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Multicenter Study
. 2012 Jun;31(6):592-8.
doi: 10.1097/INF.0b013e318253844b.

Impact of HIV severity on cognitive and adaptive functioning during childhood and adolescence

Renee Smith  1 , Miriam Chernoff, Paige L Williams, Kathleen M Malee, Patricia A Sirois, Betsy Kammerer, Megan Wilkins, Sharon Nichols, Claude Mellins, Ann Usitalo, Patricia Garvie, Richard Rutstein; Pediatric HIV/AIDS Cohort Study (PHACS) Team
Collaborators, Affiliations
Multicenter Study

Impact of HIV severity on cognitive and adaptive functioning during childhood and adolescence

Renee Smith et al. Pediatr Infect Dis J. 2012 Jun.

Abstract

Background: The influence of disease severity on cognitive and adaptive functioning in perinatally HIV-infected youth with (PHIV+/C) and without (PHIV+/NoC) a previous AIDS-defining illness (Centers for Disease Control and Prevention Class C event), compared with perinatally HIV-exposed but uninfected youth (PHEU) is not well understood.

Methods: This was a cross-sectional analysis of cognitive and adaptive functioning in PHIV+/C (n = 88), PHIV+/NoC (n = 270) and PHEU (n = 200) youth aged 7-16 years, from a multisite prospective cohort study. Youth and caregivers completed the Wechsler Intelligence Scale for Children, Fourth Edition and the Adaptive Behavior Assessment System, Second Edition, respectively. We compared means and rates of impairment between groups, and examined associations with other psychosocial factors.

Results: Overall mean scores on measures of cognitive and adaptive functioning were in the low average range for all 3 groups. After adjustment for covariates, mean full-scale intelligence quotient scores were significantly lower for the PHIV+/C group than the PHIV+/NoC and PHEU groups (mean = 77.8 versus 83.4 and 83.3, respectively), whereas no significant differences were observed between the PHEU and PHIV+/NoC groups in any domain. Lower cognitive performance for the PHIV+/C group was primarily attributable to a prior diagnosis of encephalopathy. No significant differences between groups were observed in adaptive functioning.

Conclusion: For long-term survivors, youth with HIV infection and a prior Centers for Disease Control and Prevention Class C event have higher risk for cognitive but not adaptive impairment regardless of current health status; this finding appears attributable to a previous diagnosis of encephalopathy. Early preventive therapy may be critical in reducing risk of later neurodevelopmental impairments.

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Figures

Figure 1
Figure 1. Unadjusted Rates of Cognitive Impairment: % Scoring 2 SD Below the Mean
PHIV+/NoC=Perinatal HIV infection with no CDC Class C event; PHIV+/C=Perinatal HIV infection with a prior CDC Class C event; PHEU=Perinatally HIV Exposed but uninfected; FSIQ=Full Scale Intelligence Quotient
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