Five year neurodevelopment outcomes of perinatally HIV-infected children on early limited or deferred continuous antiretroviral therapy
Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
Wiley Open Access
Abstract
Introduction: Early antiretroviral therapy (ART) has improved neurodevelopmental outcomes of HIV-infected (HIV-positive)
children; however, little is known about the longer term outcomes in infants commencing early ART or whether temporary ART
interruption might have long-term consequences. In the children with HIV early antiretroviral treatment (CHER) trial, HIVinfected
infants ≤12 weeks of age with CD4 ≥25% were randomized to deferred ART (ART-Def); immediate time-limited ART
for 40 weeks (ART-40W) or 96 weeks (ART-96W). ART was restarted in the time-limited arms for immunologic/clinical progression.
Our objective was to compare the neurodevelopmental profiles in all three arms of Cape Town CHER participants.
Methods: A prospective, longitudinal observational study was used. The Griffiths mental development scales (GMDS), which
includes six subscales and a global score, were performed at 11, 20, 30, 42 and 60 months, and the Beery-Buktenica developmental
tests for visual motor integration at 60 months. HIV-exposed uninfected (HEU) and HIV-unexposed (HU) children were
enrolled for comparison. Mixed model repeated measures were used to compare groups over time, using quotients derived
from standardized British norms.
Results: In this study, 28 ART-Def, 35 ART-40W, 33 ART-96W CHER children, and 34 HEU and 39 HU controls were
enrolled. GMDS scores over five years were similar between the five groups in all subscales except locomotor and general
Griffiths (interaction p < 0.001 and p = 0.02 respectively), driven by early lower scores in the ART-Def arm. At 60 months,
scores for all groups were similar in each GMDS scale. However, Beery visual perception scores were significantly lower in
HIV-infected children (mean standard scores: 75.8 ART-Def, 79.8 ART-40W, 75.9 ART-96W) versus 84.4 in HEU and 90.5 in
HU (p < 0.01)).
Conclusions: Early locomotor delay in the ART-Def arm resolved by five years. Neurodevelopmental outcomes at five years in
HIV-infected children on early time-limited ART were similar to uninfected controls, apart from visual perception where HIVinfected
children scored lower. Poorer visual perception performance warrants further investigation.
Description
CITATION: Laughton, B., et al. 2018. Five year neurodevelopment outcomes of perinatally HIVinfected children on early limited or deferred continuous antiretroviral therapy. Journal of the International AIDS Society, 21(5):e25106, doi:002/jia2.25106.
The original publication is available at https://onlinelibrary.wiley.com
The original publication is available at https://onlinelibrary.wiley.com
Keywords
HIV-positive children -- Early treatment, Neurodevelopment of children -- Early interventions, Antiretroviral agents
Citation
Laughton, B., et al. 2018. Five year neurodevelopment outcomes of perinatally HIVinfected children on early limited or deferred continuous antiretroviral therapy. Journal of the International AIDS Society, 21(5):e25106, doi:002/jia2.25106