Mental health functioning among children and adolescents with perinatal HIV infection and perinatal HIV exposure

Abstract

Mental health problems (MHPs) among children with perinatal HIV infection have been described prior to and during the highly active antiretroviral therapy (HAART) era. Yet child, caregiver and socio-demographic factors associated with MHPs are not fully understood. We examined the prevalence of MHPs among older children and adolescents with perinatal HIV exposure, including both perinatally HIV-infected (PHIV + ) and perinatally HIV-exposed but uninfected (PHEU) youth. Our aims were to identify the impact of HIV infection by comparing PHIV+ and PHEU youth and to delineate risk factors associated with MHPs, in order to inform development of appropriate prevention and intervention strategies. Youth and their caregivers were interviewed with the Behavior Assessment System for Children, 2nd edition (BASC-2) to estimate rates of at-risk and clinically significant MHPs, including caregiver-reported behavioral problems and youth-reported emotional problems. The prevalence of MHPs at the time of study entry was calculated for the group overall, as well as by HIV status and by demographic, child health, and caregiver characteristics. Logistic regression models were used to identify factors associated with youth MHPs. Among 416 youth enrolled between March 2007 and July 2009 (295 PHIV+, 121 PHEU), the overall prevalence of MHPs at entry was 29% and greater than expected based on recent national surveys of the general population. MHPs were more likely among PHEU than among PHIV+ children (38% versus 25%, p<0.01). Factors associated with higher odds of MHPs at p<0.10 included caregiver characteristics (psychiatric disorder, limit-setting problems, health-related functional limitations) and child characteristics (younger age and lower IQ). These findings suggest that PHEU children are at high risk for MHPs, yet current models of care for these youth may not support early diagnosis and treatment. Family-based prevention and intervention programs for HIV affected youth and their caregivers may minimize long-term consequences of MHPs.

Keywords:

• mental health problems
• children and adolescents
• perinatal HIV exposure
• HIV infection

Acknowledgements

We thank the children and families for their participation in the PHACS Adolescent Master Protocol (AMP), and the individuals and institutions involved in the conduct of PHACS AMP. The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with co-funding from the National Institute of Allergy and Infectious Diseases, the National Institute on Drug Abuse, the National Institute of Mental Health, National Institute of Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute, National Institute of Neurological Disorders and Stroke, and the National Institute on Alcohol Abuse and Alcoholism, through cooperative agreements with the Harvard University School of Public Health (U01 HD052102-04) (Principal Investigator: George Seage; Project Director: Julie Alperen) and the Tulane University School of Medicine (U01 HD052104-01) (Principal Investigator: Russell Van Dyke; Co-Principal Investigator: Kenneth Rich; Project Director: Patrick Davis). Data management services were provided by Frontier Science and Technology Research Foundation (PI: Suzanne Siminski), and regulatory services and logistical support were provided by Westat, Inc (PI: Mercy Swatson).

 The following institutions, clinical site investigators and staff participated in conducting PHACS AMP in 2009, in alphabetical order: Baylor College of Medicine: William Shearer, Norma Cooper; Bronx Lebanon Hospital Center: Murli Purswani, Mahboobullah Baig; Children's Diagnostic & Treatment Center: Ana Puga, Sandra Navarro; Children's Hospital, Boston: Sandra Burchett, Nancy Karthas; Children's Memorial Hospital: Ram Yogev, Eric Cagwin; Jacobi Medical Center: Andrew Wiznia, Marlene Burey; St. Christopher's Hospital for Children: Janet Chen, Elizabeth Gobs; St. Jude Children's Research Hospital: Katherine Knapp, Kim Allison; San Juan Hospital/Department of Pediatrics: Midnela Acevedo-Flores, Heida Rios; Tulane University Health Sciences Center: Margarita Silio, Cheryl Borne; University of California, San Diego: Stephen Spector, Kim Norris; University of Colorado Denver Health Sciences Center: Elizabeth McFarland, Emily Barr; University of Maryland, Baltimore: Douglas Watson, Nicole Messenger; University of Medicine and Dentistry of New Jersey: Arry Dieudonne, Linda Bettica; University of Miami: Gwendolyn Scott, Lisa Himic, Elizabeth Willen. The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Insitutes of Health or US Department of Health and Human Services.