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Neruodevelopmental Outcomes in Preschool Children Living With HIV-1 Subtypes A and D in Uganda
Horacio Ruiseñor-Escudero1, Alla Sikorskii1, Itziar Familiar-Lopez1
1From the Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lancing, MI.
Insights
This study found no significant neurodevelopmental differences between HIV-1 subtypes A and D in Ugandan preschoolers. However, some language and memory outcomes showed slight advantages for subtype A, warranting further research.
Area of Science:
- Neurovirology
- Pediatric Neurodevelopment
- Global Health
Background:
- Human Immunodeficiency Virus (HIV) can negatively impact early childhood neurodevelopment.
- This research is the first to explore how different HIV-1 subtypes affect neurodevelopment in young Ugandan children.
Purpose of the Study:
- To investigate the impact of HIV-1 subtype (A vs. D) on the neurodevelopment of preschool-aged children in Uganda.
- To compare neurodevelopmental outcomes between children infected with HIV-1 subtype A and subtype D.
Main Methods:
- Neurodevelopment was assessed in 87 HIV-1 infected and 221 HIV-exposed uninfected Ugandan children (1.8-4.9 years) using the Mullen Scales of Early Learning (MSEL), Color Object Association Test (COAT), and Early Childhood Vigilance Test.
- HIV-1 subtypes were determined via phylogenetic analysis, and general linear models were used to analyze differences, adjusting for covariates.
- Scores were benchmarked against HIV-exposed uninfected children for interpretation.
Main Results:
- No statistically significant differences in overall neurodevelopmental scores were found between HIV-1 subtypes A and D.
- Minor differences favoring subtype A were observed in specific areas, including the MSEL Composite Score, Receptive Language (MSEL), and Total Memory (COAT).
- Children with subtype A were older than those with subtype D, but other demographic and clinical factors were similar.
Conclusions:
- Unlike older children, preschool-aged children infected with HIV-1 subtypes A and D show similar neurodevelopmental profiles.
- Subtle differences in language production and memory may favor subtype A, requiring further investigation.
- Larger sample sizes and longitudinal studies are recommended to confirm these findings.
Background:
HIV is a neuropathogenic virus that may result in detrimental neurodevelopmental (ND) outcomes early in life. This is the first study to evaluate the effect of HIV-1 subtype on neurodevelopment of Ugandan preschool children.
Methods:
Neurodevelopment of 87 HIV-1 infected and 221 HIV exposed uninfected Ugandan children 1.8-4.9 years of age was assessed using 4 scales of the Mullen Scales of Early Learning (MSEL), 2 scales of the Color Object Association Test (COAT), and 1 score of the Early Childhood Vigilance Test. HIV-1 subtype was defined by phylogenetic analyses. General linear models were used to relate test scores to HIV-1 subtype (A versus D) while adjusting for relevant covariates. The scores were benchmarked against HIV exposed uninfected group to facilitate the interpretation.
Results:
Seventy-one percentage of children infected with subtype A versus 60% of children with subtype D were currently on antiretroviral therapy (P = 0.49). Children with HIV-1 subtype A infection were older when compared with subtype D (3.29 vs. 2.76 years, respectively, P = 0.03), but similar regarding sex, socioeconomic status, weight-for-age z-score, CD4+ and CD8+ (% and total), viral load. No statistically significant differences by HIV-1 subtype were observed in the MSEL, COAT and Early Childhood Vigilance Test. Differences ≥ 0.33 of the SD were observed for the MSEL Composite Score, Receptive Language (MSEL) and Total Memory (COAT).
Conclusions:
In contrast to previously reported differences in ND outcomes of school-age children by HIV-1 subtype, ND scores among preschool children were similar for subtypes A and D, with few potential differences on language production and memory outcomes that favored subtype A. Further investigation with larger sample sizes and longitudinal follow-up is needed.
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