Developmental challenges in HIV infected children—An updated systematic review

Children with HIV infection are at risk of developmental and behavioural challenges. A systematic review in 2009 set out the extent of delay documented in HIV positive children. This study presents an update and re-analysis. Full searches were conducted in Medline, Cochrane Database and PsycINFO, from which reviewers selected abstracts and followed references to provide detailed studies on HIV and cognitive performance in children under 18 to cover the period 2008–2013. The search generated 21 new studies, 17 of which (81%) report some form of cognitive delay for HIV positive children compared to controls. Some domains measured seem to be more affected than others, with mixed evidence on language and executive functioning. The need for more definitive control of variables was highlighted by the environmental factors contributing to behavioural and cognitive outcomes. In conclusion this systematic review confirms the prevalence of cognitive delay in children with HIV and explores the complexity of the issue. The findings suggest the need for internationally agreed monitoring tools and studies which control for known contributing factors. Research for children is needed with a full understanding of developmental challenges, to point the way forward for effective interventions.