A description of early neurodevelopment in a cohort of HIV-exposed uninfected children

Introduction: Successful strategies preventing mother-to-child HIV transmission have resulted in increasing numbers of uninfected children exposed to maternal HIV and ART in-utero, and while breastfeeding. Some reports describe exposure as impacting neurodevelopment. Methods: This cross-sectional analysis included 49 of the 70 HIV-exposed uninfected (HEU) birth-enrolled children as the control arm of an observational cohort study of early treatment in HIV-infected infants in Johannesburg, South Africa. We used the Bayley Scales of Infant and Toddler Development-3rd Edition (BSID-III) to assess neurodevelopment at 12 months of age. Cognitive, language and motor subscale composite scores and performance categories were analysed. We evaluated associations between BSID-III performance categories and cohort variables. Results: Evaluating composite scores according to performance categories showed a higher percentage of scores in the average, high average and superior categories as compared to test reference norms. Maternal BMI ≥ 25 kg/m² and mid-upper arm circumference ≥ 32 cm were associated with higher than average infant language scores. Six children scored below average (<90) - three in the cognitive and three in the language subscale. Conclusion: No developmental delay was found in ART-exposed HEU children at 12 months of age. A small number of at-risk children suggest ongoing screening, referral and follow-up is needed.