Lower IQ and poorer cognitive profiles in treated perinatally HIV-infected children is irrespective of having a background of international adoption

• Published in: PloS one Vol. 14; no. 12; p. e0224930
• Main Authors: Van den Hof, M, Ter Haar, A M, Scherpbier, H J, Reiss, P, Wit, F W N M, Oostrom, K J, Pajkrt, D
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05.12.2019; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adoption; Age; AIDS; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Biology and Life Sciences; Case-Control Studies; Child; Child, Preschool; Children; Cognition; Cognitive ability; Cognitive development; Cohort Studies; Cross-Sectional Studies; Disease control; Drug therapy; Education; Ethnicity; Executive function; Female; HIV; HIV Infections - congenital; HIV Infections - drug therapy; HIV Infections - physiopathology; Hospitals; Human immunodeficiency virus; Humans; Infant; Infections; Infectious diseases; Information processing; Intellectual Disability - etiology; Intelligence; Intelligence Tests; Internal medicine; Internationality; Laboratories; Male; Medical diagnosis; Medical treatment; Medicine; Medicine and Health Sciences; Minority & ethnic groups; Motor skill learning; Neurosciences; Parents & parenting; Pediatrics; People and Places; Prospective Studies; Regression analysis; Regression models; Sensorimotor integration; Sex; Sexually transmitted diseases; Short term memory; Social Sciences; Sociodemographics; Socioeconomic factors; Socioeconomics; STD; Visual discrimination learning; Visual perception; United States > US; Netherlands; Baltimore Maryland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0224930

HIV-associated cognitive deficiency in perinatally HIV-infected (PHIV) children has been studied in Western countries in a population of which an increasing proportion has been internationally adopted. Studies often lack an appropriate internationally adopted HIV-uninfected control group, potentially confounding the relationship between HIV and cognitive functioning. This study aims to further elucidate the association between treated HIV infection and cognitive development by addressing the background of international adoption. We cross-sectionally studied the impact of HIV on cognition by comparing PHIV children and HIV- uninfected controls, matched for age-, sex-, ethnicity-, socioeconomic status (SES)- and adoption status. We used a standardized neuropsychological test battery to measure intelligence (IQ), and the cognitive domains of processing speed, working memory, executive function, learning ability and visual-motor function and compared outcomes using lineair regression models, adjusted for IQ. We determined cognitive profiles and cognitive impairment by using multivariate normative comparison (MNC) and explored associations with HIV disease- and treatment-related factors. We enrolled fourteen PHIV children (mean age 10.45 years [1.73 SD], 93% adopted from sub-Saharan Africa at a median age of 3.3 years [IQR 2.1-4.2]) and fifteen HIV- uninfected controls. Groups did not clinically nor statistically differ in age, sex, ethnicity, SES, region of birth, adoption status and age at adoption. PHIV scored consistently lower on all cognitive domains and MNC outcomes. Compared to controls, PHIV children had a significant lower IQ (mean 81 [SD 11] versus mean 97 [SD 15], p = 0.005), and a poorer cognitive profile by MNC (Hotelling's T2 mean -4.36 [SD 5.6] versus mean 0.16 [SD 4.5], p = 0.021), not associated with HIV disease- and treatment-related factors. Two PHIV (14%) and one control (7%) were classified as cognitively impaired (p = 0.598). Findings indicate treated HIV-infection to be independently associated with lower IQ and poorer cognitive profiles in PHIV children, irrespective of a background of international adoption.