Brahmbhatt Heena, Boivin Michael, Ssempijja Victor, Kagaayi Joseph, Kigozi Godfrey, Serwadda David, Violari Avy, Gray Ronald H
*Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Rakai Health Science Program, Rakai, Uganda; ‡Michigan State University, Lansing, MI; §Makerere University, School of Public Health, Kampala, Uganda; and ‖Perinatal HIV Research Unit, Johannesburg, South Africa.
J Acquir Immune Defic Syndr. 2017 May 1;75(1):1-8. doi: 10.1097/QAI.0000000000001305.
The impact of HIV infection and antiretroviral therapy (ART) on neurocognitive outcomes among children aged 7-14 years was assessed. We hypothesized that ART would ameliorate neurocognitive sequelae of HIV infection.
HIV-positive and HIV-negative mother-child pairs from the Rakai Community Cohort Study and ART clinics in Rakai, Uganda, were followed prospectively for 4 years. Exposures were stratified as: perinatally HIV infected, perinatally HIV exposed but uninfected, and HIV unexposed and uninfected. The Kaufman Assessment Battery for Children assessed sequential and simultaneous processing, learning, planning, knowledge, and fluid crystalized index for overall functioning. Multivariable generalized linear models estimated adjusted prevalence rate ratios by age.
Of the 370 mother-child pairs, 55% were HIV unexposed and uninfected, 7% were perinatally HIV exposed but uninfected, and 37.9% were perinatally HIV infected. Among HIV-infected children, longer duration of ART was associated with a significant improvement of sequential processing skills (adjusted prevalence rate ratios 25-36 months: 0.55, 95% confidence interval [CI]: 0.34 to 0.9; 37-48 months: 0.39, 95% CI: 0.2 to 0.76; 49+ months: 0.23, 95% CI: 0.1 to 0.54). Each additional year of schooling was associated with a 30%-40% decrease of impairment for all neurocognitive measures assessed. Healthier children (higher age-standardized height and weight) had improved sequential and simultaneous processing and overall fluid crystalized index.
Sequential processing skills of working memory improved with prolonged ART, and increased duration of schooling was associated with a reduction of neurocognitive impairment. Early initiation and sustained use of ARTs and longer schooling are needed to reduce neurocognitive impairment among HIV-infected school-aged children.
评估了艾滋病毒感染和抗逆转录病毒疗法（ART）对7至14岁儿童神经认知结局的影响。我们假设抗逆转录病毒疗法会改善艾滋病毒感染的神经认知后遗症。
对来自乌干达拉凯社区队列研究和拉凯抗逆转录病毒疗法诊所的艾滋病毒阳性和艾滋病毒阴性母婴对进行了为期4年的前瞻性随访。暴露情况分为：围产期感染艾滋病毒、围产期暴露于艾滋病毒但未感染、未暴露于艾滋病毒且未感染。考夫曼儿童评估量表评估了顺序和同时处理、学习、计划、知识以及整体功能的流体结晶指数。多变量广义线性模型按年龄估计调整后的患病率比。
在370对母婴对中，55%未暴露于艾滋病毒且未感染，7%围产期暴露于艾滋病毒但未感染，37.9%围产期感染艾滋病毒。在感染艾滋病毒的儿童中，抗逆转录病毒疗法使用时间越长，顺序处理技能显著改善（调整后的患病率比25 - 36个月：0.55，95%置信区间[CI]：0.34至0.9；37 - 48个月：0.39，95% CI：0.2至0.76；49个月以上：0.23，95% CI：0.1至0.54）。每多上一年学，所有评估的神经认知指标的损伤就会减少30% - 40%。健康状况较好的儿童（年龄标准化身高和体重较高）顺序和同时处理能力以及整体流体结晶指数有所改善。
随着抗逆转录病毒疗法疗程延长，工作记忆的顺序处理技能得到改善，上学时间增加与神经认知损伤减少有关。需要尽早开始并持续使用抗逆转录病毒疗法以及延长上学时间，以减少感染艾滋病毒的学龄儿童的神经认知损伤。
