a. Nutritional Status and Cognitive Function in Children with or exposed to HIV: Evidence from the HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) Study

William Raskopf ¹, Esau Mbewe ², Heather Adams ¹

⁰University of Rochester School of Medicine.

Journal of Acquired Immune Deficiency Syndromes (1999) +

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December 2, 2025

View abstract on PubMed

Summary

Children with HIV in Sub-Saharan Africa face neurocognitive challenges. Improving their nutritional status, including diet and growth, can significantly enhance cognitive outcomes, particularly for those with HIV.

Area Of Science

Neuroscience
Pediatrics
Public Health

Background

Children with HIV in Sub-Saharan Africa are at risk for HIV-associated neurocognitive disorder (HAND) despite antiretroviral therapy (ART).
Nutritional status is increasingly recognized as a key factor influencing cognitive development and outcomes in pediatric HIV.
Understanding these links is crucial for developing effective interventions.

Purpose Of The Study

To investigate the association between nutritional status and cognitive function in children with HIV and compare them to HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) children.
To identify specific nutritional indicators that predict cognitive outcomes.
To determine if nutritional status mediates the relationship between HIV infection and cognitive impairment.

Main Methods

A prospective cohort study involving 614 children (aged 8-17) in Lusaka, Zambia, including children with HIV, HEU, and HUU controls.
Quarterly assessments over four years measured cognitive function (NPZ5, GDS) and nutritional status (meals/week, height percentile, etc.).
Statistical analyses included regression models, Lasso feature selection, and mediation analysis to identify nutritional predictors and their role in the HIV-cognition association.

Main Results

Children with HIV exhibited poorer nutritional status and significantly worse cognitive outcomes compared to both control groups (p<0.001).
Specific nutritional factors like height and weight percentiles showed nonlinear effects, while others like mid-upper arm circumference had linear associations with cognition.
A predictive nutritional index combining malnutrition, food security, protein intake, and growth measures was identified (β=0.27, 95% CI: 0.11-0.42), and nutrition partially mediated the HIV-cognition link.

Conclusions

Nutritional status is a significant predictor of cognitive outcomes in all studied groups, with profound implications for children living with HIV.
Interventions targeting nutritional status, including diet, food security, and growth monitoring, are essential for mitigating neurocognitive impairment in pediatric HIV.
These findings underscore the critical role of nutrition in supporting cognitive health for children affected by HIV.

Keywords:

HAND HIV Nutrition Zambia cognitive impairment pediatric