Stephen J Kerr1,2,3, Thanyawee Puthanakit1,4, Kathleen M Malee5, Kulvadee Thongpibul6, Penh Sun Ly7, Jiratchaya Sophonphan1, Tulathip Suwanlerk1, Pope Kosalaraksa8, Pradthana Ounchanum9, Linda Aurpibul10, Suparat Kanjanavanit11, Chaiwat Ngampiyaskul12, Kea Chettra7, Reuben Robbins13, Robert Paul14, Jintanat Ananworanich15,16,17,18, Claude A Mellins13. 1. The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand. 2. Biostatistics Excellence Centre, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 3. The Kirby Institute, The University of New South Wales, Sydney, Australia. 4. Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 5. Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL. 6. Department of Psychology, Faculty of Humanities, Chiang Mai University, Chiang Mai, Thailand. 7. National Center for HIV/AIDS Dermatology and STDs, Phnom Penh, Cambodia. 8. Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 9. Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand. 10. Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. 11. Nakornping Hospital, Chiang Mai, Thailand. 12. Prapokklao Hospital, Chanthaburi, Thailand. 13. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, and Columbia University, New York, NY. 14. Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO. 15. SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand. 16. The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD. 17. U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD. 18. Department of Global Health, University of Amsterdam, Amsterdam, the Netherlands.
Abstract
BACKGROUND: Large numbers of perinatally HIV-infected (PHIV) children are aging into adolescence. We examined cognitive and behavioral outcomes in a longitudinal cohort of Asian youth. METHODS: We followed up 231 PHIV, 125 perinatally HIV-exposed, uninfected (HEU), and 138 HIV-unexposed, uninfected (HUU) adolescents (aged 10 years and older), matched by age/sex, in Thailand and Cambodia for 3 years. Executive function was assessed with Children's Color Trails Tests 1 and 2 (CCTT-1 and -2), the design fluency test, and the verbal fluency test. Working memory (Freedom from Distractibility Index) and processing speed index were assessed using WISC-III. Visual memory was assessed by design memory and design recognition subtests of the Wide Range Assessment of Memory and Learning (WRAML-2) and behavioral problems using the Child Behavior Checklist (CBCL). Generalized estimating equations examined adjusted odds ratios of cognitive impairment (Z-scores ≥2 SD below age-adjusted means of the HUU group) and CBCL T-scores in the borderline-clinical range (T-Scores ≥60) in PHIV and HEU versus HUU youth, adjusting for ethnicity, household income, and caregiver characteristics. RESULTS: The median age at enrollment was 13.8 years, with 58% women and 63% Thai participants. PHIV youth had >86% virological suppression and significantly higher impairment rates on CCTT-1 and -2 tests, design fluency test, verbal fluency tests, design memory, and CBCL internalizing and externalizing problems. Results were mostly similar between HEU and HUU groups, apart from higher impairment rates on CCTT-1 and internalizing problems in HEU. CONCLUSION: Asian adolescents with PHIV remain at risk of cognitive and mental health problems despite HIV treatment. Selective risks are observed among HEU youth.
BACKGROUND: Large numbers of perinatally HIV-infected (PHIV) children are aging into adolescence. We examined cognitive and behavioral outcomes in a longitudinal cohort of Asian youth. METHODS: We followed up 231 PHIV, 125 perinatally HIV-exposed, uninfected (HEU), and 138 HIV-unexposed, uninfected (HUU) adolescents (aged 10 years and older), matched by age/sex, in Thailand and Cambodia for 3 years. Executive function was assessed with Children's Color Trails Tests 1 and 2 (CCTT-1 and -2), the design fluency test, and the verbal fluency test. Working memory (Freedom from Distractibility Index) and processing speed index were assessed using WISC-III. Visual memory was assessed by design memory and design recognition subtests of the Wide Range Assessment of Memory and Learning (WRAML-2) and behavioral problems using the Child Behavior Checklist (CBCL). Generalized estimating equations examined adjusted odds ratios of cognitive impairment (Z-scores ≥2 SD below age-adjusted means of the HUU group) and CBCL T-scores in the borderline-clinical range (T-Scores ≥60) in PHIV and HEU versus HUU youth, adjusting for ethnicity, household income, and caregiver characteristics. RESULTS: The median age at enrollment was 13.8 years, with 58% women and 63% Thai participants. PHIV youth had >86% virological suppression and significantly higher impairment rates on CCTT-1 and -2 tests, design fluency test, verbal fluency tests, design memory, and CBCL internalizing and externalizing problems. Results were mostly similar between HEU and HUU groups, apart from higher impairment rates on CCTT-1 and internalizing problems in HEU. CONCLUSION: Asian adolescents with PHIV remain at risk of cognitive and mental health problems despite HIV treatment. Selective risks are observed among HEU youth.
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