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An analysis of select emerging executive skills in perinatally HIV-1-infected children
Antolin M Llorente1, Pim Brouwers, Robert Leighty
1a Department of Pediatrics , University of Maryland School of Medicine , Baltimore , Maryland.
Insights
Perinatal HIV-1 infection did not significantly impair executive functions in children aged 8-12. Psychosocial factors, not HIV disease severity, explained apparent deficits in executive skills.
Area of Science:
- Neuropsychology
- Pediatric Infectious Diseases
- Child Development
Background:
- Perinatal Human Immunodeficiency Virus type 1 (HIV-1) infection can impact child development.
- Executive functions are crucial for cognitive and behavioral self-regulation in children.
Purpose of the Study:
- To investigate the effects of perinatal HIV-1 infection on emerging executive skills in children aged 8 to 12 years.
- To differentiate the impact of HIV-1 disease severity from psychosocial factors on executive functions.
Main Methods:
- Compared executive functions in HIV-positive (n=76) and HIV-negative (n=85) children using neuropsychological tests (NEPSY, Trail-Making Test-Part B, Woodcock-Johnson Battery-Revised) and caretaker ratings (Behavior Rating Inventory of Executive Functions).
- Utilized generalized estimating equations, discriminant analyses, and global deficit score analyses with strict controls for moderating variables.
- Categorized HIV-positive children by disease severity based on CDC Class C events.
Main Results:
- Initial analyses showed significant unadjusted group differences in executive functioning scores.
- These differences were not statistically significant after accounting for moderating psychosocial and environmental variables.
- The apparent executive function deficits in HIV-positive children were primarily attributed to psychosocial factors, not HIV disease itself.
Conclusions:
- In this cohort, perinatal HIV-1 infection had negligible effects on emerging executive functions when controlling for treatment and moderating psychosocial variables.
- Psychosocial and environmental factors play a significant role in executive function outcomes for children with perinatal HIV-1 exposure.
- Further research should focus on the interplay between HIV-1, treatment, and psychosocial influences on child neurodevelopment.
Abstract:
This study examined the effect of perinatal HIV-1 infection on emerging executive skills in children (n = 161) ages 8 to 12 years. HIV-positive (n = 76) and HIV-negative (n = 85) children were eligible to participate. The HIV-positive children included those who had experienced a CDC Class C event (greater severity, n = 22) and those who were HIV-positive but who had not experienced a CDC Class C event (less severity, n = 54). Measures of emerging executive functions completed by the children included subtests from the Developmental Neuropsychological Assessment (NEPSY), the Trail-Making Test-Part B, and a subtest from the Woodcock-Johnson Battery-Revised. Ratings of executive functions were obtained from caretakers using the Behavior Rating Inventory of Executive Functions. Generalized estimating equations methods, discriminate analyses, and global deficit score analyses were performed to determine whether differences emerged between the three clinical groups while using strict controls. The present results revealed significant group differences in unadjusted mean scores measuring executive functioning. However, such differences did not remain statistically significant when moderating variables were taken into consideration in the models. The apparent deficit in executive functioning for the HIV-positive children was found to be largely due to differential psychosocial and environmental factors rather than HIV disease and its severity, and in this cohort, the effects of HIV-1 infection on emerging executive functions appeared to be negligible when controlling for treatment and moderating psychosocial variables.
