Five year neurodevelopment outcomes of perinatally HIV-infected children on early limited or deferred continuous antiretroviral therapy

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dc.contributor.authorLaughton, Barbaraen_ZA
dc.contributor.authorCornell, Mornaen_ZA
dc.contributor.authorKidd, Martinen_ZA
dc.contributor.authorSpringer, Priscilla Estelleen_ZA
dc.contributor.authorDobbels, Elsen_ZA
dc.contributor.authorVan Rensburg, Anita Janseen_ZA
dc.contributor.authorOtwombe, Kennedyen_ZA
dc.contributor.authorBabiker, Abdelen_ZA
dc.contributor.authorGibb, Diana M.en_ZA
dc.contributor.authorViolari, Avyen_ZA
dc.contributor.authorKruger, Marianaen_ZA
dc.contributor.authorCotton, Mark F.en_ZA
dc.date.accessioned2020-04-25T11:49:50Z
dc.date.available2020-04-25T11:49:50Z
dc.date.issued2018
dc.descriptionCITATION: 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.
dc.descriptionThe original publication is available at https://onlinelibrary.wiley.com
dc.description.abstractIntroduction: 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.en_ZA
dc.description.urihttps://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25106
dc.description.versionPublisher's version
dc.format.extent11 pages
dc.identifier.citationLaughton, 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
dc.identifier.issn1758-2652 (online)
dc.identifier.otherdoi:002/jia2.25106
dc.identifier.urihttp://hdl.handle.net/10019.1/107727
dc.language.isoen_ZAen_ZA
dc.publisherWiley Open Access
dc.rights.holderAuthors retain copyright
dc.subjectHIV-positive children -- Early treatmenten_ZA
dc.subjectNeurodevelopment of children -- Early interventionsen_ZA
dc.subjectAntiretroviral agentsen_ZA
dc.titleFive year neurodevelopment outcomes of perinatally HIV-infected children on early limited or deferred continuous antiretroviral therapyen_ZA
dc.typeArticleen_ZA
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