Implications of a perinatal HIV infection on adolescent health

HIV remains a significant global health problem. HIV causes an incurable infectious disease that has become manageable (and thus chronic) with combination antiretroviral therapy (cART). HIV has neurotropic properties and invades the brain rapidly after infection. cART reduces mortality and morbidity, yet neurological, cognitive and cardiovascular complications (CVD) are present. This thesis contains results from the Neurological, cOgnitive and VIsual performance in perinatally HIV-infected ChildrEn (NOVICE) cohort study which enrolled children and adolescents living with perinatally acquired HIV (PHIV) visiting the outpatient clinic of the Emma Children’s Hospital in Amsterdam and HIV-negative controls matched for age, sex, ethnic origin and socio-economic status.
In brief, about half of adolescents living with PHIV has white matter (WM) lesions, yet their association with HIV or treatment remains to be debated. Lower WM integrity in adolescents living with PHIV is lower compared to adoption-matched HIV-negative controls, suggesting independent microscopic effects of HIV on the brain. These changes may likely be acquired in the past, due to normal serum neurofilament light levels at present, which suggest no evidence of ongoing neuroaxonal damage. A majority of adolescents living with PHIV has persistent higher lipoprotein(a) levels, suggesting increased CVD risk. While previous studies predominantly assessed neurological and cognitive complications, future research may further investigate the potentially increased CVD risk in adolescents living with PHIV growing into adulthood.