title: Impact of HIV severity on cognitive and adaptive functioning during childhood and adolescence.
abstract: BACKGROUND
  The influence of disease severity on cognitive and adaptive functioning in perinatally HIV-infected youth with (PHIV+/C) and without (PHIV+/NoC) a previous AIDS-defining illness (Centers for Disease Control and Prevention Class C event), compared with perinatally HIV-exposed but uninfected youth (PHEU) is not well understood.
  
  
  METHODS
  This was a cross-sectional analysis of cognitive and adaptive functioning in PHIV+/C (n = 88), PHIV+/NoC (n = 270) and PHEU (n = 200) youth aged 7-16 years, from a multisite prospective cohort study. Youth and caregivers completed the Wechsler Intelligence Scale for Children, Fourth Edition and the Adaptive Behavior Assessment System, Second Edition, respectively. We compared means and rates of impairment between groups, and examined associations with other psychosocial factors.
  
  
  RESULTS
  Overall mean scores on measures of cognitive and adaptive functioning were in the low average range for all 3 groups. After adjustment for covariates, mean full-scale intelligence quotient scores were significantly lower for the PHIV+/C group than the PHIV+/NoC and PHEU groups (mean = 77.8 versus 83.4 and 83.3, respectively), whereas no significant differences were observed between the PHEU and PHIV+/NoC groups in any domain. Lower cognitive performance for the PHIV+/C group was primarily attributable to a prior diagnosis of encephalopathy. No significant differences between groups were observed in adaptive functioning.
  
  
  CONCLUSIONS
  For long-term survivors, youth with HIV infection and a prior Centers for Disease Control and Prevention Class C event have higher risk for cognitive but not adaptive impairment regardless of current health status; this finding appears attributable to a previous diagnosis of encephalopathy. Early preventive therapy may be critical in reducing risk of later neurodevelopmental impairments.
authors.affiliation: Department of Pediatrics, University of Illinois at Chicago, Chicago, IL 60612, USA. resmith@uic.edu
authors.forename: Renee
authors.initials: R
authors.lastname: Smith
authors.forename: Miriam
authors.initials: M
authors.lastname: Chernoff
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Malee
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Sirois
authors.forename: Betsy
authors.initials: B
authors.lastname: Kammerer
authors.forename: Megan
authors.initials: M
authors.lastname: Wilkins
authors.forename: Sharon
authors.initials: S
authors.lastname: Nichols
authors.forename: Claude
authors.initials: C
authors.lastname: Mellins
authors.forename: Ann
authors.initials: A
authors.lastname: Usitalo
authors.forename: Patricia
authors.initials: P
authors.lastname: Garvie
authors.forename: Richard
authors.initials: R
authors.lastname: Rutstein
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000473:pathology* / Q000523:psychology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D014888:Wechsler Scales