title: Longitudinal Evaluation of Language Impairment in Youth With Perinatally Acquired Human Immunodeficiency Virus (HIV) and Youth With Perinatal HIV Exposure.
abstract: BACKGROUND
  Language impairment (LI) risk is increased for perinatally acquired human immunodeficiency virus-infected (PHIV) and perinatally exposed to HIV but uninfected (PHEU) youth. This study evaluates the persistence of LI in these groups.
  
  
  METHODS
  The Clinical Evaluation of Language Fundamentals was repeated on participants of the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol 18 months postbaseline. Regression models identified factors associated with change in standardized score (SC) and the resolution or development of LI.
  
  
  RESULTS
  Of 319 participants, 112 had LI at baseline. Upon re-evaluation, SCs were highly stable and changes were similar in PHIV (n = 212) and PHEU (n = 107) participants. Those with family history of language delays had a 2.39 point lower mean increase in SCs than those without, after controlling for demographic and socioeconomic factors and baseline LI status. Among PHIV participants, CD4 count <350 cells/mm3was associated with lower mean SC change (4.32 points), and exposure to combination antiretroviral therapy (cART) or protease inhibitors (PIs) was associated with a higher mean SC change (5.93 and 4.19 points, respectively). Initial LI was persistent in most cases (78%); 20 new cases occurred (10%). Female sex was associated with higher odds of LI resolution. Among PHIV, duration and baseline cART and history of PI use were associated with LI resolution; higher percentage of detectable viral loads before baseline was associated with lower odds of resolution.
  
  
  CONCLUSIONS
  The PHIV and PHEU youth are at risk for persistent LI, and family history of language delays was a risk factor for persistence of problems. Measures of successful HIV treatment predicted more favorable outcomes among PHIV youth.
authors.affiliation: Communication Sciences and Disorders, University of Utah.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Redmond
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health.
authors.forename: Tzy-Jyun
authors.initials: TJ
authors.lastname: Yao
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Russell
authors.affiliation: Child Language Program, University of Kansas.
authors.forename: Mabel L
authors.initials: ML
authors.lastname: Rice
authors.affiliation: Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health.
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Hoffman
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.affiliation: Maternal, Child and Adolescent Center for Infectious Diseases and Virology, Keck School of Medicine of the University of Southern California.
authors.forename: Toni
authors.initials: T
authors.lastname: Frederick
authors.affiliation: Division of Pediatric Infectious Disease, Department of Pediatrics, Bronx-Lebanon Hospital Center, New York, New York.
authors.forename: Murli
authors.initials: M
authors.lastname: Purswani
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health.
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D015658:HIV Infections / Q000503:physiopathology* / Q000523:psychology* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D007806:Language Disorders / Q000503:physiopathology* / Q000523:psychology*; D008137:Longitudinal Studies; D009483:Neuropsychological Tests; D011594:Psychometrics; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: antiretroviral therapy; language development; language impairment; perinatal HIV; youth