Neuropsychiatric Outcomes in Children and Adolescents with Perinatally Acquired HIV: A Systematic Review and Meta Analysis.

Objective: The objective of this study is to define the neuropsychiatric challenges including developmental delay, cognitive impairment and psychiatric illness faced by children with perinatally acquired HIV.

Data sources: Nine databases were searched on 30/05/2023: MEDLINE, Embase, and PsycINFO (all via Ovid SP); CINAHL and Child Development and Adolescent Studies (via EBSCO); the Web of Science Core Collection; Scopus; ProQuest Dissertations and Theses Global; and WHO Global Index Medicus. No limits were applied. Search strategies incorporated keywords and thesaurus headings to describe children and adolescents aged 0-25 with perinatally acquired HIV and terms to describe the spectrum of neuropsychiatric impairment.

Study selection: Entries were reviewed by two independent reviewers. Studies were included if they involved a population of children with perinatally acquired HIV and investigated a neurological or psychiatric outcome.

Main outcome measures: Hypothesis that children with pHIV would have more neuropsychiatric challenges than children without pHIV was formulated before the study. Main outcome measures include incidence and severity of cognitive impairment, developmental delay and psychiatric illness in children with pHIV.

Results: 45 studies on cognitive impairment were included of which eight studies were included for meta-analysis and demonstrated a standardised mean difference of -0.508 where children without HIV had higher cognitive scores (95% CI -0.7903; -0.2272). 15 studies on developmental delay were included of which nine were included for meta-analysis and demonstrated, for motor delay, a standardised mean difference (SMD) of -0.794 where children without HIV achieved higher motor function scores (95% CI: -0.9986 to -0.590; ) and for cognitive delay a SMD of -0.697 where children without HIV achieved higher cognitive function scores (CI -0.976 to -0.417;). 39 studies on psychiatric illness were included with an odds ratio for anxiety and depression of 1.105, suggesting that children with HIV had slightly higher odds of developing anxiety or depression, however this result was not significant (CI: 0.778 - 1.571).

Conclusions: Children with perinatally acquired HIV may have a greater cognitive impairment, motor and cognitive delay and would likely benefit from tailored approaches to improve their outcomes.