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 May 30, 2023: MEDLINE, Embase, and PsycINFO (all through Ovid SP); CINAHL and Child Development and Adolescent Studies (through 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 years with perinatally acquired HIV and terms to describe the spectrum of neuropsychiatric impairment. STUDY SELECTION: Entries were reviewed by 2 independent reviewers. Studies were included if they involved a population of children with perinatally acquired HIV and investigated a neurologic 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: Forty-five studies on cognitive impairment were included of which 8 studies were included for meta-analysis and demonstrated a standardized mean difference of -0.508 where children without HIV had higher cognitive scores (95% CI: -0.7903 to -0.2272). In total, 15 studies on developmental delay were included, of which 9 were included for meta-analysis and demonstrated, for motor delay, a standardized 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 an SMD of -0.697 where children without HIV achieved higher cognitive function scores (95% CI: -0.976 to -0.417). In total, 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 (95% CI: 0.778 to 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.