Nichols Sharon L, Chernoff Miriam C, Malee Kathleen M, Sirois Patricia A, Woods Steven P, Williams Paige L, Yildirim Cenk, Delis Dean, Kammerer Betsy
Department of Neurosciences, University of California, San Diego, La Jolla.
Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
J Pediatric Infect Dis Soc. 2016 Dec;5(suppl 1):S15-S23. doi: 10.1093/jpids/piw049.
Executive functions (EFs) are critical for management of life activities, but few studies have evaluated EFs in children and adolescents with perinatally acquired HIV (PHIV), who are at risk for problems in academics, behavior, and medication adherence. We compared EFs in youth with PHIV and in perinatally HIV-exposed but uninfected (PHEU) youth.
Four Delis-Kaplan Executive Function System (D-KEFS) subtests were administered to 173 youth with PHIV and 85 PHEU youth, aged 9 to <19 years, who were enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) Memory and Executive Functioning Study. Youth with PHIV, with or without history of a Centers for Disease Control and Prevention Class C (AIDS-defining) condition (PHIV/C [n = 45] and PHIV/non-C [n = 128], respectively), were compared with each other and with PHEU youth. Among youth with PHIV, associations with measures of current and past disease severity were evaluated using adjusted linear regression models.
The PHIV/C group (mean age, 15.5 years), compared with the PHIV/non-C and PHEU groups (mean ages, 14.5 and 12.9 years, respectively), were significantly slower on the Inhibition and Color Naming/Reading Combined conditions of the Color-Word Interference subtest and made more errors on Inhibition; differences between the PHIV/C and PHEU groups persisted in adjusted models. No differences in adjusted means for fluency or problem-solving were found. The PHIV/non-C and PHEU groups did not differ on any measure. Associations of specific EF measures with HIV RNA viral load, CD4-positive T-lymphocyte percentage, and age at greatest disease severity were observed.
Youth with PHIV and previous AIDS-defining conditions performed more poorly on some EF measures. Relationships of EF development with the degree and timing of disease severity require further study. Implications for long-term outcomes and interventions are important avenues for follow-up.
执行功能（EFs）对于生活活动的管理至关重要，但很少有研究评估围产期感染艾滋病毒（PHIV）的儿童和青少年的执行功能，这些儿童和青少年在学业、行为和药物依从性方面存在问题的风险。我们比较了感染PHIV的青少年和围产期暴露于艾滋病毒但未感染（PHEU）的青少年的执行功能。
对173名感染PHIV的青少年和85名PHEU青少年进行了四项Delis-Kaplan执行功能系统（D-KEFS）子测试，这些青少年年龄在9至<19岁之间，参加了儿科艾滋病毒/艾滋病队列研究（PHACS）记忆和执行功能研究。将感染PHIV的青少年，无论有无疾病控制和预防中心C类（定义艾滋病）疾病史（分别为PHIV/C组[n = 45]和PHIV/非C组[n = 128]），相互之间以及与PHEU青少年进行比较。在感染PHIV的青少年中，使用调整后的线性回归模型评估与当前和过去疾病严重程度测量指标的关联。
与PHIV/非C组和PHEU组（平均年龄分别为14.5岁和12.9岁）相比，PHIV/C组（平均年龄15.5岁）在颜色-单词干扰子测试的抑制和颜色命名/阅读联合条件下明显更慢，并且在抑制方面犯的错误更多；在调整后的模型中，PHIV/C组和PHEU组之间的差异仍然存在。在流畅性或解决问题的调整后均值方面未发现差异。PHIV/非C组和PHEU组在任何测量指标上均无差异。观察到特定执行功能测量指标与艾滋病毒RNA病毒载量、CD4阳性T淋巴细胞百分比以及疾病最严重时的年龄之间的关联。
有过定义艾滋病疾病史的感染PHIV的青少年在某些执行功能测量指标上表现更差。执行功能发展与疾病严重程度的程度和时间的关系需要进一步研究。对长期结果和干预措施的影响是后续研究的重要途径。
