APA: Kids with HIV Infection Keep Up Academically

SAN FRANCISCO, Aug. 24 -- Children infected with HIV at birth appear to maintain normal behavior and academic performance after 10 years of follow-up, researchers reported here.

"It appears that the long-term prognosis for children infected at birth with HIV is good," said Suzie Franklin, Ph.D., assistant clinical professor of pediatrics at the Medical College of Wisconsin in Milwaukee. "There is little evidence of behavioral or academic deterioration over time that can be directly attributed to HIV infection itself."

In a report at the American Psychological Association meeting, the researchers found that the behavior of the children normalized and their academic performance appeared to mirror their IQ status and was relatively stable over time.

Dr. Franklin and colleagues reported on outcomes of testing over a 10-year period on 25 children infected through vertical transmission of HIV.

She and her colleagues performed serial evaluations of the children using the validated Achenbach Child Behavior Checklist and the Woodcock Johnson Tests of Academic Achievement-R.

"There have been concerns that HIV infection could impact intellectual development," Dr. Franklin said. "Yet for children who are receiving antiretroviral therapy there does not seem to be a detectable problem."

In fact, the researchers' hypothesis was that children with HIV infection would develop behavioral problems and would show an intellectual falloff over time, a reduction from that expected for the child's IQ.

The researchers noted that in previous studies of behavioral adjustment in children with HIV the results have varied. In studies done prior to the advent of combination highly active antiretroviral therapy (HAART) in 1996, some researchers reported high rates of behavioral disorders.

On the other hand, in later studies done well into the HAART era, researchers found little difference in emotional status between siblings with and without HIV infection. Others observed that children with hemophilia and HIV showed reduced depression and anxiety symptoms over time.

Similarly, studies that looked at children's academic performance reported less accomplishment than would be expected for IQ in children with HIV infection in the pre-HAART era. But in the HAART era, researchers found no academic differences were found between siblings with and without infection.

Dr. Franklin found that the children in her study had average scores on all the studies, and no alarming trends for either behavioral or academic tests.

For example, in the Woodcock Johnson test::

• The participants in the comprehension domain had median score of 91, an upward trend in the test where the range is 53-123.
• The participants in the applied problems domain had a median score of 89, a non-significant score in the test where the range is 16-123.
• The participants in the spelling domain had a median score of 80, a non-significant score in the test where the range was 2-109.

"This long-term longitudinal study is the type of research we are all looking for in this field," commented Abigail F. Freedman, M.D., medical director of the Pediatric Center for Special Studies at New York-Presbyterian Hospital, Weill Cornell Medical College.

"While these results are encouraging we are still looking to see whether there are some subtle effects of the disease that we have not yet picked up on," she added. "We are also examining what effects the social and psychosocial exposures that surround these children have on their development."

Dr. Freedman added, "We long for information that as these children grow into adulthood that they can have as normal development as possible. While the numbers of children born with HIV continue to decrease to an almost vanishing number in the U.S., these studies will have more impact in the rest of the world as treatment becomes extended to less developed areas."