Structural brain differences in school-aged children who are HIV-exposed uninfected

Area of Science:

• Neuroscience
• Pediatrics
• Public Health

Background:

• Antiretroviral therapy (ART) has decreased perinatal HIV transmission.
• A growing population of children are HIV-exposed but uninfected (CHEU).
• Long-term neuroanatomic effects of in utero HIV and ART exposure in school-aged children are not well understood.

Purpose of the Study:

• To investigate the long-term neuroanatomic developmental impacts of in utero HIV and ART exposure in school-aged children.
• To compare brain structure differences between CHEU and HIV-unexposed, uninfected children (CHUU).
• To explore sex-specific effects of in utero exposure on brain development.

Main Methods:

• Recruited 58 CHEU and 38 CHUU children aged 6-12 years.
• Analyzed T1-weighted MRI scans for brain volume, cortical thickness, and gray/white matter volume.
• Used multiple linear regression models, controlling for covariates, with sex-stratified analyses.

Main Results:

• CHEU had significantly smaller total brain volumes and thinner cortices compared to CHUU.
• Male CHEU exhibited volumetric age-exposure interactions in regions associated with motor function and language.
• Reduced frontal lobe cortical thickness and altered amygdala and hippocampal volumes were observed in CHEU, with more pronounced effects in males.

Conclusions:

• In utero HIV and ART exposure are associated with broad neuroanatomic developmental impacts, especially in boys.
• Observed structural differences correlate with previously reported motor and language deficits in CHEU.
• Findings underscore the importance of early intervention and tailored support for CHEU.