HIV-associated cognitive disorders in perinatally infected children and adolescents: a novel composite cognitive domains score

Abstract

Accurate assessment of HIV-associated cognitive disorders in perinatally infected children and adolescents is challenging. Assessments of general intellectual functioning, or global cognition, may not provide information regarding domain-specific strengths and weaknesses, and may therefore fail to detect, impaired trajectories of development within particular cognitive domains. We compare the efficacy of global cognitive scores to that of composite cognitive domain scores in detecting cognitive disorders in a sample of perinatally HIV-infected children, and a demographically matched HIV negative control group, drawn from the Cape Town Adolescent Antiretroviral Cohort (CTAAC) study. All children were administered a comprehensive neuropsychological test battery. Using data from that test battery, we created ten separate composite cognitive domains: general intellectual functioning, attention, working memory, visual memory, verbal memory, language, visual spatial ability, motor coordination, processing speed and executive function. Within each domain, each test bore a high level of association with each of the other tests in that domain (Cronbach's α ≥ .70 for all domains). We found that composite domain scores calculated on whole-sample data were significantly higher than those calculated using control-sample data. Our comparison of a global cognitive score to composite domain scores suggested that the latter provided more detailed information (regarding strengths, weaknesses, areas of impairment), and when compared to global scores, were more sensitive in detecting HIV-associated cognitive disorders, and were able to distinguish HIV-infected patients from uninfected controls. Hence, we recommend using this method of composite cognitive domains scores, rather than global aggregate scores, when assessing cognitive function in paediatric HIV. This method provides a convenient and relatively accurate assessment that might help with cross-cultural and cross-region comparisons as researchers try to detect cognitive impairment patterns in HIV-infected children and adolescents globally.

Multisystem impairment in South African adolescents with Perinatally acquired HIV on antiretroviral therapy (ART)

“…The study found the prevalence of any cardiac, respiratory or neurocognitive impairment in PHIV+ participants was significantly higher than in HIV− participants. Similar findings of individual system involvement have been reported in other studies of adolescents with perinatally acquired HIV with a high prevalence of cardiac, respiratory, neurocognitive or less commonly renal impairment .…”

“…The study found the prevalence of any cardiac, respiratory or neurocognitive impairment in PHIV+ participants was significantly higher than in HIVÀ participants. Similar findings of individual system involvement have been reported in other studies of adolescents with perinatally acquired HIV with a high prevalence of cardiac, respiratory, neurocognitive or less commonly renal impairment [5,36,37]. Neurocognitive impairment occurring most commonly, is perhaps the most concerning morbidity, impacting on PHIV+ adolescents as it influences all spheres of health including treatment adherence and school performance.…”

Lower IQ and poorer cognitive profiles in treated perinatally HIV-infected children is irrespective of having a background of international adoption

“…We standardized WISC or WAIS raw subtests into Wechsler norm scores (with a mean of 10 and standard deviation [SD] of 3) and into scale scores (mean 100, SD 15) using age- and sex-adjusted Dutch norm standards from test manuals[20, 21]. We converted Beery VMI raw scores into t-scores (with a mean of 50 and SD of 10)[24], and standardized TMT and RAVLT raw scores into Z-scores, as no appropriate Dutch reference values were available[22, 23, 25]. We calculated Z-scores based on the mean and SD of the control group [25].…”

“…We converted Beery VMI raw scores into t-scores (with a mean of 50 and SD of 10)[24], and standardized TMT and RAVLT raw scores into Z-scores, as no appropriate Dutch reference values were available[22, 23, 25]. We calculated Z-scores based on the mean and SD of the control group [25]. We reverse coded variables in order to align interpretation in the same direction: for all tests lower scores indicate poorer test performance.…”

A study protocol “saving futures: developing an integrated model of rehabilitation and paediatric HIV care to foster success at school”

“…A recent meta-analysis found that working memory, executive functioning, and processing speed are the cognitive domains most affected in children and adolescents living with HIV [8]. Sherr et al suggested that since the evidence for HIV-associated cognitive impairment is consistent, children living with HIV should be routinely and regularly monitored for developmental delays and cognitive dysfunction so they can be referred to available intervention [9].…”