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Peer-reviewedCC BY-NC-ND 4.0AIDS and Behavior

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

  • Seth Frndak1,2
  • Nicole Dear1,2
  • Natalie Burns1,2,3
  • Hannah Kibuuka4
  • John Owuoth5,6
  • Valentine Sing’oei5,6
  • Jonah Maswai7,8
  • Emmanuel Bahemana9,10
  • Zahra Parker2,11
  • Neha Shah1
  • Trevor A. Crowell1,2
  • Victor Valcour12,13,14
2 more authors
  • Julie A. Ake1
  • Elena Tsoy13,14
14 affiliations
  1. 1U.S. Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, MD USA
  2. 2Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
  3. 3U.S. Military HIV Research Program, 6720-A Rockledge Dr., Suite 400, Bethesda, MD 20817 USA
  4. 4Makerere University Walter Reed Project, Kampala, Uganda
  5. 5U.S. Military HIV Research Program, Walter Reed Army Institute of Research Africa, Kisumu, Kenya
  6. 6HJF Medical Research International, Kisumu, Kenya
  7. 7U.S. Military HIV Research Program, Walter Reed Army Institute of Research Africa, Kericho, Kenya
  8. 8HJF Medical Research International, Kericho, Kenya
  9. 9U.S. Military HIV Research Program, Walter Reed Army Institute of Research Africa, Mbeya, Tanzania
  10. 10HJF Medical Research International, Mbeya, Tanzania
  11. 11U.S. Military HIV Research Program, Walter Reed Army Institute of Research Africa, Lagos, Nigeria
  12. 12Department of Medicine, Division of Geriatric Medicine, University of California San Francisco, San Francisco, CA USA
  13. 13Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA USA
  14. 14Global Brain Health Institute, University of California San Francisco, San Francisco, CA USA
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Abstract

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 (βFI*age = 0.17 [95%CI: 0.07, 0.27], pFI*age=0.001) and poorer executive functions at older age (βFI*age = 1.63 [95%CI: 0.56, 2.70], pFI*age=0.003). Additional cognitive interventions may be needed for young PLWH including nutrient-based interventions that are developmentally tailored to unique cognitive domains.

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Cite

BibTeXRIS
BibTeX
@article{frndak2026food,
  title = {{Food Insecurity and Cognitive Performance Among Young People Living With and Without HIV: A Study Across Four African Countries}},
  author = {Seth Frndak and Nicole Dear and Natalie Burns and Hannah Kibuuka and John Owuoth and Valentine Sing’oei and Jonah Maswai and Emmanuel Bahemana and Zahra Parker and Neha Shah and Trevor A. Crowell and Victor Valcour and Julie A. Ake and Elena Tsoy},
  journal = {AIDS and Behavior},
  year = {2026},
  month = jun,
  doi = {10.1007/s10461-026-05121-6},
  url = {https://doi.org/10.1007/s10461-026-05121-6},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Food Insecurity and Cognitive Performance Among Young People Living With and Without HIV: A Study Across Four African Countries
AU  - Seth Frndak
AU  - Nicole Dear
AU  - Natalie Burns
AU  - Hannah Kibuuka
AU  - John Owuoth
AU  - Valentine Sing’oei
AU  - Jonah Maswai
AU  - Emmanuel Bahemana
AU  - Zahra Parker
AU  - Neha Shah
AU  - Trevor A. Crowell
AU  - Victor Valcour
AU  - Julie A. Ake
AU  - Elena Tsoy
PY  - 2026
DA  - 2026/06/05
JO  - AIDS and Behavior
DO  - 10.1007/s10461-026-05121-6
UR  - https://doi.org/10.1007/s10461-026-05121-6
AB  - 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 (βFI*age = 0.17 [95%CI: 0.07, 0.27], pFI*age=0.001) and poorer executive functions at older age (βFI*age = 1.63 [95%CI: 0.56, 2.70], pFI*age=0.003). Additional cognitive interventions may be needed for young PLWH including nutrient-based interventions that are developmentally tailored to unique cognitive domains.
SN  - 1090-7165
SN  - 1573-3254
ER  -