Neurocognitive function in youth living with HIV

Abstract

University of WashingtonAbstract Neurocognitive test performance among adolescents and youth living with HIV in Kenya Caren Wambui Mburu MBChB, MMED Chair of supervisory committee: Sarah Benki-Nugent MS PhD Department of Global Health Background: Adolescents and youth who acquired HIV perinatally have increased risk for neurocognitive compromise. Evaluation of neurocognition is important to identify youth with HIV (YHIV) who may benefit from focused support. Setting: A high volume HIV clinic within a tertiary facility in Nairobi, Kenya Methods: Demographic and clinical characteristics of participants were collected and summarized using proportions for categorical and medians (interquartile range [IQR]) for continuous variables. Neurocognitive screening was performed using the NeuroScreen tool, a short, validated tablet-based application. Screening for depressive, anxiety symptoms, and behavioral problems was conducted using the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorders 7 questionnaire (GAD-7), and the Strengths and Difficulties Questionnaire, respectively. Neurocognitive test raw scores were summarized as means and z-scores. Total test scores were calculated as composite z-scores. Linear regression analysis was conducted to determine the correlates of neurocognitive performance. Analysis was adjusted for sex and level of education and stratified by gender. Results: Among 149 participants, median age was 18 years, 53% were male and 79% were enrolled in school. Many YHIV (46%) had early-stage disease (WHO stage I/II) at HIV diagnosis and 23% had detectable viral load at last measurement. Male sex and education were associated with significantly higher scores. Adjusted for sex and level of education, Adolescents with above average and average school grades had higher scores compared to those with below-average grades (mean difference 4.68 [1.44,7.92]) p= 0.005 and 3.72 (0.71, 6.74) p=0.016, respectively. A trend towards higher scores for youth with WHO Stage I/II HIV disease at diagnosis was noted, though the correlation was not statistically significant (mean difference, 1.67 (95% CI -5.05, -0.05) p=0.114). Conclusion: Neuroscreen testing was correlated with poorer school performance, suggesting that the test reflects functional performance. Sex differences may reflect social or educational differences. Non-severe HIV disease at diagnosis was associated with higher cognitive scores and underscores the need for prompt diagnosis and treatment of pediatric/adolescent HIV. Keywords: Adolescent, HIV, neurocognitive disorders, NeuroScreen