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Even with early treatment, HIV still attacks young brains

Date:
December 18, 2019
Source:
Michigan State University
Summary:
The majority of children living with HIV are in sub-Saharan Africa. While early antiretroviral therapy has ensured less deadly outcomes for children living with and exposed to HIV, the virus still may affect the brain, disrupting neurodevelopment. Michael Boivin, director of the Psychiatry Research Program in the MSU College of Osteopathic Medicine, has set out to understand exactly how HIV impacts children's neuropsychological development in a two-year longitudinal study, published in Clinical Infectious Diseases.
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The vast majority of children living with HIV today are in sub-Saharan Africa. While early antiretroviral therapy, or ART, has ensured less deadly outcomes for children living with and exposed to HIV, studies show the virus still may affect the brain. HIV may disrupt neurodevelopment, affecting how children learn, reason and function.

That's why Michael Boivin, professor and director of the Psychiatry Research Program in the Michigan State University College of Osteopathic Medicine, set out to understand exactly how HIV impacts children's neuropsychological development in a two-year longitudinal study, published in Clinical Infectious Diseases.

The research was supported in part by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.

Boivin and his colleagues evaluated the neuropsychological development of three groups of children aged 5 to 11: those who acquired HIV perinatally and were treated with ART, those exposed but HIV-negative, and those who were never exposed. The research took place at six study sites across four countries in sub-Saharan Africa for a robust view of how HIV is affecting children in the region.

To date, it's the first well-validated, multi-site neuropsychological evaluation of African school-aged children affected by HIV.

What the researchers discovered through various assessments was that even in the face of early treatment and good clinical care, there are still significant neuropsychological problems for children living with HIV.

"These children came into the study with a deficit compared to their counterparts," Boivin said. "It stayed about the same throughout the two years, except in one important area: reasoning and planning. On that specific test domain, the children living with HIV failed to progress over time."

In other words, the gap between infected and HIV-negative children grew in the planning and reasoning area over the study period. Typically, these abilities tend to blossom in the school-aged years in healthy children.

"This is the most important cognitive function for the future of children living with HIV in terms of their likelihood of taking their medications, making good decisions, abstaining from risky behaviors like early sexual activity, psychosocial issues and school-related achievement," Boivin said.

The bottom line? Early medical treatment, started as early as 6 months of age, is probably not enough to address the neurocognitive deficits associated with HIV, even though it helps keep children alive and healthier than they would be without treatment. In these children, treatment should be started even earlier to improve long-term neurocognitive outcomes.

"We're going to have to complement the long-term care and support with actual behavioral interventions," Boivin said.

That's something Boivin and his colleagues are already working on. Earlier this year, Boivin received a 5-year, $3.2 million NIH grant to continue his work with children affected by HIV in Uganda and Malawi.

Through this grant, researchers will investigate how MSU-developed computer cognitive games can serve as tools for neurocognitive evaluation, enrichment and potentially rehabilitation.

Boivin hopes that the results of both of these studies will help make this model of neuropsychological evaluation a considered part of the cost benefit of care for kids affected by HIV.

"Often it's overlooked or seen as an afterthought, but unlike other areas of medical follow up, neuropsychological evaluation really gets at how well the kids are going to adapt and function in school, at home, in the community and in society in general," Boivin said. "It's really what links us most directly to the human burden of disease."


Story Source:

Materials provided by Michigan State University. Note: Content may be edited for style and length.


Journal Reference:

  1. Michael J Boivin, Miriam Chernoff, Lee Fairlie, Barbara Laughton, Bonnie Zimmer, Celeste Joyce, Linda Barlow-Mosha, Mutsawashe Bwakura-Dangarembizi, Tichaona Vhembo, Mmule Ratswana, Portia Kamthunzi, Katie McCarthy, Itziar Familiar-Lopez, Patrick Jean-Philippe, Joan Coetzee, Nasreen Abrahams, Hermien Gous, Avy Violari, Mark F Cotton, Paul E Palumbo. African Multi-Site 2-Year Neuropsychological Study of School-Age Children Perinatally Infected, Exposed, and Unexposed to Human Immunodeficiency Virus. Clinical Infectious Diseases, 2019; DOI: 10.1093/cid/ciz1088

Cite This Page:

Michigan State University. "Even with early treatment, HIV still attacks young brains." ScienceDaily. ScienceDaily, 18 December 2019. <www.sciencedaily.com/releases/2019/12/191218090208.htm>.
Michigan State University. (2019, December 18). Even with early treatment, HIV still attacks young brains. ScienceDaily. Retrieved February 25, 2024 from www.sciencedaily.com/releases/2019/12/191218090208.htm
Michigan State University. "Even with early treatment, HIV still attacks young brains." ScienceDaily. www.sciencedaily.com/releases/2019/12/191218090208.htm (accessed February 25, 2024).

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