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Subcortical Brain Volumes and Neurocognitive Function in Children With Perinatal HIV Exposure: A Population-Based
Catherine J Wedderburn1,2,3, Shunmay Yeung2, Nynke A Groenewold3,4
1Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Insights
Children exposed to HIV (HEU) show smaller brain volumes in key areas like the putamen and hippocampus. These brain differences correlate with lower language scores, highlighting the importance of maternal HIV care for child neurodevelopment.
Area of Science:
- Neuroimaging
- Developmental Neuroscience
- Pediatric HIV Research
Background:
- Children exposed but uninfected (HEU) face risks for neurodevelopmental impairment.
- Previous studies noted smaller basal ganglia in HEU neonates, but data in older children is limited.
- This study investigates subcortical brain structures and neurocognition in HEU children aged 2-3 years.
Purpose of the Study:
- To compare subcortical brain volumes in HIV-exposed and uninfected (HEU) children versus HIV-unexposed (HU) children.
- To examine the association between subcortical brain volumes and neurodevelopmental outcomes, specifically language.
- To explore the impact of maternal HIV factors on child brain structure.
Main Methods:
- Neuroimaging study within the Drakenstein Child Health Study cohort in South Africa.
- T1-weighted MRI scans used to compare subcortical brain volumes in HEU (n=70) and HU (n=92) children aged 2-3 years.
- Bayley Scales of Infant and Toddler Development III used to assess neurodevelopmental outcomes; linear regression analyzed brain volumes and correlations.
Main Results:
- HEU children exhibited approximately 3% lower overall subcortical grey matter volumes compared to HU children.
- Significantly smaller volumes were observed in the putamen (-5%) and hippocampus (-3%) of HEU children, even after adjusting for confounders.
- Maternal viremia and lower CD4 counts were linked to smaller putamen volumes; HEU children had lower language scores, correlated with putamen and hippocampus volumes.
Conclusions:
- HIV-exposed and uninfected children demonstrate reduced subcortical brain volumes in basal ganglia and hippocampal regions.
- These structural differences are associated with impaired language function in HEU children.
- Optimizing maternal perinatal HIV care is crucial for supporting healthy child brain development.
Background:
Children who are HIV-exposed and uninfected (HEU) are at risk for early neurodevelopmental impairment. Smaller basal ganglia nuclei have been reported in neonates who are HEU compared to HIV-unexposed (HU); however, neuroimaging studies outside infancy are scarce. We examined subcortical brain structures and associations with neurocognition in children who are HEU.
Methods:
This neuroimaging study was nested within the Drakenstein Child Health Study birth cohort in South Africa. We compared (T1-weighted) magnetic resonance imaging-derived subcortical brain volumes between children who were HEU (n = 70) and HU (n = 92) at age 2-3 years using linear regression. Brain volumes were correlated with neurodevelopmental outcomes measured with the Bayley Scales of Infant and Toddler Development III.
Results:
Compared to HU children, on average children who were HEU had 3% lower subcortical grey matter volumes. Analyses of individual structures found smaller volume of the putamen nucleus in the basal ganglia (-5% difference, P = .016) and the hippocampus (-3% difference, P = .044), which held on adjustment for potential confounders (P < .05). Maternal viremia and lower CD4 count in pregnancy were associated with smaller child putamen volumes. Children who were HEU had lower language scores than HU; putamen and hippocampus volumes were positively correlated with language outcomes.
Conclusions:
Overall, children who are HEU had a pattern of smaller subcortical volumes in the basal ganglia and hippocampal regions compared to HU children, which correlated with language function. Findings suggest that optimizing maternal perinatal HIV care is important for child brain development. Further studies are needed to investigate underlying mechanisms and long-term outcomes.
