Association between HIV and cytomegalovirus and neurocognitive outcomes among children with HIV.

IF 3.4 2区 医学 Q3 IMMUNOLOGY AIDS Pub Date : 2024-11-15 Epub Date: 2024-08-28 DOI:10.1097/QAD.0000000000004000
Jillian Neary, Daisy Chebet, Sarah Benki-Nugent, Hellen Moraa, Barbra A Richardson, Irene Njuguna, Agnes Langat, Evelyn Ngugi, Dara A Lehman, Jennifer Slyker, Dalton Wamalwa, Grace John-Stewart
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Abstract

Objectives: Children with HIV may experience adverse neurocognitive outcomes despite antiretroviral therapy (ART). Cytomegalovirus (CMV) is common in children with HIV. Among children on ART, we examined the influences of early HIV viral load and CMV DNA on neurocognition.

Design: We determined the association between pre-ART viral load, cumulative viral load, and CMV viremia and neurocognition using data from a cohort study.

Methods: Children who initiated ART before 12 months of age were enrolled from 2007 to 2010 in Nairobi, Kenya. Blood was collected at enrollment and every 6 months thereafter. Four neurocognitive assessments with 12 domains were conducted when children were a median age of 7 years. Primary outcomes included cognitive ability, executive function, attention, and motor z scores. Generalized linear models were used to determine associations between HIV viral load (pre-ART and cumulative; N  = 38) and peak CMV DNA (by 24 months of age; N  = 20) and neurocognitive outcomes.

Results: In adjusted models, higher peak CMV viremia by 24 months of age was associated with lower cognitive ability and motor z scores. Higher pre-ART HIV viral load was associated with lower executive function z scores. Among secondary outcomes, higher pre-ART viral load was associated with lower mean nonverbal and metacognition z scores.

Conclusion: Higher pre-ART viral load and CMV DNA in infancy were associated with lower executive function, nonverbal and metacognition scores and cognitive ability and motor scores in childhood, respectively. These findings suggest long-term benefits of early HIV viral suppression and CMV control on neurocognition.

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艾滋病毒和巨细胞病毒与感染艾滋病毒儿童的神经认知结果之间的关系。
目的:尽管接受了抗逆转录病毒疗法(ART),但感染艾滋病毒的儿童可能会出现不良的神经认知结果。巨细胞病毒(CMV)在 HIV 感染儿童中很常见。在接受抗逆转录病毒疗法的儿童中,我们研究了早期 HIV 病毒载量(VL)和 CMV DNA 对神经认知的影响:设计:我们利用一项队列研究的数据确定了抗逆转录病毒疗法前 VL、累积 VL 和 CMV 病毒血症与神经认知之间的关系:2007-2010 年间,肯尼亚内罗毕对 12 个月前开始接受抗逆转录病毒疗法的儿童进行了登记。入组时采集血液,之后每 6 个月采集一次。在儿童的中位年龄为 7 岁时,对他们进行了四次神经认知评估,共涉及 12 个领域。主要结果包括认知能力、执行功能、注意力和运动能力。采用广义线性模型来确定 HIV VL(ART 前和累积;N = 38)和 CMV DNA 峰值(24 个月之前;N = 20)与神经认知结果之间的关系:在调整模型中,24 个月时较高的 CMV 病毒血症峰值与较低的认知能力和运动 Z 评分相关。抗逆转录病毒治疗前较高的 VL 值与较低的执行功能 z 评分有关。在次要结果中,较高的ART前VL与较低的平均非语言和元认知Z分数相关:结论:婴儿期较高的ART前VL和CMV DNA分别与较低的执行功能、非语言和元认知得分以及儿童期认知能力得分有关。这些研究结果表明,早期艾滋病病毒抑制和CMV控制对神经认知有长期益处。
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来源期刊
AIDS
AIDS 医学-病毒学
CiteScore
5.90
自引率
5.30%
发文量
478
审稿时长
3 months
期刊介绍: ​​​​​​​​​​​​​​​​​Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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