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Impact of Perinatally Acquired HIV Disease Upon Longitudinal Changes in Memory and Executive Functioning
Kathleen M Malee1, Miriam C Chernoff, Patricia A Sirois
1*Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; †Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA; ‡Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA; §Research Department, Children's Diagnostic and Treatment Center, Fort Lauderdale, FL; ‖Department of Psychiatry, Boston Children's Hospital, Boston, MA; ¶Department of Pediatrics, Baylor College of Medicine, Houston, TX; #Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY; and **Department of Neurosciences, University of California, San Diego, La Jolla, CA.
Insights
Perinatally acquired HIV infection (PHIV) did not significantly impact memory and executive functioning (EF) in adolescents over two years. Youth with PHIV showed stable cognitive skills, offering cautious optimism for long-term outcomes.
Area of Science:
- Neuroscience
- Pediatrics
- Infectious Diseases
Background:
- Longitudinal effects of perinatally acquired HIV infection (PHIV) on adolescent memory and executive functioning (EF) are not well understood.
- These cognitive skills are crucial for adult independence.
Purpose of the Study:
- To investigate the longitudinal changes in memory and EF in adolescents with PHIV compared to HIV-unexposed youth.
- To examine the association between disease severity and cognitive outcomes in PHIV.
Main Methods:
- Compared memory and EF changes over 2 years in perinatally HIV-exposed uninfected (PHEU) youth (n=79) and PHIV youth (n=144) aged 12-17.
- Subgroup analysis of PHIV youth included those with (PHIV/C, n=39) and without (PHIV/non-C, n=105) a history of AIDS-defining diagnoses.
- Used adjusted linear regression to assess associations of baseline/past disease severity with follow-up cognitive performance.
Main Results:
- Memory and EF scores generally ranged from low-average to average at follow-up.
- PHIV/non-C youth showed a statistically significant greater decline in one verbal recognition task compared to PHEU youth (P=0.02).
- Among PHIV youth, better baseline immune status correlated with better verbal recall/recognition and cognitive inhibition/flexibility; past AIDS diagnoses and higher viral load were linked to poorer EF.
Conclusions:
- Adolescents with PHIV maintained stable memory and EF over a 2-year period.
- Findings suggest cautious optimism for the long-term cognitive outcomes in youth with PHIV.
- Disease severity, including immune status and past AIDS diagnoses, influences cognitive performance in PHIV.
Background:
Little is known regarding effects of perinatally acquired HIV infection (PHIV) on longitudinal change in memory and executive functioning (EF) during adolescence despite the importance of these skills for independence in adulthood.
Methods:
PHIV (n = 144) and perinatally HIV-exposed uninfected youth (PHEU, n = 79), ages 12-17, completed standardized tests of memory and EF at baseline and 2 years later. Changes from baseline for each memory and EF outcome were compared between PHEU and PHIV youth with (PHIV/C, n = 39) and without (PHIV/non-C, n = 105) history of CDC class C (AIDS-defining) diagnoses. Among PHIV youth, associations of baseline and past disease severity with memory and EF performance at follow-up were evaluated using adjusted linear regression models.
Results:
Participants were primarily black (79%); 16% were Hispanic; 55% were female. Mean memory and EF scores at follow-up generally fell in the low-average to average range. Pairwise comparison of adjusted mean change from baseline to follow-up revealed significantly greater change for PHIV/non-C compared with PHEU youth in only one verbal recognition task, with a difference in mean changes for PHIV/non-C versus PHEU of -0.99 (95% CI: -1.80 to -0.19; P = 0.02). Among youth with PHIV, better immunologic status at baseline was positively associated with follow-up measures of verbal recall and recognition and cognitive inhibition/flexibility. Past AIDS-defining diagnoses and higher peak viral load were associated with lower performance across multiple EF tasks at follow-up.
Conclusions:
Youth with PHIV demonstrated stable memory and EF during a 2-year period of adolescence, allowing cautious optimism regarding long-term outcomes.
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