Pierre Debeaudrap1, Florence Bodeau-Livinec2, Estelle Pasquier3, David Germanaud4,5,6, Suzie Tetang Ndiang7, Anne Njom Nlend7, Francis Ateba Ndongo8, Georgette Guemkam8, Callixte Ida Penda9,10, Josiane Warszawski11, Diavolana Koecher12, Albert Faye4,5,13, Mathurin Cyrille Tejiokem14. 1. CEPED, Institut de Recherche pour le Développement, Paris Descartes University, INSERM 1244,Paris. 2. EHESP, Inserm, CRESS, Obstetrical, Perinatal, and Pediatric Epidemiology Team, UMR1153, Rennes. 3. Expertise France, Initiative 5%, Paris. 4. Hôpital Robert-Debré, Assistance Publique - Hôpitaux de Paris. 5. France Université Paris Diderot, Sorbonne Paris Cité, Paris. 6. Inserm U1129, NeuroSpin, CEA-Saclay, Gif-sur-Yvette, France. 7. Pediatric Unit, Centre Hospitalier d'Essos, Yaounde. 8. Pediatric Unit, Mother & Child Center, Chantal Biya Fundation, Yaounde. 9. Day Hospital of Laquintinie Hospital, Douala. 10. Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon. 11. INSERM 1018, Villejuif, France. 12. Service de Pédiatrie, Faculté de Médecine Mahajanga, Madagascar. 13. Inserm U1123, ECEVE, Paris, France. 14. Centre Pasteur du Cameroun, Yaoundé, Cameroon.
Abstract
OBJECTIVE: HIV infection is associated with cognitive impairments, but outcomes are poorly explored in children starting antiretroviral therapy (ART) early or in those exposed but uninfected. DESIGN: Nested cross-sectional evaluation of the neurocognitive and behavioural outcomes of HIV-infected, HIV-exposed uninfected (HEU) and HIV-unexposed (HUU) Cameroonian children at age 4-9 years prospectively followed. METHODS: Cognitive development was assessed in 127 HIV-infected, 101 HEU, 110 HUU children using the KABC-II, neurologic dysfunction using the Touwen examination and behavioural difficulties using the Strength and Difficulties Questionnaire (SDQ). Analyses were adjusted for children age, sex and primary language. Contextual factors were included in a second step to assess their effects on outcomes. RESULTS: All HIV-infected children were treated before 12 months. There was a negative linear gradient in KABC-II scores from HUU children to HEU and HIV-infected children [gradient: -6.0 (-7.7; -4.3) for nonverbal index, NVI, and -8.8 (-10.7; -6.8) for mental processing index, MPI]. After adjusting for contextual factors, scores of HEU children were not significantly different from those of HUU children (all P > 0.1) and differences between HIV-uninfected and HUU children reduced [NVI: from -11.9 (-15.3; -8.5) to -3.4 (-6.8; -0.01), MPI: from -17.6 (-21.3; -13.8) to -5.5 (-9.3; -1.7)]. Compared with uninfected children, HIV-infected children had more neurological dysfunctions and higher SDQ scores (P = 0.002). CONCLUSION: Despite early ART, perinatal-HIV infection is associated with poorer neurocognitive scores and increased behavioural difficulties during childhood. Contextual factors play an important role in this association, which emphasizes the need for early nutritional and developmental interventions targeting both HIV-affected infants and their relatives.
OBJECTIVE:HIV infection is associated with cognitive impairments, but outcomes are poorly explored in children starting antiretroviral therapy (ART) early or in those exposed but uninfected. DESIGN: Nested cross-sectional evaluation of the neurocognitive and behavioural outcomes of HIV-infected, HIV-exposed uninfected (HEU) and HIV-unexposed (HUU) Cameroonian children at age 4-9 years prospectively followed. METHODS: Cognitive development was assessed in 127 HIV-infected, 101 HEU, 110 HUU children using the KABC-II, neurologic dysfunction using the Touwen examination and behavioural difficulties using the Strength and Difficulties Questionnaire (SDQ). Analyses were adjusted for children age, sex and primary language. Contextual factors were included in a second step to assess their effects on outcomes. RESULTS: All HIV-infectedchildren were treated before 12 months. There was a negative linear gradient in KABC-II scores from HUU children to HEU and HIV-infectedchildren [gradient: -6.0 (-7.7; -4.3) for nonverbal index, NVI, and -8.8 (-10.7; -6.8) for mental processing index, MPI]. After adjusting for contextual factors, scores of HEU children were not significantly different from those of HUU children (all P > 0.1) and differences between HIV-uninfected and HUU children reduced [NVI: from -11.9 (-15.3; -8.5) to -3.4 (-6.8; -0.01), MPI: from -17.6 (-21.3; -13.8) to -5.5 (-9.3; -1.7)]. Compared with uninfected children, HIV-infectedchildren had more neurological dysfunctions and higher SDQ scores (P = 0.002). CONCLUSION: Despite early ART, perinatal-HIV infection is associated with poorer neurocognitive scores and increased behavioural difficulties during childhood. Contextual factors play an important role in this association, which emphasizes the need for early nutritional and developmental interventions targeting both HIV-affected infants and their relatives.
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