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. 2012 Apr;54(7):1001-9.
doi: 10.1093/cid/cir1037. Epub 2012 Feb 4.

Neurocognitive and motor deficits in HIV-infected Ugandan children with high CD4 cell counts

Theodore D Ruel  1 , Michael J Boivin, Hannah E Boal, Paul Bangirana, Edwin Charlebois, Diane V Havlir, Philip J Rosenthal, Grant Dorsey, Jane Achan, Carolyne Akello, Moses R Kamya, Joseph K Wong
Affiliations

Neurocognitive and motor deficits in HIV-infected Ugandan children with high CD4 cell counts

Theodore D Ruel et al. Clin Infect Dis. 2012 Apr.

Abstract

Background: Human immunodeficiency virus (HIV) infection causes neurocognitive or motor function deficits in children with advanced disease, but it is unclear whether children with CD4 cell measures above the World Health Organization (WHO) thresholds for antiretroviral therapy (ART) initiation suffer significant impairment.

Methods: The neurocognitive and motor functions of HIV-infected ART-naive Ugandan children aged 6-12 years with CD4 cell counts of >350 cells/μL and CD4 cell percentage of >15% were compared with those of HIV-uninfected children, using the Test of Variables of Attention (TOVA), the Kaufman Assessment Battery for Children, second edition (KABC-2), and the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2).

Results: Ninety-three HIV-infected children (median CD4 cell count, 655 cells/μL; plasma HIV RNA level, 4.7 log(10) copies/mL) were compared to 106 HIV-uninfected children. HIV-infected children performed worse on TOVA visual reaction times (multivariate analysis of covariance; P = .006); KABC-2 sequential processing (P = .005), simultaneous processing (P = .039), planning/reasoning (P = .023), and global performance (P = .024); and BOT-2 total motor proficiency (P = .003). High plasma HIV RNA level was associated with worse performance in 10 cognitive measures and 3 motor measures. In analysis of only WHO clinical stage 1 or 2 HIV-infected children (n = 68), significant differences between the HIV-infected and HIV-uninfected groups (P < .05) remained for KABC-2 sequential processing, KABC-2 planning/reasoning, and BOT-2 motor proficiency.

Conclusions: Significant motor and cognitive deficits were found in HIV-infected ART-naive Ugandan children with CD4 cell counts of ∼350 cells/μL and percentages of >15%. Study of whether early initiation of ART could prevent or reverse such deficits is needed.

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Figures

Figure 1.
Figure 1.
Mean raw scores of Kaufman Assessment Battery for Children (second edition; KABC-2) (A) and Bruininks-Oseretsky Test of Motor Proficiency (second edition) (B) of human immunodeficiency virus (HIV)–positive (HIV+) and HIV-negative (HIV−) children in Uganda, compared by analysis of covariance with age, sex, total socioeconomic status score, and Caldwell Home Observation for the Measurement of the Environment (HOME) score [16]. Error bars represent standard deviation. KABC-2 rebus and Atlantis scores were divided by 4 to fit in the figure scale. *P < .05; **P < .01; ***P < .001.
See this image and copyright information in PMC

Comment in

  • Yet another reason to treat HIV infection.
    Wagner TA, Frenkel LM. Wagner TA, et al. Clin Infect Dis. 2012 Apr;54(7):1010-2. doi: 10.1093/cid/cir1041. Epub 2012 Feb 4. Clin Infect Dis. 2012. PMID: 22308271 No abstract available.

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