This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. HIV is a neurotropic virus which, in perinatally-infected individuals, is present at the time of birth and is able to cross the blood brain barrier, suggesting that its effects may present differently at different developmental stages. Central Nervous System (CNS) effects of the virus may not just be due to direct cellular damage, but may also be related to treatment neurotoxicities and length of exposure to antiretroviral therapies. Recent data suggest that perinatally HIV-infected children and adolescents have significantly higher rates of psychiatric hospitalizations when compared to both HIV-exposed but uninfected children and adolescents, as well as the general pediatric population. Reports of neurodevelopmental and neurologic changes in perinatally HIV- infected children and adolescents followed over time indicate that behavioral problems, particularly ADD and hyperactivity, appear to be common in HIV-infected children and adolescents, sometimes reported as high as 50%. It has also been suggested that various stressors (biological, societal, and viral) associated with HIV augment the psychosocial stigmata of HIV, potentiating the effects of the virus on brain processing and disease. Life stressors lead to a cascade of neurohormonal responses, culminating in immune suppression and worsening the effects of HIV in the sanctuary of the CNS. Converging evidence, from a number of studies, suggests that behavioral and emotional disturbances are associated with specific mental health risk factors. There are no published prospective outcome studies of children and adolescents with HIV that have examined these risk factors and their relationship to the frequency and severity of psychiatric symptoms and the relationship between HIV severity or treatment and later development of psychiatric symptoms. Knowledge of HIV status is also associated with an increased risk of psychiatric hospitalizations. Therefore, it is reasonable to examine the relationship between HIV self-knowledge and development of psychiatric symptomatology over time. Recent studies of adherence to medications in HIV-infected adults suggest that poor adherence is related to the presence of psychological morbidity. Better attention paid to treatment of psychiatric disorders may lead to better adherence, and thus better outcomes from HAART. All studies of psychopathology in HIV-infected children and adolescents suffer from one or more of the following limitations: (a) insufficient sample size, (b) non-representative samples, (c) inadequate comparison groups; (d) non-DSM-IV symptomatology, or (e) pre-HAART exposure. This study will examine differential rates of psychiatric symptoms in HIV-infected children and adolescents and control subjects to better understand the relationship of the prevalence and severity of psychiatric symptomatology with HIV infection. Preliminary findings from PACTG studies indicate relatively high rates of psychiatric symptoms in HIV-infected children and relatively high rates of psychiatric drug prescribing. The significance of this study rests in its focus on a potentially high-risk sample exposed to a neurotropic virus and therapeutic regimens with altered penetration into the brain. By using an epidemiological design, the study will generate data that will potentially contribute to existing research on the effects of HIV infection on the mental health of children and adolescents. Understanding the means by which co-occurring symptoms develop in the HIV-infected population, as compared to the control population, could inform prevention and early intervention efforts to decrease the likelihood that these children and adolescents would have to deal with additional psychosocial stressors.
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