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Schwabenland M, Mossad O, Sievert A, Peres AG, Ringel E, Baasch S, Kolter J, Cascone G, Dokalis N, Vlachos A, Ruzsics Z, Henneke P, Prinz M, Blank T. Neonatal immune challenge poses a sex-specific risk for epigenetic microglial reprogramming and behavioral impairment. Nat Commun 2023; 14:2721. [PMID: 37169749 PMCID: PMC10175500 DOI: 10.1038/s41467-023-38373-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/27/2023] [Indexed: 05/13/2023] Open
Abstract
While the precise processes underlying a sex bias in the development of central nervous system (CNS) disorders are unknown, there is growing evidence that an early life immune activation can contribute to the disease pathogenesis. When we mimicked an early systemic viral infection or applied murine cytomegalovirus (MCMV) systemically in neonatal female and male mice, only male adolescent mice presented behavioral deficits, including reduced social behavior and cognition. This was paralleled by an increased amount of infiltrating T cells in the brain parenchyma, enhanced interferon-γ (IFNγ) signaling, and epigenetic reprogramming of microglial cells. These microglial cells showed increased phagocytic activity, which resulted in abnormal loss of excitatory synapses within the hippocampal brain region. None of these alterations were seen in female adolescent mice. Our findings underscore the early postnatal period's susceptibility to cause sex-dependent long-term CNS deficiencies following infections.
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Affiliation(s)
- Marius Schwabenland
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Omar Mossad
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Annika Sievert
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Adam G Peres
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elena Ringel
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Baasch
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Kolter
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Giulia Cascone
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nikolaos Dokalis
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Andreas Vlachos
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in Neuromodulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Zsolt Ruzsics
- Institute for Virology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Philipp Henneke
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Pediatrics and Adolescent Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- CIBSS Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Marco Prinz
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in Neuromodulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Signalling Research Centres BIOSS and CIBSS-Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Thomas Blank
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Mugo C, Firdawsi O, Wang J, Njuguna IN, Wamalwa DC, Slyker JA, John-Stewart GC, O'Malley G, Wagner AD. "When they are all grown, I will tell them": Experience and perceptions of parental self-disclosure of HIV status to children in Nairobi, Kenya. BMC Public Health 2023; 23:519. [PMID: 36932351 PMCID: PMC10024367 DOI: 10.1186/s12889-023-15387-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 03/07/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND There is mixed evidence on the influence of self-disclosure of one's HIV status on mental health, health behaviours and clinical outcomes. We studied the patterns of self-disclosure among parents living with HIV, and factors that influence parental disclosure. METHODS This mixed-methods study was among adults in HIV care participating in a study assessing the uptake of pediatric index-case testing. They completed a survey to provide demographic and HIV-related health information, and assess self-disclosure to partners, children and others. We ran generalized linear models to determine factors associated with disclosure and reported prevalence ratios (PR). Eighteen participants also participated in in-depth interviews to explore perceived barriers and facilitators of self-disclosure to one's child. A content analysis approach was used to analyze interview transcripts. RESULTS Of 493 caregivers, 238 (48%) had a child ≥ 6 years old who could potentially be disclosed to about their parent's HIV status. Of 238 participants, 205 (86%) were female, median age was 35 years, and 132 (55%) were in a stable relationship. Among those in a stable relationship, 96 (73%) knew their partner's HIV status, with 79 (60%) reporting that their partner was living with HIV. Caregivers had known their HIV status for a median 2 years, and the median age of their oldest child was 11 years old. Older caregiver age and older first born child's age were each associated with 10% higher likelihood of having disclosed to a child (PR: 1.10 [1.06-1.13] and PR: 1.10 [1.06-1.15], per year of age, respectively). The child's age or perceived maturity and fear of causing anxiety to the child inhibited disclosure. Child's sexual activity was a motivator for disclosure, as well as the belief that disclosing was the "right thing to do". Caregivers advocated for peer and counseling support to gain insight on appropriate ways to disclose their status. CONCLUSIONS Child's age is a key consideration for parents to disclose their own HIV status to their children. While parents were open to disclosing their HIV status to their children, there is a need to address barriers including anticipated stigma, and fear that disclosure will cause distress to their children.
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Affiliation(s)
- Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, 00202, Kenya.
- Department of Epidemiology, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA.
| | - Olivia Firdawsi
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Jiayu Wang
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Irene N Njuguna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, 00202, Kenya
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Dalton C Wamalwa
- Department of Medicine, University of Washington, Box 359909, WA, 98104, Seattle, USA
| | - Jennifer A Slyker
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Grace C John-Stewart
- Department of Epidemiology, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
- Department of Medicine, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
- Department of Pediatrics, University of Nairobi, Nairobi, KE, 00202, USA
| | - Gabrielle O'Malley
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
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Khobo IL, Jankiewicz M, Holmes MJ, Little F, Cotton MF, Laughton B, van der Kouwe AJW, Moreau A, Nwosu E, Meintjes EM, Robertson FC. Multimodal magnetic resonance neuroimaging measures characteristic of early cART-treated pediatric HIV: A feature selection approach. Hum Brain Mapp 2022; 43:4128-4144. [PMID: 35575438 PMCID: PMC9374890 DOI: 10.1002/hbm.25907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 04/03/2022] [Accepted: 04/26/2022] [Indexed: 11/09/2022] Open
Abstract
Children with perinatally acquired HIV (CPHIV) have poor cognitive outcomes despite early combination antiretroviral therapy (cART). While CPHIV-related brain alterations can be investigated separately using proton magnetic resonance spectroscopy (1 H-MRS), structural magnetic resonance imaging (sMRI), diffusion tensor imaging (DTI), and functional MRI (fMRI), a set of multimodal MRI measures characteristic of children on cART has not been previously identified. We used the embedded feature selection of a logistic elastic-net (EN) regularization to select neuroimaging measures that distinguish CPHIV from controls and measured their classification performance via the area under the receiver operating characteristic curve (AUC) using repeated cross validation. We also wished to establish whether combining MRI modalities improved the models. In single modality analysis, sMRI volumes performed best followed by DTI, whereas individual EN models on spectroscopic, gyrification, and cortical thickness measures showed no class discrimination capability. Adding DTI and 1 H-MRS in basal measures to sMRI volumes produced the highest classification performancevalidation accuracy = 85 % AUC = 0.80 . The best multimodal MRI set consisted of 22 DTI and sMRI volume features, which included reduced volumes of the bilateral globus pallidus and amygdala, as well as increased mean diffusivity (MD) and radial diffusivity (RD) in the right corticospinal tract in cART-treated CPHIV. Consistent with previous studies of CPHIV, select subcortical volumes obtained from sMRI provide reasonable discrimination between CPHIV and controls. This may give insight into neuroimaging measures that are relevant in understanding the effects of HIV on the brain, thereby providing a starting point for evaluating their link with cognitive performance in CPHIV.
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Affiliation(s)
- Isaac L. Khobo
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Marcin Jankiewicz
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Cape Universities Body Imaging CenterUniversity of Cape TownCape TownSouth Africa
| | - Martha J. Holmes
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Francesca Little
- Department of Statistical SciencesUniversity of Cape TownCape TownSouth Africa
| | - Mark F. Cotton
- Department of Pediatrics & Child Health, Family Center for Research with Ubuntu, Tygerberg HospitalStellenbosch UniversityCape TownSouth Africa
| | - Barbara Laughton
- Department of Pediatrics & Child Health, Family Center for Research with Ubuntu, Tygerberg HospitalStellenbosch UniversityCape TownSouth Africa
| | - Andre J. W. van der Kouwe
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- A.A. Martinos Centre for Biomedical ImagingMassachusetts General HospitalBostonMassachusettsUSA
- Department of RadiologyHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Emmanuel Nwosu
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
| | - Ernesta M. Meintjes
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Cape Universities Body Imaging CenterUniversity of Cape TownCape TownSouth Africa
| | - Frances C. Robertson
- Division of Biomedical Engineering, Department of Human Biology, Biomedical Engineering Research CenterUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Cape Universities Body Imaging CenterUniversity of Cape TownCape TownSouth Africa
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Sirois PA, Huo Y, Nozyce ML, Garvie PA, Harris LL, Malee K, McEvoy R, Mellins CA, Nichols SL, Smith R, Tassiopoulos K. Ageing with HIV: a longitudinal study of markers of resilience in young adults with perinatal exposure to HIV, with or without perinatally acquired HIV. J Int AIDS Soc 2022; 25 Suppl 4:e25982. [PMID: 36176020 PMCID: PMC9522985 DOI: 10.1002/jia2.25982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/01/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Medical challenges, including perinatally acquired HIV (PHIV), can be considered adversity with the potential to compromise individuals' ability to meet societal expectations across the lifespan. Studies suggest that resilience, defined as positive adaptation in the context of adversity, helps individuals overcome challenges and improve their quality of life. Few longitudinal studies have examined resilience in young adults with perinatally acquired HIV (YAPHIV) or perinatal HIV exposure, uninfected (YAPHEU). We examined three young adult milestones, which can affect the life-long quality of life, as markers of resilience: high school graduation, postsecondary education and current employment. METHODS Analyses included YAPHIV and YAPHEU, ages 19-27 years, followed in longitudinal cohort studies: Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol (AMP) (7-17 years) and AMP Up (≥18 years). Factors known to influence the attainment of milestones (outcomes) were examined: executive function, cognitive efficiency (working memory and processing speed), behavioural/social-emotional functioning, parent/caregiver mental/physical health and cumulative risk. HIV disease markers for YAPHIV were examined. The most recent AMP assessment was used for each factor; outcomes were measured at AMP Up 1-year follow-up. Separate robust Poisson regression models were used to assess associations of each factor with each outcome; PHIV status was explored as an effect modifier of each association. RESULTS Participants (N = 315; YAPHIV = 228): 58% female, 67% Black and 27% Hispanic. Compared to YAPHEU, YAPHIV were older and from families with higher median income and fewer symptoms of parent/caregiver mental health/substance use disorders. Proportions of YAPHIV and YAPHEU, respectively, who achieved each milestone were comparable: 82% versus 78% for high school graduation (p = 0.49), 45% versus 51% for postsecondary education (p = 0.35) and 48% versus 54% for current employment (p = 0.32). Higher cognitive efficiency was positively associated with postsecondary education and current employment. Higher executive function, age-appropriate behavioural/social-emotional functioning and lower cumulative risk were associated with academic milestones. Among YAPHIV, positive associations were: higher current CD4 with postsecondary education and lower nadir CD4 with current employment. PHIV status did not modify any association. CONCLUSIONS YAPHIV and YAPHEU demonstrated resilience, attaining at least one young adult milestone. Cognitive, behavioural and social resources to support resilience in childhood and adolescence may provide the foundation for continued achievement throughout adulthood.
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Affiliation(s)
- Patricia A. Sirois
- Department of PediatricsTulane University School of MedicineNew OrleansLouisianaUSA
| | - Yanling Huo
- Center for Biostatistics in AIDS ResearchHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Molly L. Nozyce
- Department of PediatricsJacobi Medical CenterAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Patricia A. Garvie
- Research DepartmentChildren's Diagnostic & Treatment CenterFort LauderdaleFloridaUSA
| | | | - Kathleen Malee
- Departments of Infectious Diseases and Psychiatry and Behavioral ScienceNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Robin McEvoy
- Department of Pediatrics, Infectious DiseasesUniversity of Colorado School of MedicineChildren's Hospital ColoradoAuroraColoradoUSA
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral StudiesNew York State Psychiatric Instituteand Departments of Psychiatry and Sociomedical SciencesColumbia UniversityNew York CityNew YorkUSA
| | - Sharon L. Nichols
- Department of NeurosciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Renee Smith
- Department of PediatricsUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Katherine Tassiopoulos
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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Nichols SL. Central Nervous System Impact of Perinatally Acquired HIV in Adolescents and Adults: an Update. Curr HIV/AIDS Rep 2022; 19:121-132. [PMID: 35107809 PMCID: PMC8904346 DOI: 10.1007/s11904-021-00598-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/24/2022]
Abstract
Purpose of Review Perinatally acquired HIV infection (PHIV) can confer neurodevelopmental risk. As children with PHIV increasingly survive through adolescence and into adulthood, understanding its long-term central nervous system (CNS) impacts is critical for maximizing adult outcomes and quality of life. Recent Findings Recently published neurocognitive and neuroimaging findings show impacts on the CNS associated with early HIV disease progression that endure into adolescence and young adulthood. Although developmental trajectories in adolescence largely appear stable, further research on maturational processes is indicated. Summary Although early antiretroviral therapy in infancy appears to be protective, it is not universally available and current youth largely developed without its benefit. The neurocognitive effects of HIV and the multiple other risks to neurodevelopment experienced by youth with PHIV call for further longitudinal research and a multifaceted approach to prevention and intervention.
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Affiliation(s)
- Sharon L Nichols
- Department of Neurosciences, University of California, San Diego 9500 Gilman Drive, #0935, CA, 92093, La Jolla, USA.
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Arenas-Pinto A, Judd A, Melvin D, Le Prevost M, Foster C, Sturgeon K, Winston A, Thompson LC, Gibb DM, Castro H. Learning and memory function in young people with and without perinatal HIV in England. PLoS One 2022; 17:e0273645. [PMID: 36107958 PMCID: PMC9477265 DOI: 10.1371/journal.pone.0273645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/12/2022] [Indexed: 11/25/2022] Open
Abstract
Learning and memory are important for successful education and career progression. We assess these functions in young people (YP) with perinatal HIV (PHIV) (with or without a previous AIDS-defining illness) and a comparable group of HIV-negative YP. 234 PHIV and 68 HIV-negative YP completed 9 tests; 5 National Institutes of Health (NIH) Toolbox tests (2 executive function, 1 speed of information processing, 2 memory); 2 Hopkins Verbal Learning Test Revised (HVLT-R) (learning (L), delayed recall (R)), and 2 verbal application measures. Z-scores for each test were calculated using normative data and averaged by domain where appropriate. The effect of predictors on test scores in the three domains with the lowest z-scores were analysed using linear regression. 139(59%) and 48(71%) PHIV and HIV-negative YP were female, 202(86%) and 52(76%) Black, and median age was 19 [17, 21] and 18 [16, 21] years respectively. 55(24%) PHIV had a previous Center for Disease Control and Prevention (CDC) class C AIDS-defining diagnosis (PHIV/C). For HVLT-R, there was a trend towards PHIV/C YP having the lowest mean z-scores (L -1.5 (95% CI -1.8,-1.2), R -1.7 (-2.0,-1.4)) followed by PHIV without a CDC C diagnosis (L -1.3 (-1.4,-1.1), R -1.4 (-1.5,-1.2)) and then the HIV-negative group (L -1.0 (-1.3,-0.7), R -1.1 (-1.3,-0.8)); all were greater than 1 SD below the reference mean. The same trend was seen for verbal application measures; however, z-scores were within 1 SD below the reference mean. NIH Toolbox tests were similar for all groups. In multivariable analyses PHIV/C and Black ethnicity predicted lower HVLT-R scores. Black ethnicity also predicted lower executive function scores, however each year increase in age predicted higher scores. In conclusion, cognitive performance in verbal learning and recall fell below population normative scores, and was more pronounced in PHIV/C, supporting wider findings that earlier antiretroviral therapy initiation, before the occurrence of AIDS-defining conditions, may protect aspects of cognitive development.
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Affiliation(s)
- Alejandro Arenas-Pinto
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
- Centre for Clinical Research in Infection and Sexual Health, University College London Institute for Global Health, London, United Kingdom
- * E-mail:
| | - Ali Judd
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Diane Melvin
- Imperial College Healthcare and Central North West London National Health Service Trust, London, United Kingdom
| | - Marthe Le Prevost
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Caroline Foster
- Imperial College Healthcare and Central North West London National Health Service Trust, London, United Kingdom
| | - Kate Sturgeon
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | | | - Lindsay C. Thompson
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Diana M. Gibb
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Hannah Castro
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
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Rowe K, Duta M, Demeyere N, Wagner RG, Pettifor A, Kahn K, Tollman S, Scerif G, Stein A. The relationship between executive function, risky behaviour and HIV in young women from the HPTN 068 study in rural South Africa. AIDS Care 2021; 33:682-692. [PMID: 33258691 PMCID: PMC8650142 DOI: 10.1080/09540121.2020.1851016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
Executive function (EF) may predict sexual risk-taking and HIV risk in young women in rural South Africa. We tested associations between EF and seven risky behavioural outcomes: binge drinking, illicit substance use, unprotected vaginal sex, concurrent sexual relationships, transactional sex, herpes simplex virus type 2 (HSV-2) infection, and HIV infection. We compared EF in young women with HIV to matched controls. 1080 young women underwent cognitive assessments. Better verbal short-term memory was associated with a lower risk of HSV-2 (OR 0.77; 95% CI 0.69, 0.86; p < 0.001). Uncorrected trends (p < 0.05) were better verbal working memory being associated with a lower risk of concurrency, better planning with a lower risk of illicit drug use, and better affective inhibition with a lower risk of transactional sex. 78 participants with sexually acquired HIV were matched with 153 HIV-negative controls and had poorer verbal working memory than controls (Hedge's g = -0.38; 95% CI -0.66, -0.10; p = 0.0076), but this was non-significant after adjustment. EF's contribution to young women's risky behaviour in this context does not hold when stringent statistical corrections are applied, with only verbal short term memory reaching statistical significance as predictor. Replication in other samples is recommended.
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Affiliation(s)
- Kirsten Rowe
- Department of Psychiatry, University of Oxford, Oxford, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Mihaela Duta
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Merville O, Puangmala P, Suksawas P, Kliangpiboon W, Keawvilai W, Tunkam C, Yama S, Sukhaphan U, Sathan S, Marasri S, Rolland-Guillard L, Sirirungsi W, Le Cœur S. School trajectory disruption among adolescents living with perinatal HIV receiving antiretroviral treatments: a case-control study in Thailand. BMC Public Health 2021; 21:189. [PMID: 33478442 PMCID: PMC7818931 DOI: 10.1186/s12889-021-10189-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents living with perinatal HIV often experience difficult living circumstances that can impact educational achievement and thus their transition to adult life. We explored their school trajectories and evaluated the contribution of perinatal HIV-infection, in Thailand, where education is free and compulsory until the age of 15. METHODS We used data from the Teens Living with Antiretrovirals (TEEWA) study, a cross-sectional case-control study conducted from 2011 to 2014 in Thailand. Participants were 707 adolescents living with perinatal HIV (ALPHIV, cases) aged 12-19 receiving antiretroviral therapy in 19 hospitals throughout Thailand and 689 HIV-uninfected adolescents (controls) living in the same institutions or, for those living in family settings, randomly selected from the general population and individually matched for sex, age, and place of residence. School trajectory disruption was defined as ≥1 year of academic delay or as early school dropout (before 15 years of age). Logistic regression models were used to assess factors independently associated with disrupted school trajectory and to estimate the proportion of school disruption attributable to HIV-infection. We used multivariate imputations by chained equations (MICE) to manage missing data and performed two sensitivity analyses to evaluate the main model's reliability. RESULTS The study population's median age was 14.5 years (58% female). School trajectory disruption was experienced by 37% of ALPHIV and 12% of the controls. After adjusting for sociodemographic factors, ALPHIV were 5 times more likely to experience disruption than controls (ORA =5.2 [3.7-7.2]). About 50% of school trajectory disruption was attributable to HIV-infection. Males and adolescents living in institutions were more likely to experience school trajectory disruption (ORA =1.8 [1.3-2.4] and ORA =11.0 [7.7-15.8], respectively). Among ALPHIV, neurocognitive difficulties and growth delay were significantly associated with disruption (ORA =3.3 [2.1-5.2] and ORA =1.8 [1.3-2.6], respectively). For those living in families, disruption was also associated with having a caregiver who had less than a secondary-level education (ORA =2.1 [1.1-3.9]) or having experienced stigmatization (ORA =1.9 [1.2-3.1]). CONCLUSIONS HIV and contextual factors combine to aggravate the educational disadvantage among ALPHIV. The impact of this disadvantage on their life prospects, especially regarding access to higher education and professional achievement, should be further explored.
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Affiliation(s)
- Ophélie Merville
- Institut national d'études démographiques (INED), Paris, France.
| | | | | | | | | | | | | | | | | | | | | | - Wasna Sirirungsi
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
| | - Sophie Le Cœur
- Institut national d'études démographiques (INED), Paris, France.,Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand.,Institut de recherche pour le développement (IRD) UMI 174-PHPT, Chiang Mai, Thailand
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McLaurin KA, Li H, Cook AK, Booze RM, Mactutus CF. S-EQUOL: a neuroprotective therapeutic for chronic neurocognitive impairments in pediatric HIV. J Neurovirol 2020; 26:704-718. [PMID: 32870477 DOI: 10.1007/s13365-020-00886-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 12/18/2022]
Abstract
Chronic neurocognitive impairments, commonly associated with pediatric human immunodeficiency virus type 1 (PHIV), are a detrimental consequence of early exposure to HIV-1 viral proteins. Strong evidence supports S-Equol (SE) as an efficacious adjunctive neuroprotective and/or neurorestorative therapeutic for neurocognitive impairments in adult ovariectomized female HIV-1 transgenic (Tg) rats. There remains, however, a critical need to assess the therapeutic efficacy of SE when treatment occurs at an earlier age (i.e., resembling a therapeutic for children with PHIV) and across the factor of biological sex. Utilization of a series of signal detection operant tasks revealed prominent, sex-dependent neurocognitive deficits in the HIV-1 Tg rat, characterized by alterations in stimulus-reinforcement learning, the response profile, and temporal processing. Early (i.e., postnatal day 28) initiation of SE treatment precluded the development of chronic neurocognitive impairments in all (i.e., 100%) HIV-1 Tg animals, albeit not for all neurocognitive domains. Most notably, the therapeutic effects of SE are generalized across the factor of biological sex, despite the presence of endogenous hormones. Results support, therefore, the efficacy of SE as a neuroprotective therapeutic for chronic neurocognitive impairments in the post-cART era; an adjunctive therapeutic that demonstrates high efficacy in both males and females. Optimizing treatment conditions by evaluating multiple factors (i.e., age, neurocognitive domains, and biological sex) associated with PHIV and HIV-1 associated neurocognitive disorders (HAND) affords a key opportunity to improve the therapeutic efficacy of SE.
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Affiliation(s)
- Kristen A McLaurin
- Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Hailong Li
- Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Anna K Cook
- Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Rosemarie M Booze
- Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Charles F Mactutus
- Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, USA.
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Gruver RS, Mall S, Kvalsvig JD, Knox JR, Mellins CA, Desmond C, Kauchali S, Arpadi SM, Taylor M, Davidson LL. Cognitive and Language Development at Age 4-6 Years in Children HIV-Exposed But Uninfected Compared to Those HIV-Unexposed and to Children Living With HIV. New Dir Child Adolesc Dev 2020; 2020:39-54. [PMID: 32618410 DOI: 10.1002/cad.20351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Perinatal HIV infection is associated with delayed neurocognitive development, but less is known about children perinatally HIV-exposed but uninfected (CHEU). We compared cognitive and language outcomes in 4-6-year old CHEU versus children HIV-unexposed and uninfected (CHUU) and children living with HIV (CLHIV). We enrolled 1,581 children (77% of the child population) in five communities in KwaZulu-Natal, South Africa. Children completed: Grover-Counter Scale of cognitive development, sub-scales of the Kaufman Assessment Battery for Children, Reynell Developmental Language Scales. HIV status of children and primary caregivers was determined by repeated rapid tests or report of prior testing. We conducted a cross-sectional multivariable linear regression on 922 dyads with complete data (257 CHEU, 627 CHUU, 38 CLHIV). On all outcome measures, CHEU and CHUU groups had comparable scores; CLHIV scored significantly lower. Emerging global progress toward the elimination of vertical HIV transmission may not only reduce mortality, but also positively impact child development.
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Affiliation(s)
- Rachel S Gruver
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sumaya Mall
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane D Kvalsvig
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Justin R Knox
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Chris Desmond
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Shuaib Kauchali
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Stephen M Arpadi
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Myra Taylor
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Leslie L Davidson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY, USA
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11
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Lentoor AG. Clinico-Immunological Status and Neurocognitive Function of Perinatally Acquired HIV-Positive Children on cART: A Cross-Sectional Correlational Study in South Africa. Front Neurol 2020; 11:243. [PMID: 32362864 PMCID: PMC7180221 DOI: 10.3389/fneur.2020.00243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/13/2020] [Indexed: 12/23/2022] Open
Abstract
Despite the undisputed benefits of combination antiretroviral therapy (cART), perinatally acquired human immunodeficiency virus (PHIV) children on treatment often present with a spectrum of neurological deficits known as HIV-associated neurocognitive impairment. Even higher CD4 cell count does not seem to prevent the development of neurocognitive impairment in children with PHIV. While CD4 cell count has shown to have the greatest prognostic value, its association with neurocognitive abilities remains to be clarified. This study aimed at determining the correlation between plasma CD4+ lymphocyte and neurocognitive function in children with PHIV on cART. In total, 152 purposively recruited hospital-based sample of children with PHIV on cART, aged 3 years to 7 years 6 months (mean age, 63.13 months), underwent neurocognitive assessment using the Wechsler Preschool and Primary Scale of Intelligence, Third Edition. Immunological status of each child was based on the plasma CD4+ lymphocyte levels. The mean CD4+ lymphocyte cell count at the time of neurocognitive assessment was 1,259.85 cells/mm3 (mean range, 139-2,717 cells/mm3), with significant age difference on CD4+ lymphocyte count levels [F (2, 149) = 13.58, p = 0.000]. CD4+ lymphocyte counts was significantly correlated with subdomains of neurocognitive function scores of task that measures working memory, processing speed, and perceptual reasoning. Global cognitive ability (Full Scale Intellectual Quotient) had no significant association with immunological status of the children. The findings support an association between immunological status of PHIV infection and executive function task. These neurocognitive faculties are critical for learning, school readiness and success in early childhood, and ultimately treatment adherence in adolescence. The need for early identification of neurodevelopment deficits in children, even when on cART, is crucial because early psychosocial and neurorehabilitative interventions can lead to better outcome for children with PHIV.
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Affiliation(s)
- Antonio G. Lentoor
- Department of Clinical Psychology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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12
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García-Navarro C, Martín-Bejarano M, Jimenez de Ory S, Zamora B, Ruiz-Saez B, Velo C, Cuéllar-Flores I, Garcia Lopez-Hortelano M, Guillen-Martin S, Navarro-Gómez ML, Ramos JT, González-Tomé MI. Neurocognitive and quality of life study in perinatally HIV-infected young people and their peers. NeuroCoRISpeS study. Enferm Infecc Microbiol Clin 2020; 38:417-424. [PMID: 32113706 DOI: 10.1016/j.eimc.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/22/2019] [Accepted: 01/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Assessing the role of HIV and non-HIV related factors is essential for a better understanding of the neurocognitive outcomes in perinatally HIV-infected (PHIV+) young people. The aim of our study was to assess cognition and quality of life (QoL) of a PHIV+ cohort of young people and to compare it with a control group. METHODS Thirty PHIV+ and 30 HIV(-) healthy young adults matched by age, sex and socioeconomic status completed a protocol that included neurocognitive tests, a psychosocial semi-structured interview and a QoL questionnaire (PedsQL). Neurocognitive domain-specific and domain-general (NPZ-5) Z-scores were calculated. CDC AIDS-defining category C or not C (PHIV+/C, PHIV+/noC) was considered to evaluate differences within the PHIV+ group. Univariate and multivariate analysis were performed. RESULTS Sixty patients were included; 67% were female; median age (IQR) 19 years (18-21). Regarding PHIV+ young people, 27% showed CDC C category (none encephalopathy), 93% were on ART and 77% had undetectable viral load. No differences regarding occupation were found, although the HIV(-) group repeated less grades (p=0.028) and had a higher education level (p=0.021). No differences were found between PHIV+/noC and HIV(-) participants. However, the PHIV+/C group showed poorer performance than PHIV+/noC (NPZ-5, p=0.037) and HIV(-) subjects (crystallised intelligence, p=0.025; intelligence quotient, p=0.016). Higher nadir CD4+ T-cell count was related to better Z-score in memory (p=0.007) and NPZ-5 (p=0.025). Earlier and longer exposure to ART resulted in better performance in memory (p=0.004) and executive functions (p=0.015), respectively. CONCLUSIONS No significant differences were found in the neurocognitive profile nor QoL between PHIV+/noC and HIV(-) adolescents; however, PHIV+/C participants obtained lower scores. The use of longer and earlier ART seems to have a beneficial effect.
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Affiliation(s)
- Cristina García-Navarro
- Department of Paediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Manuela Martín-Bejarano
- Department of Paediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Santiago Jimenez de Ory
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Madrid, Spain
| | - Berta Zamora
- Department of Paediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Beatriz Ruiz-Saez
- Molecular Biology and Immunology Laboratory, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Spanish HIV HGM BioBank, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Madrid, Spain
| | - Carlos Velo
- Department of Paediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Isabel Cuéllar-Flores
- Department of Psychology/Paediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Milagros Garcia Lopez-Hortelano
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Madrid, Spain; La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Sara Guillen-Martin
- Department of Pediatric Infectious Diseases, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Maria Luisa Navarro-Gómez
- Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Madrid, Spain; Department of Paediatric Infectious Diseases, Hospital Universitario Gregorio Marañón, Madrid, Spain; Complutense University (UCM), Madrid, Spain; Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - José Tomás Ramos
- Department of Paediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain; Departamento de Salud Pública y Materno-Infantil (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
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13
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HIV-infected youths transitioning from pediatric to adult outpatient care in a teaching tertiary care hospital in São Paulo city, Brazil. Braz J Infect Dis 2019; 23:291-297. [PMID: 31479628 PMCID: PMC9427935 DOI: 10.1016/j.bjid.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 07/04/2019] [Accepted: 07/21/2019] [Indexed: 11/20/2022] Open
Abstract
Background HIV-infected children surviving until adulthood have been transitioning to adult outpatient health care service in Brazil since the late 2000's. Deterioration of clinical condition is expected during this period, as reported among youths with non-communicable chronic diseases. Despite their young age, they are long-term hosts of the virus, have prolonged exposure to antiretroviral therapy and have suffered from the social determinants and stigma of HIV infection since early childhood. Objectives This study aimed to 1) describe demographic and clinical characteristics at the first appointment at adult care service following pediatric care of a cohort of Brazilian youths living with HIV since childhood; and 2) retrospectively address adherence and clinical variables in the last two years of pediatric follow-up. Methods Descriptive study. Results 41 consecutive patients referred to adult outpatient care from a pediatric HIV unit were enrolled, median age 19 years, and median lifetime CD4 + nadir 117 cell/mm3; 89% reported previous AIDS-defining conditions. At first laboratory assessment in adult care, only 46% had undetectable (<400 copies/ml) HIV viral load and the median CD4 + count was 250 cell/mm3. Conclusion Youths living with HIV at the transition from pediatric to adult care had poor treatment adherence, low lifetime CD4 + cell nadir, low CD4 cell count and detectable HIV viral load. Health care providers should closely monitor these adolescents in a youth friendly environment, prepared for open communication about all aspects of their health.
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Gómez LA, Crowell CS, Njuguna I, Cranmer LM, Wamalwa D, Chebet D, Otieno V, Maleche-Obimbo E, Gladstone M, John-Stewart G, Benki-Nugent S. Improved Neurodevelopment After Initiation of Antiretroviral Therapy in Human Immunodeficiency Virus-infected Children. Pediatr Infect Dis J 2018; 37:916-922. [PMID: 29438131 PMCID: PMC6087680 DOI: 10.1097/inf.0000000000001942] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Late human immunodeficiency virus (HIV) diagnosis after severe co-morbidity remains common in resource-limited settings. Neurodevelopmental recovery during antiretroviral therapy (ART) for late-diagnosed children is understudied. We determined 6-month neurodevelopmental trajectories in HIV-infected children initiating ART during hospitalization. METHODS HIV-infected children initiated ART after HIV diagnosis during hospitalization in Kenya. The Malawi Developmental Assessment Tool was administered after clinical stabilization within 1 month and at 6 months post-ART initiation. Baseline versus 6-month Z scores for each developmental domain were compared; cofactors for change in Z scores were evaluated using linear regression. RESULTS Among 74 children, median age was 1.7 years (interquartile range, 0.8-2.4) and median Z scores for gross motor, fine motor, social and language domains were -1.34, -1.04, -0.53 and -0.95, respectively. At baseline, children with higher plasma viremia had lower social Z scores (P = 0.008). Better nourished (weight-for-age Z score [WAZ] ≥-2) children had higher Z scores in all developmental domains (all P values ≤0.05). After 6 months on ART (n = 58), gross and fine motor Z scores improved significantly (mean change 0.39; P = 0.007 and 0.43; P = 0.001, respectively), but social and language did not. Children with better immune and growth response to ART had higher gains in gross motor (0.05 per unit-gain CD4%; P = 0.04; 0.34 per unit-gain WAZ; P = 0.006 and 0.44 per unit-gain height-for-age Z score; P = 0.005), social (0.37 per unit-gain WAZ; P = 0.002) and language (0.25 per unit-gain height-for-age Z score; P = 0.01). CONCLUSIONS Children had significant neurodevelopmental gains during 6 months of ART, and children with better growth and immune recovery had greater improvement. Prompt commencement of ART may improve neurodevelopment in addition to immunity and growth.
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Affiliation(s)
- Laurén A. Gómez
- Dept. of Global Health, Univ. of Washington, Seattle, WA, USA
| | - Claudia S. Crowell
- Dept. of Pediatrics, Div. of Pediatric Infectious Diseases, Univ. of Washington and Seattle Children’s Hospital, Seattle, WA, USA
| | - Irene Njuguna
- Dept. of Paediatrics & Child Health, Univ. of Nairobi, Nairobi, Kenya
| | - Lisa M. Cranmer
- Dept. of Pediatrics, Emory Univ. and Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Dalton Wamalwa
- Dept. of Paediatrics & Child Health, Univ. of Nairobi, Nairobi, Kenya
| | - Daisy Chebet
- Dept. of Paediatrics & Child Health, Univ. of Nairobi, Nairobi, Kenya
| | - Vincent Otieno
- Dept. of Paediatrics & Child Health, Univ. of Nairobi, Nairobi, Kenya
| | | | - Melissa Gladstone
- Dept. Of Women’s and Children’s Health, University of Liverpool, Liverpool, UK
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15
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Kang E, Leu CS, Snyder J, Robbins RN, Bucek A, Mellins CA. Caregiver perceptions of environment moderate relationship between neighborhood characteristics and language skills among youth living with perinatal HIV and uninfected youth exposed to HIV in New York City. AIDS Care 2018; 31:61-68. [PMID: 29950105 DOI: 10.1080/09540121.2018.1492698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Despite the increased recognition of how neighborhood conditions bear on cognitive and academic outcomes, no studies have examined the influences of objective and subjective neighborhood indices on specific areas of cognitive functioning among youth living with perinatal HIV (PHIV). In the United States (US), this is of particular concern as HIV has disproportionately affected African American youth living in economically disadvantaged and racially segregated communities. Thus, based on a longitudinal cohort study of psychosocial and behavioral health outcomes in 340 perinatally HIV-exposed but uninfected (PHEU) and PHIV youth residing in New York City, ages 9-16 years at enrollment, we analyzed data from baseline and multiple follow-up (FU) quantitative interviews with youth and their primary caregivers, from when they were at least 13-years-old (approximately 4-6 years post enrollment). We examined the association between baseline neighborhood indices (2000 US census data and caregiver's perception of neighborhood stressors) and youth receptive language skills (PPVT; Peabody Picture Vocabulary Test) at FU2 and FU3. Census data (percentage of families in neighborhood living below the national poverty rate, median neighborhood household income, and percentage of residents professionally employed) were not independently associated with PPVT scores at both follow-ups. However, in the logistic regression model, the more caregivers perceived their neighborhood as stressful and subjected to violence, the stronger the relationship between census data indicators of low resource neighborhoods and lower PPVT scores for both groups. Findings support "place-based" policies and practices that alleviate caregiver experiences of neighborhood stressors which may contribute to improved cognitive outcomes for youth living with and affected by PHIV.
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Affiliation(s)
- Ezer Kang
- a Department of Psychology , Howard University , Washington , DC , USA
| | - Cheng-Shiun Leu
- b HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute, Columbia University , New York , NY , USA
| | - Jordan Snyder
- c Department of Psychology , Wheaton College , Wheaton , IL , USA
| | - Reuben N Robbins
- b HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute, Columbia University , New York , NY , USA
| | - Amelia Bucek
- b HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute, Columbia University , New York , NY , USA
| | - Claude A Mellins
- b HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute, Columbia University , New York , NY , USA
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Impact of Perinatally Acquired HIV Disease Upon Longitudinal Changes in Memory and Executive Functioning. J Acquir Immune Defic Syndr 2017; 75:455-464. [PMID: 28481783 DOI: 10.1097/qai.0000000000001441] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known regarding effects of perinatally acquired HIV infection (PHIV) on longitudinal change in memory and executive functioning (EF) during adolescence despite the importance of these skills for independence in adulthood. METHODS PHIV (n = 144) and perinatally HIV-exposed uninfected youth (PHEU, n = 79), ages 12-17, completed standardized tests of memory and EF at baseline and 2 years later. Changes from baseline for each memory and EF outcome were compared between PHEU and PHIV youth with (PHIV/C, n = 39) and without (PHIV/non-C, n = 105) history of CDC class C (AIDS-defining) diagnoses. Among PHIV youth, associations of baseline and past disease severity with memory and EF performance at follow-up were evaluated using adjusted linear regression models. RESULTS Participants were primarily black (79%); 16% were Hispanic; 55% were female. Mean memory and EF scores at follow-up generally fell in the low-average to average range. Pairwise comparison of adjusted mean change from baseline to follow-up revealed significantly greater change for PHIV/non-C compared with PHEU youth in only one verbal recognition task, with a difference in mean changes for PHIV/non-C versus PHEU of -0.99 (95% CI: -1.80 to -0.19; P = 0.02). Among youth with PHIV, better immunologic status at baseline was positively associated with follow-up measures of verbal recall and recognition and cognitive inhibition/flexibility. Past AIDS-defining diagnoses and higher peak viral load were associated with lower performance across multiple EF tasks at follow-up. CONCLUSIONS Youth with PHIV demonstrated stable memory and EF during a 2-year period of adolescence, allowing cautious optimism regarding long-term outcomes.
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17
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Abstract
Remarkable advances have been made in the treatment of HIV. Despite progress in reducing perinatal HIV transmission, there is a growing number of adolescents and emerging adults with HIV who will require transfer of care from pediatric to adult providers. Adolescents with HIV have poorer retention in care and viral suppression compared to other age groups with HIV. Barriers to successful care of youth with HIV include mental health disorders, poor medication adherence, socioeconomic instability, and HIV-related stigma. Transfer of care to adult providers is often met with reluctance on the part of the adolescent. Recommendations for effective transfer of care include clear communication between adult and pediatric providers, early initiation of a transition planning discussion, a multidisciplinary team approach, and meeting the adult provider prior to the transfer of care. Adult HIV care may be more fragmented than adolescents are familiar with, but thoughtful transition approaches can foster development of health and life skills among youth with HIV. [Pediatr Ann. 2017;46(5):e198-e202.].
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Nichols SL, Chernoff MC, Malee KM, Sirois PA, Woods SP, Williams PL, Yildirim C, Delis D, Kammerer B. Executive Functioning in Children and Adolescents With Perinatal HIV Infection and Perinatal HIV Exposure. J Pediatric Infect Dis Soc 2016; 5:S15-S23. [PMID: 27856672 PMCID: PMC5181544 DOI: 10.1093/jpids/piw049] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/19/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND Executive functions (EFs) are critical for management of life activities, but few studies have evaluated EFs in children and adolescents with perinatally acquired HIV (PHIV), who are at risk for problems in academics, behavior, and medication adherence. We compared EFs in youth with PHIV and in perinatally HIV-exposed but uninfected (PHEU) youth. METHODS Four Delis-Kaplan Executive Function System (D-KEFS) subtests were administered to 173 youth with PHIV and 85 PHEU youth, aged 9 to <19 years, who were enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) Memory and Executive Functioning Study. Youth with PHIV, with or without history of a Centers for Disease Control and Prevention Class C (AIDS-defining) condition (PHIV/C [n = 45] and PHIV/non-C [n = 128], respectively), were compared with each other and with PHEU youth. Among youth with PHIV, associations with measures of current and past disease severity were evaluated using adjusted linear regression models. RESULTS The PHIV/C group (mean age, 15.5 years), compared with the PHIV/non-C and PHEU groups (mean ages, 14.5 and 12.9 years, respectively), were significantly slower on the Inhibition and Color Naming/Reading Combined conditions of the Color-Word Interference subtest and made more errors on Inhibition; differences between the PHIV/C and PHEU groups persisted in adjusted models. No differences in adjusted means for fluency or problem-solving were found. The PHIV/non-C and PHEU groups did not differ on any measure. Associations of specific EF measures with HIV RNA viral load, CD4-positive T-lymphocyte percentage, and age at greatest disease severity were observed. CONCLUSIONS Youth with PHIV and previous AIDS-defining conditions performed more poorly on some EF measures. Relationships of EF development with the degree and timing of disease severity require further study. Implications for long-term outcomes and interventions are important avenues for follow-up.
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Affiliation(s)
- Sharon L. Nichols
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Miriam C. Chernoff
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kathleen M. Malee
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patricia A. Sirois
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Paige L. Williams
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Cenk Yildirim
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Dean Delis
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Betsy Kammerer
- Department of Psychiatry, Boston Children's Hospital, Massachusetts
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19
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Sirois PA, Chernoff MC, Malee KM, Garvie PA, Harris LL, Williams PL, Woods SP, Nozyce ML, Kammerer BL, Yildirim C, Nichols SL. Associations of Memory and Executive Functioning With Academic and Adaptive Functioning Among Youth With Perinatal HIV Exposure and/or Infection. J Pediatric Infect Dis Soc 2016; 5:S24-S32. [PMID: 27856673 PMCID: PMC5181543 DOI: 10.1093/jpids/piw046] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/11/2016] [Indexed: 11/13/2022]
Abstract
BACKGROUND Perinatally acquired HIV (PHIV) confers risk for neurocognitive impairment, which potentially affects school performance and functional independence of infected children. In this study, we examined the associations of 2 key neurocognitive domains, memory and executive function (EF), with academic and adaptive skills among youth with PHIV and perinatally HIV-exposed but uninfected (PHEU) youth. METHODS Participants ages 9 to <19 years enrolled in the Pediatric HIV/AIDS Cohort Study's Memory and Executive Functioning Study completed standardized measures of reading and math. The primary caregivers completed a standardized measure of their child's adaptive behavior. Participants with PHIV, those with (PHIV/C) and without (PHIV/non-C) a Centers for Disease Control and Prevention class C diagnosis, and PHEU participants were compared. Retrospective memory (RM), prospective memory (PM), and EF were evaluated relative to outcomes using general linear regression models adjusted for sociodemographic characteristics. RESULTS Of the participants (N = 258; mean age, 14.1 years), 46% were male, 75% were black, and 18% were Hispanic. Adjusted mean scores in math and adaptive behavior did not differ among the youth with PHIV/C (n = 45), those with PHIV/non-C (n = 128), and PHEU youth (n = 85). Youth with PHIV/C had lower adjusted mean reading scores than PHIV/non-C and PHEU youth (86.9 vs 93.8 [P = .02] and 93.2 [P = .04], respectively). There were positive associations of RM, PM, EF, and some sociodemographic characteristics with higher reading and math scores. Immediate and delayed verbal memory, delayed visual memory, PM, and some EF measures were positively associated with adaptive behavior. CONCLUSIONS Higher-order cognitive abilities such as memory and EF seem to play a key role in academic and adaptive capacities, regardless of a child's HIV status, and might serve as intervention targets for improving functional outcomes.
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Affiliation(s)
- Patricia A. Sirois
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana
| | - Miriam C. Chernoff
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kathleen M. Malee
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patricia A. Garvie
- Research Department, Children's Diagnostic & Treatment Center, Fort Lauderdale, Florida
| | | | - Paige L. Williams
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Molly L. Nozyce
- Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Cenk Yildirim
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Sharon L. Nichols
- Department of Neurosciences, University of California, San Diego, La Jolla
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Phillips N, Amos T, Kuo C, Hoare J, Ipser J, Thomas KGF, Stein DJ. HIV-Associated Cognitive Impairment in Perinatally Infected Children: A Meta-analysis. Pediatrics 2016; 138:peds.2016-0893. [PMID: 27940772 PMCID: PMC5079077 DOI: 10.1542/peds.2016-0893] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 01/26/2023] Open
Abstract
CONTEXT Research shows, conclusively, that perinatal HIV infection has negative effects on cognitive functioning of children and adolescents. However, the extent of these cognitive impairments is unknown. Current literature does not document specific cognitive domains most affected in HIV-infected children and adolescents. OBJECTIVE To systematically review and meta-analyze the degree of cognitive impairment, and the specific cognitive domains affected, in children and adolescents with perinatally acquired HIV infection. DATA SOURCES We systematically searched 5 electronic bibliographic databases, namely: PubMed, PsychINFO, Academic Search Premier, Scopus, and WorldCat, by using a search protocol specifically designed for this study. STUDY SELECTION Studies were selected on the basis of set a priori eligibility criteria. Titles, abstracts, and full texts were assessed by 2 independent reviewers. DATA EXTRACTION Data from included studies were extracted into Microsoft Excel by 2 independent reviewers. RESULTS Twenty-two studies were identified for inclusion in the systematic review and of this, 6 studies were included in the meta-analysis. Results from the meta-analysis indicated that working memory and executive function were the domains most affected by the HIV virus. LIMITATIONS Only 27% of the included studies were suitable to enter into the meta-analysis. There was significant geographic bias in published studies, with only 32% (7/22) of included studies from sub-Saharan Africa. CONCLUSIONS The evidence supports an association between HIV infection in children and adolescents and cognitive impairment in the domains of working memory, executive function and processing speed, with effect size estimates also providing some support for deficits in visual memory and visual-spatial ability.
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Affiliation(s)
| | - Taryn Amos
- Department of Psychiatry and Mental Health and
| | - Caroline Kuo
- Department of Psychiatry and Mental Health and,Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island; and
| | | | | | - Kevin G. F. Thomas
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health and,South African Medical Research Council Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
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