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Early antiretroviral therapy improves neurodevelopmental outcomes in infants
Barbara Laughton1, Morna Cornell, Debbie Grove
1Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa. BL2@sun.ac.za
Insights
Early antiretroviral therapy (ART) significantly improves neurodevelopment in HIV-infected infants. Infants receiving early ART showed better general and locomotor skills compared to those on deferred ART.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurodevelopmental Sciences
Background:
- Human Immunodeficiency Virus (HIV) infection in infants poses risks to neurodevelopment.
- The optimal timing for initiating antiretroviral therapy (ART) in HIV-infected infants is crucial for long-term outcomes.
Purpose of the Study:
- To assess the impact of early versus deferred ART initiation on infant neurodevelopment.
- To compare neurodevelopmental outcomes in HIV-infected infants receiving different ART schedules within the CHER trial.
Main Methods:
- Randomized controlled trial comparing early (<3 months) versus deferred ART in HIV-infected infants.
- Neurodevelopmental assessment using Griffiths Mental Development Scales (GMDS) and neurological examination between 10-16 months.
- Blinded assessment by testers to infant's HIV status and ART allocation.
Main Results:
- Infants on early ART demonstrated significantly better General and Locomotor scores on the GMDS compared to those on deferred ART.
- All GMDS scores were lower in the deferred ART group.
- HIV-infected infants on early ART performed comparably to HIV-uninfected infants, except for the Locomotor subscale.
Conclusions:
- Early ART initiation in HIV-infected infants leads to superior neurodevelopmental outcomes, particularly in general and locomotor domains.
- Deferred ART, even with monitoring, resulted in lower GMDS scores.
- Early ART is recommended to optimize neurodevelopmental trajectories in infants with HIV.
Objectives:
To evaluate the effect of early versus deferred antiretroviral therapy (ART) on the neurodevelopment of infants from Cape Town participating in the Children with HIV Early Antiretroviral Therapy (CHER) trial.
Design:
HIV-infected infants were randomized to early (<3 months) or deferred ART. HIV-uninfected infants (HIV-exposed and HIV-unexposed) provide background data.
Methods:
Neurological examination and Griffiths Mental Development Scales (GMDS) were administered between 10-16 months of age by testers blind to HIV status and randomized allocation. Mean quotients were compared using paired Student's t-tests.
Results:
Sixty-four infants on early ART and 26 on deferred ART (of potential 77 and 38 respectively on CHER trial) were assessed at median age 11 months (range 10-16). On the GMDS, all scores were lower in the deferred arm and the General Griffiths and Locomotor Scores were significantly lower: mean (SD) =100.1 (13.8) vs. 106.3 (10.6) P=0.02; and 88.9 (16.3) vs. 97.7 (12.5), P<0.01, respectively. Children with HIV who received early ART performed as well as children without HIV except on the Locomotor subscale. Both infected and uninfected mean GMDS scores were within the average range.
Conclusion:
Infants initiated on early ART have significantly better Locomotor and general scores on the GMDS at median age 11 months compared to infants on deferred ART, despite careful monitoring and ready access to ART in the latter.
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