Despite early antiretroviral therapy, or ART, has ensured less deadly outcomes for children
living with and exposed to HIV
, studies show the virus still may affect the brain
may disrupt neurodevelopment, affecting how children learn, reason and function.
Dr Michael Boivin, professor and director of the Psychiatry Research Program in the Michigan State University College of Osteopathic Medicine has set out to understand exactly how HIV
impacts children's neuropsychological development in a two-year longitudinal study, published in Clinical Infectious Diseases
The two year research was supported in part by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.
Dr Boivin and his colleagues evaluated the neuropsychological development of three groups of children
aged 5 to 11: those who acquired HIV
perinatally and were treated with ART, those exposed but HIV
-negative, and those who were never exposed. The research took place at six study sites across four countries in sub-Saharan Africa for a robust view of how HIV
is affecting children
in the region.
The study,to date is the first well-validated, multi-site neuropsychological evaluation of African school-aged children
affected by HIV
The researchers discovered through various assessments was that even in the face of early treatment and good clinical care, there are still significant neuropsychological problems for children
living with HIV
Dr Boivin told Thailand Medical
News, "These children
came into the study with a deficit compared to their counterparts"It stayed about the same throughout the two years, except in one important area: reasoning and planning. On that specific test domain, the children
living with HIV
failed to progress over time."
Basically, the gap between infected and HIV-
grew in the planning and reasoning area over the study period. Typically, these abilities tend to blossom in the school-aged years in healthy children
Dr Boivin added, "This is the most important cognitive function for the future of children
living with HIV i
n terms of their likelihood of taking their medications, making good decisions, abstaining from risky behaviors like early sexual activity, psychosocial issues and school-related achievement."
The key findings: Early medical treatment, started as early as 6 months of age, is probably not enough to address the neurocognitive deficits associated with HIV
, even though it helps keep children
alive and healthier than they would be without treatment. In these children
, treatment should be started even earlier to improve long-term neurocognitive outcomes.
Dr Boivin added, "We're going to have to complement the long-term care and support with actual behavioral interventions." That's something Boivin and his colleagues are already working on. Earlier this year, Boivin received a 5-year, $3.2 million NIH grant to continue his work with children
affected by HIV
in Uganda and Malawi.Through this grant, researchers will investigate how MSU-developed computer cognitive games can serve as tools for neurocognitive evaluation, enrichment and potentially rehabilitation.
Dr Boivin hopes that the results of both of these studies will help make this model of neuropsychological evaluation a considered part of the cost benefit of care for kids affected by HIV
Dr Boivin concluded, "Often it's overlooked or seen as an afterthought, but unlike other areas of medical follow up, neuropsychological evaluation really gets at how well the kids are going to adapt and function in school, at home, in the community and in society in general. It's really what links us most directly to the human burden of disease."
Reference : African Multi-Site 2-Year Neuropsychological Study of School-Age Children Perinatally Infected, Exposed, and Unexposed to Human Immunodeficiency Virus, Michael J Boivin, Miriam Chernoff, Lee Fairlie, Barbara Laughton, Bonnie Zimmer, Celeste Joyce, Linda Barlow-Mosha, Mutsawashe Bwakura-Dangarembizi, Tichaona Vhembo, Mmule Ratswana ... Clinical Infectious Diseases, ciz1088, https://doi.org/10.1093/cid/ciz1088