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Abstract Details

Longitudinal Cognitive Outcomes in Children with Human Immunodeficiency Virus in Zambia
Child Neurology and Developmental Neurology
Child Neurology and Developmental Neurology Posters (7:00 AM-5:00 PM)
052
To identify predictors of cognitive outcomes in children with perinatally-acquired Human Immunodeficiency Virus (HIV).
Multiple prior studies have shown that children with HIV demonstrate delayed development and impaired cognition compared to uninfected children.  However, there are limited data on longitudinal cognitive outcomes in children with HIV.
We conducted a prospective cohort study of 208 perinatally-infected children with HIV ages 8-17 and 208 HIV-exposed uninfected (HEU) controls to assess long-term cognitive function. All participants were followed for 2 years with repeated measures collected every 3 months. Cognition was assessed with comprehensive neuropsychological testing and a summary cognition score was generated for each participant.  Initial models included both HIV+ and HEU participants, followed by separate models for HIV+ participants to assess the contribution of HIV-specific variables.  The relative contribution of health-related variables, nutritional status, HIV disease severity, and socioeconomic status to baseline and longitudinal cognitive outcomes was explored using bivariable and multivariable regression models and group based trajectory modeling.

In the bivariable analysis, HIV was strongly associated with poorer cognition at baseline (β-13.7, 95% CI -20.5 to -6.8, p<0.001).  In the HIV specific model, the strongest predictors of cognitive function included socioeconomic status (β 3.0, 95% CI 0.98-5.0, p=0.004), WHO Stage (β -11.4, 95% CI -22.2 to -.057, p=0.04), and self-reported poor health (β -18.8, 95% CI -37.7 to .02, p=0.05).  Group based trajectory modeling identified three groups.  HIV+ status predicted membership in the lowest performing cognitive trajectory (OR 2.3, p=0.006).  In the HIV specific model predicting trajectory membership, the strongest predictors again included socioeconomic status, self-reported poor health, and WHO Stage.

Children with HIV are at risk of poor cognitive outcomes.  Targeted interventions addressing the key risk factors for poor cognitive outcomes are necessary to improve cognitive outcomes in this population.
Authors/Disclosures
Gauri Patil, MD (Ichan School of Medicine at Mount Sinai)
PRESENTER 		Ms. Patil has nothing to disclose.
Hannah D. Smith (University of Rochester Medical School) Hannah Smith has nothing to disclose.
Heather Adams The institution of Heather Adams has received research support from Current: NIH; Past: Abeona; Batten Research Alliance; American University Centers on Disabilities. An immediate family member of Heather Adams has received publishing royalties from a publication relating to health care. Heather Adams has received personal compensation in the range of $500-$4,999 for serving as a Consultant with Critical Path Institute.
Esau G. Mbewe Esau G. Mbewe has received research support from Research was supported by the National Institute Of Neurological Disorders And Stroke of the National Institutes of Health under Award Number K23NS117310. .
Pelekelo Kabundula Pelekelo Kabundula has nothing to disclose.
Sylvia Mwanza-Kabaghe No disclosure on file
Michael Potchen Michael Potchen has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Jackson & Campbell, P.C.. Michael Potchen has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Rotezel & Andress.
Gretchen L. Birbeck, MD, MPH, DTMH, FÂ鶹´«Ã½Ó³»­ (University of Rochester/CHET) An immediate family member of Dr. Birbeck has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. Dr. Birbeck has a non-compensated relationship as a Ambassador for Zambia with RSTMH that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.
David Bearden, MD (University of Rochester School of Medicine) Dr. Bearden has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Bearden has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Praxis. Dr. Bearden has received personal compensation in the range of $100,000-$499,999 for serving as an Expert Witness for law firms.