A review of the psychological effects of vertically acquired HIV infection in infants and children

Mother to child transmission of HIV (vertical transmission) is the main source of paediatric HIV in the UK and worldwide. Research in Europe indicates that the rate of vertical transmission is 15-20 per cent. This rate is lower than that of less developed countries such as those in sub-Saharan Africa where the rate is approximately 30 per cent. Approximately 40 per cent of HIV+ children develop AIDS within the first four years of life. Prognosis is poor for children who rapidly progress from asymptomatic to symptomatic HIV disease. Neurological and associated conditions are common in children and frequently take the form of developmental delay, neurological symptoms, specific cognitive difficulties and sometimes behavioural problems. However, there are a growing number of children who survive for longer, due in part to advances in medical understanding, but in whom visuo-spatial and language problems are common. It has been difficult to separate the effects of HIV and in utero drug exposure but recent studies point to the effects of parental intravenous drug use (IVDU) as more important than HIV in the emergence of behavioural difficulties in HIV+ children. Factors such as chronic illness (in parents, child, or both), stigmatization of HIV and missed schooling may also contribute to psychological and emotional difficulties.