EARLY LANGUAGE-DEVELOPMENT IN CHILDREN EXPOSED TO OR INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

Objectives. To compare language development in infants and young child ren with human immunodeficiency virus (HIV) infection to language deve lopment in children who had been exposed to HIV but were uninfected, a nd (among subjects with HIV infection) to compare language development with cognitive and neurologic status. Design. Prospective evaluation of language development in infected and in exposed but uninfected infa nts and young children. Setting. Pediatric Infectious Disease Clinic, State University of New York-Health Science Center at Syracuse. Subjec ts. Nine infants and young children infected with HIV and 69 seroposit ive but uninfected infants and children, age 6 weeks to 45 months. Res ults. Mean Early Language Milestone Scale, 2nd edition (ELM-2) Global Language scores were significantly lower for subjects with HIV infecti on, compared with uninfected subjects (89.3 vs 96.2, Mann-Whitney U te st). The proportion of subjects scoring >2 SD below the mean on the EL M-2 on at least one occasion also was significantly greater for subjec ts with HIV infection, compared with uninfected subjects (4 of 9 infec ted subjects, but only 5 of 69 uninfected subjects; Fisher's exact tes t). Seven of the 9 subjects with HIV infection manifested deterioratio n of language function. Four manifested unremitting deterioration; onl y 1 of these 4 demonstrated unequivocal abnormality on neurologic exam ination. Three subjects with HIV infection and language deterioration showed improvement in language almost immediately after the initiation of antiretroviral drug treatment Magnetic resonance imaging or comput ed tomography of the brain were performed in 6 of 7 infected subjects with language deterioration, and findings were normal in all 6. ELM-2 Global Language sealed scores showed good agreement with the Bayley Me ntal Developmental Index or the McCarthy Global Cognitive Index (r = 0 .70). Language deterioration, or improvement in language after initiat ion of drug therapy, coincided with or preceded changes in global cogn itive function, at times by intervals of up to 12 months. Conclusions. Language deterioration occurs commonly in infants and young children with HIV infection, is seen frequently in the absence of abnormalities on neurologic examination or central nervous system imaging, and may precede evidence of deterioration in global cognitive ability. Periodi c assessment of language development should be added to the developmen tal monitoring of infants and young children with HIV infection as a m eans of monitoring disease progression and the efficacy of drug treatm ent.