Cognitive assessment of school-age children infected with maternally transmitted human immunodeficiency virus type 1☆,☆☆,★,★★

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Abstract

Thirty-three children vertically infected with human immunodeficiency virus type 1 (HIV-1), who were born before 1985, were followed in a single center, and had reached the age of 6 years, were studied and tested for school achievement. Of these 33 children, 24 were also tested for cognitive abilities, fine motor and language skills, and emotional adaptation. Of the 33 patients, 22 (67%) had normal school achievement at a mean age of 9.5 ± 1.6 years. The mean IQ was 95 ± 11, but 54% of the patients (13/24) had abnormal results on visual-spatial and time orientation tests, 44% had speech and/or language delay or articulation disorders, and 29% of the children and 42% of the parents had psychoaffective disturbances of intermediate or high severity. Normal school performance was positively correlated with results of the different cognitive tests and to a lesser extent with the absence of psychoaffective symptoms, but was independent of the mode of maternal infection or the parents' educational level. Children with normal school achievement had a higher percentage of circulating CD4+ lymphocytes during the course of infection. We conclude that children whose HIV-1 infection is maternally acquired have better cognitive abilities and school achievement than was initially thought, and that the percentage of circulating CD4+ lymphocytes during the first years of life appears to be pre dictive of future school adaptation or cognitive abilities. (J PEDIATR 1995;126: 375-9)

Section snippets

Study design

All children infected by maternal-fetal transmission of the virus, followed at our center and born before Aug. 31, 1985, were included in the study (n = 57). The children were routinely followed by both an immunologist and a neurologist throughout the study. The usual clinical and biologic evaluations were obtained serially.1 The time of the first evaluation was recorded, as was the start of antiviral treatment or the time of death.

Among the 57 HIV-1-infected children, 33 were examined. Of the

Medical evaluation

By August 1993, the cutoff date, 58% of the patients were in CDC class P-1/P-2, subclass A and all patients were ambulatory (Table I). Neurologic findings, including head circumference, were normal in 30 patients. One child had, from the age of 5 years, a pseudo bulbar syndrome with buccolingual dyspraxia and unexpressive facies. Another had multiple brain metastases of a leimyosarcoma, and one patient had a generalized cytomeg alovirus infection. The last two patients died during the course of

DISCUSSION

The survival rate at 6 years of age of the patients whom we studied was similar to that of the patients from the French Prospective Study,24 which supports the conclusion that the population of children studied was representative of perinatally HIV-1-infected children at school age. Two thirds of the children followed had normal performance in elementary school, and most had normal results on tests evaluating general abilities, language, and motor functions; these results are in opposition to

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    ☆

    From the Service de Neurologie, Département de Pédiatrie, the Unité INSERM U292, Hôpital de Bicêtre, and the Unité d'Immuno-Hématologie, Hôpital des Enfants-Malades, Paris, France

    ☆☆

    Supported by the Agence Nationale de Recherche sur le SIDA (ANRS), and by a grant from the Banque Nationale de Paris.

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    Reprint requests: Marc Tardieu, MD, Service de Neurologie, Département de Pédiatrie, Hôpital de Bicêtre, 94275 Le Kremlin- Bicêtre Cedex, France.

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    0022-3476/95/$3.00 + 0 9/20/60906

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