Neuropsychological performance in African children with HIV enrolled in a multisite antiretroviral clinical trial.
Neuropsychological performance in African children with HIV enrolled in a multisite antiretroviral clinical trial.
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DOI：
10.1097/qad.0000000000001683
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发表时间：
2018-01-14
期刊：
影响因子：
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通讯作者：
IMPAACT P1104s Study Team
中科院分区：
文献类型：
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作者：
Boivin MJ;Barlow-Mosha L;Chernoff MC;Laughton B;Zimmer B;Joyce C;Bwakura-Dangarembizi M;Ratswana M;Abrahams N;Fairlie L;Gous H;Kamthunzi P;McCarthy K;Familiar-Lopez I;Jean-Phillippe P;Coetzee J;Violari A;Cotton MF;Palumbo PE;IMPAACT P1104s Study Team
感染艾滋病毒（HIV+）的儿童存在神经心理风险，但很少有研究在低收入和中等收入国家（LMICs）的多个地点对此进行评估。我们比较了来自4个撒哈拉以南国家的HIV阳性、HIV未感染围产期暴露（HEU）和HIV未暴露（HU）儿童入组时的神经心理结果（bb - 5岁）。impact P1060比较了奈韦拉平（NVP）与洛匹那韦/利托那韦（LPVr）为基础的抗逆转录病毒治疗在6 - 35月龄hiv感染儿童中的应用。本研究（p1104）招募了P1060名5-11岁的儿童，并使用kbc - ii、TOVA、BOT-2和家长报告的BRIEF评估了他们2年来的神经心理表现。采用经地点、儿童年龄和性别以及儿童和照顾者的个人和社会特征调整后的GEE最小二乘均值对队列进行比较。在6个地点（南非、津巴布韦、马拉维、乌干达）登记的615人中，有611人（246人HIV阳性，183人HEU， 182人HU）可供分析。平均年龄为7.2岁，男性占48%，在校学生占69%。未调整和调整后的比较结果一致。HIV阳性儿童在kbc - ii、TOVA、BOT-2上的表现明显差于HEU和HUU (P< 0.001)，但在BRIEF上无显著差异。HUU组和HEU组在认知结果上具有可比性。1岁前开始接受抗逆转录病毒治疗的HIV阳性儿童仅在BOT-2总运动熟练程度上比1岁后开始治疗的儿童有显著改善。HIV阳性儿童有明显的认知缺陷。需要进行早期艾滋病毒治疗、神经心理监测和康复干预。随后2年的检测将有助于评估艾滋病毒感染和暴露如何影响发育轨迹。
Children with HIV infection (HIV+) are at neuropsychological risk, but few studies have evaluated this at multiple sites in low and middle income countries (LMICs). We compared neuropsychological outcomes at enrollment (> 5 yrs age) among HIV+, HIV-uninfected perinatally-exposed (HEU), and HIV unexposed (HU) children from 4 sub-Saharan countries. IMPAACT P1060 compared Nevirapine (NVP) versus Lopinavir/Ritonavir (LPVr)-based ART in HIV-infected children 6 to 35 months of age. This study (P1104s) enrolled P1060 children at 5–11 years of age and evaluated their neuropsychological performance over 2 years using the KABC-II, TOVA, BOT-2, and parent-reported BRIEF . Cohorts were compared using GEE least-squares means adjusted for site, child age and gender, and personal and social characteristics for child and caregiver. 611 (246 HIV+, 183 HEU, 182 HU) of the 615 enrolled at 6 sites (South Africa, Zimbabwe, Malawi, Uganda) were available for analysis. Mean age was 7.2 years, 48% male, 69% in school. Unadjusted and adjusted comparisons were consistent. HIV+ children performed significantly worse than HEU and HUU on KABC-II, TOVA, BOT-2 (P< 0.001), but not on the BRIEF. HUU and HEU cohorts were comparable on cognitive outcomes. HIV+ children initiated on ARV treatment before one year of age had significantly better only in BOT-2 total motor proficiency compared to those started after. Significant cognitive deficits were documented among HIV+ children. Earlier HIV treatment, neuropsychological monitoring and rehabilitative interventions are needed. Subsequent testing for 2 more years will help evaluate how HIV infection and exposure affect the developmental trajectory.