CEPED, Institut de Recherche pour le Développement, Paris Descartes University, INSERM 1244,Paris.
EHESP, Inserm, CRESS, Obstetrical, Perinatal, and Pediatric Epidemiology Team, UMR1153, Rennes.
AIDS. 2018 Nov 28;32(18):2749-2757. doi: 10.1097/QAD.0000000000002023.
HIV infection is associated with cognitive impairments, but outcomes are poorly explored in children starting antiretroviral therapy (ART) early or in those exposed but uninfected.
Nested cross-sectional evaluation of the neurocognitive and behavioural outcomes of HIV-infected, HIV-exposed uninfected (HEU) and HIV-unexposed (HUU) Cameroonian children at age 4-9 years prospectively followed.
Cognitive development was assessed in 127 HIV-infected, 101 HEU, 110 HUU children using the KABC-II, neurologic dysfunction using the Touwen examination and behavioural difficulties using the Strength and Difficulties Questionnaire (SDQ). Analyses were adjusted for children age, sex and primary language. Contextual factors were included in a second step to assess their effects on outcomes.
All HIV-infected children were treated before 12 months. There was a negative linear gradient in KABC-II scores from HUU children to HEU and HIV-infected children [gradient: -6.0 (-7.7; -4.3) for nonverbal index, NVI, and -8.8 (-10.7; -6.8) for mental processing index, MPI]. After adjusting for contextual factors, scores of HEU children were not significantly different from those of HUU children (all P > 0.1) and differences between HIV-uninfected and HUU children reduced [NVI: from -11.9 (-15.3; -8.5) to -3.4 (-6.8; -0.01), MPI: from -17.6 (-21.3; -13.8) to -5.5 (-9.3; -1.7)]. Compared with uninfected children, HIV-infected children had more neurological dysfunctions and higher SDQ scores (P = 0.002).
Despite early ART, perinatal-HIV infection is associated with poorer neurocognitive scores and increased behavioural difficulties during childhood. Contextual factors play an important role in this association, which emphasizes the need for early nutritional and developmental interventions targeting both HIV-affected infants and their relatives.
艾滋病毒感染与认知障碍有关，但对于早期开始抗逆转录病毒治疗（ART）的儿童或暴露于艾滋病毒但未感染的儿童，其治疗结果仍未得到充分探索。
前瞻性随访了 4-9 岁的感染艾滋病毒、艾滋病毒暴露未感染（HEU）和未暴露于艾滋病毒（HUU）的喀麦隆儿童，对其进行了神经认知和行为结果的嵌套横断面评估。
使用 KABC-II 评估了 127 名感染艾滋病毒的儿童、101 名 HEU 儿童和 110 名 HUU 儿童的认知发育情况，使用 Touwen 检查评估了神经功能障碍，使用 SDQ 评估了行为困难。分析调整了儿童年龄、性别和主要语言。在第二步中纳入了背景因素，以评估它们对结果的影响。
所有感染艾滋病毒的儿童在 12 个月前都接受了治疗。KABC-II 评分从 HUU 儿童到 HEU 儿童和感染艾滋病毒的儿童呈负线性梯度[非言语指数（NVI）的梯度：-6.0（-7.7；-4.3），心理处理指数（MPI）：-8.8（-10.7；-6.8）]。在校正背景因素后，HEU 儿童的评分与 HUU 儿童的评分无显著差异（均 P>0.1），并且 HIV 未感染儿童与 HUU 儿童的差异减少[NVI：从-11.9（-15.3；-8.5）到-3.4（-6.8；-0.01），MPI：从-17.6（-21.3；-13.8）到-5.5（-9.3；-1.7）]。与未感染的儿童相比，感染艾滋病毒的儿童有更多的神经功能障碍和更高的 SDQ 评分（P=0.002）。
尽管进行了早期 ART，但围产期感染艾滋病毒与儿童期较差的神经认知评分和增加的行为困难有关。背景因素在这种关联中起着重要作用，这强调了需要针对受艾滋病毒影响的婴儿及其亲属进行早期营养和发育干预。
