Neurodevelopmental and behavioural outcomes of HIV-exposed uninfected and HIV-unexposed children at 2–3 years of age in Cape Town, South Africa

Springer, Priscilla; Slogrove, Amy L.; Kidd, Martin; Kalk, Emma; Bettinger, Julie A.; Esser, Monika; Cotton, Mark F.; Zunza, Moleen; Molteno, Christopher D.; Kruger, Mariana

doi:10.1080/09540121.2019.1637506

Cited by 20 publications

(48 citation statements)

References 42 publications

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“…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]. Cognitive developmental delay was often more prevalent among infants who were HEU at 12-13 months [49,56] compared to HUU but may not persist to three years of age [53]. One study reported that in comparison to reference norms, a higher proportion of infants who were HEU had average, higher average, and superior performance on measures of cognitive outcomes [54].…”

Section: Cognitive Outcomesmentioning

confidence: 99%

“…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. Within these nine studies, two reported data on longitudinal neurodevelopmental assessments (for cognitive (n = 2), motor (n = 2), and language (n = 1) outcomes) [50,51], and seven reported cross-sectional assessment data (for cognitive (n = 7), motor (n = 7), language (n = 7), and behavioural (n = 3) outcomes) [52][53][54][55][56][57][58]. [34] of studies reporting on neurodevelopmental outcomes in infants in relation to HIV-exposure status.…”

Section: Study Location Demographics and Designmentioning

confidence: 99%

“…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].…”

Section: Cognitive Outcomesmentioning

confidence: 99%

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

White

Connor

2020

Nutrients

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The developing brain is especially vulnerable to infection and suboptimal nutrition during the pre- and early postnatal periods. Exposure to maternal human immunodeficiency virus (HIV) infection and antiretroviral therapies (ART) in utero and during breastfeeding can adversely influence infant (neuro) developmental trajectories. How early life nutrition may be optimised to improve neurodevelopmental outcomes for infants who are HIV-exposed has not been well characterised. We conducted an up-to-date evidence review and meta-analysis on the influence of HIV exposure in utero and during breastfeeding, and early life nutrition, on infant neurodevelopmental outcomes before age three. We report that exposure to maternal HIV infection may adversely influence expressive language development, in particular, and these effects may be detectable within the first three years of life. Further, while male infants may be especially vulnerable to HIV exposure, few studies overall reported sex-comparisons, and whether there are sex-dependent effects of HIV exposure on neurodevelopment remains a critical knowledge gap to fill. Lastly, early life nutrition interventions, including daily maternal multivitamin supplementation during the perinatal period, may improve neurodevelopmental outcomes for infants who are HIV-exposed. Our findings suggest that the early nutritional environment may be leveraged to improve early neurodevelopmental trajectories in infants who have been exposed to HIV in utero. A clear understanding of how this environment should be optimised is key for developing targeted nutrition interventions during critical developmental periods in order to mitigate adverse outcomes later in life and should be a priority of future research.

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Section: Cognitive Outcomesmentioning

confidence: 99%

Section: Study Location Demographics and Designmentioning

confidence: 99%

Section: Cognitive Outcomesmentioning

confidence: 99%

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

White

Connor

2020

Nutrients

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“…Numerous instruments have been developed for the assessment of child development based on age, domains tested, and type (performance based, self/caregiver rating). Unlike in adult TBM, these have been extensively reviewed elsewhere in published literature including comparison of available tests and suitability for use in LMIC settings 100,101 . Although there is no consensus or consistency on the measures used to assess outcome post TBM in infants and children, ideal testing requires wide age-range; the ability to measure floor and ceiling effects as some of the children are left with very low residual function, and needs to assess fine and gross motor ability, receptive and expressive language as well as behavioural, social and adaptive skills.…”

Section: Paediatricsmentioning

confidence: 99%

Neurocognitive and functional impairment in adult and paediatric tuberculous meningitis

et al. 2019

Self Cite

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In those who survive tuberculous meningitis (TBM), the long-term outcome is uncertain; individuals may suffer neurocognitive, functional and psychiatric impairment, which may significantly affect their ability to lead their lives as they did prior to their diagnosis of TBM. In children who survive, severe illness has occurred at a crucial timepoint in their development, which can lead to behavioural and cognitive delay. The extent and nature of this impairment is poorly understood, particularly in adults. This is in part due to a lack of observational studies in this area but also inconsistent inclusion of outcome measures which can quantify these deficits in clinical studies. This leads to a paucity of appropriate rehabilitative therapies available for these individuals and their caregivers, as well as burden at a socioeconomic level. In this review, we discuss what is known about neurocognitive impairment in TBM, draw on lessons learnt from other neurological infections and discuss currently available and emerging tools to evaluate function and cognition and their value in TBM. We make recommendations on which measures should be used at what timepoints to assess for impairment, with a view to optimising and standardising assessment of neurocognitive and functional impairment in TBM research.

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“…A number of recent studies have suggested that CHEU may be more likely to experience delay or disability in neurocognitive or language development compared to children who are HIV-unexposed and uninfected (CHUU) (le Roux et al, 2018(le Roux et al, , 2019McHenry et al, 2018;Mukherjee, Devamare, Seth, & Sapra, 2019;Wedderburn et al, 2019;Wu et al, 2018). However, conflicting evidence from methodologically similar studies indicates that developmental scores among CHEU do not differ from those of CHUU (McHenry et al, 2018;Boivin et al, 2018;Desmonde, Goetghebuer, Thorne, & Leroy, 2018;Springer et al, 2018Springer et al, , 2019. Many of the studies to date have been limited by small sample size, differing recruitment and eligibility criteria for the CHEU, CHUU, and CLHIV groups, and/or lack of adjustment for potentially confounding variables, such as household food insecurity or lower education.…”

Section: Introductionmentioning

confidence: 99%

Cognitive and Language Development at Age 4–6 Years in Children HIV‐Exposed But Uninfected Compared to Those HIV‐Unexposed and to Children Living With HIV

Gruver

Kvalsvig

Knox

et al. 2020

New Directions for Child and Adolescent Development

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Perinatal HIV infection is associated with delayed neurocognitive development, but less is known about children perinatally HIV‐exposed but uninfected (CHEU). We compared cognitive and language outcomes in 4–6‐year old CHEU versus children HIV‐unexposed and uninfected (CHUU) and children living with HIV (CLHIV). We enrolled 1,581 children (77% of the child population) in five communities in KwaZulu‐Natal, South Africa. Children completed: Grover‐Counter Scale of cognitive development, sub‐scales of the Kaufman Assessment Battery for Children, Reynell Developmental Language Scales. HIV status of children and primary caregivers was determined by repeated rapid tests or report of prior testing. We conducted a cross‐sectional multivariable linear regression on 922 dyads with complete data (257 CHEU, 627 CHUU, 38 CLHIV). On all outcome measures, CHEU and CHUU groups had comparable scores; CLHIV scored significantly lower. Emerging global progress toward the elimination of vertical HIV transmission may not only reduce mortality, but also positively impact child development.

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Neurodevelopmental and behavioural outcomes of HIV-exposed uninfected and HIV-unexposed children at 2–3 years of age in Cape Town, South Africa

Cited by 20 publications

References 42 publications

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

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

Neurocognitive and functional impairment in adult and paediatric tuberculous meningitis

Cognitive and Language Development at Age 4–6 Years in Children HIV‐Exposed But Uninfected Compared to Those HIV‐Unexposed and to Children Living With HIV

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