PEDIATRICS Vol. 117 No. 3 March 2006, pp. 729-740 (doi:10.1542/peds.2004-2699)
Health, Neurologic, and Cognitive Status of HIV-Infected, Long-Surviving, and Antiretroviral-Naive Ugandan Children
a Makerere University Medical School, Kampala, Uganda
c Behavioral and Developmental Pediatrics, Case Western Reserve University, Cleveland, Ohio
b International Health/Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
d Department of Psychology, Indiana Wesleyan University, Marion, Indianapolis
OBJECTIVE. The purpose of this study was to assess the health status and school-age neurodevelopmental progress of antiretroviral treatment (ARVT)–naive, HIV-infected Ugandan children who had been followed as part of cohorts of children born to HIV-infected and -noninfected mothers between 1989 and 1993.
METHODS. Twenty-eight children, aged 6 to 12 years, vertically infected with HIV-1 and never treated with ARVT were evaluated in terms of health status, neurologic, and psychometric testing. A randomly selected group of 42 seroreverters and 37 HIV-1 negative children who were age- and gender-matched and who had been followed in the same cohorts were evaluated also. The families studied were homogenous in their socioeconomic status. None of the mothers or children had received ARVT or been exposed to illicit drugs.
RESULTS. The HIV-infected children showed significantly more evidence of acute malnutrition. They also had more illness, especially parotitis, otitis media, upper respiratory infections, and lymphadenopathy. However, they did not differ significantly in neurologic and cognitive assessments when compared with age- and gender-matched seroreverter and HIV-negative children. They were in the normal range with respect to neurologic and psychometric development measures.
CONCLUSIONS.These children seem to represent a significant subgroup of HIV-infected child survivors for whom the progress of the disease is less aggressive throughout early life. Given the fact that many infants, especially in developing countries, continue to be born without the benefit of perinatal ARVT, there will likely continue to be many older HIV-infected children in the same situation as those described in this follow-up study. They will not have been recognized as being HIV-infected. It is important that such children be identified and offered access to ARVT and other appropriate support services.
Key Words: HIV • pediatrics • AIDS • cognitive ability • intelligence • motor development • social development • neuropsychology • children • Africa • Kaufman Assessment Battery for Children • K-ABC
Abbreviations: CDC—Centers for Disease Control and Prevention • ARVT—antiretroviral treatment • SES—socioeconomic status • K-ABC—Kaufman Assessment Battery for Children • WRAT-3—Wide Range Achievement–Third Edition • ANOVA—analysis of variance • WAZ—weight-for-age z score(s) • HAZ—height-for-age z score(s) • FTT—failure to thrive • PE—progressive encephalopathy
Accepted Jul 13, 2005.
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