.4). There was no significant difference in the overall ICIT scores between HIV infected and uninfected children (p 0.209). The adaptive behavior (VSMS) scores were significantly less in HIV infected children as compared to others (p 0.028). CONCLUSIONS There was no significant difference in the overall cognitive abilities in HIV infected children using ICIT as compared to HIV uninfected children, although significant difference in the adaptive behavior between the two groups was observed. It is important to conduct larger prospective studies using standardized test batteries that are inclusive of multiple cognitive domains sensitive to HIV effects in Indian children.
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Affiliation(s)
- Manisha Ghate
- Department of Clinical Sciences, National AIDS Research Institute, Pune, Maharashtra, India,
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Giordani B, Novak B, Sikorskii A, Bangirana P, Nakasujja N, Winn BM, Boivin MJ. Designing and evaluating Brain Powered Games for cognitive training and rehabilitation in at-risk African children. Glob Ment Health (Camb) 2015; 2:e6. [PMID: 28596854 PMCID: PMC5269631 DOI: 10.1017/gmh.2015.5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Valid, reliable, accessible, and cost-effective computer-training approaches can be important components in scaling up educational support across resource-poor settings, such as sub-Saharan Africa. The goal of the current study was to develop a computer-based training platform, the Michigan State University Games for Entertainment and Learning laboratory's Brain Powered Games (BPG) package that would be suitable for use with at-risk children within a rural Ugandan context and then complete an initial field trial of that package. METHODS After game development was completed with the use of local stimuli and sounds to match the context of the games as closely as possible to the rural Ugandan setting, an initial field study was completed with 33 children (mean age = 8.55 ± 2.29 years, range 6-12 years of age) with HIV in rural Uganda. The Test of Variables of Attention (TOVA), CogState computer battery, and the Non-Verbal Index from the Kaufman Assessment Battery for Children, 2nd edition (KABC-II) were chosen as the outcome measures for pre- and post-intervention testing. The children received approximately 45 min of BPG training several days per week for 2 months (24 sessions). RESULTS Although some improvements in test scores were evident prior to BPG training, following training, children demonstrated clinically significant changes (significant repeated-measures outcomes with moderate to large effect sizes) on specific TOVA and CogState measures reflecting processing speed, attention, visual-motor coordination, maze learning, and problem solving. CONCLUSIONS Results provide preliminary support for the acceptability, feasibility, and neurocognitive benefit of BPG and its utility as a model platform for computerized cognitive training in cross-cultural low-resource settings.
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Affiliation(s)
- B. Giordani
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Departments of Neurology and Psychology and School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - B. Novak
- Games for Entertainment and Learning (GEL) Laboratory, Department of Media and Information, Michigan State University, East Lansing, Michigan, USA
| | - A. Sikorskii
- Department of Statistics and Probability, Michigan State University, East Lansing, Michigan, USA
| | - P. Bangirana
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - N. Nakasujja
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - B. M. Winn
- Games for Entertainment and Learning (GEL) Laboratory, Department of Media and Information, Michigan State University, East Lansing, Michigan, USA
| | - M. J. Boivin
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Departments of Psychiatry and of Neurology & Ophthalmology, Michigan State University, East Lansing, Michigan, USA
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Banks LM, Zuurmond M, Ferrand R, Kuper H. The relationship between HIV and prevalence of disabilities in sub-Saharan Africa: systematic review (FA). Trop Med Int Health 2015; 20:411-29. [PMID: 25495989 DOI: 10.1111/tmi.12449] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To systematically review evidence on the prevalence and risk of disabilities among children and adults living with HIV in sub-Saharan Africa. METHODS Articles were identified from 1980 to June 2013 through searching seven electronic databases. Epidemiological studies conducted in sub-Saharan Africa that explored the association between HIV status and general disability or specific impairments, with or without an HIV-uninfected comparison group, were eligible for inclusion. RESULTS Of 12 867 records initially identified, 61 papers were deemed eligible for inclusion. The prevalence of disability was high across age groups, impairment types and study locations. Furthermore, 73% of studies using an HIV- comparator found significantly lower levels of functioning in people living with HIV (PLHIV). By disability type, the results were as follows: (i) for studies measuring physical impairments (n = 14), median prevalence of limitations in mobility and motor function among PLHIV was 25.0% (95% CI: 21.8-28.2%). Five of eight comparator studies found significantly reduced functioning among PLHIV; for arthritis, two of three studies which used an HIV- comparison group found significantly increased prevalence among PLHIV; (ii) for sensory impairment studies (n = 17), median prevalence of visual impairment was 11.2% (95%CI: 9.5-13.1%) and hearing impairment was 24.1% (95%CI: 19.2-29.0%) in PLHIV. Significantly increased prevalence among PLHIV was found in one of four (vision) and three of three studies (hearing) with comparators; (iii) for cognitive impairment in adults (n = 30), median prevalence for dementia was 25.3% (95% CI: 22.0-28.6%) and 40.9% (95% CI: 37.7-44.1%) for general cognitive impairment. Across all types of cognitive impairment, twelve of fourteen studies found a significant detrimental effect of HIV infection; (iv) for developmental delay in children with HIV (n = 20), median prevalence of motor delay was 67.7% (95% CI: 62.2-73.2%). All nine studies that included a comparator found a significant difference between PLHIV and controls; for cognitive development and global delay, a significant detrimental effect of HIV was found in five of six and one of two studies, respectively. In the nine cohort studies comparing vertically infected and uninfected children, eight showed a significant gap in development over time in children with HIV. Finally, fifteen of thirty-one (48%) studies found a statistically significant dose-response relationship between indicators of disease progression (CD4 or WHO stage) and disability. CONCLUSIONS HIV is widespread in sub-Saharan Africa and the evidence suggests that it is linked to disabilities, affecting a range of body structures and functions. More research is needed to better understand the implications of HIV-related disability for individuals, their families as well as those working in the fields of disability and HIV so that appropriate interventions can be developed.
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Affiliation(s)
- Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
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Correlates of age at attainment of developmental milestones in HIV-infected infants receiving early antiretroviral therapy. Pediatr Infect Dis J 2015; 34:55-61. [PMID: 25144793 PMCID: PMC4336221 DOI: 10.1097/inf.0000000000000526] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infant HIV-1 infection is associated with impaired neurologic and motor development. Antiretroviral therapy (ART) has the potential to improve developmental outcomes but the relative contributions of pre-ART disease status, growth, treatment regimen and ART response during infancy are unknown. METHODS Kenyan ART-naive infants <5-months old initiated ART and had monthly assessment of age of full neck control, unsupported walking and monosyllabic speech during 24 months of follow-up. Pre-ART and post-ART correlates of age at milestone attainment were evaluated using t tests or multivariate linear regression. RESULTS Among 99 infants, pre-ART correlates of later milestone attainment included: underweight and stunted (neck control, walking and speech, all P values <0.05), missed prevention of mother-to-child transmission (P = 0.04) (neck control), previous hospitalization, World Health Organization (WHO) Stage III/IV, low CD4 count, and wasting (speech and walking, all P values <0.05), and low maternal CD4 (speech, P = 0.04). Infants initiated ART at a median of 14 days following enrollment. Infants receiving nevirapinevs lopinavir/ritonavir-based ART attained later speech (18.1 vs. 15.5 months, P = 0.003) [corrected]. Adjusting for pre-ART level, lower 6-month gain in CD4% was associated with later walking (0.18 months earlier per unit increase in CD4%; P = 0.004) and speech (0.12 months earlier per unit increase in CD4%; P = 0.05), and lower 6-month gains in weight-for-age (P = 0.009), height-for-age (P = 0.03) and weight-for-height (P = 0.02) were associated with later walking. CONCLUSION In HIV-infected infants, compromised pre-ART immune and growth status, poor post-ART immune and growth responses, and use of nevirapine- vs. lopinavir/ritonavir-based ART were each associated with later milestone attainment [corrected]. The long-term consequences of these delays are unknown.
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Neurodevelopmental benefits of antiretroviral therapy in Ugandan children aged 0-6 years with HIV. J Acquir Immune Defic Syndr 2014; 67:316-22. [PMID: 25314252 DOI: 10.1097/qai.0000000000000295] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Insufficient data on neurodevelopmental benefits of antiretroviral therapy (ART) in children. METHODS Prospective study of 329 mothers and children aged 0-6 years to assess neurodevelopment. Results stratified by the maternal (M) and child (C) HIV status (MHIV⁻/CHIV⁻, MHIV⁺/CHIV⁻, and MHIV⁺/CHIV⁺). Gross Motor, Visual Reception, Fine Motor, Receptive, and Expressive Language scores were assessed by Mullen Scales of Early Learning. Global cognitive function was derived from an Early Learning Composite (ELC) score. Standardized weight and height for age z scores were constructed, and the lowest 15% cutoff defined disability. Generalized linear models were used to estimate prevalence rate ratios (PRR) adjusted for the child's age, weight, and height. In HIV-positive children, generalized linear models assessed the impact of ART initiation and duration on neurodevelopment. RESULTS Compared with MHIV⁻/CHIV⁻ children, HIV-positive children were more likely to have global deficits in all measures of neurodevelopment except gross motor skills, whereas in MHIV⁺/CHIV⁻ children, there was impairment in receptive language [adjusted PRR = 2.67; confidence interval (CI): 1·08 to 6.60] and the ELC (adjusted PRR = 2.94; CI: 1.11 to 7.82). Of the children born to HIV-positive mothers, HIV-positive children did worse than MHIV⁺/CHIV⁻ only in visual reception skills (adjusted PRR = 2.86; CI: 1.23 to 6.65). Of the 116 HIV-positive children, 44% had initiated ART. Compared with ART duration of <12 months, ART durations of 24-60 months were associated with decreased impairments in Fine Motor, Receptive Language, Expressive Language, and ELC scores. CONCLUSIONS Longer duration on ART is associated with reduction of some neurologic impairment and early diagnosis and treatment of HIV-positive children is a priority.
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A systematic review of psychological functioning of children exposed to HIV: using evidence to plan for tomorrow's HIV needs. AIDS Behav 2014; 18:2059-74. [PMID: 24729015 DOI: 10.1007/s10461-014-0747-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Prevention of mother to child transmission of HIV can virtually eliminate paediatric HIV infection. Studies are needed to understand child development outcomes for children exposed to HIV in utero but born HIV negative (HIV affected children). This systematic review examined cognitive, developmental and behavioural outcomes for HIV affected children compared to control unexposed and uninfected children. Key word searches of electronic databases generated 1,739 hits and 11 studies with adequate quality design and measures of standardised cognitive, behavioural and developmental indices. Cognitive performance, behaviour and developmental delay were measured with 15 different standardised scales from 650 HIV affected children, 736 control children and 205 HIV positive children. Performance scores for HIV affected children were significantly lower than controls in at least one measure in 7/11 studies. An emerging pattern of delay seems apparent. HIV affected children will grow in number and their development needs to be monitored and provided for.
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Ene L, Franklin DR, Burlacu R, Luca AE, Blaglosov AG, Ellis RJ, Alexander TJ, Umlauf A, Grant I, Duiculescu DC, Achim CL, Marcotte TD. Neurocognitive functioning in a Romanian cohort of young adults with parenterally-acquired HIV-infection during childhood. J Neurovirol 2014; 20:496-504. [PMID: 25185868 PMCID: PMC4324616 DOI: 10.1007/s13365-014-0275-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/12/2014] [Accepted: 07/25/2014] [Indexed: 12/22/2022]
Abstract
The Romanian cohort can provide valuable information about the effect of chronic HIV-infection and exposure to combined antiretroviral therapy (cART) on the developing brain, based on its unique characteristics: young adults infected parenterally with HIV clade F in the late 1980s and exposed to cART for a decade. We conducted a prospective study using a neuropsychological test battery validated in other international HIV cohorts, in order to evaluate the rate and severity of neurocognitive impairment in a group of young Romanian adults. The 49 HIV-infected (HIV+) participants and the 20 HIV negative (HIV-) controls were similar for age and gender, although the HIV- group tended to be more educated. We found higher cognitive impairment prevalence in the HIV+ group (59.1 %) versus the HIV- group (10 %), and the impairment rate remained significantly higher even when the groups were matched based on the educational level (38.7 % for the HIV+ group vs. 10.0 % for the HIV- controls; p = 0.025). The nadir CD4 count was <200 in 71.4 % of patients, but at the time of neurocognitive assessment, 89.5 % of patients had normal immunological status and 81.8 % undetectable HIV load. Among the HIV-impaired group, 26 % of the participants had syndromic impairment while the other 74 % had asymptomatic neurocognitive impairment. We found a high prevalence of neurocognitive dysfunction in the Romanian young adults growing-up with HIV. The greatest HIV-related cognitive deficits were in the domains of executive and motor functioning, consistent with a frontosubcortical pattern.
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Affiliation(s)
- Luminita Ene
- HIV Department, "Dr. Victor Babes" Hospital for Infectious and Tropical Diseases, 281, sos. Mihai Bravu, 030303, Bucharest, Romania,
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Abstract
BACKGROUND AND OBJECTIVES Children infected with HIV are at risk for significant neurological and neuropsychological problems. This study is aimed at identifying cognitive deficits in HIV-infected children and to compare them with equal number of normal controls. MATERIALS AND METHODS Twenty children with HIV infection who are currently on antiretroviral therapy were recruited. They were assessed for their intelligence using Malin's Intelligence Scale for Indian Children and also evaluated for their cognitive abilities with a comprehensive neuropsychological battery. They were matched with equal number of normal controls. RESULTS HIV-infected children have shown substantial impairments in the domains of attention, language, verbal learning and memory, visuomotor functions, fine motor performance, and executive functions. CONCLUSION HIV-infected children have average intelligence, but they performed poorly on several neuropsychological measures.
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Affiliation(s)
- O S Ravindran
- Department of Psychiatry, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
| | - Mrudula P Rani
- Department of Clinical Psychology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
| | - G Priya
- Department of Clinical Psychology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
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Bumoko GM, Sombo MT, Okitundu LD, Mumba DN, Kazadi KT, Tamfum-Muyembe JJ, Lasarev MR, Boivin MJ, Banea JP, Tshala-Katumbay DD. Determinants of cognitive performance in children relying on cyanogenic cassava as staple food. Metab Brain Dis 2014; 29:359-66. [PMID: 24481810 PMCID: PMC4024334 DOI: 10.1007/s11011-014-9492-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
Abstract
While risk factors for konzo are known, determinants of cognitive impairment in konzo-affected children remain unknown. We anchored cognitive performance (KABC-II scores) to serum levels of free-thyroxine (free-T4), thyroid-stimulating hormone (TSH), albumin, and motor proficiency (BOT-2 scores) in 40 children including 21 with konzo (median age: 9 years) and 19 without konzo (median age: 8 years). A multiple regression model was used to determine variables associated with changes in KABC-II scores. Age (β: -0.818, 95% CI: -1.48, -0.152) (p = 0.018), gender (β: -5.72; 95% CI: -9.87, -1.57 for females) (p = 0.009), BOT-2 score (β: 0.390; 95% CI: 0.113, 0.667) (p = 0.008), and free-T4 (β: 1.88; 95% CI: 0.009, 3.74) (p = 0.049) explained 61.1 % of variation in KABC-II scores. Subclinical hypothyroidism was not associated with poor cognition. A crude association was found between serum albumin and KABC-II scores (β: 1.26; 95 % CI: 0.136, 2.39) (p = 0.029). On spot urinary thiocyanate reached 688 μmol/l in children without konzo and 1,032 μmol/L in those with konzo. Female gender and low serum albumin are risk factors common to cognitive and proportionally associated motor deficits in children exposed to cassava cyanogens. The two types of deficits may share common mechanisms.
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Affiliation(s)
- G M Bumoko
- Department of Neurology, University of Kinshasa, Kinshasa, Congo
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Ciaranello A, Lu Z, Ayaya S, Losina E, Musick B, Vreeman R, Freedberg KA, Abrams EJ, Dillabaugh L, Doherty K, Ssali J, Yiannoutsos CT, Wools-Kaloustian K. Incidence of World Health Organization stage 3 and 4 events, tuberculosis and mortality in untreated, HIV-infected children enrolling in care before 1 year of age: an IeDEA (International Epidemiologic Databases To Evaluate AIDS) East Africa regional analysis. Pediatr Infect Dis J 2014; 33:623-9. [PMID: 24378935 PMCID: PMC4024340 DOI: 10.1097/inf.0000000000000223] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few studies have reported CD4%- and age-stratified rates of World Health Organization Stage 3 (WHO3) events, World Health Organization Stage 4 (WHO4) events, tuberculosis (TB) and mortality in HIV-infected infants before initiation of antiretroviral therapy. METHODS HIV-infected children enrolled before 1 year of age in the International Epidemiologic Databases to Evaluate AIDS East Africa region (October 1, 2002, to November, 2008) were included. We estimated incidence rates of earliest clinical event (WHO3, WHO4 and TB), before antiretroviral therapy initiation per local guidelines, stratified by current age (< or ≥6 months) and current CD4% (<15%, 15-24%, ≥25%). CD4%-stratified mortality rates were estimated separately for children who did not experience a clinical event ("background" mortality) and for children who experienced an event, including "acute" mortality (≤30 days post event) and "later" mortality (>30 days post event). RESULTS Among 847 children (median enrollment age: 4.8 months; median pre-antiretroviral therapy follow up: 10.8 months; 603 (71%) with ≥1 CD4% recorded), event rates were comparable for those aged <6 and ≥6 months. Current CD4% was associated with risk of WHO4 events for children <6 months of age and with all evaluated events for children ≥6 months old (P < 0.05). "Background" mortality was 3.7-8.4/100 person-years (PY). "Acute" mortality (≤30 days post event) was 33.8/100 PY (after TB) and 41.1/100 PY (after WHO3 or WHO4). "Later" mortality (>30 days post event) ranged by CD4% from 4.7 to 29.1/100 PY. CONCLUSIONS In treatment-naïve, HIV-infected infants, WHO3, WHO4 and TB events were common before and after 6 months of age and led to substantial increases in mortality. Early infant HIV diagnosis and treatment are critically important, regardless of CD4%.
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Affiliation(s)
- Andrea Ciaranello
- Division of Infectious Diseases and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Zhigang Lu
- Division of General Medicine and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Samuel Ayaya
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, KENYA
| | - Elena Losina
- Division of General Medicine and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA,Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Beverly Musick
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Rachel Vreeman
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kenneth A. Freedberg
- Division of Infectious Diseases and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA,Division of General Medicine and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Elaine J. Abrams
- ICAP, Mailman School of Public Health, Columbia University and College of Physicians & Surgeons, Columbia University, NY, USA
| | - Lisa Dillabaugh
- Family AIDS Care and Education Service (FACES) program, Kisumu, KENYA, and Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Katie Doherty
- Division of General Medicine and Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - John Ssali
- Masaka Regional Referral Hospital, AHF-Uganda Cares Masaka, Uganda
| | | | - Kara Wools-Kaloustian
- Division of Infectious Disease, Indiana University School of Medicine, Indianapolis, IN, USA
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Frizzera Dias C, Moreira-Silva SF, Reis MA, Ribeiro Patrício L, Biancardi Gavioli CF, Miranda AE. Late diagnosis and HIV infection in children attending a service of specialized care for pediatric AIDS in Brazil. Rev Soc Bras Med Trop 2014; 47:93-6. [PMID: 24749159 DOI: 10.1590/0037-8682-1737-2013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study describes the frequency of late diagnosis and HIV among children attending a pediatric AIDS clinic. METHODS Cross-sectional study in children exposed to HIV from 2005-2008. A questionnaire was given that included questions on demographics and clinical information. RESULTS Two-hundred twenty-one (97.8%) children were exposed to HIV during pregnancy/childbirth. A total of 193 (87.3%) children had late enrolment in the service and late access to HIV serology. The frequency of HIV was 21.3% (95% confidence interval [CI] 15.9%-26.7%). Protective factors were earlier diagnosis [odds ratio (OR)=0.17 (0.08-0.37)] and receiving complete prophylaxis [OR=0.29 (0.09-0.97)]; being born by vaginal delivery was a risk factor [OR=4.45 (1.47-13.47)]. CONCLUSIONS There was a high frequency of late diagnosis in this patient cohort. Earlier diagnosis is an important measure for controlling HIV among children.
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Crowell CS, Malee KM, Yogev R, Muller WJ. Neurologic disease in HIV-infected children and the impact of combination antiretroviral therapy. Rev Med Virol 2014; 24:316-31. [PMID: 24806816 DOI: 10.1002/rmv.1793] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/23/2014] [Accepted: 03/24/2014] [Indexed: 11/10/2022]
Abstract
The prevalence of HIV-associated neurocognitive impairment in perinatally HIV-infected children has declined since the introduction of combination antiretroviral therapy (cART). Early initiation of cART in infancy has been shown to positively impact neurodevelopment; however, children continue to be diagnosed with HIV outside of the early infancy period and can experience subtle to severe neurocognitive deficits despite cART. The causes of these neurocognitive deficits despite effective cART are multifactorial and likely include continued viral replication in the CNS, ongoing neuroinflammation, irreversible CNS injury prior to cART initiation, neurotoxic effects of cART, and socioeconomic and psychosocial effects. Many aspects of our understanding of HIV-associated neurocognitive disorders have emerged from research in adult patients, but perinatally HIV-infected children represent a very different population. These children were exposed to HIV during a period of rapid brain development and have lifelong infection and potential lifelong cART exposure. HIV is no longer a rapidly fatal disease, and most HIV-infected children in resource-rich countries are living into adulthood. It is therefore critical to optimize neurocognitive outcomes of these youth. This review summarizes current understanding of the pathogenesis of HIV-associated CNS infection and the impact of cART on neurocognitive function in children and adolescents and discusses important areas for future research.
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Affiliation(s)
- Claudia S Crowell
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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48
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Smith R, Wilkins M. Perinatally acquired HIV infection: long-term neuropsychological consequences and challenges ahead. Child Neuropsychol 2014; 21:234-68. [PMID: 24697320 DOI: 10.1080/09297049.2014.898744] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Over the past three decades, perinatal HIV infection in the United States has evolved from a fatal disease to a manageable chronic illness. As the majority of youth with perinatal HIV infection age into adolescence and adulthood, management of this stigmatizing, transmittable disease in the backdrop of a cadre of environmental stressors presents challenges beyond those of other chronic illnesses. The neurologic and neuropsychological consequences of this neurotropic virus have important implications for the successful navigation of responsibilities related to increasingly independent living of this aging population. This article will review the neurologic and neuropsychological consequences of perinatal HIV infection and concomitant factors in the era of highly active antiretroviral therapy and will provide an overview of the neuropathology, pathogenesis, neuroimaging findings, and treatment of perinatal HIV infection, as well as recommendations for service provision and future research.
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Affiliation(s)
- Renee Smith
- a Department of Pediatrics , University of Illinois at Chicago , Chicago IL , USA
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Haase VG, Nicolau NC, Viana VN, Barreto GDV, Pinto JA. Executive function and processing speed in Brazilian HIV-infected children and adolescents. Dement Neuropsychol 2014; 8:32-39. [PMID: 29213877 PMCID: PMC5619446 DOI: 10.1590/s1980-57642014dn81000006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Cognitive disorders in infants and children who are vertically infected with human immunodeficiency virus (HIV) have been recognized since the inception of the epidemic. Objective The present study investigated neuropsychological performance in a cohort of vertically infected Brazilian children and adolescents who underwent antiretroviral therapy. The neuropsychological tasks were designed to evaluate executive function and processing speed. Methods Children and adolescents were recruited at a major research and treatment reference center for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV) in Minas Gerais, Brazil. Forty-one individuals aged 5 to 17 years were enrolled. Twelve were mildly symptomatic (HIV-infected group, Centers for Disease Control and Prevention [CDC] class A or B), and 29 had advanced clinical disease (AIDS group, CDC class C). Results The results showed that HIV-infected children and adolescents exhibited lower performance on neuropsychological tasks than sociodemographically comparable, typically developing controls. Motor and cognitive processing speed and executive function appeared to be the most discriminative domains. Conclusion HIV-infected individuals with more-advanced disease stages exhibited lower performance levels and had greater performance heterogeneity on neuropsychological tasks. Thus, the observed neuropsychological impairments, although more pronounced in participants with more advanced stages of the disease, did not correlate with the variable used (CDC stage).
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Affiliation(s)
- Vitor Geraldi Haase
- Faculdade de Filosofia e Ciências Humanas - Universidade Federal de Minas Gerais, Minas Gerais, Brasil
| | - Nelsa Carol Nicolau
- Faculdade de Medicina, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal de Minas Gerais, Brasil
| | - Virgínia Nunes Viana
- Instituto de Ciências Biológicas - Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Brasil
| | - Gustavo de Val Barreto
- Instituto de Ciências Biológicas - Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Brasil.,Centro Universitário UNA
| | - Jorge Andrade Pinto
- Faculdade de Medicina, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal de Minas Gerais, Brasil
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Abstract
Neurodevelopmental delay, neurodisability, and malnutrition interact to contribute a significant burden of disease in global settings. Assessments which are well integrated with plans of management or advice are most likely to improve outcomes. Assessment tools used in clinical research and programming to evaluate outcomes include developmental and cognitive tools that vary in complexity, sensitivity, and validity as well as the target age of assessment. Few tools have been used to measure socioemotional outcomes and fewer to assess the disabled child with malnutrition. There is a paucity of tools used clinically which actually provide families and professionals with advice to improve outcomes. Brain imaging, electroencephalography, audiology, and visual assessment can also be used to assess the effect of malnutrition on brain structure and function. The interaction of neurodisability and malnutrition is powerful, and both need to be considered when assessing children. Without an integrated approach to assessment and management, we will not support children and families to reach their best potential outcomes.
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