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. 2018 Jun 1;32(9):1173-1183.
doi: 10.1097/QAD.0000000000001790.

In-utero exposure to antiretrovirals and neurodevelopment among HIV-exposed-uninfected children in Botswana

Sumona Chaudhury  1 , Gloria K Mayondi  2 , Paige L Williams  1   3 , Jean Leidner  4 , Roger Shapiro  5 , Modiegi Diseko  2 , Gbolahan Ajibola  2 , Penny Holding  6 , Vicki Tepper  7 , Joseph Makhema  2 , Chipo Petlo  2 , George R Seage 3rd  1 , Shahin Lockman  2   8   9 , Betsy Kammerer  10   11
Affiliations

In-utero exposure to antiretrovirals and neurodevelopment among HIV-exposed-uninfected children in Botswana

Sumona Chaudhury et al. AIDS. .

Abstract

Objective: Conflicting data exist regarding the impact of in-utero exposure to maternal combination antiretrovirals. We compared neurodevelopmental outcomes between HIV-exposed-uninfected (HEU) children exposed in utero to three-drug combination antiretroviral therapy (ART) vs. zidovudine (ZDV) monotherapy.

Design: Prospective study of child neurodevelopment, nested within two cohorts of HIV-infected mothers and their children in Botswana (one observational, one interventional).

Methods: The Tshipidi and Mma Bana studies enrolled HIV-infected women during pregnancy and followed their HEU children for 24 months. Mothers took three-drug ART or ZDV during pregnancy. ART-exposed babies were mostly breastfed, and ZDV-exposed were formula-fed. Neurodevelopmental outcomes, measured at 24 months using Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III) and Development Milestones Checklist (DMC), were compared in adjusted linear regression according to antiretroviral exposure.

Results: Of 598 HEU children with valid neurodevelopment assessments, 382 were ART-exposed and 210 were ZDV-exposed. Adjusted mean Bayley-III scores were similar among ART-exposed vs. ZDV-exposed, with adjusted mean differences (95% confidence interval): Bayley-III Cognitive: -0.3 (-1.4, 0.9); Gross Motor: 0.8 (-0.1, 1.7); Fine Motor: 0.5 (-0.2, 1.3); Expressive Language: 0.7 (-0.3, 1.7); Receptive Language: 0.1 (-0.7, 0.8); and DMC Locomotor: 0.0 (-0.5, 0.6); Fine Motor: 0.3 (-0.3, 0.8); Language: -0.1 (-0.5, 0.4); Personal-Social: 0.2 (-0.7, 1.1). Similarly, when restricted to formula-fed children in one cohort (Tshipidi), there were no differences in adjusted mean scores.

Conclusion: Neurodevelopmental outcomes at 24 months of age were similar in ART-exposed vs. ZDV-exposed HEU children. Maternal ART with breastfeeding does not appear to have an adverse effect on neurodevelopment.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of HIV-Exposed/Uninfected (HEU) children undergoing neurodevelopment testing in the Tshipidi and Mma Bana studies
Figure 2
Figure 2
Unadjusted mean Bayley-III and DMC neurodevelopment scores at age 24 months according to ART + feeding strategy among 598 HEU children from the Mma Bana and Tshipidi studies, Botswana 2009–2012
See this image and copyright information in PMC

References

    1. Filteau S. The HIV-exposed, uninfected African child. Trop Med Int Health. 2009;14:276–287. - PubMed
    1. Brogly SB, Ylitalo N, Mofenson LM, Oleske J, Van Dyke R, Crain MJ, et al. In utero nucleoside reverse transcriptase inhibitor exposure and signs of possible mitochondrial dysfunction in HIV-uninfected children. Aids. 2007;21:929–938. - PubMed
    1. Le Doare K, Bland R, Newell ML. Neurodevelopment in children born to HIV-infected mothers by infection and treatment status. Pediatrics. 2012;130:e1326–1344. - PubMed
    1. Heidari S, Mofenson L, Cotton MF, Marlink R, Cahn P, Katabira E. Antiretroviral drugs for preventing mother-to-child transmission of HIV: a review of potential effects on HIV-exposed but uninfected children. J Acquir Immune Defic Syndr. 2011;57:290–296. - PubMed
    1. UNAIDS. HIV and AIDS estimates. 2015 http://www.unaids.org/en/regionscountries/countries/botswana.

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