HIV-associated neurocognitive disorders, among adolescents with HIV in India

Research on neurocognition among Indian adolescents with HIV (AHIV) has only recently begun to emerge, with earlier studies predominantly focusing on adult cohorts or international populations.

This study examined neurocognitive functioning in adolescents aged 11-16 years from Bengaluru, Karnataka, comparing perinatally infected AHIV with healthy controls.

This cross-sectional study investigated HIV-associated neurocognitive disorder (HAND) in 148 participants, 70 perinatally infected AHIV and 78 controls. Participants completed a neurocognitive battery assessing eight domains: attention, processing speed, verbal memory, visual memory, visual-spatial memory, language, motor coordination, and executive functioning.

AHIV performed significantly worse than controls across all assessed domains, reflecting widespread and multidomain cognitive vulnerability during adolescence. Significant impairments were observed in attention (estimate = -0.83, P < 0.001), processing speed (estimate = -0.81, P < 0.001), executive functioning (estimate = -0.82, P < 0.001), language (estimate = -0.68, P < 0.001), verbal memory (estimate = -0.46, P < 0.001), motor coordination (estimate = -0.46, P < 0.001), and visual memory (estimate = -0.29, P < 0.001). The assessment battery, originally validated in South Africa, demonstrated reliability (Cronbach's α ranging from 0.67 to 0.88) and cultural sensitivity through rigorous translation and back-translation procedures, supporting its cross-cultural applicability in the Indian context.

Neurocognitive impairment remains a persistent and clinically meaningful outcome of perinatal HIV infection despite antiretroviral therapy, underscoring the urgent need for standardized neurocognitive assessment and early intervention for AHIV in low- and middle-income country (LMIC) settings.