ABSTRACT. Background. The neurodevelopmental outcomes of human immunodeficiency virus type 1 (HIV-1)-infected Ugandan infants of nondrug-using mothers were studied using controlled, prospective methodology.Method. The sample of 436 full-term infants included 79 HIV-infected infants of HIV-1-infected mothers, 241 uninfected infants of HIV-1-infected mothers (seroreverters), and 116 uninfected infants born to HIV-negative mothers. Neurologic status, information processing ability, and motor and mental development were assessed from 6 to 24 months of age. Observations of caretaker-child interaction and home environments were made at 6 and 12 months. All evaluators were blinded to the HIV status of the child and family.Results. Compared with seroreverters and uninfected infants, HIV-infected infants demonstrated greater deficits in motor development and neurologic status, and more frequent and earlier onset of motor and neurologic abnormalities. Compared with controls, HIV-infected infants had more abnormalities in mental development at 6 and 18 months and an earlier onset of abnormalities. By 12 months, 30% of HIV-infected infants demonstrated motor abnormalities and 26% cognitive abnormalities as compared with 11% and 6% among seroreverters and 5% and 6% among seronegative infants. HIV-infected infants (62%) demonstrated a higher probability of developing an abnormal neurologic examination by 12 months, compared with seroreverters (17%) or seronegative infants (15%). Information-processing abilities did not differ as a function of HIV infection. Home environments and infants' interactions with caretakers were similar across groups.Conclusion. We conclude that HIV infection results in more frequent and earlier abnormalities in infants' neurologic status and motor development that are not attributable to other biological and environmental risk factors. More frequent mental developmental abnormalities were evident at several ages. However, informationprocessing abilities, such as recognition memory, may be spared from HIV-related deficits. Pediatrics 1997;100(1). URL: http://www.pediatrics.org/cgi/content/full/100/1/e5; HIV infection, neurodevelopment, mental development, motor development, neurological status, information processing ability.ABBREVIATION. HIV, human immunodeficiency virus.T he prevalence of human immunodeficiency virus type 1 (HIV-1) in infants and young children in the United States and in the world has dramatically increased. [1][2][3][4] Prevalence rates of HIV infection, which are now more than one million children worldwide, indicate that HIV-1-related central nervous system disease will become a significant cause of mental deficiency and developmental disabilities in the United States and worldwide. 5 Generalized cognitive deficiencies, 6 -14 language 15 and motor 9 deficits, and variation in the type and severity of developmental and neurologic deficits have been consistently reported. 8 -16 For this reason, there is a continuing need for controlled studies of neurodevelopmental outcomes amon...

These children seem to represent a significant subgroup of HIV-infected child survivors for whom the progress of the disease is less aggressive throughout early life. Given the fact that many infants, especially in developing countries, continue to be born without the benefit of perinatal ARVT, there will likely continue to be many older HIV-infected children in the same situation as those described in this follow-up study. They will not have been recognized as being HIV-infected. It is important that such children be identified and offered access to ARVT and other appropriate support services.

ABSTRACT. Objective. To study the effect of perinatally acquired human immunodeficiency virus (HIV) on somatic growth and examine the relationship of nutritional status to mortality in HIV-infected infants.Method. Pregnant women attending the antenatal clinic at Mulago hospital in Kampala, Uganda, were enrolled. All live-born babies born to HIV-1 seropositive (HIV؉) women, and to every fourth age-matched HIV-1 seronegative (HIV؊) woman, were followed for 25 months.Results. The mean weight-for-age and length-for-age curves of HIV؉ children were significantly lower than those of HIV؊ controls and seroeverters. Forty-five (54%) of the 84 HIV؉ infants died before their second birthday, as compared with a 1.6% and 5.6% mortality in HIV؊ and seroeverters. HIV؉ infants with an average weight-forage Z-score below ؊1.5 in the first year of life have a nearly fivefold risk of dying before 25 months of age compared with noninfected controls.Conclusion. Perinatally acquired HIV infection is associated with early and progressive growth failure. The severity of growth failure is associated with an increased risk of mortality. The effect of early, aggressive nutritional intervention in delaying HIV progression and mortality should be evaluated by controlled intervention studies. Pediatrics 1997;100(1). URL: http://www. pediatrics.org/cgi/content/full/100/1/e7; HIV-1, mortality, weight-for-age Z-score, height for age Z-score.

No abstract

GH-training opportunities are important to pediatric residents when selecting a program, and many are graduating with intentions to volunteer/work in a developing country after residency. The low exposure to GH topics among a broad cross-section of pediatric residents suggests that additional work is needed to adequately prepare pediatricians for work in GH after residency.