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Impact of HIV Severity on Cognitive and Adaptive Functioning During Childhood and Adolescence

Smith, Renee PhD*; Chernoff, Miriam PhD; Williams, Paige L. PhD; Malee, Kathleen M. PhD§; Sirois, Patricia A. PhD; Kammerer, Betsy PhD; Wilkins, Megan PhD**; Nichols, Sharon PhD††; Mellins, Claude PhD‡‡; Usitalo, Ann PhD§§; Garvie, Patricia PhD¶¶; Rutstein, Richard MD║║

The Pediatric Infectious Disease Journal: June 2012 - Volume 31 - Issue 6 - p 592–598
doi: 10.1097/INF.0b013e318253844b
HIV Reports

Background: The influence of disease severity on cognitive and adaptive functioning in perinatally HIV-infected youth with (PHIV+/C) and without (PHIV+/NoC) a previous AIDS-defining illness (Centers for Disease Control and Prevention Class C event), compared with perinatally HIV-exposed but uninfected youth (PHEU) is not well understood.

Methods: This was a cross-sectional analysis of cognitive and adaptive functioning in PHIV+/C (n = 88), PHIV+/NoC (n = 270) and PHEU (n = 200) youth aged 7–16 years, from a multisite prospective cohort study. Youth and caregivers completed the Wechsler Intelligence Scale for Children, Fourth Edition and the Adaptive Behavior Assessment System, Second Edition, respectively. We compared means and rates of impairment between groups, and examined associations with other psychosocial factors.

Results: Overall mean scores on measures of cognitive and adaptive functioning were in the low average range for all 3 groups. After adjustment for covariates, mean full-scale intelligence quotient scores were significantly lower for the PHIV+/C group than the PHIV+/NoC and PHEU groups (mean = 77.8 versus 83.4 and 83.3, respectively), whereas no significant differences were observed between the PHEU and PHIV+/NoC groups in any domain. Lower cognitive performance for the PHIV+/C group was primarily attributable to a prior diagnosis of encephalopathy. No significant differences between groups were observed in adaptive functioning.

Conclusion: For long-term survivors, youth with HIV infection and a prior Centers for Disease Control and Prevention Class C event have higher risk for cognitive but not adaptive impairment regardless of current health status; this finding appears attributable to a previous diagnosis of encephalopathy. Early preventive therapy may be critical in reducing risk of later neurodevelopmental impairments.

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From the *Department of Pediatrics, University of Illinois at Chicago, Chicago, IL; Center for Biostatistics in AIDS Research, Harvard School of Public Health; Department of Biostatistics, Harvard School of Public Health, Boston, MA; §Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatrics, Tulane University Health Sciences Center, New Orleans, LA; Departments of Psychiatry and Otolaryngology and Communication Disorders, Children’s Hospital Boston, Boston, MA; **St. Jude Children’s Research Hospital, Memphis, TN; ††Department of Neurosciences, University of California, San Diego, CA; ‡‡Department of Psychiatry and Sociomedical Sciences, Columbia University, New York; §§University of Florida, Jacksonville, FL; ¶¶Consulting Psychologist, Memphis, TN; ║║Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA.

Accepted for publication February 13, 2012.

Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with cofunding from the National Institute of Allergy and Infectious Diseases, the National Institute on Drug Abuse, the National Institute of Mental Health, the National Institute of Deafness and other Communication Disorders, the National Heart Lung and Blood Institute, National Institute of Neurological Disorders and Stroke and the National Institute on Alcohol Abuse and Alcoholism, through cooperative agreements with the Harvard University School of Public Health (U01 HD0522102-04) and the Tulane University School of Medicine (U01 HD 052104-01). The authors have no other funding or conflicts of interest to disclose.

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Address for correspondence: Renee Smith, PhD, University of Illinois at Chicago, Department of Pediatrics, 840 S. Wood St., M/C 856 Chicago, IL 60612. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.