Declining immune function in children and adolescents with hemophilia and HIV infection: Effects on neuropsychological performance

Objective: To determine whether declines in immune functioning are associat ed with changes in neuropsychological performance in children and adolescen ts with hemophilia who are infected with the human immunodeficiency virus ( HIV). Methods: Participants were 333 males with hemophilia, ages 6-19 years at en try. A baseline and four annual neuropsychological evaluations were given. A longitudinal growth curves analysis of data was performed to detect chang es associated with declining immune function. The cohort was stratified int o four groups: (1) HIV- (n = 126); (2) HIV+, average of first two and last two CD4 counts greater than or equal to 200 (n = 106; High CD4 group); (3) HIV+, average first two counts greater than or equal to 200, average last t wo counts <200 (n = 41; CD4 Drop group); and (4) HIV+, average first two an d 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 effe ct for repeated measurements, the Low CD4 group participants' scores remain ed stable over time, suggesting opposing effects of practice and HIV-relate d declines. Lowered academic performance relative to IQ was found in all gr oups. Conclusions: Declines in neuropsychological functioning are directly relate d to declines in immune functioning in HIV+ children, adolescents, and youn g adults with hemophilia. Hemophilia itself may be a risk factor for academ ic underachievement.