title: Declining immune function in children and adolescents with hemophilia and HIV infection: effects on neuropsychological performance. Hemophilia Growth and Development Study.
abstract: OBJECTIVE
  To determine whether declines in immune functioning are associated with changes in neuropsychological performance in children and adolescents with hemophilia who are infected with the human immunodeficiency virus (HIV).
  
  
  METHODS
  Participants were 333 males with hemophilia, ages 6-19 years at entry. A baseline and four annual neuropsychological evaluations were given. A longitudinal growth curves analysis of data was performed to detect changes associated with declining immune function. The cohort was stratified into four groups: (1) HIV- (n = 126); (2) HIV+, average of first two and last two CD4 counts > or = 200, (n = 106; High CD4 group); (3) HIV+, average first two counts > or = 200, average last two counts < 200 (n = 41; CD4 Drop group); and (4) HIV+, average first two and last two counts < 200 (n = 60; Low CD4 group).
  
  
  RESULTS
  There were significant differences among the four groups over time in nonverbal intelligence, perceptual/performance skills, nonverbal memory, academic achievement, and language. The Low CD4 group consistently showed the greatest decrement in performance. On measures showing a practice effect for repeated measurements, the Low CD4 group participants' scores remained stable over time, suggesting opposing effects of practice and HIV-related declines. Lowered academic performance relative to IQ was found in all groups.
  
  
  CONCLUSIONS
  Declines in neuropsychological functioning are directly related to declines in immune functioning in HIV+ children, adolescents, and young adults with hemophilia. Hemophilia itself may be a risk factor for academic underachievement.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Texas Medical School, Houston 77030, USA. klovelnd@msi.uth.tmc.edu
authors.forename: K A
authors.initials: KA
authors.lastname: Loveland
authors.forename: J A
authors.initials: JA
authors.lastname: Stehbens
authors.forename: E M
authors.initials: EM
authors.lastname: Mahoney
authors.forename: P A
authors.initials: PA
authors.lastname: Sirois
authors.forename: S
authors.initials: S
authors.lastname: Nichols
authors.forename: J D
authors.initials: JD
authors.lastname: Bordeaux
authors.forename: J M
authors.initials: JM
authors.lastname: Watkins
authors.forename: N
authors.initials: N
authors.lastname: Amodei
authors.forename: S D
authors.initials: SD
authors.lastname: Hill
authors.forename: S
authors.initials: S
authors.lastname: Donfield
mesh_terms: D000293:Adolescent; D018791:CD4 Lymphocyte Count; D002648:Child; D004522:Educational Status; D015658:HIV Infections / Q000276:immunology* / Q000523:psychology*; D006467:Hemophilia A / Q000276:immunology* / Q000523:psychology*; D006801:Humans; D007360:Intelligence; D007802:Language; D008297:Male; D008568:Memory; D009483:Neuropsychological Tests; D011597:Psychomotor Performance