Neurocognitive and motor deficits in HIV-infected Ugandan children with high CD4 cell counts.
BACKGROUND
Human immunodeficiency virus (HIV) infection causes neurocognitive or motor function deficits in children with advanced disease, but it is unclear whether children with CD4 cell measures above the World Health Organization (WHO) thresholds for antiretroviral therapy (ART) initiation suffer significant impairment.


METHODS
The neurocognitive and motor functions of HIV-infected ART-naive Ugandan children aged 6-12 years with CD4 cell counts of >350 cells/μL and CD4 cell percentage of >15% were compared with those of HIV-uninfected children, using the Test of Variables of Attention (TOVA), the Kaufman Assessment Battery for Children, second edition (KABC-2), and the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2).


RESULTS
Ninety-three HIV-infected children (median CD4 cell count, 655 cells/μL; plasma HIV RNA level, 4.7 log(10) copies/mL) were compared to 106 HIV-uninfected children. HIV-infected children performed worse on TOVA visual reaction times (multivariate analysis of covariance; P = .006); KABC-2 sequential processing (P = .005), simultaneous processing (P = .039), planning/reasoning (P = .023), and global performance (P = .024); and BOT-2 total motor proficiency (P = .003). High plasma HIV RNA level was associated with worse performance in 10 cognitive measures and 3 motor measures. In analysis of only WHO clinical stage 1 or 2 HIV-infected children (n = 68), significant differences between the HIV-infected and HIV-uninfected groups (P < .05) remained for KABC-2 sequential processing, KABC-2 planning/reasoning, and BOT-2 motor proficiency.


CONCLUSIONS
Significant motor and cognitive deficits were found in HIV-infected ART-naive Ugandan children with CD4 cell counts of ∼350 cells/μL and percentages of >15%. Study of whether early initiation of ART could prevent or reverse such deficits is needed.
Division of Infectious Disease, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, CA 94143-0136, USA. ruelt@peds.ucsf.edu
Theodore D
TD
Ruel
Michael J
MJ
Boivin
Hannah E
HE
Boal
Paul
P
Bangirana
Edwin
E
Charlebois
Diane V
DV
Havlir
Philip J
PJ
Rosenthal
Grant
G
Dorsey
Jane
J
Achan
Carolyne
C
Akello
Moses R
MR
Kamya
Joseph K
JK
Wong
D015526:AIDS Dementia Complex / Q000453:epidemiology*; D018791:CD4 Lymphocyte Count; D002648:Child; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology*; D006801:Humans; D008297:Male; D016472:Motor Neuron Disease / Q000453:epidemiology*; D015995:Prevalence; D014454:Uganda