The burden and predictors of cognitive impairment among 6- to 8-year-old children infected and uninfected with HIV from Harare, Zimbabwe: a cross-sectional study

Abstract

With long-term survival of children infected with HIV, information on cognitive function at school age is needed. To determine cognitive function among 6- to 8 year-old children exposed to HIV and to assess factors associated with cognitive impairment, we conducted a cross-sectional study from October 2010 to December 2011 among children whose mothers participated in a national HIV prevention program in Harare. Cognitive function was assessed using the McCarthy Scales of Children's Abilities (MSCA). Of the 306 assessed children, 32 (10%) were HIV infected, 121 (40%) exposed uninfected, and 153 (50%) unexposed uninfected. The mean (SD) General Cognitive Index for the whole study group was 82 (15). An overall of 49 (16%) out of the 306 children had cognitive impairment with no difference in general cognitive function among the three groups. Children with HIV infection scored lowest in perceptual performance domain, p = .028. Unemployed caregivers, child orphanhood and undernutrition were associated with impaired cognitive performance in univariate analysis. In multivariate analysis, caregiver unemployment status remained a factor associated with cognitive impairment with an ODDS ratio of 2.1 (95% CI 1.03-3.36). In a cohort of 6- to 8-year-olds, HIV infection did not show evidence of significant difference in general cognitive function. Children infected with HIV had major deficits in perceptive performance. Lower socioeconomic status was associated with cognitive impairment. In resource-constrained settings, strategies aimed at poverty alleviation and good nutritional management should complement early infant diagnosis and treatment of HIV in order to optimize neurocognitive potential.

Keywords: Cognitive impairment; HIV; School children; Zimbabwe.