In this prospective cohort study, children aged 8-17 with HIV and control groups were recruited from the Pediatric Center for Excellence in Lusaka, Zambia and completed quarterly follow-up visits over an average of four years, during which cognitive (e.g., NPZ5 score, GDS score), and nutritional (e.g., number of meals per week, height percentile). Statistical analyses, including regression models were conducted in order to identify important predictors of cognitive outcomes.

This study included 614 participants: 69 HIV-unexposed/uninfected (HUU), 209 HIV-exposed/uninfected (HEU), and 336 HIV+. In general, HIV+ participants had poorer nutritional and cognitive outcomes compared to the HEU and HUU groups. Many nutritional variables, such as height percentile and malnutrition, were strongly associated with cognitive impairment. Lasso models identified malnutrition, food security, height percentile, food spending, protein, head circumference, and days gone without food as key predictors of cognitive outcome. When a nutritional index (NTR1) was constructed using these variables, a linear relationship between NTR1 and NPZ5 scores was observed across all groups.

In conclusion, nutritional status is a strong predictor of cognitive outcomes in HIV+ children in Zambia. It is thus crucial for additional nutritional measures to be taken in Sub-Saharan Africa in order to ease the cogntivie burden of HIV among infected children. In addition, this study opens the door to additional research on the specific nutritional mediators of this relationship, (e.g., micronutrients) in order to guide nutritional measures and medical treatment.