Behavioral problems and lower than average scores on tests measuring development and intellectual capacity are common in HIV-infected children, according to a report in the journal Pediatrics.

HIV-infected children are at high risk for developing neurological and neurodevelopmental impairments, the authors explain, but the effect of HIV infection on specific behavioral issues is poorly understood.

Dr. Molly L. Nozyce from the Bronx Lebanon Hospital Center, New York and colleagues characterized the behavioral and intellectual profiles of 274 children with stable HIV infection previously treated with antiretroviral drugs.

The children scored significantly lower than the average score of 100 in the general population on intellectual evaluations, the authors report.

The results from the Conners’ Parent Rating Scale (CPRS) indicated that 16 percent of the children had a conduct problem, 25 percent had a learning problem, 28 percent were psychosomatic, 19 percent were impulsive-hyperactive, 8 percent had an anxiety problem, and 20 percent had attention deficit with hyperactive disorder (ADHD).

The authors note that the prevalence of ADHD in the general population, according to the American Psychiatric Association, is 3 percent to 5 percent.

Anxiety problems were more likely among children over 9 years of age, the results indicate, but children who lived with their biological parents were less likely to have conduct problems, learning problems or hyperactivity.

Children with CD4 counts below 660 cells per microliter, white blood cells used to follow the loss of immune function, were more likely to have conduct problems than were children with higher CD4 counts, the researchers note. Children with higher IQ scores were less likely to have learning problems or behaviors associated with ADHD.

There were no gender differences for any of the behavioral parameters evaluated, the investigators observe, and there were no significant correlations between behavioral problems and neuroimaging results.

The source of behavioral abnormalities in HIV-positive children “is likely to be multifactorial, including factors such as prenatal drug exposure, difficult family environment, level of maternal education, changes in caregivers, exposure to lead, nutrition and poverty,” the researchers suggest.

“As therapies improve and children live longer, studies such as ours will help raise awareness and promote the development of therapeutic interventions designed to improve learning and behavior in this population of children,” the authors conclude.

SOURCE: Pediatrics, March 2006.