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. 2020 Nov 18;15(11):e0242244.
doi: 10.1371/journal.pone.0242244. eCollection 2020.

Neurodevelopment of HIV-exposed uninfected children in Cape Town, South Africa

Hlengiwe P Madlala  1   2 , Landon Myer  1   2 , Thokozile R Malaba  1   2 , Marie-Louise Newell  3   4
Affiliations

Neurodevelopment of HIV-exposed uninfected children in Cape Town, South Africa

Hlengiwe P Madlala et al. PLoS One. .

Abstract

Background: Evidence shows that antiretroviral (ART) exposure is associated with neurodevelopmental delays in human immunodeficiency virus (HIV)-exposed uninfected (HEU) children. However, there are few insights into modifiable maternal and child factors that may play a role in improving neurodevelopment in HEU children. We used a parent-centric neurodevelopment tool, Ages & Stages Questionnaire (ASQ) to examined neurodevelopment in HEU children at 12-24 months of age, and associations with maternal and child factors.

Methods: 505 HIV-infected women (initiated ART pre- or during pregnancy) with live singleton births attending primary health care were enrolled; 355 of their HEU children were assessed for neurodevelopment (gross motor, fine motor, communication, problem solving and personal-social domains) at 12-24 months using age-specific ASQ administered by a trained fieldworker. Associations with maternal and child factors were examined using logistic regression models.

Results: Among mothers (median age 30 years, IQR, 26-34), 52% initiated ART during pregnancy; the median CD4 count was 436 cells/μl (IQR, 305-604). Most delayed neurodevelopment in HEU children was in gross (9%) and fine motor (5%) functions. In adjusted models, maternal socio-economic status (aOR 0.42, 95% CI 0.24-0.76) was associated with reduced odds of delayed gross-fine motor neurodevelopment. Maternal age ≥35 years (aOR 0.22, 95% CI 0.05-0.89) and maternal body mass index (BMI) <18.5 (aOR 6.76, 95% CI 1.06-43.13) were associated with delayed communication-problem-solving-personal-social neurodevelopment. There were no differences in odds for either domain by maternal ART initiation timing.

Conclusions: Delayed neurodevelopment was detected in both gross and fine motor functions in this cohort of HEU children, with strong maternal predictors that may be explored as potentially modifiable factors associated with neurodevelopment at one to two years of age.

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Conflict of interest statement

Co-author Landon Myer has served as an editor for PLOS ONE in the past. The authors confirm that this does not alter their adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flow diagram showing participant enrolment and retention at different study visits by maternal ART initiation status.
GA—gestational age, ART—antiretroviral therapy, IUD—intrauterine death, TOP—termination of pregnancy, ANC—antenatal care, LTFU—loss to follow up, ASQ—Ages & Stages Questionnaire.
Fig 2
Fig 2. Distribution of delayed neurodevelopment on two, three and four overlapping domains.
Neurodevelopment delay overlap on two domains: Fine+PerSocial: fine motor & personal social; Fine+ProbSolv: fine motor & problem solving; Gross+ProbSolv: gross motor & problem solving; Gross+Fine: gross & fine motor; Comm+Fine: communication & fine motor; Comm+Gross: communication & gross motor. Neurodevelopment delay overlap on three domains: Fine+ProbSolv+PerSocial: fine motor & problem solving & personal social; Gross+Fine+PerSocial: gross motor & fine motor & personal social; Gross+Fine+ProbSolv: gross motor & fine motor & problem solving. Neurodevelopment delay overlap on four domains: Gross+Fine+ProbSolv+PerSocial: gross motor & fine motor & problem solving & personal social; Comm+Gross+Fine+ProbSolv: communication & gross motor & fine motor & problem solving.
See this image and copyright information in PMC

References

    1. le Roux S, Donald K, Brittain K, Phillips T, Zerbe A, Nguyen K, et al. Neurodevelopment of breastfed HIV-exposed uninfected and HIV-unexposed children in South Africa. AIDS. 2018;32(13):1781–91. 10.1097/QAD.0000000000001872 - DOI - PMC - PubMed
    1. McHenry MS, McAteer CI, Oyungu E, McDonald BC, Bosma CB, Mpofu PB, et al. Neurodevelopment in young children born to HIV-infected mothers: a meta-analysis. Pediatr. 2018;141(2):e20172888–902. 10.1542/peds.2017-2888 - DOI - PMC - PubMed
    1. Rice ML, Zeldow B, Siberry GK, Purswani M, Malee K, Hoffman HJ, et al. Evaluation of risk for late language emergence after in utero antiretroviral drug exposure in HIV-exposed uninfected infants. Pediatr Infect Dis. J 2013;32(10):e406–13. 10.1097/INF.0b013e31829b80ee - DOI - PMC - PubMed
    1. UNAIDS. Progress report on the global plan: towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. Geneva, Switzerland 2015. Available at: https://www.unaids.org/en/resources/documents/2015/JC2774_2015ProgressRe... GlobalPlan. [Accessed 03 February 2020].
    1. Baker-Henningham H, López Bóo F. Early childhood stimulation interventions in developing countries: A comprehensive literature review. Social Protection and Health Division. 2010:1–74.

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