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Neurodevelopment in Young Children Born to HIV-Infected Mothers: A Meta-analysis
Megan S McHenry1,2, Carole I McAteer3,2, Eren Oyungu4
1Departments of Pediatrics, msuhl@iu.edu.
Insights
Young children infected with HIV (HIV+) and those exposed but uninfected (HEU) show poorer neurodevelopmental outcomes than HIV-unexposed (HUU) children. Antiretroviral (ARV) exposure may further impact these outcomes, warranting further research.
Area of Science:
- Pediatric Neurology
- Developmental Psychology
- Infectious Diseases
Background:
- HIV-infected (HIV+) children exhibit poorer neurodevelopmental outcomes compared to HIV-uninfected peers.
- Limited data exists on neurodevelopmental differences among young HIV+ children, HIV-exposed but uninfected (HEU) children, and HIV-unexposed and uninfected (HUU) children.
Purpose of the Study:
- To systematically review and meta-analyze neurodevelopmental performance data in young HIV+, HEU, and HUU children.
- To compare cognitive and motor scores across these pediatric groups.
Main Methods:
- Systematic search of Ovid Medline, Embase, PsycINFO, ERIC, and Cochrane Database of Systematic Reviews.
- Inclusion criteria applied to 45 identified studies; 11 studies with Bayley Scales of Infant and Toddler Development scores included in meta-analysis.
- Data extraction and cross-checking by independent reviewers.
Main Results:
- Compared to HUU children, both HIV+ and HEU children demonstrated lower cognitive and motor scores.
- HIV+ and HEU children with antiretroviral (ARV) exposure had significantly lower cognitive and motor scores than those without ARV exposure.
Conclusions:
- Both HIV+ and HEU children exhibit worse developmental outcomes than HUU children.
- ARV exposure in HIV+ and HEU children is associated with poorer outcomes, though this requires cautious interpretation.
- Further research is necessary to elucidate the specific impact of ARV exposure on early childhood development.
Context:
HIV-infected (HIV+) children have worse neurodevelopmental outcomes compared with HIV-uninfected children. However, little is known regarding the differences in neurodevelopment between young HIV+ children, HIV-exposed but uninfected (HEU) children, and HIV-unexposed and uninfected (HUU) children.
Objective:
To systematically review and meta-analyze data on neurodevelopmental performance between young HIV+, HEU, and HUU children.
Data Sources:
We systematically searched the following electronic bibliographic databases: Ovid Medline, Embase, PsycINFO, Education Resources Information Center, and the Cochrane Database of Systematic Reviews.
Study Selection:
Studies were selected on the basis of defined inclusion criteria. Titles, abstracts, and full texts were assessed by 2 independent reviewers.
Data Extraction:
Data were extracted by 2 independent reviewers and cross-checked by 2 additional reviewers.
Results:
Forty-five studies were identified for inclusion in the systematic review, and of these, 11 were included in the meta-analysis on the basis of availability of Bayley Scales of Infant and Toddler Development scores. Within the meta-analysis, when compared with their HUU peers, HIV+ and HEU children had lower cognitive and motor scores. HIV+ and HEU children with antiretroviral (ARV) exposure had lower cognitive and motor scores compared with those without ARV exposure.
Limitations:
We were unable to control adequately for intravenous drug use, geographic location, or quality of the assessment independently.
Conclusions:
Both HIV+ and HEU children had worse developmental outcomes compared with HUU children. HIV+ and HEU children with ARV exposure also had worse developmental outcomes compared with those without exposure; however, these results should be interpreted with caution. More research is needed to identify the impact of ARV exposure on young children.
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