Nutritional and immunological correlates of memory and neurocognitive development among HIV-infected children living in Kayunga, Uganda

Objective: To identify the nutritional and immunological correlates of memory and neurocognitive development as measured by the Mullen Scales of Early Learning (MSEL) and by the Color Object Association Test (COAT) among children in Uganda. Design: This analysis uses baseline data collected between 2008 and 2010 from 119 HIV-infected children aged 1-6 years, participating in a randomized controlled trial of an interventional parenting program in Kayunga, Uganda. Methods: Peripheral blood draws were performed to determine immunological biomarkers. Unadjusted and adjusted linear regression models were used to relate MSEL and COAT scores to sociodemographic characteristics, weight-for-age Z scores (WAZs), antiretroviral therapy status, and immunological biomarkers. Results: In the final analysis, 111 children were included. Lower levels of CD4⁺ CD38⁺ T cells (P = 0.04) were associated to higher immediate and total recall scores (P = 0.04). Higher levels of CD8⁺ HLA-DR⁺ T cells were associated with higher total recall score (P = 0.04) of the COAT. Higher CD4⁺ CD38⁺ HLA-DR⁺ T cells levels were associated with higher gross motor scores of the MSEL (P = 0.02). WAZ was positively correlated to visual reception, fine motor, expressive language, and composite score of the MSEL. Conclusions: Overall, WAZ was a stronger predictor of neurocognitive outcomes assessed by the MSEL. CD4⁺ CD38⁺ T cells were more specifically associated with memory-related outcomes. Future research should include immunological markers and standardized neurocognitive tests to further understand this relationship.