Effect of Perinatally Acquired HIV Infection on Cognitive Function and Educational Attainment in Adolescents in the Era of Antiretroviral Therapy: A Cross-sectional Study in Zimbabwe

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PURPOSE: HIV infection in children is associated with neurocognitive deficits. Whether these deficits persist as children age is unclear. We investigated the effect of HIV infection on cognition among adolescents with perinatally acquired HIV (AWH). METHODS: In this cross-sectional study, AWH aged 11-19 years taking antiretroviral therapy for ≥6 months were recruited from a public-sector HIV clinic in Harare, Zimbabwe. An age-matched HIV-negative comparison group was recruited from the same catchment area. Cognitive function was evaluated using the Kaufman Assessment Battery for Children, second Edition (KABC-II) and National Institute for Health Cognition Battery. Multivariable linear regression was used to investigate the association between HIV and cognition. RESULTS: Overall, 507 adolescents (253 AWH, 254 HIV-negative), mean age 15 (SD 2.5) years and 53% female, participated. Adjusting for age, sex, socioeconomic status and maternal education, AWH scored lower than HIV-negative peers on KABC-II Mental Processing Index (MPI) (adjusted mean difference (AMD) -3.01 [95% CI -4.95, -1.07]) and KABC-II nonverbal index (AMD -4.37 [95% CI -6.26, -2.48]). Lower KABC-II MPI scores interacted with stunting in AWH (nonstunted AWH: AMD -1.40 [95% CI -3.56, 0.76]; stunted AWH: AMD -6.30 [95% CI -9.05, -3.54]). AWH also scored lower than HIV-negative peers on the National Institute for Health Cognition Battery Fluid Cognition Score (AMD -2.74 [95% CI -5.08, -0.41]). Among those in school, 71/190 (37.4%) AWH versus 35/194 (18.0%) HIV-negative participants were two or more school grades below expected for age (≤2), (p < 0.001). School grade ≤2 was associated with lower KABC-II MPI scores in AWH (mean difference -3.76 [95% CI -6.53, -0.98]). DISCUSSION: Cognitive function in AWH was impaired compared to HIV-negative peers, which translated to poorer educational outcomes.

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