Memory Functioning in Children and Adolescents with Perinatal HIV Infection

围产期艾滋病毒感染儿童和青少年的记忆功能

• 批准号: 8369331
• 负责人: SHARON L NICHOLS
• 金额: $ 37.42万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-12-18 至 2014-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8369331
• 关键词: AIDS neuropathy; AIDS/HIV problem; Academic achievement; Adaptive Behaviors; Adherence; Adolescence; Adolescent; Adult; Affect; Age; Anti-Retroviral Agents; Area; Attention; Behavior; Behavioral; Birth; Brain; Caregivers; Caring; Centers for Disease Control and Prevention (U.S.); Child; Childhood; Chronic Disease; Clinical Sciences; Cognitive; Cohort Studies; Communities; Complex; Data; Development; Diagnosis; Disease; Disease Marker; Failure; Future; Generations; Goals; HIV; HIV Infections; HIV-1; Health; Healthcare; Impairment; Infection; Intention; Intervention; Investigation; Knowledge; Language; Learning; Life; Literature; Longevity; Longitudinal Studies; Measures; Medical; Medication Management; Memory; Mosses; Neuraxis; Neurocognitive; Occupational; Outcome; Parents; Pattern; Performance; Perinatal; Perinatal Infection; Persons; Pharmaceutical Preparations; Population; Problem Solving; Protocols documentation; Provider; Public Health; Quality of life; Reading; Recording of previous events; Relative (related person); Research; Research Design; Resistance; Resources; Risk; Sampling; Self Care; Severities; Severity of illness; Short-Term Memory; Site; Task Performances; Testing; Time; Underserved Population; Viral; Virus; Youth; advanced disease; base; coping; cost effective; daily functioning; design; economic implication; effective intervention; executive function; falls; flexibility; functional outcomes; health economics; improved functioning; insight; longitudinal design; medication compliance; meetings; neuropathology; pediatric human immunodeficiency virus infection; peer; physical conditioning; prospective memory; skills; social; social skills; therapy development; tool; young adult

DESCRIPTION (provided by applicant): Current treatments have transformed HIV/AIDS from an inevitably fatal disease to one commonly managed as a chronic illness. Many children born with HIV infection, who previously suffered brief life spans, are now surviving into adulthood. This creates the need to understand more fully the obstacles these youth encounter in becoming independent, productive adults. In adults, HIV commonly is associated with impairments in memory and executive functions (such as inhibition, cognitive flexibility, and problem solving), which increase the risk of problems in day-to-day functioning, including medication nonadherence. Studies of memory and executive functions in children and youth with HIV infection are extremely limited, however, and none have included measures of prospective memory (that is, the ability to execute a future intention), which is a particularly robust predictor of daily functioning in adults with HIV. Furthermore, our current understanding of the functional impact of HIV on brain development is limited. The study proposed here would be the first to evaluate the complex interplay between development and HIV infection on memory and executive functions in the context of important functional outcomes in an effort to advance the clinical science of pediatric neuroAIDS. The study will test the hypotheses that: 1) perinatally acquired HIV is associated with deficits in memory and executive functioning; 2) HIV severity and history, including age at greatest disease severity, will be associated with degree of impairment in memory and executive functioning ; 3) developmental change and changes in HIV severity will interact to influence these functions over time; and 4) impairments in memory and executive function contribute to problems in daily functioning (including medication adherence, academic achievement, and adaptive behavior). Using a longitudinal design to examine and control for developmental changes in these functions during adolescence, we will administer measures of verbal and nonverbal retrospective memory, prospective memory, executive functions, and medication adherence to 200 HIV-infected and 75 uninfected youth age 9-18 at two time points, two years apart. Data will be collected at eight sites participating in a large national, longitudinal study of outcomes of perinatal HIV infection, the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol, thus allowing us to examine memory and executive functioning in an efficient and cost-effective manner in the larger context of demographic, health-related, cognitive, and behavioral aspects of perinatal HIV infection. This is an important area for investigation because deficits in memory and executive function in youth with HIV could have wide-ranging effects on their acquisition of health and medication management skills, adaptive and academic functioning, behavior, and, ultimately, social and occupational outcome in adulthood. We anticipate this study will not only elucidate developmental neurocognitive aspects of perinatally acquired HIV but will also provide important information and additional tools to target areas of intervention for perinatally HIV-infected youth at risk for poor functional outcomes.

描述（由申请人提供）：目前的治疗方法已将艾滋病毒/艾滋病从一种不可避免的致命疾病转变为一种通常作为慢性疾病进行治疗的疾病。许多出生时就感染艾滋病毒的儿童以前寿命很短，现在却能活到成年。这就需要更全面地了解这些年轻人在成为独立、富有成效的成年人时遇到的障碍。在成人中，艾滋病毒通常与记忆和执行功能（例如抑制、认知灵活性和问题解决能力）受损有关，这增加了日常功能出现问题的风险，包括不依从药物治疗。然而，对感染艾滋病毒的儿童和青少年的记忆和执行功能的研究极其有限，而且没有一项研究包括前瞻性记忆的测量（即执行未来意图的能力），而前瞻性记忆是艾滋病毒感染者日常功能的特别有力的预测指标。此外，我们目前对艾滋病毒对大脑发育的功能影响的了解还有限。这里提出的这项研究将是第一个在重要功能结果的背景下评估发育和艾滋病毒感染之间对记忆和执行功能的复杂相互作用的研究，以努力推进儿科神经艾滋病的临床科学。该研究将检验以下假设：1）围产期感染艾滋病毒与记忆力和执行功能缺陷有关； 2) HIV的严重程度和病史，包括疾病最严重的年龄，将与记忆和执行功能的损伤程度相关； 3) 随着时间的推移，发育变化和 HIV 严重程度的变化会相互作用，影响这些功能； 4) 记忆和执行功能受损会导致日常功能问题（包括药物依从性、学业成绩和适应行为）。使用纵向设计来检查和控制青春期期间这些功能的发育变化，我们将在相隔两年的两个时间点对 200 名 HIV 感染者和 75 名未感染的 9-18 岁青少年进行言语和非言语回顾性记忆、前瞻性记忆、执行功能和药物依从性测量。数据将在八个参与围产期艾滋病毒感染结果的大型全国性纵向研究（即儿科艾滋病毒/艾滋病队列研究青少年主方案）的地点收集，从而使我们能够在围产期艾滋病毒感染的人口、健康相关、认知和行为方面的更大背景下，以高效且具有成本效益的方式检查记忆和执行功能。这是一个重要的研究领域，因为艾滋病毒青少年的记忆和执行功能缺陷可能会对他们获得健康和药物管理技能、适应和学术功能、行为以及最终成年后的社会和职业结果产生广泛影响。我们预计这项研究不仅将阐明围产期感染艾滋病毒的发育神经认知方面的问题，还将提供重要信息和其他工具，为有功能结果不良风险的围产期艾滋病毒感染青少年提供针对性的干预领域。