Browsing by Subject "Pediatric HIV"

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    Demographic and neuropsychological profile of HIV-positive children referred for an assessment at a local clinic over a 5-year period
    (2025) Mokoena, Limpho; Schrieff, Leigh
    Individuals in low- and middle-income countries (LMICs) are disproportionately affected by the human immunodeficiency virus (HIV) relative to high-income countries (HICs). Children are particularly vulnerable given the impact of HIV on brain development. Neuropsychology is still in its infancy in South Africa and there are limited services dedicated to addressing neuropsychological difficulties, including the assessment of children living with HIV. At the pediatric neuropsychology clinic (PNC) at the Red Cross War Memorial Children's Hospital (RXH) in Cape Town, South Africa, free services related to neuropsychological assessments are available to those referred by health professionals, an offering that is rare in South Africa. Considering the impact of HIV on the brain, the PNC offers services and resources to support the study of the effect of HIV (and other pathologies that result in neuropsychological impairments) on the developing brain and its influence on children more broadly in the South African context. Given how limited such services of this nature are in this context and the related opportunity for research and knowledge based on such services, I aimed to the describe the demographic, medical, developmental, and neuropsychological profiles of children referred to RXH PNC over a 5-year period (with an in depth focus on those who are HIV-positive). I investigated a series of neuropsychological reports from the PNC, retrospectively from the year 2012 to 2016, using qualitative and quantitative methods. I report on all the children referred to the clinic within this period (N= 158) and then specifically report in depth on the proportion of children who were HIV-positive (n= 73, 45%) and describe their demographic profiles. I then compared the neuropsychological outcomes of the HIV-Positive Subsample to a separate demographically matched typically developing Control Group (n=41) recruited from local communities. Overall, there were no significant differences in the demographic profile between the HIV- Positive Subsample and the Control Group. However, in the neuropsychological profile there were significant differences found between these two groups in all of the neuropsychological domains except visual memory. The evidence from this study supported the association between cognitive deficits found in children with HIV often discussed in literature. Given the dearth of specialist neuropsychological assessment facilities that are accessible to the public, this highlights the importance of clinics such as the PNC. More specifically the PNC is at the forefront of providing pediatric neuropsychology services in South Africa. The benefits of the PNC include a hub for data of cognitive fall out seen at the clinic which can inform research and other collaborative projects with clinicians and universities. Further, having detailed neuropsychological and demographic profiles/data of children living with HIV can inform intervention-based studies. Intervention-based studies can include a practical component in assisting HIV-positive children attaining a better quality of life considering their neuropsychological difficulties.
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    Resolved lower limb muscle tone abnormalities in children with HIV encephalopathy receiving standard antiretroviral therapy
    (2015) Mann, Theresa N; Donald, Kirsten A; Walker, Kathleen G; Langerak, Nelleke G
    BackgroundThis short report arose from a follow-up study of children previously diagnosed with human immunodeficiency virus (HIV) encephalopathy and spastic diplegia and is among the first to describe that increased lower limb muscle tone in children with a confirmed HIV encephalopathy diagnosis may resolve over time in some cases.ResultsOf 19 children previously diagnosed with HIV encephalopathy and increased lower limb muscle tone, some were found to have resolved muscle tone abnormalities during a follow-up physical examination [resolved group, n=13, median age 9years 7months (interquartile range 7years 3months–10years 9months)] whereas others continued to show increased lower limb muscle tone at follow-up [unresolved group, n=6 median age 8years 6months (interquartile range 7years 9months–9years 7months)]. A review of clinical records showed no significant differences in age or follow-up time between the resolved and unresolved groups. However, the unresolved group appeared to have severe disease at an earlier age than the resolved group, based on the age at antiretroviral treatment initiation [median age at start of treatment 2years 3months (interquartile range 7months–5years 3months) vs. 8months (interquartile range 6–12months), p=0.08] and had more severe neurological signs at the initial assessment.ConclusionsIt is anticipated that this information may be of immediate value to those involved in the treatment of children with HIV encephalopathy and increased lower limb muscle tone whilst awaiting the outcome of future controlled clinical trials.
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    Weight-for-age distributions among children with HIV on antiretroviral therapy in the International epidemiology Databases to Evaluate AIDS (IeDEA) multiregional consortium
    (2020-05-24) Jesson, Julie; Desmonde, Sophie; Yiannoutsos, Constantin T; Patten, Gabriela; Malateste, Karen; Duda, Stephany N; Kumarasamy, Nagalingeswaran; Yotebieng, Marcel; Davies, Mary-Ann; Musick, Beverly; Leroy, Valeriane; Ciaranello, Andrea
    Objective Pediatric antiretroviral therapy (ART) for children with HIV (CHIV) must be dosed appropriately for children’s changing weights as they grow. To inform accurate estimates of ART formulations and doses needed, we described weight-for-age distributions among CHIV on ART in the IeDEA global pediatric collaboration between 2004 and 2016, using data from six regions (East, West, Central, and Southern Africa, Asia–Pacific, and Central/South America and the Caribbean). Results Overall, 59,862 children contributed to the analysis. Age and weight data were available from 530,080 clinical encounters for girls and 537,894 for boys. For each one-year age stratum from 0 to 15 years, we calculated the proportion of children in each of the weight bands designated by the World Health Organization as relevant to pediatric ART formulations: 0 to  < 3 kg, 3 to  < 6 kg, 6 to  < 10 kg, 10 to  < 14 kg, 14 to  < 20 kg, 20 to  < 25 kg, 25 to  < 30 kg, 30 to  < 35 kg, 35 to  < 40 kg, 40 to  < 45 kg, 45 to  < 50 kg, 50 to  < 55 kg, 55 to  < 60 kg, and ≥ 60 kg. Data are reported for the entire cohort, as well as stratified by sex and IeDEA region, calendar year of ART use, and duration on ART at time of assessment (< 12 or ≥ 12 months), provided in data tables. These data are critical to improve the accuracy of forecasting and procurement of pediatric ART formulations as the pediatric HIV epidemic and pediatric HIV treatment strategies evolve.