title: Discordance of cognitive and academic achievement outcomes in youth with perinatal HIV exposure.
abstract: BACKGROUND
  To evaluate achievement in youth with perinatally acquired HIV (PHIV) compared with HIV-exposed uninfected peers (HEU) and to examine differential effects of HIV on cognition-achievement concordance.
  
  
  METHODS
  Cognition and achievement were assessed using standardized measures. Intelligence quotient-derived predicted achievement scores were subtracted from observed achievement scores to calculate discrepancy values. Linear regression models were used to compare achievement discrepancies between PHIV and HEU, adjusting for demographic covariates.
  
  
  RESULTS
  
  
  
  METHODS
  295 PHIV and 167 HEU youth; 71% black, 48% male, mean age 13.1 and 11.3 years, respectively. PHIV youth were relatively healthy (mean CD4%, 32%; viral load ≤400 copies/mL, 72%). PHIV and HEU youth had cognitive and achievement scores significantly below population norm means (P < 0.001), but did not differ in cognition (mean full scale IQ = 86.7 vs. 89.4, respectively). In unadjusted models, HEU outperformed PHIV youth on total achievement (mean = 89.2 vs. 86.0, P = 0.04) and numerical operations (mean = 88.8 vs. 82.9, P < 0.001); no differences remained after adjustment. Mean observed-predicted achievement discrepancies reflected "underachievement". History of encephalopathy predicted poorer achievement (P = 0.039) and greater underachievement, even after adjustment. PHIV showed greater underachievement than HEU for numerical operations (P < 0.001) and total achievement (P = 0.03), but these differences did not persist in adjusted models.
  
  
  CONCLUSIONS
  Both PHIV and HEU youth demonstrated lower achievement than normative samples and underachieved relative to predicted achievement scores. Observed-predicted achievement discrepancies were associated with prior encephalopathy, older age and other non-HIV factors. PHIV youth with prior encephalopathy had significantly lower achievement and greater underachievement compared with PHIV without encephalopathy and HEU youth, even in adjusted models.
authors.affiliation: From the *Children's Diagnostic & Treatment Center, Fort Lauderdale, FL; †Harvard School of Public Health, Boston, MA; ‡Northwestern University Feinberg School of Medicine, Chicago, IL; §University of California, San Diego, La Jolla, CA; ¶University of Illinois at Chicago, Chicago, IL; and ‖St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Garvie
authors.forename: Bret
authors.initials: B
authors.lastname: Zeldow
authors.forename: Kathleen
authors.initials: K
authors.lastname: Malee
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Nichols
authors.forename: Renee A
authors.initials: RA
authors.lastname: Smith
authors.forename: Megan L
authors.initials: ML
authors.lastname: Wilkins
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D001927:Brain Diseases / Q000523:psychology; D002648:Child; D003071:Cognition; D004522:Educational Status; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000523:psychology* / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D007360:Intelligence; D007361:Intelligence Tests; D016014:Linear Models; D008297:Male; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000523:psychology / Q000821:virology; D012044:Regression Analysis