Horton Rebecca H, Mcintosh Amy, Ostinelli Edoardo G, Harriss Elinor, Fazel Mina
Department of Paediatrics, University of Oxford, Oxford, United Kingdom.
Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
J Acquir Immune Defic Syndr. 2025 Apr 15;98(5):411-428. doi: 10.1097/QAI.0000000000003595.
The objective of this study is to define the neuropsychiatric challenges including developmental delay, cognitive impairment, and psychiatric illness faced by children with perinatally acquired HIV.
Nine databases were searched on May 30, 2023: MEDLINE, Embase, and PsycINFO (all through Ovid SP); CINAHL and Child Development and Adolescent Studies (through EBSCO); the Web of Science Core Collection; Scopus; ProQuest Dissertations and Theses Global; and WHO Global Index Medicus. No limits were applied. Search strategies incorporated keywords and thesaurus headings to describe children and adolescents aged 0-25 years with perinatally acquired HIV and terms to describe the spectrum of neuropsychiatric impairment.
Entries were reviewed by 2 independent reviewers. Studies were included if they involved a population of children with perinatally acquired HIV and investigated a neurologic or psychiatric outcome.
Hypothesis that children with pHIV would have more neuropsychiatric challenges than children without pHIV was formulated before the study. Main outcome measures include incidence and severity of cognitive impairment, developmental delay, and psychiatric illness in children with pHIV.
Forty-five studies on cognitive impairment were included of which 8 studies were included for meta-analysis and demonstrated a standardized mean difference of -0.508 where children without HIV had higher cognitive scores (95% CI: -0.7903 to -0.2272). In total, 15 studies on developmental delay were included, of which 9 were included for meta-analysis and demonstrated, for motor delay, a standardized mean difference (SMD) of -0.794 where children without HIV achieved higher motor function scores (95% CI: -0.9986 to -0.590) and for cognitive delay an SMD of -0.697 where children without HIV achieved higher cognitive function scores (95% CI: -0.976 to -0.417). In total, 39 studies on psychiatric illness were included with an odds ratio for anxiety and depression of 1.105, suggesting that children with HIV had slightly higher odds of developing anxiety or depression, however, this result was not significant (95% CI: 0.778 to 1.571).
Children with perinatally acquired HIV may have a greater cognitive impairment, motor and cognitive delay, and would likely benefit from tailored approaches to improve their outcomes.
本研究的目的是明确围生期感染人类免疫缺陷病毒（HIV）的儿童所面临的神经精神方面的挑战，包括发育迟缓、认知障碍和精神疾病。
于2023年5月30日检索了9个数据库：医学期刊数据库（MEDLINE）、荷兰医学文摘数据库（Embase）和心理学文摘数据库（PsycINFO）（均通过Ovid SP平台）；护理学与健康领域数据库（CINAHL）以及儿童发展与青少年研究数据库（通过EBSCO平台）；科学引文索引核心合集；Scopus数据库；ProQuest学位论文与全球博硕士论文数据库；以及世界卫生组织全球医学索引。未设任何限制条件。检索策略纳入了关键词和叙词表标题，以描述围生期感染HIV的0至25岁儿童，并纳入了描述神经精神障碍范围的术语。
由2名独立评审员对条目进行审查。纳入的研究需涉及围生期感染HIV的儿童群体，并调查神经或精神方面的结局。
在研究开展之前，就提出了关于感染围生期HIV儿童比未感染HIV儿童面临更多神经精神方面挑战的假设。主要结局指标包括感染围生期HIV儿童认知障碍、发育迟缓及精神疾病的发生率和严重程度。
纳入了45项关于认知障碍的研究，其中8项研究纳入了荟萃分析，结果显示标准化均数差为 -0.508，即未感染HIV的儿童认知得分更高（95%置信区间：-0.7903至-0.2272）。总共纳入了15项关于发育迟缓的研究，其中9项纳入了荟萃分析，结果显示，在运动发育迟缓方面，标准化均数差（SMD）为 -0.794，即未感染HIV的儿童运动功能得分更高（95%置信区间：-0.9986至-0.590）；在认知发育迟缓方面，标准化均数差为 -0.697，即未感染HIV的儿童认知功能得分更高（95%置信区间：-0.976至-0.417）。总共纳入了39项关于精神疾病的研究，焦虑和抑郁的优势比为1.105，这表明感染HIV的儿童患焦虑或抑郁的几率略高，然而，这一结果并不显著（95%置信区间：0.778至1.571）。
围生期感染HIV的儿童可能存在更严重的认知障碍、运动和认知发育迟缓，可能会从针对性的干预措施中受益，以改善其结局。
