Cognitive impairment and behavioural disturbances following malaria or HIV infection in childhood

Abstract

While both falciparum malaria and human immunodeficiency virus infections are not classified under the neglected disease criteria, both have been shown to affect the central nervous system (CNS), which is of importance but neglected area of neuroscience research. The brunt of these two diseases is borne by children in sub-Saharan Africa, and unfortunately, the study of long-term effect cognitive deficits and disorders due the CNS infections in these children has been neglected. We review the evidence of the effect of falciparum malaria and HIV on the brain, describe the patterns of involvement and propose mechanisms by which these infections can alter the brain function. The results reveal that falciparum malaria results in different patterns of impairment, which may in part be explained by methodological and definition differences, however the cognitive impairment appear to cover all categories of cognition suggesting diffuse damage. HIV has been shown to impact on multiple developmental domains starting early in life and persisting into adolescence. Various biomedical and psychosocial factors have been observed to either exacerbate or ameliorate the negative effects of HIV. Existing knowledge gap on impairment related to malaria and HIV shows significant gaps especially as it relates to elucidating pathways to poor outcome. Future research efforts need to focus on understanding these mechanisms so as to guide targeted intervention.