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


Gomez, Lauren A, Crowell, Claudia S, Njuguna, Irene, Cranmer, Lisa M, Wamalwa, Dalton, Chebet, Daisy, Otieno, Vincent, Maleche-Obimbo, Elizabeth, Gladstone, Melissa ORCID: 0000-0002-2579-9301, John-Stewart, Grace et al (show 1 more authors) (2018) Improved Neurodevelopment After Initiation of Antiretroviral Therapy in Human Immunodeficiency Virus-infected Children. PEDIATRIC INFECTIOUS DISEASE JOURNAL, 37 (9). pp. 916-922.

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Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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: 11 Oct 2023 12:29
DOI: 10.1097/INF.0000000000001942
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3024148
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