HIV infection, even with antiretroviral therapy, appears to damage a growing child's brain

October 17, 2017, Frontiers

HIV infection alters brain development in young children, even when they receive antiretroviral treatment early in life, shows a report in Frontiers in Neuroanatomy. Children exposed to, but not infected by, HIV also appear to have ongoing changes in their brain development.

Although advances in HIV therapy have enabled millions of people to live longer and healthier lives, the of HIV-positive infants and children remains complex. HIV has been shown to cause abnormalities in a child's brain development, however therapeutic interventions can also harm a growing child. While children have always been eligible for treatment, it is only since 2008 that treatment for newborns became standard, after preliminary data from the Children with HIV Early Antiretroviral (CHER) clinical trial. Now, in the era of early treatment, researchers are working to better understand how HIV infection affects children's development—specifically their neurodevelopment.

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

The researchers used an advanced magnetic resonance imaging technique, called diffusion tensor imaging, to look at differences in one type of brain tissue—called white matter—between groups of 65 HIV-positive and 46 uninfected 7-year-old children. White matter plays a critical role in transmitting information between distinct brain regions. The latest study confirmed ongoing microstructural differences in certain tracts between infected and uninfected children.

All the HIV-positive children had started by the age of 18 months in the CHER trial, in Cape Town and Soweto, South Africa. This most recent study follows up on similar observations made when the children were 5 years old.

"The CHER cohort is one of the largest and best-documented trials of children receiving antiretroviral therapy within the first two years of life," says Jankiewicz. "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 neurodevelopmental sub-study also included children who were exposed to HIV, but who were not infected (for example when the mother was infected during pregnancy, but the infection did not transfer to the fetus or infant). These children formed a subset of the uninfected group in the current study, providing an opportunity to see if there were consequences of HIV and antiretroviral exposure in the absence of infection. Unfortunately, these children also appear to have ongoing changes in their white matter development.

While this was a small study and the future implications of such abnormalities are not yet clear, Jankiewicz hopes that these studies will contribute to a better understanding of brain in HIV-infected and exposed , as well as the impact of long-term antiretroviral treatment.

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

Explore further: Mathematical modeling uncovers mysteries of HIV infection in the brain

More information: Marcin Jankiewicz et al, White Matter Abnormalities in Children with HIV Infection and Exposure, Frontiers in Neuroanatomy (2017). DOI: 10.3389/fnana.2017.00088

Related Stories

Mathematical modeling uncovers mysteries of HIV infection in the brain

June 19, 2017
After uncovering the progression of HIV infection in the brain thanks to a new mathematical model developed by a UAlberta research team, clinicians and researchers are developing a nasal spray to administer drugs more effectively.

Antiretroviral regimen associated with less virological failure among HIV-infected children

April 30, 2013
Elizabeth D. Lowenthal, M.D., M.S.C.E., of the University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, and colleagues conducted a study to determine whether there was a difference in ...

SA child living with HIV maintains remission without ARVs since 2008

July 26, 2017
Dr Avy Violari, head of pediatric research at the Perinatal HIV Research Unit (PHRU) in the Faculty of Health Sciences, University of the Witwatersrand, reported the case on 25 July 2017 at the 9th International AIDS Society ...

UN: Children lag sharply in antiretroviral effort

December 1, 2014
A United Nations report says global efforts to provide antiretroviral therapy to children with HIV lags sharply compared to adults.

Mother-to-child HIV transmission low, but more progress possible

March 13, 2017
(HealthDay)—A small proportion of HIV-infected women continue to transmit the virus to their neonates despite access to high-quality care, according to research published in the April issue of Obstetrics & Gynecology.

Recommended for you

Small-scale poultry farming could mean big problem in developing countries

December 16, 2018
Small-scale farming in developing countries provides those in rural communities with income and access to protein, but it may have a large impact on antibiotic resistance, according to a new University of Michigan study.

Wiring diagram of the brain provides a clearer picture of brain scan data

December 14, 2018
Already affecting more than five million Americans older than 65, Alzheimer's disease is on the rise and expected to impact more than 13 million people by 2050. Over the last three decades, researchers have relied on neuroimaging—brain ...

RNA processing and antiviral immunity

December 14, 2018
The RIG-I like receptors (RLRs) are intracellular enzyme sentries that detect viral infection and initiate a first line of antiviral defense. The cellular molecules that activate RLRs in vivo are not clear.

Scientists identify method to study resilience to pain

December 14, 2018
Scientists at the Yale School of Medicine and Veterans Affairs Connecticut Healthcare System have successfully demonstrated that it is possible to pinpoint genes that contribute to inter-individual differences in pain.

Parents' brain activity 'echoes' their infant's brain activity when they play together

December 13, 2018
When infants are playing with objects, their early attempts to pay attention to things are accompanied by bursts of high-frequency activity in their brain. But what happens when parents play together with them? New research, ...

In the developing brain, scientists find roots of neuropsychiatric diseases

December 13, 2018
The most comprehensive genomic analysis of the human brain ever undertaken has revealed new insights into the changes it undergoes through development, how it varies among individuals, and the roots of neuropsychiatric illnesses ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.