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Randomized Controlled Trial
. 2015 Jan;34(1):55-61.
doi: 10.1097/INF.0000000000000526.

Correlates of age at attainment of developmental milestones in HIV-infected infants receiving early antiretroviral therapy

Sarah Benki-Nugent  1 , Christal Eshelman, Dalton Wamalwa, Agnes Langat, Ken Tapia, Helen Moraa Okinyi, Grace John-Stewart
Affiliations
Randomized Controlled Trial

Correlates of age at attainment of developmental milestones in HIV-infected infants receiving early antiretroviral therapy

Sarah Benki-Nugent et al. Pediatr Infect Dis J. 2015 Jan.

Erratum in

  • Pediatr Infect Dis J. 2015 Aug;34(8):892

Abstract

Background: Infant HIV-1 infection is associated with impaired neurologic and motor development. Antiretroviral therapy (ART) has the potential to improve developmental outcomes but the relative contributions of pre-ART disease status, growth, treatment regimen and ART response during infancy are unknown.

Methods: Kenyan ART-naive infants <5-months old initiated ART and had monthly assessment of age of full neck control, unsupported walking and monosyllabic speech during 24 months of follow-up. Pre-ART and post-ART correlates of age at milestone attainment were evaluated using t tests or multivariate linear regression.

Results: Among 99 infants, pre-ART correlates of later milestone attainment included: underweight and stunted (neck control, walking and speech, all P values <0.05), missed prevention of mother-to-child transmission (P = 0.04) (neck control), previous hospitalization, World Health Organization (WHO) Stage III/IV, low CD4 count, and wasting (speech and walking, all P values <0.05), and low maternal CD4 (speech, P = 0.04). Infants initiated ART at a median of 14 days following enrollment. Infants receiving nevirapinevs lopinavir/ritonavir-based ART attained later speech (18.1 vs. 15.5 months, P = 0.003) [corrected]. Adjusting for pre-ART level, lower 6-month gain in CD4% was associated with later walking (0.18 months earlier per unit increase in CD4%; P = 0.004) and speech (0.12 months earlier per unit increase in CD4%; P = 0.05), and lower 6-month gains in weight-for-age (P = 0.009), height-for-age (P = 0.03) and weight-for-height (P = 0.02) were associated with later walking.

Conclusion: In HIV-infected infants, compromised pre-ART immune and growth status, poor post-ART immune and growth responses, and use of nevirapine- vs. lopinavir/ritonavir-based ART were each associated with later milestone attainment [corrected]. The long-term consequences of these delays are unknown.

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Conflict of interest statement

Conflicts of Interest: None of the authors have financial interests or conflicts of interest relevant to this study.

Figures

FIGURE 1
FIGURE 1
Flow-diagram of infants included in analysis. 73, 54, and 53 infants had available data for neck control, walking, and speech, respectively and were included in analyses of correlates of age at milestone attainment.
See this image and copyright information in PMC

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