Abstract Details

Title Evaluating the Relationship Between Depression and HIV-associated Cognitive Impairment Among Children and Adolescents in Zambia

Topic Global Health and Neuroepidemiology

Presentation(s) S7 - Global Health (3:30 PM-3:41 PM)

Poster/Presentation
Number 001

Objective To assess the link between depression and cognitive dysfunction in the pediatric HIV+ population in Zambia.

Background Cognitive impairment affects 30-50% of youth with Human Immunodeficiency Virus (HIV) in resource-limited settings. Multiple studies demonstrate a link between depression and cognitive dysfunction, but the contribution of depressive symptoms to cognitive impairment has been minimally investigated in this population. We assessed this relationship among youth living with HIV in Zambia, a Sub-Saharan nation with high rates of pediatric HIV infection.

Design/Methods A prospective cohort study was conducted in Lusaka, Zambia including 200 perinatally-infected children with HIV ages 8-17, all treated with combination antiretroviral therapy (cART), and 200 HIV-exposed uninfected controls. Cognition was assessed with a comprehensive neuropsychological battery, and cognitive impairment was defined using a global deficit score approach. Depressive symptoms were evaluated using the NIH Toolbox Sadness module and the Patient Health Questionnaire-9 (PHQ9). The relationship between depressive symptoms and cognition was evaluated in multivariable logistic regression models.

Results Participants’ median age was 11, and 50% of participants were male. All subjects with HIV had been treated with cART for at least 1 year (median treatment time 8 years, IQR 6-10 years). 90% of HIV+ subjects had undetectable viral loads. In both HIV+ and HIV- groups, a NIH Toolbox Sadness T-score >60 was the optimal cut point on ROC curves for identifying subjects with clinically significant depressive symptoms. Subjects with HIV were more likely to be depressed than controls (24% vs. 13%, p=0.03), and depression was strongly associated with cognitive impairment (Unadjusted OR 2.7, 95% CI 1.3-5.6, p=0.005).

Conclusions Depression is common among youth with HIV in Zambia, and is strongly associated with cognitive impairment, though the causal relationship between depression and cognitive impairment is unclear. Further studies are necessary to determine whether identifying and treating depression may improve cognition in youth adolescents with HIV.

Authors/Disclosures
Maria E. Molinaro, MD (Johns Hopkins) PRESENTER	Ms. Molinaro has nothing to disclose.
Sylvia Mwanza-Kabaghe	No disclosure on file
Milimo Mweemba	Milimo Mweemba has nothing to disclose.
	No disclosure on file
Esau G. Mbewe	Esau G. Mbewe has received research support from Research was supported by the National Institute Of Neurological Disorders And Stroke of the National Institutes of Health under Award Number K23NS117310. .
Pelekelo Kabundula	Pelekelo Kabundula has nothing to disclose.
Heather Adams	The institution of Heather Adams has received research support from Current: NIH; Past: Abeona; Batten Research Alliance; American University Centers on Disabilities. An immediate family member of Heather Adams has received publishing royalties from a publication relating to health care. Heather Adams has received personal compensation in the range of $500-$4,999 for serving as a Consultant with Critical Path Institute.
	No disclosure on file
David Bearden, MD (University of Rochester School of Medicine)	Dr. Bearden has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Bearden has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Praxis. Dr. Bearden has received personal compensation in the range of $100,000-$499,999 for serving as an Expert Witness for law firms.

��ɫ��

��ɫ��