Aims An audit was carried out to assess the prevalence of neurocognitive disorders (NCDs) in 88 HIV positive children. This audit also recorded the Cerebrospinal fluid Penetration Effectiveness (CPE) score of all children on anti-retroviral therapy (ART).
Methods The audit was retrospective; data was collected from patients notes using a proforma adapted from guidelines from the Children's HIV Association (CHIVA)1 and the Paediatric European Network for the Treatment of AIDS (PENTA). CPE scores were calculated using the CNS HIV ART Effects Research (CHARTER) study scoring system.2
Results 28.4% of children (n=25) had evidence of NCDs – the most common were learning difficulties and cerebral palsy. 92% of children with NCDs (n=23) were referred to community paediatricians for formal developmental assessments; 61.2% (n=15) underwent diagnostic brain imaging. 52% (n=13) had evidence of risk factors for brain pathology such as prematurity, previous meningitis or encephalitis, birth related injury, or cerebrovascular accident. 82% (n=72) of children were on ART; CPE scores were calculated and whether or not these were above 9 (threshold recommended by CHARTER study).
Conclusions Results show that there is a high prevalence of NCDs; this is likely to be an underestimate as few children have had a developmental assessment. Given the high prevalence of NCDs in HIV positive children, a lower threshold for referral should be considered. Two thirds of patients had inadequate CPE scores. This is in part explained by issues of compliance, palatability and side-effects common to ART.
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