HIV-associated neurocognitive disorders, among adolescents with HIV in India.

Abstract

Background: Research on neurocognition among Indian adolescents with HIV (AHIV) has only recently begun to emerge, with earlier studies predominantly focusing on adult cohorts or international populations.

Objective: This study examined neurocognitive functioning in adolescents aged 11-16 years from Bengaluru, Karnataka, comparing perinatally infected AHIV with healthy controls.

Design and methods: This cross-sectional study investigated HIV-associated neurocognitive disorder (HAND) in 148 participants, 70 perinatally infected AHIV and 78 controls. Participants completed a neurocognitive battery assessing eight domains: attention, processing speed, verbal memory, visual memory, visual-spatial memory, language, motor coordination, and executive functioning.

Results: AHIV performed significantly worse than controls across all assessed domains, reflecting widespread and multidomain cognitive vulnerability during adolescence. Significant impairments were observed in attention (estimate = -0.83, P  < 0.001), processing speed (estimate = -0.81, P  < 0.001), executive functioning (estimate = -0.82, P  < 0.001), language (estimate = -0.68, P  < 0.001), verbal memory (estimate = -0.46, P  < 0.001), motor coordination (estimate = -0.46, P  < 0.001), and visual memory (estimate = -0.29, P  < 0.001). The assessment battery, originally validated in South Africa, demonstrated reliability (Cronbach's α ranging from 0.67 to 0.88) and cultural sensitivity through rigorous translation and back-translation procedures, supporting its cross-cultural applicability in the Indian context.

Conclusion: Neurocognitive impairment remains a persistent and clinically meaningful outcome of perinatal HIV infection despite antiretroviral therapy, underscoring the urgent need for standardized neurocognitive assessment and early intervention for AHIV in low- and middle-income country (LMIC) settings.