Abstract

Neurocognitive function in HIV positive children in a developing country

Presented by Samantha Walker (Jamaica).

S. Walker¹, R. Pierre¹, C. Christie-Samuels¹, S. Chang-Lopez², Kingston Pediatric & Perinatal HIV/AIDS Program (KPAIDS) Research Group

¹University of the West Indies, Obstetrics, Gynaecology & Child Health, Mona, Jamaica, ²University of the West Indies, Child Development Unit / Tropical Metabolism Research Institute, Mona, Jamaica

Background: Despite increased access to antiretroviral therapy in resource-limited settings, HIV encephalopathy remains an important cause of morbidity in infected children. We aimed to characterize neurological outcomes in a prospective cohort of infected children attending four pediatric clinics in the Kingston Metropolitan Area, Jamaica.
Methods: The neurological outcomes of 287 children between September 2002 and August 2008 were characterized; prevalence of HIV encephalopathy (CDC criteria, 1994) determined, and change in neurological outcome 12-months post-initiation of highly active anti-retroviral therapy (HAART) compared using paired T-test.
A nested case-control study conducted between July - September 2009 used fifteen randomly selected encephalopathic children (aged 7-10 years) who were age, gender, education, residence and ARV-matched with non-encephalopathic controls. Neurocognitive function was evaluated using clinical assessment and the following tests: concept formation (Raven´s Coloured Progressive Matrices), short-term memory (visuo-spatial - Corsi Blocks and auditory - Digit SPan), selective attention (Test of Everyday Attention for Children), and fine motor and coordination function (Posting Coins, Grooved Pegbaord, and Hand Pronation-Supination). Outcomes were compared using Fisher´s Exact and Mann Whitney U tests.
Results: Sixty-seven (23.3%) children (35/52.2% male) were diagnosed with HIV encephalopathy. Median age at diagnosis of encephalopathy was 1.57 years [interquartile range (IQR) 1.08 - 3.43]. Vertical transmission was the predominant mode of transmission (64/95.5% encephalopathic, and 194/88.2% non-encephalopathic). Predominant abnormalities at diagnosis (n=67) included delayed milestones (59/88.1%), hyperreflexia (59/88.1%), spasticity (50/64.6%), microcephaly (42/62.7%) and quadriparesis (21/31.4%). No significant reduction in prevalence of neurodevelopmental abnormalities was seen 12-months post-HAART. Encephalopathic children achieved lower scores for tests of concept formation, short-term memory and selective attention, and required a longer duration to complete tests of fine motor and coordination when compared to controls (p< .05).
Conclusions: HIV infection impairs neurocognitive function in infected children. As these children transition into adulthood, characterization of neurocognitive impairment and rehabilitation become important foci for healthcare providers.