Contributions of Disease Severity, Psychosocial Factors, and Cognition to Behavioral Functioning in US Youth Perinatally Exposed to HIV

Abstract

Among perinatally HIV-infected (PHIV) and perinatally HIV-exposed, uninfected (PHEU) youth, we evaluated the contributions of home environment, psychosocial, and demographic factors and, among PHIV only, HIV disease severity and antiretroviral treatment (ART), to cognitive functioning (CF) and behavioral functioning (BF). A structural equation modeling (SEM) approach was utilized. Exploratory factor analysis was used to reduce predictor variables to major latent factors. SEMs were developed to measure associations between the latent factors and CF and BF outcomes. Participants included 231 PHIV and 151 PHEU youth (mean age = 10.9 years) enrolled in the PHACS adolescent master protocol. Youth and caregivers completed assessments of CF, BF, psychosocial factors and HIV health. Medical data were also collected. Clusters of predictors were identified, establishing four parsimonious SEMs: child-assessed and caregiver-assessed BF in PHIV and PHEU youth. Among both groups, higher caregiver-child stress predicted worse BF. Caregiver resources and two disease severity variables, late presenter and better past HIV health, were significant predictors of CF in PHIV youth. Higher youth CF was associated with better caregiver-reported BF in both groups. Caregiver resources predicted caregiver-reported BF in PHEU youth, which was mediated via youth CF. Among PHIV youth, better past HIV health and caregiver resources mediated the effects of CF on caregiver-assessed BF. Using SEMs, we found a deleterious impact of caregiver and child stress on BF in both groups and of HIV disease factors on the CF of PHIV youth, reinforcing the importance of early comprehensive intervention to reduce risks for impairment.

Agreement and Discrepancy on Emotional and Behavioral Problems Between Caregivers and HIV-Infected Children and Adolescents From Uganda

“…Caregivers caring for multiple children may have a higher burden of care, and caregivers with poorer overall health status may also face increased stressors that influence their ratings of CA-HIV mental health status. A study from New York in CA-HIV, aged between 7 and 16 years, utilizing structural equation modeling (SEM), found that caregiver–child stress (including factors such as parent–child relationship problems, caregiver mental health problems, and stressful or negative life events) was associated with both CA-HIV self-reported and caregiver-reported EBPs (78). Other studies have also demonstrated that parents reporting increased caregiving stress rated EBPs as more severe than their children self-reported (42, 76).…”

The global epidemiology of adolescents living with HIV

“…Despite these ALHIV having received ART, 64% of deaths were due to HIV-related infections, predominantly bacterial infection and/or sepsis and 27% were due to other HIV-related causes. Two suicides, recorded amongst other non-HIV-related deaths, may be an unrecognized consequence of the mental health strains of growing up with HIV (23, 24). The International Epidemiology Databases to Evaluate AIDS (IeDEA) Global consortium conducted a multiregional analysis of 164,218 adolescents and youth aged 10–24 years across the Caribbean and Central and South America, sub-Saharan Africa, and Asia, and observed that those over 15 years of age had substantially higher incidence of WHO stage 4 events following ART initiation compared with younger ALHIV 10–14 years of age (1.5 [95% CI 1.3–1.7] vs. 0.21 [95% CI 0.9–0.23] per 100 person-years) (25).…”

Interventions to Improve Antiretroviral Therapy Adherence Among Adolescents and Youth in Low- and Middle-Income Countries: A Systematic Review 2015–2019

“…Major barriers to ART adherence for adolescents and youth can be divided into 3 categories: patient-level factors (e.g. socioeconomic status, stigma) [34,35], health services factors (e.g. clinic waiting times, drug availability, quality of care) [36,37], and medication factors (e.g.…”