Implications of Combined Exposure to Household Air Pollution and HIV on Neurocognition in Children

Abstract

Air pollution exposure and HIV infection can each cause neurocognitive insult in children. The purpose of this study was to test whether children with combined high air pollution exposure and perinatal HIV infection have even greater risk of neurocognitive impairment. This was a cross-sectional study of HIV-uninfected unexposed (HUU) and HIV-infected children and their caregivers in Nairobi, Kenya. We used a detailed neuropsychological battery to evaluate neurocognitive functioning in several domains. We measured caregiver 24-h personal CO exposure as a proxy for child CO exposure and child urinary 1-hydroxypyrene (1-OHP), a biomarker for exposure to polycyclic aromatic hydrocarbons (PAHs). Median 24-h caregiver CO exposure was 6.1 and 3.7 ppm for 45 HIV-infected (mean age 6.6 years) and 49 HUU (mean age 6.7 years), respectively; 48.5% of HIV-infected and 38.6% of HUU had caregiver 24-h CO levels exceeding the WHO recommended level. Median 1-OHP exposure was 0.6 and 0.7 µmol/mol creatinine among HIV-infected and HUU children, respectively. HIV-infected children with high urinary 1-OHP (exceeding 0.68 µmol/mol creatinine) had significantly lower global cognition (p = 0.04), delayed memory (p = 0.01), and attention scores (p = 0.003). Among HUU children, urinary 1-OHP and caregiver 24-h caregiver CO were not significantly associated with neurocognitive function. Our findings suggest that combined chronic exposure to air pollutants and perinatal HIV infection may be associated with poorer neurocognitive outcomes. High prevalence of air pollution exposure highlights the need to reduce these exposures.

Pediatric tuberculosis in India: Justice and human rights

“…Due to the various impacts air pollution has on the cellular level, it can disrupt proper function of multicellular immune responses and promote disease (Glencross et al., 2020). Exposure to air pollution also exacerbates the consequences of HIV, whereas children living with HIV may suffer worse neurocognitive outcomes when they are also exposed to hazardous levels of air pollution like those that are common in India (Suter et al., 2018). Immune system function is crucial to battling TB, especially in children whose bodies are still developing.…”

Central Nervous System Impact of Perinatally Acquired HIV in Adolescents and Adults: an Update

“…A second class of prevention strategies is through addressing the multiple other neurodevelopmental risks faced by children and adolescents with PHIV outlined above. These include structural change to reduce poverty, trauma and adversity, food insecurity, air pollution, systemic inequality and racism, educational and health inequity, and other risks to which children with PHIV are disproportionately exposed [103][104][105]. Comprehensive care to address mental health and substance use is important and behavioral interventions have been developed for this population [83,[106][107][108].…”

Most Early-Treated Children With Perinatally Acquired HIV Have Preserved Lung Function at School Age

“…Carbon monoxide (CO) exposure was assessed in caregivers (primarily the biological mother) as a proxy for child CO exposure using Lascar electronic continuous CO monitors (EL-USB-CO). 23 Measurement of CO was performed within a median of 17 months (IQR 14, 20) before spirometry. Carbon monoxide levels were collected every 60 seconds.…”