Cognitive performance in adolescents with perinatally-acquired HIV and associations with oral health in Nigeria

Background: Objectives: – To compare cognitive performance between adolescents with and without perinatally acquired HIV and to evaluate the association between oral health and cognitive performance. Methods: – A cross-sectional analysis was conducted using baseline data from a study of 118 age- and sex-matched adolescents (59 PHIV, 59 HUU) aged 9.5–16.5 years in Benin City, Nigeria. Cognitive function was assessed using two tablet-based tools: NeuroScreen and the NIH Toolbox Cognition Battery. Oral health was evaluated via clinical examination using the Decayed, Missing, and Filled Teeth (DMFT) and oral hygiene questionnaires. ANOVA and ANCOVA were used to examine associations between HIV status, oral health, and cognitive outcomes. Results: – Adolescents with PHIV demonstrated significantly lower cognitive performance compared to their HUU peers, particularly in processing speed, executive function, and language domains. NeuroScreen assessments revealed longer completion times in Trail Making tasks (TM1: 44.8 vs 37.7, adjusted p = 0.039; TM2: 51.4 vs 42.5, adjusted p = 0.018; TM3: 25.6 vs 19.8, adjusted p = 0.027) and lower scores in Visual Discrimination (VD2: 19.3 vs 21.9, adjusted p = 0.002) and Number Speed tests (NSd: 53.1 vs 46.1, adjusted p = 0.008) among adolescents with PHIV. In addition, NIH Toolbox results indicated lower scores across all cognitive domains for adolescents with PHIV. Higher DMFT scores were associated with poorer executive function, and this relationship was observed only among adolescents with PHIV in stratified analyses, across both the NeuroScreen and NIH Toolbox assessments. Conclusion: – Adolescents with PHIV exhibited notable neurocognitive deficits and a tendency toward poorer oral health compared with uninfected peers. Poor oral health correlated with diminished cognitive performance, underscoring the need for integrated care models that address both neurocognitive and oral health in youth living with HIV.