title: Language impairment in children perinatally infected with HIV compared to children who were HIV-exposed and uninfected.
abstract: OBJECTIVE
  To investigate the risk for language impairment (LI) in children perinatally infected or exposed to HIV.
  
  
  METHODS
  We evaluated the prevalence of LI in 7- to 16-year-old children with perinatal HIV infection (HIV+) compared with HIV-exposed and uninfected children, using a comprehensive standardized language test (Clinical Evaluation of Language Functioning-Fourth Edition [CELF-4]). LI was classified as primary LI (Pri-LI) (monolingual English exposure and no cognitive or hearing impairment), concurrent LI (Con-LI) (cognitive or hearing impairment), or no LI. Associations of demographic, caregiver, HIV disease, and antiretroviral treatment factors with LI category were evaluated using univariate and multivariable logistic regression models.
  
  
  RESULTS
  Of the 468 children with language assessments, 184 (39%) had LI. No difference was observed by HIV infection status for overall LI or for Pri-LI or Con-LI; mean (SD) CELF-4 scores were 88.5 (18.4) for HIV+ versus 87.5 (17.9) for HIV-exposed and uninfected children. After adjustment, black children had higher odds of Pri-LI versus no LI (adjusted odds ratio [aOR] = 2.43, p = .03). Children who were black, Hispanic, had a caregiver with low education or low intelligence quotient, or a nonbiological parent as caregiver had higher odds of Con-LI versus no LI. Among HIV+ children, viral load >400 copies/mL (aOR = 3.04, p < .001), Centers for Disease Control and Prevention Class C (aOR = 2.19, p = .02), and antiretroviral treatment initiation <6 months of age (aOR = 2.12, p = .02) were associated with higher odds of Con-LI versus no LI.
  
  
  CONCLUSIONS
  Children perinatally exposed to HIV are at high risk for LI, but such risk was not increased for youth with HIV. Risk factors differed for Pri-LI and Con-LI.
authors.affiliation: Department of Speech, Language, Hearing, University of Kansas, Lawrence, KS 66045, USA. mabel@ku.edu
authors.forename: Mabel L
authors.initials: ML
authors.lastname: Rice
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Buchanan
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Malee
authors.forename: Bret
authors.initials: B
authors.lastname: Zeldow
authors.forename: Toni
authors.initials: T
authors.lastname: Frederick
authors.forename: Murli U
authors.initials: MU
authors.lastname: Purswani
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Hoffman
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Sirois
authors.forename: Renee
authors.initials: R
authors.lastname: Smith
authors.forename: Peter
authors.initials: P
authors.lastname: Torre
authors.forename: Susannah M
authors.initials: SM
authors.lastname: Allison
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D001741:Black or African American; D002648:Child; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000523:psychology* / Q000635:transmission; D006630:Hispanic or Latino; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D007806:Language Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D007807:Language Tests; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index