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Discordance of Cognitive and Academic Achievement Outcomes in Youth With Perinatal HIV Exposure

Garvie, Patricia A. PhD*; Zeldow, Bret MS; Malee, Kathleen PhD; Nichols, Sharon L. PhD§; Smith, Renee A. PhD; Wilkins, Megan L. PhD; Williams, Paige L. PhD; for the Pediatric HIVAIDS Cohort Study (PHACS)

Pediatric Infectious Disease Journal: September 2014 - Volume 33 - Issue 9 - p e232–e238
doi: 10.1097/INF.0000000000000314
HIV Reports

Background: To evaluate achievement in youth with perinatally acquired HIV (PHIV) compared with HIV-exposed uninfected peers (HEU) and to examine differential effects of HIV on cognition-achievement concordance.

Methods: Cognition and achievement were assessed using standardized measures. Intelligence quotient-derived predicted achievement scores were subtracted from observed achievement scores to calculate discrepancy values. Linear regression models were used to compare achievement discrepancies between PHIV and HEU, adjusting for demographic covariates.

Results: Participants: 295 PHIV and 167 HEU youth; 71% black, 48% male, mean age 13.1 and 11.3 years, respectively. PHIV youth were relatively healthy (mean CD4%, 32%; viral load ≤400 copies/mL, 72%). PHIV and HEU youth had cognitive and achievement scores significantly below population norm means (P < 0.001), but did not differ in cognition (mean full scale IQ = 86.7 vs. 89.4, respectively). In unadjusted models, HEU outperformed PHIV youth on total achievement (mean = 89.2 vs. 86.0, P = 0.04) and numerical operations (mean = 88.8 vs. 82.9, P < 0.001); no differences remained after adjustment. Mean observed-predicted achievement discrepancies reflected “underachievement”. History of encephalopathy predicted poorer achievement (P = 0.039) and greater underachievement, even after adjustment. PHIV showed greater underachievement than HEU for numerical operations (P < 0.001) and total achievement (P = 0.03), but these differences did not persist in adjusted models.

Conclusions: Both PHIV and HEU youth demonstrated lower achievement than normative samples and underachieved relative to predicted achievement scores. Observed-predicted achievement discrepancies were associated with prior encephalopathy, older age and other non-HIV factors. PHIV youth with prior encephalopathy had significantly lower achievement and greater underachievement compared with PHIV without encephalopathy and HEU youth, even in adjusted models.

From the *Children’s Diagnostic & Treatment Center, Fort Lauderdale, FL; Harvard School of Public Health, Boston, MA; Northwestern University Feinberg School of Medicine, Chicago, IL; §University of California, San Diego, La Jolla, CA; University of Illinois at Chicago, Chicago, IL; and St. Jude Children’s Research Hospital, Memphis, TN.

Accepted for publication, February 12, 2014.

The Pediatric HIV/AIDS Cohort Study (PHACS) was supported 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 Abuse and Alcoholism, through cooperative agreements with the Harvard University School of Public Health (HD052102, 3 U01 HD052102-05S1, 3 U01 HD052102-06S3; principal investigator: George Seage; project director: Julie Alperen) and the Tulane University School of Medicine (HD052104, 3U01 HD052104-06S1; principal investigator: Russell Van Dyke; co-principal investigator: Kenneth Rich; project director: Patrick Davis).

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 the U.S. Department of Health and Human Services. The authors have no other funding or conflict of interest to disclose.

Address for correspondence: Patricia A. Garvie, PhD, Children’s Diagnostic & Treatment Center, 1401 S. Federal Hwy, Fort Lauderdale, FL 33316. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.