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Nutritional Status and Cognitive Function in Children With or Exposed to HIV: Evidence From the HIV-Associated

William Raskopf1, Esau Mbewe2, Heather Adams1

  • 1University of Rochester School of Medicine, Lusaka, Zambia.

Journal of Acquired Immune Deficiency Syndromes (1999)
|December 2, 2025
PubMed

Insights

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.
Abstract

Keywords:
HANDHIVZambiacognitive impairmentmetadatanutritionpediatric

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