Loveland, K.A., Stehbens, J.A., Mahoney, E., Sirois, P., Nichols, S., Bordeaux, J., Watkins, J., Amodei, N., Hill, S. Donfield, S. & the Hemophilia Growth and Development Study. Declining immune function in children and adolescents with hemophilia and HIV infection: Effects on neuropsychological performance. (2000, in press). The Journal of Pediatric Psychology.

Objective: To determine whether declines in immune functioning are associated with changes in neuropsychological performance in children and adolescents with hemophilia who are infected with the Human Immunodeficiency Virus (HIV).

Methods: Participants were 333 males with hemophilia, aged 6 - 19 years at entry. A baseline and four annual neuropsychological evaluations were given. A longitudinal growth curves analysis of data was performed to detect changes associated with declining immune function. The cohort was stratified into four groups: a) HIV- (n = 126); b) HIV+, average of first two and last two CD4 counts > 200 (n = 106; High CD4 group); c) HIV+, average first two counts > 200, average last two counts < 200 (n = 41; CD4 Drop group); d) HIV+, average first two and 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 effect for repeated measurements, the Low CD4 group participants’ scores remained stable over time, suggesting opposing effects of practice and HIV-related declines. Lowered academic performance relative to IQ was found in all groups.

Conclusions: Declines in neuropsychological functioning are directly related to declines in immune functioning in HIV+ children, adolescents and young adults with hemophilia. Hemophilia itself may be a risk factor for academic under-achievement.

Key words: Human immunodeficiency virus (HIV); hemophilia; children and adolescents; neuropsychology.