HIV-Related Cognitive Impairment of Orphans in Myanmar with Vertically Transmitted HIV Taking Antiretroviral Therapy

We determined the effect of perinatally acquired HIV on neurocognition in Myanmar children treated with antiretroviral therapy by comparison to demographically matched seronegative children.

Myanmar has one of the highest HIV-1 prevalence rates in Southeast Asia. Studies from other resource-poor countries have shown that HIV-infected children differ in socioeconomic, nutritional and caregiver status compared to normal controls. Some vertically infected orphans in Myanmar reside separately from HIV-uninfected children in separate orphanages, thus the demographic variables of interest are naturally controlled. This study provides a unique evaluation of the neurocognitive effects of HIV in children, with control over key demographic variables. We hypothesized that HIV-infected orphans would perform significantly worse on cognitive indices compared with HIV-negative orphans.

A battery of cognitive tests sensitive to HIV-associated impairments in children was administered to 28 perinatally acquired HIV-positive children and 31 HIV-negative children from two orphanages in Myanmar; 21 children from each cohort underwent testing at baseline and again after 12 months.

Baseline comparison of the two groups indicated that the HIV-infected children performed poorly across all tests, with significant group differences in executive function, visuospatial reasoning, fine motor dexterity, and visual motor integration. On subsequent testing, both cohorts of children showed improvements across multiple domains, with no significant effect of age at treatment initiation.

Our results demonstrate a strong effect of HIV infection on specific neurocognitive deficits in vertically infected children. Understanding viral and host determinants and timing and choice of antiretroviral therapy on cognition will be critical to preventing cognitive impairment of children with HIV.

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By: Linn K1, Fay A2, Meddles K3, Isbell S4, Lin PN1, Thair C1, Heaps J5, Paul R6, Mar SS3.

• 1Pediatric Neurology Unit, Yangon Children's Hospital, Yangon, Myanmar.
• 2Department of Pediatric Neurology, Washington University, St. Louis, Missouri
• 3Department of Pediatric Neurology, Washington University, St. Louis, Missouri.
• 4Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri.
• 5Department of Psychology and Behavioral Neuroscience, University of Missouri, St. Louis, Missouri.
• 6Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri.