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South African Journal of Child Health

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Neurological and neurocognitive function of HIV-infected children commenced on antiretroviral therapy

L Smith, C Adnams, B Eley

Abstract


Aim: To describe neurological and neurocognitive deficits in  HIV-infected children and the short-term effect of highly active
antiretroviral therapy (HAART) on the observed deficits
Methods: In this prospective study, 39 children (15 females) were evaluated before the start of HAART and 30 reassessed 6
months later. The subjects were evaluated with a range of cognitive tests used in everyday clinical practice.
Results: At enrolment, the mean (±SD) age was 60±46 months, 17 (44%) and 22 (56%) had Centers for Disease Control (CDC)
clinical category B and C disease respectively, and 36 (92%) had severe immunosuppression. At the start of HAART no child
had cranial nerve or cerebellar dysfunction, but 13/29 (33.3%) had evidence of motor dysfunction. By 6 months 1 child had
developed cerebellar dysfunction, but there was no statistically significant change in the frequency of motor dysfunction.
Mean baseline performances on cognitive testing were generally subnormal. Between 33% and 81% of the children recorded
subnormal intelligence quotients on various cognitive tests. Mean performances did not change significantly after 6 months
of HAART.
Conclusion: Neurological and neurocognitive deficits are frequent in HIV-infected children. The prevalence and extent of
deficits did not change significantly in response to short-term HAART, indicating neither spontaneous improvement nor
deterioration during early treatment.



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