Despite Treatment HIV Infected Children Continue To Have Diminished Cognitive Skills

Sophie Cohen MD, PhD Student Department of Pediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands Cairns Base Hospital Australia MedicalResearch.com Interview with:
Sophie Cohen MD, PhD Student

Department of Pediatric Haematology, Immunology and Infectious Diseases,
Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
Cairns Base Hospital Australia

Medical Research: What is the background for this study? What are the main findings?

Response: Since combination antiretroviral therapy (cART) has become widely available for HIV-infected children, the incidence of severe neurological complications has decreased drastically from 30-50% to less than 2%. Unfortunately, even in cART-treated HIV-infected children a range of cognitive problems have been found, such as a lower intelligence quotient (IQ) and poorer visual-motor integration. Importantly, while most HIV-infected children in industrialized countries are immigrants with a relatively low socioeconomic status (SES), cognitive studies comparing HIV-infected children to SES-matched controls are very scarce.  Understanding the prevalence and etiology of cognitive deficits in HIV-infected children is essential because they may result in more pronounced problems, and influence future intellectual performance, job opportunities and community participation. Also, early detection of cognitive impairment might trigger the development of early intervention strategies.

In this study we aimed to compare the neuropsychological profile of HIV-infected children to that of healthy controls, matched for age, gender, ethnicity and SES. Also, we aimed to determine the prevalence of cognitive impairment in the HIV-infected group and detect associations between HIV/cART parameters and cognitive performance.

We found that the HIV-infected group had a poorer cognitive performance compared with the healthy children on all tested domains (including intelligence, information processing speed, attention, memory, executive- and visual-motor functioning). Using a novel statistical method called Multivariate normative comparison (MNC), we detected a prevalence of 17% with cognitive impairment in the HIV-infected group. Lastly, we found that the center for disease control (CDC) clinical category at HIV diagnosis was inversely associated with verbal IQ (CDC C: coefficient -22.98, P=0.010).

Medical Research: What should clinicians and patients take away from your report?

Response: Our study showed that despite adequate HIV-suppression with cART, HIV-infected children still have poorer cognitive skills as compared to healthy children, also when taking potential confounding factors such as socioeconomic status into account. This means that cognitive performance should be an important item to pay attention to while treating an HIV-infected child. If an HIV-infected child shows difficulties in school or behavioural problems, the possibilities for helping the child to reach his/her maximum potential should be considered by the treatment team. Of note, children with a previous AIDS diagnosis seemed most affected in our study, which emphasizes the importance of early diagnosis and treatment for preventing disease progress and cognitive problems in HIV-infected children.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: In the near future, we intend to focus on the pathophysiological mechanisms behind the observations we have made with our study. Also, longitudinal studies (with both cognitive and imaging outcome parameters) should be performed to better understand the processes underlying neurological and cognitive problems in cART-treated HIV-infected children.

Citation:

Sophie Cohen, Jacqueline A. ter Stege, Gert J. Geurtsen, Henriette J. Scherpbier, Taco W. Kuijpers, Peter Reiss, Ben Schmand, and Dasja Pajkrt

Poorer cognitive performance in perinatally HIV-infected children as compared to healthy socioeconomically matched controls Clin Infect Dis. first published online December 16, 2014 doi:10.1093/cid/ciu1144

 

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