SAN DIEGO, Oct. 31 -- For a variety of factors, HIV-infected children appear to have more psychiatric problems than uninfected children, researchers said here.
Caregivers reported significantly higher severity of generalized anxiety disorder and attention deficit hyperactivity disorder (ADHD), according to preliminary findings of an ongoing, multicenter, longitudinal study reported at the American Academy of Child and Adolescent Psychiatry meeting.
These findings show that perinatally infected children are at higher risk for developing psychopathology, likely due to effects of the virus on the central nervous system, neurotoxicity of antiretroviral medications, and psychosocial complications, said Jerry Heston, M.D., of St. Jude Children's Research Hospital in Memphis.
"As the domestic perinatally HIV-infected population ages, concern is mounting that long-term effects of HIV and its treatments may result in increased psychiatric disorders," he and colleagues said in a poster presentation.
Mean generalized anxiety severity scores were 3.29 for the 281 HIV-infected participants and 2.91 for the 244 uninfected children who were perinatally HIV-exposed or living in the same household of an HIV-infected person (P=0.032).
ADHD subcategory scores were also higher in HIV-infected children than uninfected controls, though only inattention severity was significantly different. The findings were:
- ADHD inattention severity 8.23 versus 7.26 (P=0.041),
- ADHD hyperactivity severity 5.13 versus 5.11 (P=0.485), and
- ADHD combined severity 13.34 versus 12.35 (P=0141).
However, caregiver-reported Symptom Inventory-4 scores did not indicate significant differences for any of the measures except a lower incidence of conduct disorder in the control group than the infected group (10% versus 4%, P=0.0145).
"If you just look at diagnostic criteria reported by parents, you might not think they have more problems," Dr. Heston said, "but when you look at symptom severity you see they do."
The researchers reported these baseline findings of the ongoing study in these initially six- to 18-year-old children. The HIV-infected group was significantly older than the uninfected group (median 13.0 versus 11.2 years, P<0.001), less likely to live with their biologic parents (43% versus 78%, P<0.0001), and have a greater yearly household income (P=0.0006).
The children who were HIV-infected before or at birth were in "relatively good" immunologic health with 76% classified as having no, mild or moderate symptoms according to Centers for Disease Control and Prevention criteria. CD4 counts were below 500 cells for 71% of the infected children and 55% had viral loads of 400 copies or less. Most (81%) were on highly active antiretroviral therapy.
"While these infected children are in good immunologic health, this does not exclude the impact that prenatal viral exposure, medication effects or neurotoxic effects of the virus may have on the development of psychopathology in infected children," the authors wrote.
They said further study is needed to understand the role of HIV infection and its treatments on psychiatric symptoms. They noted that parents have historically not been accurate reporters of depression and anxiety in their children, so future reports from the ongoing study including non-parental reported symptoms may find more significant differences between groups.
The study is being sponsored by the National Institutes of Health- and National Institute of Mental Health.
Primary Source
American Academy of Child and Adolescent Psychiatry
Source Reference: Heston J, et al "Psychiatric Symptoms in Perinatally HIV-Infected Children: Preliminary Findings" AACAP 2006; 33:F39.