Abstract
HIV-positive children and adolescents are at increased risk of both central nervous system (CNS) sequelae and mental disorders owing to a number of factors, including the impact of HIV infection on the brain, social determinants of health (e.g. poverty and orphanhood) and psychosocial stressors related to living with HIV. Every effort should be made to identify perinatally HIV-infected children and initiate them on antiretroviral therapy early in life. HIV clinicians should ideally screen for mental health and neurocognitive problems, as part of the routine monitoring of children attending antiretroviral clinics. This guideline is intended as a reference tool for HIV clinicians to support the early identification, screening and management of mental health disorders and/or CNS impairment in children and adolescents. This guideline covers mental disorders (section 1) and HIV-associated neurocognitive disorders (section 2) among children and adolescents.
Highlights
HIV-positive children and adolescents are at increased risk of both central nervous system (CNS) sequelae and mental disorders owing to a number of factors, including the impact of HIV infection on the brain, social determinants of health and psychosocial stressors related to living with HIV
Untreated perinatally HIV-infected (PHIV) children are at increased risk of central nervous system (CNS) sequelae compared with HIV-infected children who begin antiretroviral therapy (ART) in infancy
Patients receiving ART may remain vulnerable to the effects of HIV on the brain because the CNS may be a reservoir for persistent viral replication
Summary
Prevalence: ⢠In HIV-positive children, prevalence rates of 25 - 50% ⢠Most common: attention deficit hyperactivity disorder (ADHD), mood disorders, anxiety disorders, substance use disorders (SUDs) (adolescents) ⢠Less common: psychotic disorders, bipolar mood disorder Risk factors: ⢠Previous AIDS-defining diagnosis, lower intelligence quotient, caregiver psychiatric disorder, parental loss, limitsetting problems Effects: ⢠Untreated psychiatric illness may affect ART adherence, and educational and medical outcomes ⢠Adolescents vulnerable to depression, non-disclosure, school failure/dropout, sexual risk behaviours and SUDs
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