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Neurocognitive Functioning in Pediatric HIV Infection: Effects of
Combination Therapy
The objectives of the current study were to assess the impact of
combination antiretroviral therapy on neurocognitive outcomes in
perinatally HIV-infected patients and to determine if CD4 percentage
and plasma HIV-1 RNA level (viral load) are predictive of future
neurocognitive
function.
This
retrospective cohort study was conducted in an HIV-dedicated urban
care center. The participants were one hundred forty-six perinatally HIV-infected children
born between June 1990 and May 2003 with at least 1 neurocognitive
evaluation.
The
main outcome measures were neurocognitive standard testing scores
as well as diagnosis of progressive encephalopathy,
probable progressive encephalopathy, or static encephalopathy.
Results
The prevalence
of progressive encephalopathy has decreased in children born prior
to 1996 (period 1) compared with those born after 1996 (period 2)
from 29.6% to 12.1% (P = .049).
The
prevalence of all progressive encephalopathy and static encephalopathy
decreased from 40.7% to 18.2% in period 1 vs 2 (P = .02).
For
those diagnosed as neurocognitively healthy, neurocognitive scores
remained stable over time with a mean (SD) standard score of 89.6
(11.8) at first evaluation compared with 91.9 (11.93) at most recent
evaluation.
The
most recent mean (SD) standard score increased from 82.3 (18) to
87.2 (10.49) in period 1 vs period 2 (P = .001).
A
weak association was found between both the mean viral load (P =
.06) and CD4 percentage (P<.001) and neurocognitive testing score
6 months later.
Based
on these results, the authors conclude, “Since 1996, fewer children
have been diagnosed with progressive encephalopathy, and neurocognitive
functioning is preserved over time in those deemed neurocognitively
healthy at entry.”
“Viral
load and CD4 percentage are
marginally predictive of future changes in neurocognitive standard
scores.”
“These
data support the observation that combination antiretroviral therapy
is associated with improved neurocognitive outcomes in children
with perinatally acquired HIV infection.”
Divisions of General Pediatrics, Infectious
Diseases, and Child Development and Rehabilitation, Department of
Biostatistics, Children's Hospital of Philadelphia, Philadelphia,
Pa; Division of General Pediatrics, Mount Sinai Hospital, New York
City, NY.
07/11/05
Reference
M C Shanbhag and others. Neurocognitive Functioning in Pediatric
Human Immunodeficiency Virus Infection: Effects of Combined Therapy.
Archives of Pediatrics and Adolescent
Medicine 159(7): 651-656. July 2005.
Articles on HIV-infected Children
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