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Executive Functioning in Children and Adolescents With Perinatal HIV Infection

Nichols, Sharon L. PhD*; Brummel, Sean S. PhD; Smith, Renee A. PhD; Garvie, Patricia A. PhD§; Hunter, Scott J. PhD; Malee, Kathleen M. PhD; Kammerer, Betsy L. PhD**; Wilkins, Megan L. PhD††; Rutstein, Richard MD‡‡; Tassiopoulos, Katherine DSc§§; Chernoff, Miriam C. PhD¶¶; Mellins, Claude A. PhD‖‖ for the Pediatric HIVAIDS Cohort Study

The Pediatric Infectious Disease Journal: September 2015 - Volume 34 - Issue 9 - p 969–975
doi: 10.1097/INF.0000000000000809
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Background: Perinatal HIV (PHIV) infection may place youth at risk for impairments in executive functioning (EF). We examined associations of EF with HIV infection, disease severity and other factors among youth with PHIV and perinatally HIV-exposed, uninfected youth (PHEU).

Methods: Within the US-based Pediatric HIV/AIDS Cohort Study, 354 PHIV and 200 PHEU youth completed a standardized EF measure (Children’s Color Trails Test, CCTT) and youth and/or caregivers completed a questionnaire measuring everyday EF (Behavior Rating Inventory of Executive Function, BRIEF). Covariates included HIV status, current and historical disease severity, demographic and caregiver variables and other cognitive measures. Analyses used linear and logistic regression and proportional odds models.

Results: No significant HIV status group differences were found on CCTT scores. Caregiver BRIEF ratings indicated significantly fewer problems for PHIV than PHEU youth. However, PHIV youth with past encephalopathy self-endorsed significantly greater metacognitive (ie, cognitive regulation) problems on the BRIEF and performed more slowly on the CCTT than PHEU youth. CCTT and caregiver BRIEF scores had significant associations with indicators of past and present disease severity. Both PHIV and PHEU had significantly worse scores than population means on CCTT and BRIEF; scores had significant associations with demographic covariates.

Conclusions: Youth with PHIV show EF problems likely associated with risk factors other than HIV. However, cognitive slowing and self-reported metacognitive problems were evident in PHIV youth with a history of encephalopathy. Assessment and treatment of EF impairment may be important to identifying PHIV youth at particular risk for poor health and behavioral outcomes.

From the *Department of Neurosciences, University of California, San Diego, La Jolla, CA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Pediatrics, University of Illinois at Chicago, Chicago, IL; §Research Department, Children’s Diagnostic & Treatment Center, Fort Lauderdale, FL; Departments of Psychiatry & Behavioral Neuroscience and Pediatrics, University of Chicago; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; **Department of Psychiatry, Boston Children’s Hospital, Boston, MA; ††Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN; ‡‡Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA; §§Department of Epidemiology, Harvard T.H. Chan School of Public Health; ¶¶Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA; and ‖‖Departments of Psychiatry and Sociomedical Sciences, Columbia University, New York, NY.

Accepted for publication December 15, 2014.

The Pediatric HIV/AIDS Cohort Study (PHACS) was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with co-funding 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) [Principal Investigator (PI): George Seage; Project Director: Julie Alperen] and the Tulane University School of Medicine (HD052104) (Principal Investigator: Russell Van Dyke; Co-Principal Investigator: Kenneth Rich; Project Director: Patrick Davis). Data management services were provided by Frontier Science and Technology Research Foundation (PI: Suzanne Siminski), and regulatory services and logistical support were provided by Westat, Inc (PI: Julie Davidson). 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 U.S. 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 website (www.pidj.com).

Address for correspondence: Sharon L. Nichols, PhD, University of California, San Diego, 9500 Gilman Drive, Mail Code 0935, La Jolla, CA 92093. E-mail: slnichols@ucsd.edu.

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