Neurocognitive Consequences of HIV in Preschool age Children: A Brief Report

Background and purpose: The effect of paediatric HIV infection on neurodevelopment at preschool age is under reported in Sub -Sahara Africa where the burden lies. This study assessed cognitive outcome and health status at preschool age among Zimbabwean children, enrolled from a national PMTCT program, with vertically transmitted HIV type 1 infection followed up for 5 years. Methods: Cognitive function was assessed in 278 preschool children with Kaufman short form of McCarthy Scales of Children`s Abilities (MSCA): 25 HIV infected, 94 HIV exposed uninfected, 126 HIV unexposed uninfected (controls) and 33 with unknown HIV status. Only115 had received prophylactic single dose nevirapine at delivery, but none were on antiretroviral treatment. Results: HIV infected children did not differ significantly in global cognitive ability compared to their age matched HIV exposed uninfected and HIV unexposed uninfected peers of similar background. Mean scores were significantly lower between HIV exposed uninfected and HIV unexposed uninfected children in specific subtests representative of verbal, perceptual performance and quantitative performance. HIV infected children were significantly more stunted, had more skin disorders, and lymphadenopathy compared to their uninfected peers. Maternal age and family income were predictive of lower GCI in this study. Conclusion: HIV infected children who survive to preschool age did not manifest lower cognitive scores than established child norms. The prevalence of cognitive impairment in this study was 8.6% and was more frequent in HIV uninfected children. Chronic malnutrition as indexed by stunting was associated with poor cognitive function at preschool age. Therefore comprehensive interventions to prevent childhood HIV and malnutrition could result in significant improvement in cognitive function at preschool age and later academic achievement.