Background: Insufficient data on neurodevelopmental benefits of antiretroviral therapy (ART) in children.
Methods: Prospective study of 329 mothers and children aged 0-6 years to assess neurodevelopment. Results stratified by the maternal (M) and child (C) HIV status (MHIV-/CHIV-, MHIV+/CHIV-, and MHIV+/CHIV+). Gross Motor, Visual Reception, Fine Motor, Receptive and Expressive Language scores assessed by Mullen Scales of Early Learning. Global cognitive function was derived from an Early Learning Composite score (ELC). Standardized Weight and Height for Age z-scores were constructed and the lowest 15% cut-off defined disability. Generalized linear models were used to estimate Prevalence Rate Ratios (PRR) adjusted for the child's age, weight and height. In HIV-positive children, generalized linear models assessed the impact of ART initiation and duration on neurodevelopment.
Results: Compared to MHIV-/CHIV- children, HIV+ children were more likely to have global deficits in all measures of neurodevelopment except gross motor skills, whereas in MHIV+/CHIV- children, there was impairment in receptive language (adj.PRR=2.67, CI: 1.08, 6.60) and the ELC (adj.PRR=2.94, CI: 1.11, 7.82). Of the children born to HIV positive mothers, HIV+ children did worse than - MHIV+/CHIV- only in Visual Reception skills (adj.PRR=2.86; CI: 1.23-6.65). Of the 116 HIV+ children, 44% had initiated ART. Compared to ART duration of <12 months, ART durations 24-60 months was associated with decreased impairments in Fine Motor, Receptive Language, Expressive Language and ELC scores.
Conclusions: Longer duration on ART is associated with reduction of some neurologic impairment and early diagnosis and treatment of HIV+ children is a priority.
(C) 2014 by Lippincott Williams & Wilkins