Neuropsychological functioning and viral load in stable antiretroviral therapy-experienced HIV-infected children.
OBJECTIVE
Neuropsychological functioning and its correlation with viral load were investigated for previously treated HIV-infected children who underwent a change in treatment regimen.


METHODS
Thirteen age-appropriate measures of cognitive, neurologic, and behavioral functioning were administered to 489 HIV-infected children who were aged 4 months to 17 years and had been treated previously for at least 16 weeks with antiretroviral therapy. These clinically and immunologically stable children were randomized onto 1 of 7 drug treatment combinations, 6 of which included a protease inhibitor (PI), and evaluated prospectively for 48 weeks with respect to changes in neuropsychological performance and viral load.


RESULTS
Neuropsychological functioning was significantly poorer at baseline for the HIV-infected children as compared with established norms for their age. Children with higher viral load had poorer cognitive, both-hands fine-motor, and neurologic signs at baseline, but single-hand fine-motor and behavioral functioning were not correlated with viral load. After 48 weeks of treatment with PI-containing combination therapy, there was significant improvement in only the vocabulary score. Neuropsychological changes did not differ among the 6 PI-containing combination regimens. At week 48, even children with a viral load response below the level of detection (RNA < or =400 copies/mL) still showed poorer neuropsychological functioning compared with established norms.


CONCLUSIONS
Poor neuropsychological functioning was seen for HIV-infected children and was worse for children with higher viral loads. Only 1 measure of neuropsychological functioning showed improvement after treatment with PI-containing combination therapy, and the extent of that improvement was relatively minor. Treatment strategies for children with HIV disease need to be reevaluated so that they consider restoration of neuropsychological functioning in addition to lowering the viral load.
Jeremy
Rita J
RJ
Pediatric Clinical Research Center, Department of Pediatrics, School of Medicine, University of California-San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0105, USA. jeremyr@peds.ucsf.edu
Kim
Soyeon
S
Nozyce
Molly
M
Nachman
Sharon
S
McIntosh
Kenneth
K
Pelton
Stephen I
SI
Yogev
Ram
R
Wiznia
Andrew
A
Johnson
George M
GM
Krogstad
Paul
P
Stanley
Kenneth
K
D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002648:Child; D002652:Child Behavior / Q000187:drug effects; D002653:Child Behavior Disorders / Q000209:etiology; D002675:Child, Preschool; D003071:Cognition / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D008570:Memory, Short-Term / Q000187:drug effects; D009048:Motor Skills / Q000187:drug effects; D009483:Neuropsychological Tests; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load; D014825:Vocabulary
D044966:Anti-Retroviral Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral