Impact of Perinatally Acquired HIV Disease Upon Longitudinal Changes in Memory and Executive Functioning

Abstract

Background Little is known regarding effects of perinatally-acquired HIV infection (PHIV) on longitudinal change in memory and executive functioning (EF) during adolescence, despite the importance of these skills for independence in adulthood. Methods PHIV (n=144) and perinatally HIV-exposed uninfected youth (PHEU, n=79), ages 12–17, completed standardized tests of memory and EF at baseline and two years later. Changes from baseline for each memory and EF outcome were compared between PHEU and PHIV youth with (PHIV/C, n=39) and without (PHIV/non-C, n=105) history of CDC Class C (AIDS-defining) diagnoses. Among PHIV youth, associations of baseline and past disease severity with memory and EF performance at follow-up were evaluated using adjusted linear regression models. Results Participants were primarily black (79%); 16% were Hispanic; 55% were female. Mean memory and EF scores at follow-up generally fell in the low-average to average range. Pairwise comparison of adjusted mean change from baseline to follow-up revealed significantly greater change for PHIV/non-C compared to PHEU youth in only one verbal recognition task, with a difference in mean changes for PHIV/non-C versus PHEU of −0.99 (95%CI: −1.80, −0.19; p=0.02). Among youth with PHIV, better immunologic status at baseline was positively associated with follow-up measures of verbal recall and recognition and cognitive inhibition/flexibility. Past AIDS-defining diagnoses and higher peak viral load were associated with lower performance across multiple EF tasks at follow-up. Conclusions Youth with PHIV demonstrated stable memory and EF during a two-year period of adolescence, allowing cautious optimism regarding long-term outcomes.

Real-World Analysis of Survival and Clinical Events in a Cohort of Italian Perinatally HIV-1 Infected Children From 2001 to 2018

“…We also observed children who developed acquired motor deficits, failure to attain or loss of psychomotor developmental milestones, neurocognitive delay (non-meeting CDC diagnostic criteria for HIV-1 encephalopathy). This finding reflects what observed in other recent studies: even if the introduction of cART reduced the rates of HIV-1-related encephalopathy (43,44,50), milder neurocognitive deficits (lower total intelligence quotient, language impairment, poorer working memory, gross and fine motor functioning, visual-motor impairment) are diagnosed more and more frequently (51)(52)(53)(54)(55)(56).…”

Neuropsychological and Psychosocial Functioning of Children with Perinatal HIV-Infection in The Netherlands

“…In contrast with previous literature, our study did not reveal associations of executive functioning with medical characteristics, which could be explained by the limited sample size or the little variation in current medical characteristics due to successful treatment with cART. Previous studies found associations between lower CD4 cell count, a history of AIDS-defining diagnoses, and higher peak viral load with compromised executive functioning [43,44]. These studies and our finding that HIV-infected children have more teacher-reported problems in their executive functioning than their siblings, support the hypothesis that the HIV-infection is a contributor to cognitive problems, especially executive functioning.…”

“…These studies and our finding that HIV-infected children have more teacher-reported problems in their executive functioning than their siblings, support the hypothesis that the HIV-infection is a contributor to cognitive problems, especially executive functioning. The development of problems in executive functioning is of significant concern for its negative impact on academic learning, successful transition to adulthood, and medication adherence [43,45]. Hence, care providers should be aware of the risk for compromised executive functioning in HIV-infected children, and refer them to a neuropsychologist if problems in this domain arise.…”

Effects of perinatal HIV-infection on the cortical thickness and subcortical gray matter volumes in young adulthood

“…[ 30 – 32 ] For example, diminished CT in the orbitofrontal area in adolescence correlates to impulsive behavior, [ 33 ] and an executive function known as inhibition, deficit of which has been widely described in PHIV patients. [ 34 – 36 ]…”