HIV Negatively Affects Children's Brains Despite Treatment

HIV-positive children administered antiretroviral therapy have changes in their white matter brain tissue.

Despite treatment with antiretroviral therapy (ART), HIV may have a significant impact on the brain development of pediatric patients, according to a new study published by Frontiers in Neuroanatomy.

Notably, even children exposed to HIV who did not develop an infection may have brain changes related to the virus, according to the study authors.

While novel treatments have translated HIV from a lethal diagnosis to a chronic disease, treatment for infants and children is complex because HIV is known to cause brain abnormalities, but treatment can also have ill effects.

The authors said that treatment for HIV-positive infants became standard. Due to the new standards, researchers have attempted to better understand how HIV can affect child development.

"Despite early antiretroviral therapy, we continue to observe white matter damage at the age of 7 years, with new damage evident between the ages of 5 and 7," said lead author Marcin Jankiewicz, PhD. "These observations in HIV-positive children point to ongoing disruptions in white matter development regardless of early antiretroviral therapy and viral suppression."

Included the study were 65 HIV-positive and 46 HIV-negative children aged 7 years. HIV-positive patients started ART by 18 months of age due to enrollment in the Children with HIV Early Antiretroviral (CHER) clinical trial.

Diffusion tensor imaging was used to analyze the white matter of the patients. This type of brain tissue is involved with transmitting information between different regions of the brain, according to the authors.

The investigators said their findings confirm the microstructural differences between HIV-positive and negative patients, according to the study.

"The CHER cohort is one of the largest and best-documented trials of children receiving antiretroviral therapy within the first 2 years of life," Dr Jankiewicz said. "Since age- and community-matched uninfected infants were enrolled in parallel, and our colleagues at Stellenbosch University had tracked brain development in these children throughout their early years in a neurodevelopmental sub-study, we had an amazing opportunity to add state-of-the-art neuroimaging assessments."

The study also included patients who were exposed to the virus but were not infected, including infants whose mothers were HIV-positive. These children were incorporated into the uninfected cohort, which allowed researchers to investigate the potential effect of HIV and ART exposure without infection.

The authors noted that HIV-negative children exposed to the virus also had alterations in their white matter development, according to the study.

Due to the relatively small sample size, the authors are uncertain what these changes mean for children exposed to HIV and those with the infection; however, they note that their findings may increase the understanding of brain development for these children and the long-term effect of ART.

"We hope that our work will eventually help identify the parts of the brain that are particularly vulnerable to HIV and/or antiretroviral therapy and clarify how the timing of therapy affects brain development," Dr Jankiewicz said. "This could inform treatment policy, help improve drug combinations, and guide early intervention strategies."