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Published on: January 21, 2021
Early neurodevelopmental markers predictive of mortality in infants infected with HIV-1
Antolin Llorente1, Pim Brouwers, Manhattan Charurat
1The Neuropsychology Progam, Mt Washington Pediatric Hospital, 1708 West Rogers Avenue, Baltimore, MD 21209-4596, USA. allorente@mwph.org
Insights
Early neurodevelopmental assessments in vertically infected HIV-1 infants can predict mortality. Lower scores on the Bayley Scales of Infant Development (BSID) at 4 months are linked to higher mortality risk in these young children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurodevelopmental Pediatrics
Background:
- Vertical transmission of HIV-1 poses significant risks to infant health.
- Early neurodevelopmental assessment is crucial for identifying at-risk infants.
- Predictors of mortality in vertically infected infants require further investigation.
Purpose of the Study:
- To determine if early neurodevelopmental markers predict mortality in vertically infected HIV-1 positive infants.
- To assess the utility of the Bayley Scales of Infant Development (BSID) as a prognostic tool.
- To identify factors associated with mortality in this vulnerable population.
Main Methods:
- Longitudinal assessment of 157 vertically infected HIV-1 positive infants.
- Utilized survival analysis and Cox proportional hazards regression.
- Bayley Scales of Infant Development (BSID) scores at 4 months were used as baseline predictors.
Main Results:
- Infants with lower BSID (Mental Developmental Index and Psychomotor Developmental Index) scores at 4 months showed significantly higher mortality rates (p=0.004, p=0.036).
- Increased mortality was associated with lower CD4+ percentage, preterm birth (<37 weeks), smaller head circumference, advanced HIV stage, and higher plasma viral load.
- BSID scores independently predicted mortality even after adjusting for clinical and virological factors.
Conclusions:
- Early neurodevelopmental assessment using BSID scores is a valuable independent predictor of mortality in vertically infected HIV-1 infants.
- These findings highlight the importance of integrating neurodevelopmental monitoring into the care of HIV-exposed and infected infants.
- Early identification of neurodevelopmental deficits can aid in risk stratification and timely intervention for improved outcomes.
Abstract:
One-hundred and fifty-seven vertically infected HIV-1 positive infants (85 males, 72 females) underwent longitudinal assessment to determine whether early neurodevelopmental markers are useful predictors of mortality in those infants who survive to at least 4 months of age. Survival analysis methods were used to estimate time to death for quartiles of 4-month scores (baseline) on the Bayley Scales of Infant Development (BSID). Cox proportional hazards progression was used to estimate relative hazard (RH, 95% CI) of death for BSID scores and potential confounders. Thirty infants with BSID scores at 4 months of age died during follow-up. Survival analysis revealed greater mortality rates in infants with BSID (Mental Developmental Index and Psychomotor Developmental Index) scores in the lower quartile (p=0.004, p=0.036). Unadjusted univariate analyses revealed increased mortality associated with baseline CD4+ 29%, gestational age <37 weeks, smaller head circumference, advanced HIV and higher plasma viral load. BSID scores independently predicted mortality after adjusting for treatment, clinical category, gestational age, plasma viral load and CD4+ percentage.
