Food Insecurity and Cognitive Performance Among Young People Living With and Without HIV: A Study Across Four African Countries

Cognitive development in young adulthood among people living with HIV (PLWH) is not well understood, especially in the context of food insecurity (FI). Nutrient-based interventions may have unique cognitive benefits dependent on age and HIV status. Our analysis included participants enrolled in the African Cohort Study (AFRICOS). AFRICOS enrolls PLWH and without HIV (PLWoH) across 12 PEPFAR-supported facilities in Kenya, Nigeria, Tanzania, and Uganda. All participants were 15–27 years old and on antiretroviral therapy (ART) ≥ 6 months if PLWH. Annual neuropsychological assessments included the WHO Auditory Verbal Learning Test (AVLT; learning and memory), Trail Making Test Part A (TMT-A; processing speed), Color Trails 1 (CT1; processing speed), Color Trails 2 (CT2; executive functions), and Verbal Fluency (VF; language generativity). FI was determined by self-reporting not enough to eat or having < 3 meals per day. Linear mixed models assessed independent and interactive effects of age, HIV status, and time-varying FI on longitudinal cognitive outcomes. From 2013 to 2023 we collected data from 1,012 participants, of whom 575 (56.8%) were female and 476 (47.0%) ever FI. Overall, increasing age was associated with better cognitive performance. Despite ART experience, PLWH performed worse than PLWoH on language generativity (VF; β=-0.47, p = 0.032) and executive functions (CT2; β = 8.10, p = 0.004). FI was associated with worse memory performance at younger ages (β_FI*age = 0.17 [95%CI: 0.07, 0.27], p_FI*age=0.001) and poorer executive functions at older age (β_FI*age = 1.63 [95%CI: 0.56, 2.70], p_FI*age=0.003). Additional cognitive interventions may be needed for young PLWH including nutrient-based interventions that are developmentally tailored to unique cognitive domains.