Exploring Cognitive Disparities: Cognitive Outcomes in HIV Exposed Uninfected Children In Kenya

Abstract

BackgroundRecent studies suggest that children exposed to HIV (CHEU) have poorer neurocognitive outcomes than those who are not exposed to HIV (CHUU). However, evidence is limited to neurodevelopmental outcomes among children under the age of 5 years. Few studies have examined outcomes at school age, and evidence for poor outcomes is mixed. Methods In a cross-sectional study, we recruited Kenyan CHEU and CHUU aged 7 to 18 years. Using the NIH Toolbox African Languages cognitive battery, we assessed memory, attention and inhibitory control, cognitive flexibility, and processing speed. Assessments were administered in either Kiswahili or Dholuo. We compared domain scores between groups and determined correlates of lower scores using linear regression, with models adjusted for age and socio-demographic factors that differed in the 2 groups. Results Overall, 219 and 209 CHEU and CHUU, respectively, were enrolled. The median age was 12 years (IQR: 9.1, 14.0) for CHEU and 12.8 (IQR: 9.2, 15.0) for CHUU. CHEU were more likely to be orphaned and vulnerable children (OVC) and to have mild food insecurity. Compared to CHUU, CHEU had significantly lower scores in working memory (age adjusted coefficient 1.3, 95% CI 0.5, 2.1, p = 0.001), and processing speed (age adjusted coefficient 4.65, 95% CI 2.3, 7.0, p < 0.001). These differences persisted in separate models adjusted for age and food security as well as age and OVC status. There were no differences in the other domains assessed (episodic memory, attention and inhibitory control, and cognitive flexibility). Among CHEU, male sex was linked to higher episodic memory scores, while food insecurity was associated with lower processing speed scores. Older maternal age and higher years of maternal education were each associated with higher processing speed scores. ConclusionOur findings suggest that CHEU may experience deficits in working memory and processing speed. Biological and sociodemographic factors were each associated with cognitive outcomes. These findings highlight the need to address socio-economic factors to improve neurodevelopment and to better understand mechanisms that lead to neurodevelopment compromise in CHEU.