Professional Documents
Culture Documents
in HIV-infected Children
Endah Citraresmi
HIV Task Force, Indonesia Pediatric Society
Harapan Kita Women & Children Hospital, Jakarta
Outline
Normal Neurodevelopmental
HIV in children development in problems in HIV-
children infected children
Neurodevelopmental
screening in HIV- Summary
infected children
HIV in Children
HIV affects an estimated 3.2 million children worldwide, and the
majority of the 240,000 newly infected children are perinatally HIV
(PHIV)-infected
The virus can enter the central nervous system (CNS) within days after
primary infection, posing a major threat to neurodevelopment
Global Update on the Health Sector Response to HIV. Geneva: WHO; 2014
J Infect Dis. 2012;206(2):275282
HIV in Children
Children infected with HIV are at increased risk for CNS disease
characterized by cognitive, language, motor, and behavioral
impairments.
The severity: ranges from subtle impairments in selective domain to
severe deterioration of global developmental skills
HIV-related CNS dysfunction in children is primarily the result of HIV
infection in the brain
Delay
Developmental Delay in HIV Children
Virus
Environmental factors
Poverty Parental risks: alcohol, drug use, Family illness Stigma, hospitalisation,
mental health disorders separation, rejection
HIV-Encephalopathy
HIVE refers to the disease, damage or malfunction of the brain caused
by HIV-1.
Static HIVE is an unchanging, less threatening type of encephalopathy,
whereas,
Progressive HIVE gradually becomes more destructive over time.
Currently, HIVE is classified as a stage 4 AIDS-defining illness (WHO)
reflecting the severity of the disease
HIV-encephalopathy diagnostic criteria
Pediatrics. 2007;119(3):e681e693
Loss of motor function is less evident in older children, but subtle strength
and fine-motor impairments have been reported in clinically stable school-
age PHIV-infected children, both cART-nave and -experienced
Pediatrics 2005;115:380387
Clin Infect Dis. 2012;54(7):10011009
Percentage of infants delayed at each
visit for developmental outcomes.
100
90
83 83 86
80
78 75
Mean IQ Score
60
40
20
Pediatrics 2008;122:e123-8
Pediatrics 2012;130:e132644
List of the neurobehavioral
functions to be assessed and
psychometric tests that can be
used as part of a comprehensive
psychological assessment of
children with HIV infection
Recommended neurodevelopmental serial
assessment schedule for children with HIV-1 infection
at various ages