Neurological Disabilities More Likely in Children With HIV

While the prevalence of neurological disabilities among children with HIV has drastically decreased since the emergence of antiretroviral therapy (ART), the prevalence remains higher in this patient population. Recent study results have found that these developmental issues, such as impaired brain growth, are more likely to occur in children with HIV than those without the virus.

South African children with HIV aged 4 to 6 were 4 times more likely to have delays in sitting, standing, walking, and speaking. They were also more than twice as likely to have a hearing disability or cognitive delay.

The children were recruited through an initial door-to-door survey that identified households in South Africa with children between age 4 and 6. Doctors used the Ten Questions (TQ) screen, which measures a child’s functions relative to peers. They also collected a standardized medical history and conducted physical examinations with hearing and vision screening, a psychological assessment for cognition and language delay, and voluntary HIV testing.

The doctors were able to complete assessment of 1330 children, of which 61 were HIV positive. The authors noted that only 20 of these children had known about their HIV diagnosis previously, and 18 were receiving ART.

Analyzing the assessments, the doctors observed that the children with HIV were more likely to screen positive for at least 1 TQ item than children without HIV (59.3% vs 42.7%). However, 40.7% of the children with HIV did not screen positive on a single TQ item that was indicative of a disability. Of the children with HIV who did screen positive, 25.4% screened positive for 1 item, 17% screened positive on 2 items, and 17% screened positive on 3 or more items.

Comparatively, among the children without the virus, 57.2% did not screen positive on a single TQ item, 26.7% screened positive on 1 item, 8.1% screened positive on 2 items, and 7.9% screened positive on 3 or more items.

In addition to the reported delays in sitting, standing, walking, and speaking, children with HIV were also nearly 3 times more likely to have difficulty walking or have weakness in the arms or legs.

“This study demonstrates that many HIV positive children have unrecognized neurodevelopmental disabilities and need a wide range of interventions and support to survive and develop,” the researchers wrote. “Increased attention to early HIV diagnosis and intervention is necessary to prevent these neurocognitive issues, as far as possible.”

They conclude by recommending researchers, public health professionals, and policy makers consider the implementation of the TQ screen, as it has the potential to significantly decrease the amount of children requiring more intensive neurodevelopmental assessment and maximize the use of limited resources in setting with few skilled healthcare professionals.

Reference

Knox J, Arpadi S, Kauchali S, et al. Screening for developmental disabilities in HIV positive and HIV negative children in South Africa: results from the Asenze Study [published online July 3, 2018]. PLOS One. doi: https://doi.org/10.1371/journal.pone.0199860.