Cognitive and motor development in HIV infected children : a systematicreview

[摘要] ENGLISH ABSTRACT: The global epidemic of HIV continues with an estimated 2.2 million children under 15years of age worldwide living with HIV and 640 000 newly infected in 2004 (WHO,2009). HIV crosses the blood–brain barrier which may lead to neuronal damage anddeath. There is controversial evidence within available research on effects of HIV oncognitive and motor development in children because of the limitations imposed bystudy designs, study populations and study methodological quality.The aims of the review were:- To conduct a systematic review of published research to establish the effects andthe prevalence of HIV infection on cognitive and motor development in children.- To critically appraise the methodological quality of published research regardingcognitive and motor development of HIV infected children.The objectives of the review were:- To assess evidence on the cognitive and motor development of HIV-1 infectedchildren- To describe anthropometric outcomes including: weight for age, weight forheight, height for age and head circumference in children with a HIV infection.- To assess the methodological quality of studies on the cognitive and motordevelopment of HIV infected children.The following databases were searched for identification of articles; MEDLINE, GoogleScholar, AIDSTRIALS, AIDSLINE and CINHAL. The search time frame includedpublished works from inception to July 2011 without language restrictions.Analytical observational trials that assessed at least one outcome (cognitive or motordevelopment or 1 of the anthropometric outcomes) between HIV positive and HIVnegative children aged 5 years and below or children with a mean age of less than 5years were employed.Two review authors independently searched for eligible studies, evaluatedmethodological quality and extracted the data. Meta-analysis was carried out using RevMan 5.1 using the risk ratio for categorical data and standard mean difference forcontinuous data.Fifteen studies with a total of 3 086 participants met the inclusion criteria. HIV infectedchildren were 2.45 times at higher risk of developing cognitive developmental delay thanHIV negative children (RR, 95% CI, 1.95, 3.07, P < 0.00001). Infected children scored -0.54 less than HIV negative children (SMD 95% CI, -0.70, -0.39, 97, p < 0.00001) forcognitive development and -0.68 in motor development (SMD 95% CI, -0.82, -0.55, p<0.00001). The risk of motor developmental delays was 2.95 times in HIV positivecompared with HIV negative children (RR 95% CI, 2.19, 3.99, p < 0.00001).HIV infected children are slower in aspects of cognitive and motor developmentcompared to their HIV negative counterparts. They also showed delays inanthropometric outcomes; weight for age and height for age. Study design influencedresults of the studies with children scoring more on cross sectional than cohort studies.There is still need to develop culturally appropriate or standardise neurodevelopmenttools as most African studies still rely on international tools. More evidence is needed onthe effectiveness of HAART in reducing cognitive and motor delay.

[发布机构] Stellenbosch University