Ageing with HIV: a longitudinal study of markers of resilience in young adults with perinatal exposure to HIV, with or without perinatally acquired HIV

Patricia A Sirois, Yanling Huo, Molly L Nozyce, Patricia A Garvie, Lynnette L Harris, Kathleen Malee, Robin McEvoy, Claude A Mellins, Sharon L Nichols, Renee Smith, Katherine Tassiopoulos, Pediatric HIV/AIDS Cohort Study, Patricia A Sirois, Yanling Huo, Molly L Nozyce, Patricia A Garvie, Lynnette L Harris, Kathleen Malee, Robin McEvoy, Claude A Mellins, Sharon L Nichols, Renee Smith, Katherine Tassiopoulos, Pediatric HIV/AIDS Cohort Study

Abstract

Introduction: Medical challenges, including perinatally acquired HIV (PHIV), can be considered adversity with the potential to compromise individuals' ability to meet societal expectations across the lifespan. Studies suggest that resilience, defined as positive adaptation in the context of adversity, helps individuals overcome challenges and improve their quality of life. Few longitudinal studies have examined resilience in young adults with perinatally acquired HIV (YAPHIV) or perinatal HIV exposure, uninfected (YAPHEU). We examined three young adult milestones, which can affect the life-long quality of life, as markers of resilience: high school graduation, postsecondary education and current employment.

Methods: Analyses included YAPHIV and YAPHEU, ages 19-27 years, followed in longitudinal cohort studies: Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol (AMP) (7-17 years) and AMP Up (≥18 years). Factors known to influence the attainment of milestones (outcomes) were examined: executive function, cognitive efficiency (working memory and processing speed), behavioural/social-emotional functioning, parent/caregiver mental/physical health and cumulative risk. HIV disease markers for YAPHIV were examined. The most recent AMP assessment was used for each factor; outcomes were measured at AMP Up 1-year follow-up. Separate robust Poisson regression models were used to assess associations of each factor with each outcome; PHIV status was explored as an effect modifier of each association.

Results: Participants (N = 315; YAPHIV = 228): 58% female, 67% Black and 27% Hispanic. Compared to YAPHEU, YAPHIV were older and from families with higher median income and fewer symptoms of parent/caregiver mental health/substance use disorders. Proportions of YAPHIV and YAPHEU, respectively, who achieved each milestone were comparable: 82% versus 78% for high school graduation (p = 0.49), 45% versus 51% for postsecondary education (p = 0.35) and 48% versus 54% for current employment (p = 0.32). Higher cognitive efficiency was positively associated with postsecondary education and current employment. Higher executive function, age-appropriate behavioural/social-emotional functioning and lower cumulative risk were associated with academic milestones. Among YAPHIV, positive associations were: higher current CD4 with postsecondary education and lower nadir CD4 with current employment. PHIV status did not modify any association.

Conclusions: YAPHIV and YAPHEU demonstrated resilience, attaining at least one young adult milestone. Cognitive, behavioural and social resources to support resilience in childhood and adolescence may provide the foundation for continued achievement throughout adulthood.

Keywords: lifespan development; milestones; perinatal HIV infection; perinatal HIV-exposed uninfected; resilience; young adults.

© 2022 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

Figures

Figure 1
Figure 1
Compensatory (main effects) model of resilience in the AMP Up cohort of the Pediatric HIV/AIDS Cohort Study. Resilience was defined by participants’ attainment of one or more young adult milestones. A measure of cumulative risk developed for this study assessed the total number of risks present across all domains. All measures were collected during AMP except for the PHQ‐9 and CES‐D‐10 collected at entry into AMP Up. AMP, Adolescent Master Protocol; AMP Up, long‐term follow‐up of participants age 18 and older; BASC‐2, Behavior Assessment System for Children, Second Ed. [37]; BRIEF, Behavior Rating Inventory of Executive Function [36]; BRI, Behavioral Regulation Index; CDC, Centers for Disease Control and Prevention; CES‐D‐10, Center for Epidemiological Studies Depression Scale [42]; MCI, Metacognition Index; PHQ‐9, Patient Health Questionnaire [41]; Wechsler, Wechsler Intelligence Scale for Children, Fourth Ed. [34] or Wechsler Adult Intelligence Scale, Fourth Ed. [35]; YAPHIV, young adults with perinatally acquired HIV.
Figure 2
Figure 2
(a) Adjusted associations between predictors and attainment of young adult milestones. The association between each predictor and outcome is presented as follows: the solid diamond represents the prevalence ratio, and the horizontal line represents the 95% confidence interval. In addition, the dotted vertical line represents the null value (prevalence ratio = 1.0). The adjusted prevalence ratio for the attainment of a specific milestone compared participants with a specific predictor versus a reference group. Each model adjusted for sex, race/ethnicity, Wechsler FSIQ (except the model for cognitive efficiency due to potential overcorrection), family socio‐economic status (an index including annual income and household density) and age at the time of measurement of each predictor. aIndicates lower frequency or intensity of problems. (b) Adjusted associations between predictors and attainment of young adult milestones. The association between each predictor and outcome is presented as follows: the solid diamond represents the prevalence ratio, and the horizontal line represents the 95% confidence interval. In addition, the dotted vertical line represents the null value (prevalence ratio = 1.0). The adjusted prevalence ratio for the attainment of a specific milestone compared participants with a specific predictor versus a reference group. Each model adjusted for sex, race/ethnicity, Wechsler FSIQ, family socio‐economic status (an index including annual income and household density), and age at the time of measurement of each predictor. BASC‐2, Behavior Assessment System for Children, Second Ed. [37]; BRIEF, Behavior Rating Inventory of Executive Function [36]; Risk index, a study‐specific summary of risks; Wechsler FSIQ, Wechsler Intelligence Scale for Children, Fourth Ed. [34] or Wechsler Adult Intelligence Scale, Fourth Ed. [35] Full‐Scale Intelligence Quotient.
Figure 3
Figure 3
Adjusted associations between measures of HIV disease severity and attainment of young adult milestones in YAPHIV. The association between each predictor and outcome is presented as follows: the solid diamond represents the prevalence ratio, and the horizontal line represents the 95% confidence interval. In addition, the dotted vertical line represents the null value (prevalence ratio = 1.0). The adjusted prevalence ratio for the attainment of a specific milestone compared YAPHIV participants with a specific measure of HIV disease severity (predictor) versus a reference group. Each model adjusted for sex, race/ethnicity, Wechsler FSIQ (except the models for nadir CD4 and peak viral load), family socio‐economic status (an index including annual income and household density) and age at the time of measurement of each predictor. Wechsler FSIQ, Wechsler Intelligence Scale for Children, Fourth Ed. [34] or Wechsler Adult Intelligence Scale, Fourth Ed. [35] Full‐Scale Intelligence Quotient; YAPHIV, young adults with perinatally acquired HIV.

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