Clinico-Immunological Status and Neurocognitive Function of Perinatally Acquired HIV-Positive Children on cART: A Cross-Sectional Correlational Study in South Africa.

Antonio G Lentoor

doi:10.3389/fneur.2020.00243

Abstract

Despite the undisputed benefits of combination antiretroviral therapy (cART), perinatally acquired human immunodeficiency virus (PHIV) children on treatment often present with a spectrum of neurological deficits known as HIV-associated neurocognitive impairment. Even higher CD4 cell count does not seem to prevent the development of neurocognitive impairment in children with PHIV. While CD4 cell count has shown to have the greatest prognostic value, its association with neurocognitive abilities remains to be clarified. This study aimed at determining the correlation between plasma CD4+ lymphocyte and neurocognitive function in children with PHIV on cART. In total, 152 purposively recruited hospital-based sample of children with PHIV on cART, aged 3 years to 7 years 6 months (mean age, 63.13 months), underwent neurocognitive assessment using the Wechsler Preschool and Primary Scale of Intelligence, Third Edition. Immunological status of each child was based on the plasma CD4+ lymphocyte levels. The mean CD4+ lymphocyte cell count at the time of neurocognitive assessment was 1,259.85 cells/mm3 (mean range, 139–2,717 cells/mm3), with significant age difference on CD4+ lymphocyte count levels [F(2, 149) = 13.58, p = 0.000]. CD4+ lymphocyte counts was significantly correlated with subdomains of neurocognitive function scores of task that measures working memory, processing speed, and perceptual reasoning. Global cognitive ability (Full Scale Intellectual Quotient) had no significant association with immunological status of the children. The findings support an association between immunological status of PHIV infection and executive function task. These neurocognitive faculties are critical for learning, school readiness and success in early childhood, and ultimately treatment adherence in adolescence. The need for early identification of neurodevelopment deficits in children, even when on cART, is crucial because early psychosocial and neurorehabilitative interventions can lead to better outcome for children with PHIV.

Highlights

While progress has been made toward the UNAIDS 90-90-90 targets for prevention and treatment, human immunodeficiency virus (HIV) infection continues to be a major global public health issue [1]
According to the Global AIDS update 2019 report, the vast majority of people living with HIV is in lowand middle-income countries, with an estimated 66% living in sub-Saharan Africa, while South Africa accounts for a third of all new HIV infections in this region [2]
Consistent with previous studies, the findings from the present study showed that perinatally HIVinfected children are at high risk of developing neurocognitive impairment, even when on combination antiretroviral therapy (cART) [21, 22]

Summary

Introduction

While progress has been made toward the UNAIDS 90-90-90 targets for prevention and treatment, human immunodeficiency virus (HIV) infection continues to be a major global public health issue [1]. According to the Global AIDS update 2019 report, the vast majority of people living with HIV is in lowand middle-income countries, with an estimated 66% living in sub-Saharan Africa, while South Africa accounts for a third of all new HIV infections in this region [2]. While HIV prevalence remains high in the general population in South Africa, the report indicated a rapid decline in new infections among South African children, from 25,000 in 2010 to 13,000 in 2017. It is reported that of the estimated 280,000 children (aged 0–14 years) living in South Africa, 58% were on treatment [3] This is mainly due to South Africa’s antiretroviral treatment program, which is considered to be the largest in the world and most successful in sub-Saharan Africa. Dramatic expansion of South Africa’s antiretroviral therapy (ART) program over the years has led to everyone with a positive diagnosis being eligible to start and access to treatment [4]

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