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

Puthanakit, Thanyawee; Aurpibul, Linda; Louthrenoo, Orawan; Tapanya, Pimmas; Nadsasarn, R.; Insee-ard, Sukrapee; Sirisanthana, Virat

doi:10.1089/apc.2009.0314

Cited by 65 publications

(68 citation statements)

References 16 publications

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“…The mean age starting ART in the deferred group was 31.4 weeks. While this is early compared to many studies describing neurodevelopmental outcomes[3-4, 12-15], even this delay is associated with poorer outcomes. The mean time on ART in infants receiving early ART compared to those on deferred ART was significantly longer (18.7 vs 40.9 weeks), potentially influencing our findings.…”

Section: Discussionmentioning

confidence: 95%

Early antiretroviral therapy improves neurodevelopmental outcomes in infants

Laughton

Cornell

Grové

et al. 2012

Aids

164

141

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Objectives To evaluate the effect of early versus deferred antiretroviral therapy (ART) on neurodevelopment of infants from Cape Town participating in the CHER (Children with HIV Early Antiretroviral Therapy) trial. Design HIV-infected infants were randomised to early (<3 months) or deferred ART. HIV-uninfected infants (HIV-exposed and HIV-unexposed) provide background data. Methods Neurological examination and Griffiths Mental Development Scales (GMDS) were administered between 10–16 months of age, by testers blind to HIV status and randomised allocation. Mean quotients were compared using paired t-tests. Results 64 infants on early ART and 26 on deferred ART (of potential 77 and 38 respectively on CHER trial) were assessed at median age 11 months (range 10-16). On the GMDS, all scores were lower in the deferred arm and the General Griffiths and Locomotor Scores were significantly lower: mean (standard deviation): 100.1 (13.8) vs 106.3 (10.6) p=0.02; and 88.9 (16.3) vs 97.7 (12.5), p<0.01, respectively. Children with HIV who received early ART performed as well as children without HIV except on the locomotor subscale. Both infected and uninfected mean GMDS scores were within the average range. Conclusions Infants initiated on early ART have significantly better Locomotor and General Scores on the GMDS at median age 11 months compared to infants on deferred ART, despite careful monitoring and ready access to ART in the latter.

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Section: Discussionmentioning

confidence: 95%

Early antiretroviral therapy improves neurodevelopmental outcomes in infants

Laughton

Cornell

Grové

et al. 2012

Aids

164

141

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“…71–73 Despite treatment with antiretroviral drugs, subtle defects persist and have important implications for adolescents, particularly with respect to adherence to medication, education and career planning, risk behaviours, and overall quality of life. 73,74 …”

Section: Chronic Diseasementioning

confidence: 99%

Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges

Lowenthal

Bakeera-Kitaka

Marukutira

et al. 2014

The Lancet Infectious Diseases

382

404

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Worldwide, more than three million children are infected with HIV, 90% of whom live in sub-Saharan Africa. As the HIV epidemic matures and antiretroviral treatment is scaled up, children with HIV are reaching adolescence in large numbers. The growing population of adolescents with perinatally acquired HIV infection living within this region presents not only unprecedented challenges but also opportunities to learn about the pathogenesis of HIV infection. In this Review, we discuss the changing epidemiology of paediatric HIV and the particular features of HIV infection in adolescents in sub-Saharan Africa. Longstanding HIV infection acquired when the immune system is not developed results in distinctive chronic clinical complications that cause severe morbidity. As well as dealing with chronic illness, HIV-infected adolescents have to confront psychosocial issues, maintain adherence to drugs, and learn to negotiate sexual relationships, while undergoing rapid physical and psychological development. Context-specific strategies for early identification of HIV infection in children and prompt linkage to care need to be developed. Clinical HIV care should integrate age-appropriate sexual and reproductive health and psychological, educational, and social services. Health-care workers will need to be trained to recognise and manage the needs of these young people so that the increasing numbers of children surviving to adolescence can access quality care beyond specialist services at low-level health-care facilities.

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“…There are now a number of studies that have identified important predictors of the behavioral health risks assessed in this paper, including cognitive function, 51,52 caregiver supervision and monitoring, [53][54][55] caregiver mental health, 11,56 and parent-child relationship factors, 11,[55][56][57] many of which could be targeted in these services. To date, only a few efficacy-based interventions have been developed that target caregiver-child relationship factors as well as supervision and monitoring to support mental health and reduce risk behavior in PHIV + youth and youth living with HIV + caregivers, 39,58 as well as nonadherence in PHIV + youth 39,59 and none of the interventions developed for PHIV + youth have been tested in large scale randomized control trials.…”

Section: Mellins Et Almentioning

confidence: 99%

Behavioral Health Risks in Perinatally HIV-Exposed Youth: Co-Occurrence of Sexual and Drug Use Behavior, Mental Health Problems, and Nonadherence to Antiretroviral Treatment

Mellins

Tassiopoulos

Malee

et al. 2011

AIDS Patient Care and STDs

156

121

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In a sample of perinatally HIV-infected (PHIV +) and perinatally HIV-exposed, uninfected (PHEU) adolescents, we examined the co-occurrence of behavioral health risks including mental health problems, onset of sexual and drug use behaviors, and (in PHIV + youth) nonadherence to antiretroviral therapy (ART). Participants, recruited from 2007 to 2010, included 349 youth, ages 10-16 years, enrolled in a cohort study examining the impact of HIV infection and ART. Measures of the above behavioral health risks were administered to participants and primary caregivers. Nearly half the participants met study criteria for at least one behavioral health risk, most frequently, mental health problems (28%), with the onset of sexual activity and substance use each reported by an average of 16%. Among the sexually active, 65% of PHIV + and 50% of PHEU youth reported unprotected sex. For PHIV + youth, 34% reported recent ART nonadherence, of whom 45% had detectable HIV RNA levels. Between 16% (PHIV +) and 11% (PHEU) of youth reported at least two behavioral health risks. Older age, but not HIV status, was associated with having two or more behavioral health risks versus none. Among PHIV + youth, living with a birth mother (versus other caregivers) and detectable viral load were associated with co-occurrence of behavioral health risks. In conclusion, this study suggests that for both PHIV + and PHEU youth, there are multiple behavioral health risks, particularly mental health problems, which should be targeted by service systems that can integrate prevention and treatment efforts.

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

Cited by 65 publications

References 16 publications

Early antiretroviral therapy improves neurodevelopmental outcomes in infants

Early antiretroviral therapy improves neurodevelopmental outcomes in infants

Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges

Behavioral Health Risks in Perinatally HIV-Exposed Youth: Co-Occurrence of Sexual and Drug Use Behavior, Mental Health Problems, and Nonadherence to Antiretroviral Treatment

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