University of Rochester School of Medicine & Dentistry, Rochester, NY.
Department of Educational Psychology, University of Zambia, Lusaka, Zambia.
J Acquir Immune Defic Syndr. 2022 Oct 1;91(2):217-225. doi: 10.1097/QAI.0000000000003052.
To describe longitudinal outcomes and predictors of cognitive outcomes in children with HIV in Zambia.
Multiple studies have shown that children with HIV are at risk for impaired cognition. 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 years, all treated with antiretroviral therapy, and 208 HIV-exposed uninfected controls. Participants were followed for 2 years. Cognition was assessed with a custom NIH Toolbox Cognition Battery, and tests were combined to generate a Summary Cognition Score (SCS). The contribution of potential risk factors to outcomes was explored using regression models and group-based trajectory modeling.
HIV was strongly associated with lower SCS at baseline [β-14, 95% confidence interval (CI): -20 to -7, P < 0.001]. Change scores over time were similar between groups, but poorer average performance in children with HIV persisted at the 2-year follow-up visit (adjusted β = -11, 95% CI: -22 to -0.3, P = 0.04). Other than HIV, the strongest predictors of baseline SCS included socioeconomic status index (β =3, 95% CI: 1, 5, P = 0.004), history of growth stunting (β=-14, 95% CI: -23 to -6, P = 0.001), history of CD4 count below 200 (β = -19, 95% CI: -35 to -2, P = 0.02), and history of World Health Organization stage 4 disease (β = -10, 95% CI: -19 to -0.2, P = 0.04). In the group-based trajectory model, HIV+ status predicted membership in the lowest performing trajectory group (odds ratio 2.5, 95% CI: 1.2 to 5.1, P = 0.01).
Children with HIV are at risk of poor cognitive outcomes, despite chronic treatment with antiretroviral therapy.
描述赞比亚 HIV 感染儿童的认知结果的纵向结局和预测因素。
多项研究表明，HIV 感染儿童存在认知受损的风险。然而，关于 HIV 感染儿童的纵向认知结果的数据有限。
我们对 208 名年龄在 8-17 岁的经围产期感染的 HIV 感染儿童和 208 名 HIV 暴露但未感染的对照者进行了前瞻性队列研究，所有参与者均接受了抗逆转录病毒治疗。参与者随访 2 年。使用 NIH 工具包认知电池对认知进行评估，并将测试组合起来生成综合认知评分（SCS）。使用回归模型和基于群组的轨迹建模来探讨潜在风险因素对结果的影响。
HIV 与基线时较低的 SCS 密切相关[β-14，95%置信区间（CI）：-20 至-7，P<0.001]。两组之间的随时间变化的评分相似，但在 2 年随访时 HIV 感染儿童的平均表现仍较差（调整后的β=-11，95%CI：-22 至-0.3，P=0.04）。除 HIV 外，SCS 基线的最强预测因素还包括社会经济地位指数（β=3，95%CI：1，5，P=0.004）、生长迟缓史（β=-14，95%CI：-23 至-6，P=0.001）、CD4 计数低于 200 的病史（β=-19，95%CI：-35 至-2，P=0.02）和世界卫生组织 4 期疾病史（β=-10，95%CI：-19 至-0.2，P=0.04）。在基于群组的轨迹模型中，HIV+状态预测了属于表现最差的轨迹组的成员资格（优势比 2.5，95%CI：1.2 至 5.1，P=0.01）。
尽管接受了慢性抗逆转录病毒治疗，但 HIV 感染儿童仍存在认知不良结局的风险。
