Predicting HIV disease progression in children using measures of neuropsychological and neurological functioning

Background. Neuropsychological testing and 2 measures of neurological statu s, cortical atrophy, and motor dysfunction were assessed for their usefulne ss in predicting human immunodeficiency virus (HIV) disease progression in infants, children, and adolescents who participated in Pediatric AIDS Clini cal Trials Group Protocol 152 (PACTG 152). Methods. A cohort of 722 antiretroviral therapy-naive children with symptom atic HIV infection were assessed at study entry and at later intervals. Ass essments included neurodevelopmental testing, neuroradiologic imaging, and neurological examination of motor function. CD4 cell count and plasma RNA v iral load also were measured. Results. Children with the lowest neuropsychological functioning (IQ < 70) at baseline had the highest risk for later HIV disease progression (56%), c ompared with those with borderline/low (IQ = 70-89) functioning (26%), or w ith average or above (IQ > 90) functioning (18%). This was also true of wee k 48 neuropsychological functioning. Motor dysfunction (especially reduced muscle mass) at entry also predicted disease progression. Furthermore, moto r dysfunction and week 48 neuropsychological functioning provided predictiv e information beyond that obtainable from surrogate markers of HIV disease status (eg, CD4 count, HIV RNA level). Children with cortical atrophy also were at higher risk for later disease progression, but when CD4 count and R NA viral load were known, cortical atrophy information provided no addition al predictive information. Conclusions. Measures of neuropsychological and motor function status provi de unique information regarding pediatric HIV disease progression. As such, these findings have important implications for predicting long-term outcom es (eg, longevity) in pediatric patients.