Human Immunodeficiency Virus Disease Severity, Psychiatric Symptoms, and Functional Outcomes in Perinatally Infected Youth

Since the advent of highly active antiretroviral therapy (HAART), perinatally human immunodeficiency virus–infected (HIV+) youth are surviving childhood in increasing numbers. We recently reported on a large sample of HIV+ youth (aged 6–18 years) and a comparison sample of control youth (exposed but not infected or living in a household with an HIV+ individual) in which we observed comparable rates of youth self-report of psychiatric symptoms (among HIV+youth 12–17 years old, 24%; among controls, 33%).1 Compared with controls, HIV+ youth received significantly higher rates of behavioral, educational, and pharmacological intervention (23% vs 12%), suggesting the possibility of a link between the virus or its pharmacological treatments and behavioral disturbance.2 Unfortunately, few studies have examined this possibility in HIV+ youth, and there is little information about the short- and long-term effects of HIV illness severity or different forms of HAART on the development of neuropsychiatric symptoms.3–8 Mellins et al9 examined 47 HIV+youth aged 9 to 16 years who were recruited from a New York City HIV clinic population and did not find a significant association between HIV illness severity and development of psychiatric illnesses. In contrast, Wood and colleagues10 found an association between a past Centers for Disease Control and Prevention (CDC) AIDS-defining illness (class C [CDC-C]) and an increased risk of psychiatric impairment in a sample of 81 HIV+ adolescents. In that retrospective study, behavioral problems were assessed using the Conners Rating Scale11 (completed by the teacher and caregiver), and psychiatric illnesses were reported by clinic physicians on the basis of symptoms. The authors did not find any significant associations with IQ. Smith et al12 also examined the relation of HIV disease severity with psychiatric and cognitive outcomes and found that youth with past CDC-C diagnoses, especially those with encephalopathy, had slower processing speed than those who did not carry a CDC-C diagnosis. Owing to the well-documented role of behavioral disturbance and cognitive impairment on social and academic difficulties, as well as risky sexual behavior in adolescents (and their implications for disease transmission), it is critical to better understand the true relation of HIV disease severity measures and attendant therapies with the severity of psychiatric symptoms in HIV+ youth as they age. The present study examines these issues in a large, geographically representative, well-characterized sample of HIV+ youth who were evaluated prospectively with well-validated measures of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) symptoms.