Perinatal HIV infection/exposure, stress and long-term functional survival in Ugandan adolescents

宫内和产后高效抗逆转录病毒治疗的长期功能意义 （HAART）暴露于围产期人类免疫缺陷病毒（HIV）暴露或感染的儿童， 学龄及以后的情况不详。美国儿科HIV/AIDS队列研究的最新数据 （PHACS）发现，围产期艾滋病毒暴露和围产期艾滋病毒感染的儿童有认知测试 得分在正常的低范围内，但没有发现显着的认知缺陷，艾滋病毒暴露 子宫内有和没有HAART的未暴露儿童。几乎没有关于这一主题的数据， 撒哈拉以南非洲的儿童，估计每年有140万儿童受到 医源性HAART在神经，身体和社会发展的敏感时期。 围产期艾滋病毒暴露或感染的儿童与源源不断的生理和 子宫内、幼儿期和整个生命过程中的心理社会压力。这些压力源 在发育的敏感期，可能与中长期功能性 赤字例如，学业成绩和心理社会适应代表了共同标准 在童年和青少年时期衡量个人成功的标准。适当发展， 这些领域与整体学术成就和未来的生产能力密切相关 作为一个成年人，对于围产期艾滋病毒感染的青少年， 他们逐步负责管理他们的慢性健康状况， 坚持HAART方案，并获得在医疗保健系统中导航的能力。这些 能力要求有强有力的执行认知功能和适当的心理社会调整。 告知知识差距，并提供关于功能差异的新数据。 围产期艾滋病毒的结局（即认知发展、心理社会适应和生活质量） 暴露和感染相比，围产期艾滋病毒未暴露的儿童，我们评估艾滋病毒状况相关 11-18岁乌干达儿童队列中有和无 围产期艾滋病毒暴露/感染。我们专门评估心理社会和生理压力-测量 作为多个器官系统失调的复合物，作为任何HIV相关缺陷的介导物， 功能障碍通过设计，我们区分了HIV暴露或 感染艾滋病毒的儿童与来自同一社区的围产期未接触艾滋病毒的儿童相比。这 因此，这项研究旨在对艾滋病毒的具体影响进行全面和可靠的评估 学龄和青少年功能指标。本次调查的数据将告知 优化患者长期功能状态所需的可能补救干预措施的性质 围产期接触或感染艾滋病毒的儿童和青少年。

The long-term functional implication of in utero and postnatal highly active antiretroviral therapy (HAART) exposures for perinatally human immunodeficiency virus (HIV) exposed or infected children in school-age and beyond is unknown. Recent data from the US pediatric HIV/AIDS Cohort Study (PHACS) finds that perinatally HIV exposed and perinatally HIV infected children have cognitive test scores in the low range of normal but did not find significant cognitive deficit for HIV-exposed unexposed children with and without in utero HAART. Almost no data on this subject is available for children from sub-Saharan Africa where an estimated 1.4 million children per year are exposed to iatrogenic HAART during sensitive periods of neural, physical and social development. Perinatally HIV exposed or infected children contend with a steady stream of physiologic and psychosocial stressors in utero, early childhood and throughout their life course. These stressors occur during sensitive periods of development and may be associated with medium to long-term functional deficits. For example, academic achievement and psychosocial adjustment represent common standards by which individual success is measured in childhood and adolescence. Appropriate development in these areas is closely linked to overall academic attainment and future capacity to productively contribute to the society as an adult. For perinatally HIV infected adolescents, there is a simultaneous exectation that they progressively take charge of managing their chronic health condition through consistent adherence to HAART regimen and gaining competence in navigating the healthcare system. These capacities require a robust executive cognitive function and appropriate psychosocial adjustment. To inform knowledge gaps, and contribute new data on long-term differences in functional outcomes (i.e. cognitive development, psychosocial adjustment and quality of life) for perinatally HIV exposed and infected compared to perinatally HIV unexposed children, we evaluate HIV status related differences in functional outcomes in a cohort of 11-18 years old Ugandan children with and without perinatal HIV exposure/infection. We specifically assess psychosocial and physiologic stress – measured as a composite of dysregulations across multiple organ systems, as mediators of any HIV-related deficits in functional impairment. By design we distinguish between functional outcomes for HIV exposed or infected children in comparison to perinatally HIV unexposed children from the same community. This study is therefore positioned to provide a comprehensive and robust assessment of HIV specific impact on functional indicators in school-age and adolescence. Data arising from this investigation will inform the nature of possible remedial interventions required to optimize the long-term functional status of perinatally HIV exposed or infected children and adolescents.