(P09-007-25) Vitamin B12 Sufficiency and Cognitive Test Scores of Children With and Without Perinatally Acquired HIV Infection or Exposure – A Prospective Cohort Study

Objectives: To determine the relationship between vitamin B12 sufficiency and cognition and examine its variation by perinatal HIV status.

Methods: A cohort of 741 children (251 CPHIV, 235 CHEU, 254 CHUU), aged 6–18 years, were enrolled. Cognition was assessed at intake and every 6–12 months over 75 months using standardized neuropsychological battery covering eight domains: motor speed, motor control, executive function, processing speed, working memory, and learning. Baseline serum B12 levels were classified as deficient ( < 200 pm/L), sub-clinically deficient (200–300 pm/L), sufficient (300–900 pm/L), or high ( >900 pm/L). Multivariable linear regression adjusted for time, child (age, sex, stress, HIV status), and caregiver factors (age, sex, education, depression, income) estimated mean differences (MD) in cognition, with 95% confidence intervals (CI). Results were stratified by HIV status if the HIV-by-B12 interaction p-value was < 0.10.

Results: High B12, sub-clinical, and overt deficiency prevalence were 24.1%, 19.4%, and 5.9%, respectively. Overall, higher B12 levels predicted better motor function (MD=0.3–0.4, 95%CI: 0.01, 0.8) and processing speed (MD=0.4–0.5, 95%CI: 0.2, 0.7). Among CHUU, sufficiency correlated with better delayed recall (MD=0.3, 95%CI: -0.1, 0.6) and working memory (MD=0.6, 95%CI: 0.3, 0.8). Among CHEU, sufficiency predicted faster processing (MD=-0.9, 95%CI: -1.6, -0.2), executive function (MD=-1.3, 95%CI: -2.5, -0.2), and motor speed (MD=-0.8, 95%CI: -1.4, -0.1). Among CPHIV, higher B12 predicted faster executive function performance. High vs. sufficient B12 was linked to worse delayed recall (MD=-0.29, 95%CI: -0.6, -0.01) and verbal memory (MD= -0.3, 95%CI: -0.5, -0.01) among CHUU, slower processing, and motor speed (MD=0.5, 95%CI: 0.01, 0.9) among CHEU, but not among CPHIV.

Conclusions: B12 sufficiency predicted better performance motoric and processing speed overall and within HIV-groups associated with better performance in four domains while hypervitaminosis B12 associated with worse cognition in several tests among CHEU and CHUU but not CPHIV. Addressing B12 deficiency may benefit cognition, though the complex relationship in CPHIV requires further study to target interventions.

Funding Sources: National Institute of Child Health and Human Development
National Institute of Neurological Diseases and Strokes