Lower working memory and processing speed among children and youth exposed to HIV

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OBJECTIVES: To compare cognitive function and identify correlates of lower cognitive functioning among children and youth exposed to HIV (CHEU) aged 7-18 years and peers unexposed to HIV (CHU). DESIGN: Cross sectional survey. METHODS: Using the NIH Toolbox African Languages cognitive battery, we assessed working memory, attention and inhibitory control, episodic memory, cognitive flexibility, and processing speed. We compared domain scores between HIV exposure groups and determined correlates using multivariable linear regression adjusted for age and potential confounders. RESULTS: Among 185 CHEU and 187 CHU assessed, median age was 12 years (interquartile range [IQR]: 10, 14) for CHEU and 13 (IQR: 10, 15) for CHU. CHEU were more likely to be orphaned and had older, less educated mothers. Among CHEU, 54.1% mothers started antiretroviral treatment prepregnancy. Compared to CHU, CHEU had significantly lower scores in working memory (adjusted β -1.2, 95% CI -2.0, -0.5, P = 0.002) and processing speed (adjusted β -4.9, 95% CI -7.3, -2.5, P < 0.001).Among CHEU, maternal combination ART in pregnancy was associated with better working memory; food insecurity was associated with poorer processing speed. In both groups, maternal education and child male sex were associated with better cognitive outcomes. CONCLUSIONS: CHEU experienced deficits in working memory and processing speed compared to CHU. Discerning mechanisms for CHEU could inform interventions. Ensuring maternal ART and addressing food insecurity among CHEU may enhance cognitive outcomes.

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