Perinatal HIV transmission may lead to cognitive deficits

Perinatal transmission of HIV to newborns is associated with serious cognitive deficits as children grow older, according to an analysis of 35 studies by neuroscientists at the Georgetown University Medical Center. Their findings, published in the journal eClinicalMedicine, help to pinpoint the geographic regions and factors that may be important for brain development outcomes related to perinatal HIV infection: mother-to-child HIV transmission during pregnancy, labour and delivery, or breastfeeding.

Mostly because of advances in antiretroviral therapies, AIDS, which is caused by HIV infection, has largely become a chronic disease rather than a life-threatening condition. There are nearly 3 million children and adolescents currently living with HIV and over 300,000 new HIV infections that occur annually.

To better understand the impact of perinatal HIV disease on cognitive development, Georgetown researchers led by medical student Sophia Dahmani analysed the results of nearly three dozen studies published between 2012 and 2023 that included over 4000 perinatally infected HIV people, over 2300 HIV-exposed but uninfected people and nearly 2500 HIV-unexposed, uninfected people. The investigators based their cognition analyses on neurological scores of the children when they reached an average age of around 11 years old, focusing on test scores from three cognitive domains that play crucial roles in childhood development: executive function, which generates plans, solutions to problems and organises structures that guide future action; working memory, which is how someone processes, uses and remembers information on a daily basis; and the speed at which someone processes information.

Compared to the two uninfected groups, perinatally HIV-infected children and adolescents had significant impairments in processing speed (a so-called Hedge’s g score of -0.64, where -0.2 is a small deviation, -0.5 is a medium deviation and -0.8 is a large deviation), working memory (-0.69) and executive function (-0.35). Additional analyses suggested that the deficit for processing speed negatively correlated with a country’s gross national income (GNI) per capita — in other words, the lower the GNI per capita of that country, the more severely affected the processing speed for people with perinatal HIV living in that country.

“There are many ways to help children and adolescents living with HIV to receive high-quality education so that they can have constructive and independent lives,” Jiang said. “The introduction of early childhood education programs, academic accommodations whereby teachers provide more time during exams to account for reduced processing speeds and caregiver training programs could help improve the long-term cognitive and functional outcomes of these children and adolescents.”

The researchers say that a future direction in this field is to encourage better and bigger studies on perinatal HIV in more countries so that experts don’t need to rely on combining multiple smaller studies for their analyses. They say this will require collaborative efforts from the World Health Organization, the United Nations and governments of low- to middle-income as well as high-income countries.

Image credit: iStock.com/Kobackpacko