Just The PHACS Summaries - 2020-2021
154. How consistently do youth in AMP and AMP Up report their sexual behavior over time?
When participants are asked to self-report on their own sexual behavior, their answers can be affected by memory recall (answering incorrectly because they don’t remember), social desirability (answering incorrectly to “look good” or to avoid stigma or shame), or not understanding the questions. This study looked at how consistent computer survey responses were over time among 277 adolescents and 250 young adults with PHIV or PHEU who were asked about their experiences with oral, vaginal and anal sex. There were more inconsistent answers about same-sex partnerships and anal sex when lookiing at survey responses over time. Factors linked to inconsistent responses over time included longer time between surveys, male sex, and younger age at first survey. The majority (84%) of young adults answered an attention check question correctly. However, factors related to lower attention during the survey included having less than a high school diploma, lower cognitive scores, and negative attitude about the survey. These findings can help researchers and clinicians understand better ways to ask sensitive questions, making the information collected more reliable.
Cantos, K, Franke MK, Tassiopoulos K, Williams PL, Moscicki AB, Seage III GR, for the Pediatric HIV/AIDS Cohort Study (PHACS). Inconsistent sexual behavior reporting among youth affected by perinatal HIV exposure in the United States. AIDS Behav 2021 Oct; 25(10):3398-3412.
153. Substance use, behavior, and thinking skills among youth born to women living with HIV
Substance use (SU) can increase the risk for health problems among adolescents and young adults living with PHIV. It is important to understand how common substance use is, and why people use substances, in order to find ways to prevent, manage, and treat it. This study examined the relationships between substance use and self-regulation (one’s own behavior and emotions) and cognitive functioning over time. Among 390 youth with PHIV and 211 youth with PHEU, about half started using alcohol or marijuana by the end of the study follow-up. Additionally, about one in ten of those who used marijuana did so daily and one in three said they had used tobacco. Those with PHIV and PHEU were equally likely to use substances, and factors linked to alcohol and marijuana use were similar between the two groups. They included lower self-regulation, tendency to seek out excitement or risk experiences, and higher cognitive functioning. Overall, youth who reported problems managing their own behavior and emotions were more likely to use alcohol and marijauana. Programs and counseling could help them improve self-regulation and avoid substance use.
Nichols, SL, et al. The role of behavioral and neurocognitive functioning in substance use among youth with perinatally acquired HIV infection and perinatal HIV exposure without infection. AIDS Behav 2021 Sept; 25(9):2827-2840.
152. Genetics suggest link between inflammation and cognitive challenges in children living with HIV
Perinatal HIV (PHIV) has been associated with cognitive impairment including learning difficulties in some children, as well as with inflammation. It is unclear what factors put some children, but not others, at risk for cognitive difficulties. In genetic studies in adults with HIV, several genetic factors were identified that may play a role in adult cognitive impairment. In this study, researchers examined the genetics (DNA) of youth from 3 cohorts for variations (called single-nucleotide variants; SNVs) that might be linked to lower cognitive functioning (having a cognitive score lower than 70). Three variations were identified in all 3 cohorts that were associated with cognitive impairment in children with PHIV. Variants in two genes (RETREG1 and YWHAH) were linked with a higher risk of cognitive impairment and increased inflammation, while a variant in a third gene (CCRL2) was linked to a lower risk of cognitive impairment and decreased inflammation. Treatments that help decrease inflammation in the body may be helpful to children with PHIV who have cognitive impairment.
Rawat, P, et al. Genomics links inflammation with neurocognitive impairment in children living with Human Immunodeficiency Virus type-1. J Infect Dis 2021 Dec 29; 224(5):870-880.
151. Hospitalizations for young children with PHEU linked to two respiratory viruses
Children with PHEU have higher rates of hospitalizations in the first two years of life than children who were not exposed to HIV in utero (HUU). It is unknown whether this is due to their immune systems having a weak response to common viruses or a weak response to childhood vaccines. This study compared blood samples from 556 infants with PHEU, from two large cohorts in the U.S. (IMPAACT and PHACS), and 100 infants who were HUU. The study found that more than 10% of infants with PHEU were hospitalized before the age of one. Infants with PHEU who had respiratory infections caused by respiratory syncytial virus (RSV), andparainfluenza (PIV) were more likely to be hospitalized. Also, infants with PHEU had strong immune responses to several common childhood vaccines, indicating that this was not the cause of their hospitalizations. Infants born with PHEU should be prioritized for RSV immunizations.
Smith, C, et al. Immunologic and virologic factors associated with hospitalization in human immunodeficiency virus- exposed, uninfected infants in the United States. Clin Infect Dis 2021 Sep 15;73(6):1089-1096.
150. Zidovudine used in pregnancy not linked to a specific type of genetic damage
Zidovudine (ZDV) has been widely used to treat HIV and prevent transmission from mother to child. However, some reports have suggested that ZDV may cause genetic damage in infants. This study examined whether there was a link between in utero ZDV exposure and having a type of genetic mutation called clonal hematopoiesis (CH), which can lead to health complications in adulthood. We analyzed the genomes of 185 infants with PHEU from the SMARTT and WITS studies. 94 of the infants’ mothers had taken ZDV while pregnant, while the other 91 had not. The study did not find a connection between exposure to ZDV in the womb and having this type of genetic mutation (CH). However, future research should look at potential longer-term genetic effects of ZDV.
Lin SH, et al., for the Pediatric HIV/AIDS Cohort Study (PHACS). In utero exposure to Zidovudine and clonal hematopoiesis in HEU children. AIDS 2021 Aug 1; 35(10):1525-1535.
149. Perinatal HIV sometimes linked with having mitochondrial dysfunction
HIV and antiretrovirals (ARVs) can affect mitochondria, the special compartment within cells that make energy. Some children with PHEU or PHIV have problems related to their mitochondria. This study used blood samples to analyze differences in the mitochondrial function of 118 children with PHEU and 243 children with PHIV. Several markers of mitochondrial activity (levels of lactate/pyruvate ratio and Complex I and IV enzyme activities) suggested youth with PHIV may be more likely to have mitochondrial dysfunction. However, youth with PHIV who had lower viral loads and higher CD4 counts tended to have better mitochondrial functioning. It is important to follow youth with PHIV to see if these markers continue to influence mitochondrial function as they grow up.
Jao, J, et al. Perinatally acquired HIV infection is associated with abnormal blood mitochondrial function during childhood/adolescence. AIDS 2021 Jul 15; 35(9):1385-1394.
148. Emotional and behavioral health of youth born to women living with HIV
Some research suggests that youth with PHIV may have higher rates of behavioral issues compared to the general population, though we do not know why. In this study, 391 youth with PHIV, 209 youth with PHEU, and their parents reported on their behavior at up to 8 study visits. The researchers analyzed their responses, looking at race, ethnicity, HIV status, age, and other factors. They found that parents of non-Hispanic Black youth with PHEU reported the most concerns about their children’s behavior, especially for their older teens. Parents’ mental health, household factors, and having less access to the routine and supportive services offered to youth with PHIV could all be factors in this difference.
Bather JR, Williams PL, Broadwell C, Smith R, Patel K, Garvie PA, Karalius B, Kacanek D, Mellins CA, Malee K for the Pediatric HIV/AIDS Cohort Study (PHACS). Racial and ethnic disparities in longitudinal emotional-behavioral functioning among youth born to women living with HIV. J Acquir Immune Defic Syndr 2021 Jul 1;87(3):889-898.
144. Using hair samples to measure tenofovir levels in women living with HIV at time of delivery
While blood samples can tell how much medicine is in a person’s body at one point in time, assessing a sample of a person’s hair can measure how much ART medicine a person has absorbed over a longer period of time. However, to date, no one has used this method among pregnant or postpartum women living with HIV in the US. In this study, researchers used lab testing to assess hair samples from 121 women in SMARTT who took tenofovir during pregnancy. They wanted to see if tenofovir levels were at a safe level for the mom and baby, and high enough to prevent the baby from getting HIV. They measured the amount of tenofovir in the hair samples (which were collected close to the time of delivery) and looked for any associations between tenofovir levels and specific characteristics of the women. Researchers found lower than expected amounts of tenofovir in the hair samples of two-thirds of women at the time of birth. Women with detectable HIV viral loads in late pregnancy had lower amounts of tenofovir in their hair, as did women who did not take tenofovir for very long during pregnancy. This may indicate that some women need from more support with taking their ARV medicines during pregnancy, or that the body may process tenofovir differently during pregnancy. This study was also a pilot to see whether women in SMARTT would be willing to give hair samples, and a high number (81%) of women asked to participate said yes to donating a hair sample. This method could be applied to future research measuring ART exposure over time.
Pintye J, Huo Y, Kacanek D, Zhang K, Kuncze K, Okochi H, Gandhi M for the Pediatric HIV/AIDS Cohort Study (PHACS). Detectable HIV RNA in late pregnancy associated with low tenofovir hair levels at time of delivery among women living with HIV in the United States. AIDS. 2021Feb 2;35(2):267-274.
142. Measuring biochemicals in saliva to understand gum disease in youth born to women living with HIV
HIV can increase the risk of oral diseases, such as gum (periodontal) disease. Researchers wanted to see whether HIV and/or gum disease led to changes in the biochemical make-up of saliva in youth with HIV. They tested saliva samples from 40 AMP participants: 10 with PHIV and gum disease, 10 with PHIV without gum disease, 10 with PHEU and gum disease, and 10 with PHEU and without gum disease. They compared the biochemical makeup of their saliva and found that overall, it was similar across these groups. However, the participants with gum disease had higher levels of a biochemical produced by bacteria called cadaverine, and the differences were greater in participants with PHEU. They also found large amounts of peptides created when proteins in saliva are broken down. This suggests that bacteria in the mouth and saliva composition may be influenced by HIV and/or anti-retroviral (ARV) therapy. Future research could look at whether specific ARVs called protease inhibitors might influence the breakdown of proteins in saliva.
Schulte F, King OD, Paster BJ, Moscicki AB, Yao TJ, Van Dyke RB, Shiboski C, Ryder M, Seage G, Hardt M, for the Pediatric HIV/AIDS Cohort Study (PHACS). Salivary metabolite levels in perinatally HIV-infected youth with periodontal disease. Metabolomics. 2020 Sept 11; 16:98.
140. Abnormalities with mitochondrial function linked to pre-diabetes in children living with PHIV
Recent studies suggest higher rates of pre-diabetes in children living with PHIV, and this has been linked to lower function of the mitochondria (the “powerhouse” of the cell that makes energy). HIV and antiretroviral medications may change how well the mitochondria work in the white blood cells that fight HIV infection. In this study, researchers analyzed the white blood cells of 39 children with PHIV who were pre-diabetic and 107 children with PHIV who were not pre-diabetic. They measured how well the mitochondria worked in the white blood cells that fight HIV infection. They also compared the participants’ medical histories to look at how early HIV infection affects mitochondrial function. The children who were pre-diabetic had lower activity within a portion of their mitochondria, and their medical records also showed they’d had lower CD4s and higher viral loads after their initial HIV diagnosis. This suggests a link between challenges with controlling HIV, mitochondrial dysfunction, and developing pre-diabetes. These children could benefit from additional support in managing their HIV and monitoring pre-diabetes.
Gojanovich GS, Jacobson D, Jao J, Russell J, VanDyke R, LiButti DE, Sharma TS, Geffner ME, Gerschenson M, for the Pediatric HIV/AIDS Cohort Study (PHACS). Mitochondrial dysfunction and insulin resistance in pubertal youth living with perinatally-acquired HIV. AIDS Res Hum Retroviruses. 2020 Jun 26; 36(9):703-711.
138. Preferences of young adults in PHACS for using social media and technology
In focus groups and interviews, 37 young adults (YAs) with PHIV and 7 YAs with PHEU in AMP Up described experiences of adulthood and how they use social media, cell phones, and computers. Most YAs said they use social media and technology frequently in their personal lives, but only some were willing to use these methods to stay in touch with PHACS or a study about HIV due to fear of accidental disclosure. Many YAs also said HIV is only one part of their lives, along with relationships, work, school, housing, and other interests. PHACS should offer flexible communication options and let participants choose how to stay in touch. Resources from PHACS should focus on adulthood more broadly instead of only on health and HIV.
Berman CA, Kacanek D, Nichamin M, Wilson D, Davtyan M, Salomon L, Patel K, Reznick M, Tassiopoulos K, Lee S, Bauermeister J, Paul M, Aldape T, & Seage G III, for the Pediatric HIV/AIDS Cohort Study (PHACS). Using social media and technology to communicate in pediatric HIV research: Qualitative study with young adults living with or exposed to perinatal HIV. JMIR Pediatr Parent. 2020 Jun 23;3(1):e20712.