IDSA: Neurologic and Psychiatric Problems Common Years after Perinatal HIV Infection

SAN DIEGO, Oct. 8 -- Adolescents and teenagers with perinatally acquired HIV infection have high rates of neurologic, psychiatric, and cognitive problems that can confound attempts to treat them, investigators reported here.

A third of patients had neurologic disorders, particularly HIV encephalopathy, and a third had psychiatric illness, Christos Karatzios, M.D., of McGill University in Montreal, told attendees at the Infectious Diseases Society of America meeting.

As a group, the young HIV patients exhibited below-average IQ, growth impairment, drug-resistant diseases, and poor virologic control.

"This is a shrinking population of HIV-positive patients because of advances in preventing perinatal transmission," said Dr. Karatzios. "However, the findings still apply to medically underserved areas of North America."

Many young people who contracted HIV infection early in life did not receive antiretroviral therapy until they were older, he said. The consequences of delayed therapy have not been studied extensively.

So Dr. Karatzios and colleagues retrospectively reviewed records on 165 patients seen at the pediatric HIV clinic at the University of Miami. The patients' median age was 16.

The records showed that half the patients were below the 25^th percentile in height, and a quarter were above the 75^th percentile for weight. Although 93% of the patients were on antiretroviral therapy, 82% had detectable viral loads. Drug-resistant disease was common, and 10% of the patients had multidrug-resistant disease.

Of the one-third of patients with neurologic diagnoses, 39% had HIV encephalopathy and 28% had cognitive dysfunction.

Of the one-third with psychiatric diagnoses, 95% had attention deficit hyperactivity disorder or depression. The patients had a mean IQ of 78.3, compared with a national average of about 99.

Dr. Karatzios reported that 60% of the patients' caregivers were people other than biological parents. Additionally, in 80% of cases one or both of the parents had died. Among those who were sexually active, 37% did not use condoms and 63% said they did not disclose their HIV status to sex partners.

"Clearly, these kids have a lot of problems that can complicate treatment of HIV and interfere with any attempt to live a normal life," said Dr. Karatzios.

Another study of perinatally acquired HIV infection demonstrated similar findings. The study included 81 patients whose median age was 15. The population included 38 patients with severe disease (class C diagnosis) and 43 patients without a prior class C diagnosis. There were no significant differences between the groups at their most recent visit in CD4+ cell percentage or HIV plasma viral RNA levels.

The entire cohort had a below-average IQ of 87, which included a median of 82 among 38 patients with severe infection. More than 40% had learning disabilities, and almost 20% had ADHD, reported Sarah M. Wood, a medical student at the University of Pennsylvania in Philadelphia.

Almost half the patients (48%) had psychiatric diagnoses, including 60% of those with severe infection. Compared with patients who did not have a history of severe HIV disease, patients with a history of a class C diagnosis demonstrated significantly more psychiatric diagnoses, psychiatric hospitalizations, and learning disabiliites. These same patients also scored significantly lower on IQ tests.

"Our data suggest that advanced HIV disease early in life may have severe neurocognitive and psychiatric consequences, irrespective of progressive encephalopathy," said Wood. "These data would argue strongly in favor of early neuroprotective treatment with HAART in HIV-infected infants."