Division of Infectious Disease, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, CA 94143-0136, USA.
Clin Infect Dis. 2012 Apr;54(7):1001-9. doi: 10.1093/cid/cir1037. Epub 2012 Feb 4.
Human immunodeficiency virus (HIV) infection causes neurocognitive or motor function deficits in children with advanced disease, but it is unclear whether children with CD4 cell measures above the World Health Organization (WHO) thresholds for antiretroviral therapy (ART) initiation suffer significant impairment.
The neurocognitive and motor functions of HIV-infected ART-naive Ugandan children aged 6-12 years with CD4 cell counts of >350 cells/μL and CD4 cell percentage of >15% were compared with those of HIV-uninfected children, using the Test of Variables of Attention (TOVA), the Kaufman Assessment Battery for Children, second edition (KABC-2), and the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2).
Ninety-three HIV-infected children (median CD4 cell count, 655 cells/μL; plasma HIV RNA level, 4.7 log(10) copies/mL) were compared to 106 HIV-uninfected children. HIV-infected children performed worse on TOVA visual reaction times (multivariate analysis of covariance; P = .006); KABC-2 sequential processing (P = .005), simultaneous processing (P = .039), planning/reasoning (P = .023), and global performance (P = .024); and BOT-2 total motor proficiency (P = .003). High plasma HIV RNA level was associated with worse performance in 10 cognitive measures and 3 motor measures. In analysis of only WHO clinical stage 1 or 2 HIV-infected children (n = 68), significant differences between the HIV-infected and HIV-uninfected groups (P < .05) remained for KABC-2 sequential processing, KABC-2 planning/reasoning, and BOT-2 motor proficiency.
Significant motor and cognitive deficits were found in HIV-infected ART-naive Ugandan children with CD4 cell counts of ∼350 cells/μL and percentages of >15%. Study of whether early initiation of ART could prevent or reverse such deficits is needed.
人类免疫缺陷病毒（HIV）感染可导致晚期疾病患儿出现神经认知或运动功能缺陷，但尚不清楚 CD4 细胞计数高于世界卫生组织（WHO）抗逆转录病毒治疗（ART）启动阈值的患儿是否会出现显著损伤。
对 6-12 岁 CD4 细胞计数>350 个/μL 且 CD4 细胞百分比>15%的未接受 ART 的 HIV 感染的乌干达儿童与 HIV 未感染者的神经认知和运动功能进行比较，采用变量测试（TOVA）、考夫曼儿童评估成套测验（KABC-2）和布鲁因克斯-奥塞尔斯基运动熟练程度测试（BOT-2）。
将 93 名 HIV 感染儿童（中位数 CD4 细胞计数 655 个/μL，血浆 HIV RNA 水平 4.7log10 拷贝/ml）与 106 名 HIV 未感染者进行比较。HIV 感染儿童在 TOVA 视觉反应时间方面表现更差（协方差多变量分析；P=0.006）；KABC-2 连续处理（P=0.005）、同时处理（P=0.039）、计划/推理（P=0.023）和总体表现（P=0.024）；BOT-2 总运动熟练程度（P=0.003）。高血浆 HIV RNA 水平与 10 项认知指标和 3 项运动指标的表现更差相关。在仅分析 WHO 临床分期 1 或 2 的 HIV 感染儿童（n=68）中，HIV 感染组与 HIV 未感染组之间仍存在显著差异（P<0.05），包括 KABC-2 连续处理、KABC-2 计划/推理和 BOT-2 运动能力。
在 CD4 细胞计数约 350 个/μL 且百分比>15%的未接受 ART 的 HIV 感染乌干达儿童中发现了显著的运动和认知缺陷。需要研究早期启动 ART 是否可以预防或逆转这些缺陷。
