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J Pediatric Infect Dis Soc. 2016 Dec;5(suppl 1):S33-S40.

Longitudinal Evaluation of Language Impairment in Youth With Perinatally Acquired Human Immunodeficiency Virus (HIV) and Youth With Perinatal HIV Exposure.

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Communication Sciences and Disorders, University of Utah.
Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health.
Child Language Program, University of Kansas.
Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health.
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.
Maternal, Child and Adolescent Center for Infectious Diseases and Virology, Keck School of Medicine of the University of Southern California.
Division of Pediatric Infectious Disease, Department of Pediatrics, Bronx-Lebanon Hospital Center, New York, New York.



Language impairment (LI) risk is increased for perinatally acquired human immunodeficiency virus-infected (PHIV) and perinatally exposed to HIV but uninfected (PHEU) youth. This study evaluates the persistence of LI in these groups.


The Clinical Evaluation of Language Fundamentals was repeated on participants of the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol 18 months postbaseline. Regression models identified factors associated with change in standardized score (SC) and the resolution or development of LI.


Of 319 participants, 112 had LI at baseline. Upon re-evaluation, SCs were highly stable and changes were similar in PHIV (n = 212) and PHEU (n = 107) participants. Those with family history of language delays had a 2.39 point lower mean increase in SCs than those without, after controlling for demographic and socioeconomic factors and baseline LI status. Among PHIV participants, CD4 count <350 cells/mm3 was associated with lower mean SC change (4.32 points), and exposure to combination antiretroviral therapy (cART) or protease inhibitors (PIs) was associated with a higher mean SC change (5.93 and 4.19 points, respectively). Initial LI was persistent in most cases (78%); 20 new cases occurred (10%). Female sex was associated with higher odds of LI resolution. Among PHIV, duration and baseline cART and history of PI use were associated with LI resolution; higher percentage of detectable viral loads before baseline was associated with lower odds of resolution.


The PHIV and PHEU youth are at risk for persistent LI, and family history of language delays was a risk factor for persistence of problems. Measures of successful HIV treatment predicted more favorable outcomes among PHIV youth.


antiretroviral therapy; language development; language impairment; perinatal HIV; youth

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