Normal neurocognitive development in perinatally HIV-infected adolescents on ART


  • Daniela Ovadia — Agenzia Zoe
  • Medical News
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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.