Improved Neurodevelopment After Initiation of Antiretroviral Therapy in Human Immunodeficiency Virus–infected Children

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Gómez, LA, Crowell, CS, Njuguna, I, Cranmer, LM, Wamalwa, D, Chebet, D, Otieno, V, Maleche-Obimbo, E, Gladstone, M ORCID: 0000-0002-2579-9301, John-Stewart, G et al (show 1 more authors) and Benki-Nugent, S (2018) Improved Neurodevelopment After Initiation of Antiretroviral Therapy in Human Immunodeficiency Virus–infected Children Pediatric Infectious Disease Journal, 37 (9). pp. 916-922. ISSN 0891-3668, 1532-0987

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Abstract

Background: Late human immunodeficiency virus (HIV) diagnosis after severe co-morbidity remains common in resource-limited settings. Neurodevelopmental recovery during antiretroviral therapy (ART) for late-diagnosed children is understudied. We determined 6-month neurodevelopmental trajectories in HIV-infected children initiating ART during hospitalization. Methods: HIV-infected children initiated ART after HIV diagnosis during hospitalization in Kenya. The Malawi Developmental Assessment Tool was administered after clinical stabilization within 1 month and at 6 months post-ART initiation. Baseline versus 6-month Z scores for each developmental domain were compared; cofactors for change in Z scores were evaluated using linear regression. Results: Among 74 children, median age was 1.7 years (interquartile range, 0.8–2.4) and median Z scores for gross motor, fine motor, social and language domains were −1.34, −1.04, −0.53 and −0.95, respectively. At baseline, children with higher plasma viremia had lower social Z scores (P = 0.008). Better nourished (weight-for-age Z score [WAZ] ≥−2) children had higher Z scores in all developmental domains (all P values ≤0.05). After 6 months on ART (n = 58), gross and fine motor Z scores improved significantly (mean change 0.39; P = 0.007 and 0.43; P = 0.001, respectively), but social and language did not. Children with better immune and growth response to ART had higher gains in gross motor (0.05 per unit-gain CD4%; P = 0.04; 0.34 per unit-gain WAZ; P = 0.006 and 0.44 per unit-gain height-for-age Z score; P = 0.005), social (0.37 per unit-gain WAZ; P = 0.002) and language (0.25 per unit-gain height-for-age Z score; P = 0.01). Conclusions: Children had significant neurodevelopmental gains during 6 months of ART, and children with better growth and immune recovery had greater improvement. Prompt commencement of ART may improve neurodevelopment in addition to immunity and growth.

Item Type:	Article
Uncontrolled Keywords:	child development, nutrition, Africa, Malawi Developmental Assessment Tool
Depositing User:	Symplectic Admin
Date Deposited:	25 Jul 2018 09:02
Last Modified:	01 Mar 2026 08:38
DOI:	10.1097/INF.0000000000001942
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3024148
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