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Journal of Pediatric Psychology, Vol. 25, No. 5, 2000, pp. 309-322
© 2000 Society of Pediatric Psychology

Declining Immune Function in Children and Adolescents With Hemophilia and HIV Infection : Effects on Neuropsychological Performance

Katherine A. Loveland, PhD1, James A. Stehbens, PhD2, Elizabeth M. Mahoney, ScD3, Patricia A. Sirois, PhD4, Sharon Nichols, PhD5, Janice D. Bordeaux, PhD6, John M. Watkins, PhD7, Nancy Amodei, PhD8, Suzanne D. Hill, PhD, Sharyne Donfield, PhD9 and Hemophilia Growth and Development Study

1 University of Texas Medical, School, Houston, 2 University of Iowa College of Medicine, 3 Emory University, 4 Tulane University Medical Center, 5 University of California, San Diego, 6 Rice University, 7 Children's Hospital of Orange Country, 8 University of Texas Health Science Center, San Autonio, 9 Rho, Inc., Chapel Hill, North Carolina

All correspondence should be sent to Katherine A. Loveland, Center for Human Development Research, Department of Psychiatry and Behavioral Sciences, University of Texas Medical School, Houston ; U. T. Mental Sciences Institute, 1300 Moursund Street, Houston, Texas 77030. E-mail : klovelnd{at}msi.uth.tmc.edu

Objective : To determine whether declines in immune functioning are associated with changes in neuropsychological performance in children and adolescents with hemophilia who are infected with the human immunodeficiency virus (HIV).

Methods : Participants were 333 males with hemophilia, ages 6-19 years at entry. A baseline and four annual neuropsychological evaluations were given. A longitudinal growth curves analysis of data was performed to detect changes associated with declining immune function. The cohort was stratified into four groups : (1) HIV- (n = 126) ; (2) HIV+, average of first two and last two CD4 counts >=200, (n = 106 ; High CD4 group) ; (3) HIV+, average first two counts >=200, average last two counts <200 (n = 41 ; CD4 Drop group) ; and (4) HIV+, average first two and last two counts <200 (n = 60 ; Low CD4 group).

Results : There were significant differences among the four groups over time in nonverbal intelligence, perceptual/performance skills, nonverbal memory, academic achievement, and language. The Low CD4 group consistently showed the greatest decrement in performance. On measures showing a practice effect for repeated measurements, the Low CD4 group participants' scores remained stable over time, suggesting opposing effects of practice and HIV-related declines. Lowered academic performance relative to IQ was found in all groups.

Conclusions : Declines in neuropsychological functioning are directly related to declines in immune functioning in HIV+ children, adolescents, and young adults with hemophilia. Hemophilia itself may be a risk factor for academic underachievement.

Key words: human immunodeficiency virus (HIV); hemophilia; children and adolescents; neuropsychology.


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