Longitudinal Evaluation of Language Impairment in Youth With Perinatally Acquired Human Immunodeficiency Virus (HIV) and Youth With Perinatal HIV Exposure

Abstract

Background: Language impairment (LI) risk is increased for perinatally acquired human immunodeficiency virus-infected (PHIV) and perinatally exposed to HIV but uninfected (PHEU) youth. This study evaluates the persistence of LI in these groups.

Methods: The Clinical Evaluation of Language Fundamentals was repeated on participants of the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol 18 months postbaseline. Regression models identified factors associated with change in standardized score (SC) and the resolution or development of LI.

Results: Of 319 participants, 112 had LI at baseline. Upon re-evaluation, SCs were highly stable and changes were similar in PHIV (n = 212) and PHEU (n = 107) participants. Those with family history of language delays had a 2.39 point lower mean increase in SCs than those without, after controlling for demographic and socioeconomic factors and baseline LI status. Among PHIV participants, CD4 count <350 cells/mm³ was associated with lower mean SC change (4.32 points), and exposure to combination antiretroviral therapy (cART) or protease inhibitors (PIs) was associated with a higher mean SC change (5.93 and 4.19 points, respectively). Initial LI was persistent in most cases (78%); 20 new cases occurred (10%). Female sex was associated with higher odds of LI resolution. Among PHIV, duration and baseline cART and history of PI use were associated with LI resolution; higher percentage of detectable viral loads before baseline was associated with lower odds of resolution.

Conclusions: The PHIV and PHEU youth are at risk for persistent LI, and family history of language delays was a risk factor for persistence of problems. Measures of successful HIV treatment predicted more favorable outcomes among PHIV youth.

Keywords: antiretroviral therapy; language development; language impairment; perinatal HIV; youth.

Figure 1.

Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4) core language standards scores at baseline and follow up, by human immunodeficiency virus (HIV) infection group. The baseline mean was 88.1 (95% confidence interval [CI], 85.6–90.7) for perinatally acquired HIV (PHIV) and 89.2 (95% CI, 85.8–92.6) for perinatally exposed to HIV but uninfected (PHEU); the mean change was 2.2 (95% CI, 1.2–3.3) for PHIV and 1.5 (95% CI, −.3 to 3.3) for PHEU. The Pearson correlation coefficient was 0.91 (95% CI, .88–.93) for PHIV and 0.86 (95% CI, .80–.90) for PHEU.