Neurocognitive functioning in pediatric human immunodeficiency virus infection: effects of combined therapy.

OBJECTIVES

To assess the impact of combination antiretroviral therapy on neurocognitive outcomes in perinatally human immunodeficiency virus (HIV)-infected patients and to determine if CD4 percentage and plasma HIV-1 RNA level (viral load) are predictive of future neurocognitive function.

DESIGN

Retrospective cohort study.

SETTING

An HIV-dedicated urban care center.

PARTICIPANTS

One hundred forty-six perinatally HIV-infected children born between June 1990 and May 2003 with at least 1 neurocognitive evaluation.

MAIN OUTCOME MEASURES: Neurocognitive standard testing scores as well as diagnosis of progressive encephalopathy, probable progressive encephalopathy, or static encephalopathy.

RESULTS

The prevalence of progressive encephalopathy has decreased in children born prior to 1996 (period 1) compared with those born after 1996 (period 2) from 29.6% to 12.1% (P = .049). The prevalence of all progressive encephalopathy and static encephalopathy decreased from 40.7% to 18.2% in period 1 vs 2 (P = .02). For those diagnosed as neurocognitively healthy, neurocognitive scores remained stable over time with a mean (SD) standard score of 89.6 (11.8) at first evaluation compared with 91.9 (11.93) at most recent evaluation. The most recent mean (SD) standard score increased from 82.3 (18) to 87.2 (10.49) in period 1 vs period 2 (P = .001). A weak association was found between both the mean viral load (P = .06) and CD4 percentage (P<.001) and neurocognitive testing score 6 months later.

CONCLUSIONS

Since 1996, fewer children have been diagnosed with progressive encephalopathy, and neurocognitive functioning is preserved over time in those deemed neurocognitively healthy at entry. Viral load and CD4 percentage are marginally predictive of future changes in neurocognitive standard scores. These data support the observation that combination antiretroviral therapy is associated with improved neurocognitive outcomes in children with perinatally acquired HIV infection.