PSYCHIATRIC COMORBITY IN PERINATALLY HIV INFECTED CHILDREN AND ADOLESCENTS

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Hypothesis: Children and adolescents infected with HIV will exhibit a greater prevalence of psychiatric comorbidity as compared to non-HIV infected controls. Among HIV infected subjects, psychiatric morbidity would be different based on exposure to antiretroviral therapy. Subjects with depression symptomatology or those with impulse control problems will display lapses in adherence to antiretroviral therapy. Recent data suggest that perinatally HIV-infected children and adolescents have significantly higher rates of psychiatric hospitalizations when compared to both HIV-exposed but uninfected children and adolescents (1). P1055 is a multicenter, non-treatment, observational study of the effect of HIV on the prevalence and severity of psychiatric symptoms in 400 perinatally HIV-infected children and adolescents ages 6 to <18 as compared to a demographically matched control group of 400 children and adolescents who are uninfected but HIV-exposed, or are living with a household member who is HIV-infected. Enrollment of HIV-infected subjects will be stratified by gender and age group (6 to < 12 or > 12 to < 18), and then control subjects will be selected to be frequency matched within the four strata created by gender and age group. All 800 subjects will be assessed for the prevalence and severity of psychiatric symptoms at entry and at approximately 1 year (48 weeks) and 2 years (96 weeks) after entry. In addition, a subset of 200-240 HIV-infected subjects and control subjects (100 - 120 in each group) and their parents/primary caregivers will participate in semi-structured psychiatric interviews to clinically evaluate tentative psychiatric diagnoses based on DSM-IV defined disorders. This study will examine the relationship between child and adolescent psychiatric symptoms and HIV variables (e.g., length and type of antiretroviral therapy, severity of HIV symptoms, Center for Disease Control [CDC] clinical and immunological categories), compliance with treatment regimens, and environmental adversities (e.g., exposure to trauma, violence, substance abuse/use, poverty, mental health of primary caregiver, etc.). The influence of these variables on child and adolescent mental health is expected to be nonspecific with regard to measures of multiple symptoms, although the strongest effect, based on prior studies of children and adolescents with chronic illness and our own research on children and adolescents with neurological disorders, is expected to be frequency and severity of anxiety, depression, and ADHD symptoms. The direct and indirect effects of the child or adolescent's demographic characteristics (age and gender), intellectual functioning, parent/primary caregiver mental health, family stability, and the presence of possible protective factors will also be examined. This study will focus on these characteristics in an attempt to understand the differential vulnerability or resilience to the effects of HIV infection.