A new study on how the HIV infection affects the development of intellect and other areas of brain development in children shows that early treatment doesn’t completely avert these negative outcomes. The paper, published in the journal Clinical Infectious Diseases shows that HIV in children can lead to impaired learning, reasoning and brain functioning.
The study, carried out over a two-year period, looked at 3 groups of children from ages 5-11. The first group had been infected during birth and had been put on antiretroviral treatment (ART). The second group had been exposed to the infection but were still testing negative for the virus. The third group consisted of children who had not been exposed. All the children were at one of six locations chosen for the study in four sub-Saharan countries in Africa.
The study was motivated by the need to understand how the HIV infection is causing the health of children in this region and is the first to undertake testing of the brain function and psychological status of this set of participants across multiple sites and using validated technology. Prior studies have shown that children with HIV performed less well across a wide field of cognitive development tests, compared to those free of the infection. This gap persisted over the years. Earlier researchers have called this a chronic static encephalopathy occurring in early childhood in HIV-infected children.
Studies have also shown that perinatal infection may have more severe impact on the central nervous system because of the increased susceptibility of the rapidly developing brain to virus-induced damage.
The results showed that despite initiating treatment for HIV infection in early life and despite the good quality of treatment, children with HIV are still left with significant issues relating to the brain’s normal development. At entry level, children in the first group showed an impairment in neuropsychological development, and this remained constant over the 2-year study period, except in the area of reasoning and planning, where there was no noticeable improvement with time.
This means that after two years, there was a wider gap between children with and without HIV in this test domain – which is otherwise the area in which children show marked growth during school years. This is also the one area of psychological development that has the most impact on their future health and development.
Researcher Michael Boivin explains: “This is the most important cognitive function for the future of children living with HIV in 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.”
MSU psychiatrist Michael Boivin has spent more than two decades working in Africa to help children affected by HIV, severe malaria and other diseases. Photo by G.L. Kohuth.
If children with HIV do not show adequate learning progress in the area of reasoning and planning, they will probably not be able to understand the importance of complying with their treatment, nor can they take wise health-related decisions or those related to their future.
In view of this study, the scientists say that ART started at 6 months is probably not the best way to prevent defects of neurological development or cognition in children with HIV. It does achieve significant gains in health and long-term survival, but to protect and improve brain function, other interventions will be needed, such as behavioral therapy.
The researchers are already working in this area, having received over $3 million to continue research on HIV-affected children. Their focus will be on exploring the role of specially designed computer games that encourage cognitive functions, and also help to understand the level of cognitive functioning through play. In addition, these could be used to rehabilitate the affected children.
Once that study is complete, its findings, added to those of the current study, will hopefully become the basis of adopting such cognitive games as part of clinical care for HIV-affected children.
Boivin points out the gravity of failing to deal with this area of impairment, which he sees as being the most fundamentally related to the human burden posed by HIV on the community: “Often it's overlooked, 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.”
Michael J Boivin, Miriam Chernoff, Lee Fairlie, Barbara Laughton, Bonnie Zimmer, Celeste Joyce, Linda Barlow-Mosha, Mutsawashe Bwakura-Dangarembizi, Tichaona Vhembo, Mmule Ratswana, Portia Kamthunzi, Katie McCarthy, Itziar Familiar-Lopez, Patrick Jean-Philippe, Joan Coetzee, Nasreen Abrahams, Hermien Gous, Avy Violari, Mark F Cotton, Paul E Palumbo, African Multi-Site 2-Year Neuropsychological Study of School-Age Children Perinatally Infected, Exposed, and Unexposed to Human Immunodeficiency Virus, Clinical Infectious Diseases, , ciz1088, https://doi.org/10.1093/cid/ciz1088, https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciz1088/5649306?redirectedFrom=fulltext