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Published on: January 5, 2016
Changes in neurodevelopmental outcomes from 24 to 36 months among children HIV-exposed uninfected (CHEU) and
Ruchi Tiwari1, Brent R Collett2,3, Irene Oucho4
1Department of Global Health, University of Washington, Seattle, Washington.
Insights
Children exposed to maternal dolutegravir-based ART (CHEU) showed no neurodevelopmental differences compared to unexposed children (CHU). Fine motor delays were more common in CHEU but not linked to ART exposure, highlighting environmental impacts.
Area of Science:
- Pediatric neurodevelopment
- Maternal antiretroviral therapy
- HIV-exposed, uninfected children
Background:
- Antiretroviral therapy (ART) including dolutegravir (DTG) is crucial for preventing mother-to-child HIV transmission.
- Understanding the long-term neurodevelopmental outcomes of children exposed to DTG-based ART is essential.
Purpose of the Study:
- To compare neurodevelopment at 36 months in breastfed HIV-exposed, uninfected children (CHEU) exposed to maternal DTG-based ART versus HIV-unexposed children (CHU).
Main Methods:
- Prospective cohort study in Kenya, following infants to 36 months.
- Neurodevelopment assessed at 24 and 36 months using Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4).
- Compared cognitive, language, and motor z-scores, and delays between CHEU and CHU groups.
Main Results:
- No significant differences in Bayley-4 scores or developmental trajectories between CHEU and CHU groups at 24 or 36 months.
- Higher prevalence of fine motor delay in CHEU in unadjusted analysis, but not after adjusting for socio-demographic factors.
- Similar overall rates of any delay (37% CHEU vs. 35% CHU) at 36 months.
Conclusions:
- Neurodevelopmental outcomes did not differ between CHEU and CHU, suggesting socio-demographic factors, not ART, influenced fine motor delays.
- The high prevalence of delays in both groups emphasizes the significant impact of environmental and nutritional factors on early child development.
Objective:
To compare neurodevelopment through 36 months between breastfed children who are HIV-exposed and uninfected (CHEU) exposed to maternal dolutegravir (DTG)-based antiretroviral therapy (ART) and children born to mothers without HIV (CHU).
Methods:
We enrolled a prospective cohort of pregnant women with and without HIV in Migori, Kenya, and followed infants to 36 months. Neurodevelopment was assessed at 24 and 36 months using the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4). Outcomes included cognitive, language, and motor z-scores, domain-specific delay (z-score<-1SD), and any delay. Multivariable linear and Poisson regression compared CHEU and CHU, and mixed-effects models evaluated developmental trajectories.
Results:
Among 293 children (CHEU = 149; CHU = 144), 49% were female and 9% were preterm. Breastfeeding at 12 months was similar between groups. Most CHEU (89%) were DTG-exposed in-utero. At 24 months, 43% had any delay (42% CHEU; 44% CHU), with similar prevalence at 36 months (37% CHEU; 35% CHU). Risk of fine motor delay was significantly higher among CHEU in unadjusted analyses but not after adjustment. Bayley-4 scores and trajectories did not differ between groups.
Conclusion:
Fine motor delay was more common among CHEU, but lack of difference in adjusted analyses suggests these delays were likely attributable to socio-demographic rather than biologic factors. The high prevalence of delays in both groups underscores the strong influence of environmental and nutritional factors on early child development.
