Executive function in HIV-affected children and adolescents: a systematic review and meta-analyses

ABSTRACT

This review aimed to determine: whether EF is affected in children and adolescents (2–24-years-old) with perinatal HIV infection, perinatal HIV exposure without infection, and behaviourally acquired HIV. A systematic review (PROSPERO number: CRD42017067813) was conducted using 11 electronic databases (01.01.1981–09.07.2019) and 8 conference websites. Primary quantitative studies with EF scores on cognitive tasks and/or behavioural report measures were included. Meta-analyses were performed by EF subtype and subpopulations compared. 1789 records were found. Sixty-one studies were included in the narrative synthesis; 32 (N = 7884 participants) were included in meta-analyses. There was a distinct pattern of reduced EF in those with perinatal HIV infection on antiretroviral therapy compared to controls: pooled effect sizes were largest for verbal and visuospatial working memory, with smaller effects on planning, inhibitory control and set-shifting. Data were limited for other HIV-affected subpopulations. Perinatal HIV infection is associated with reduced EF with varying effect sizes for the different EF subtypes.

KEYWORDS:

• Perinatally acquired HIV
• executive function
• systematic review
• HIV-associated neurocognitive disorder
• paediatric HIV
• neurodevelopment

Acknowledgements

KR was funded by the Rhodes Trust, the Africa-Oxford Initiative, and SEMPRE. AS was supported by a grant from the MRC Newton fund. KR, AS, GS and RGW conceptualised the topic. KR wrote the protocol and performed the search. KR screened all records for inclusion. TH and MR each screened half the records for inclusion independently. KR, TH and MR chose the final studies for inclusion. KR extracted data and did quality assessments on all included studies. RB, TH and MR checked data extraction. RB did independent quality assessments on all included studies. KR analysed the data and drafted the manuscript. AS, GS and RGW critically reviewed the manuscript for intellectual content. All authors assisted with manuscript revision and approved the final draft of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Medical Research Council [Newton Fund]; Rhodes Trust; Africa-Oxford Initiative; the Society for Education, Music and Psychology Research (SEMPRE).