African Multi-Site 2-Year Neuropsychological Study of School-Age Children Perinatally Infected, Exposed, and Unexposed to Human Immunodeficiency Virus
African Multi-Site 2-Year Neuropsychological Study of School-Age Children Perinatally Infected, Exposed, and Unexposed to Human Immunodeficiency Virus
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DOI：
10.1093/cid/ciz1088
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发表时间：
2020-10-01
影响因子：
11.8
通讯作者：
Palumbo, Paul E.
中科院分区：
文献类型：
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作者：
Boivin, Michael J.;Chernoff, Miriam;Palumbo, Paul E.
背景。感染人类免疫缺陷病毒（HIV）的儿童面临认知和运动功能障碍的神经心理学风险。然而，很少有前瞻性、多中心研究纵向评估接受早期抗逆转录病毒治疗 (ART) 的围产期感染非洲儿童的神经心理学结果。方法。我们在 6 个地点（南非 [3]、津巴布韦、马拉维、乌干达）招募了 611 名 5 至 11 岁的儿童。其中，有 246 名 HIV 感染者 (HIV+) 在之前一项比较奈韦拉平与洛匹那韦/利托那韦的临床试验中在 3 岁之前开始接受 ART（国际孕产妇儿科青少年获得性免疫缺陷综合症临床试验 [IMPAACT] P1060）； 183 名年龄匹配、暴露但未感染 (HEU) 的儿童；以及 182 名未暴露和未感染 (HUU) 的儿童。他们在 3 个评估时间点（第 0、48 和 96 周）对认知能力（考夫曼儿童评估电池，第二版 [KABC-II]）、注意力/冲动性（注意力变量测试 [TOVA]）、运动能力（Bruininks-Oseretsky 测试，第二版 [BOT-2]）和执行功能行为评定量表 (BRIEF) 进行比较。使用线性混合模型对队列进行比较，调整地点、儿童的年龄和性别以及选定的个人/家庭控制变量。结果。对于所有 3 个时间点的所有 KABC-II、TOVA 和 BOT-2 表现结果，HIV+ 队列的表现均显着差于 HEU 和 HUU 队列（P 值 < .001）。 HUU 和 HEU 队列具有可比性。对于 KABC-II 计划/推理子测试，随着时间的推移，HIV + 儿童的进步程度低于 HUU 和 HEU 组。各组在简要结论上没有显着差异。尽管在儿童早期就开始了抗逆转录病毒疗法，并且在入组时进行了良好的病毒抑制，但随着时间的推移，艾滋病毒+组的神经心理学表现较差，计划/推理方面的差距逐渐扩大。这可能会削弱青春期的自我管理能力。
Background. Children living with human immunodeficiency virus (HIV) are at neuropsychological risk for cognitive and motor dysfunction. However, few prospective, multi-site studies have evaluated neuropsychological outcomes longitudinally among perinatally infected African children who received early antiretroviral treatment (ART).Methods. We enrolled 611 children aged 5 to 11 years at 6 sites (South Africa [3], Zimbabwe, Malawi, Uganda). Of these, there were 246 children living with HIV (HIV+) who were initiated on ART before 3 years of age in a prior clinical trial comparing nevirapine to lopinavir/ritonavir (International Maternal Pediatric Adolescent Acquired Immunodeficiency Syndrome Clinical Trials [IMPAACT] P1060); 183 age-matched, exposed but uninfected (HEU) children; and 182 unexposed and uninfected (HUU) children. They were compared across 3 assessment time points (Weeks 0, 48, and 96) on cognitive ability (Kaufman Assessment Battery for Children, second edition [KABC-II]), attention/impulsivity (Tests of Variables of Attention [TOVA]), motor proficiency (Bruininks-Oseretsky Test, second edition [BOT-2]), and on the Behavior Rating Inventory of Executive Function (BRIEF). The cohorts were compared using linear mixed models, adjusting for site, child's age and sex, and selected personal/family control variables.Results. The HIV+ cohort performed significantly worse than the HEU and HUU cohorts for all KABC-II, TOVA, and BOT-2 performance outcomes across all 3 time points (P values < .001). The HUU and HEU cohorts were comparable. For the KABC-II planning/reasoning subtests, the HIV+ children showed less improvement over time than the HUU and HEU groups. The groups did not differ significantly on the BRIEF.Conclusions. Despite initiation of ART in early childhood and good viral suppression at the time of enrollment, the HIV+ group had poorer neuropsychological performance over time, with the gap progressively worsening in planning/reasoning. This can be debilitating for self-management in adolescence.