Cognitive outcomes at ages seven and nine years in South African children from the children with HIV early antiretroviral (CHER) trial: a longitudinal investigation.
Cognitive outcomes at ages seven and nine years in South African children from the children with HIV early antiretroviral (CHER) trial: a longitudinal investigation.
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DOI：
10.1002/jia2.25734
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发表时间：
2021-07
影响因子：
6
通讯作者：
Thomas KG
中科院分区：
文献类型：
--
作者：
van Wyhe KS;Laughton B;Cotton MF;Meintjes EM;van der Kouwe AJ;Boivin MJ;Kidd M;Thomas KG
许多感染艾滋病毒的儿童 (CLWH) 表现出认知障碍。尽管早期联合抗逆转录病毒疗法（ART）可改善认知结果，但仍需要更多长期结果数据。 2011 年结束艾滋病毒儿童早期抗逆转录病毒 (CHER) 试验后，我们调查了 7 岁和 9 岁时的认知表现。参与者被随机分配至延迟 ART（ART-Def；n = 22）；立即限时 ART 40 周（ART‐40W；n = 30）和立即限时 ART 96 周（ART‐96W；n = 18）。我们还招募了暴露于艾滋病毒的未感染儿童（CHEU；n = 28）和未暴露于艾滋病毒的儿童（CHU；n = 35）。数据收集于 2012 年 5 月至 2017 年 12 月之间。混合模型重复测量方差分析评估了 CLWH（ART-40W、ART-96W 和 ART-Def）以及 CHIV-CHEU 和 CHU 之间随时间的差异。以及 ART-40W、ART-96W、ART-Def、CHEU 和 CHU 之间。所有比较都发现时间对大多数结果变量有显着影响（九岁时的分数比七岁时的分数更好；ps < 0.05）。第一个方差分析发现，对于 (a) 运动灵活性，CLWH 在 7 年时的表现比 CHIV- 差 (p < 0.001)，但在 9 年时改善到相当，(b) 视觉空间处理和问题解决能力，只有 CLWH (p < 0.04) 随着时间的推移表现出显着的表现改善；(c) 工作记忆和执行功能，CLWH 在 7 年和 9 年的表现都比 CHIV- 差（p = 0.03 和 0.04）。第二次方差分析发现，对于 (a) 工作记忆，CHU 的表现优于 ART-Early 和 CHEU（p < 0.01 和 <0.04），以及 (b) 运动灵活性，ART-Def 在 7 年时的表现比 ART-Early、CHEU 和 CHU 差（分别为 p = 0.02、<0.001 和 <0.001），但在 9 年时改善到相当水平（ps > 0.17）。同样，对于运动灵活性，ART‐Def 在七年时的表现比 ART‐96W、CHEU 和 CHU 差（p < 0.04、<0.001 和 <0.001），但在 9 年时改善到相当（ps > 0.20）。尽管治疗组和对照组的神经认知发展轨迹基本相似（即成绩从 7 岁提高到 9 岁），但所有接受 ART 治疗的儿童，无论采用哪种治疗组，在学龄早期仍然面临认知缺陷的风险。尽管这些缺陷的性质可能会随着认知发展的进展而改变，但对这些孩子未来的学习、推理和适应功能有潜在的负面影响。
Many children living with HIV (CLWH) display impaired cognition. Although early combination antiretroviral therapy (ART) produces improved cognitive outcomes, more long‐term outcome data are needed. After concluding the Children with HIV Early antiRetroviral (CHER) trial in 2011, we investigated cognitive performance, at seven and nine years of age. Participants had been randomized to deferred ART (ART‐Def; n = 22); immediate time‐limited ART for 40 weeks (ART‐40W; n = 30) and immediate time‐limited ART for 96 weeks (ART‐96W; n = 18). We also recruited HIV‐exposed uninfected (CHEU; n = 28) and HIV‐unexposed (CHU; n = 35) children. Data were collected between May 2012 and December 2017. Mixed‐model repeated‐measures ANOVAs assessed differences over time between CLWH (ART‐40W, ART‐96W and ART‐Def) and CHIV‐ CHEU and CHU between ART‐Early (ART‐40W and ART‐96W), ART‐Def, CHEU and CHU; and between ART‐40W, ART‐96W, ART‐Def, CHEU and CHU. All comparisons found significant effects of Time for most outcome variables (better scores at nine than at seven years; ps < 0.05). The first ANOVAs found that for (a) motor dexterity, CLWH performed worse than CHIV‐ at seven years (p < 0.001) but improved to equivalence at nine years, (b) visual‐spatial processing and problem solving, only CLWH (p < 0.04) showed significant performance improvement over time and (c) working memory and executive function, CLWH performed worse than CHIV‐ at both seven and nine years (p = 0.03 and 0.04). The second ANOVAs found that for (a) working memory, CHU performed better than ART‐Early and CHEU (p < 0.01 and <0.04), and (b) motor dexterity, ART‐Def performed worse than ART‐Early, CHEU and CHU at seven years (p = 0.02, <0.001 and <0.001 respectively) but improved to equivalence at nine years (ps > 0.17). Similarly, for motor dexterity, ART‐Def performed worse than ART‐96W, CHEU and CHU at seven years (p < 0.04, <0.001 and <0.001) but improved to equivalence at nine years (ps > 0.20). Although neurocognitive developmental trajectories for treatment groups and controls were largely similar (i.e. performance improvements from 7 to 9), all ART‐treated children, regardless of treatment arm, remain at risk for cognitive deficits over early school ages. Although the nature of these deficits may change as cognitive development proceeds, there are potential negative consequences for these children’s future learning, reasoning and adaptive functioning.
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影响因子：
3.8
作者：
Innes, Steve;Laughton, Barbara;Cotton, Mark F.
通讯作者：
Cotton, Mark F.
DOI：
10.1097/qad.0000000000001683
发表时间：
2018-01-14
期刊：
AIDS (London, England)
影响因子：
--
作者：
Boivin MJ;Barlow-Mosha L;Chernoff MC;Laughton B;Zimmer B;Joyce C;Bwakura-Dangarembizi M;Ratswana M;Abrahams N;Fairlie L;Gous H;Kamthunzi P;McCarthy K;Familiar-Lopez I;Jean-Phillippe P;Coetzee J;Violari A;Cotton MF;Palumbo PE;IMPAACT P1104s Study Team
通讯作者：
IMPAACT P1104s Study Team
影响因子：
9.9
作者：
Hoare, Jacqueline;Phillips, Nicole;Thomas, Kevin G. F.
通讯作者：
Thomas, Kevin G. F.
影响因子：
1.9
作者：
Potterton, J.;Hilburn, N.;Strehlau, R.
通讯作者：
Strehlau, R.
DOI：
10.3174/ajnr.a4921
发表时间：
2016-12
期刊：
AJNR. American journal of neuroradiology
影响因子：
--
作者：
Ackermann C;Andronikou S;Saleh MG;Laughton B;Alhamud AA;van der Kouwe A;Kidd M;Cotton MF;Meintjes EM
通讯作者：
Meintjes EM