Neurodevelopment at 11 months after starting antiretroviral therapy within 3 weeks of life

Abstract

BackgroundAntiretroviral therapy (ART) started between 7 and 12 weeks of age improves neurodevelopmental outcomes in HIV-infected (HIV+) infants, but the impact of even earlier initiation is not yet described.ObjectivesWe assessed the early neurodevelopment of HIV+ infants who started ART within 21 days of life.MethodParticipants were enrolled from the public sector birth HIV-diagnosis programme. Inclusion criteria included the following: birth weight > 2000 g, infant commencing ART < 6 weeks and no infant cytomegalovirus disease. Antiretroviral therapy included Zidovudine/Lamivudine/Nevirapine for the first 2 weeks, the latter then replaced by Lopinavir/Ritonavir. Once body weight > 3 kg and gestational age > 44 weeks, Abacavir replaced Zidovudine. The Griffiths mental development scales (GMDS) were administered at 10–12 months.ResultsOf 29 infants assessed, 23 (79%) were girls. Mean birth weight was 3002 ± 501 g. Twenty-four mothers (83%) received ART during pregnancy. Seven (24%) infants were diagnosed HIV+ within 48 h of birth. Median [interquartile range] viral load (VL) at diagnosis was 3904 [259–16 922] copies/mL, age starting ART was 6.0 [3–10] days and age at VL suppression was 19.1 [15–36] weeks. At the GMDS assessment, nine (31%) participants had detectable VL and 26 (90%) had World Health Organization (WHO) clinical stage I disease. The GMDS was performed at a mean age of 11.5 ± 0.8 months. Mean quotients were within the average range: Global Griffiths score was 103.6 ± 10.9 and mean quotients on the subscales ranged from lowest 95.9 ± 13.4 for locomotor to highest 112.8 ± 11.3 for hearing-and-language.ConclusionPreliminary findings in this small group suggest that early neurodevelopmental scores are within the normal range in infants with perinatal HIV infection who started ART at a median of 6 days.

Neurodevelopment in early treated HIV‐infected infants participating in a developmental stimulation programme compared with controls

“…At 12 months of age, children in the OG achieved good BSID-III scores, which were all within 1 SD of the test reference mean. Similar results, from a 2019 South African cohort of HEI infants starting ART within 3 weeks of life and assessed using the Griffiths Mental Development Scale at a mean age of 11.5 ± 0.8 months, reported infants to achieve scores within the normal range (Laughton et al, 2019).…”

Antiretroviral choice and severe disease predict poorer neuropsychological outcomes in HIV+ children from Africa

“…Undoubtably, the key issue in neuropsychological function preservation in children is early HIV diagnosis and treatment, ideally through birth diagnosis or within the first few weeks of life. Not only does this limit HIV-encephalopathy and neurocognitive impairment, but also all the comorbidities associated with untreated HIV infection ( 6 , 7 , 54 ). Brain structure and integrity are central to neurocognitive development and neuroimaging studies have shown a number of abnormalities in CALHIV that can explain these deficits.…”

“…Early ART initiation has a substantial positive impact on neurocognitive function (6,7). Numerous studies report worse neuropsychological outcomes in CLHIV than HIVuninfected children and adolescents, specifically regarding executive functioning (8)(9)(10)(11)(12)(13)(14)(15).…”

Intrapartum human immunodeficiency virus transmission rate in a central hospital in the Western Cape province after universal antiretroviral therapy roll-out

“…The early initiation of ART in infants has been shown to reduce morbidity and mortality and to improve neurodevelopmental outcomes; therefore, it is of paramount importance to educate mothers on the significance of followup visits. 15…”