# Trajectories, predictors, and neurocognitive impact of HIV viral control among children living with HIV in Kenya

> **NIH NIH F31** · UNIVERSITY OF WASHINGTON · 2021 · $46,036

## Abstract

Project summary / Abstract:
The primary goal of this project is to characterize the trajectories, predictors, and neurocognitive impact of viral
control among children living with HIV in Kenya. There are approximately 1.7 million children ages 0-14 years
living with HIV globally. For children living with HIV, early initiation of antiretroviral therapy (ART) is crucial to
suppress viral load and recover immunity, resulting in improved survival, growth, neurocognition, and reduced
likelihood of opportunistic infections. To control HIV replication, lifelong ART adherence is required, and children
face unique challenges, including inappropriate drug dosing, poor adherence, and drug resistance, that make
them less likely than adults to remain virally suppressed. Despite viral suppression, the viral reservoir persists
as replication-competent provirus in infected cells that can reactivate when individuals living with HIV discontinue
ART, resulting in rebound viremia. The viral reservoir remains the greatest challenge to post-treatment viral
control and HIV cure; however, few studies have evaluated viral control and reservoirs in children. By leveraging
samples and results from neurocognitive assessments performed within the 5R01HD094718 study (MPI: Drs.
Grace John-Stewart and Dara Lehman), which involves two cohorts of children living with HIV with 10 years of
post-ART follow up in Kenya, this project will contribute to the understanding of post-ART viral control among
children living with HIV. Aim 1a will determine longitudinal trajectories and predictors of decline in HIV DNA
among perinatally infected children. HIV DNA decline will be modeled using nonlinear mixed effects models and
predictors will include age at ART initiation, ART regimen, baseline HIV RNA, baseline CD4, and early
cytomegalovirus coinfection. Aim 1b will determine predictors of high viral reservoir among perinatally infected
children on ART using generalized estimating equations. Predictors will include age at ART initiation, ART
regimen, baseline HIV RNA, baseline CD4, and early cytomegalovirus coinfection. Aim 2 will determine
incidence and predictors of virologic failure (HIV RNA exceeding ≥1,000, ≥400, and ≥50 copies/ml) among
children who are virally suppressed at two years post-ART initiation using Cox regression. Predictors will include
age at ART initiation, baseline CD4, ART regimen, caregiver disclosure, and child adherence to ART. Lastly, this
project will determine the impact of viral control on neurocognition among children living with HIV. Aim 3 will
determine the association between CD4, HIV RNA, HIV DNA, and reservoir levels and neurocognitive outcomes
using generalized estimating equations. Findings from this project will optimize early treatment and potentially
contribute to HIV cure strategies. This research plan will provide the F31 candidate with rigorous predoctoral
training, including 1) advanced epidemiologic statistical methods including analyses of comple...

## Key facts

- **NIH application ID:** 10159497
- **Project number:** 1F31HD106261-01
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Jillian Neary
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $46,036
- **Award type:** 1
- **Project period:** 2021-03-16 → 2024-03-15

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10159497

## Citation

> US National Institutes of Health, RePORTER application 10159497, Trajectories, predictors, and neurocognitive impact of HIV viral control among children living with HIV in Kenya (1F31HD106261-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10159497. Licensed CC0.

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