Perinatal HIV Status and Executive Function During School-Age and Adolescence

Ezeamama, Amara E.; Kizza, Florence N; Zalwango, Sarah; Nkwata, Allan; Zhang, Ming; Rivera, Mariana L.; Sekandi, Juliet N.; Kakaire, Robert; Kiwanuka, Noah; Whalen, Christopher C.

doi:10.1097/md.0000000000003438

Cited by 20 publications

(9 citation statements)

References 38 publications

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“…PHIV and HEU status were objectively determined prior to the 18th month of life on the basis of a positive and negative DNA-polymerase chain reaction, respectively. For both HEU and HUU, HIV-status at enrolment was confirmed on the basis of a negative HIV-rapid diagnostic test [26,27].…”

Section: Methodsmentioning

confidence: 99%

Serum n-6 Fatty Acids are Positively Associated with Growth in 6-to-10-Year Old Ugandan Children Regardless of HIV Status—A Cross-Sectional Study

et al. 2019

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Fatty acids (FAs) are crucial in child growth and development. In Uganda, antiretroviral therapy (ART) has drastically reduced perinatal human immunodeficiency virus (HIV) infection of infants, however, the interplay of FAs, ART, and HIV in relation to child growth is not well understood. To investigate this, serum was collected from 240 children between 6–10 years old in Uganda and analyzed for FAs using gas-chromatography mass-spectrometry. HIV status and anthropometric measurements were taken, and relationships with FAs were assessed. No significant differences in growth parameters or serum FAs were found between HIV uninfected children with and without exposure to ART. HIV positive children had significantly lower height-for-age-z-scores (HAZ) than uninfected children (p < 0.001). HIV-positive children had higher arachidonic acid than uninfected children (p = 0.003). Total omega-6 FAs were significantly associated with HAZ regardless of HIV status (p = 0.035). Mean total omega-3 FAs (2.90%) were low in this population compared to other cohorts in Africa. These results provide reference serum FA values for 6–10-year-old children in Uganda and may be used to inform lipid supplementation programs to promote child growth. Future studies should investigate the relationships between child growth trajectories in relation to HIV status and serum FAs.

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Section: Methodsmentioning

confidence: 99%

Serum n-6 Fatty Acids are Positively Associated with Growth in 6-to-10-Year Old Ugandan Children Regardless of HIV Status—A Cross-Sectional Study

et al. 2019

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“…Socio-emotional adjustment (SEA) was measured using the Parent Rating Scales of the Behavioral Assessment System for Children (BASC-3) with assessments at enrollment, months 6 and 12. The BASC was adapted for cultural context, forward translated to Luganda and then back translated to Luganda as previously described [26]. Snacks were provided before each interview session to mitigate the distracting effect of hunger on responses.…”

Section: Methodsmentioning

confidence: 99%

“…Snacks were provided before each interview session to mitigate the distracting effect of hunger on responses. In the absence of local norms for BASC, SEA measures were internally age and sex standardized as follows: (raw-score-sample mean)/SD [26]. SEA quantifies a range of adaptive and problem behaviors that children may exhibit in home or community settings.…”

Section: Methodsmentioning

confidence: 99%

Serum Vitamin D is Differentially Associated with Socioemotional Adjustment in Early School-Aged Ugandan Children According to Perinatal HIV Status and In Utero/Peripartum Antiretroviral Exposure History

et al. 2019

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An impact of vitamin D in neurocognitive function has been theorized but it remains unknown whether vitamin-D insufficiency (VDI) is associated with worse socio-emotional adjustment (SEA) in vulnerable early school-aged children. This study examines the thesis that deficits in SEA are related to VDI using longitudinal data from 254 children that are perinatally HIV-infected (PHIV), exposed-uninfected (HEU), or unexposed-uninfected (HUU). In utero/peripartum antiretroviral (IPA) exposure was established per medical record documentation of biological mother’s ART regimen in pregnancy. Four caregiver-reported age- and sex-standardized measures of SEA were obtained at months 0, 6, and 12 for dependent children aged 6–10 years: externalizing problems (EPC), internalizing problems (IPC), behavioral symptoms index (BSI), and adaptive skills index (ASI). VDI was highly prevalent (74%, n = 188), and its association with change in SEA measures over 12 months varied by HIV-status (VDI*HIV, all p-values < 0.03). There was further variation in relationship of vitamin-D to SEA by IPA among PHIV (for ASI, BSI, and EPC, vitamin-D*IPA, p-value ≤ 0.01) and HEU (for BSI and EPC, vitamin-D*IPA, p-value ≤ 0.04). Among HUU, BSI (β = −0.32, 95% CI: −0.50, −0.13), IPC (β = −0.28, 95% CI: −0.47, −0.09), and EPC (β = −0.20, 95% CI: −0.37, −0.02) all declined moderately per quartile increment in VD. Among PHIV, on the one hand higher vitamin D predicted ASI gains (moderate vs. low VD, β = 0.52, p = 0.002), but this protective association was absent for BSI, EPC, and IPC (β = 0.36–0.77, p < 0.05). In absence of IPA-exposure, increasing vitamin-D predicted declines in BSI and EPC (moderate vs. low Vitamin D, β = −0.56 to −0.71, p ≤ 0.02) among HEU. However, given IPA exposure among HEU, higher VDI predicted moderate elevation in BSI (β = 0.39, 95% CI: 0.00, 0.78) and IPC (β = 0.48, 95% CI: 0.05, 0.92). Interaction between VD and IPA exposure for SEA outcomes among HEU and PHIV children warrants further investigation. The vitamin-D associated SEA improvement among HUU and HEU without IPA exposure suggests vitamin-D supplementation may remediate behavioral and adaptive deficits in this groups.

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“…Children in Sub-Saharan Africa are at a greater risk of neurocognitive impairment potentially associated with widespread poverty, malnutrition, and endemic malarial infections including cerebral malaria whose effects on brain functioning tend to persist (3). ALHIV may be at an even greater risk of cognitive challenges potentially resulting from exposure of the developing brain to maternal HIV or antiretroviral therapy (ART) in the womb (4,5), the direct effects of own vertically-acquired HIV infection (6,7), ongoing HIV-associated in ammatory responses (8,9), and HIV-associated opportunistic infections (10).…”

Section: Introductionmentioning

confidence: 99%

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

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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.

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Perinatal HIV Status and Executive Function During School-Age and Adolescence

Abstract: Supplemental Digital Content is available in the text

Cited by 20 publications

References 38 publications

Serum n-6 Fatty Acids are Positively Associated with Growth in 6-to-10-Year Old Ugandan Children Regardless of HIV Status—A Cross-Sectional Study

Serum n-6 Fatty Acids are Positively Associated with Growth in 6-to-10-Year Old Ugandan Children Regardless of HIV Status—A Cross-Sectional Study

Serum Vitamin D is Differentially Associated with Socioemotional Adjustment in Early School-Aged Ugandan Children According to Perinatal HIV Status and In Utero/Peripartum Antiretroviral Exposure History

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?

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