HIV Treatment May Help Reduce Severity of Mental Impairment in Children with HIV Infection
• Science Update
During the first few years of life, children born with HIV infection are most susceptible to central nervous system (CNS) disease, and can develop impaired cognitive, language, motor and behavioral functioning. However, NIH-funded researchers have found that among children with HIV infection, treatment with a protease inhibitor (PI)- based highly active antiretroviral therapy (HAART) helped protect against cognitive and motor difficulties compared to a control group of age-matched children who were born to HIV-infected mothers but who did not contract the virus themselves (e.g., HIV-exposed).
The findings are part of the large-scale, longitudinal study conducted within the Pediatric AIDS Clinical Trials Group (PACTG) Network and are published in the March 2007 issue of Pediatrics. This particular protocol within PACTG is designed to follow HIV-exposed and infected infants, children and adolescents from birth to age 24 and tracks long-term benefits or any harmful effects of medications or vaccines developed to prevent or treat HIV. Jane C. Lindsey, ScD, of Harvard School of Public Health and colleagues examined the effects of HIV infection and the impact of PI-based HAART on the neurodevelopment of infants and children during the first three years of life. They compared infants and children infected with HIV who were born after June 1997—when PI-based HAART became available for use in children—with a control group of children who were exposed but did not contract the virus from their infected mothers.
Before one year of age, children with HIV infection had lower mental and motor skills than their HIV-exposed but uninfected counterparts. However, using standardized tests, the researchers found that the mental and motor skills of uninfected children appeared to decline with age—likely resulting from the complex interplay between genetic and environmental factors. In contrast, test scores of the children with HIV infection for mental skills declined less than expected, and their scores for motor skills actually improved slightly. HIV-infected children who were born prior to 1997 and therefore did not receive PI-based HAART continued to decline in mental and motor skills.
The results offer encouragement for treating infants and young children with HIV infection, who are at the highest risk for neurodevelopmental difficulties. However, more research is needed to better understand how PI-based HAART intersects with genetic, health, and environmental factors to affect neurodevelopment in these children.
The study was co-sponsored by the National Institute of Mental Health, the National Institute of Allergy and Infectious Diseases, and the National Institute of Child Health and Human Development.
Lindsey JC, Malee KM, Brouwers P, Hughes MD, 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. 2007 Mar; 119(3): E681-E693.