Published online March 1, 2006
PEDIATRICS Vol. 117 No. 3 March 2006, pp. 851-862 (doi:10.1542/peds.2005-0804)
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Human Immunodeficiency Virus...

Effects of Perinatal HIV Infection and Associated Risk Factors on Cognitive Development Among Young Children

Renee Smith, PhDa, Kathleen Malee, PhDb, Robert Leighty, PhDc, Pim Brouwers, PhDd, Claude Mellins, PhDe, Joan Hittelman, PhDf, Cynthia Chase, PhDg, Ileana Blasini, MDh for the Women and Infants Transmission Study Group

a University of Illinois at Chicago, Chicago, Illinois
b Northwestern University/Children's Memorial Hospital, Chicago, Illinois
c Clinical Trials Surveys Corp, Baltimore, Maryland
d Baylor College of Medicine, Houston, Texas
e Columbia College of Physicians and Surgeons, New York, New York
f State University of New York Health Science Center at Brooklyn, Brooklyn, New York
g Boston Medical Center, Boston, Massachusetts
h University of Puerto Rico, San Juan, Puerto Rico

OBJECTIVE. We examined the effect of HIV, in combination with other important health and social factors, on the development of cognitive abilities of children perinatally exposed to HIV.

METHODS. Serial cognitive assessments were performed for 117 children who were infected vertically and 422 children who were exposed to but not infected with HIV, in a multicenter, natural history, longitudinal study. Repeated-measures analyses were used to evaluate the neurocognitive development of children between the ages of 3 and 7 years, as measured by the McCarthy Scales of Children’s Abilities (MSCA).

RESULTS. Children with HIV infection and class C status scored significantly lower in all domains of cognitive development, across all time points, than did those who were HIV infected without an AIDS-defining illness and those who were HIV exposed but not infected. There were no significant differences between the 2 latter groups in General Cognitive Index or specific domain scores. Rates of change in cognitive development were comparable (parallel) among all 3 groups over a period of 4 years. Factors that were associated consistently and significantly with lower mean scores were HIV status, number of times an examination had been completed previously, primary language, maternal education, and gender. No factors were related to rate of change of any mean domain score.

CONCLUSIONS. An early AIDS-defining illness increased the risk of chronic static encephalopathy during the preschool and early school age years. Children with HIV infection but no class C event performed as well as noninfected children in measures of general cognitive ability. No significantly different profiles of strengths and weaknesses for verbal, perceptual-performance, quantitative, or memory functioning were observed among children with or without HIV infection. A number of factors were found to have significant effects on the mean scores of children in all 3 groups; however, they were not related to the rate at which learning occurred.

Key Words: pediatric HIV • cognition • longitudinal

Abbreviations: WITS—Women and Infants Transmission Study • MSCA—McCarthy Scales of Children's Abilities • GCI—General Cognitive Index • HAART—highly active antiretroviral therapy

Accepted Aug 10, 2005.




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J. C. Lindsey, K. M. Malee, P. Brouwers, M. D. Hughes, and for the PACTG 219C Study Team
Neurodevelopmental Functioning in HIV-Infected Infants and Young Children Before and After the Introduction of Protease Inhibitor-Based Highly Active Antiretroviral Therapy
Pediatrics, March 1, 2007; 119(3): e681 - e693.
[Abstract] [Full Text] [PDF]