Poorer cognitive performance in perinatally HIV-infected children versus healthy socioeconomically matched controls

Abstract

Background. Despite the declining incidence of severe neurological complications such as HIV encephalopathy, human immunodeficiency virus (HIV) infection in children is still associated with a range of cognitive problems. Although most HIV-infected children in industrialized countries are immigrants with a relatively low socioeconomic status (SES), cognitive studies comparing HIV-infected children to SES-matched controls are lacking. Methods. This cross-sectional study included perinatally HIV-infected children and controls matched for age, sex, ethnicity, and SES, who completed a neuropsychological assessment evaluating intelligence, information processing speed, attention, memory, executive function, and visual-motor function. Multivariate normative comparison was used to assess the prevalence of cognitive impairment in the HIV-infected group. Multivariable regression analyses were performed to identify HIV- and combination antiretroviral therapy-related factors associated with cognitive performance. Results. In total, 35 perinatally HIV-infected children (median age, 13.8 years; median CD4 count, 770 × 106 cells/L; 83% with undetectable HIV RNA) and 37 healthy children (median age, 12.1 years) were included. HIV-infected children scored lower than the healthy controls on all cognitive domains (eg, intelligence quotient [IQ], 76 [standard deviation {SD}, 15.7] vs 87.5 [SD, 13.6] for HIV-infected vs healthy children; P =. 002). Cognitive impairment was found in 6 HIV-infected children (17%). The Centers for Disease Control and Prevention (CDC) clinical category at HIV diagnosis was inversely associated with verbal IQ (CDC clinical category C: coefficient -22.98; P =. 010). Conclusions. Our results show that cognitive performance of HIV-infected children is poor compared with that of SES-matched healthy controls. Gaining insight into these cognitive deficits is essential, as subtle impairments may progress to more pronounced complications that will influence future intellectual performance, job opportunities, and community participation of HIV-infected children.