Departments of Psychiatry and Neurology & Ophthalmology, Michigan State University, East Lansing, Michigan, USA.
Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda.
AIDS. 2018 Jan 14;32(2):189-204. doi: 10.1097/QAD.0000000000001683.
Children with HIV infection (HIV+) are at neuropsychological risk, but few studies have evaluated this at multiple sites in low-income and middle-income countries. We compared neuropsychological outcomes at enrollment (>5 years age) among HIV+, HIV perinatally exposed uninfected (HEU), and HIV unexposed uninfected (HUU) children from four sub-Saharan countries.
IMPAACT P1060 compared nevirapine versus lopinavir/ritonavir-based antiretroviral treatment (ART) in HIV-infected children 6-35 months of age. The present study (P1104s) enrolled P1060 children at 5-11 years of age and evaluated their neuropsychological performance over 2 years using the Kaufman Assessment Battery for Children, 2nd edition (KABC-II), Tests of Variables of Attention (TOVA), Bruininks-Oseretsky Test, 2nd edition (BOT-2), and parent-reported Behavior Rating Inventory of Executive Function (BRIEF). Cohorts were compared using generalized estimating equations least-squares means adjusted for site, child age and sex, and personal and social characteristics for child and caregiver.
Six hundred and eleven (246 HIV+, 183 HEU, 182 HUU) of the 615 enrolled at six sites [South Africa (three), Zimbabwe, Malawi, Uganda] were available for analysis. Mean age was 7.2 years, 48% male, 69% in school. Unadjusted and adjusted comparisons were consistent. HIV+ children performed significantly worse than HEU and HUU cohorts on all KABC-II cognitive performance domains and on BOT-2 total motor proficiency (P < 0.001), but not on the BRIEF Global Executive Indices. HUU and HEU cohorts were comparable on cognitive outcomes. HIV+ children initiated on ART before 1 year of age had significantly better BRIEF evaluations (lower scores - fewer behavior problems), compared with those started after (P = 0.03).
Significant cognitive deficits were documented among HIV+ children at school age, even when started on ART at an early age. Earlier HIV treatment, neuropsychological monitoring, and rehabilitative interventions are all needed. Subsequent testing for 2 more years will help further evaluate how HIV infection and exposure affect the developmental trajectory.
感染艾滋病毒（HIV）的儿童存在神经心理风险，但在低收入和中等收入国家，很少有研究在多个地点对此进行评估。我们比较了来自撒哈拉以南四个国家的感染 HIV、围产期感染未感染 HIV（HEU）和未感染 HIV（HUU）的儿童在入学时（>5 岁）的神经心理学结局。
IMPACT P1060 比较了奈韦拉平与洛匹那韦/利托那韦为基础的抗逆转录病毒治疗（ART）在 6-35 个月龄 HIV 感染儿童中的效果。本研究（P1104s）招募了 P1060 儿童在 5-11 岁时，并使用 Kaufman 儿童评估成套测验，第二版（KABC-II）、注意力变量测试（TOVA）、布鲁因克斯-奥塞尔斯基测试，第二版（BOT-2）和家长报告的执行功能行为评定量表（BRIEF）在两年内评估他们的神经心理学表现。使用广义估计方程最小二乘均值，根据地点、儿童年龄和性别以及儿童和照顾者的个人和社会特征，对队列进行了比较。
在六个地点（南非三个、津巴布韦、马拉维、乌干达）入组的 615 名儿童中，有 611 名（246 名 HIV+、183 名 HEU、182 名 HUU）可进行分析。平均年龄为 7.2 岁，48%为男性，69%在上学。未调整和调整后的比较结果一致。与 HEU 和 HUU 队列相比，HIV+儿童在所有 KABC-II 认知表现领域和 BOT-2 总运动技能（P<0.001）上表现明显较差，但 BRIEF 全球执行指数无差异。HEU 和 HUU 队列在认知结果上无差异。在 1 岁前开始接受 ART 的 HIV+儿童的 BRIEF 评估明显更好（评分较低-行为问题较少），与那些在 1 岁后开始接受治疗的儿童相比（P=0.03）。
即使在早期开始 ART，HIV+儿童在学龄时也会出现明显的认知缺陷。需要更早的 HIV 治疗、神经心理学监测和康复干预。随后再进行两年的测试，将有助于进一步评估 HIV 感染和暴露如何影响发育轨迹。
