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

Background: Neuropsychological testing and 2 measures of neurological status, cortical atrophy, and motor dysfunction were assessed for their usefulness in predicting human immunodeficiency virus (HIV) disease progression in infants, children, and adolescents who participated in Pediatric AIDS Clinical Trials Group Protocol 152 (PACTG 152).Methods: A cohort of 722 antiretroviral therapy-naive children with symptomatic HIV infection were assessed at study entry and at later intervals. Assessments included neurodevelopmental testing, neuroradiologic imaging, and neurological examination of motor function. CD4 cell count and plasma RNA viral 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%), compared with those with borderline/low (IQ = 70–89) functioning (26%), or with average or above (IQ > 90) functioning (18%). This was also true of week 48 neuropsychological functioning. Motor dysfunction (especially reduced muscle mass) at entry also predicted disease progression. Furthermore, motor dysfunction and week 48 neuropsychological functioning provided predictive 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 RNA viral load were known, cortical atrophy information provided no additional predictive information.Conclusions: Measures of neuropsychological and motor function status provide unique information regarding pediatric HIV disease progression. As such, these findings have important implications for predicting long-term outcomes (eg, longevity) in pediatric patients

Ebooks and Interlibrary Loan: Licensed to Fill?

Increasingly, libraries of all types and sizes are now adding electronic book (ebook) titles to their collections. A survey was used to explore the implications of ebook licensing and interlibrary loan use. Among academic libraries in the United States a widespread preference for handling print books was found along with a need for more information about ebook interlibrary loan rights at one’s own institution and a means to identify format type available from potential lending libraries

Cognitive impairment and behavioural disturbances following malaria or HIV infection in childhood

While both falciparum malaria and human immunodeficiency virus infections are not classified under the neglected disease criteria, both have been shown to affect the central nervous system (CNS), which is of importance but neglected area of neuroscience research. The brunt of these two diseases is borne by children in sub-Saharan Africa, and unfortunately, the study of long-term effect cognitive deficits and disorders due the CNS infections in these children has been neglected. We review the evidence of the effect of falciparum malaria and HIV on the brain, describe the patterns of involvement and propose mechanisms by which these infections can alter the brain function. The results reveal that falciparum malaria results in different patterns of impairment, which may in part be explained by methodological and definition differences, however the cognitive impairment appear to cover all categories of cognition suggesting diffuse damage. HIV has been shown to impact on multiple developmental domains starting early in life and persisting into adolescence. Various biomedical and psychosocial factors have been observed to either exacerbate or ameliorate the negative effects of HIV. Existing knowledge gap on impairment related to malaria and HIV shows significant gaps especially as it relates to elucidating pathways to poor outcome. Future research efforts need to focus on understanding these mechanisms so as to guide targeted intervention