by Perinatal transmission of Human Immunodeficiency Virus (HIV) to newborns is linked to notable cognitive deficits as they grow older, according to a comprehensive analysis of 35 studies conducted by researchers at Georgetown University Medical Center. The study sheds light on the geographic regions and factors contributing to brain development outcomes related to perinatal HIV infection, including mother-to-child transmission during pregnancy, labor, and breastfeeding.
Advancements in antiretroviral therapies have transformed HIV from a life-threatening condition into a chronic disease. Currently, there are approximately 3 million children and adolescents living with HIV and over 300,000 new HIV infections occurring annually worldwide.
Despite achieving a perinatal HIV transmission rate below one percent in the U.S., racial and ethnic disparities persist, requiring ongoing efforts to eliminate them, says Xiong Jiang, Ph.D., the study’s senior author and an associate professor in the Department of Neuroscience at Georgetown University Medical Center.
However, significant challenges remain in diagnosing and treating perinatal HIV infection in low and middle-income countries. These disparities stem from limited access to care, procurement of antiretroviral drugs, suboptimal viral suppression in young children, and high rates of co-morbidities such as tuberculosis and malnutrition.
To better understand the impact of perinatal HIV disease on cognitive development, researchers led by Sophia Dahmani, a third-year medical student at the Georgetown University School of Medicine, analyzed data from 35 studies published between 2012 and 2023. These studies included over 4,000 perinatally-infected HIV individuals, over 2,300 HIV-exposed but uninfected individuals, and nearly 2,500 HIV-unexposed, uninfected individuals. The researchers based their cognitive analyses on neurological scores of the children when they reached an average age of around 11 years old.
The study focused on test scores from three cognitive domains that closely correlate and play essential roles in childhood development: executive function, working memory, and processing speed. Perinatally HIV-infected children and adolescents had significant impairments in processing speed (-.64), working memory (-.69), and executive function (-.35) compared to the two uninfected groups. Additional analyses suggested that the deficit for processing speed negatively correlated with a country’s gross national income (GNI) per capita, meaning that the lower the GNI per capita of a country, the more severely affected the processing speed for people with perinatal HIV living in that country.
To improve the long-term cognitive and functional outcomes of children and adolescents living with HIV, researchers suggest introducing early childhood education programs, academic accommodations, and caregiver training programs.
Future research directions include encouraging larger and more comprehensive studies on perinatal HIV in various countries to reduce the need for combining multiple smaller studies for analysis. This will necessitate collaborative efforts from international organizations like the World Health Organization, the United Nations, and governments of both low to middle-income and high-income countries.
