Discordance of cognitive and academic achievement outcomes in youth with perinatal HIV exposure

Abstract

Background: To evaluate achievement in youth with perinatally acquired HIV (PHIV) compared with HIV-exposed uninfected peers (HEU) and to examine differential effects of HIV on cognition-achievement concordance.

Methods: Cognition and achievement were assessed using standardized measures. Intelligence quotient-derived predicted achievement scores were subtracted from observed achievement scores to calculate discrepancy values. Linear regression models were used to compare achievement discrepancies between PHIV and HEU, adjusting for demographic covariates.

Participants: 295 PHIV and 167 HEU youth; 71% black, 48% male, mean age 13.1 and 11.3 years, respectively. PHIV youth were relatively healthy (mean CD4%, 32%; viral load ≤400 copies/mL, 72%). PHIV and HEU youth had cognitive and achievement scores significantly below population norm means (P < 0.001), but did not differ in cognition (mean full scale IQ = 86.7 vs. 89.4, respectively). In unadjusted models, HEU outperformed PHIV youth on total achievement (mean = 89.2 vs. 86.0, P = 0.04) and numerical operations (mean = 88.8 vs. 82.9, P < 0.001); no differences remained after adjustment. Mean observed-predicted achievement discrepancies reflected "underachievement". History of encephalopathy predicted poorer achievement (P = 0.039) and greater underachievement, even after adjustment. PHIV showed greater underachievement than HEU for numerical operations (P < 0.001) and total achievement (P = 0.03), but these differences did not persist in adjusted models.

Conclusions: Both PHIV and HEU youth demonstrated lower achievement than normative samples and underachieved relative to predicted achievement scores. Observed-predicted achievement discrepancies were associated with prior encephalopathy, older age and other non-HIV factors. PHIV youth with prior encephalopathy had significantly lower achievement and greater underachievement compared with PHIV without encephalopathy and HEU youth, even in adjusted models.

Figure 1. Mean Observed WIAT-II-A Achievement (a) and WISC-IV Cognition Index Scores (b) by HIV Status

Figure 1a) Achievement: PHIV and HEU did not differ on Spelling or Word Reading subtests, but PHIV means were significantly lower than HEU on Numerical Operations and Total Achievement; Figure 1b) Cognition: PHIV and HEU did not differ on FSIQ or VCI, but PHIV mean score was significantly lower than HEU on PRI. All achievement and cognition scores were significantly below population norm means (p<0.001), although still within the Low Average range of functioning. HEU = HIV exposed uninfected; PHIV = Perinatally acquired HIV; WIAT-II-A = Wechsler Individual Achievement Test, 2^nd Edition, Abbreviated; WISC-IV = Wechsler Intelligence Scales for Children, 4^th Edition; FSIQ= Full Scale IQ; VCI = Verbal Comprehension Index; PRI = Perceptual Reasoning Index.