Early AIDS in children impairs cognition

Tue Mar 21, 2006

By Martha Kerr

NEW YORK (Reuters Health) - Early diagnosis of an AIDS-defining illness in children who acquired HIV infection from their mothers is associated with impaired cognitive development, investigators with the Women and Infants Transmission Study Group report in the medical journal Pediatrics.

Dr. Renee Smith of the University of Illinois at Chicago and colleagues followed 117 children with maternally acquired HIV infection and 422 children who were exposed to HIV but did not become infected. Neurocognitive development was assessed at 3 year and again at 7 years of age.

Children with a diagnosis of AIDS "scored significantly lower in all domains of cognitive development, across all time points" than those with HIV infection but without AIDS, or children exposed to but not infected with HIV, the investigators report. The latter two groups had similar levels of neurocognitive development.

Smith told Reuters Health that it is not completely clear why the AIDS-defining episodes so strongly affect the cognitive abilities in these children. However, "the central nervous system is a compartment that is very vulnerable to HIV infection," which through indirect effects does "substantial structural and functional damage to the brain."

The researcher speculates that children who develop AIDS very early in life "may have been infected with the virus during earlier periods of their mother's pregnancy, rather than later, during the birthing process," Smith speculated.

"Being infected during pregnancy may mean either that the baby was infected for a longer period of time, with longer periods of HIV replication, than those infected close to birth, or that the virus and its pathological processes were introduced at a time when critical brain development was occurring, and resulted in a long-term impact on functioning," Smith suggested.

SOURCE: Pediatrics, March 2006.

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