Skip to main content

Advertisement

SpringerLink
Log in

CNS Impact of Perinatal HIV Infection and Early Treatment: the Need for Behavioral Rehabilitative Interventions Along with Medical Treatment and Care

  • Central Nervous System and Cognition (SS Spudich, Section Editor)
  • Published:
Current HIV/AIDS Reports Aims and scope Submit manuscript

Abstract

There is growing concern that although the more severe forms of HIV-associated neurologic deficits are reduced following highly active anti-retroviral therapy (HAART), mild to moderate cognitive disorders may persist for years after HAART initiation and this may occur despite complete plasma viral suppression. According to the UNAIDS 2014 report, there were 3.2 million children living with HIV around the world at the end of 2013 and 91 % of these resided in sub-Saharan Africa. In the same year, only 24 % of children who needed antiretroviral treatment (ART) received it and 190,000 children died of AIDS-related illnesses. We propose that behavioral interventions are needed in combination with medical treatment and care in order to fully address the needs of children and adolescents in Africa living with HIV. In early childhood, caregiver training programs to enhance the developmental milieu of the child with HIV can enhance their cognitive and social development and that such interventions are both feasible and well-accepted by the local population. For school-age children, computerized cognitive rehabilitation training can be an entertaining and engaging way to improve attention, working memory, and problem solving skills for children with HIV. Further dissemination and implementation science work is needed for arriving at cost-effective strategies for scaling up such behavioral interventions in African resource-constrained settings, given that the vast majority of HIV-affected children and youth worldwide presently live in sub-Saharan Africa.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Jeremy RJ, Kim S, Nozyce M, Nachman S, McIntosh K, Pelton SI, et al. Neuropsychological functioning and viral load in stable antiretroviral therapy-experienced HIV-infected children. Pediatrics. 2005;115:380–7.

    Article  PubMed  Google Scholar 

  2. Puthanakit T, Aurpibul L, Louthrenoo O, Tapanya P, Nadsasarn R, Insee-ard S, et al. Poor cognitive functioning of school-aged children in Thailand with perinatally acquired HIV infection taking antiretroviral therapy. AIDS Patient Care STDs. 2010;24:141–6.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Van Rie A, Dow A, Mupuala A, Stewart P. Neurodevelopmental trajectory of HIV-infected children accessing care in Kinshasa, Democratic Republic of Congo. J Acquir Immune Defic Syndr. 2009;52:636–42.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Le Doare K, Bland R, Newell ML. Neurodevelopment in children born to HIV-infected mothers by infection and treatment status. Pediatrics. 2012;130:e1326–44.

    Article  PubMed  Google Scholar 

  5. Brahmbhatt H, Boivin M, Ssempijja V, Kigozi G, Kagaayi J, Serwadda D, et al. Neurodevelopmental benefits of antiretroviral therapy in Ugandan children aged 0-6 years with HIV. J Acquir Immune Defic Syndr. 2014;67:316–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Taylor BS, Hammer SM. The challenge of HIV-1 subtype diversity. N Engl J Med. 2008;359:1965–6.

    Article  CAS  PubMed  Google Scholar 

  7. Brenner BG, Oliveira M, Doualla-Bell F, Moisi DD, Ntemgwa M, Frankel F, et al. HIV-1 subtype C viruses rapidly develop K65R resistance to tenofovir in cell culture. Aids. 2006;20:F9–F13.

    Article  CAS  PubMed  Google Scholar 

  8. Martinez-Cajas JL, Pant-Pai N, Klein MB, Wainberg MA. Role of genetic diversity amongst HIV-1 non-B subtypes in drug resistance: a systematic review of virologic and biochemical evidence. AIDS Rev. 2008;10:212–23.

    PubMed  Google Scholar 

  9. Varatharajan L, Thomas SA. The transport of anti-HIV drugs across blood-CNS interfaces: summary of current knowledge and recommendations for further research. Antiviral Res. 2009;82:A99–A109.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Smurzynski M, Wu K, Letendre S, Robertson K, Bosch RJ, Clifford DB, et al. Effects of central nervous system antiretroviral penetration on cognitive functioning in the ALLRT cohort. AIDS. 2011;25:357–65.

  11. Laughton B, Cornell M, Grove D, Kidd M, Springer PE, Dobbels E, et al. Early antiretroviral therapy improves neurodevelopmental outcomes in infants. AIDS. 2012;26:1685–90. This review article concludes that even with HAART treatment from an early age and with good medical care and support, there is still a high prevalence of developmental and psychosocial need among children with HIV, especially as they age through middle childhood into adolescence.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Puthanakit T, Ananworanich J, Vonthanak S, et al. Cognitive function and neurodevelopmental outcomes in HIV-infected children older than 1 year of age randomized to early versus deferred antiretroviral therapy: the PREDICT neurodevelopmental study. Pediatr Infect Dis J. 2013. DOI: 10.1097/INF.0b013e31827fb19d.

  13. Sohn AH, Hazra R. The changing epidemiology of the global paediatric HIV epidemic: keeping track of perinatally HIV-infected adolescents. J Int AIDS Soc. 2013;16:18555.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tobin NH, Aldrovandi GM. Immunology of pediatric HIV infection. Immunol Rev. 2013;254:143–69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Marcotte TD, Deutsch R, McCutchan JA, Moore DJ, Letendre S, Ellis RJ, et al. Prediction of incident neurocognitive impairment by plasma HIV RNA and CD4 levels early after HIV seroconversion. Arch Neurol. 2003;60:1406–12.

    Article  PubMed  Google Scholar 

  16. Sanchez-Ramon S, Bellon JM, Resino S, Canto-Nogues C, Gurbindo D, Ramos JT, et al. Low blood CD8+ T-lymphocytes and high circulating monocytes are predictors of HIV-1-associated progressive encephalopathy in children. Pediatrics. 2003;111:E168–75.

    Article  PubMed  Google Scholar 

  17. Jennings C, Rich K, Siegel JN, Landay A. A phenotypic study of CD8+ lymphocyte subsets in infants using three-color flow cytometry. Clin Immunol Immunopathol. 1994;71:8–13.

    Article  CAS  PubMed  Google Scholar 

  18. Kapetanovic S, Aaron L, Montepiedra G, Burchett SK, Kovacs A. T-cell activation and neurodevelopmental outcomes in perinatally HIV-infected children. AIDS. 2012;26:959–69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Mekmullica J, Brouwers P, Charurat M, Paul M, Shearer W, Mendez H, et al. Early immunological predictors of neurodevelopmental outcomes in HIV-infected children. Clin Infect Dis. 2009;48:338–46.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Davidson RJ, Slagter HA. Probing emotion in the developing brain: functional neuroimaging in the assessment of the neural substrates of emotion in normal and disordered children and adolescents. Ment Retard Dev Disabil Res Rev. 2000;6:166–70.

    Article  CAS  PubMed  Google Scholar 

  21. Galderisi S, Mucci A. Emotions, brain development, and psychopathologic vulnerability. CNS Spectr. 2000;5:44–8.

    Article  CAS  PubMed  Google Scholar 

  22. Charmandari E, Kino T, Souvatzoglou E, Chrousos GP. Pediatric stress: hormonal mediators and human development. Horm Res. 2003;59:161–79.

    CAS  PubMed  Google Scholar 

  23. Mahncke HW, Bronstone A, Merzenich MM. Brain plasticity and functional losses in the aged: scientific bases for a novel intervention. In: Moller AR, editor. Progress in brain research. Amsterdam: Elsevier B.V; 2006. p. 81–109.

    Google Scholar 

  24. Bonnier C. Evaluation of early stimulation programs for enhancing brain development. Acta Paediatr. 2008;97:853–8.

    Article  PubMed  Google Scholar 

  25. Klein P, Rye H. Interaction-oriented early intervention in Ethiopia: the MISC approach. Infants and Young Children. 2004;17.

  26. Klein PS. Early Intervention: cross-cultural experiences with a mediational approach, Garland Reference Library of Social Science. New York: Garland Press; 1996.

    Google Scholar 

  27. Klein PS. Seeds of hope: twelve years of early intervention in Africa. Oslo: unipub forlag; 2001.

    Google Scholar 

  28. Armstrong F, Willen E, Surgen K. HIV/AIDS in children and adolescents. In: Handbook of pediatric psychology. 3rd ed. 2003. p. 359–74.

    Google Scholar 

  29. O’Hare BA, Venables J, Southall D. Child health in Africa: 2005 a year of hope? Arch Dis Child. 2005;90:776–81.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bass E. The two sides of PEPFAR in Uganda. Lancet. 2005;365:2077–8.

    Article  PubMed  Google Scholar 

  31. Cohen J. ABC in Uganda: success or subterfuge. HIV AIDS Policy and Law Review. 2005;10:23–4.

    Google Scholar 

  32. Nyamukapa CA, Gregson S, Lopman B, Saito S, Watts HJ, Monasch R, et al. HIV-associated orphanhood and children’s psychosocial distress: theoretical framework tested with data from Zimbabwe. Am J Public Health. 2008;98:133–41.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bose S. An examination of adaptive functioning in HIV infected children: exploring the relationships with HIV disease, neurocognitive functioning, and psychosocial characteristics. ProQuest Inform Learn. AAM9719709. 1997;Dissertation Abstracts International: Section B: The Sciences and Engineering:409.

  34. UNAIDS. UNAIDS Report on the global AIDS epidemic/2010. In: Joint United Nations Programmes on HIV/AIDS; 2010.

    Google Scholar 

  35. Ronald AR, Sande MA. HIV/AIDS care in Africa today. Clin Infect Dis. 2005;40:1045–8.

    Article  PubMed  Google Scholar 

  36. Caruso N. Refuge from the Lord’s Resistance Army in Uganda: a report from a Medecins Sans Frontieres team leader. Emerg Med Australas. 2006;18:295–8.

    Article  PubMed  Google Scholar 

  37. Fabiani M, Nattabi B, Opio AA, Musinguzi J, Biryahwaho B, Ayella EO, et al. A high prevalence of HIV-1 infection among pregnant women living in a rural district of north Uganda severely affected by civil strife. Trans R Soc Trop Med Hyg. 2006;100:586–93.

    Article  PubMed  Google Scholar 

  38. Orach CG, De Brouwere V. Integrating refugee and host health services in West Nile districts, Uganda. Health Policy Plan. 2006;21:53–64.

    Article  PubMed  Google Scholar 

  39. Foster G, Williamson J. A review of current literature on the impact of HIV/AIDS on children in sub-Saharan Africa. Aids. 2000;14 Suppl 3:S275–84.

    PubMed  Google Scholar 

  40. Boivin MJ, Green SD, Davies AG, Giordani B, Mokili JK, Cutting WA. A preliminary evaluation of the cognitive and motor effects of pediatric HIV infection in Zairian children. Health Psychol. 1995;14:13–21.

    Article  CAS  PubMed  Google Scholar 

  41. Ruel TD, Boivin MJ, Boal HE, Bangirana P, Charlebois E, Havlir DV, et al. Neurocognitive and motor deficits in HIV-infected Ugandan children with high CD4 cell counts. Clin Infect Dis. 2012;54:1001–9.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kamau JW, Kuria W, Mathai M, Atwoli L, Kangethe R. Psychiatric morbidity among HIV-infected children and adolescents in a resource-poor Kenyan urban community. AIDS Care. 2012;24:836–42.

    Article  PubMed  Google Scholar 

  43. Van Rie A, Mupuala A, Dow A. Impact of the HIV/AIDS epidemic on the neurodevelopment of preschool-aged children in Kinshasa, Democratic Republic of the Congo. Pediatrics. 2008;122:e123–8.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Msellati P, Lepage P, Hitimana DG, Van Goethem C, Van de Perre P, Dabis F. Neurodevelopmental testing of children born to human immunodeficiency virus type 1 seropositive and seronegative mothers: a prospective cohort study in Kigali, Rwanda. Pediatrics. 1993;92:843–8.

    CAS  PubMed  Google Scholar 

  45. Bunupuradah T, Kosalaraksa P, Vibol U, Hansudewechakul R, Sophonphan J, Kanjanavanit S, et al. Impact of antiretroviral therapy on quality of life in HIV-infected Southeast Asian children in the PREDICT study. AIDS Patient Care STDs. 2013;27:596–603.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Musisi S, Kinyanda E. Emotional and behavioural disorders in HIV seropositive adolescents in urban Uganda. East Afr Med J. 2009;86:16–24.

    Article  CAS  PubMed  Google Scholar 

  47. Scharko AM. DSM psychiatric disorders in the context of pediatric HIV/AIDS. AIDS Care. 2006;18:441–5.

    Article  CAS  PubMed  Google Scholar 

  48. Benton TD. Psychiatric considerations in children and adolescents with HIV/AIDS. Child Adolesc Psychiatr Clin N Am. 2010;19:387–400. x.

    Article  PubMed  Google Scholar 

  49. Benton TD. Treatment of psychiatric disorders in children and adolescents with HIV/AIDS. Curr Psychiatry Rep. 2010;12:104–10.

    Article  PubMed  Google Scholar 

  50. Laughton B, Cornell M, Boivin M, Van Rie A. Neurodevelopment in perinatally HIV-infected children: a concern for adolescence. J Int AIDS Soc. 2013;16:18603.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Hazra R, Siberry GK, Mofenson LM. Growing up with HIV: children, adolescents, and young adults with perinatally acquired HIV infection. Annu Rev Med. 2010;61:169–85.

    Article  CAS  PubMed  Google Scholar 

  52. Foster C, Fidler S. Optimizing antiretroviral therapy in adolescents with perinatally acquired HIV-1 infection. Expert Rev Anti Infect Ther. 2010;8:1403–16.

    Article  CAS  PubMed  Google Scholar 

  53. Ciaranello AL, Chang Y, Margulis AV, Bernstein A, Bassett IV, Losina E, et al. Effectiveness of pediatric antiretroviral therapy in resource-limited settings: a systematic review and meta-analysis. Clin Infect Dis. 2009;49:1915–27.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Sutcliffe CG, van Dijk JH, Bolton C, Persaud D, Moss WJ. Effectiveness of antiretroviral therapy among HIV-infected children in sub-Saharan Africa. Lancet Infect Dis. 2008;8:477–89.

    Article  PubMed  Google Scholar 

  55. Mellins CA, Malee KM. Understanding the mental health of youth living with perinatal HIV infection: lessons learned and current challenges. J Int AIDS Soc. 2013;16:18593.

    Article  PubMed  PubMed Central  Google Scholar 

  56. UNAIDS. UNAIDS Report on the global AIDS epidemic/2010. In: Joint United Nations Report on HIV/AIDS 2013. 2013.

    Google Scholar 

  57. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B. Developmental potential in the first 5 years for children in developing countries. Lancet. 2007;369:60–70.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Farah MJ, Betancourt L, Shera DM, Savage JH, Giannetta JM, Brodsky NL, et al. Environmental stimulation, parental nurturance and cognitive development in humans. Dev Sci. 2008;11:793–801.

    Article  PubMed  Google Scholar 

  59. Rao H, Betancourt L, Giannetta JM, Brodsky NL, Korczykowski M, Avants BB, et al. Early parental care is important for hippocampal maturation: evidence from brain morphology in humans. Neuroimage. 2009.

  60. Feuerstein R. Instrumental enrichment: redevelopment of cognitive functions of retarded performers. New York: University Park Press; 1980.

    Google Scholar 

  61. Vygotsky LS. Mind in society: the development of higher psychological processes. Cambridge, MA: Harvard University Press; 1978.

    Google Scholar 

  62. Feurerstein R. Then dynamic assessment of retarded performers. 1979.

    Google Scholar 

  63. Feurerstein R. Instrumental enrichment: redevelopment of cognitive functions of retarded performers. 1980.

    Google Scholar 

  64. Boivin MJ, Bangirana P, Nakasujja N, Page CF, Shohet C, Givon D, et al. A year-long caregiver training program improves cognition in preschool Ugandan children with human immunodeficiency virus. J Pediatr. 2013;163:1409–16. This publication is the first to document that a caregiver training program can significantly enhance neurodevelopmental outcomes in African children with HIV. This study also documents that such a program can improve mental health outcomes in the caregivers and survival rates among younger children with HIV.

    Article  PubMed  Google Scholar 

  65. Grantham-McGregor S, Schofield W, Harris L. Effect of psychosocial stimulation on mental development of severely malnourished children: an interim report. Pediatrics. 1983;72:239–43.

    CAS  PubMed  Google Scholar 

  66. Grantham-McGregor S, Schofield W, Powell C. Development of severely malnourished children who received psychosocial stimulation: six-year follow-up. Pediatrics. 1987;79:247–54.

    CAS  PubMed  Google Scholar 

  67. Grantham-McGregor S, Stewart ME, Schofield WN. Effect of long-term psychosocial stimulation on mental development of severely malnourished children. Lancet. 1980;2:785–9.

    Article  CAS  PubMed  Google Scholar 

  68. Klein PS, Rye H. Interaction-oriented early intervention in Ethiopia: the MISC approach. Infants and Young Children. 2004;17:340–54.

    Article  Google Scholar 

  69. Feuerstein R. The dynamic assessment of retarded performers. New York: University Park Press; 1979.

    Google Scholar 

  70. Boivin MJ, Bangirana P, Nakasujja N, Page CF, Shohet C, Givon D, et al. A year-long caregiver training program to improve neurocognition in preschool Ugandan HIV-exposed children. J Dev Beh Ped. 2013;34:269–78.

  71. Klein PS. More intelligent and sensitive child. Ramat-Gan, Israel: Bar-Ilan University; 1985.

    Google Scholar 

  72. Minde KK. Psychological problems in Ugandan school children: a controlled evaluation. J Child Psychol Psychiatry. 1975;16:49–59.

    Article  CAS  PubMed  Google Scholar 

  73. Bass JK, Nakasujja N, Familiar-Lopez I, Sikorskii A, Murray SM, Opoka R, et al. Association of caregiver quality of care with neurocognitive outcomes in HIV-affected children aged 2–5 years in Uganda. AIDS Care. 2016. http://dx.doi.org/10.1080/09540121.2016.1146215:1-8.

  74. Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P, Dahlstrom K, et al. Computerized training of working memory in children with ADHD—a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry. 2005;44:177–86.

    Article  PubMed  Google Scholar 

  75. Klingberg T, Forssberg H, Westerberg H. Training of working memory in children with ADHD. J Clin Exp Neuropsychol. 2002;24:781–91.

    Article  PubMed  Google Scholar 

  76. Rabiner DL, Murray DW, Skinner AT, Malone PS. A randomized trial of two promising computer-based interventions for students with attention difficulties. In: Journal of Abnormal Child Psychology; 2010. p. 131–42.

    Google Scholar 

  77. Koekkoek S, de Sonneville LMJ, Wolfs RFW, Licht R, Greelen SPM. Neurocognitive function profile in HIV-infected school-age children. Eur J Paediatr Neurol. 2008;12:290–7.

    Article  PubMed  Google Scholar 

  78. Martin SC, Wolters PL, Toledo-Tamula MA, Zeichner SL, Hazra R, Civitello L. Cognitive functioning in school-aged children with vertically acquired HIV infection being treated with highly active antiretroviral therapy (HAART). Dev Neuropsychol. 2006;30:633–57.

    Article  PubMed  Google Scholar 

  79. Bisiacchi PS, Suppiej A, Laverda A. Neuropsychological evaluation of neurologically asymptomatic HIV-infected children. Brain Cogn. 2000;43:49–52.

    CAS  PubMed  Google Scholar 

  80. Koekkoek S, Eggermont L, De Sonneville L, Jupimai T, Wicharuk S, Apateerapong W, et al. Effects of highly active antiretroviral therapy (HAART) on psychomotor performance in children with HIV disease. J Neurol. 2006;253:1615–24. 

  81. Tardieu M, Mayaux MJ, Seibel N, Funck-Brentano I, Straub E, Teglas JP, et al. Cognitive assessment of school-age children infected with maternally transmitted human immunodeficiency virus type 1. J Pediatr. 1995;126:375–9.

    Article  CAS  PubMed  Google Scholar 

  82. Boivin MJ, Ruel TD, Boal HE, Bangirana P, Cao H, Eller LA, et al. HIV-subtype A is associated with poorer neuropsychological performance compared with subtype D in antiretroviral therapy-naive Ugandan children. AIDS. 2010;24:1163–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Bangirana P, Boivin MJ, Giordani B. Computerized Cognitive Rehabilitation Therapy (CCRT) for African children: evidence for neuropsychological benefit and future directions. In: Boivin MJ, Giordani B, editors. Neuropsychology of children in Africa: perspectives on risk and resilience. New York: Springer Science+Business Media; 2013. p. 277–98. This review chapter is the first to document the evidence supporting the neuropsychological benefit of computerized cognitive rehabilitation training (CCRT) with African children with HIV and those surviving severe malaria. This review also considers strategies for scaling such interventions to the community level.

    Chapter  Google Scholar 

  84. Lowenthal ED, Marukutira TC, Chapman J, Mokete K, Riva K, Tshume O, et al. Psychosocial assessments for HIV+ African adolescents: establishing construct validity and exploring under-appreciated correlates of adherence. PLoS ONE. 2014;9:e109302

  85. Lowenthal ED, Bakeera-Kitaka S, Marukutira T, Chapman J, Goldrath K, Ferrand RA. Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges. Lancet Infect Dis. 2014;14:627–39

  86. Cowan F, Pettifor A. HIV in adolescents in sub-Saharan Africa. Curr Opin HIV AIDS. 2009;4:288–93.

    Article  PubMed  Google Scholar 

  87. Engle PL, Black MM, Behrman JR, Cabral de Mello M, Gertler PJ, Kapiriri L, et al. Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world. Lancet. 2007;369:229–42.

    Article  PubMed  Google Scholar 

  88. Walker SP, Wachs TD, Gardner JM, Lozoff B, Wasserman GA, Pollitt E, et al. Child development: risk factors for adverse outcomes in developing countries. Lancet. 2007;369:145–57.

    Article  PubMed  Google Scholar 

  89. Boivin MJ, Bangirana P, Tomac R, Parikh S, Opoka RO, Nakasujja N, et al. Neuropsychological benefits of computerized cognitive rehabilitation training in Ugandan children surviving cerebral malaria and children with HIV. BMC Proc. 2008;2:P7.

    Article  Google Scholar 

  90. Boivin MJ, Busman RA, Parikh SM, Bangirana P, Page CF, Opoka RO, et al. A pilot study of the neuropsychological benefits of computerized cognitive rehabilitation in Ugandan children with HIV. Neuropsychology. 2010;24:667–73.

    Article  PubMed  Google Scholar 

  91. Boivin MJ, Giordani B. Neuropsychological assessment of African children: evidence for a universal basis to cognitive ability. In: Chiao JY, editor. Cultural neuroscience: cultural influences on brain function. New York: Elsevier Publications; 2009. p. 113–35.

    Chapter  Google Scholar 

  92. Boivin MJ, Nakasujja N, Sikorskii A, Opoka RO, Giordani B. A randomized controlled trial to evaluate if computerized cognitive rehabilitation improves neurocognition in Ugandan children with HIV. AIDS Res Hum Retroviruses. 2016;32:743–55.

    Article  PubMed  Google Scholar 

  93. Giordani B, Novak B, Sikorskii A, Bangirana P, Nakasujja N, Winn BM, et al. Designing and evaluating Brain Powered Games for cognitive training and rehabilitation in at-risk African children. Global Mental Health. 2015;2:1–14.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and the Department of Neurology and Ophthalmology, Michigan State University, 909 Fee Road, Rm 321 West Fee Hall, East Lansing, MI, 48894, USA

    Michael J. Boivin

  2. Department of Psychiatry, Michigan State University, 909 Fee Road, Rm 321 West Fee Hall, East Lansing, MI, 48894, USA

    Michael J. Boivin, Horacio Ruiseñor-Escudero & Itziar Familiar-Lopez

Authors
  1. Michael J. Boivin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Horacio Ruiseñor-Escudero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Itziar Familiar-Lopez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael J. Boivin.

Ethics declarations

Conflict of Interest

Michael J. Boivin, Horacio Ruiseñor-Escudero, and Itziar Familiar-Lopez declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Central Nervous System and Cognition

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boivin, M.J., Ruiseñor-Escudero, H. & Familiar-Lopez, I. CNS Impact of Perinatal HIV Infection and Early Treatment: the Need for Behavioral Rehabilitative Interventions Along with Medical Treatment and Care. Curr HIV/AIDS Rep 13, 318–327 (2016). https://doi.org/10.1007/s11904-016-0342-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11904-016-0342-8

Keywords

Search

Navigation