The Neurocognitive Assessment of HIV-Infected School-Aged Nigerian Children

Gbemisola O. Boyede, Foluso E. A. Lesi, Chinyere V. Ezeaka, Charles S. Umeh

Clinical Psychology Unit, Department of Psychiatry, Lagos University Teaching Hospital, Lagos, Nigeria.
Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria.
Division of Developmental Paediatrics, School and Child and Adolescent Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa.

DOI: 10.4236/wja.2013.32017                

Abstract

Objective: Studies available on cognitive function among school-aged HIV-infected African and in particular Nigerian children are few. The purpose of the study was to assess the neurocognitive function of a group of HIV-infected schoolaged (6 - 15 years) children using the Raven’s Standard Progressive Matrices (RPM). Method: Cognitive assessments of 69 HIV positive children and 69 age- and sex-matched apparently healthy HIV negative control children were performed using the Raven’s Standard Progressive Matrices (RPM). The children were subdivided (Piaget’s developmental staging) into two sub-groups: the concrete operation stage (6 - 11 years) and the formal operation stage (12 - 15 years) for analysis. Result: The mean RPM score for the HIV positive children was 18.2 (8.0 - 47.0, SD 9.8) which was significantly lower than the score of 27.2 (8.0 - 52.0, SD 13.8) for the HIV negative children (p < 0.001). On the RPM grading and using the HIV negative children as the standard, 56.5% of the HIV positive children had cognitive performance at below average to intellectually defective range. Conclusion: School-aged HIV positive children had significantly lower cognitive scores compared with age and gender-matched HIV negative children. Routine neuropsychological evaluation of all school-aged HIV-infected children is recommended. Early detection of cognitive impairment will help in planning appropriate interventions.

Keywords

Pediatric HIV; Cognitive Assessment; School-Age Children; Ravens Progressive Matrices; Nigeria

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. Tindyebwa, J. Kayita, P. Musoke, B. Eley, R. Nduati, H. Coovadia, R. Bobart, D. Mbori-Ngacha and M. Kieffer, “Handbook on Paediatric AIDS in Africa,” African Network for the Care of Children Affected by AIDS, 2006.
[2]	Joint United Nation Programme on HIV/AIDS (UNAIDS), “AIDS Epidemic Update,” 2009. http://www.unaids.org
[3]	C. Chase, J. Ware, J. Hittelman, I. Blasini, R. Smith, A. Llorente, E. Anisfeld, C. Diaz, M. Fowler, D. Moye and L. Kaligh, “Early Cognitive and Motor Development among Infants Born to Women Infected with Human Immunodeficiency Virus: Women and Infants Transmission Study Group,” Pediatrics, Vol. 106, No. 2, 2000, p. e25. doi:10.1542/peds.106.2.e25
[4]	E. Cooper, C. Hanson, C. Diaz, H. Mendez, R. Abboud, R. Nugent, J. Pitt, K. Rich, E. Rodriguez and V. Smeriglio, “Encephalopathy and Progression of Human Immunodeficiency Virus Disease in a Cohort of Children with Perinatally Acquired Human Immunodeficiency Virus Infection: Women and Infants Transmission Study Group,” Journal of Pediatrics, Vol. 132, No. 2, 1998, pp. 808-812. doi:10.1016/S0022-3476(98)70308-7
[5]	C. Mellins, R. Levenson, R. Zawadzki, R. Kairam and M. Weston, “Effects of Pediatric HIV Infection and Prenatal Drug Exposure on Mental and Psychomotor Development,” Journal of Pediatric Psychology, Vol. 19, No. 5, 1994, pp. 617-628. doi:10.1093/jpepsy/19.5.617
[6]	P. Wolters, P. Brouwers, H. Moss and P. Pizzo, “Differential Receptive and Expressive Language Functioning of Children with Symptomatic HIV Disease and Relation to CT Scan Brain Abnormalities,” Pediatrics, Vol. 95, No. 1, 1995, pp. 112-119.
[7]	R. Smith, K. Malee, R. Leighty, P. Brouwers, C. Mellins, J. Hittelman, C. Chase and I. Blasini, “Effects of Perinatal HIV Infection and Associated Risk Factors on Cognitive Development among Young Children,” Pediatrics, Vol. 117, No. 3, 2006, pp. 851-862. doi:10.1542/peds.2005-0804
[8]	L. Millana-Cuevas, J. Portellano and R. Martinez-Arias, “Neuropsychological Impairment in Human Immunodeficiency Virus-Positive Children,” Revista de Neurología, Vol. 44, No. 6, 2007, pp. 366-374.
[9]	G. Diamond, P. Gurdin, A. Wiznia, A. Belman, A. Rubinstein and H. Cohen, “Effects of Congenital HIV Infection on Neurodevelopmental Status of Babies in Foster Care,” Developmental Medicine & Child Neurology, Vol. 32, No. 11, 1990, pp. 999-1005. doi:10.1111/j.1469-8749.1990.tb08123.x
[10]	R. Levenson, C. Mellins, R. Zawadzki, R. Kairam and Z. Stein, “Cognitive Assessment of Human Immunodeficiency Virus-Exposed Children,” American Journal of Diseases of Children, Vol. 146, No. 12, 1992, pp. 1479-1483.
[11]	P. Fishkin, F. Armstrong, D. Routh, L. Harris, W. Thompson, K. Miloslavich, J. Levy, A. Johnson, C. Morrow, E. Bandstra, C. Mason and G. Scott, “Brief Report: Relationship between HIV Infection and WPPSI-R Performance in Preschool-Age children,” Journal of Pediatric Psychology, Vol. 25, No. 5, 2000, pp. 347-351. doi:10.1093/jpepsy/25.5.347
[12]	P. Msellati, P. Lepage, D. Hitimana, C. Van Goethem, P. Van de Perre and F. Dabis, “Neurodevelopmental Testing of Children Born to Human Immunodeficiency Virus Type 1 Seropositive and Seronegative Mothers: A Prospective Cohort Study in Kigali, Rwanda,” Pediatrics, Vol. 92, No. 6, 1993, pp. 843-848.
[13]	D. Drotar, K. Olness, M. Wiznitzer, L. Guay, L. Marum, G. Svilar, D. Hom, J. Fagan, C. Ndugwa and R. KiziriMayengo, “Neurodevelopmental Outcomes of Ugandan Infants with Human Immunodeficiency Virus Type 1 Infection,” Pediatrics, Vol. 100, No. 1, 1997, p. e5. doi:10.1542/peds.100.1.e5
[14]	M. Boivin, S. Green, A. Davies, B. Giordani, J. Mokili and W. Cutting, “A Preliminary Evaluation of the Cognitive and Motor Effects of Pediatric HIV Infection in Zairian Children,” Health Psychology, Vol. 14, No. 1, 1995, pp. 13-21. doi:10.1037/0278-6133.14.1.13
[15]	N. McGrath, D. Bellinger, J. Robins, G. Msamanga, E. Tronick and W. Fawzi, “Effect of Maternal Multivitamin Supplementation on the Mental and Psychomotor Development of Children Who Are Born to HIV-1-Infected Mothers in Tanzania,” Pediatrics, Vol. 117, No. 2, 2006, pp. e216-e225. doi:10.1542/peds.2004-1668
[16]	A. Van Rie, A. Mupuala and A Dow, “Impact of the HIV/ AIDS Epidemic on the Neurodevelopment of PreschoolAged Children in Kinshasa, Democratic Republic of the Congo,” Pediatrics, Vol. 122, No. 1, 2008, pp. e123-e128. doi:10.1542/peds.2007-2558
[17]	A. Abubakar, A. Van Baar, F. Van de Vijver, P. Holding and C. Newton, “Paediatric HIV and Neurodevelopment in Sub-Saharan Africa: A Systematic Review,” Tropical Medicine & International Health, Vol. 13, No. 7, 2008, pp. 880-887. doi:10.1111/j.1365-3156.2008.02079.x
[18]	D. Bagenda, A. Nassali, I. Kalyesubula, B. Sherman, D. Drotar, M. Boivin and K. Olness, “Health, Neurologic, and Cognitive Status of HIV-Infected, Long-Surviving, and Antiretroviral-Naive Ugandan Children,” Pediatrics, Vol. 117, No. 3, 2006, pp. 729-740. doi:10.1542/peds.2004-2699
[19]	J. Raven, “Standard Progressive Matrices,” H. K. Lewis, London, 1958.
[20]	O. Ogunlade, “The Predictive Validity of the Raven’s Progressive Matrices with Some Nigerian Children,” Educational and Psychological Measurement, Vol. 38, No. 2, 1978, pp. 465-467. doi:10.1177/001316447803800232
[21]	Federal Ministry of Health, “National Guidelines for Paediatric HIV and AIDS Treatment and Care,” Federal Ministry of Health, HIV and AIDS Division, Abuja, 2007.
[22]	G. A. Oyedeji, “Socioeconomic and Cultural Background of Hospitalized Children in Ilesa,” Nigerian Journal of Paediatrics, Vol. 12, No. 4, 1985, pp. 111-117.
[23]	World Health Organization, “Revised WHO Paediatric Clinical Staging System,” WHO, Geneva, 2006.
[24]	SPSS for Windows (Computer Programme), Release 16.0.1, SPSS Inc., Chicago, 2007.
[25]	P. Papola, M. Alvarez and H. Cohen, “Developmental and Service Needs of School Children with HIV,” Pediatrics, Vol. 94, No. 6, 1994, pp. 914-918.
[26]	G. Bertou, L. Thomaidis, V. Spoulou and M. Theodoridou, “Cognitive and Behavioral Abilities of Children with HIV Infection in Greece,” Pediatrics, Vol. 121, No. 2, 2008, p. S100. doi:10.1542/peds.2007-2022BB
[27]	C. Chiriboga, S. Fleishman, S. Champion, L. Gaye-Robinson and E. Abrams, “Incidence and Prevalence of HIV Encephalopathy in Children with HIV Infection Receiving Highly Active Anti-Retroviral Therapy (HAART),” Journal of Pediatrics, Vol. 146, No. 3, 2005, pp. 402-407. doi:10.1016/j.jpeds.2004.10.021
[28]	M. Tardieu, M. Mayaux, N. Seibel, I. Funck-Brentano, E. Straub, J. Teglas and S. Blanche, “Cognitive Assessment of School-Age Children Infected with Maternally Transmitted Human Immunodeficiency Virus Type 1,” Journal of Pediatrics, Vol. 126, No. 3, 1995, pp. 375-379. doi:10.1016/S0022-3476(95)70451-5
[29]	W. Mitchell, “Neurological and Developmental Effects of HIV and AIDS in Children and Adolescents,” Mental Retardation and Developmental Disabilities Research Reviews, Vol. 7, No. 3, 2001, pp. 211-216. doi:10.1002/mrdd.1029