Language Impairment May Be More Common Than Previously Thought in Perinatally HIV-Infected Children, Study Suggests

An Interview With Mabel Rice, Ph.D.

There's nothing like hearing the results of studies directly from those who actually conducted the research. In this interview, you'll meet one of these impressive HIV researchers and read her explanation of a study she presented at CROI 2009.

My name is Mabel Rice; I'm from the University of Kansas. The title of our poster is "Language Impairment in 7- to 16-Year-Old Perinatally HIV-Infected Children." This is a study that's taking a look at a broad set of issues known as HAND, or HIV-associated neurocognitive disorders. In particular, we're interested in children's language acquisition. It's a part of cortical functioning that can be affected: The language can be affected [directly], or broader cognitive processes can be affected that, in turn, drive the language impairment.

Mabel Rice, Ph.D.
Mabel Rice, Ph.D.

There are two things we have that are unusual for this kind of work. One of them is that we have direct assessment of hearing, and we know that some of the children that were identified as being language impaired are children who have a hearing deficit, which is very important. Mitochondrial RNA is related to the risk of hearing impairments with these kids; we're able to document that. We're also able to document that there's a greater-than-expected risk for language impairment [among perinatally HIV-infected children]. These youngsters are trailing their typically developing peers in language acquisition by a considerable extent. We looked at children who scored in the bottom percentile, roughly, on an omnibus language measure. Then we looked to see the extent to which they had other cognitive problems.

How many children were you looking at?

We had 178. These are children that were perinatally exposed [to HIV] and are HIV positive. Out of those 178, about 33% score low on language assessments. When you subdivide that, about two-thirds of those are youngsters who have cognitive impairment as well. There's a higher risk than we would expect for children to be delayed in language acquisition, even if they are not cognitively impaired.

Figure 1: Percent With HIV Disease Severity Markers Within Each Language Impairment Category

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Mabel Rice et al. CROI 2009; abstract 919. Reprinted with permission. Download the full poster.

Then we took a look at disease indicators, and found that those who were cognitively impaired as well were more likely to have these disease indicators: a CDC [U.S. Centers for Disease Control and Prevention] Class C event at entry into the study; a higher viral load; or a lower percentage of CD4 cells available to fight the disease.

The import of all of this is that the kids who are more at risk for these disease indicators are kids who have more pervasive, higher cognitive risk as well. We have to keep our eye on these kids who are just language-impaired.

One of the predictors was having been on protease inhibitor [PI] treatment at study entry [with an odds ratio of approximately 4.0; P = .07 in a multivariate analysis].

Not any particular PI?

Table 2: Univariate Logistic Regression Models for Primary LI vs. No Impairment

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Mabel Rice et al. CROI 2009; abstract 919. Reprinted with permission. Download the full poster.

No, this is lumped across different PIs.

What was the racial breakdown in the children?

It's about 73% African American. We have done more detailed analyses of race as a risk indicator. These analyses indicate that that risk is significant when we look at secondary language impairment versus no impairment -- that is, the more severe, more extensive cognitive impairment, plus language impairment, is where that predictor variable becomes significant.

We have follow-up analyses planned on that, and we have a follow-up group coming along right behind this group [to examine] children who are HIV negative even though they were also perinatally exposed. We'll be able to compare that group with the [children who became] HIV positive out of perinatal exposure, to help sort through some of these other predictor variables as well.

How is this correlated with viral load and CD4 count?

Table 3: Univariate Logistic Regression Models for Secondary LI vs. No Impairment

Click to enlarge

Mabel Rice et al. CROI 2009; abstract 919. Reprinted with permission. Download the full poster.

The predictor is quite strong for the secondary impairment -- a P level about .07 for secondary impairment versus no impairment. It makes quite a difference, actually.

OK. Thank you very much.

You're very welcome. It's my pleasure. This is my first time at this meeting. My major line of work involves kids with language impairment who are not carrying any other known disease state, so this is a natural complement. I've really enjoyed it.

This transcript has been lightly edited for clarity.


  1. Rice M, Williams P, Malee K, et al, for the Pediatric HIV/AIDS Cohort Study (PHACS). Language impairment in 7- to 16-year-old perinatally HIV-infected children. In: Program and abstracts of the 16th Conference on Retroviruses and Opportunistic Infections; February 8-11, 2009; Montréal, Canada. Abstract 919.
    View poster: Download PowerPoint

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