Published online March 1, 2006
PEDIATRICS Vol. 117 No. 3 March 2006, pp. 763-770 (doi:10.1542/10.1542/peds.2005-0451)

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A Behavioral and Cognitive Profile of Clinically Stable HIV-Infected Children

Molly L. Nozyce, PhD^a, Sophia S. Lee, MS^b, Andrew Wiznia, MD^c, Sharon Nachman, MD^d, Lynne M. Mofenson, MD^e, Mary E. Smith, MD^f, Ram Yogev, MD^g, Kenneth McIntosh, MD^h, Kenneth Stanley, PhDⁱ and Stephen Pelton, MD^j

^a Department of Pediatrics, Bronx Lebanon Hospital Center, Bronx, New York
^b Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
^c Department of Pediatrics, Jacobi Medical Center and Albert Einstein College of Medicine, Bronx, New York
^d Department of Pediatrics, State University of New York Health Science Center, Stony Brook, New York
^e Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland
^f Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
^g Division of Infectious Diseases, Children's Memorial Hospital and Northwestern University School of Medicine, Chicago, Illinois
^h Division of Infectious Diseases, Children's Hospital and Harvard Medical School, Boston, Massachusetts
ⁱ Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
^j Department of Pediatrics, Boston Medical Center, Boston, Massachusetts

OBJECTIVE. The purpose of this research was to characterize behavioral and cognitive profiles of clinically and immunologically stable antiretroviral-experienced HIV-infected children.

METHODS. Two hundred seventy-four previously treated HIV-infected children aged 2 to 17 years were assessed for behavioral, developmental, and cognitive functioning. Correlations between neuropsychological measures, age, and CD4 lymphocyte count were investigated.

RESULTS. The most common behavioral problems, as measured by the Conners' Parent Rating Scale, were psychosomatic (28%), learning (25%), hyperactivity (20%), impulsive-hyperactive (19%), conduct (16%), and anxiety (8%) problems. Mean Wechsler Intelligence Scale for Children-III scores were less than established population norms; the mean verbal IQ was 85, the mean performance IQ was 90, and the mean full-scale score was 86. Hyperactivity was more frequent in children with a Wechsler Intelligence Scale for Children-III performance IQ of <90. Anxiety problems were more likely in children 9 years of age. Children with CD4 counts of <660 cells per mm³ were more likely to be identified as having a conduct disorder. No association was noted between behavioral problems and neuroimaging.

CONCLUSIONS. Clinically and immunologically stable HIV-infected children had more frequent behavioral problems and lower developmental and cognitive scores than established childhood norms.

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Key Words: HIV • child • cognition • behavioral symptoms • attention-deficit disorder with hyperactivity • neuropsychological tests • antiretroviral agents

Abbreviations: ADHD—attention-deficit/hyperactivity disorder • CPRS—Conners' Parent Rating Scales • CT—computed tomography • PACTG—Pediatric AIDS Clinical Trials Group • WISC-III—Wechsler Intelligence Scale for Children-3rd edition • WPPSI-R—Wechsler Preschool and Primary Scales of Intelligence-Revised

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Accepted Jul 19, 2005.

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