Socioeconomic Status and Cognitive Function in Children With HIV: Evidence From the HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) Study

Mbewe, Esau G.; Kabundula, Pelekelo P.; Mwanza-Kabaghe, Sylvia; Buda, Alexandra; Adams, Heather; Schneider, Colleen; Potchen, Michael J.; Mweemba, Milimo; Mathews, Manoj; Menon, J. Anitha; Wang, Bo; Baseler, Travis; Paciorkowski, Alex R.; Birbeck, Gretchen L.; Bearden, David

doi:10.1097/qai.0000000000002825

Cited by 10 publications

(10 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The current analysis focuses on a relatively limited cognitive battery that was performed every 3 months; future analyses will report the more comprehensive battery that was performed at annual intervals. However, our analysis of the comprehensive battery at baseline 36 suggested a similar result.…”

Section: Discussionsupporting

confidence: 69%

“…Demographic and health data were collected at baseline using structured interviews with participants and their parents and chart review. Measures of socioeconomic status were combined into a socioeconomic status index (SESI; see Mbewe et al 36 2022 for details). Nutritional status was assessed using a combination of structured interviews, record review, and growth curves.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

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

Patil

Mbewe

Kabundula

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

Background: Multiple studies have shown that children with HIV are at risk for impaired cognition. However, there are limited data on longitudinal cognitive outcomes in children with HIV. Methods:We conducted a prospective cohort study of 208 perinatally infected children with HIV ages 8-17 years, all treated with antiretroviral therapy, and 208 HIV-exposed uninfected controls. Participants were followed for 2 years. Cognition was assessed with a custom NIH Toolbox Cognition Battery, and tests were combined to generate a Summary Cognition Score (SCS). The contribution of potential risk factors to outcomes was explored using regression models and group-based trajectory modeling.Results: HIV was strongly associated with lower SCS at baseline [b-14, 95% confidence interval (CI): 220 to 27, P , 0.001]. Change scores over time were similar between groups, but poorer average performance in children with HIV persisted at the 2-year follow-up visit (adjusted b = 211, 95% CI: 222 to 20.3, P = 0.04). Other than HIV, the strongest predictors of baseline SCS included socioeconomic status index (b =3, 95% CI: 1, 5, P = 0.004), history of growth stunting (b=214, 95% CI: 223 to 26, P = 0.001), history of CD4 count below 200 (b = 219, 95% CI: 235 to 22, P = 0.02), and history of World Health Organization stage 4 disease (b = 210, 95% CI: 219 to 20.2, P = 0.04). In the group-based trajectory model, HIV+ status predicted membership in the lowest performing trajectory group (odds ratio 2.5, 95% CI: 1.2 to 5.1, P = 0.01). Conclusions:Children with HIV are at risk of poor cognitive outcomes, despite chronic treatment with antiretroviral therapy.

show abstract

Section: Discussionsupporting

confidence: 69%

Section: Methodsmentioning

confidence: 99%

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

Patil

Mbewe

Kabundula

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

show abstract

“…Children in the rural areas were accessing care at the ART clinic associated with their residential catchment area. In contrast, the urban cohort were children seeking care at Zambia's largest tertiary care children's hospital and previous work has shown that children accessing care at this site are among the most economically deprived in the city 33,34 . Seizure severity burden was high with children presenting many hours after the index seizure onset with fulminant status epilepticus and/or coma.…”

Section: Discussionmentioning

confidence: 98%

“…In contrast, the urban cohort were children seeking care at Zambia's largest tertiary care children's hospital and previous work has shown that children accessing care at this site are among the most economically deprived in the city. 33,34 Seizure severity burden was high with children presenting many hours after the index seizure onset with fulminant status epilepticus and/or coma. Acute seizure management options are quite constrained in Zambia relative to high-income settings and intubation for ventilation is not de facto available even at the Teaching Hospitals for such cases.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes after new‐onset seizure among Zambian children with HIV during the antiretroviral therapy era

et al. 2022

Self Cite

View full text Add to dashboard Cite

Objective This study describes clinical profiles including human immunodeficiency virus (HIV) disease history and seizure etiology among children living with HIV presenting with new‐onset seizure during the era of antiretroviral therapy (ART) in Zambia. 30‐day mortality and cause of death are also reported. Methods Children living with HIV (CLWHIV) with new‐onset seizures were prospectively evaluated at one large urban teaching hospital and two non‐urban healthcare facilities. Interviews with family members, review of medical records, and where needed, verbal autopsies were undertaken. Two clinicians who were not responsible for the patients' care independently reviewed all records and assigned seizure etiology and cause of death with adjudication as needed. Results From April 2016 to June 2019, 73 children (49 urban, 24 rural) were identified. Median age was 6 years (IQR 2.2‐10.0) and 39 (53%) were male children. Seizures were focal in 36 (49%) and were often severe, with 37% presenting with multiple recurrent seizures in the 24 hours before admission or in status epilepticus. Although 36 (49%) were on ART at enrollment, only 7 of 36 (19%) were virally suppressed. Seizure etiologies were infectious in over half (54%), with HIV encephalitis, bacterial meningitis, and tuberculous meningitis being the most common. Metabolic causes (19%) included renal failure and hypoglycemia. Structural lesions identified on imaging accounted for 10% of etiologies and included stroke and non‐accidental trauma. No etiology could be identified in 12 (16%) children, most of whom died before the completion of clinical investigations. Twenty‐two (30%) children died within 30 days of the index seizure. Significance Despite widespread ART roll out in Zambia, new‐onset seizure in CLWHIV occurs in the setting of advanced, active HIV disease. Seizure severity/burden is high as is early mortality. Enhanced programs to assure early ART initiation, improve adherence, and address ART failure are needed to reduce the burden of neurological injury and premature death in CLWHIV.

show abstract

“…This suggests that performance in cognitive tasks may be tempered by factors and influences not related to HIV disease and highlights the importance of having an appropriate comparison group [ 4 , 19 , 22 ]. However, a longitudinal analysis comparing cognitive testing performance in children with perinatally acquired HIV and HIV-exposed but uninfected children in Zambia, recently reported that socioeconomic factors impacted testing performance in both groups, but with a more marked effect in the PHIV group [ 23 ]. Another study in South Africa showed uninfected children exposed to maternal HIV infection had language delays at 2 years of age, so further work is needed to understand developmental outcomes of this population [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Learning and memory function in young people with and without perinatal HIV in England

et al. 2022

View full text Add to dashboard Cite

Learning and memory are important for successful education and career progression. We assess these functions in young people (YP) with perinatal HIV (PHIV) (with or without a previous AIDS-defining illness) and a comparable group of HIV-negative YP. 234 PHIV and 68 HIV-negative YP completed 9 tests; 5 National Institutes of Health (NIH) Toolbox tests (2 executive function, 1 speed of information processing, 2 memory); 2 Hopkins Verbal Learning Test Revised (HVLT-R) (learning (L), delayed recall (R)), and 2 verbal application measures. Z-scores for each test were calculated using normative data and averaged by domain where appropriate. The effect of predictors on test scores in the three domains with the lowest z-scores were analysed using linear regression. 139(59%) and 48(71%) PHIV and HIV-negative YP were female, 202(86%) and 52(76%) Black, and median age was 19 [17, 21] and 18 [16, 21] years respectively. 55(24%) PHIV had a previous Center for Disease Control and Prevention (CDC) class C AIDS-defining diagnosis (PHIV/C). For HVLT-R, there was a trend towards PHIV/C YP having the lowest mean z-scores (L -1.5 (95% CI -1.8,-1.2), R -1.7 (-2.0,-1.4)) followed by PHIV without a CDC C diagnosis (L -1.3 (-1.4,-1.1), R -1.4 (-1.5,-1.2)) and then the HIV-negative group (L -1.0 (-1.3,-0.7), R -1.1 (-1.3,-0.8)); all were greater than 1 SD below the reference mean. The same trend was seen for verbal application measures; however, z-scores were within 1 SD below the reference mean. NIH Toolbox tests were similar for all groups. In multivariable analyses PHIV/C and Black ethnicity predicted lower HVLT-R scores. Black ethnicity also predicted lower executive function scores, however each year increase in age predicted higher scores. In conclusion, cognitive performance in verbal learning and recall fell below population normative scores, and was more pronounced in PHIV/C, supporting wider findings that earlier antiretroviral therapy initiation, before the occurrence of AIDS-defining conditions, may protect aspects of cognitive development.

show abstract

Socioeconomic Status and Cognitive Function in Children With HIV: Evidence From the HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) Study

Cited by 10 publications

References 47 publications

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

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

Clinical characteristics and outcomes after new‐onset seizure among Zambian children with HIV during the antiretroviral therapy era

Learning and memory function in young people with and without perinatal HIV in England

Contact Info

Product

Resources

About