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Neurodevelopment of HIV-Exposed and HIV-Unexposed Uninfected Children at 24 Months
Sumona Chaudhury1, Paige L Williams1,2, Gloria K Mayondi3
1Departments of Epidemiology.
Insights
HIV-exposed uninfected children showed no worse neurodevelopmental outcomes at 24 months compared to unexposed children. Early neurodevelopment appears unaffected by in-utero HIV and antiretroviral exposure in this Botswana study.
Area of Science:
- Pediatric neurodevelopment
- HIV research
- Global health
Background:
- Growing population of HIV-exposed uninfected (HEU) children globally.
- Need to understand neurodevelopmental outcomes in HEU children compared to HIV-unexposed uninfected (HUU) children.
- Botswana study setting for prospective observational research.
Purpose of the Study:
- To determine if HEU children exhibit neurodevelopmental deficits at 24 months compared to HUU children.
- Assess cognitive, motor, and language domains using standardized tools.
- Investigate the impact of in-utero HIV and antiretroviral exposure on early child development.
Main Methods:
- Prospective observational study in Botswana (May 2010-July 2012).
- Neurodevelopmental assessment at 24 months using Bayley Scales of Infant and Toddler Development (Bayley-III) and Development Milestones Checklist (DMC).
- Linear regression models adjusted for socioeconomic and maternal health factors.
Main Results:
- No neurodevelopmental domain scores were significantly lower in HEU children versus HUU children.
- HEU children demonstrated significantly higher scores in Bayley-III cognitive and DMC personal-social domains, though differences were small.
- Maternal antiretroviral treatment exposure varied among HEU children; breastfeeding rates differed significantly between HEU and HUU groups.
Conclusions:
- HEU children performed comparably to HUU children on 24-month neurodevelopmental assessments.
- Findings suggest no adverse impact of in-utero HIV and antiretroviral exposure on early neurodevelopment.
- Reassuring results for the expanding global HEU population.
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.
