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FOCUSED COGNITIVE FUNCTION TESTING IN YOUNG PEOPLE WITH PERINATAL HIV IN ENGLAND
Alejandro Arenas-Pinto1, Hannah Castro1, Diane Melvin2, Marthe Le Prevost1, Caroline Foster2, Kate Sturgeon1, Alan Winston3, Lindsay Thompson1, Diana Gibb1, Ali Judd1
1MRC Clinical Trials Unit at UCL, London, UK,2Imperial College Healthcare NHS Trust, London, UK,3Imperial College London, London, UK
We previously reported that cognitive performance in young people with perinatal HIV (PHIV+) without a CDC C diagnosis (PHIV+/no C) was similar to a comparable group of HIV-negative (HIV-) young people in England, but poorer than normative data, most noticeably in the domains of learning and memory. Here, we assess cognitive performance in the same cohort 2 years later, with expanded testing of these specific cognitive domains.
234 PHIV+ and 68 HIV- young people completed 9 tests: 5 NIH Toolbox tests measuring executive function (Flanker inhibitory control/attention, dimensional change card sort), speed of information processing (pattern comparison), and memory (list sorting, picture sequence); 2 Hopkins Verbal Learning Tests (HVLT-R) (learning (L) (sum of 3 trials), delayed recall (R)); and 2 verbal language measures (Weschler Individual Achievement Test word reading (WIAT-II)), British Picture Vocabulary Scale). Z scores for each test were calculated using normative data, adjusted for age (and sex, ethnicity, and education for NIH Toolbox), and averaged by domain where appropriate. Chi squared, Wilcoxon rank sum and ANOVA tests compared proportions, median and means respectively, by HIV and CDC C status.
139(59%) and 48(71%) of PHIV+ and HIV- were female (p=0.09), 202(86%) and 52(76%) were black (p=0.05), and median age was 19[17,21] and 18[16,21] years (p=0.45) respectively. 55(24%) of PHIV+ had a CDC C diagnosis (PHIV+/C). For HVLT-R, PHIV+/C participants had lower mean z scores (L -2.8 (95% CI -3.3, -2.2), R -2.6 (-3.1, -2.0)) than PHIV+/no C (L -2.0 (-2.3, -1.8), R -1.9 (-2.1, -1.6)) and HIV- participants (L -1.7 (-2.1, -1.3), R -1.5 (-1.9, -1.0)), and all were <1 SD below the reference mean (Figure). However, 292(97%) improved their score over the learning trials, and this was seen in all groups (p=0.62). PHIV+/C had poorer scores than the other 2 groups for verbal language measures, however mean scores were within 1 SD below the reference mean for all groups indicating mild impairment. NIH Toolbox executive function, speed of information processing and memory tests were similar for all 3 groups.
Cognitive function was similar between PHIV+ and HIV- young people in most domains/tests. However, performance in verbal learning and recall fell below population normative scores, and was more pronounced in PHIV+/C, supporting wider findings that earlier ART initiation may protect aspects of cognitive development.