Cognitive and psychosocial development of HIV pediatric patients receiving highly active anti-retroviral therapy: a case-control study

Abstract
Background: The psychosocial development of pediatric HIV patients has not been extensively evaluated. The
study objectives were to evaluate whether emotional and social functions are differentially associated with HIVrelated
complications.
Methods: A matched case-control study design was conducted. The case group (n = 20) consisted of vertically
infected children with HIV (aged 3-18 years) receiving HAART in Greece. Each case was matched with two randomly
selected healthy controls from a school-based population. CNS imaging and clinical findings were used to identify
patients with HIV-related neuroimaging abnormalities. The Wechsler Intelligence Scale III and Griffiths Mental Abilities
Scales were applied to assess cognitive abilities. The age specific Strengths and Difficulties Questionnaire was used to
evaluate emotional adjustment and social skills. The Fisher’s exact test, student’s t-test, and Wilcoxon rank sum test
were used to compare categorical, continuous, and ordinal scores, respectively, of the above scales between groups.
Results: HIV patients without neuroimaging abnormalities did not differ from patients with neuroimaging
abnormalities with respect to either age at HAART initiation (p = 0.306) or months of HAART treatment (p = 0.964).
While HIV patients without neuroimaging abnormalities had similar cognitive development with their healthy
peers, patients with neuroimaging abnormalities had lower mean General (p = 0.027) and Practical (p = 0.042)
Intelligence Quotient scores. HIV patients without neuroimaging abnormalities had an increased likelihood of both
Abnormal Emotional Symptoms (p = 0.047) and Hyperactivity scores (p = 0.0009). In contrast, HIV patients with
neuroimaging abnormalities had an increased likelihood of presenting with Abnormal Peer Problems (p = 0.033).
Conclusions: HIV patients without neuroimaging abnormalities are more likely to experience maladjustment with
respect to their emotional and activity spheres, while HIV patients with neuroimaging abnormalities are more likely
to present with compromised social skills. Due to the limited sample size and age distribution of the study
population, further studies should investigate the psychosocial development of pediatric HIV patients following the
disclosure of their condition.

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