Executive function in HIV-affected children and adolescents: a systematic review and meta-analyses

Rowe, Kirsten; Buivydaite, Ruta; Heinsohn, Torben; Rahimzadeh, Mana; Wagner, Ryan G.; Scerif, Gaia; Stein, Alan

doi:10.1080/09540121.2021.1873232

Cited by 6 publications

(5 citation statements)

References 121 publications

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“…The most pronounced differences between HIV-infected and siblings were found in teacher-reported executive functioning, caregiver-reported problems with peers and caregiver-, and self-reported general health. The teacher-reported difference in executive functioning is in line with previous studies that show that this domain of cognitive functioning is particularly compromised in HIV-infected children [5,11,38,39].…”

Section: Discussionsupporting

confidence: 90%

Neuropsychological and Psychosocial Functioning of Children with Perinatal HIV-Infection in The Netherlands

Opstal

Dogterom

Wagener

et al. 2021

Viruses

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Advances in antiretroviral treatment improved the life expectancy of perinatally HIV-infected children. However, growing up with HIV provides challenges in daily functioning. This cross-sectional cohort study investigated the neuropsychological and psychosocial functioning of a group of perinatally HIV-infected children in the Netherlands and compared their outcomes with Dutch normative data and outcomes of a control group of uninfected siblings. The children’s functioning was assessed with internationally well-known and standardized questionnaires, using a multi-informant approach, including the perspectives of caregivers, teachers, and school-aged children. In addition, we explored the associations of socio-demographic and medical characteristics of the HIV-infected children with their neuropsychological and psychosocial functioning. Caregivers reported compromised functioning when compared to Dutch normative data for HIV-infected children in the areas of attention, sensory processing, social-emotional functioning, and health-related quality of life. Teachers reported in addition compromised executive functioning for HIV-infected children. A comparison with siblings revealed differences in executive functioning, problems with peers, and general health. The concurrent resemblance between HIV-infected children and siblings regarding problems in other domains implies that social and contextual factors may be of influence. A family-focused approach with special attention to the child’s socio-environmental context and additional attention for siblings is recommended.

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Section: Discussionsupporting

confidence: 90%

Neuropsychological and Psychosocial Functioning of Children with Perinatal HIV-Infection in The Netherlands

Opstal

Dogterom

Wagener

et al. 2021

Viruses

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“…A number of recent reviews have summarized the literature on cognitive and neuroimaging findings among children with PHIV [5,[8][9][10][11][12][13][14][15]. In general, these reviews acknowledge that, despite decreases in severe neurological sequelae since the advent of cART for children, cognitive impairments continue to be a concern, particularly in the developing world where ART is less available, older antiretroviral medications with greater neurotoxicity are more commonly used, and HIV encephalopathy continues to occur [16].…”

Section: Introductionmentioning

confidence: 99%

“…In general, these reviews acknowledge that, despite decreases in severe neurological sequelae since the advent of cART for children, cognitive impairments continue to be a concern, particularly in the developing world where ART is less available, older antiretroviral medications with greater neurotoxicity are more commonly used, and HIV encephalopathy continues to occur [16]. Systematic reviews note that decreased functioning is apparent in specific domains of cognitive functioning, such as executive functioning (particularly working memory), processing speed, visual memory, and visuospatial ability [8,11]. However, the degree to which impairments are attributed to HIV versus other developmental, environmental, and socioeconomic risks varies.…”

Section: Introductionmentioning

confidence: 99%

Central Nervous System Impact of Perinatally Acquired HIV in Adolescents and Adults: an Update

Nichols

2022

Curr HIV/AIDS Rep

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Purpose of Review Perinatally acquired HIV infection (PHIV) can confer neurodevelopmental risk. As children with PHIV increasingly survive through adolescence and into adulthood, understanding its long-term central nervous system (CNS) impacts is critical for maximizing adult outcomes and quality of life. Recent Findings Recently published neurocognitive and neuroimaging findings show impacts on the CNS associated with early HIV disease progression that endure into adolescence and young adulthood. Although developmental trajectories in adolescence largely appear stable, further research on maturational processes is indicated. Summary Although early antiretroviral therapy in infancy appears to be protective, it is not universally available and current youth largely developed without its benefit. The neurocognitive effects of HIV and the multiple other risks to neurodevelopment experienced by youth with PHIV call for further longitudinal research and a multifaceted approach to prevention and intervention.

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“…4 Yet evidence suggests that despite cART, adolescents with PHIV still exhibit a higher prevalence of cognitive impairment compared with uninfected peers, including lower IQ and poorer executive function. 5,6 MRI biomarkers are sensitive in detecting early HIV-related brain changes. 7 For example, a large study found lower gray matter (GM) and white matter (WM) volume in children with PHIV compared with healthy controls.…”

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confidence: 99%

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confidence: 99%

Brain Differences in Adolescents Living With Perinatally Acquired HIV Compared With Adoption Status Matched Controls

et al. 2022

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Background and ObjectivesDespite effective combination antiretroviral therapy (cART), adolescents with perinatally acquired HIV (PHIV) exhibit cognitive impairment, of which structural changes could be the underlying pathophysiological mechanism. Prior MRI studies found lower brain volumes, more white matter (WM) hyperintensities (WMH) volume, lower WM integrity, and differences in cerebral blood flow (CBF). However, these findings may be confounded by adoption status, as the large portion PHIV adolescents have been adopted. Adoption has been associated with malnutrition and neglect which in turn may have affected brain development. We investigated the long-term effects of PHIV on the brain, while minimizing the confounding effect of adoption status.MethodsWe determined whole brain gray matter (GM) and WM volume with 3D T1-weighted scans; total WMH volume with fluid-attenuated inversion recovery (FLAIR); CBF in the following regions of interest (ROIs): WM, GM and subcortical GM with arterial spin labeling (ASL); and whole brain WM microstructural markers: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD) with diffusion tensor imaging (DTI) in cART treated PHIV adolescents visiting our outpatient clinic in Amsterdam and controls matched for age, sex, ethnic origin, socio-economic status, and adoption status. We assessed differences in neuroimaging parameters between PHIV adolescents and controls using linear regression models adjusted for age and sex and applied multiple comparisons correction.Results35 PHIV adolescents and 38 controls were included with a median age (years) of 14.9 (IQR: 10.7-18.5) and 15.6 (IQR:11.1-17.6), respectively with a similar rate of adoption. We found a lower overall FA (beta = -0.012; p<0.014, -2.4%), higher MD (beta = 0.014, p = 0.014, 1.3%) and higher RD (beta = 0.02, p = 0.014, 3.3%) in PHIV adolescents vs. adoption-matched controls, but no differences in AD. We found comparable GM, WM and WMH volume, and CBF in ROIs between PHIV adolescents and controls. We did not find an association between cognitive profiles and WM microstructural markers in PHIV adolescents.DiscussionIrrespective of adoption status, PHIV adolescents exhibited subtle lower WM integrity. Our findings may point towards early-acquired WM microstructural alterations associated with HIV.

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Executive function in HIV-affected children and adolescents: a systematic review and meta-analyses

Cited by 6 publications

References 121 publications

Neuropsychological and Psychosocial Functioning of Children with Perinatal HIV-Infection in The Netherlands

Neuropsychological and Psychosocial Functioning of Children with Perinatal HIV-Infection in The Netherlands

Central Nervous System Impact of Perinatally Acquired HIV in Adolescents and Adults: an Update

Brain Differences in Adolescents Living With Perinatally Acquired HIV Compared With Adoption Status Matched Controls

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