HIV-associated changes in adaptive, emotional, and behavioral functioning in children and adolescents with hemophilia: Results from the hemophilia growth and development study

Objective: To assess changes in adaptive, emotional, and behavioral functio ning over four years in children and adolescents with hemophilia and with o r without HIV infection and to evaluate the relationship of these changes t o immune status. Methods: Participants were 277 HIV-seropositive and 126 HIV-seronegative bo ys with hemophilia. Participants with HIV infection were divided into three groups based on trajectory of immune functioning (CD4+ cell counts) over t he course of the study. Caregivers completed the Vineland Adaptive Behavior Scales and Pediatric Behavior Scale (PBS). Results: Results showed declining Vineland Communication scores for partici pants with consistently poor immune functioning. These participants also st arted with more PBS Attention Deficit and Deviation symptoms, which then de creased more sharply than for other groups. Low CD4+ counts were consistent ly associated with more Health and Depression-Anxiety symptoms on the PBS. However, with few exceptions, group means remained within normal limits. Conclusions: According to their caregivers, boys with hemophilia and HIV in fection showed considerable resilience with regard to adaptive behavior and emotional and behavioral problems. However, over time changes occurred in these areas that appear to be related to immune functioning.