Increased Risk of Executive Function and Emotional Behavioral Problems among Virologically Well-Controlled Perinatally HIV-Infected Adolescents in Thailand and Cambodia

Stephen J. Kerr*, Thanyawee Puthanakit, Kathleen M. Malee, Kulvadee Thongpibul, Penh Sun Ly, Jiratchaya Sophonphan, Tulathip Suwanlerk, Pope Kosalaraksa, Pradthana Ounchanum, Linda Aurpibul, Suparat Kanjanavanit, Chaiwat Ngampiyaskul, Kea Chettra, Reuben Robbins, Robert Paul, Jintanat Ananworanich, Claude A. Mellins

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background:Large numbers of perinatally HIV-infected (PHIV) children are aging into adolescence. We examined cognitive and behavioral outcomes in a longitudinal cohort of Asian youth.Methods:We followed up 231 PHIV, 125 perinatally HIV-exposed, uninfected (HEU), and 138 HIV-unexposed, uninfected (HUU) adolescents (aged 10 years and older), matched by age/sex, in Thailand and Cambodia for 3 years. Executive function was assessed with Children's Color Trails Tests 1 and 2 (CCTT-1 and -2), the design fluency test, and the verbal fluency test. Working memory (Freedom from Distractibility Index) and processing speed index were assessed using WISC-III. Visual memory was assessed by design memory and design recognition subtests of the Wide Range Assessment of Memory and Learning (WRAML-2) and behavioral problems using the Child Behavior Checklist (CBCL). Generalized estimating equations examined adjusted odds ratios of cognitive impairment (Z-scores ≥2 SD below age-adjusted means of the HUU group) and CBCL T-scores in the borderline-clinical range (T-Scores ≥60) in PHIV and HEU versus HUU youth, adjusting for ethnicity, household income, and caregiver characteristics.Results:The median age at enrollment was 13.8 years, with 58% women and 63% Thai participants. PHIV youth had >86% virological suppression and significantly higher impairment rates on CCTT-1 and -2 tests, design fluency test, verbal fluency tests, design memory, and CBCL internalizing and externalizing problems. Results were mostly similar between HEU and HUU groups, apart from higher impairment rates on CCTT-1 and internalizing problems in HEU.Conclusion:Asian adolescents with PHIV remain at risk of cognitive and mental health problems despite HIV treatment. Selective risks are observed among HEU youth.

Original languageEnglish (US)
Pages (from-to)297-304
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume82
Issue number3
DOIs
StatePublished - Nov 1 2019

Keywords

  • HIV
  • executive function
  • mental health
  • perinatally infected youth

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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