Cognitive Function in Young Persons With and Without Perinatal HIV in the AALPHI Cohort in England: Role of Non–HIV-Related Factors

Judd, Ali; Prevost, Marthe Le; Melvin, Diane; Arenas‐Pinto, Alejandro; Parrott, Francesca; Winston, Alan; Foster, Caroline; Sturgeon, Kate; Rowson, K. E. K.; Gibb, D.M.

doi:10.1093/cid/ciw568

Cited by 34 publications

(37 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Of the psychosocial factors tested here, only higher depressive symptoms remained independently associated with cognitive and functional di culties among both ALHIV and community controls. These ndings are concordant with those among perinatally HIV-infected youth in high-incomecountries (13,67). The biological mechanisms underpinning the link between depression and cognitive functioning are not clearly understood.…”

Section: Discussionsupporting

confidence: 51%

“…Systematic reviews show that children in resource-constrained settings do not start treatment as fast as they should and do not always achieve persistent viral suppression due to several contextual factors including suboptimal access and retention in care (11). Our understanding of either theory is limited by failure of current ALHIV studies to disaggregate ndings by mode of infection (10,12) or the narrow focus on verticallyinfected adolescents (13).…”

Section: Introductionmentioning

confidence: 99%

“…This then begs the question, what are the risk and protective correlates for neurocognitive impairment among ALHIV? Some cross-sectional studies report HIV-related measures (higher plasma viral load and lower CD4 count) (19)(20)(21) as risk factors for neurocognitive impairment among ALHIV while others report non HIV-related risk factors such as caregiver unemployment, poor nutrition, and orphanhood (22), and higher depression scores may be important to consider (13). Moreover, high rates of psychological (23)(24)(25)(26) and psychiatric disorders (27,28) have been reported among adolescents in Sub-Saharan Africa, and depression has been shown to be reciprocally associated with cognitive functioning in the general population (29).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cross-Sectional Analysis of Cognitive And Functional Difficulties Among Adolescents Living With HIV In Low-Resourced Settings: Can A Simple Screening Algorithm Identify Adolescents For Support?

Natukunda

Toska

Boyes

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Comprehensive neuropsychological testing for adolescents living with HIV is rare and often impractical for overstretched healthcare systems in low-resourced settings. This study aimed to 1) test the potential of a simple algorithm to screen for cognitive and functional difficulties among at-risk adolescents, and 2) using this algorithm, investigate the correlates of cognitive and functional difficulties in a large community-traced sample of South African adolescents. Methods: The study interviewed 10-19-year-old adolescents living with HIV (n = 1059) and uninfected community controls (n = 467), attending 53 public health facilities in the Eastern Cape in 2014-15. Cognitive and functional difficulties were assessed using an algorithm (either adolescent reports of memory, attention or concentration problems, or < 60% total recall on a memory task, or caregiver reports of an adolescent being a ‘slow-learner’, or attending a special needs school) and adolescent reports of functional difficulties. Data on healthcare and psychosocial variables were also collected. Multivariable logistic regressions tested correlates of cognitive and functional difficulties, controlling for sociodemographic and household covariates. Results: Across the sample, the prevalence of cognitive and functional difficulties was 19.3% (95% CI: 17.4-21.4). Adolescents living with HIV had significantly higher rates of cognitive and functional difficulties than community controls (21.9% vs. 13.5%, p<.001). Validating the algorithm with self-reported school grade repetition (lifetime) and number of grades repeated, cognitive and functional difficulties were associated with higher odds of lifetime grade repetition (aOR1.62 95%CI 1.24-2.11) and a higher likelihood of repeating multiple grades (β=0.27, p<.001). Independent of covariates, potential correlates of cognitive and functional difficulties among adolescents were higher depressive symptoms (aOR1.18 95%CI1.11-1.26), concurrent infections (aOR1.92 95%CI1.44-2.58), and more often missing school for clinic appointments (aOR1.66 95%CI1.24-2.23). Conclusions: Cognitive and functional difficulties were more prevalent among adolescents living with HIV than community controls and were associated with psychosocial, physical health, and healthcare factors. Simple algorithms – like the one tested in this study – may be feasible for use in low-resourced settings, following validation against neuropsychological assessment batteries in specialised facilities. Routine screening for cognitive and functional difficulties may be integrated into HIV care to identify adolescents for additional support.

show abstract

Section: Discussionsupporting

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cross-Sectional Analysis of Cognitive And Functional Difficulties Among Adolescents Living With HIV In Low-Resourced Settings: Can A Simple Screening Algorithm Identify Adolescents For Support?

Natukunda

Toska

Boyes

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Other reports have showed as well that HIV adolescents are at risk of more emotional stress and neurocognitive impairment. 44,45…”

Section: Discussionmentioning

confidence: 99%

Sleep Profile and Self-Reported Neuropsychiatric Symptoms in Vertically HIV-Infected Adolescents on cART

González-Tomé

García-Navarro

Ruiz-Saez

et al. 2018

J Pediatr Infect Dis

View full text Add to dashboard Cite

Background Sleep quality (SQ) data in human immunodeficiency virus (HIV) pediatric population are scarce. Our main objective was to assess SQ in our cohort and to determine the impact of antiretroviral therapy (ART) on sleep in a cohort of HIV-infected adolescents on cART. Materials and Methods The SQ was assessed through the Pittsburgh Sleep Quality Index (PSQI). Neuropsychiatric symptoms (NS) were recorded using an auto-administered questionnaire. To determine the antiretroviral (ARV) impact of efavirenz (EFV) on SQ, patients on EFV versus protease inhibitors-based regimens were compared. Results Forty-six patients were evaluated (median age: 16 years, interquartile range [IQR]: 10.8, 17)). Age at the start of ART: 1.3 years (0.4, 5.2); 23.9% showed acquired immunodeficiency syndrome (AIDS) category. Median CD4 at baseline was 656 (550, 808) cells/mm3; 91.3% had viral load <50 copies/mL. Median time on cART was 11.3 years (7.5, 15.2). Fifty-two percent of the patients were on EFV-based regimen. No differences were found in clinical and immunovirological variables although patients on EFV were older and were exposed for a longer time to ARV. Poor SQ was found in 26.1% of patients. Most frequent complaints were: sleep disturbances (76.1%), sleep latency (63%), and daytime dysfunction (54.3%). Similarly, there were no significant differences in NS between both treatment groups according to patients' reports but were significantly more common in bad sleepers. Patients on EFV-based regimen were more likely to repeat one or more school grades after the adjustment for age at evaluation and nadir CD4 percentage (odds ratio [OR]: 14.421, confidence interval [CI] 95%: 1.207–172.249, p = 0.035). Conclusions Sleep complaints and NS are common among our cohort of HIV adolescents on long-term cART and interestingly, not only in those who were receiving EFV.

show abstract

“…The Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort is a prospective study evaluating the impact of HIV on young people with perinatal HIV-infected and HIV-affected but uninfected young people. Detailed methods have been reported elsewhere [ 23 ]. Briefly, PHIV young people were aged 13 to 21 years, had a history of paediatric care in the UK/Ireland, and were aware of their HIV status for at least 6 months [ 17 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

Sexual health of young people with perinatal HIV and HIV negative young people in England

et al. 2018

Self Cite

View full text Add to dashboard Cite

As adolescents with perinatal HIV (PHIV) survive into adulthood, gaining insight into sexual behaviour and risk-taking is important. Between 2013–2015, 296 PHIV aged 13–21 years and 96 HIV negative affected adolescents (13–23 years) were recruited to the Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort in England. Sexual health data were collected through computer-assisted self-interview questionnaires. Quality of life and household deprivation were also measured. T-tests compared means, and χ2 proportions; logistic regression examined predictors of ever having sex. 120(41%) PHIV and 31(32%) HIV- young people were male, 254(86%) and 70(73%) were black, median age 16 [IQR 15,18] and 16 [14,18] years respectively. 77(26%) PHIV had a previous AIDS diagnosis. 93(32%) PHIV and 38(40%) HIV- had ever had sex; median number of partners was 3 [1,6] and 4 [1,6] respectively. 54 (41%) of 131 young people who were sexually active reported not always using condoms, including 32% (30/93) of PHIV. In multivariable analysis, older age, male sex, worse deprivation score, worse quality of life, and alcohol and/or drugs were associated with ever having sex, but not HIV status. 12/30 PHIV reporting unprotected sex had at least one HIV viral load ≥200c/ml in the previous 12 months. Age at first sex and number of sexual partners were similar among PHIV and HIV-, and comparable to normative data. In conclusion, small numbers of PHIV reported condomless sex with a detectable viral load, which could result in HIV transmission, indicating the need for targeted sexual health and ART adherence interventions for young people with perinatal HIV.

show abstract

Cognitive Function in Young Persons With and Without Perinatal HIV in the AALPHI Cohort in England: Role of Non–HIV-Related Factors

Abstract: Cognitive performance was similar between PHIV+/no C and HIV- participants and indicated relatively mild impairment compared with normative data. The true impact on day-to-day functioning needs further investigation.

Cited by 34 publications

References 41 publications

Cross-Sectional Analysis of Cognitive And Functional Difficulties Among Adolescents Living With HIV In Low-Resourced Settings: Can A Simple Screening Algorithm Identify Adolescents For Support?

Cross-Sectional Analysis of Cognitive And Functional Difficulties Among Adolescents Living With HIV In Low-Resourced Settings: Can A Simple Screening Algorithm Identify Adolescents For Support?

Sleep Profile and Self-Reported Neuropsychiatric Symptoms in Vertically HIV-Infected Adolescents on cART

Sexual health of young people with perinatal HIV and HIV negative young people in England

Contact Info

Product

Resources

About