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Neurocognitive and Motor Deficits in HIV-Infected Ugandan Children With High CD4 Cell Counts

Year: 2012
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Human immunodeficiency virus (HIV) infection causes neurocognitive or motor function deficits in children with advanced disease, but it is unclear whether children with CD4 cell measures above the World Health Organization (WHO) thresholds for antiretroviral therapy (ART) initiation suffer significant impairment. METHODS: The neurocognitive and motor functions of HIV-infected ART-naive Ugandan children aged 6-12 years with CD4 cell counts of >350 cells/μL and CD4 cell percentage of >15% were compared with those of HIV-uninfected children, using the Test of Variables of Attention (TOVA), the Kaufman Assessment Battery for Children, second edition (KABC-2), and the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2). RESULTS: Ninety-three HIV-infected children (median CD4 cell count, 655 cells/μL; plasma HIV RNA level, 4.7 log(10) copies/mL) were compared to 106 HIV-uninfected children. HIV-infected children performed worse on TOVA visual reaction times (multivariate analysis of covariance; P = .006); KABC-2 sequential processing (P = .005), simultaneous processing (P = .039), planning/reasoning (P = .023), and global performance (P = .024); and BOT-2 total motor proficiency (P = .003). High plasma HIV RNA level was associated with worse performance in 10 cognitive measures and 3 motor measures. In analysis of only WHO clinical stage 1 or 2 HIV-infected children (n = 68), significant differences between the HIV-infected and HIV-uninfected groups (P < .05) remained for KABC-2 sequential processing, KABC-2 planning/reasoning, and BOT-2 motor proficiency. CONCLUSIONS: Significant motor and cognitive deficits were found in HIV-infected ART-naive Ugandan children with CD4 cell counts of ∼350 cells/μL and percentages of >15%. Study of whether early initiation of ART could prevent or reverse such deficits is needed.
DOI: 10.1093/cid/cir1037
Authors: T. D. Ruel, M. J. Boivin, H. E. Boal, P. Bangirana, E. Charlebois, D. V. Havlir, P. J. Rosenthal, G. Dorsey, J. Achan, C. Akello, M. R. Kamya, J. K. Wong
Institutions: University of California, San Francisco, UCSF Benioff Children's Hospital, Michigan State University, Seattle Children's Hospital, University of Washington, Makerere University
Language: English
Subfield: Virology
Open Access status: bronze
Funders: National Institutes of Health, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, National Institute of Neurological Disorders and Stroke, National Center for Research Resources, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1328437748, G2176523045, G2222902302, G2548217053, Clinical and Transtional Science Institute, G6213812619, G6631710078, Variation in Neurocognitive Impairment of HIV Ugandan Children by HIV Subtype, G851092770, G8728942511, G8741167305, G97119092
OpenAlex ID: W2107582491
FWCI: 5.53
Cites: 38
Cited by: 154
Related to: 10