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23-27 July 2012, Washington DC

Anita Shet, Smitha Holla, Vijaya Raman, Chitra Dinakar, Sapna V, Mysore Ashok St. John’s Medical College Hospital Bangalore, India. Cognitive, neurological and adaptive behaviour functioning among children with perinatally-acquired HIV infection. 23-27 July 2012, Washington DC. Background.

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23-27 July 2012, Washington DC

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  1. Anita Shet, Smitha Holla, Vijaya Raman, Chitra Dinakar, Sapna V, Mysore AshokSt. John’s Medical College HospitalBangalore, India Cognitive, neurological and adaptive behaviour functioning among children with perinatally-acquired HIV infection 23-27 July 2012, Washington DC

  2. Background • Increased access to ART for children will result in improved survival. • HIV is now a chronic disease. • Neurocognitive and behavioral functioning of HIV-infected children: an important area to address.

  3. Background • In infancy: delay in motor and mental development. • Drotar D et al. Peds 1997; Chase C et al. Pediatrics 2000. • Later childhood: poorer neurocognitive functioning in comparison to HIV-uninfected children. • Jeremy RJ, et al. Pediatrics 2005; 380-7 • Impact of ART: improvement in some test scores. • Martin SC, et al. Dev Neuropsychol 2006 • Other risk factors: malnutrition, poverty, parental illness and death.

  4. Specific Aims • To examine the effects of HIV infection on cognitive, neurological, and behavioral functioning on children by comparing these areas in HIV-infected and HIV-uninfected children. • To determine whether clinical, immunological, and treatment status can predict adaptive behavior and neurocognitive functioning in HIV-infected children.

  5. Methods

  6. Specific Testing Tools Neurological Testing • Motor, sensory, cranial, cerebellar examinations. • Soft neurological signs using Physical and Neurological Examination for Soft Signs (PANESS) tool. Cognitive Testing • 3.5 to 6 yrs: Wechsler Preschool & Primary Scales of Intelligence (WPPSI) • 7-16 yrs: Wechsler Intelligence Scale for Children, 3rd Ed (WISC-III) (Verbal and Performance IQ) Adaptive Behaviour • Ability to adjust to different situations for day-to-day functioning. • The Vineland Adaptive Behaviour Scales (VABS) assesses personal and social functioning.

  7. Results: Patient characteristics

  8. Results: Patient characteristics

  9. Results: Patient characteristics

  10. Soft Neurological signs • HIV-infected children had higher scores • Difference most marked at ages 7-10 yrs. • Boys with HIV had more abnormal soft neurological signs.

  11. Cognition: IQ Scores • HIV-infected children had lower IQ scores compared to HIV-uninfected children, irrespective of age, sex, orphan status, anemia status

  12. Adaptive behaviour (VAB) • Adaptive behaviour scores were similar for both HIV-infected and uninfected children – at all ages, and both in males and females. • Among the orphans HIV-infected children had higher/better scores than orphans without HIV.

  13. IQ Scores: ART status p=0.006 p=0.06 p=0.02 Not on ART (39) On ART (43) Score Total IQ Performance IQ Verbal IQ ART may have a role in improving overall cognitive functioning

  14. IQ Scores in children not on ART • Among children who were not on ART, mean total IQ scores demonstrated a tendency to decrease with increasing age

  15. IQ Scores and VABS: Immunological status CD4 ≥ 15% 78 Low CD4 (<15%) 96 IQ Score VABS score 69 89 Total IQ Score VABS

  16. Multivariate regression analysis Cognition Independent factors that affected IQ scores: • HIV status (OR 9.1) • Weight-for-age Z score (OR 2.5) • Hemoglobin (OR 2.1) Adaptive behaviour and soft neurological signs • HIV status had no independent effect

  17. Conclusions • HIV-infected children had higher risk of having abnormal soft neurological signs. • and lower IQ scores compared to HIV-uninfected children, irrespective of age, gender, orphan status, anemia status. • indicating subtle neurocognitive impairment that may be related to perinatal HIV infection. • Malnutrition and anemia had a definite role in poor cognitive outcomes. • Use of ART has a positive effect, and subtle worsening may be seen among those children not on ART.

  18. Recommendations • Routine neurocognitive assessments in children • Early initiation of ART • Early intervention and stimulation, with focus on educational and emotional development

  19. Acknowledgements • St. John’s Research Society for funding support • National AIDS Control Organization • Sneha Care Home and Prithvi House staff • Staff at the ID and general pediatric clinics • Children and caregivers who participated

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