A Study of Neuropsychological Profile of Human Immunodeficiency Virus-Positive Children and Adolescents on Antiretroviral Therapy

By Murthy, Vasantmeghna; Nayak, Ajita et al. | Indian Journal of Psychiatry, January-March 2018 | Go to article overview

A Study of Neuropsychological Profile of Human Immunodeficiency Virus-Positive Children and Adolescents on Antiretroviral Therapy


Murthy, Vasantmeghna, Nayak, Ajita, Joshi, Minal, Ninawe, Kaneenica, Indian Journal of Psychiatry


Byline: Vasantmeghna. Murthy, Ajita. Nayak, Minal. Joshi, Kaneenica. Ninawe

Aims: The aim is to study the neuropsychological and functional profile of children and adolescents with human immunodeficiency virus (HIV) infection on antiretroviral therapy (ART) and the association between the neuropsychological status and medical illness variables, treatment variables, and functional status in the cases of the sample and compare with normal controls. Materials and Methods: Forty-two HIV-positive children and adolescents on ART were evaluated and compared with 40 matched controls not known to be HIV-positive. The tools used were the Wechsler Intelligence Scale for Children-III R for neuropsychological evaluation, the Brief Impairment Scale to assess functional impairment, and a semi-structured questionnaire to obtain other relevant details. Results: There were significant differences between the verbal, performance intelligence quotients (IQs), global IQ score, and several individual subtests between cases and controls. The HIV group was also found to have a significant functional impairment. Conclusion: Our findings show that HIV infection is associated with significant cognitive and functional impairment. The role of ART in these impairments requires further study. Such understanding can help to introduce wholesome and relatively safer management strategies for youngsters with HIV infection and improve their quality of life.

Introduction

According to the UNAIDS global AIDS update 2016, there were 17 million people living with human immunodeficiency virus (HIV) infection on antiretroviral therapy (ART) in the year 2015. The Asia-pacific region saw a rise in ART coverage from 19% (17%-22%) to 41% (35%-47%) in 2015. This heartening trend is believed to be responsible for a 26% decline in global AIDS-related deaths recorded since 2010.[1] In light of India's contribution to the global HIV/AIDS burden, we are one of the fast-track countries on the way to achieve the goal of ending the global AIDS epidemic by 2030 as envisioned by UNAIDS.

The National AIDS Control Organization reported that the total number of people living with HIV in India in 2015 was 21.17 lakhs (17.11-26.49 lakhs).[2] Children (below 15 years of age) accounted for 6.54% of these. Children are a unique subset of this population for diverse reasons. They are almost always infected perinatally when their physiological development itself is incomplete. Hence, the underdeveloped immune system is affected early on. Perinatally transmitted HIV (PHIV) has been found to affect physical health and nutrition directly, interfering with normal growth and development; causing structural and functional brain damage; and disrupting the social environment of affected children.[3],[4],[5],[6],[7],[8]

With increasing availability of ART people with HIV live longer lives than they would have otherwise.[9],[10] However, ART has also been found to be associated with worsened quality of life (QoL).[11] A matter of concern is the impact of prolonged exposure to ART during developmental periods in children. One area of focus is cognitive abilities such as attention, concentration, abstraction, and arithmetic, which are essential for effective communication, self-care, education, training, employment, and leading a fruitful and independent life. Children with PHIV are additionally disadvantaged by susceptibility to early parental losses and significant changes in their primary support groups.

Studies have been conducted across the globe to verify and quantify the occurrence of cognitive and functional impairment among patients with HIV/AIDS using varied tools (e.g., progressive matrices and trail-making tests). The effect of ART on cognitive abilities independent of the disease itself is yet to be determined with certainty. The increasing diagnosis of HIV dementia necessitates a study of the effect of HIV and ART on early cognitive development. …

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