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 2 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 with 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 to −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 2-year period of adolescence, allowing cautious optimism regarding long-term outcomes.
*Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL;
†Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA;
‡Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA;
§Research Department, Children's Diagnostic and Treatment Center, Fort Lauderdale, FL;
‖Department of Psychiatry, Boston Children's Hospital, Boston, MA;
¶Department of Pediatrics, Baylor College of Medicine, Houston, TX;
#Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY; and
**Department of Neurosciences, University of California, San Diego, La Jolla, CA.
Correspondence to: Kathleen M. Malee, PhD, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 155, Chicago, IL 60611 (e-mail: kmalee@luriechildrens.org).
The Memory and Executive Functioning Substudy of the Pediatric HIV/AIDS Cohort Study (PHACS) was supported by the National Institute of Mental Health[MH084794; Principal Investigator (PI): S.L.N.]. Additional support was provided by PHACS, which was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with cofunding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, the Office of AIDS Research, the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute, the National Institute of Dental and Craniofacial Research, and the National Institute on Alcohol Abuseand Alcoholism, through cooperative agreements with the Harvard University T.H. Chan School of Public Health (HD052102) (Principal Investigator: George Seage; Project Director: Julie Alperen) and the Tulane University School of Medicine (HD052104) (Principal Investigator: Russell Van Dyke; Co-Principal Investigators: Kenneth Rich, Ellen Chadwick; Project Director: Patrick Davis).
The authors have no conflicts of interest to disclose.
The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).
Received January 06, 2017
Accepted April 06, 2017
