Normal neurocognitive development in perinatally HIV-infected adolescents on ART

  • Daniela Ovadia — Agenzia Zoe
  • Medical News
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Key messages

  • Combination antiretroviral therapy (cART)-treated adolescents with perinatal HIV-infection (PHIV+) who transition into young adulthood show similar development in global cognition over time compared to healthy peers (HIV-negative adolescents).
  • Compared to healthy controls, PHIV+'s intelligence coefficient (IQ) score is lower at first assessment but increase significantly over time.
  • PHIV+ adolescents show a delay in the domain of executive functioning, which becomes stronger by older age at cART initiation.


Cognitive impairment in cART-treated PHIV+ children compared to healthy controls has been reported, but some studies suggest no differences in cognitive development. It is difficult to make a conclusion, due to relevant confounders and difference in ages and follow-up time.

The NOVICE study (Amsterdam University Medical Center, Netherlands) showed a significant cognitive impairment in cART-treated PHIV+ children (13.4 years [SD 2.8]) compared to age-, sex-, ethnicity- and socioeconomic status (SES)-matched HIV-controls. A second assessment in the same adolescents was performed (after 4.6 years) in order to investigate the effect of HIV infection and cART exposure on cognitive development.

21 PHIV+ and 23 HIV- completed the second assessment. They were similar concerning age, sex, ethnicity and SES.

Authors conducted a standardised cognitive test battery and compared cognitive trajectories between groups using linear mixed models. Compared to HIV-, in PHIV+ IQ score increased significantly more over time (adjusted group*time interaction beta coefficient: 6.02; P=0.012) and thus the difference between groups (IQ score lower in PHIV+ at first assessment) was neutralised.

In the domain of executive functioning, PHIV+ showed a significant unfavourable change over time compared to HIV- (group*time -1.43 z-score; P

Changes over time in the domains of processing speed, learning ability, working memory and visual-motor function were not statistically different between groups.

Exploration of associations with disease and treatment-related factors showed that those who started cART at an older age deviated more in executive functioning (-0.13 z-score; P=0.043).

Finally, the number of participants classified as cognitively impaired did not statistically differ between groups, analysed by multivariate normative comparison.

Limitations: This study was performed in a single centre; not all NOVICE cohort participants gave consent for a second assessment; different migration history between groups; different neuropsychologist between first and second assessment.