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Int. J. Environ. Res. Public Health 2018, 15(1), 163; https://doi.org/10.3390/ijerph15010163

Implications of Combined Exposure to Household Air Pollution and HIV on Neurocognition in Children

1
Department of Epidemiology, University of Washington School of Public Health, Seattle, WA 98195, USA
2
Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98105, USA
3
Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA 98195, USA
4
Department of Global Health, University of Washington School of Public Health, Seattle, WA 98104, USA
5
Department of Paediatrics and Child Health, University of Nairobi, Nairobi 30197, Kenya
6
Department of Psychiatry, Michigan State University, East Lansing, MI 48824, USA
7
Department of Psychiatry, Makerere University College of Health Sciences, Kampala 7062, Uganda
*
Author to whom correspondence should be addressed.
Received: 18 November 2017 / Revised: 16 January 2018 / Accepted: 17 January 2018 / Published: 20 January 2018
(This article belongs to the Special Issue Global Children’s Environmental Health)
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Abstract

Air pollution exposure and HIV infection can each cause neurocognitive insult in children. The purpose of this study was to test whether children with combined high air pollution exposure and perinatal HIV infection have even greater risk of neurocognitive impairment. This was a cross-sectional study of HIV-uninfected unexposed (HUU) and HIV-infected children and their caregivers in Nairobi, Kenya. We used a detailed neuropsychological battery to evaluate neurocognitive functioning in several domains. We measured caregiver 24-h personal CO exposure as a proxy for child CO exposure and child urinary 1-hydroxypyrene (1-OHP), a biomarker for exposure to polycyclic aromatic hydrocarbons (PAHs). Median 24-h caregiver CO exposure was 6.1 and 3.7 ppm for 45 HIV-infected (mean age 6.6 years) and 49 HUU (mean age 6.7 years), respectively; 48.5% of HIV-infected and 38.6% of HUU had caregiver 24-h CO levels exceeding the WHO recommended level. Median 1-OHP exposure was 0.6 and 0.7 µmol/mol creatinine among HIV-infected and HUU children, respectively. HIV-infected children with high urinary 1-OHP (exceeding 0.68 µmol/mol creatinine) had significantly lower global cognition (p = 0.04), delayed memory (p = 0.01), and attention scores (p = 0.003). Among HUU children, urinary 1-OHP and caregiver 24-h caregiver CO were not significantly associated with neurocognitive function. Our findings suggest that combined chronic exposure to air pollutants and perinatal HIV infection may be associated with poorer neurocognitive outcomes. High prevalence of air pollution exposure highlights the need to reduce these exposures. View Full-Text
Keywords: 1-hydroxypyrene; carbon monoxide; neurocognition; polycyclic aromatic hydrocarbon; HIV; Sub-Saharan Africa; household air pollution; pediatric 1-hydroxypyrene; carbon monoxide; neurocognition; polycyclic aromatic hydrocarbon; HIV; Sub-Saharan Africa; household air pollution; pediatric
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Suter, M.K.; Karr, C.J.; John-Stewart, G.C.; Gómez, L.A.; Moraa, H.; Nyatika, D.; Wamalwa, D.; Paulsen, M.; Simpson, C.D.; Ghodsian, N.; Boivin, M.J.; Bangirana, P.; Benki-Nugent, S. Implications of Combined Exposure to Household Air Pollution and HIV on Neurocognition in Children. Int. J. Environ. Res. Public Health 2018, 15, 163.

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