A systematic review examining whether interventions are effective in reducing cognitive delay in children infected and affected with HIV

Abstract

Cognitive delay has been recorded in children infected and affected by HIV. This finding is well established, yet few countries report provision of special educational interventions for this group of children. The general rehabilitation literature describes an array of effective interventions for children with learning difficulties. These have rarely been adapted for children affected by HIV, despite their growing numbers. A systematic review was conducted to examine effective interventions for cognitive delay in children (under 18 years) infected with HIV and/or exposed to HIV (HIV-negative child born to an HIV-positive mother). A keyword search of electronic databases with reference follow-up generated 1745 hits. These abstracts were screened for relevance, resulting in 17 papers available for shortlisting. Studies were then included if they were randomised control trials, were longitudinal, pre/post or cohort studies and presented empirical data on an intervention for children infected by HIV or exposed to HIV and had at least one cognitive measure. Carer interventions were included if they had at least one child cognitive measure. Of the 17 papers, 4 met the inclusion criteria based on design and quality. Interventions included cognitive rehearsal, home-based stimulation and parental support. All four interventions showed at least one significant child improvement at follow-up. Despite such improvements, many children still scored within the disability range at follow-up. These results show that the effective interventions are available and should be scaled up to meet the needs of children. Complex interventions are not sufficiently studied. This review suggests an ongoing need to build evidence-based interventions, but calls on evidence-based programmes to be initiated for HIV-positive and HIV-affected children.

Social protection: potential for improving HIV outcomes among adolescents

“…HIV-positive adolescents include two co-existing groups with shared and unique risks [ 39 ]. Survivors of vertical infection are growing up with lifelong exposure to HIV, high risk of cognitive impairment [ 40 ] and parenting environments often characterized by illness and death. Adolescents who acquire HIV through sexual transmission may differ in behavioural profiles, but both groups are strongly influenced by family-level and structural factors [ 41 ].…”

Could cash and good parenting affect child cognitive development? A cross-sectional study in South Africa and Malawi

“…Yet interventions at scale are wanting [8]. Of particular concern is cognitive development, as this may affect the child’s ability to reach their full developmental potential, limit their access to education and subsequently have long term implications for their life opportunities [9] Some areas of cognitive development are crucial for interpersonal behaviours and indeed are the very skills needed for HIV prevention.…”

High-content analysis and Kinetic Image Cytometry identify toxic and epigenotoxic effects of HIV antiretrovirals on human iPSC-neurons and primary neural precursor cells

“…As the HIV+ cART population ages, ANI and MNI might progress to more serious cognitive impairment and the pathways involved are similar to those of Alzheimer's Disease 9,10 (e.g., Aβ-oligomers are elevated 11 ). Also, HIV+ children on cART, display reduced IQ and cognition [12][13][14][15][16] and HIV-children, perinatally exposed to cART, experience developmental delays 17 . There is growing concern that cART, itself, may have effects on cognition 18 .…”