Trajectory Analysis of Cognitive Outcomes in Children With Perinatal HIV

Abstract

Background: Children with perinatal HIV (pHIV) may display distinct long-term cognitive phenotypes. We used group-based trajectory modeling to identify clusters of children with pHIV after similar developmental trajectories and predictors of belonging to select cognitive trajectory groups.

Methods: Participants included children, 4-17 years of age, with pHIV in Thailand and Cambodia. Cognitive measures included translated versions of Intelligence Quotient tests, Color Trails Tests and Beery-Buktenica Developmental Test of Visual-Motor Integration conducted semiannually over 3-6 years. The best fit of trajectory groups was determined using maximum likelihood estimation. Multivariate logistic regression identified baseline factors associated with belonging to the lowest scoring trajectory group.

Results: Group-based trajectory analyses revealed a 3-cluster classification for each cognitive test, labeled as high, medium and low scoring groups. Most trajectory group scores remained stable across age. Verbal IQ declined in all 3 trajectory groups and the high scoring group for Children's Color Trails Test 1 and 2 showed an increase in scores across age. Children in the lowest scoring trajectory group were more likely to present at an older age and report lower household income.

Conclusions: Group-based trajectory modeling succinctly classifies cohort heterogeneity in cognitive outcomes in pHIV. Most trajectories remained stable across age suggesting that cognitive potential is likely determined at an early age with the exception of a small subgroup of children who displayed developmental gains in select cognitive domains and may represent those with better cognitive reserve. Poverty and longer duration of untreated HIV may predispose children with pHIV to suboptimal cognitive development.

Figure 1:. Performance and Verbal Intelligence Quotient (IQ) trajectory groups

Trajectory subgroups, characterized as high, medium and low, for performance and verbal IQ test and percentage of children of children belonging to each subgroup. Solid lines display mean scores and dashed lines display confidence intervals for each trajectory group across age. A. Scores in each subgroup for performance IQ remained relatively stable across age. B. Scores in all trajectory groups for verbal IQ decreased across age by approximately 10 points.

Figure 2:. Color Trail Tests trajectory groups

A. Trajectory subgroups, characterized as high, medium and low, for Children’s Color Trails Test 1 and 2 and percentage of children of children belonging to each subgroup. Solid lines display mean scores and dashed lines display confidence intervals for each trajectory group across age. A. Scores in the low and medium trajectory groups remained stable, while scores in high group increased by 10 points across age for Childen’s Color Trails Test 1. B. Scores in the low and medium subgroups remained stable, while scores in the high performance group increased by 11 points across age for Children’s Color Trails Test 2.

Figure 3:. Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) trajectory groups

Beery VMI trajectory subgroups characterized as high, medium and low performance and the percentage of children belonging to each subgroup. Solid lines display mean scores and dashed lines display confidence intervals for each trajectory group across age. Scores of Beery VMI remained stable across age in all trajectory groups.