Nutritional Status and Cognitive Function in Children with HIV: Evidence from the HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) Study
William Raskopf1, Heather Adams1, Alexandra Buda1, Gretchen Birbeck2, Esau Mbewe3, Caroline Kabwe4, Milimo Mweemba4, Pelekelo Kabundula5, David Bearden1
1University of Rochester School of Medicine, 2University of Rochester/CHET, 3Department of Educational Psychology, University of Zambia, Lusaka, Zambia, 4University Teaching Hospital, Neurology Research Office, Lusaka Zambia, 5Department of Psychology, University of Zambia, Lusaka, Zambia
Objective:
This study aims to unveil the relationship between malnutrition and HIV-associated cognitive outcomes in children, leveraging the high concentrations of both malnutrition and HIV in Zambia.
Background:
Despite advancements in antiretroviral therapy (ART), children with HIV in Sub-Saharan Africa remain vulnerable to HIV-associated neurocognitive disorder (HAND). Emerging evidence points to malnutrition indicators, such as growth stunting and food security, as important predictors of cognitive outcomes in these patients.
Design/Methods:

 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.


Results:

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.


Conclusions:

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. 


10.1212/WNL.0000000000211605
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