Department of Epidemiology, University of Washington, Seattle, WA, USA.
Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
AIDS. 2024 Nov 15;38(14):1972-1977. doi: 10.1097/QAD.0000000000004000. Epub 2024 Aug 28.
Children with HIV may experience adverse neurocognitive outcomes despite antiretroviral therapy (ART). Cytomegalovirus (CMV) is common in children with HIV. Among children on ART, we examined the influences of early HIV viral load and CMV DNA on neurocognition.
We determined the association between pre-ART viral load, cumulative viral load, and CMV viremia and neurocognition using data from a cohort study.
Children who initiated ART before 12 months of age were enrolled from 2007 to 2010 in Nairobi, Kenya. Blood was collected at enrollment and every 6 months thereafter. Four neurocognitive assessments with 12 domains were conducted when children were a median age of 7 years. Primary outcomes included cognitive ability, executive function, attention, and motor z scores. Generalized linear models were used to determine associations between HIV viral load (pre-ART and cumulative; N = 38) and peak CMV DNA (by 24 months of age; N = 20) and neurocognitive outcomes.
In adjusted models, higher peak CMV viremia by 24 months of age was associated with lower cognitive ability and motor z scores. Higher pre-ART HIV viral load was associated with lower executive function z scores. Among secondary outcomes, higher pre-ART viral load was associated with lower mean nonverbal and metacognition z scores.
Higher pre-ART viral load and CMV DNA in infancy were associated with lower executive function, nonverbal and metacognition scores and cognitive ability and motor scores in childhood, respectively. These findings suggest long-term benefits of early HIV viral suppression and CMV control on neurocognition.
尽管接受了抗逆转录病毒疗法（ART），但 HIV 感染儿童仍可能出现不良神经认知结局。巨细胞病毒（CMV）在 HIV 感染儿童中很常见。在接受 ART 的儿童中，我们研究了早期 HIV 病毒载量和 CMV DNA 对神经认知的影响。
我们通过队列研究的数据，确定了 ART 前病毒载量、累积病毒载量和 CMV 血症与神经认知之间的关联。
2007 年至 2010 年，在肯尼亚内罗毕招募了 12 个月龄前开始 ART 的儿童。在入组时和此后每 6 个月采集一次血液。当儿童的中位年龄为 7 岁时，进行了 4 次具有 12 个领域的神经认知评估。主要结局包括认知能力、执行功能、注意力和运动 z 评分。使用广义线性模型确定 HIV 病毒载量（ART 前和累积；N = 38）和峰值 CMV DNA（24 个月龄时；N = 20）与神经认知结局之间的关联。
在调整后的模型中，24 个月龄时较高的峰值 CMV 病毒血症与较低的认知能力和运动 z 评分相关。较高的 ART 前 HIV 病毒载量与较低的执行功能 z 评分相关。在次要结局中，较高的 ART 前病毒载量与较低的平均非言语和元认知 z 评分相关。
较高的 ART 前病毒载量和婴儿期的 CMV DNA 与较低的执行功能、非言语和元认知评分以及儿童期的认知能力和运动评分相关。这些发现表明早期 HIV 病毒抑制和 CMV 控制对神经认知有长期益处。
