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Early viral suppression improves neurocognitive outcomes in HIV-infected children

Claudia S Crowell1, Yanling Huo, Katherine Tassiopoulos

  • 1Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA.

AIDS (London, England)
|February 18, 2015
PubMed

Insights

Early viral suppression in children with perinatally acquired HIV (PHIV+) is linked to better neurocognitive outcomes. Central nervous system penetration effectiveness (CPE) scores did not show a significant association with cognitive function.

Area of Science:

  • Pediatric HIV/AIDS research
  • Neuroimmunology
  • Public Health

Background:

  • Children with perinatally acquired HIV infection (PHIV+) face neurodevelopmental challenges.
  • Antiretroviral therapy (ART) aims for viral suppression, but its impact on cognitive function varies.
  • Central nervous system penetration effectiveness (CPE) scores assess drug penetration into the brain, but their role in neurocognition is unclear.

Purpose of the Study:

  • To investigate the association between the age of achieving viral suppression and CPE scores with neurocognitive functioning in school-aged children with PHIV+.
  • To determine if earlier viral suppression correlates with better cognitive outcomes.
  • To assess the influence of antiretroviral drug CNS penetration on neurodevelopment.

Main Methods:

  • Analysis of data from two US-based multisite prospective cohort studies involving 396 PHIV+ children.
  • Multivariable general linear regression models used to assess associations between age at viral suppression, CPE scores, and neurocognitive assessments (Wechsler Intelligence Scale for Children).
  • Sensitivity analyses stratified by birth cohort (pre- and post-1996) to account for changes in HIV treatment.

Main Results:

  • Significant positive associations were found between viral suppression by ages 4 and 5 and improved Full-Scale Intelligence Quotient (FSIQ) and Performance IQ/Perceptual Reasoning Index (PIQ/PRI).
  • The association between age at viral suppression and cognitive function was significant only for children born after 1996.
  • Central nervous system penetration effectiveness (CPE) scores showed no significant association with any neurocognitive outcomes (FSIQ, PIQ/PRI, VIQ/VCI).

Conclusions:

  • Achieving virologic suppression in infancy or early childhood is associated with enhanced neurocognitive outcomes in school-aged children with PHIV+.
  • The timing of viral suppression is critical for neurodevelopmental trajectories in this population.
  • CPE scores of ART regimens are not predictive of neurocognitive outcomes in children with PHIV+.
Abstract

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