Children infected with HIV are significantly more likely to have worse results in neurological assessments, despite having well-controlled HIV disease, according to the findings of a study published in the Journal of Acquired Immune Deficiency Syndromes.
The findings of the study, which was conducted in Zambia, suggest that children infected with HIV could struggle with cognitive and mental health issues.
Additionally, the results show that early intervention, including antiretroviral therapies and better nutrition, could close the gap.
“HIV remains a major global health burden, and children who are exposed to the virus during childbirth are known to be at greater risk for neurocognitive and psychiatric problems, like depression, as they age,” David Bearden, MD, assistant professor of neurology and pediatrics at the University of Rochester Medical Center (URMC), said in a statement. “This research is an attempt to understand if these problems persist and become more pronounced over time and whether we can predict who will do well cognitively and who will not.”
Since 1994, a team of investigators from URMC partnered with the government of Zambia and the University Teaching Hospital (UTH) to examine the neurological problems associated with infectious diseases, including HIV and malaria, which are major public health concerns in sub-Saharan Africa.
The findings are from the HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) study, an ongoing longitudinal study that follows 600 children aged 8 to 15 years for 5 years.
Individuals included in the study completed a series of neurocognitive assessments with the National Institutes of Health (NIH) Toolbox Cognition Battery, an instrument used to measure several cognitive processes, including executive function, memory, processing speed, and reaction time.
Investigators found that children who were HIV-positive who were on combination antiretroviral therapy (cART) did significantly worse on the cognitive measures at baseline and did not improve over 2 years compared with children who were HIV-negative.
Interventions could improve neurological function, according to the study results.
Additionally, children who were malnourished or suffered more severe cases of HIV did worse on the assessments.
“These findings suggest that one of the most important things that we can do is find [children] with HIV early and get them on antiretroviral therapy, because if [they] don't get real sick from HIV, then they do much better cognitively,” Bearden said. “The other key factor here is the nutritional piece, and we’re doing more research to try to figure out exactly what kind of support could help improve cognition or prevent cognitive impairment in this population.”
The Neurology Research Office, established by Gretchen Birbeck, MD, neurologist at URMC, has served as the hub for several NIH-funded research and training programs to help investigators and neurologists at UTH. This has increased opportunities for collaboration with URMC medical students, neurologists, and trainees.
According to the study results, cART is widely accessible. However, many children who are infected still experience neurocognitive and psychiatric issues, such as delayed academic development and depression.