Predicting HIV Disease Progression in Children Using Measures of Neuropsychological and Neurological Functioning

Abstract

ABSTRACT. Background. Neuropsychological testing and 2 measures of neurological status, cortical atrophy, and motor dysfunction were assessed for their usefulness in predicting human immunodeficiency virus (HIV) disease progression in infants, children, and adolescents who participated in Pediatric AIDS Clinical Trials Group Protocol 152 (PACTG 152).Methods. A cohort of 722 antiretroviral therapy-naive children with symptomatic HIV infection were assessed at study entry and at later intervals. Assessments included neurodevelopmental testing, neuroradiologic imaging, and neurological examination of motor function. CD4 cell count and plasma RNA viral load also were measured.Results. Children with the lowest neuropsychological functioning (IQ < 70) at baseline had the highest risk for later HIV disease progression (56%), compared with those with borderline/low (IQ ‫؍‬ 70 -89) functioning (26%), or with average or above (IQ > 90) functioning (18%). This was also true of week 48 neuropsychological functioning. Motor dysfunction (especially reduced muscle mass) at entry also predicted disease progression. Furthermore, motor dysfunction and week 48 neuropsychological functioning provided predictive information beyond that obtainable from surrogate markers of HIV disease status (eg, CD4 count, HIV RNA level). Children with cortical atrophy also were at higher risk for later disease progression, but when CD4 count and RNA viral load were known, cortical atrophy information provided no additional predictive information.Conclusions. Measures of neuropsychological and motor function status provide unique information regarding pediatric HIV disease progression. As such, these findings have important implications for predicting long-term outcomes (eg, longevity) in pediatric patients. Pediatrics 2000;106(6). URL: http://www. pediatrics.org/cgi/content/full/106/6/e76; human immunodeficiency virus, children, neuropsychology, cognitive, development, cortical atrophy, motor function.

HIV‐stage, nutritional status, and child psychomotor development in resource‐poor settings – a causal web

“…On the other hand, malnutrition probably contributes to poorer psychomotor functioning. And finally, an earlier longitudinal study 4 showed that poor psychomotor functioning (the outcome of Abubakar et al's study) was a predictor of HIV ⁄ AIDS disease progression (a predictor in this study). The relationships between disease stage, nutritional status, and psychomotor development are likely to be intricately interrelated.…”

Developmental delay in HIV-exposed infants in Harare, Zimbabwe

“…Cognitive delay in HIVinfected children has been well documented in numerous studies with a variety of clinical manifestations. These include: behavioural impairments, learning impairments, lower intellectual function, poor ability in sequential processing, attentiondeficit disorders; and spatial memory impairment (Ruel, et al, 2012;Grover, et al, 2007;Willen, 2006;Chase, et al, 2000;Blanchette, et al, 2001;Pearson, et al, 2000;Boivin, et al, 1995;Gay, et al, 1995;Brouwers, et al, 1995;Mellins, et al, 1994;.…”

“…In the decade following the 1990s, studies started to be published in the United States and Puerto Rico using data from the Woman and Infants Transmission Study (WITS) (Nozyce, et al, 2006;Smith, et al, 2006;Llorente, et al, 2003;Macmillan, et al, 2003;Chase, et al, 2000;Smith, et al, 2000), the Pediatric AIDS Clinical Trials Group (Lindsey, et al, 2007;Pearson, et al, 2000), and from the Adolescent Master Protocol (Rice, et al, 2012). These studies were primarily concerned with describing the type of neurodevelopmental impairment.…”

“…Other studies reported on severity of impairments being associated with outcomes in HIV-infected children (Smith, et al, 2006;Llorente, et al, 2003;Pearson, et al, 2000) with a reduction in mortality and severity with the use of ART (Lindsey, et al, 2007).…”

“…All except one study (Chase, et al, 2000) showed that children with HIV infection received ARVs according to accepted guidelines (at the time of data collection) on the standard of care for paediatric HIV patients (Rice, et al, 2012;Koekkoek, et al, 2008;Lindsey, et al, 2007;Foster, et al, 2006;Nozyce, et al, 2006;Smith, et al, 2006;Llorente, et al, 2003;Macmillan, et al, 2003;Blanchette, et al, 2001;Pearson, et al, 2000;Smith, et al, 2000). The advancements in pharmacological management during the data collection period of these studies introduced error which could not be controlled.…”