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Impact of HIV and Atiretroviral Therapy on Neurocognitive Outcomes Among School-Aged Children

Brahmbhatt, Heena PhD*,†; Boivin, Michael PhD; Ssempijja, Victor MHS; Kagaayi, Joseph MD; Kigozi, Godfrey MD; Serwadda, David MD†,§; Violari, Avy MD; Gray, Ronald H. MD*,†

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2017 - Volume 75 - Issue 1 - p 1–8
doi: 10.1097/QAI.0000000000001305

Introduction: The impact of HIV infection and antiretroviral therapy (ART) on neurocognitive outcomes among children aged 7–14 years was assessed. We hypothesized that ART would ameliorate neurocognitive sequelae of HIV infection.

Methods: HIV-positive and HIV-negative mother–child pairs from the Rakai Community Cohort Study and ART clinics in Rakai, Uganda, were followed prospectively for 4 years. Exposures were stratified as: perinatally HIV infected, perinatally HIV exposed but uninfected, and HIV unexposed and uninfected. The Kaufman Assessment Battery for Children assessed sequential and simultaneous processing, learning, planning, knowledge, and fluid crystalized index for overall functioning. Multivariable generalized linear models estimated adjusted prevalence rate ratios by age.

Results: Of the 370 mother–child pairs, 55% were HIV unexposed and uninfected, 7% were perinatally HIV exposed but uninfected, and 37.9% were perinatally HIV infected. Among HIV-infected children, longer duration of ART was associated with a significant improvement of sequential processing skills (adjusted prevalence rate ratios 25–36 months: 0.55, 95% confidence interval [CI]: 0.34 to 0.9; 37–48 months: 0.39, 95% CI: 0.2 to 0.76; 49+ months: 0.23, 95% CI: 0.1 to 0.54). Each additional year of schooling was associated with a 30%–40% decrease of impairment for all neurocognitive measures assessed. Healthier children (higher age-standardized height and weight) had improved sequential and simultaneous processing and overall fluid crystalized index.

Conclusions: Sequential processing skills of working memory improved with prolonged ART, and increased duration of schooling was associated with a reduction of neurocognitive impairment. Early initiation and sustained use of ARTs and longer schooling are needed to reduce neurocognitive impairment among HIV-infected school-aged children.

*Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;

Rakai Health Science Program, Rakai, Uganda;

Michigan State University, Lansing, MI;

§Makerere University, School of Public Health, Kampala, Uganda; and

Perinatal HIV Research Unit, Johannesburg, South Africa.

Correspondence to: Heena Brahmbhatt, PhD, Johns Hopkins Bloomberg School of Public Health, E4010, 615 North Wolfe Street, Baltimore, MD 21205 (e-mail:

Supported by Fogarty International-NICHD (5K01TW007403), Center for Global Health, Johns Hopkins University, WW Smith Charitable Trust Foundation.

H.B., M.B., V.S., J.K., G.K., D.S., A.V., R.H.G. Impact of HIV infection and ART duration on neurodevelopment outcomes among children aged 7–14 years in Rakai, Uganda. Poster Presentation. International AIDS Conference, July, 2016. Durban, South Africa.

The authors have no conflicts of interest to disclose.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

Received September 05, 2016

Accepted December 19, 2016

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