Neurocognition in Viral Suppressed HIV-Infected Children

In the era of combination antiretroviral therapy (ART), children and adolescents with perinatally acquired HIV (PHIV) infection remain at risk for subtle to severe neurocognitive deficits. Early ART initiation in infancy may mitigate global or selective deficits, likely due to viral suppression; however, youth with PHIV who initiate ART later in childhood are less likely to demonstrate normal neurocognition after ART initiation. The presence of neurocognitive deficits and/or the lack of neurocognitive improvement after ART initiation in older children may be due to damage associated with prior immunosuppression, intermittent periods of HIV replication and neuroinflammation during formative years, and/or ART-associated neurotoxicities. The literature supports the need for early ART initiation during infancy, not only for survival benefit but also for optimizing short-term neurodevelopmental outcomes. However, prospective, longitudinal studies remain necessary to determine the long-term neurocognitive outcomes among children with variably timed viral suppression as well as the functional impact of deficits and potential resilience.