Introduction: Adolescents with perinatal HIV (PHIV) show developmental differences despite viral suppression. Prior work links HIV to immune activation, delayed molar eruption, and cognitive impairment, but rarely examines these systems together. We tested whether molar eruption timing marks immune and cognitive disruption. Methods: We studied 118 Nigerian adolescents (59 PHIV, 59 HIV-unexposed uninfected [HUU]). Subset A (n=118) had eruption and cognition (Table 1; Figures 1–2). Subset B (n=38) had saliva cytokines (Figure 3). Subset C (n=21) had eruption, cognition, and cytokines for the 3D model (Figure 4). Subsets were defined by measure availability. Eruption scored 0–4 unerupted and classified as delayed vs no delay. Cognition (NIH Toolbox, NeuroScreen) standardized into a composite index. Cytokines measured by multiplex and averaged into an index. Results: Eruption timing did not differ by HIV status (Figure 1). Delayed eruption was associated with lower NIH Toolbox and selected NeuroScreen scores (verbal memory, trail making, etc; p < 0.001; Figure 2). Cytokine comparisons were not statistically significant, though IL-1α showed a visible difference by HIV and eruption status (Figure 3). The 3D model linking cytokine and cognitive indices with eruption status showed a marginal association (F-test p = 0.0845), limited by n=21 (Figure 4). Conclusion: Delayed molar eruption, independent of HIV status, was linked to lower cognition. Although cytokine analyses were underpowered, eruption timing may serve as a noninvasive marker complementing immune biomarkers to identify adolescents at risk for neurodevelopmental disruption.