Related Experiment Video
Updated: Jun 30, 2025
Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
Published on: November 20, 2015
Association of in utero HIV exposure with child brain structure and language development: a South African birth
Catherine J Wedderburn1,2,3, Shunmay Yeung4, Sivenesi Subramoney5
1Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa. catherine.wedderburn@uct.ac.za.
Insights
Children exposed to HIV in utero, even if uninfected, show altered brain structure. This may explain language delays, highlighting the need for further research into neurodevelopmental outcomes.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Radiology
Background:
- Growing population of children with in utero HIV exposure at risk for poor neurodevelopmental outcomes.
- Underlying neurobiological pathways and neuroimaging data are lacking.
- Investigate cortical brain structure in HIV-exposed and uninfected (HEU) vs. HIV-unexposed (HU) children.
Purpose of the Study:
- Compare cortical brain structure between HEU and HU children.
- Examine the relationship between brain structure and neurodevelopment.
- Identify potential neurobiological pathways for neurodevelopmental differences.
Main Methods:
- Longitudinal cohort study in a high HIV prevalence area (South Africa).
- Acquired high-resolution MRI scans from 162 children (70 HEU, 92 HU) at 2-3 years.
- Analyzed prefrontal cortex cortical thickness and surface area; assessed neurodevelopment using Bayley Scales.
Main Results:
- HIV exposure associated with increased prefrontal cortical thickness, particularly in the medial orbitofrontal cortex (mOFC).
- No differences in cortical surface area observed between groups.
- Lower language scores in HEU children correlated with greater prefrontal cortical thickness; mOFC thickness mediated this relationship.
Conclusions:
- In utero HIV exposure is linked to altered early-life cortical structure.
- Prefrontal cortical thickness differences in HEU children may be a pathway to language impairment.
- Longitudinal studies are necessary to confirm lasting impacts on neurodevelopment.
Background:
There is a growing population of children with in utero HIV exposure who are at risk of poor neurodevelopmental outcomes despite avoiding HIV infection. However, the underlying neurobiological pathways are not understood and neuroimaging studies are lacking. We aimed to investigate the cortical brain structure of children who are HIV-exposed and uninfected (HEU) compared to HIV-unexposed (HU) children and to examine the relationship with neurodevelopment.
Methods:
The Drakenstein Child Health birth cohort study enrolled pregnant women from a high HIV prevalence area in South Africa with longitudinal follow-up of mother-child pairs. High-resolution magnetic resonance imaging scans from 162 children (70 HEU; 92 HU) were acquired at 2-3 years of age. All HEU children were born to mothers taking antiretroviral therapy. Measures of brain structure (cortical thickness and surface area) in the prefrontal cortex regions were extracted from T1-weighted images and compared between groups using multivariate analysis of variance and linear regression. Child development, assessed using the Bayley Scales of Infant and Toddler Development-III, was correlated with cortical structure, and mediation analyses were performed.
Results:
Analyses demonstrated an association between HIV exposure and cortical thickness across the prefrontal cortex (p = 0.035). Children who were HEU had thicker cortices in prefrontal regions, with significantly greater cortical thickness in the medial orbitofrontal cortex (mOFC) bilaterally compared to HU children (3.21 mm versus 3.14 mm, p = 0.009, adjusted effect size 0.44 [95% CI 0.12 to 0.75]). Estimates held across multiple sensitivity analyses. There were no group differences in cortical surface area. Language scores, which were lower in HEU versus HU children (81.82 versus 86.25, p = 0.011, effect size - 0.44 [95% CI - 0.78 to - 0.09]), negatively correlated with prefrontal cortical thickness in both groups. Cortical thickness in the mOFC mediated the relationship between HIV exposure and poor language outcomes (Sobel test p = 0.032).
Conclusions:
In this cohort study, exposure to HIV during pregnancy was associated with altered cortical structure in early life. Our findings indicate that differences in cortical thickness development in the prefrontal region in children who are HEU may be a pathway leading to language impairment. Longitudinal studies are needed to determine the lasting impact.
