Children exposed to HIV at high risk for language impairment

Rice ML. J Dev Behav Pediatr. 2011;doi:10.1097/DBP.0b013e318241ed23.

Issue: February 2012

Children exposed to HIV before birth may be at risk for language impairments. Therefore, these children may benefit from routine screening for language impairment, even if they show no obvious signs of a language problem, according to a study published online.

The investigators, led by Mabel L. Rice, PhD, of the University of Kansas, also reported that the rate of language impairments was similar for children in HIV-positive and HIV-exposed uninfected groups, both overall and within sub-classifications of primary language impairment or concurrent language impairment (cognitive or hearing impairment).

The researchers found that 35% of a group of school-age children born to women with an HIV infection during pregnancy have difficulty understanding spoken words and expressing themselves verbally. On a standard series of tests of language ability, children exposed to HIV before birth scored, on average, within the lowest 21% of all children who have taken the test.

Children exposed to HIV before birth tended to have language delays, regardless if they later became infected with HIV.

“Our results show that children exposed to HIV have more than twice the chance of having a language impairment than do children in the general population,” said George K. Siberry, MD, MPH, of the Pediatric, Adolescent and Maternal AIDS Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a press release.

The 468 children in the study ranged in age from 7 to 16 years. Three hundred six children were HIV-positive, while the remaining 162 were exposed to HIV during pregnancy but did not become infected. The investigators also evaluated the children’s medical records, tested their hearing and evaluated their general cognitive development. Based on the results of this analysis, the children were classified into three groups:

Those with no language impairment, 65%.
Those with a concurrent language impairment, 24%.
Those with a primary language impairment only, 11%.

Among the children who were HIV-positive, those with a severe or poorly controlled HIV infection were about three times more likely than students with HIV who responded to treatment to experience language delays associated with cognitive impairments or hearing loss.

The study could not determine whether the high rates of language impairment in the HIV-exposed children can be attributed to HIV exposure or to other unidentified factors, such as their family status, maternal substance use, environment, or social or economic background.

The researchers said it is important for those who care for children exposed to HIV in the womb to provide early treatment for language impairments. Besides being at risk for school failure, children who do not use language well may have difficulty communicating with their peers and establishing friendships, according to the findings.

Disclosure: Funding for the study was also provided by the NIH.

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