Early viral suppression improves neurocognitive outcomes in HIV-infected children
Claudia S Crowell, Yanling Huo, Katherine Tassiopoulos, Kathleen M Malee, Ram Yogev, Rohan Hazra, Richard M Rutstein, Sharon L Nichols, Renee A Smith, Paige L Williams, James Oleske, William J Muller, PACTG 219C Study Team and the Pediatric HIVAIDS Cohort Study (PHACS), Russell Van Dyke, James M Oleske, Mark Abzug, John Farley, Mary Glen Fowler, Michael Brady, Wayne Dankner, Elizabeth Smith, Anne Fresia, Gregory Ciupak, Michelle Eagle, Dorothy R Smith, Paul Palumbo, John Sleasman, James Connor, Michael Hughes, Rebecca Oyomopita, George Johnson, Andrew Wiznia, Nancy Hutton, Andrea Kovacs, Mary Sawyer, Martin Anderson, Audrey Rogers, William Borkowsky, Jane Lindsey, Jack Moye, Myron Levin, Marilyn Crain, Paul Britto, Ruth Toumala, Joseph Cervia, Eileen Monagham, Kenneth Dominguez, Melody Higgins, George Seage, Denise Gaughan, Phil Gona, William Shearer, Lois Howland, Deborah Storm, Kathleen Malee, Wendy Mitchell, Carol Gore, Eve Powell, Michelle McConnell, Newana Beatty, Susan Brogly, Jennifer Bryant, Miriam Chernoff, Barbara Heckman, Dawn English, Edward Handelsman, Patrick Jean-Philippe, Kathleen Kaiser, Joyce Kraimer, Linda Millar, Shirley Traite, Paige Williams, Elizabeth Woods, Carol Worrell, Ram Yogev, Margaret A Sanders, Kathleen Malee, Scott Hunter, William Shearer, Mary Paul, Norma Cooper, Lynnette Harris, Murli Purswani, Mahboobullah Baig, Anna Cintron, Ana Puga, Sandra Navarro, Patricia Garvie, James Blood, Sandra Burchett, Nancy Karthas, Betsy Kammerer, Andrew Wiznia, Marlene Burey, Molly Nozyce, Arry Dieudonne, Linda Bettica, Susan Adubato, Janet Chen, Maria Garcia Bulkley, Latreaca Ivey, Mitzie Grant, Katherine Knapp, Kim Allison, Megan Wilkins, Midnela Acevedo-Flores, Heida Rios, Vivian Olivera, Margarita Silio, Medea Jones, Patricia Sirois, Stephen Spector, Kim Norris, Sharon Nichols, Elizabeth McFarland, Alisa Katai, Jennifer Dunn, Suzanne Paul, Gwendolyn Scott, Patricia Bryan, Elizabeth Willen, Claudia S Crowell, Yanling Huo, Katherine Tassiopoulos, Kathleen M Malee, Ram Yogev, Rohan Hazra, Richard M Rutstein, Sharon L Nichols, Renee A Smith, Paige L Williams, James Oleske, William J Muller, PACTG 219C Study Team and the Pediatric HIVAIDS Cohort Study (PHACS), Russell Van Dyke, James M Oleske, Mark Abzug, John Farley, Mary Glen Fowler, Michael Brady, Wayne Dankner, Elizabeth Smith, Anne Fresia, Gregory Ciupak, Michelle Eagle, Dorothy R Smith, Paul Palumbo, John Sleasman, James Connor, Michael Hughes, Rebecca Oyomopita, George Johnson, Andrew Wiznia, Nancy Hutton, Andrea Kovacs, Mary Sawyer, Martin Anderson, Audrey Rogers, William Borkowsky, Jane Lindsey, Jack Moye, Myron Levin, Marilyn Crain, Paul Britto, Ruth Toumala, Joseph Cervia, Eileen Monagham, Kenneth Dominguez, Melody Higgins, George Seage, Denise Gaughan, Phil Gona, William Shearer, Lois Howland, Deborah Storm, Kathleen Malee, Wendy Mitchell, Carol Gore, Eve Powell, Michelle McConnell, Newana Beatty, Susan Brogly, Jennifer Bryant, Miriam Chernoff, Barbara Heckman, Dawn English, Edward Handelsman, Patrick Jean-Philippe, Kathleen Kaiser, Joyce Kraimer, Linda Millar, Shirley Traite, Paige Williams, Elizabeth Woods, Carol Worrell, Ram Yogev, Margaret A Sanders, Kathleen Malee, Scott Hunter, William Shearer, Mary Paul, Norma Cooper, Lynnette Harris, Murli Purswani, Mahboobullah Baig, Anna Cintron, Ana Puga, Sandra Navarro, Patricia Garvie, James Blood, Sandra Burchett, Nancy Karthas, Betsy Kammerer, Andrew Wiznia, Marlene Burey, Molly Nozyce, Arry Dieudonne, Linda Bettica, Susan Adubato, Janet Chen, Maria Garcia Bulkley, Latreaca Ivey, Mitzie Grant, Katherine Knapp, Kim Allison, Megan Wilkins, Midnela Acevedo-Flores, Heida Rios, Vivian Olivera, Margarita Silio, Medea Jones, Patricia Sirois, Stephen Spector, Kim Norris, Sharon Nichols, Elizabeth McFarland, Alisa Katai, Jennifer Dunn, Suzanne Paul, Gwendolyn Scott, Patricia Bryan, Elizabeth Willen
Abstract
Objective: To estimate the association of age of viral suppression and central nervous system penetration effectiveness (CPE) score with neurocognitive functioning among school-age children with perinatally acquired HIV infection (PHIV+).
Design: We analyzed data from two US-based multisite prospective cohort studies.
Methods: Multivariable general linear regression models were used to evaluate associations of age at viral suppression and CPE scores (of initial antiretroviral therapy regimen and weighted average) with the Wechsler Intelligence Scale for Children, Third or Fourth Edition neurocognitive assessments [Full-Scale Intelligence Quotient (FSIQ); Performance IQ/Perceptual Reasoning Index (PIQ/PRI); and Verbal IQ/Verbal Comprehension Index (VIQ/VCI)], adjusted for demographic and clinical covariates. Sensitivity analyses were stratified by birth cohort (before versus after 1996).
Results: A total of 396 PHIV+ children were included. Estimated differences in mean FSIQ (comparing virally suppressed versus unsuppressed children) by each age cutoff were 3.7, 2.2, 3.2, 4.4, and 3.9 points at ages 1, 2, 3, 4, and 5, respectively. For PIQ/PRI, estimated mean differences were 3.7, 2.4, 2.2, 4.6, and 4.5 at ages 1 through 5, respectively. In both cases, these differences were significant only at the age 4 and 5 thresholds. After stratifying by birth cohort, the association between age at suppression and cognitive function persisted only among those born after 1996. Age at viral suppression was not associated with VIQ/VCI; CPE score was not associated with FSIQ, verbal comprehension, or perceptual reasoning indices.
Conclusion: Virologic suppression during infancy or early childhood is associated with improved neurocognitive outcomes in school-aged PHIV+ children. In contrast, CPE scores showed no association with neurocognitive outcomes.
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Source: PubMed