title: Treatment initiation factors and cognitive outcome in youth with perinatally acquired HIV infection.
abstract: OBJECTIVE
  Although cognitive outcomes among perinatally infected youth have improved with highly active antiretroviral therapy (HAART), the impact of the age of initiation of treatment and the central nervous system (CNS) penetration effectiveness (CPE) of the regimen on cognitive outcomes is unknown. We aimed to describe the association between initiation age/regimen CPE score and cognitive outcomes in perinatally HIV-infected youth.
  
  
  METHODS
  Linear regression was used to retrospectively assess the association between full-scale IQ score (FSIQ) and age of initiation of HAART, regimen CPE, and the presence/absence of an AIDS diagnosis before initiation of HAART in an urban US cohort.
  
  
  RESULTS
  A total of 88 of 181 subjects (48.6%) had an AIDS diagnosis. In 69, AIDS preceded the start of HAART. Mean FSIQ (mean age 155.4 months) was 86.3 [standard deviation (SD) 15.6]. Neither age of initiation of HAART (P = 0.45) nor regimen CPE score (P = 0.33) was associated with FSIQ. Mean FSIQ for patients with an AIDS diagnosis before HAART initiation [82 (SD 17.0)] was significantly lower than for patients initiating HAART before an AIDS diagnosis [90 (SD 13)] (P = 0.001). Of the 129 subjects without AIDS by age 5 years, 41 (31.8%) initiated HAART before age 5 years; four of 41 later developed AIDS, compared with 32 of 88 of those who did not initiate HAART before age 5 years. The relative risk of AIDS if HAART was initiated before age 5 years was 0.19 (95% confidence interval 0.05-0.60).
  
  
  CONCLUSIONS
  Earlier age at HAART initiation and higher CPE score of a regimen did not improve cognitive outcomes. However, initiating HAART prior to AIDS protected against AIDS and was associated with a significantly higher FSIQ.
authors.affiliation: Institute for Graduate Clinical Psychology, Widener University, Chester, PA, USA.|Special Immunology Family Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: J Rutstein
authors.initials: JR
authors.lastname: Lazarus
authors.affiliation: Special Immunology Family Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Rutstein
authors.affiliation: Special Immunology Family Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: E D
authors.initials: ED
authors.lastname: Lowenthal
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D007360:Intelligence / Q000187:drug effects*; D016014:Linear Models; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D019380:Anti-HIV Agents
keywords: HIV infection; antiretroviral therapy; central nervous system penetration effectiveness; cognitive outcome