Background:  Children infected with HIV are at increased risk for developing central nervous system disease characterized by cognitive, language, motor, and behavioral impairment. Although HIV-infected children on HAART may have an overall cognitive functioning within normal limits with adequate functioning in school and activities of daily living, they often have significant impairments in selective neurobehavioral functions. We hypothesize that children with viremia (>400 copies HIV RNA/mL) will have evidence of decreased neurocognitive function compared with healthy, uninfected controls and infected children without viremia (<400 copies HIV RNA/mL).

Methods:  Neurobehavioral testing was performed on 22 HIV-infected children and 20 controls (8 to 17 years old) enrolled in an 18-month study. In the baseline analysis HIV-infected children were divided into those with (n = 14) and without (n = 8) viremia. Statistical methods: Kruskal-Wallis test and ANOVA.

Results:  HIV-infected children with viremia performed 1.5 to 2 standard deviations below controls on all components of the Children’s Paced-Serial Addition Test (p = 0.01 to 0.08). Children with viremia also had lower scores than controls on the Delis-Kaplan Executive Function System motor speed assessment with mean scaled scores of 9.0±3.0 and 11.25±2.6, respectively (p = 0.01). Parents of HIV-infected young children with viremia (n = 6, 8 to 11 years) endorsed fewer symptoms of depressed mood (p = 0.01) than did parents of controls (n = 7) on the Behavior Assessment System for Children (BASC). There were no differences in parent-endorsed symptoms of depression among older children (12 to 17 years) on the BASC adolescent subscale.

Conclusions:  HIV-infected children with viremia have significantly decreased attention and motor coordination compared with healthy controls. Parents of children with HIV may underestimate the effect of the infection on their child’s mental health, a phenomenon described in other chronic diseases.