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Neurodevelopment at 11 months after starting antiretroviral therapy within 3 weeks of life

Barbara Laughton1, Shalena Naidoo2, Els F M T Dobbels1

  • 1Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.

Southern African Journal of HIV Medicine
|November 21, 2019
PubMed

Insights

Starting antiretroviral therapy (ART) within days of birth in HIV-infected infants shows normal early neurodevelopment. This early intervention is crucial for positive outcomes in infants with perinatal HIV.

Area of Science:

  • Pediatric Infectious Diseases
  • Neurodevelopmental Pediatrics
  • Public Health

Background:

  • Antiretroviral therapy (ART) initiated between 7-12 weeks improves neurodevelopment in HIV-infected infants.
  • The effects of initiating ART even earlier, within 21 days of life, were not previously well-described.

Purpose of the Study:

  • To assess the early neurodevelopmental outcomes of human immunodeficiency virus (HIV)-positive infants who commenced ART within 21 days of birth.
  • To evaluate the impact of very early ART initiation on infant neurodevelopment.

Main Methods:

  • Infants were enrolled from a public sector HIV diagnosis program, meeting criteria for birth weight, early ART initiation (<6 weeks), and absence of cytomegalovirus disease.
  • ART regimens varied based on initial treatment and infant weight/gestational age, with Zidovudine/Lamivudine/Nevirapine followed by Lopinavir/Ritonavir, and later Abacavir substitution.
  • Neurodevelopment was assessed using the Griffiths Mental Development Scales (GMDS) between 10-12 months of age.

Main Results:

  • Twenty-nine HIV-infected infants were assessed, with 79% being female and 83% of mothers receiving ART during pregnancy.
  • ART was initiated at a median of 6 days, with viral load suppression achieved by a median of 19.1 weeks.
  • At 11.5 months, global and subscale neurodevelopmental quotients measured by GMDS were within the average range, despite 31% having detectable viral load at assessment.

Conclusions:

  • Very early initiation of ART (median 6 days) in infants with perinatal HIV infection is associated with neurodevelopmental scores within the normal range.
  • These preliminary findings in a small cohort suggest that timely ART commencement is beneficial for neurodevelopmental outcomes.
  • Further research with larger cohorts is warranted to confirm these positive early neurodevelopmental findings.
Abstract

Keywords:
HIVantiretroviral therapyinfantsneurodevelopmentpaediatrics

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