FOGARTY PROGRAM

1
THE IMPACT OF HIV INFECTION ON THE DEVELOPMENT OF
PRESCHOOL DOMINICAN CHILDREN
M. Hernandez-Reif1, R. Mendoza2, R. Castillo2, G.
Zhang4, G. Shor-Posner3 1Touch Research
Institute, University of Miami School of
Medicine 2CENISMI/Robert Reid Cabral Childrens
Hospital, Santo Domingo, DR 3Division of Disease
Prevention, Dept of Psychiatry and Behavioral
Sciences, University of Miami School of Medicine
4Miami-Dade County Health Department/Florida
Department of Health
Supported by NIH/NCCAM R21 AT01160 and
NIH/Fogarty D43 TW00017 (GSP)
2
BACKGROUND
HIV/AIDS is becoming the leading infectious cause
for developmental delays in children.
HIV vertically infected children show

• Structural anomalies in the brain via CT Scans
  (including brain atrophy, calcification,
  ventricular enlargement) (Blanchette et al. 2001,
  Canadian study).

3
BACKGROUND, cont

• Delayed pubertal onset and pubertal maturation
  (Buchacz et al. 2003, large USA study).

4
BACKGROUND, cont

• Delayed motor learning in HIV children on HAART
  (von Giesen et al. 2003, German Study).

5
BACKGROUND, cont

• Greater delays in motor and mental development
  occur within the first 30 months of life in
  children infected vertically (Smith et al. 2000,
  NIH National Study).

6
BACKGROUND, cont

• The Dominican Republic has the 2nd highest
  incidence of HIV-1 infected children in the
  Caribbean
• Antiretrovirals are not yet widely available in
  the Dominican Republic.

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PURPOSE

• To evaluate the developmental profile of
  preschool children with HIV/AIDS living in the
  Dominican Republic who are not receiving
  antiretrovirals.

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METHODS
Participants (Preliminary data Final sample
will be 54 children) 29 HIV Dominican children
receiving care at the Robert Reid Cabral
Childrens Hospital

• Age 3-7 years old
• 59 Females

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INSTRUMENT
DEVELOPMENTAL PROFILE-II (Alpern, Bell Shearer,
2000)

• 186 items that assess childs functional
  developmental age
• Interview and direct testing approaches
• Sensitive to Ethnic Socioeconomic (SES) Biases

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RESULTS
IQ Equivalence Academic Age/Chronological Age

• Counting (1, 2, 3)
• Aware that different activities occur at
  different times of day (meals)
• After listening to a short story can answer
  simple questions
• Can draw a picture of a person (at least the head)

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ACADEMIC
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IQ RESULTS

• Approximately 40 of the children were not
  enrolled in school
• 97 of the children had IQ scores below the
  normal IQ score for children their age (Mean IQ
  77)
• 23 of the children scored in the mild mental
  retardation range (IQ 55-70)

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PHYSICAL

• Throw a ball
• Turn a door knob
• Hop on one foot
• Jump
• Cut a circle using scissors and paper

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PHYSICAL
15
SOCIAL

• Plays games (hide-and-seek, etc.)
• Uses thank you and youre welcome
• Recognizes emotions in others (mad, angry)
• Tells secrets to friends

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SOCIAL
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COMMUNICATIVE

• Knows first and last name when asked
• Can sing a short song (30 words)
• Can tell a short story (Little Red Riding Hood)
• Displays age using fingers
• Recognizes and can read some words (older
  children)

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COMMUNICATIVE
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SELF-HELP

• Can put on own shoes, dress self
• Awakens without bladder or bowel accident
• Puts toys or things away when asked
• Can fix him/herself something simple to eat
• Can brush or comb hair

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SELF-HELP
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CONCLUSIONS

• IQ 97 Average
• 25 Mild Mental Retardation

• Effects might relate to
• HIV virus in the brain
• Lack of school enrollment (40)
• Lower SES
• And/or invalid IQ test

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CONCLUSIONS

• 40 showed delays in physical development
• 24 revealed delays in self-help
• Despite their HIV status, the majority of the
  children appeared to be capable of caring for
  themselves

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CONCLUSIONS

• About 30 were delayed in social development
• About 90 were delayed in communication skills
• Effects might be related to
• HIV virus
• SES
• Sensitivity of DP-II

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GENDER DIFFERENCES
Male children showed more physical and social
delays than girls
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CONCLUSIONS
Findings should be considered with caution until

• Replicated with a larger sample size
• Compared with normative data HIV seropositive
  Dominican children

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CONCLUSIONS

• Overall findings suggest
• Dominican children infected with HIV not
  receiving antiretrovirals show developmental
  delays in several domains.