title: Stimulant Medications and Cognition, Behavior and Quality of Life in Children and Youth with HIV.
abstract: BACKGROUND
  Limited empirical investigation exists into longitudinal changes in cognition, behavior or quality of life (QOL) in children with perinatal HIV who are prescribed stimulants.
  
  
  METHODS
  This study was an analysis of longitudinal data from children age 3-19 years, with perinatal HIV infection, with and without prescriptions for stimulant medications [prescription (PG) and comparison (CG) groups, respectively], matched on age, availability of CD4% and outcome measures of cognition, behavior and QOL. Generalized estimating equation models were used to evaluate effects of stimulant exposure on change in measured outcomes over 3 years of follow-up, adjusting for baseline levels of outcomes and relevant covariates.
  
  
  RESULTS
  Children in both the PG (n = 132) and the CG (n = 392) obtained mean verbal and performance (nonverbal) intelligence quotients (VIQ and PIQ, respectively) in the low-average range for age. At baseline, those in PG demonstrated more frequent signs of hyperactivity, impulsivity and conduct and learning problems than those in CG (P ≤ 0.003 in unadjusted analyses). At follow-up, after adjustment for baseline functioning and other relevant covariates, there were no significant changes from baseline in VIQ or PIQ. Stimulant prescription use, however, was associated with worsening symptoms of hyperactivity (P = 0.01), impulsivity (P = 0.04), learning problems (P < 0.001) and worsening of perceived health status (P < 0.001).
  
  
  CONCLUSIONS
  The results suggest expectations for behavioral improvement may not align well with long-term effects of stimulant prescription use on behavior and QOL in children with HIV. Further research is necessary to determine if there are subsets of children who may benefit from stimulant therapy.
authors.affiliation: From the *Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana; †Department of Biostatistics, ‡Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts; §Department of Psychiatry and Behavioral Sciences, University of Texas Medical School, Houston, Texas; ¶Department of Psychiatry and The Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California; ‖Children's Diagnostic & Treatment Center, Fort Lauderdale, Florida; **Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York; ††Department of Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; ‡‡Department of Neurosciences, University of California, at San Diego, La Jolla, California; §§Department of Psychiatry, Boston Childrens Hospital, Boston, Massachusetts; ¶¶Department of Neurology, Children's Hospital Los Angeles; ‖‖Keck School of Medicine of University of Southern California, Los Angeles, California; ***The Center for Neurological and Neurodevelopmental Health (CNNH); †††The Clinical Research Center of New Jersey (CRCNJ), Gibbsboro, New Jersey; and ‡‡‡Department of Pediatrics, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Sirois
authors.forename: Lisa
authors.initials: L
authors.lastname: Aaron
authors.forename: Grace
authors.initials: G
authors.lastname: Montepiedra
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Pearson
authors.forename: Suad
authors.initials: S
authors.lastname: Kapetanovic
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Garvie
authors.forename: Molly L
authors.initials: ML
authors.lastname: Nozyce
authors.forename: Kathleen
authors.initials: K
authors.lastname: Malee
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Nichols
authors.forename: Betsy L
authors.initials: BL
authors.lastname: Kammerer
authors.forename: Wendy G
authors.initials: WG
authors.lastname: Mitchell
authors.forename: Mark
authors.initials: M
authors.lastname: Mintz
authors.forename: James M
authors.initials: JM
authors.lastname: Oleske
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D001519:Behavior; D018791:CD4 Lymphocyte Count; D000697:Central Nervous System Stimulants / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D011307:Drug Prescriptions; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D011788:Quality of Life; D019562:Viral Load; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants