HIV-Associated Cognitive Impairment in Perinatally Infected Children: A Meta-analysis

Abstract

Context Research shows, conclusively, that perinatal HIV-infection has negative effects on cognitive functioning of children and adolescents. However, the extent of these cognitive impairments is unknown. Current literature does not document specific cognitive domains most affected in HIV-infected children and adolescents. Objective To systematically review and meta-analyse the degree of cognitive impairment, and the specific cognitive domains affected, in children and adolescents with perinatally acquired HIV-infection. Data Sources We systematically searched 5 electronic bibliographic databases namely: PubMed, PsychINFO, Academic Search Premier, Scopus, and WorldCat, using a search protocol specifically designed for this study. Study Selection Studies were selected on the basis of set a priori eligibility criteria. Titles, abstracts and full texts were assessed by two independent reviewers Data Extraction Data from included studies were extracted into Microsoft Excel by two independent reviewers. Results 22 studies were identified for inclusion in the systematic review and of this 6 studies were included in the meta-analysis. Results from the meta-analysis indicated that working memory and executive function were the domains most affected by the HIV-virus. Limitations Only 27% of the included studies were suitable to enter into the meta-analysis. There was significant geographic bias in published studies, with only 32% (7/22) of included studies from sub-Saharan Africa. Conclusions The evidence supports an association between HIV-infection in children and adolescents, and cognitive impairment in the domains of executive function and processing speed, with effect size estimates also providing some support for deficits in visual memory and visual spatial ability.

Neurodevelopment in Young Children Born to HIV-Infected Mothers: A Meta-analysis

“…9 The Population-Intervention-Comparison-Outcome (PICO) question that guided our search strategy was, "What is the extent of developmental delays in young HIV+ and HEU children compared with HUU children?" eligibility The following inclusion criteria were applied: (1) include at least 2 out of 3 populations (HIV+, HEU, or HUU), (2) only include children <8 years of age, and (3) use a standardized neuropsychological instrument with reported results. Children were limited to a younger age group to focus on studies in which researchers evaluated development when the brain is most rapidly growing and receptive to interventions.…”

“…For example, in a recent meta-analysis of older HIV+ children and adolescents, researchers found working memory, processing speed, and executive function were most affected by HIV. 2 These skills are more formally developed and easier to test in older children; however, these children also have more time and opportunities to experience positive or negative external factors that may affect development, such as social stimulation and supportive learning environments. By assessing more specific domains early, with measures such as those found within the National Institutes of Health Toolbox, 40 we could have a clearer understanding of the direct impact that HIV exposure has on neurodevelopment.…”

“…1 -3 Cognitive abilities have been a critical area of focus, and in a recent meta-analysis, researchers identified working memory, processing speed, and executive function as the domains most affected by HIV in older children and adolescents. 2 Younger HIV+ children also have lower scores in various domains of development while still having the greatest potential for benefit from early interventions. 1,3 Past reviews have generated important insights and understanding into developmental outcomes for young children born to HIV+ mothers; however, results were reported qualitatively and are limited by heterogeneity within each domain assessed.…”

Impact of Perinatally Acquired HIV Disease Upon Longitudinal Changes in Memory and Executive Functioning

“…32–34 A systematic review highlighted greater impairment among PHIV children compared to HIV unexposed and uninfected children in working memory, executive function and processing speed. 35 Memory and EF appear to vary among youth based on individual histories of disease severity and viral suppression, yet other factors, including socio-demographic characteristics, are also implicated. 36–37 Associations of Centers for Disease Control and Prevention (CDC) 38 Class C (AIDS-defining) diagnosis with poorer visual recognition memory among youth with PHIV have been observed, as well as associations between current immunologic status and poorer verbal learning.…”

Clinical round-up

“…Ditkowsky et al 2 recently published a model of a cost-benefit analysis of screening all pregnant women aged 16–25 for Chlamydia trachomatis (CT) in a high-burden setting in Brooklyn, New York, USA. This has previously not been found to be cost-effective in several countries, including the UK.…”