title: CNS Impact of Perinatal HIV Infection and Early Treatment: the Need for Behavioral Rehabilitative Interventions Along with Medical Treatment and Care.
abstract: There is growing concern that although the more severe forms of HIV-associated neurologic deficits are reduced following highly active anti-retroviral therapy (HAART), mild to moderate cognitive disorders may persist for years after HAART initiation and this may occur despite complete plasma viral suppression. According to the UNAIDS 2014 report, there were 3.2 million children living with HIV around the world at the end of 2013 and 91 % of these resided in sub-Saharan Africa. In the same year, only 24 % of children who needed antiretroviral treatment (ART) received it and 190,000 children died of AIDS-related illnesses. We propose that behavioral interventions are needed in combination with medical treatment and care in order to fully address the needs of children and adolescents in Africa living with HIV. In early childhood, caregiver training programs to enhance the developmental milieu of the child with HIV can enhance their cognitive and social development and that such interventions are both feasible and well-accepted by the local population. For school-age children, computerized cognitive rehabilitation training can be an entertaining and engaging way to improve attention, working memory, and problem solving skills for children with HIV. Further dissemination and implementation science work is needed for arriving at cost-effective strategies for scaling up such behavioral interventions in African resource-constrained settings, given that the vast majority of HIV-affected children and youth worldwide presently live in sub-Saharan Africa.
authors: Department of Psychiatry and the Department of Neurology and Ophthalmology, Michigan State University, 909 Fee Road, Rm 321 West Fee Hall, East Lansing, MI, 48894, USA. boivin@msu.edu.|Department of Psychiatry, Michigan State University, 909 Fee Road, Rm 321 West Fee Hall, East Lansing, MI, 48894, USA. boivin@msu.edu.
authors: Michael J
authors: MJ
authors: Boivin
authors: Department of Psychiatry, Michigan State University, 909 Fee Road, Rm 321 West Fee Hall, East Lansing, MI, 48894, USA.
authors: Horacio
authors: H
authors: Ruiseñor-Escudero
authors: Department of Psychiatry, Michigan State University, 909 Fee Road, Rm 321 West Fee Hall, East Lansing, MI, 48894, USA.
authors: Itziar
authors: I
authors: Familiar-Lopez
mesh_terms: D017088:AIDS-Related Opportunistic Infections; D000293:Adolescent; D017954:Africa South of the Sahara; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002648:Child; D015658:HIV Infections / Q000188:drug therapy* / Q000534:rehabilitation*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical
keywords: Caregiver training; Child development; Cognitive rehabilitation; HIV subtype; Neuropsychology; Pediatric HIV