Evaluation of motor and cognitive development among infants exposed to HIV

In Utero HIV Exposure and the Early Nutritional Environment Influence Infant Neurodevelopment: Findings from an Evidenced Review and Meta-Analysis

“…The extensive reach of PMTCT efforts in South Africa may contribute to the promising neurodevelopmental outcomes reported for infants who are HEU. How these findings may translate in different contexts, such as Brazil or Botswana, where two studies under review found poorer neurodevelopmental outcomes for infants who are HEU compared to HUU [41,57], remains to be fully understood. Additionally, of the four studies that reported scaled or composite BSID-III scores and were summarised in Figure 4, all but one reporting on cognitive outcomes [41], and all reporting on fine and gross motor, and receptive and expressive language outcomes were South African cohorts [49,50,53].…”

“…HEI often associated with lower scores on measures of motor development in comparison to infants who were HEU (up to 35 months of age [36,40,45,46]) and increased likelihood of motor developmental impairment compared to HEU and HUU infant groups [38]. While some studies suggested that infants who are HEU may also experience poorer motor outcomes in comparison to HUU [41,42], others reported no differences in average motor scores between the two groups [47,49,50,53,56] or evidence of motor delay for infants who are HEU [54,56]. One study reported psychomotor developmental delay in 3.64% of their sample (206 HEU) between birth and 18 months in comparison to a cited population rate of 1.1-2.5% [39].…”

“…Studies comparing neurodevelopmental outcomes based on infant HIV exposure status (primary inclusion criteria, n = 15) are summarised in Figure 1, and studies that reported on both early life nutrition-related variables and infant neurodevelopment (primary and secondary criteria, n = 9) are summarised in Figure 2. Within the 15 studies that met the primary inclusion criteria only, there were six that reported on longitudinal neurodevelopmental outcomes (for cognitive (n = 3), motor (n = 4), language (n = 1), and neurostructural (n = 1) themes) for infants before age three [34,[36][37][38][39][40], and nine that reported cross-sectional data (for cognitive (n = 8), motor (n = 8), language (n = 4), behavioural (n = 4), and neurostructural themes (n = 2)) [41][42][43][44][45][46][47][48][49]. For the nine studies that included analyses on early life nutrition-related variables and infant neurodevelopment, cohort characteristics and comparison groups based on nutritional intervention (if relevant) are reported in Figure 2.…”

“…Infants who were HEI frequently scored lower than their HEU counterparts in measures of cognitive development before three years of age [36,40,45] and were twice as likely to exhibit high risk for neurodevelopmental impairment when compared to HEU and HUU infant groups [38]. Reports on cognitive development for infants who were HEU (in comparison to HUU) were often inconsistent, with studies reporting associations between HEU and lower scores on measures of cognitive development [41,42], as well as no difference in scores on measures of cognitive outcomes [49,50,53]. One study reported lower cognitive developmental scores for infants who were HEU compared to HUU; however, these differences did not persist after controlling for maternal substance use [47].…”

Doesin uteroHIV-exposure and the early nutritional environment influence infant development and immune outcomes? Findings from a pilot study in Pretoria, South Africa

“…Thus, as a result of declining MTCT, the number of infants being born who are HIV-exposed (in utero and during breastfeeding) but uninfected (HEU) is rising 13 . Importantly, the extent to which HEU influences infant development is poorly understood, although evidence suggests that infants who are HEU have persistently altered motor and cognitive development [14][15][16] , albeit to a lesser extent than infants who are HEI. Further, in adults with HIV, markers of monocyte activation and altered frequencies of monocyte subsets are among some of the best predictors of non-AIDS associated co-morbid diseases 17,18 and associate with increased neuro-and peripheral inflammation 19,20 .…”