HIV-positive adolescents more likely to have poor language and writing skills

HIV-positive children and adolescents have poor language and reading skills, American researchers report in the June edition of AIDS Patient Care and STDs. The study also showed that HIV-exposed but uninfected children had lower educational attainment than expected for their age.

“This study demonstrates poor verbal and reading ability among youths infected with and affected by HIV, and highlights the importance of educational interventions that address this emergent need,” comment the investigators.

Thanks to effective HIV treatment, the majority of children infected with HIV by their mother are now surviving into adolescence. In New York City, where the current study was conducted, the majority of HIV-positive children and adolescents are from migrant or other minority racial/ethnic communities.

There are often multiple factors that affect the educational and cognitive development of these children. These include exposure to illicit substances when in the womb, residence in areas with under-performing schools, and infrequent school attendance because of ill health.

Although there is a considerable amount of research showing that infection with HIV has an adverse impact on the educational development of younger children, the data concerning older children and adolescents are limited.

Therefore investigators compared the language and reading skills of 340 children and adolescents. Of these, 206 were HIV-positive, the others being HIV-exposed but uninfected.

Recruitment to the study took place between 2003 and 2007. Information was also gathered on the children’s demographics, their school record, and for HIV-positive children, their CD4 cell count, viral load and use of antiretroviral therapy. The study participants were aged between nine and 16 years. The HIV-infected children had a median CD4 cell count of 572 cells/mm³. The majority (84%) were taking antiretroviral therapy, but only 34% had a viral load below 400 copies/ml.

Tests showed that HIV-positive children had poorer word recognition (p = 0.008) and writing skills (p = 0.028) than the HIV-exposed children.

Furthermore, the HIV-positive children were also more likely than their HIV-negative peers to have a history of special educational placement (52% vs 37%, p

When the investigators adjusted for demographic factors, such as the child’s gender, household income, education of their caregiver, and race/ethnicity, they still found that HIV-infected children had significantly poorer word recognition (p = 0.024) and writing skills (p = 0.02) than HIV-exposed but uninfected children of the same age.

Neither CD4 cell count nor viral load were associated with language or writing skills, but the investigators did find that these were significantly worse in children and adolescents taking antiretroviral therapy (p = 0.018).

“HIV-positive youths’ performance was statistically worse as compared to seroreverters on both measures of reading and language ability and HIV-positive youth were more likely to have attended special education classes”, comment the investigators, “our data suggest that infected youths continue to have learning problems at higher than expected rates as they age and enter adolescence.”

However, the investigators also note that the performance of the HIV-negative children was also “well below age expectations”.