Peer-reviewed article

Nutritional Status and Cognitive Function in Children With or Exposed to HIV: Evidence From the HIV-Associated Neurocognitive Disorders in Zambia Study.

William Raskopf, Esau Mbewe, Heather Adams, Alexandra Buda, Gretchen Birbeck et al. · 1 Apr 2026

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This study examined the relationship between nutritional status and cognitive function in children living with HIV, HIV-exposed uninfected children, and uninfected controls in Zambia. Over 4 years, researchers tracked 614 children aged 8-17 and found that children with HIV had poorer nutrition and worse cognitive outcomes than control groups. Nutritional factors including height, weight, food security, and protein intake predicted cognitive performance, with nutrition partially explaining why HIV-positive children had cognitive difficulties. The findings suggest that improving nutrition could help reduce neurocognitive impairment in children with HIV.

Key points

HIV-positive children had significantly poorer nutrition and worse cognitive outcomes compared to both HIV-exposed uninfected and HIV-unexposed uninfected control groups
Height and weight percentiles showed non-linear threshold effects on cognition, while other measures like mid-upper arm circumference and food spending showed linear associations
A nutritional index combining malnutrition, food security, protein intake, and growth measures was identified as a parsimonious predictor of cognitive outcomes
Nutritional status partially explained the association between HIV and cognitive impairment
Findings applied across all groups studied, with particularly strong implications for children living with HIV

Limitations

The study is observational and cannot establish causation, only associations between nutrition and cognition. The generalisability may be limited to the population served by the Pediatric Center for Excellence in Lusaka.

Abstract

BACKGROUND: Despite advancements in antiretroviral therapy, children with HIV in sub-Saharan Africa remain vulnerable to HIV-associated neurocognitive disorder. Emerging evidence points to nutritional status as a predictor of cognitive outcomes in these patients. METHODS: In this prospective cohort study, children aged 8-17 with HIV and HIV-exposed uninfected (HEU) or HIV-unexposed uninfected (HUU) controls were recruited from the Pediatric Center for Excellence in Lusaka, Zambia and completed quarterly follow-up visits over an average of 4 years, during which cognitive (e.g., Neuropsychological Z-score battery and the Global Deficit Score), and nutritional (e.g., number of meals per week, height percentile). Regression models, Lasso feature selection, and multivariable adaptive regression splines were used to identify nutritional predictors of cognition. Mediation analysis evaluated whether nutrition explained part of the HIV-cognition association. RESULTS: This study included 614 participants (336 HIV+, 209 HEU, 69 HUU). HIV+ children had poorer nutrition and worse cognitive outcomes than both control groups ( P < 0.001). Height and weight percentiles showed nonlinear threshold effects, whereas other measures (mid-upper arm circumference, food spending, head circumference) displayed linear associations with cognition. Lasso models identified a parsimonious nutritional index incorporating malnutrition, food security, protein intake, and growth measures (β = 0.27, 95% CI: 0.11-0.42). Mediation analysis indicated that nutritional status partially explained the association between HIV and cognition. CONCLUSION: Nutritional status was a predictor of cognitive outcomes across all groups, with especially strong implications for children living with HIV. These findings highlight nutrition as a target for interventions to mitigate neurocognitive impairment in pediatric HIV.

Findings the Hub has extracted

Each claim below is labelled by its type of design and links back to this report.

SurvivalDevelopment

Problem

HIV-associated neurocognitive disorder in children with HIV in sub-Saharan Africa, despite antiretroviral therapy advances

Intervention: Nutritional assessment and monitoring as a predictor of cognitive outcomes; the study evaluates nutrition's role in cognitive function rather than a specific nutrition intervention
Population: 614 children aged 8-17: 336 with HIV, 209 HIV-exposed uninfected, 69 HIV-unexposed uninfected controls from Lusaka, Zambia

Key finding

HIV+ children had poorer nutrition and worse cognitive outcomes than control groups (P < 0.001)

Experimental