According to a new study, children infected with the Human Immunodeficiency Virus (HIV) have to endure a significant adverse impact on their neurodevelopment and cognitive functioning.
The study was published on October 29 after a team of doctors at Fortis Memorial Research Institute in Gurugram, King George Medical University in Lucknow and Sidra Medicine in Doha, Qatar carried out the research highlighting significant fluctuations in regions of the brain that are associated with auditory, language, sensory and motor functional networks of HIV infected children.
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Analysing resting state functional MRIs the study 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.
The study was published recently in the online journal NeuroImage Clinical.
One of the investigators of the study, Dr Ravindra Garg, neurologist from Lucknow’s King George Medical University, said “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.”
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.
The neuropsychological assessment was carried out through a specially designed test for children to detect memory span, verbal meaning, mazes, learning names, quantity, discs, hidden figure, closure and exclusion. For example, in exclusion, children were given geometrical forms that have common characteristic except one and asked to pick the one that is different. This score reflects on the child’s cognition of figural classes and similarities. In closure, the children were shown incomplete pictures of familiar birds and animals for 30 seconds for them to identify. This reflects on their cognition of incomplete objects.
In mazes, children held a stylus on the maze on a paper sheet and were asked to find a way out without crossing the walls. Mazes reflect visual-motor coordination, planning etc. 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 who 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.
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.
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 neurodevelopmental support.