COGNITIVE AND BEHAVIORAL ABILITIES OF CHILDREN WITH HIV INFECTION IN GREECE

OBJECTIVE: Our goal was to evaluate cognitive and behavioral abilities of HIV-positive children in Greece. METHODS: The cognitive and behavioral abilities of 20 HIV-positive children (B and C status; 8 boys and 12 girls; aged 3–18 years [mean: 11.5 years]) who were vertically infected and were receiving antiretroviral treatment were assessed twice within a 7-year period. Clinical indices (CD4 lymphocyte and viral load counts) were monitored systematically. A detailed developmental assessment was performed for all children twice within a 7-year period. Cognitive abilities were assessed by using the Wechsler Intelligence Scale for Children III and Griffiths Mental Abilities Scales. Behavioral abilities were assessed by using the Strengths and Difficulties Questionnaire, which provides individual scores for anxiety, emotional tension, conduct, hyperactivity, and social relations with peers and provides an overall index of behavioral difficulties (IBD). Detailed neurologic examination and brain imaging were performed for all children. RESULTS: HIV encephalopathy was evident in 3 children, and 5 of 20 children presented with coexisting diseases (2 neurofibromatosis encephalopathy, 1 brain aneurysm, and 2 autistic disorders). HIV-positive children with normal MRI findings and without signs of HIV encephalopathy scored within the normal range for their chronological age in all measures of general and specific domain cognitive abilities. Low IQ scores showed in 15 of 20 HIV-positive children in both assessments. Factors that were associated consistently with lower scores were positive MRI results, coexistence of an organic disease, maternal education, and gender. The IBD was raised in 7 children. In detail, 9 children had raised IBD scores in emotional tension, 6 seemed to have conduct disorders, 5 had hyperactivity, and 11 presented as having difficulties in social relations with their peers. Factors that were associated significantly and consistently with abnormal IBD scores were lower IQ, positive MRI findings, and coexistence of an organic disease. CONCLUSIONS: Although the sample was small, the findings of our study support the idea that HIV infection places children at increased risk for poor cognitive and behavioral outcomes only if they experience a severe illness of advancing disease stage or a coexisting disease.