Longitudinal trajectories of neurocognitive test performance among individuals with perinatal HIV-infection and -exposure: adolescence through young adulthood

Abstract

There are an estimated 2.1 million youth less than 15 years of age living with HIV globally (the majority perinatally HIV-infected [PHIV]) and millions more perinatally HIV-exposed uninfected (PHEU) youth who are expected to survive through adolescence and into adulthood. The transition from adolescence to young adulthood requires adaptation to more demanding social interactions, academic pressures, and individual responsibilities which each place distinct demands on neurocognitive functions. This study examined trajectories of neurocognitive test performance in the domains of processing speed (PS), working memory (WM), and executive functioning (EF) among PHIV and demographically similar PHEU youth as they age through adolescence into young adulthood. Data for this paper come from 4 time points, spanning approximately 10 years, within the Child and Adolescent Self-Awareness and Health Study (CASAH). Youth age ranged from 15 to 29 years. Longitudinal linear mixed effect models were computed for each test as a function of age, PHIV status, PHIV status by age interaction. Our findings indicate that there are few differences in performance on tests of EF and WM between PHIV and PHEU youth as the age from adolescence to adulthood, though PHEU youth showed significantly better PS as they aged than PHIV youth. Future research is needed to understand these vulnerable youth's neurocognitive trajectories as a function of HIV-infection and -exposure, biological functions and psychosocial stressors.

Longitudinal Cognitive Outcomes in Children With HIV in Zambia: 2-Year Outcomes From the HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) Study

“…The effect of early treatment on cognitive outcomes should be investigated in future studies. Our study is also broadly consistent with previous longitudinal cohort studies among children with HIV in the United States 23,26 and Thailand. 24,25 In 2 of 3 of these previous studies (Malee et al and Puthanakit et al), children with HIV were noted to have worse cognitive performance at baseline but relatively stable cognitive function over time.…”

“…One notable difference compared with the Malee et al study is that in our study, even when excluding participants with a history of severe disease, significant differences persisted between children with HIV and HEU controls. The Robbins et al cohort study, 26 conducted with older adolescents and young adults (ages 15–26 years) in New York City, noted somewhat different findings. They found minimal baseline differences between participants with HIV and HEU controls, but noted substantial greater improvements in processing speed over time in the HEU group.…”

“…Youth living with HIV show higher rates of neurocognitive deficits in executive function, memory, and language processing skills. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] However, there are limited data on longitudinal outcomes among children and adolescents living with HIV, 13,[23][24][25][26][27][28][29][30][31][32] with only 2 previous studies conducted in sub-Saharan Africa. 28,29 In this study, we sought to investigate baseline and longitudinal cognitive function among children and adolescents living with HIV compared with HIV-exposed uninfected (HEU) controls, as part of the HIV-associated Neurocognitive Disorders in Zambia (HANDZ) study.…”

“…Youth living with HIV show higher rates of neurocognitive deficits in executive function, memory, and language processing skills. 6–22 However, there are limited data on longitudinal outcomes among children and adolescents living with HIV, 13,23–32 with only 2 previous studies conducted in sub-Saharan Africa. 28,29…”

Cognitive impairments in Polish children and adolescents with perinatal HIV infection

“…However, some observations confirmed the presence of language [2,11,12] and memory deficits, as well as executive functions deficits [2,8,9,[13][14][15][16] in PHIV+ children treated with HAART with medications that penetrate the blood-brain barrier. The most commonly described deficits of executive functioning include sequencing and planning [5,8], response inhibition [8], working memory [5,6,8,[13][14][15][16][17] (including visuospatial working memory, VMW [2,5]), flexibility of attention [2], simple response time [2], and processing speed [2,6,13,15,18].…”