Abstract
HIV-associated cognitive deficiency in perinatally HIV-infected (PHIV) children has been studied in Western countries in a population of which an increasing proportion has been internationally adopted. Studies often lack an appropriate internationally adopted HIV-uninfected control group, potentially confounding the relationship between HIV and cognitive functioning. This study aims to further elucidate the association between treated HIV infection and cognitive development by addressing the background of international adoption. We cross-sectionally studied the impact of HIV on cognition by comparing PHIV children and HIV- uninfected controls, matched for age-, sex-, ethnicity-, socioeconomic status (SES)- and adoption status. We used a standardized neuropsychological test battery to measure intelligence (IQ), and the cognitive domains of processing speed, working memory, executive function, learning ability and visual-motor function and compared outcomes using lineair regression models, adjusted for IQ. We determined cognitive profiles and cognitive impairment by using multivariate normative comparison (MNC) and explored associations with HIV disease- and treatment-related factors. We enrolled fourteen PHIV children (mean age 10.45 years [1.73 SD], 93% adopted from sub-Saharan Africa at a median age of 3.3 years [IQR 2.1-4.2]) and fifteen HIV- uninfected controls. Groups did not clinically nor statistically differ in age, sex, ethnicity, SES, region of birth, adoption status and age at adoption. PHIV scored consistently lower on all cognitive domains and MNC outcomes. Compared to controls, PHIV children had a significant lower IQ (mean 81 [SD 11] versus mean 97 [SD 15], p = 0.005), and a poorer cognitive profile by MNC (Hotelling's T2 mean -4.36 [SD 5.6] versus mean 0.16 [SD 4.5], p = 0.021), not associated with HIV disease- and treatment-related factors. Two PHIV (14%) and one control (7%) were classified as cognitively impaired (p = 0.598). Findings indicate treated HIV-infection to be independently associated with lower IQ and poorer cognitive profiles in PHIV children, irrespective of a background of international adoption.
Highlights
In industrialized as well as in developing countries, cognitive impairment is increasingly recognized as an important concern in children perinatally infected with the human immunodeficiency virus (PHIV) and treated with combination antiretroviral therapy [1,2,3]
Findings indicate treated HIV-infection to be independently associated with lower intelligence quotient (IQ) and poorer cognitive profiles in perinatally HIV-infected (PHIV) children, irrespective of a background of international adoption
We expanded the NOVICE cohort with PHIV children and a well matched internationally adopted HIV- uninfected control group and we cross-sectionally compared cognitive functioning between controls. This cross-sectional study was part of the prospective observational NOVICE cohort study investigating the effect of perinatal HIV infection and combination antiretroviral therapy (cART) exposure on neurological, Lower cognitive performance in treated perinatally HIV-infected children compared to adoption-matched controls cognitive and visual performances, conducted at the Amsterdam University Medical Centers (AUMC), University of Amsterdam, the Netherlands [3, 12,13,14,15,16,17,18]
Summary
In industrialized as well as in developing countries, cognitive impairment is increasingly recognized as an important concern in children perinatally infected with the human immunodeficiency virus (PHIV) and treated with combination antiretroviral therapy (cART) [1,2,3]. The severity of HIV disease and immune suppression, reflected by HIV viral load (VL), Center for Disease Control category C diagnoses and lower CD4+ T-cell counts, have been associated with poorer cognitive functioning in PHIV children [3,4,5,6]. In countries such as the Netherlands and the UK, the majority of PHIV children was born abroad, with an increasing proportion having been internationally adopted by adoptive parents [7, 8]. This study aims to further elucidate the association between treated HIV infection and cognitive development by addressing the background of international adoption
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