Table 2.1. Summary of Studies Investigating Neurocognitive Outcomes Among HIV-Infected Children in Africa.
| Author | Year | Country | Samplea | Age | ARV | Design | Tools | Key Findings | Psychosocial Aspects |
|---|---|---|---|---|---|---|---|---|---|
| Msellati et al. | 1993 | Rwanda | 43 I 133 E 193 C |
Birth to 24 months No | No | LG | Local tool | Multiple delays. 12.5% delayed at 6 months, 20% at 18 and 9% at 24 months. | None |
| Boivin et al.b | 1995 | DRC | 14 I 20 E 16 C |
3–18 months | No | LG | DDST | Delays in multiple developmental domains. | None |
| Boivin et al.b | 1995 | DRC | 11 I 15 E 15 C |
>2 yrs | No | CS | K-ABC ECSP | Multiple developmental delays. | None |
| Drotar et al. | 1997, 1999 | Uganda | 59 I 211 E 107 C |
Birth to 24 months | No | LG | BSID FTII HOME |
Delays in motor and cognitive domains, none in information processing. | No difference in quality of home of HIV positive and controls |
| Bagenda et al. | 2006 | Uganda | 28 I 42 E 37 C |
6–12 years | No | CS | K-ABC WRAT |
No significant delay or impairment was reported. | None |
| McGrath et al. | 2006 | Tanzania | 327 I | 6–18 months | No | LG | BSID-II | Early infected performed worse than later infected. | None |
| Baillieu & Potterton | 2008 | SA | 40 I | 18–30 months | No | CS | BSID-II | 85% gross motor and 82% language delay | None |
| Smith et al. | 2008 | SA | 39 I | 14–106 months | Yes | LG | GMDS TROG DAP VMI/VP/RCPM |
Developmental delays observed. No change in status six months into ARV treatment. | None |
| Van Rie et al. | 2008, 2009 | DRC | 35 I 35 E 90 C |
18–72 months | Yes | LG | BSID-II PDMS SON |
Developmental delays in infected children. After one year of medical care, HIV-infected children achieved mean motor and cognitive scores that were similar to HIV-uninfected and affected children although lower compared with control children. | None |
| Abubakar et al. | 2009 | Kenya | 31 I 17 E 319 C |
6–35 months | No | CS | KDI | Motor impairments. Performance worsened by disease progression and nutritional deficits. | None |
| Ferguson & Jelsma | 2009 | SA | 51 I 35 C |
6–32 months | 34 out of 51 | CS | BSID-II | 66.7% of the HIV-infected children experienced motor impairments compared to 5.7% of the controls. No difference in performance between those on ARVs and those who are not. | None |
| Boivin et al. | 2010 | Uganda | 102 I | 6–12 years | No | CS | KABC TOVA BOT-2 |
HIV clade influenced neurocognitive outcome, children with subtype A performing worse than those with subtype D. | None |
| Kandawasvika et al. | 2011 | Zimbabwe | 65 I 188 E 287 C |
Birth to 12 months | Yes | LG | BINS | HIV-infected children twice at risk of impairment; this effect becomes nonsignificant when you take into consideration other risk factors. | Levels of family income predictive of neurodevelopmental impairments |
| Jelsma, Davids, & Ferguson | 2011 | SA | 23 I 21 E |
30–59 months | Yes | CS | PDMS II | Motor delays (Cohen d = 1.450). | Residence in a foster home a predictor of outcomes |
| Lowick, Sawry, & Meyers | 2012 | SA | 30 I 30 E |
5–6 years | Yes | CS | GMDS-R | 90% of HIV-positive children and 76% of controls developmentally delayed. | None |
| Ruel et al. | 2012 | Uganda | 93 I 106 E |
6–12 years | No | CS | KABC TOVA BOT-2 |
Multiple cognitive and motor impairments. Performance worsens with advanced disease staging. | HIV positive from lower SES but same scores on HOME |
| Hoare et al. | 2012 | SA | 24 I | 8–12 years | No | CS | WASI Imaging |
Asymptomatic HIV-positive children had poorer neurocognitive outcomes compared to controls. Indicators of imaging showed poor outcomes. Strong correlation between imaging results and neurodevelopmental outcomes. | None |
| Laughton et al. | 2012 | SA | 92 I 24 E 34 C |
10–16 months | Some | CS | GMDS | Children who received ARVs early performed better than those initiated to ARVs later. | None |
| Boyede et al. | 2013a, 2013b, 2013c | Nigeria | 69 I 69 E |
6–15 years | 56% on ARV | CS | RPM | HIV positive delayed (Cohen d of 0.76). Those on ARVs better than those not on ARVs. | SES and maternal education influenced cognitive outcomes |
| Whitehead et al. | 2014 | SA | 27 I | Six months | Yes | LG | BSID-II | At baseline 48.1% cognitive impairment, 51.8% language in the HIV positive group. | None |
| Kandawasvika et al. | 2014 | Zimbabwe | 32 I 121 E 153 C |
6–8 years | 30% on ARV | CS | MSCA | No difference in performance except on perceptual tasks. | Cognitive impairments associated with caregiver unemployment, parental loss, and undernutrition |
Longitudinal study, we report sample sizes at baseline.
This chapter reported two different studies so we separated them in this report.
Design. LG: longitudinal; CS: cross-sectional.
Conditions. I: HIV infected; E: HIV exposed; C: community controls/HIV unexposed.
Locations. DRC: Democratic Republic of Congo formerly known as Zaire; SA: South Africa.
Instruments. DDST: Denver Developmental Screening Tool; BSID: Bayley’s Scales for Infant Developmental; FTII: Fagan Test of Infant Intelligence; K-ABC: Kauffman Assessment Battery for Children; WRAT: Wide Range Achievement Test; KDI: Kilifi Development Inventory; GMDS-R: Griffiths Mental Developmental Scales-Revised; PDMS II: Peabody Development Motor Scale II; RPM: Raven’s Progressive Matrices; BINS: Bayley Infant Neurodevelopmental Screener; TROG: Test for Reception of Grammar; DAP VMI/VP/Beery-Buktenica developmental tests for visual motor integration (VMI), visual perception (VP), and motor coordination (MC); MSCA: McCarthy Scales of Children’s Abilities.