Growing up with HIV: Research into brain development and long-term health

With this thesis, we aimed to investigate whether current HIV care, including the use of contemporary suppressive antiretroviral treatment, results in normal brain development in PHIV-positive children growing into adulthood. Our research shows that, indeed, when adolescents receive suppressive treatment, long-term brain development is for the most part similar to HIV-negative peers. This thesis identified one exception, delayed development in cognitive executive functioning, which we explain as the possible outcome of cerebral damage acquired in early life when HIV replication was not yet controlled by the use of cART. While our overall results look promising, this thesis also shows that adolescents living with PHIV continue to show poorer cognitive performance and more extensive brain abnormalities compared to their peers. I believe that, to further improve the long-term health of children at risk or living with PHIV globally, and to spend available money most wisely, we should prioritize three specific areas: (1) the prevention of HIV transmission and in particular mother-to-child HIV transmission, (2) early HIV diagnosis and immediate effective, well-tolerated, and least toxic treatment when HIV is diagnosed, and finally, (3) tertiary prevention to reduce complications.