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Early Antiretroviral Therapy Reduces Severity but Does Not Eliminate Neurodevelopmental Compromise in Children With

Sarah Benki-Nugent1, Nancy Tamasha2, Alice Mueni2

  • 1Department of Global Health, University of Washington, Seattle.

Journal of Acquired Immune Deficiency Syndromes (1999)
|January 24, 2023
PubMed

Insights

Starting antiretroviral therapy (ART) in infancy for children with HIV attenuates neurodevelopmental deficits but does not fully eliminate them. Early ART improves cognitive and motor outcomes compared to late ART, though some impairments persist compared to HIV-unexposed children.

Area of Science:

  • Pediatric Infectious Diseases
  • Neurodevelopmental Disorders
  • HIV/AIDS Research

Background:

  • Human Immunodeficiency Virus (HIV) infection in children can lead to neurodevelopmental impairments.
  • Early initiation of antiretroviral therapy (ART) is crucial for managing HIV in infants.
  • The precise extent of cognitive benefits from early ART in pediatric HIV is not fully understood.

Purpose of the Study:

  • To evaluate the long-term neurodevelopmental outcomes in children with HIV who received early ART versus late ART.
  • To compare the cognitive, behavioral, and motor outcomes of children with HIV (early and late ART) against HIV-unexposed uninfected children (CHUU).

Main Methods:

  • Cognitive, behavioral, and motor assessments were conducted in three groups: children with HIV and early ART (<1 year), children with HIV and late ART (1.5-6 years), and CHUU.
  • Domain z scores and odds of neurobehavioral impairment were compared using adjusted analyses.
  • Participants were recruited from HIV care centers in Nairobi, Kenya.

Main Results:

  • Children receiving late ART showed significantly poorer outcomes across multiple cognitive, learning, and motor domains compared to those receiving early ART.
  • Children receiving early ART still exhibited lower cognitive and behavioral regulation scores compared to CHUU, indicating persistent neurodevelopmental compromise.
  • Children receiving late ART had the most significant deficits across nearly all assessed domains compared to CHUU.

Conclusions:

  • Initiating ART within the first year of life significantly mitigates but does not entirely prevent the neurodevelopmental consequences of HIV infection in children.
  • While early ART improves outcomes, ongoing monitoring and support are necessary for children with HIV to address residual neurodevelopmental challenges.
Abstract

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