Neurodevelopment at 11 months after starting antiretroviral therapy within 3 weeks of life
Date
2019-10-03
Journal Title
Journal ISSN
Volume Title
Publisher
AOSIS
Abstract
Background: Antiretroviral 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.
Objectives: We assessed the early neurodevelopment of HIV+ infants who started ART within
21 days of life.
Method: Participants 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.
Results: Of 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.
Conclusion: Preliminary 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.
Description
CITATION: Laughton, B. et al. 2019. Neurodevelopment at 11 months after starting antiretroviral therapy within 3 weeks of life. Southern African Journal of HIV Medicine, 20(1):a1008, doi:10.4102/sajhivmed.v20i1.1008.
The original publication is available at https://sajhivmed.org.za
The original publication is available at https://sajhivmed.org.za
Keywords
HIV infections, Aids (Desease) in infants, Antiretroviral agents, Children -- Neurodevelopment, Paediatrics
Citation
Laughton, B. et al. 2019. Neurodevelopment at 11 months after starting antiretroviral therapy within 3 weeks of life. Southern African Journal of HIV Medicine, 20(1):a1008, doi:10.4102/sajhivmed.v20i1.1008.