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Neurobehavioral outcomes in young adults with perinatally acquired HIV
Paulina Coutifaris1, Desiree Byrd1,2,3, Jocelyn Childs4
1Department of Neurology.
Insights
Young adults with perinatally acquired HIV (pHIV) who did not receive early combination antiretroviral therapy (cART) show significant neurobehavioral deficits. These cognitive and psychiatric impairments persist into adulthood, impacting daily functioning.
Area of Science:
- Neuroscience
- Immunology
- Infectious Diseases
Background:
- Combination antiretroviral therapy (cART) allows infants with perinatally acquired HIV (pHIV) to live into adulthood.
- Many individuals with pHIV globally did not receive early cART, facing challenges during adolescence and transition to adulthood.
- Neurobehavioral outcomes in young adults with pHIV (pHIVAd) are not well-documented.
Purpose of the Study:
- To assess the neurobehavioral characteristics of pHIVAd aged 21-30 years.
- To compare these outcomes with age-matched young adults infected later in life (HIVagematch) and older adults with similar HIV duration (HIVOA).
Main Methods:
- A comprehensive neuropsychological test battery and questionnaires were administered to assess cognitive function and mood.
- Neuromedical and behavioral records were reviewed for three groups of 13 individuals each.
- Descriptive analysis and bivariate techniques were employed for group comparisons.
Main Results:
- Cognitive impairment rates were highest in pHIVAd (85%) compared to HIVagematch (38%) and HIVOA (62%).
- pHIVAd exhibited poorer global cognition, information processing speed, working memory, and verbal fluency.
- A trend towards higher psychiatric dysfunction (mood disorders) was observed in pHIVAd (85%) versus HIVagematch (46%) and HIVOA (54%).
Conclusions:
- pHIVAd demonstrated elevated rates of cognitive, psychiatric, and autoimmune dysfunction compared to matched controls.
- The findings suggest that a lack of early cART may lead to lasting neurobehavioral and immune abnormalities.
- These long-term effects manifest into adulthood, highlighting the critical importance of early intervention.
Background:
With combination antiretroviral therapy (cART), infants with perinatally acquired HIV (pHIV) are living into adolescence and adulthood. Worldwide, many have not received cART in the first years of life, and challenges of adolescence complicate transition to adulthood. Neurobehavioral outcomes in pHIV young adults (pHIVAd) are infrequently reported.
Objectives:
To examine neurobehavioral characteristics of pHIVAd ages 21-30 years, and to compare them with age-matched young adults infected in the second or third decade of life (HIVagematch), and older adults with similar duration HIV disease (HIVOA).
Methods:
A comprehensive neuropsychological test battery and questionnaires to determine cognitive function and mood, and reviews of neuromedical and behavioral records were undertaken in three groups of 13 individuals each. Descriptive analysis and bivariate techniques were used for comparisons.
Results:
Rates of cognitive impairment were highest in pHIVAd (85%) compared with HIVagematch (38%) and HIVOA (62%). pHIVAd had the worst scores in global cognition, speed of information processing, working memory, and verbal fluency (0.5--1.0 SD below other groups). There was a trend for higher rates of psychiatric dysfunction (predominantly mood disorders) in pHIVAd (85%) compared with HIV-agematch (46%) and HIVOA (54%). Only four pHIVAd reported employment or enrollment in school. Four had autoimmune disorders.
Conclusion:
These pHIVAd displayed high rates of cognitive, psychiatric, and autoimmune dysfunction, greater than age-matched or HIV duration-matched comparators. Although this small study is largely descriptive in nature, it suggests that a lack of cART in early life may result in long-term neurobehavioral and immune abnormalities manifesting into adulthood.
