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Randomized Controlled Trial
. 2017 Jan 17;17(1):24.
doi: 10.1186/s12887-017-0776-1.

Comparison of developmental milestone attainment in early treated HIV-infected infants versus HIV-unexposed infants: a prospective cohort study

Sarah Benki-Nugent  1 , Dalton Wamalwa  2 , Agnes Langat  2 , Kenneth Tapia  3 , Judith Adhiambo  2 , Daisy Chebet  2 , Helen Moraa Okinyi  2 , Grace John-Stewart  3
Affiliations
Randomized Controlled Trial

Comparison of developmental milestone attainment in early treated HIV-infected infants versus HIV-unexposed infants: a prospective cohort study

Sarah Benki-Nugent et al. BMC Pediatr. .

Abstract

Background: Infant HIV infection is associated with delayed milestone attainment. The extent to which effective antiretroviral therapy (ART) prevents these delays is not well defined.

Methods: Ages at attainment of milestones were compared between HIV-infected (initiated ART by age <5 months), and HIV-unexposed uninfected (HUU) infants. Kaplan Meier analyses were used to estimate and compare (log-rank tests) ages at milestones between groups. Adjusted analyses were performed using Cox proportional hazards models.

Results: Seventy-three HIV-infected on ART (median enrollment age 3.7 months) and 92 HUU infants (median enrollment age 1.6 months) were followed prospectively. HIV-infected infants on ART had delays in developmental milestone attainment compared to HUU: median age at attainment of sitting with support, sitting unsupported, walking with support, walking unsupported, monosyllabic speech and throwing toys were each delayed (all p-values <0.0005). Compared with HUU, the subset of HIV-infected infants with both virologic suppression and immune recovery at 6 months had delays for speech (delay: 2.0 months; P = 0.0002) and trend to later walking unsupported. Among HIV-infected infants with poor 6-month post-ART responses (lacking viral suppression and immune recovery) there were greater delays versus HUU for: walking unsupported (delay: 4.0 months; P = 0.0001) and speech (delay: 5.0 months; P < 0.0001).

Conclusions: HIV infected infants with viral suppression on ART had better recovery of developmental milestones than those without suppression, however, deficits persisted compared to uninfected infants. Earlier ART may be required for optimized cognitive outcomes in perinatally HIV-infected infants.

Trial registration: NCT00428116 ; January 22, 2007.

Keywords: Antiretroviral therapy; Early antiretroviral therapy; HIV; Infant; Neurodevelopment; Sub-Saharan Africa.

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Figures

Fig. 1
Fig. 1
Kaplan Meier survival curves comparing probability of walking unsupported and speech between HIV-infected and HIV-unexposed uninfected (HUU) infants (stratified by a, virologic response at 6 months post-ART (approximately 9 months of age); b, immune response; c, growth response)
See this image and copyright information in PMC

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