Developmental delay in HIV-exposed infants in Harare, Zimbabwe

Abstract

The aim of this cross-sectional study was to determine the difference in development (cognition; receptive and expressive language; and fine and gross motor) of Human Immunodeficiency Virus (HIV) -exposed infected (HEI) infants with the development of HIV-exposed but uninfected (HEU) infants using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Sixty infants were enrolled in the study; 32 (53.33%) HEU infants and 28 (46.67%) HEI infants. The two groups were well-matched for infant demographics, anthropometry at birth, maternal demographics, as well as socioeconomic status. Statistically significant differences were found in anthropometry and development between the HEI and HEU group. The HEI infants had malnutrition, were stunted and had smaller head circumferences than HEU infants. The BSID-III showed that the mean developmental delay for the HEI group was approximately two months below their mean chronological age for all scales (cognitive; receptive and expressive communication; and, fine and gross motor age).The HEI group showed that 64.29% had cognitive delay, 60.71% had language delay and 53.57% had motor delay, all of which was significantly different from the development of the HEU group for all domains (p<0.001). In addition to using the BSID-III, the majority of mothers were able to correctly indicate whether their child was developing at the same, or at a slower rate of development than children of the same age. This study demonstrates that infants who are HIV-exposed and infected are at risk of developmental delay.

Use of the Bayley Scales of Infant and Toddler Development, Third Edition, to Assess Developmental Outcome in Infants and Young Children in an Urban Setting in South Africa

“…The mean composite scores for each subscale were, however, all below 100 which is the 50th centile for the Bayley reference population [1]. The Bayley III scores in the current study are lower than those reported in other studies conducted in infants and young children in South Africa [4, 7]. This may be related to the older age of assessment in the present study.…”

“…The question also arises as to whether a Western tool such as the Bayley III is appropriate to use in an African setting. The Bayley III has been used in developmental outcome studies in southern Africa, frequently in the context of developmental assessment of children with HIV [4–7]; most of these Bayley III assessments were done in infants below the age of 1 year.…”

“…The Bayley III has been used to assess developmental outcome of children in South Africa; however there is very little published data on the performance of normal children. Much of the work done using the Bayley III in southern Africa was in assessing the development of HIV infected children where the group of HIV exposed but uninfected (HEU) was used as a control [3, 4]. Springer et al have recently published a small study suggesting that there is no difference in neurodevelopmental outcome between HEU children and HIV unexposed uninfected children [5].…”

Cognitive and language outcomes in HIV-uninfected infants exposed to combined antiretroviral therapy in utero and through extended breast-feeding

“…Several studies have reported developmental delay in HIV-infected infants treated with cART when compared with HIV-exposed uninfected (HEU) infants [16][17][18]; however, it has been difficult to clarify how much of this effect may be related to HIV infection of the brain versus a potential adverse drug effect of cart [17]. In fact, early cART may be protective for the neurological development of HIV-infected infants [19].…”

The cognitive processing potential of infants: Exploring the impact of an early childhood development programme

“…Brown 2009;Hutchings & Potterton 2014;Rademeyer & Jacklin 2013;Richter et al 2016). Moderate support was found for the predictive validity of the Bayley Scales in a longitudinal study involving primarily black African infants residing in an urban area in South Africa (Richter et al 2016).…”