Neurodevelopment of HIV-Exposed and HIV-Unexposed Uninfected Children at 24 Months

Author:

Chaudhury Sumona1,Williams Paige L.12,Mayondi Gloria K.3,Leidner Jean4,Holding Penny5,Tepper Vicki6,Nichols Sharon7,Magetse Jane3,Sakoi Maureen3,Moabi Kebaiphe3,Makhema Joseph3,Mdluli Charlotte3,Jibril Haruna8,Seage George R.1,Kammerer Betsy910,Lockman Shahin3101112

Affiliation:

1. Departments of Epidemiology,

2. Biostatistics,

3. Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana;

4. Goodtables Data Consulting, Norman, Oklahoma;

5. Educate Africa, Mombasa, Kenya;

6. Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland;

7. Department of Neurosciences, University of California, San Diego, California;

8. Ministry of Health Botswana, Gaborone, Botswana;

9. Department of Psychiatry, Boston Children’s Hospital, Boston, Massachusetts; and

10. Brigham and Women’s Hospital, Boston, Massachusetts

11. Immunology, and

12. Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts;

Abstract

BACKGROUND: We sought to determine if HIV-exposed uninfected (HEU) children had worse neurodevelopmental outcomes at 24 months compared with HIV-unexposed uninfected (HUU) children in Botswana. METHODS: HIV-infected and uninfected mothers enrolled in a prospective observational study (“Tshipidi”) in Botswana from May 2010 to July 2012. Child neurodevelopment was assessed at 24 months with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III: cognitive, gross motor, fine motor, expressive language, and receptive language domains) and the Development Milestones Checklist (DMC), a caregiver-completed questionnaire (locomotor, fine motor, language and personal-social domains). We used linear regression models to estimate the association of in-utero HIV exposure with neurodevelopment, adjusting for socioeconomic and maternal health characteristics. RESULTS: We evaluated 670 children (313 HEU, 357 HUU) with ≥1 valid Bayley-III domain assessed and 723 children (337 HEU, 386 HUU) with a DMC. Among the 337 HEU children with either assessment, 122 (36%) were exposed in utero to maternal 3-drug antiretroviral treatment and 214 (64%) to zidovudine. Almost all HUU children (99.5%) breastfed, compared with only 9% of HEU children. No domain score was significantly lower among HEU children in adjusted analyses. Bayley-III cognitive and DMC personal-social domain scores were significantly higher in HEU children than in HUU children, but differences were small. CONCLUSIONS: HEU children performed equally well on neurodevelopmental assessments at 24 months of age compared with HUU children. Given the global expansion of the HEU population, results suggesting no adverse impact of in-utero HIV and antiretroviral exposure on early neurodevelopment are reassuring.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

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