Development assessment of HIV exposed children aged 6-18 months: a cohort study from North India
Remya Rajan1, Anju Seth1, Sharmila B Mukherjee1
1a Department of Pediatrics , Lady Hardinge Medical College , Delhi , India.
Insights
HIV exposed children face developmental delays. While HIV-unexposed children show normal development with care, HIV-infected children have significantly lower development quotients and higher delays.
Area of Science:
- Pediatric HIV care
- Child development studies
- Global health research
Background:
- Children exposed to HIV are at risk for developmental delays due to various socioeconomic and clinical factors.
- These risks persist regardless of the child's own HIV status.
Purpose of the Study:
- To assess and compare the developmental outcomes of HIV-exposed uninfected (HEU) and HIV-infected (HI) children in India.
- To identify factors influencing development in these vulnerable populations.
Main Methods:
- A cohort study involving 50 HIV-exposed children aged 6-18 months.
- Developmental assessment using the Development Assessment Scale for Indian Infants (DASII) at baseline and 6-month follow-up.
- Comparison of development quotients (DQ) and prevalence of developmental delay (DQ ≤ 70) between HEU and HI subgroups.
- Univariate and multivariate analyses to identify influencing factors.
Main Results:
- Prevalence of developmental delay was significantly higher in HIV-infected (33.3%) compared to HIV-exposed uninfected children (2.4%).
- HIV-infected children consistently showed lower DQs across all assessments.
- Factors like lower socioeconomic status and wasting affected HEU development, while stunting, opportunistic infections, and advanced disease impacted HI development.
Conclusions:
- HIV-exposed uninfected children can achieve normal development with optimal care.
- A substantial proportion of HIV-infected children may experience persistent developmental delays, necessitating targeted interventions.
- Early identification and management of risk factors are crucial for improving developmental trajectories in HIV-exposed children.
Abstract:
HIV exposed children are vulnerable to developmental delay irrespective of their HIV status due to combined effect of risk factors like poverty, prenatal drug exposure, stress and chronic illness in family and malnutrition. This cohort study assessed the development of 50 HIV exposed children aged 6-18 months at a Pediatric Centre of Excellence in HIV care in India. The development was assessed using Development Assessment Scale for Indian Infants (DASII) at enrolment, 3 and 6 months later. The development quotient (DQ) scores and proportion of children with developmental delay (DQ ≤ 70) were compared among two sub-groups, HIV infected (HI) and HIV exposed uninfected (HEU) children. The various social and clinical factors affecting development were studied by univariate and multivariate analysis. Prevalence of developmental delay was 2.4% in the HEU (n = 41), and 33.3% in HI (n = 9). The DQ of HI was significantly lower than that of HEU at all three assessments. The DQ of HI were also significantly lower compared to the HEU at ages 12.1-18 months (83.37 ± 20.73 vs 94.68 ± 5.13, p = 0.005) and 18.1-24 months (84.55 ± 15.35 vs 94.63 ± 5.86, p = 0.006) respectively. The development of HEU was adversely affected by lower socioeconomic status and presence of wasting. In addition, development of HI was also adversely influenced by presence of stunting and opportunistic infections, advanced disease stage and shorter ART duration. We conclude that with optimum care, HEU can have a normal development, while a considerable proportion of HI may continue to have delayed development.
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