An exciting new study in PHACS is poised to expand our understanding of the development and well-being of children, adolescents and young adults affected by HIV. The Trajectories of Emotional Regulation and Behavior Outcomes and Related Brain Regions And Intrinsic Networks, also known as the TERBO BRAIN study, will evaluate brain networks, cognitive well-being and the mental and behavioral health of two groups of PHACS participants.
The following groups will be eligible to participate:
1) youth who have participated in SMARTT; and
2) young adults who have participated in AMP Up.
A unique feature of the TERBO BRAIN study is that we will utilize functional and structural neuroimaging to assess brain networks in developing adolescents who were perinatally exposed to HIV and antiretroviral therapy (ART). We will determine whether disrupted brain networks, if detected, underlie emotional regulation and may be associated with worrisome neurodevelopmental consequences sometimes observed in youth who are HIV-exposed and negative (PHEN). We will also study how brain networks and emotional regulation are related to mental health and substance use during adolescence, a developmental period during which psychiatric disorders and risk-behaviors sometimes emerge. Importantly, we will identify both positive and challenging social and neighborhood characteristics that play a role in the development and well-being of our study participants.
TERBO BRAIN will also study young adults who have lived with HIV since birth (PHIV) and those perinatally HIV-exposed and negative (PHEN). As with our adolescent participants, we will utilize neuroimaging to determine how brain networks and emotional regulation are associated with cognitive, mental health and behavioral health outcomes, including attainment of adult transition milestones, such as higher education and employment. Again, we will pay special attention to the role of both protective and difficult social and contextual conditions that may influence young adult resilience, as demonstrated by attainment of typical adult milestones.
We anticipate that our study will help us understand the complex array of conditions and experiences that contribute to the well-being of adolescents and young adults who are living with perinatal HIV and ART exposure or perinatal HIV. This new knowledge will assist us in efforts to identify and implement targeted and effective prevention and intervention strategies to support the health and positive development of youth, young adults and families affected by HIV.
These are the primary goals of TERBO BRAIN:
In TERBO BRAIN, we will study adolescents, ages 9-14 years, who are current or former PHACS SMARTT study participants; they will be enrolled and followed for two years with these aims:
- Aim 1: To longitudinally assess brain network development underlying emotional regulation and relate to mental health, cognition and risk-taking behaviors in youth who are perinatally HIV-exposed and negative (PHEN) compared to a population-based cohort.
- Aim 2: To assess longitudinally the impact of perinatal ARV exposure as well as vulnerability and protective factors on brain network development underlying emotional regulation in youth who are perinatally HIV-exposed and negative (PHEN).
We will also complete a one-time evaluation of young adults who are current or former PHACS AMP Up participants between ages 22 and 29 years of age:
- Aim 3: To assess cross-sectionally long-term brain network integrity and cognitive, social, mental health and behavioral outcomes during the adult transition period in adults living with HIV since birth (PHIV) and adults who are perinatally HIV-exposed and negative (PHEN) compared to one another and to a population-based cohort.
PHACS sites with appropriate neuroimaging capabilities and expertise will participate in this study. We hope to enroll approximately 190 youth and 100 young adults in TERBO BRAIN.
The TERBO BRAIN protocol team is grateful to NIH and the PHACS community for the opportunity to conduct this investigation. We look forward to collaborating with our colleagues and sharing what we learn in the future.