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Perinatally HIV linked to cognitive impairment in children
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An evidence-based review discovered an association between cognitive impairment in the domains of working memory, executive function and processing speed in children and adolescents with perinatally acquired HIV infection.
“Our limited understanding of the domain-specific cognitive impairments associated with perinatal HIV in children and adolescents is a significant barrier to treatment,” Nicole Phillips, MSocSci, from the department of psychiatry and mental health at the University of Cape Town, South Africa, and colleagues wrote. “To date, no systematic review has been published to assess the state of science on cognitive impairment among perinatally HIV–infected children and adolescents. Furthermore, no aggregated quantitative evidence has been published on the cognitive domains that are most affected by perinatal HIV infection.”
Phillips and colleagues conducted a systematic review and meta-analysis from data available in five electronic bibliographic databases to assess the degree of cognitive impairment and the specific domains affected in children and adolescents infected with HIV. The researchers used the Patient, Population or Problem, Intervention, Comparison, Outcomes and Setting (PICOS) method to conduct research questions for their meta-analysis and the Downs and Black 27-item checklist to gauge randomized controlled trials (RCT) and non-RCT studies on reporting, external validity, bias, confounding and power subscales.
The researchers included 22 studies after eligibility screening; only seven included data from sub-Saharan Africa. Six of the 22 studies included data for an uninfected control group that was not exposed to HIV prenatally and were the only studies included for the meta-analysis.
The average age of the participant was 9.53 years.
Their analysis showed that the three domains with the most significant differences between HIV–infected children and controls were working memory (standard mean difference [SD] = 16.46; 95% CI, –14.22 to 47.13); processing speed (SD = 9.36; 95% CI, 3.73-14.98; and executive function (SD = 3.68; 95% CI, 1.35-6.02).
The researchers conducted a qualitative review of the 16 studies not used in the meta-analysis. During their review, researchers found that three of 15 studies reported differences in executive function and one of 15 reported a group difference for working memory between HIV perinatally infected children and adolescents and uninfected controls.
“These findings from these studies seem to consistently implicate working memory, executive function, processing speed and perceptual deficits in HIV–infected children and adolescents,” the researchers wrote. “Executive functioning emerges as one of the more prominent domains to be affected in this population, which is consistent with the finding in this review of significant differences in this domain.” – by Kate Sherrer
- Reference:
- Phillips N, et al. Pediatrics. 2016;doi:10.1542/peds.2016-0893.
Disclosure: Please see the full study for a list of all authors’ relevant financial disclosures.