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

Abstract

Background Neurodevelopmental stimulation programmes can improve developmental outcomes. Antiretroviral therapy (ART) started soon after birth potentially limits the invasion of HIV into the central nervous system. A combination of developmental stimulation and early ART initiation may reduce developmental delays in children with perinatally acquired HIV infection. Methods At a single site in Johannesburg, South Africa, we enrolled 36 HIV‐infected neonates on ART into an intervention group (IG) participating in a yearlong home‐based, neurodevelopmental stimulation programme. Bayley Scales of Infant and Toddler Development‐3rd Edition (BSID‐III) assessments were conducted at 12 months. Scores were compared with 24 early treated HIV‐infected infants in an observational group (OG). BSID‐III assessments were also conducted for older children in an OG at 24 or 36 months. Cognitive, language and motor scaled and composite scores were analysed. Results BSID‐III scaled and composite scores were all higher in the IG apart from the gross motor scaled score (9.25 vs. 10, p = 0.1954). Receptive communication scaled score was significantly higher in the IG (10.96 vs. 9, p = 0.0331). IG composite scores were all higher than OG scores. OG children assessed at 24 or 36 months had lower composite scores in all subscales than 12‐month OG scores. Conclusions Early treated HIV‐infected children participating in a neurodevelopmental stimulation programme achieved higher BSID‐III scores at 12 months compared with early treated HIV‐infected children who did not receive the programme.

A focus on disability is necessary to achieve HIV epidemic control

“…67 Many people living with HIV and disabilities can benefit from community-based rehabilitation, rehabilitation, assistive technology and other specialised services. 37,[68][69][70][71][72][73] Multidisciplinary services are therefore needed, ideally near the community, to support the range of impairments connected to HIV. 38,40 However, these services are woefully lacking, particularly in Africa where HIV prevalence is highest, although efforts are underway to scale-up rehabilitation services at a global level.…”

Neurocognitive outcomes of children exposed to and living with HIV aged 3–5 years in Kilifi, Kenya

“…Approximately 1.7 million children live with HIV globally ( 6 ). Kenya is one of the SSA countries with a high burden of HIV ( 7 ) with an average prevalence of 4.8% and an estimated 1.4 million people living with the disease ( 8 ). Among those living with HIV, approximately 83,000 are children aged 0–14 years ( 8 ).…”

“…However, with early intervention the adverse effects of HIV can be mitigated. For instance, a study conducted by Strelau and colleagues in South Africa demonstrated that implementing a neurodevelopmental stimulation intervention for CHEI treated early CHEI resulted in a significant reduction in neurodevelopmental delays ( 7 ). These findings suggest that early initiation of ART alongside other early childhood stimulation programs has the potential to significantly enhance child developmental outcomes.…”