Effects of HIV and Adverse Childhood Experiences on Neurocognition

BACKGROUND: Both HIV and adverse childhood experiences (ACEs) can affect neurocognitive performance. Among youth with perinatal HIV (PHIV), living with a chronic viral infection and experiencing ACEs simultaneously may result in an interaction between the 2 and downstream effects on neurocognition. The purpose of this study was to test the effects of PHIV, childhood adversity, and their interaction on neurocognition in a sample of South African adolescent boys. SETTING: Soweto, South Africa. METHODS: Adolescent boys aged 15-19 years enrolled in a longitudinal study between November 2020 and June 2023. Recruitment was stratified by HIV status. At baseline, participants completed the ACE measure. Six months later they completed a battery of neurocognitive assessments ( NeuroScreen ). We created several regression models to examine the effects of HIV status, ACEs, and their interaction on neurocognition. We also built several exploratory models to probe the effects of viral suppression and various kinds of ACEs. RESULTS: Participants living with PHIV scored significantly lower than those without HIV on several neurocognitive domains. Among those living with PHIV, participants with a detectable viral load during the study exhibited significantly lower performance on several domains than those who were consistently virally suppressed. We found no support for the effect of ACEs or a significant HIV*ACEs interaction on neurocognition. CONCLUSIONS: Our results underscore the importance of medication adherence and viral suppression among youth living with HIV.