Discordance of Cognitive and Academic Achievement Outcomes in Youth With Perinatal HIV Exposure

Abstract

Background To evaluate achievement in youth with perinatally acquired HIV (PHIV) compared to HIV-exposed uninfected peers (HEU), and to examine differential effects of HIV on cognition-achievement concordance. Methods Cognition and achievement were assessed using standardized measures. IQ-derived predicted achievement scores were subtracted from observed achievement scores to calculate discrepancy values. Linear regression models were used to compare achievement discrepancies between PHIV and HEU, adjusting for demographic covariates. Results Participants: 295 PHIV and 167 HEU youth; 71% black, 48% male, mean age 13.1 and 11.3 years, respectively. PHIV youth were relatively healthy (mean CD4%, 32%; viral load ≤400 copies/mL, 72%). PHIV and HEU youth had cognitive and achievement scores significantly below population norm means (p<0.001), but did not differ in cognition (mean FSIQ=86.7 vs. 89.4, respectively). In unadjusted models, HEU outperformed PHIV youth on Total Achievement (TA; mean=89.2 vs. 86.0, p=0.04) and Numerical Operations (NO; mean=88.8 vs. 82.9, p<0.001); no differences remained after adjustment. Mean observed-predicted achievement discrepancies reflected “underachievement”. History of encephalopathy predicted poorer achievement (p=0.039) and greater underachievement, even after adjustment. PHIV showed greater underachievement than HEU for NO (p<0.001) and TA (p=0.03), but these differences did not persist in adjusted models. Conclusions Both PHIV and HEU youth demonstrated lower achievement than normative samples, and underachieved relative to predicted achievement scores. Observed-predicted achievement discrepancies were associated with prior encephalopathy, older age and other non-HIV factors. PHIV youth with prior encephalopathy had significantly lower achievement and greater underachievement compared to PHIV without encephalopathy and HEU youth, even in adjusted models.

Executive Functioning in Children and Adolescents With Perinatal HIV Infection

“…In fact, caregiver reports indicated fewer everyday EF problems among PHIV youth. These results are consistent with other cognitive and behavioral findings from PHACS 4,30,31 and others 21 in suggesting that differences from the normative population may be related to risk factors other than HIV infection, although the effect of prenatal HIV or antiretroviral exposure cannot be ruled out by our study. Other risk factors may include stressful life events, poverty and resulting lower environmental or educational enrichment, parental illness and functional impairment, and family history of psychiatric disorders 30 .…”

Associations of Memory and Executive Functioning With Academic and Adaptive Functioning Among Youth With Perinatal HIV Exposure and/or Infection

“…Performance on measures of RM, PM, and EF was strongly associated with achievement in reading and math. Consistent with previous research [2][3][4], in general, children in the PHEU and PHIV/non-C groups performed in the average range for age in word reading and low-average range in arithmetic computation; the PHIV/C children were in the low-average and borderline ranges, respectively. Impairments in reading and math occurred more frequently than expected in all 3 groups relative to the general US population.…”

“…In general, children with PHIV perform in the low-average to average range on measures of global cognitive ability and adaptive behavior [2,3] but underperform relative to global cognitive ability on measures of academic achievement [4,5]. Those with a history of encephalopathy or another Centers for Disease Control and Prevention (CDC) class C (AIDS-defining) diagnosis [6] generally perform more poorly on these measures than those without such history [2,3].…”

Stimulant Medications and Cognition, Behavior and Quality of Life in Children and Youth with HIV

“…The PG also showed more frequent signs of conduct problems than the CG. Findings for the PG, but not the CG, were consistent with the literature showing higher risks for behavior and learning problems among children with PHIV, 1,2,7-9 possibly because of the relatively higher prevalence of ADHD and other behavior disorders in the PG. PHIV, per se, might not be the primary mechanism for these difficulties.…”

“…1-2 Recent data from US-based cohorts suggest that children and adolescents with PHIV perform within the low-average to average range of intellectual ability and show higher than expected rates of behavioral impairment. 3-9 From infancy through adolescence, PHIV infection is associated with poorer QOL. 10-13 Youth with PHIV are at risk for clinically significant behavioral problems such as overactivity, impulsivity, and inattention, 1-2 which may affect academic learning, social relationships, and adherence to treatment regimens.…”