# Motivation levels and white matter microstructure in children living with HIV

## TL;DR

Children living with HIV show reduced motivation, which may be linked to changes in brain white matter structure, according to a study in South Africa.

## Contribution

This study is the first to link reduced motivation in children with HIV to specific white matter microstructure changes in the brain.

## Key findings

- Children living with HIV scored significantly lower on motivation assessments compared to normative values.
- Motivation levels were significantly lower in children on ART compared to ART-naïve slow progressors.
- Motivation scores correlated with white matter microstructure in frontostriatal brain regions, particularly the anterior limb of the internal capsule.

## Abstract

Central nervous system involvement in HIV infection leads to neurobehavioural sequelae. Although apathy is a well-recognised symptom in adults living with HIV linked to alterations in brain structure, there is scarce research examining motivation in children living with HIV (CLWH). We used the Children’s Motivation Scale (CMS; normative mean = 50, SD = 10) to assess motivation levels in 76 CLWH aged 6–16 years (63 on antiretroviral therapy [ART]; 13 ART-naïve slow progressors) in South Africa. Overall, CLWH scored low on the CMS (mean = 35.70 [SD = 5.87]). Motivation levels were significantly reduced in children taking ART compared to ART-naïve slow progressors (p = 0.02), but were not correlated with markers of HIV disease (CD4 + cell count or viral load), or neurocognitive function (p > 0.05). CMS scores were correlated with diffusion tensor imaging metrics of white matter microstructure in specific frontostriatal brain regions (p < 0.05). On multiple regression, associations with the anterior limb of the internal capsule, a subcortical white matter region, remained significant after adjusting for potential confounders. These findings suggest that reduced motivation may be an important neurobehavioural symptom in CLWH and may reflect changes in white matter microstructure of frontostriatal brain regions.