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HIV infected children likely to suffer cognitive impairment: study

Mumbai

Children infected with the Human Immunodeficiency Virus (HIV) have to endure a significant adverse impact on their neurodevelopment and cognitive functioning, a new study has revealed.

Analyzing resting state functional MRIs, the study, published recently in the online journal NeuroImage Clinical, reveals that HIV-infected children have lower neuropsychological test scores thus reflecting reduced memory span, attention deficit and decreased visual-motor coordination among other conditions.

Published on October 29, the study, carried out by a team of doctors at Fortis Memorial Research Institute in Gurugram, King George Medical University in Lucknow and Sidra Medicine in Doha, Qatar, highlighted significant fluctuations in regions of the brain that are associated with auditory, language, sensory and motor functional networks of HIV infected children.

“Decline of mental processes has been commonly observed in HIV infected adults. The common condition we see in adult patients is dementia, which broadly refers to a decline in memory or thinking skills and encephalopathy, a condition that affects the structure or function of the brain. This new study asserts similar impact on HIV infected children”, said neurologist Dr Ravindra Garg from Lucknow’s King George Medical University, one of the investigators of the study.

The researchers assessed 26 perinatally HIV infected children being treated under the National AIDS Control Programme in eastern Uttar Pradesh and 20 non-infected children from the same region. The mean age of the children was 10 years.

“We carried out resting state Magnetic Resonance Imaging (MRI) of all children and generated maps of Amplitude of Low Frequency Fluctuations (ALFF), a neuroimaging method to gauge spontaneous fluctuations and Functional Connectivity (FC) that analyses brain networks”, explained Dr Rakesh Gupta, a neuro-radiology expert from Fortis, adding that the findings were co-related with neuropsychological assessment scores.

The study concluded that all HIV infected children had lower neuropsychological test scores as compared to the control group.

The HIV infected children in the study were also found to have significantly decreased Amplitude of Low Frequency Fluctuations (ALFF) and Functional connectivity (FC) in multiple brain regions that are related to cognition. Such reduction suggests altered brain functional activity, the study said. “We were able to locate altered cortical thickness, subcortical volumes and structural connectivity anomalies in the HIV infected children which reflects attention deficits, behavioural implications, and other cognitive issues,” said Dr. Mohammad Haris from Qatar’s Sidra Medicine, one of the authors of the study.

Dr Haris, an expert in translational imaging, said the findings will facilitate early detection of structural and functional brain changes, allowing appropriate treatment and therapies to improve functional activities in children with immunity disorders.

HIV is a virus that attacks the immune system and is known to affect almost every organ in the human body.

Nearly 60,000 children in India are currently taking Anti-Retroviral Therapy (ART) for HIV. Doctors treating these children commonly observe slackened physical as well as mental growth.

“The virus is present in patient’s bloodstream and thus gets lodged in every part of the body. It affects the brain, heart, kidney, liver etc., leaving the patient extremely immuno-compromised,” said paediatrician Dr. Yashwant Gabhale who heads civic-run Sion Hospital’s paediatric ART centre in Mumbai.

“The key to achieving overall growth in HIV infected children is a good diet, 100% medicine compliance and regular physical activity. This ensures that their viral load is low and CD-4 (immune cells) count is high. However, a large majority of children fail to achieve this,” said Dr Gabhale, adding that larger studies with bigger sample size will reflect the ground realities more coherently.

Doctors say such studies highlight the need for a holistic approach to HIV programmes. The emphasis should not only be on medication, but also nutritional, psychological and neurodevelopment support.

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