Neuropsychological consequences of HIV in children: A review of current literature

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Abstract

Pediatric HIV has reached epidemic proportions. In 1997, 1.1 million children younger than 15 were living with HIV or AIDS. The virus affects children cognitively and developmentally due to the immaturity of their nervous systems and immune systems. Studies in the area of neuropsychological deficits are as yet limited in number and less well developed than studies on adult HIV. However, despite methodological weaknesses, the literature has proven conclusively that pediatric HIV affects children cognitively, developmentally, emotionally, psychologically, behaviorally, and educationally. Although treatments are allowing these children to live longer, the effects of the virus remain, requiring special care. This review examines the mechanisms behind HIV in children, the neuropsychological findings to date, and the limitations of this work. Possible useful future approaches in understanding the neuropsychological course of the disorder, as well as directions for treatment and prevention are addressed.

Introduction

Since the beginning of the HIV/AIDS epidemic in the late 1970s, approximately 11.7 million deaths worldwide have occurred due to illnesses associated with the virus. Of these deaths, 2.7 million were children. In 1997, HIV/AIDS associated illnesses were responsible for the deaths of 2.3 million people worldwide, 460,000 of them children. By the end of that year, it was estimated that 30.6 million people worldwide were living with HIV/AIDS, 1.1 million of them children under 15. Developing countries are responsible for 90% of new infections, which are estimated to be 5.8 million or 16,000 per day during 1997. HIV/AIDS infection rates are still growing; by the year 2000, it is estimated that 40 million people worldwide will be HIV-infected (NIAID Fact Sheet, 1998).

From 1985 to 1997, AIDS cases in US women increased from 7% to 22%; most acquired the virus from sexual contact with a man with or at risk from HIV infection or through IV drug use. Women and children are the fastest-growing populations to be infected by HIV, and children are often the hardest hit due to the fact that HIV usually affects infants and children faster and more devastatingly than adults. Children under 15 are infected by HIV primarily through mother-to-child infection (vertical transmission); in utero, intrapartum, or through breast-feeding. Other modes of transmission include blood transfusions or exposure to contaminated blood products; after universal screening of donated blood was initiated in 1985, however, this mode of transmission has been almost eradicated. The introduction of antiretroviral therapies (ARVTs) and alternatives to breast-feeding to HIV-infected or at risk pregnant women and neonates has appeared to lower the vertical transmission rate in countries where this therapy is widely available. In developing countries where breast-feeding is almost universal and HIV testing and prophylactic treatment with ARVT is not standard procedure for pregnant women, the rates have increased (Nielsen, 1998).

Fully 87% of the world's population of HIV-infected children under 15 is estimated to be in sub-Saharan Africa. Since 80% of HIV-infected women live in Africa, it is logical that most of the population of vertically infected children are also found there. According to the Report on the Global HIV/AIDS Epidemic (1998), the gap between rich and poor countries in rates of vertical transmission is widening; for example, in the US and France, rate of vertical transmission of HIV from infected women is less than 5%; in developing countries, the rate is between 25% and 35%.

Whether infected infants and children live in developing countries or in the industrialized world, there are many issues of pediatric HIV and AIDS that remain to be studied. Most literature on the subject of HIV and AIDS is research that has been done on adults. Majority of the studies performed on children have been conducted by individuals in the medical community and consist mainly of the immunological, medical, and neurological consequences of the disease, although some do include neuropsychological aspects. The purpose of this paper is to summarize what is known in regard to the neuropsychological consequences of HIV in children.

Section snippets

HIV infection in children

Before antiretroviral treatment (ARVT) became standard procedure as part of the prenatal treatment of HIV-positive women, approximately two of three HIV-exposed infants escaped HIV infection. This rate appears to be consistent in developing countries where ARVT is limited. Perinatal HIV infection rates have declined substantially since 1994 in the developed world, most likely due to various interventions aimed at reducing the risk of transmission (Nielsen, 1998).

Prenatal interventions include

Chronological review of neuropsychological literature

In the mid-1980s, investigation of pediatric HIV infection began to focus on the effect the virus had on the CNS because in addition to various infections and the expected immune deficiency, it had been noted that children suffering from AIDS appeared to have significant neurological involvement (Belman et al., 1985). Studies had documented neurological involvement clinically, neuroradiologically, and electrophysiologically in children infected by the disease. Of the cases examined, the

Discussion

While it is clear from the research to date that cognitive problems exist in many children infected with HIV, the exact nature and the etiological factors related to those deficits remain unclear because of wide variety of methodological and practical problems that influence the interpretation of these results.

Conclusion

Pediatric HIV has reached epidemic proportions. As stated at the beginning of this paper, in 1997, 1.1 million children younger than 15 were living with HIV or AIDS. The virus affects children cognitively and developmentally due to the immaturity of their nervous systems and immune systems. Although treatments are allowing them to live longer, the effects of the virus remain, requiring special care. In addition to focusing on the effects of the virus and its treatment, more effort needs to be

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