Esau G Mbewe1, Pelekelo P Kabundula1, Sylvia Mwanza-Kabaghe1, Alexandra Buda2, Heather R Adams2,3, Colleen Schneider2, Michael J Potchen4,5, Milimo Mweemba6, Manoj Mathews6,7,8, J Anitha Menon9, Bo Wang10, Travis Baseler11, Alex Paciorkowski3, Gretchen L Birbeck6,12,13, David R Bearden2,3. 1. Department of Educational Psychology, University of Zambia, Lusaka, Zambia. 2. University of Rochester School of Medicine and Dentistry, Rochester, NY. 3. Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY. 4. Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. 5. Lusaka Apex Medical University, Lusaka, Zambia. 6. University Teaching Hospital, Neurology Research Office, Lusaka, Zambia. 7. University Teaching Hospital Children's Hospital, Lusaka, Zambia. 8. Directorate of Clinical Care and Diagnostics Services, Ministry of Health, Lusaka, Zambia. 9. Department of Psychology, University of Zambia, Lusaka, Zambia. 10. Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. 11. Department of Economics, University of Rochester, Rochester, NY. 12. University of Zambia School of Medicine, Lusaka, Zambia; and. 13. Division of Epilepsy, Department of Neurology, Rochester, NY.
Abstract
BACKGROUND: Multiple previous studies have identified a detrimental effect of pediatric HIV on cognitive function. Socioeconomic status (SES) is one of the strongest predictors of cognitive performance and may affect the relationship between HIV and cognition. METHODS: As part of the ongoing HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) study, a prospective cohort study, we recruited 208 participants with HIV and 208 HIV-exposed uninfected controls, all aged 8-17 years. A standardized questionnaire was administered to assess SES, and all participants had comprehensive neuropsychological testing. An NPZ8 score was derived as a summary measure of cognitive function. Logistic regression and linear regression were used to model the relationship between SES and cognitive function, and mediation analysis was used to identify specific pathways by which SES may affect cognition. RESULTS: Children with HIV performed significantly worse on a composite measure of cognitive function (NPZ8 score -0.19 vs. 0.22, P < 0.001) and were more likely to have cognitive impairment (33% vs. 19%, P = 0.001). Higher SES was associated with reduced risk of cognitive impairment (odds ratio 0.8, 95% confidence interval: 0.75-0.92, P < 0.001) in both groups, with similar effects in children with HIV and HIV-exposed uninfected groups. SES was more strongly correlated with NPZ8 score in children with HIV than in uninfected controls (Pearson's R 0.39 vs. 0.28), but predicted NPZ8 in both groups. Mediation analysis suggested that the effect of SES on cognition was most strongly mediated through malnutrition. CONCLUSIONS: Cognitive function is strongly correlated with SES in children with HIV, suggesting a synergistic effect of HIV and poverty on cognitive function.
BACKGROUND: Multiple previous studies have identified a detrimental effect of pediatric HIV on cognitive function. Socioeconomic status (SES) is one of the strongest predictors of cognitive performance and may affect the relationship between HIV and cognition. METHODS: As part of the ongoing HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) study, a prospective cohort study, we recruited 208 participants with HIV and 208 HIV-exposed uninfected controls, all aged 8-17 years. A standardized questionnaire was administered to assess SES, and all participants had comprehensive neuropsychological testing. An NPZ8 score was derived as a summary measure of cognitive function. Logistic regression and linear regression were used to model the relationship between SES and cognitive function, and mediation analysis was used to identify specific pathways by which SES may affect cognition. RESULTS: Children with HIV performed significantly worse on a composite measure of cognitive function (NPZ8 score -0.19 vs. 0.22, P < 0.001) and were more likely to have cognitive impairment (33% vs. 19%, P = 0.001). Higher SES was associated with reduced risk of cognitive impairment (odds ratio 0.8, 95% confidence interval: 0.75-0.92, P < 0.001) in both groups, with similar effects in children with HIV and HIV-exposed uninfected groups. SES was more strongly correlated with NPZ8 score in children with HIV than in uninfected controls (Pearson's R 0.39 vs. 0.28), but predicted NPZ8 in both groups. Mediation analysis suggested that the effect of SES on cognition was most strongly mediated through malnutrition. CONCLUSIONS: Cognitive function is strongly correlated with SES in children with HIV, suggesting a synergistic effect of HIV and poverty on cognitive function.
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