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Contributions of Disease Severity, Psychosocial Factors, and Cognition to Behavioral Functioning in US Youth Perinatally Exposed to HIV

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An Erratum to this article was published on 27 August 2016

This article has been updated

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.

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  • 27 August 2016

    An erratum to this article has been published.

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Acknowledgments

We thank the children and families for their participation in PHACS, and the individuals and institutions involved in the conduct of PHACS. We would like to extend a special thanks to Pim Brouwers, Associate Director of Infant, Child & Adolescent Research at the National Institutes of Health for his guidance and expertise. We also extend our gratitude to both Laurie Dooley and Danish Siddiqui for their support regarding data organization and management. The following institutions, clinical site investigators and staff participated in conducting PHACS AMP in 2014, in alphabetical order: Ann & Robert H. Lurie Children’s Hospital of Chicago: Ram Yogev, Margaret Ann Sanders, Kathleen Malee, Scott Hunter; Baylor College of Medicine: William Shearer, Mary Paul, Norma Cooper, Lynnette Harris; Bronx Lebanon Hospital Center: Murli Purswani, Mahboobullah Baig, Anna Cintron; Children’s Diagnostic & Treatment Center: Ana Puga, Sandra Navarro, Patricia Garvie, James Blood; Children’s Hospital, Boston: Sandra Burchett, Nancy Karthas, Betsy Kammerer; Jacobi Medical Center: Andrew Wiznia, Marlene Burey, Molly Nozyce; Rutgers - New Jersey Medical School: Arry Dieudonne, Linda Bettica, Susan Adubato; St. Christopher’s Hospital for Children: Janet Chen, Maria Garcia Bulkley, Latreaca Ivey, Mitzie Grant; St. Jude Children’s Research Hospital: Katherine Knapp, Kim Allison, Megan Wilkins; San Juan Hospital/Department of Pediatrics: Midnela Acevedo-Flores, Heida Rios, Vivian Olivera; Tulane University Health Sciences Center: Margarita Silio, Medea Jones, Patricia Sirois; University of California, San Diego: Stephen Spector, Kim Norris, Sharon Nichols; University of Colorado Denver Health Sciences Center: Elizabeth McFarland, Alisa Katai, Jennifer Dunn, Suzanne Paul; University of Miami: Gwendolyn Scott, Patricia Bryan, Elizabeth Willen.

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Authors and Affiliations

  1. Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Katrina D. Hermetet-Lindsay & Richard M. Rutstein

  2. Department of Biostatistics, Harvard. T. H. Chan School of Public Health, Boston, MA, USA

    Katharine F. Correia & Paige L. Williams

  3. Department of Pediatrics, University of Illinois at Chicago Children’s Hospital, Chicago, IL, USA

    Renee Smith

  4. Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Kathleen M. Malee

  5. Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, USA

    Claude A. Mellins

  6. Lehigh University School Psychology Program, Bethlehem, PA, USA

    Katrina D. Hermetet-Lindsay

  7. Division of Neurobehavioral Health, Akron Children’s Hospital, 215 W. Bowery St. Suite 4500, Akron, OH, 44308-1062, USA

    Katrina D. Hermetet-Lindsay

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  1. Katrina D. Hermetet-Lindsay
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for the Pediatric HIV/AIDS Cohort Study

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Correspondence to Katrina D. Hermetet-Lindsay.

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Conflict of Interest

Katrina Hermetet-Lindsay, Katharine Correia, Paige Williams, Renee Smith, Kathleen Malee, Claude Mellins, and Richard Rutstein declare that they have no conflict of interest to report.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

Additional information

An erratum to this article is available at https://doi.org/10.1007/s10461-016-1518-3.

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Hermetet-Lindsay, K.D., Correia, K.F., Williams, P.L. et al. Contributions of Disease Severity, Psychosocial Factors, and Cognition to Behavioral Functioning in US Youth Perinatally Exposed to HIV. AIDS Behav 21, 2703–2715 (2017). https://doi.org/10.1007/s10461-016-1508-5

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