Cognitive Functioning in School-Aged Children With Vertically Acquired HIV Infection Being Treated With Highly Active Antiretroviral Therapy (HAART)

Abstract

In today's era of highly active antiretroviral therapy (HAART), few children with HIV-1 infection experience severe central nervous system (CNS) manifestations indicative of encephalopathy. However, little is known about the neurocognitive strengths and weaknesses of HIV-infected children treated with HAART. This cross-sectional study is the first to systematically investigate the relation between cognitive functioning and medical markers in HIV-infected children and adolescents treated with HAART with varying levels of computed tomography (CT) brain scan abnormalities. The Wechsler Intelligence Scale for Children-Third Edition was administered to 41 vertically infected children (mean age = 11.2 years) treated with HAART for at least 1 year. Other procedures at the time of testing included CT brain scans and collection of CD4 cell counts and plasma HIV1 RNA PCR. Although global cognitive functioning among participants was in the Average range, children with minimal to moderate CT brain scan abnormalities scored significantly lower than children with normal scans on composite measures of cognitive functioning and five specific subtests, especially tasks involving executive functions. Furthermore, children with worse immune status (CD4+ counts < or = 500) scored lower on subtests measuring processing speed. Viral load was unrelated to cognitive test scores. Thus, children with HIV being treated with HAART remain at risk for developing CNS disease. Findings emphasize the importance of conducting neuropsychological assessments in this population, particularly for children with cortical atrophy and absolute CD4+ cell counts < or = 500.

Poor Cognitive Functioning of School-Aged Children in Thailand with Perinatally Acquired HIV Infection Taking Antiretroviral Therapy

“…4 Few studies have demonstrated a neurocognitive deficit in HIV-infected preschool 5,6 and school-aged children. [7][8][9][10][11] Data from HIVinfected children aged from 4 months to 17 years in the United States showed lower cognitive function among the HIVinfected group compared to normal controls. 8 Moreover, cognitive function was not improved after 48 weeks of antiretroviral therapy.…”

“…11 Children with abnormal structural brain findings such as cortical atrophy, poor immune function, or an AIDS-defining illness have more risk of poor cognitive function. 9,12 Most of the neurocognitive assessment studies of HIVinfected children have been performed in the United States and Europe where children have access to treatment earlier than children in resource-limited settings. Therefore, the magnitude of cognitive impairment might be worse in HIVinfected children in resource-limited settings.…”

Linguagem oral e escrita de crianças soropositivas para o HIV: um acompanhamento longitudinal

“…As mentioned in the literature as areas damaged intelligence, executive function, working memory, episodic memory, language, processing speed, attention, and motor skills. In addition, other factors concur and contribute to changes in the development of HIVinfected children such as psychological and social factors due to the impact of the disease on the family and social environment (14,15) . Therefore, considering the cognitive alterations, social and in language development that can affect HIV-infected children and the important relationship of these factors with the reading and writing learning and still knowing that learning the written language is a complex process that requires the integrity of multiple cognitive abilities, the objective of this study was to evaluate reading and writing of children with HIV and compare with the phonological development and with clinical markers and immunovirological of AIDS.…”

A Randomized Controlled Trial to Evaluate if Computerized Cognitive Rehabilitation Improves Neurocognition in Ugandan Children with HIV

“…Cognitive, psychiatric, and behavioral (neuropsychological) disorders are emerging as a major concern in highly active antiretroviral therapy (HAART)-treated perinatally infected children as they progress into adolescence. 3,4 HIV disease in children can significantly impair attention, memory, and visual-spatial processing speed, [5][6][7][8][9] impairing school performance. These are the very domains of neurocognitive development in African children that have been most effectively improved through computerized cognitive rehabilitation treatment, computerized cognitive rehabilitation training (CCRT).…”