M. Hernandez-Reif 1 , R. Mendoza 2 , R. Castillo 2 , G. Zhang 4 , G. Shor-Posner 3

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 Children’s 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. • Structural anomalies in the brain via CT Scans (including brain atrophy, calcification, ventricular enlargement) (Blanchette et al. 2001, Canadian study). HIV vertically infected children show:

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.

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

8. METHODS Participants(Preliminary data – Final sample will be 54 children) 29 HIV+ Dominican children receiving care at the Robert Reid Cabral Children’s Hospital • Age: 3-7 years old • 59% Females

9. INSTRUMENT • 186 items that assess child’s functional developmental age • Interview and direct testing approaches • Sensitive to Ethnic & Socioeconomic (SES) Biases DEVELOPMENTAL PROFILE-II(Alpern, Bell & Shearer, 2000)

10. 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)

11. 86% Delayed Normal ACADEMIC

12. 97% 23% Below Normal Mild Mental Retardation 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)

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

14. 62% 38% Delayed Normal PHYSICAL

15. SOCIAL • Plays games (hide-and-seek, etc.) • Uses “thank you” and “you’re welcome” • Recognizes emotions in others (mad, angry) • Tells secrets to friends

16. 69% 31% Delayed Normal SOCIAL

17. 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)

18. 90% Delayed Normal COMMUNICATIVE

19. 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

20. 76% 24% Delayed Normal SELF-HELP

21. 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

22. 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

23. 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

24. 50% 50% 29% 29% Physical Social GENDER DIFFERENCES Male children showed more physical and social delays than girls

25. CONCLUSIONS Findings should be considered with caution until • Replicated with a larger sample size • Compared with normative data – HIV seropositive Dominican children

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