title: Contributions of Disease Severity, Psychosocial Factors, and Cognition to Behavioral Functioning in US Youth Perinatally Exposed to HIV.
abstract: Among perinatally HIV-infected (PHIV) and perinatally HIV-exposed, uninfected (PHEU) youth, we evaluated the contributions of home environment, psychosocial, and demographic factors and, among PHIV only, HIV disease severity and antiretroviral treatment (ART), to cognitive functioning (CF) and behavioral functioning (BF). A structural equation modeling (SEM) approach was utilized. Exploratory factor analysis was used to reduce predictor variables to major latent factors. SEMs were developed to measure associations between the latent factors and CF and BF outcomes. Participants included 231 PHIV and 151 PHEU youth (mean age = 10.9 years) enrolled in the PHACS adolescent master protocol. Youth and caregivers completed assessments of CF, BF, psychosocial factors and HIV health. Medical data were also collected. Clusters of predictors were identified, establishing four parsimonious SEMs: child-assessed and caregiver-assessed BF in PHIV and PHEU youth. Among both groups, higher caregiver-child stress predicted worse BF. Caregiver resources and two disease severity variables, late presenter and better past HIV health, were significant predictors of CF in PHIV youth. Higher youth CF was associated with better caregiver-reported BF in both groups. Caregiver resources predicted caregiver-reported BF in PHEU youth, which was mediated via youth CF. Among PHIV youth, better past HIV health and caregiver resources mediated the effects of CF on caregiver-assessed BF. Using SEMs, we found a deleterious impact of caregiver and child stress on BF in both groups and of HIV disease factors on the CF of PHIV youth, reinforcing the importance of early comprehensive intervention to reduce risks for impairment.
authors.affiliation: Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. klindsay@chmca.org.|Lehigh University School Psychology Program, Bethlehem, PA, USA. klindsay@chmca.org.|Division of Neurobehavioral Health, Akron Children's Hospital, 215 W. Bowery St. Suite 4500, Akron, OH, 44308-1062, USA. klindsay@chmca.org.
authors.forename: Katrina D
authors.initials: KD
authors.lastname: Hermetet-Lindsay
authors.affiliation: Department of Biostatistics, Harvard. T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Katharine F
authors.initials: KF
authors.lastname: Correia
authors.affiliation: Department of Biostatistics, Harvard. T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
authors.affiliation: Department of Pediatrics, University of Illinois at Chicago Children's Hospital, Chicago, IL, USA.
authors.forename: Renee
authors.initials: R
authors.lastname: Smith
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Malee
authors.affiliation: Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, USA.
authors.forename: Claude A
authors.initials: CA
authors.lastname: Mellins
authors.affiliation: Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Rutstein
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D017028:Caregivers / Q000523:psychology*; D002648:Child; D003071:Cognition / Q000502:physiology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D055118:Medication Adherence; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: Antiretroviral therapy; Behavior; Cognition; HIV; Structural equation models; Youth