The Influence of Clinical Staging and Use of Antiretroviral Therapy on Cognitive Functioning of School-Aged Nigerian Children with HIV Infection

Abstract

Objective: To find out how the World Health Organization Clinical Stages of HIV infection and use of antiretroviral therapy influence cognitive functioning of school-aged HIV-infected Nigerian children. Method: Cognitive assessments of 69 HIV positive children aged 6–15 years were performed using Raven’s Standard Progressive Matrices. Thirty children were on Highly Active Antiretroviral Therapy. The children were subdivided for the purpose of analysis into two cognitive developmental stages using Piaget’s developmental stage: the concrete operation stage (6–11 years) and the formal operation stage (12–15 years). Children on antiretroviral therapies were also compared with those not on therapies. HIV infection was staged using the revised World Health Organization Clinical Staging for Paediatric HIV/AIDS. Result: The overall mean cognitive score for HIV positive subjects on antiretroviral therapy was 20.9 which was significantly higher than the overall score for subjects not on therapies of 14.6 (p=0.007). In the age group 6–11 years, the mean cognitive scores became lower significantly with worsening clinical stage for subjects irrespective of use of anti-retroviral therapy. The mean scores for subjects on therapy were significantly higher than that of their counterparts not yet on therapy at the same clinical stage. There were no significant differences in the cognitive scores at different clinical stages among the children in the age group 12–15 years. Conclusion: Cognitive scores were lower with worsening clinical staging in the younger school-aged HIV-infected Nigerian children. Subjects on Highly Active Anti-retroviral Therapy had better cognitive scores than subjects not on therapy at the same clinical stage. Routine neuropsychological evaluation for school-aged HIV-infected children are recommended with an emphasiss on the younger children.