Abstract Details

Title Longitudinal Analysis of Cognition and Depression in Children and Adolescents with HIV in Zambia

Topic Global Health and Neuroepidemiology

Presentation(s) Global Health Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 007

Background We and others have previously described an association between depression and cognitive impairment in children with HIV. However, prior studies have been limited by cross-sectional designs.

Objective To identify the relationship between depression and cognitive function in a longitudinal study of children and adolescents with HIV in Zambia.

Design/Methods The HANDZ study is a prospective longitudinal cohort study including 208 perinatally-infected children with HIV taking antiretroviral therapy (ART) and 208 HIV-exposed uninfected (HEU) children who were 8-17 years old. Cognition was assessed using comprehensive neuropsychological testing, and depressive symptoms were assessed using self-report and parent-report of the NIH Toolbox Sadness module and the PHQ-9. Group based trajectory modeling was used to identify subgroups of participants who followed similar trajectories over time, and dual trajectory modeling was used to evaluate the longitudinal relationship between cognitive function and depression. Structural equation modeling was used to investigate the causal relationship between depression and cognition.

Results Children with HIV had an improvement in both depressive symptoms and cognitive function over time, though they remained with significantly higher levels of depression and worse cognitive function than HIV-exposed uninfected controls. Depressed mood was strongly associated with cognitive impairment (Unadjusted OR=3.3, 95% CI 1.5-7.5, p=0.004). Depression and cognitive impairment had a number of overlapping risk factors including lower socioeconomic status, poor health, adverse childhood experiences, and growth stunting. Dual trajectory modeling indicated that cognitive function had an inverse relationship with depression over time, with depressive symptoms at baseline predicting membership in the lowest performing cognitive group.

Conclusions HIV is significantly associated with both depression and cognitive impairment, and this association persists over time. Further studies are needed to determine whether both depression and cognitive impairment are part of the spectrum of HIV-associated neurocognitive disorders, or whether the association is driven by other factors.

Authors/Disclosures
Hannah D. Smith (University of Rochester Medical School) PRESENTER	Hannah Smith has nothing to disclose.
Gauri Patil, MD (Ichan School of Medicine at Mount Sinai)	Ms. Patil has nothing to disclose.
Heather Adams	The institution of Heather Adams has received research support from Current: NIH; Past: Abeona; Batten Research Alliance; American University Centers on Disabilities. An immediate family member of Heather Adams has received publishing royalties from a publication relating to health care. Heather Adams has received personal compensation in the range of $500-$4,999 for serving as a Consultant with Critical Path Institute.
Esau G. Mbewe	Esau G. Mbewe has received research support from Research was supported by the National Institute Of Neurological Disorders And Stroke of the National Institutes of Health under Award Number K23NS117310. .
Pelekelo Kabundula	No disclosure on file
Sylvia Mwanza-Kabaghe	No disclosure on file
Michael Potchen	Michael Potchen has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Jackson & Campbell, P.C.. Michael Potchen has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Rotezel & Andress.
Gretchen L. Birbeck, MD, MPH, DTMH, FAAN (University of Rochester/CHET)	An immediate family member of Dr. Birbeck has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. Dr. Birbeck has a non-compensated relationship as a Ambassador for Zambia with RSTMH that is relevant to AAN interests or activities.
David Bearden, MD (University of Rochester School of Medicine)	Dr. Bearden has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Bearden has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Praxis. Dr. Bearden has received personal compensation in the range of $100,000-$499,999 for serving as an Expert Witness for law firms.