title: Early viral suppression improves neurocognitive outcomes in HIV-infected children.
abstract: OBJECTIVE
  To estimate the association of age of viral suppression and central nervous system penetration effectiveness (CPE) score with neurocognitive functioning among school-age children with perinatally acquired HIV infection (PHIV+).
  
  
  METHODS
  We analyzed data from two US-based multisite prospective cohort studies.
  
  
  METHODS
  Multivariable general linear regression models were used to evaluate associations of age at viral suppression and CPE scores (of initial antiretroviral therapy regimen and weighted average) with the Wechsler Intelligence Scale for Children, Third or Fourth Edition neurocognitive assessments [Full-Scale Intelligence Quotient (FSIQ); Performance IQ/Perceptual Reasoning Index (PIQ/PRI); and Verbal IQ/Verbal Comprehension Index (VIQ/VCI)], adjusted for demographic and clinical covariates. Sensitivity analyses were stratified by birth cohort (before versus after 1996).
  
  
  RESULTS
  A total of 396 PHIV+ children were included. Estimated differences in mean FSIQ (comparing virally suppressed versus unsuppressed children) by each age cutoff were 3.7, 2.2, 3.2, 4.4, and 3.9 points at ages 1, 2, 3, 4, and 5, respectively. For PIQ/PRI, estimated mean differences were 3.7, 2.4, 2.2, 4.6, and 4.5 at ages 1 through 5, respectively. In both cases, these differences were significant only at the age 4 and 5 thresholds. After stratifying by birth cohort, the association between age at suppression and cognitive function persisted only among those born after 1996. Age at viral suppression was not associated with VIQ/VCI; CPE score was not associated with FSIQ, verbal comprehension, or perceptual reasoning indices.
  
  
  CONCLUSIONS
  Virologic suppression during infancy or early childhood is associated with improved neurocognitive outcomes in school-aged PHIV+ children. In contrast, CPE scores showed no association with neurocognitive outcomes.
authors: Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA.
authors: Claudia S
authors: CS
authors: Crowell
authors: Yanling
authors: Y
authors: Huo
authors: Katherine
authors: K
authors: Tassiopoulos
authors: Kathleen M
authors: KM
authors: Malee
authors: Ram
authors: R
authors: Yogev
authors: Rohan
authors: R
authors: Hazra
authors: Richard M
authors: RM
authors: Rutstein
authors: Sharon L
authors: SL
authors: Nichols
authors: Renee A
authors: RA
authors: Smith
authors: Paige L
authors: PL
authors: Williams
authors: James
authors: J
authors: Oleske
authors: William J
authors: WJ
authors: Muller
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007223:Infant; D008297:Male; D020752:Neurocutaneous Syndromes / Q000517:prevention & control*; D011446:Prospective Studies; D055502:Secondary Prevention / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents