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Published on: October 6, 2015
Neurodevelopment of children who are HIV-exposed and uninfected in Kenya
Michelle A Bulterys1,2, Irene Njuguna1,3, Maureen King'e4
1Department of Global Health, University of Washington, Seattle, Washington, USA.
Insights
Neurodevelopment in HIV-exposed uninfected children (CHEU) is comparable to HIV-unexposed children (CHUU). Factors like food insecurity, intimate partner violence, and specific antiretroviral therapy regimens impact neurodevelopmental outcomes.
Area of Science:
- Pediatric neurodevelopment
- HIV-exposed uninfected children (CHEU)
- Maternal and child health
Background:
- Predictors of neurodevelopment in children exposed to HIV but uninfected (CHEU) are not well understood.
- Understanding these factors is crucial for early intervention and support.
Purpose of the Study:
- To identify predictors of neurodevelopment in CHEU at one year of age.
- To compare neurodevelopmental outcomes between CHEU and children who are HIV-unexposed uninfected (CHUU).
Main Methods:
- Longitudinal study enrolling mothers and children during postnatal care in Kenya (March 2021-June 2022).
- Infant neurodevelopment assessed using the Malawi Developmental Assessment Tool at one year.
- Multivariate linear mixed effects models used to analyze associations between neurodevelopment, HIV/ART exposure, and household factors.
Main Results:
- CHEU (n=709) and CHUU (n=715) showed similar 1-year neurodevelopmental scores.
- Food insecurity, intimate partner violence (IPV), and preterm birth were associated with lower scores in specific domains.
- In utero exposure to efavirenz (EFV) was linked to lower gross motor scores in CHEU compared to dolutegravir (DTG).
Conclusions:
- Biologic and social factors significantly influence child neurodevelopment.
- Despite socio-demographic differences, CHEU and CHUU neurodevelopment were comparable at one year.
- Addressing food insecurity and IPV may benefit all children, irrespective of maternal HIV status; DTG use shows promise for CHEU neurodevelopment.
Introduction:
Predictors of neurodevelopment among children who are HIV-exposed uninfected (CHEU) are poorly understood.
Methods:
Mothers with and without HIV and their children were enrolled during 6-week postnatal care visits across seven sites in Kenya between March 2021 and June 2022. Infant neurodevelopment was assessed using the Malawi Developmental Assessment Tool, including social, language, fine motor and gross motor domains. We used multivariate linear mixed effects models to identify associations between 1-year neurodevelopment scores, HIV and antiretroviral therapy (ART) exposures, and household factors, adjusted for potential confounders and clustered by the site.
Results:
At 1-year evaluation, CHEU (n = 709) and children who are HIV-unexposed uninfected (CHUU) (n = 715) had comparable median age (52 weeks) and sex distribution (49% vs. 52% female). Mothers living with HIV were older (31 vs. 27 years), had lower education (50% vs. 26% primary) and were more likely to be report moderate-to-severe food insecurity (26% vs. 9%) (p < 0.01 for all). Compared to CHUU, CHEU had higher language scores (adjusted coeff: 0.23, 95% CI: 0.06, 0.39) and comparable social, fine and gross motor scores. Among all children, preterm birth was associated with lower gross motor scores (adjusted coeff: -1.38, 95% CI: -2.05, -0.71), food insecurity was associated with lower social scores (adjusted coeff: -0.37, 95% CI: -0.73, -0.01) and maternal report of intimate partner violence (IPV) was associated with lower fine motor (adjusted coeff: -0.76, 95% CI: -1.40, -0.13) and gross motor scores (adjusted coeff: -1.07, 95% CI: -1.81, -0.33). Among CHEU, in utero efavirenz (EFV) exposure during pregnancy was associated with lower gross motor scores compared to dolutegravir (DTG) exposure (adjusted coeff: -0.51, 95% CI: -1.01, -0.03). Lower fine and gross motor scores were also associated with having a single or widowed mother (adjusted coeff: -0.45, 95% CI: -0.87, -0.03) or a deceased or absent father (adjusted coeff: -0.81, 95% CI: -1.58, -0.05), respectively.
Conclusions:
Biologic and social factors were associated with child neurodevelopment. Despite socio-demographic differences between CHEU and CHUU, 1-year neurodevelopment was similar. Addressing IPV and food insecurity may provide benefits regardless of maternal HIV status. DTG use was associated with higher neurodevelopmental scores in CHEU, compared to EFV regimens, potentially contributing to a lack of neurodevelopmental difference between CHEU and CHUU.
